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Withdrawal FAQ

They're also not as well known as opiate/benzo/alcohol withdrawals and I wish I'd known in advance just how bad they are (and how shit SSRIs are in general :\).

this ^ is exactly why a section needs to be included. the medical community insists that antidepressants dont have withdrawal, and instead have "discontinuation syndrome" which totally 'isnt the same thing.'

along with the withdrawals, i'm willing to bet that long term use causes the same kind of changes to the respective receptors that long term use of other drugs cause; ie after being dependent and benzos, you'll always have higher anxiety and be more susceptible to seizures; long term AD use probably has a similar effect, although it would need some anecdotal confirmation, at the very least, before including this
 
definately worthwhile putting a warning about taking antidepressants, maybe even a safer use of anti depressants including discussion of the dangers of stopping them cold turkey
 
^but also worth not scaring people off them completely, they can be a useful temporary tool for therapy (although often relied on too much long term).
 
exactly medi, they should be used in conjunction with therapy, not as a substitute. i'm not sure how long it would take for a dependency to form though, since allegedly you need to take them for, what, 2-4 weeks just to get any effect?

the message shouldnt put people off them entirely, but it should make it clear that they need to find a new therapist/psychologist if the only thing they're doing is putting them on antidepressants for the rest of their lives, without even attempting to do any work to fix the underlying issues.

although thats kind of getting outside the realm of withdrawals...
 
Sounds like we need to break the FAQ into sections, and assign a section to the knowledgable:

General Tranquiliser/Sedative Withdrawal FAQ- including {benzodiazepines, barbiturates, z-class drugs} { GHB/analogs}, {phenibut}, alcohol. Substances like kava also need inclusion. Alchohol could be ex-cluded for its own seperate FAQ.

Opiate/opioid Withdrawal FAQ- including things such as kratom....

Alcohol Withdrawal FAQ- ??

Stimulant Dependency/Withdrawal FAQ- {amphetamines}, {cocaine/analogues}, {cathinone derivatives}, naturally occuring stimulants {ephedrine, caffeine, etc}- what have I forgotten?

SSRI/Anti-Depressant Withdrawal FAQ- {SSRI's/SNRI's}, {Trycicylic antidepressants}, {MAOi's}, supplements {St Johns Wort, SAMe, etc}

Some topics could be condensed, but many of these drugs have very different withdrawal symptoms even though they share mechanisms of action. For example, kava withdrawal is a lot less serious then valium withdrawal, even though they work in 'similar' ways.

Maybe if we could each choose one we think we know about, and write some breif drafts, to submit here.

The {} indicates that, to me, they require seperation and thourough description.

I will work on a benzo withdrawal FAQ.
 
Hey gang, thank you all for putting some time into this. What I put in was simply what I'd salvaged from the end-of-year PRUNE. I did not try to find threads that are still alive and well in existing forums.

That said, you guys have quickly discovered that we need to break this beast down. I would propose we start but grabbing one topic and hammering it out as a prototype, from there we can launch into other ones and improve the design. What I would also like to suggest/request is that we follow a format similar to our existing Drug FAQs (for example DXM, Nitrous), where things are broken out, but perhaps we'd have more of an approach of:
  • What is it (the substance, or family of substances)
  • What does it do (how it effects the body and mind)
  • Common withdrawl approaches (start with disclaimer about seeking professional help, then offer our experienced opinion on tapering, substituting, physical-mental effects at various stages and how these are compensated for, etc).
  • Emergency warning signs (when self withdrawl is a danger to you, what to do in addition to calling emergency services)
  • Long term effects (life after quitting)
  • Additional links to resources and further reading

I honestly don't care which substance to begin with, but I will be in here frequently riding this project to completion - anyone's help is greatly appreciated, and we can probably migrate the 'pilot' FAQ project to an appropriate forum, perhaps with redirects from relevant forums but keeping the discussion in one home until we bring it back in for clean up. I'll let ya'll have until Tuesday (Nov 24) to choose a pilot drug.
 
I've sorted the reference links at the top as best I can, but I'll admit a lack of knowledge on a lot of those drugs - hence the last section of "????" and the Oxy stuff showing under opiods and ???? :\ Anyone care to guide me in giving those a proper home, I'd appreciate it and will move it accordingly.



I'm going to perhaps take this in a slightly different direction at this point, but we can undo it if needed. I'm going to propose we combine this w/d effort in some degree with our drug FAQs that are overdue for a refresher and updating. We can take a Drug FAQ and add a section for the withdrawal aspects, but improve the overall content at the same time.
 
