Benzos Benzo Tolerance

[jonny11007]

My SNRI is Effexor XR btw, and I feel it works very good. Lately though, it seems to have kind of stopped working. I've read about this with all SSRIs or SNRIs and maybe a slight change in dosage is my answer.

 

[bronson]

^ That may indeed do the trick for you. For example, my Luvox dose was at 100mg daily, and stopped working almost all together. My Dr. upped it to 150mg daily, any now it has been working famously for a few months.

 

[PVMD]

A few comments about the contents of this thread:

A lot of this has been said in some way or another, I'm summing up a little.

*- SNRIs typically work better than SSRIs against anxiety and the anxiety component of conditions involving anxiety.

*- SNRIs and SSRIs can both be effective against OCD, although SSRIs would be the first choice given that no other condition is involved.

*- I'd recommend that jonny11007 augments his benzos with one of several antihistamines to combat some of the acute onset symptoms (like panic attacks). Instead of starting climbing up the diazepam ladder again.

*- Diazepam has the longest half-life among the widely used benzos. And is as such very effective for tapering out of a benzo addiction.

*- Drugs for which tapering is an effective way of reducing use; a good rule of thumb is to lower the dose with an interval equal to the "time to steady state-time". That is usually equal to about 3*half-life. If you start experiencing withdrawal symptoms -> go back to your last dose for another interval, then decrease in a smaller step (let's say half). Using this algorithm you will be approaching either cessation of use, or your minimum effective dose (given that you are using it as medicine). In the specific case of diazepam and it's highly variable half-life (between different people, putting aside the complication of interactions with other medications and/or grapejuice e.g.) the interval at which you lower doses may be the subject of some experimenting. But don't be in a rush, the goal is what's important - getting there, approaching it too fast just causes discomfort. Perceived failures to lower doses or end usage altogether often causes rebound...

*- I'd recommend jonny11007 to try to replace "acute" doses of any benzo (besides diazepam) with any of several antihistamines (hydroxyzine e.g.). If you can't give up your extra benzos try to establish a maximum daily dose for yourself, for "as needed"-use. You could also try alprazolam depot tabs. Don't change this (at least not upwards) during tapering diazepam. When you're back to healthy levels again, you can choose which meds and forms of them you want to be on.

*- Clonazepam should mostly be reserved for cases of epilepsy. I suppose it could make sense as an augment to other benzos, as it has a longer half-life than the benzos typically used for anxiety. It also has quite long subjective duration of effects. half-life: lora- & alprazolam<clonazepam<diazepam

*- To my knowledge Venlafaxine has only been clinically tested for the short-term treatment of anxiety.

*- The above being said; I think people generally are to quick to change their doses of SSRIs and SNRIs. Continue treatment for several months after symptoms have subsided, then taper (depending on med in question).


Comments and feedback welcome.

 

[mdmantpa]

^Great post, I do like the Vistaril recommendation over the Valium, that would probably be a good call for the long run

 

[puckboy]

ime clonazepam is good for having in combination with a stimulant like d-amp, you feel the full effects of the amphetamine but with no anxiety/paranoia, smoothes it all out without overpowering.

 

[jonny11007]

PVMD,
Thankyou for your post, it was extremely informative! I think using the Vistaril will help me alot to help taper me down. Also, Effexor XR has been approved for several of the anxiety disorders in the US, at least that is what they claim. Regarding the clonazepam, why do you think it should just be reserved for epilepsy? I'm just wondering because many Psychs use this as their number one benzo for treating anxiety disorders. I hear it is good because it also effects Serotonin somehow and helps to alleviate racing thoughts and obsessions.

Thanks again for your great reply, and looking forward to hearing what you have to say.
BTW, what are alprazolam depot tabs?

 

[phatass]

i was Rx'ed 3mg alprazolam and 40mg diazepam and 4 mg lormetazepam... i took my usual benzos, got hold of a bottle of clonazepam/Rivotril (25mg i think) i drank the whole bottle, drank about 5 beers and wasn't phased at all, clonazepam doesn't do shit for me...

now i'm prescribed 50mg diazepam and 1mg loprazolam and it takes 600mg of diazepam and 10mg loprazolam to get me benzoed out.... i would cut that figure in half if i had a couple of beers

 

[jonny11007]

i was Rx'ed 3mg alprazolam and 40mg diazepam and 4 mg lormetazepam... i took my usual benzos, got hold of a bottle of clonazepam/Rivotril (25mg i think) i drank the whole bottle, drank about 5 beers and wasn't phased at all, clonazepam doesn't do shit for me...

now i'm prescribed 50mg diazepam and 1mg loprazolam and it takes 600mg of diazepam and 10mg loprazolam to get me benzoed out.... i would cut that figure in half if i had a couple of beers

Like me, you have a helluva benzo tolerance. How come you were prescribed the three benzos-alprazolam, diazepam, lormetazepam at once? Ya, maybe clonazepam doesn't really effect people with high benzo tolerances.

Your dosage now, the 50mg of diazepam and the 1mg loprazolam, how do you think that is working for you? How do you like the loprazolam, and is it for anxiety or more for sleep? Thanks Phatass you always give great advice!

 

[Levvytation]

it takes 600mg of diazepam and 10mg loprazolam to get me benzoed out

Wow thats one muthafucka of a tolerance man.

I've had 35mg diaz along with my evening codeine & a couple of gin & tonics, feeling nice but its only added a very subtle enhancement to the mix. Diaz on its own at 35mg, I probably wouldn't even notice it, even tho its been a few weeks since I've touched a benzo.

I suspect my phenazepam dabbling might have something to do with it....

 

[PVMD]

PVMD,
Thankyou for your post, it was extremely informative! I think using the Vistaril will help me alot to help taper me down. Also, Effexor XR has been approved for several of the anxiety disorders in the US, at least that is what they claim. Regarding the clonazepam, why do you think it should just be reserved for epilepsy? I'm just wondering because many Psychs use this as their number one benzo for treating anxiety disorders. I hear it is good because it also effects Serotonin somehow and helps to alleviate racing thoughts and obsessions.

Thanks again for your great reply, and looking forward to hearing what you have to say.
BTW, what are alprazolam depot tabs?

You're most welcome!

I'm not sure what it is approved for, but we know it is an effective anxiolytic. I don't think there has been long term studies of that efficiency though, still it remains an effective antidepressant.

Pretty much all benzos share the anxiolytic, muscle-relaxant, hypnotic, amnestic, anticonvulsant & sedative properties, even though their profiles differ and some effects are so dose-dependent they don't usually occur with normal doses. I think