May I adopt benzo withdrawal please TLB? :)
 
You can adopt whatever you wish - I just would like to get the ball rolling strongly in any given direction, and make things start happening. :)
 
^Cool, well using your basic guidelines, I'll attempt to write a benzo w/d FAQ while speeding my tits off at work tonight. If the W/D FAQ's are essentially going to be wth the drug FAQ's that will lessen the need to explan what benzo's are etc.

EDIT: okey, well, I've written out a bit, where dost one find these general FAQ'S (SPECIFICALLY benzo's)....?
 
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I'm glad to assist with the alcohol portion... and not by drinking it. :| Have cites in the alcoholism thread in TDS already; will work on more as time permits. It can be merged/split/edited as anyone pleases as long as the essence is captured.
 
You should add a part about Post Acute Withdrawal. That shit was the bane of my existence and I'm sure it is for a lot of others.
 
It's been a little bit since this thread was initiated and last responded to. In browsing the list of Finalized FAQ's, I didn't see a withdrawal FAQ. I'm knowledgable regarding BZD withdrawal, the neural mechanisms underlying it, ways to alleviate symptoms, possible consequences of withdrawing too quickly, PAWS, "benzodiazepine withdrawal syndrome," etc. etc.

Am I overlooking it and it was in fact posted somewhere? If not, this is a *very* important topic, a "hot topic" in OD, BDD and even ADD and re-routing those posts to a comprehensive and accurate FAQ would greatly reduce the number of repeat questions of precisely the same nature. I'd be on this like a fly on cow patties if I get a positive affirmation that this thread has not yet been created. Mods/Admins PM me if you'd like someone to initiate it, and I'll drop back by here to see if anyone replies.

~ vaya
 
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You are correct, somehow there isn't a withdrawal page yet! But yes, I agree that it is a necessary addition to the project! Were you going to make a benzodiazepine specific page? or were you thinking we should have a catchall Withdrawal page.
By the way, Vaya, there is a list of all current BLWiki pages here.
 
Because the timeframes, symptoms and pharmacology vary widely between drugs that cause withdrawal symptoms (BZD, barbiturates, opiates/opioids - even SSRI's) I was thinking it might be best to compartmentalize the effort at first - that is, create Wiki pages that individually address each type of withdrawal - and then, perhaps when several have been completed (at least benzodiazepines and opioids), merge them into a catchall Withdrawal Wiki with subsections for these commonly encountered drugs of ab/use.
Feedback welcome. I'd probably begin the Wiki soon; I'm a little over halfway finished constructing a Wiki for Methamphetamine at the moment, though. It has been... well, time-consuming :)

~ vaya
 
Where are the resources for withdrawals from other GABAergics? There are no links for barbiturates.

Vaya said:
symptoms and pharmacology vary widely between drugs that cause withdrawal symptoms
I think it would be more rational to separate withdrawal information within a particular drug category according to the duration/elimination half-life (exceptions for drugs like tramadol however should be made due to its additional pharmacology relative to other opioids)- i.e., ultra-short, short/intermediate, long, & ultra-long acting drugs. This seems like a bit less work than referring to each individual drug, such as clonazepam, diazepam, alproazolam, & the gobs & gobs of other -zepam drugs! And of course, distinctions can be made for certain drugs if needed. Or, there could just be quick references to related drugs under a given category if they have more selectivity for sub-unit, alpha receptors (a variance of which is widely seen among different benzodiazepines) which results in noticeably unique withdrawal symptoms, if applicable.

It has been three months since the last post on this issue? What is the status of the wiki page? Vaya- if you need help and if those responsible for this project don't mind--i'd be more than happy to assist. I already have finished compositions of withdrawal effects, treatments, and duration of symptoms for a lot of substances (for my own use, seeing as though i'm a freelance writer w/ a lust for pharmacology since the age of 13 )--mostly accounts of my past opioid use (of every flavor, from the ultra-short acting fentanyl to the ultra-long such as buprenorphine; & also unique ones possessing kappa- or other non-opioidergic effects, chiefly meperidine & tramadol) I also have material written on some GABAergic withdrawal- barbiturates (butalbital) and carisoprodol (a prodrug of the highly addictive substance meprobamate, I personally found it more addictive than benzodiazepines). Carisoprodol has NO resources on here, btw -- and it produces a severe abstinence syndrome, not unlike barbiturates--w/ symptomatic epilepsy & convulsions! I posted the question to spark discussion in TDS some time ago (I used to be a regular poster/contributor over there when B9 & Ishtar_Isis were regular posers & moderators).. BUT, to no avail 8) ..So I think some information on this would be helpful. And I also have experience with administrative duties on here if that helps or is of any use; I used to moderate the "health Q & A" forum, of course while it still existed :D
 
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AO - Soo sorry it took me a day to get back to you!!

I think it would be more rational to separate withdrawal information within a particular drug category according to the duration/elimination half-life (exceptions for drugs like tramadol however should be made due to its additional pharmacology relative to other opioids)- i.e., ultra-short, short/intermediate, long, & ultra-long acting drugs. This seems like a bit less work than referring to each individual drug, such as clonazepam, diazepam, alproazolam, & the gobs & gobs of other -zepam drugs!

Definitely a great suggestion, AlphaOdure, thank you!
But to clarify, I hadn't meant making separate withdrawal pages (for example) between heroin, morphine, oxycodone, hydrocodone, et al. - Just a Withdrawal Wiki specifically for the class of Opiates/Opioids, one for Benzodiazepines and Z-drugs, one for Barbiturates, etc.
So, divided by class of drug, rather than by each individual drug within that class - that would amount to well over fifty separate Wiki articles which would indeed be a massive endeavor!
I do like the idea of separable sections within each category - we can most certainly approach it that way. Another angle I thought of after reading your suggestion was that, in the Benzodiazepine W/D Wiki for example, we might construct a general mass of information that pertains to withdrawal from all benzodiazepines ubiquitously. Then, a list of the benzodiazepines (divvied up by short-, intermediate- and long-lasting), followed by three subsections - one for each duration category - that describe special considerations and unique attributes to withdrawing from each relative to the rest. One example would be that shorter-lasting BZD's are more likely to lead to harsher withdrawal symptoms given their half-lives (and there's where a specific discussion of the pharmacology would come in handy). Great ideas, all of them!!

AlphaOdure said:
It has been three months since the last post on this issue? What is the status of the wiki page?

As of this time, wiki pages neither exist for "Withdrawal" nor "Drug Withdrawal." I'd L-O-V-E to get this underway!

AlphaOdure said:
Vaya- if you need help and if those responsible for this project don't mind--i'd be more than happy to assist. I already have finished compositions of withdrawal effects, treatments, and duration of symptoms for a lot of substances (for my own use, seeing as though i'm a freelance writer w/ a lust for pharmacology since the age of 13 )--mostly accounts of my past opioid use (of every flavor, from the ultra-short acting fentanyl to the ultra-long such as buprenorphine; & also unique ones possessing kappa- or other non-opioidergic effects, chiefly meperidine & tramadol) I also have material written on some GABAergic withdrawal- barbiturates (butalbital) and carisoprodol (a prodrug of the highly addictive substance meprobamate, I personally found it more addictive than benzodiazepines).

Oh, shit.
...really?? :D:D:D:D
That all sounds like gold AO; would you mind either posting in here or PM'ing me what you have so far so I can take a look? I would love nothing more than for you to collaborate with us on making this Wiki page happen - I dare say, it may be one of the most-visited pages on the BL Wiki if we can get it up and running. I'd love to see what you have; thank you so much for offering to assist us, it means so much.

In the meantime, hop on over to the Wiki and create an account there if you haven't already, and have a look at what we've got so far. The entire project is a work-in-progress, but personally I would like to see the articles presented in a nicely formatted, thorough way. These were the guidelines by which I constructed the Methamphetamine Wiki Page. It doesn't have to be a copy-cat, all-inclusive format like mine, that page represents how I would like to have seen it were I to have been seeking information on Meth from the BL Wiki. Hopefully though anything new we create (and in editing older documents) can adhere to something along the lines of that page - as thorough and with a certain degree of professionalism as we can make it (the latter makes a world of difference when someone reading the page makes a judgment call about how trustworthy they perceive what they are reading to be... on this same note, obviously, being both factual and objective are key).

Carisoprodol has NO resources on here, btw -- and it produces a severe abstinence syndrome, not unlike barbiturates--w/ symptomatic epilepsy & convulsions! I posted the question to spark discussion in TDS some time ago (I used to be a regular poster/contributor over there when B9 & Ishtar_Isis were regular posers & moderators).. BUT, to no avail 8) ..So I think some information on this would be helpful.[/QUOTE]

Although we currently wish that major contributions initially be provided to the moderators for inclusion on the actual Wiki site itself, I strongly encourage you to post/PM me anything you've got that you think would make an addition to any page - and, of course per this discussion, regarding the creation of entirely new pages, too! I love that you are embracing the spirit of collectivism that is the nucleus of what a Wiki is, AO. I really look forward to hearing from you soon about all of these ideas.

Your post made me =D

~ vaya
 
First, at risk of slightly going off topic here...
Vaya said:
Carisoprodol has NO resources on here, btw -- and it produces a severe abstinence syndrome, not unlike barbiturates
I know! I can not believe this!? Especially since it is widely available in the US (or was widely available until scheduled as a level IV substance in January). And i'd say its withdrawal is even more intense than barbiturates (granted, however, I have never experienced withdrawal from ultra-short acting barbs- which one would assume carisoprodol is more similar to, given its very short duration of action).

And there is even less general information on BL in regards to butalbital, which again, is a substance widely prescribed in the US (and is not a scheduled substance, as long as it is in doses of 50 mg; combined w/ caffeine & APAP, i.e., the "fioricet" formulation)
 
VAYA:
But I did read your PM- I will get my pieces over to you as soon as I can. But i hopped on here right before going to bed- so I will get in contact w/ you most likely tomorrow (sunday) evening! The carisoprodol withdrawal is the most comprehensive composition i've written. I also compiled a "withdrawal fact sheet" on intermediate-to-short acting barbiturate (my experience w/ butalbital withdrawal)... although I have experience w/ other barbs & benzos of most every other category/duration of action- so it would be an easy task to write up.

& yes, as I mentioned, withdrawal symptoms by category, divided into duration of psychoactivity would be more helpful (I don’t know about you, but when withdrawing from both barbs and carisoprodol especially--but also opioids--attentive ability is severely diminished, heh.. soo, I think having to sift through the MANY drugs of EACH class would be less helpful IMO). And I agree, as I said previously, exceptions should be made for certain drugs that definitively possess unique pharmacological actions that are severely distinguishable from typical withdrawal symptoms relative to the psychoactive category it belongs to (i.e., Z-drugs w/ their high selectivity at the alpha-1 sub units at GABAa receptor sites, instead of the generalized effects benzo’s possess at all GABAa sub unit sites in most cases (maybe they should be in a whole new category for Z-drugs?); kratom w/ its MAOI activity & its stimulatory effects in addition to its mainly sought after mu-opioid affinity; and tramadol w/ it’s SNRI action, unique to opioids—I know I know, it’s not technically an opiate/opioid, but for all intense and purposes it is, and it definitely has significant agonist affinity for mu-opioid receptors).

And perhaps- maybe a listing of drugs within each category, or at least the most commonly used and/pr prescribed ones, would be helpful? Just a suggestion… Since some users take whatever is handed to them w/o knowing what kind-of-drug they’re taking! So I think this would be in line w/ our intention of harm reduction!

~ ~ ~ ~

Here is a basic overview and/or abstract of the compositions i've already written:

Intro: brief introduction to the drug's (or category of drug's) pharmacodynamic action for both intoxication & for withdrawal.

Symptoms: Started w/ a general introduction to most commonly experienced symptoms. I divided such symptoms into stages, w/ duration of which based on tolerance (for both minimal & highly dependent individuals) & w/ specific symptoms listed, along with their intensity (relative to other "stages") -- w/ certain symptoms, if experienced, noted to be possibly life-threatening & warranting medical attention IMMEDIATELY. I've divided withdrawal into 3 stages. Stage 1- build up of symptomatic effects (and duration). Stage 2- the peak and/or plateau of symptoms (and duration). Stage 3- period of gradual resolution of symptoms (and duration). In addition, i've added a section of residual effects and/or PAWS, if experienced...

Helpful and contradictory drugs: i've included OTC drugs (over-the-counter in the US, at least) & non-OTC drugs (both illicit & prescription) that assist in symptomatic relief OR act as a replacement. & I have additionally included a section for drugs to avoid- which may exasperate withdrawal symptoms, in addition to drugs that are both direct & indirect/i] antagonists (again, thus exasperating w/d)- such as NSAID’s indirect effect as an antagonist for most GABAergic drugs (although particularly barbs) relative to direct antagonists such as naloxone used to reverse the effects of opioids.

Future planned additions: personal activity (i.e., working out or exercise) and diet, if tolerable. And other life-style changes (i.e., meditation) that may contradict or relieve withdrawal. And also, resources for maintaining abstinence, w/ links; NA or AA for example (although these bits of information could be contained in some sort of introduction--which i'd also be willing to write--as they generally can be beneficial to most withdrawal syndromes- at least in regards to diet, exercise, & recovery/abstinence references/resources). And finally, generalized health information not otherwise mentioned in other areas of the FAQ (of which would most likely have to be tailored to each drug-type); such as- suggestions for speaking w/ ER doctors or your PCP/GP.

Also, I would suggest--and would be willing to write up--commentary on polydrug withdrawal, although this would be limited to such cases were symptomatic synergy and/or complications are known to occur (i.e., stimulants + opioids, OR; opioids + benzodiazepines/ethanol/or other GABAergics commonly used in opioid dependent users)... I think it would be wise to keep this section brief (assuming it's ultimately decided that it should be created), otherwise this could get quite messy & lengthy! For polydrug dependency, one could just refer to the different FAQ sections for information the drugs they're looking for- such as short-acting opioids & stimulants if one is withdrawing from heroin and cocaine, for example.
 
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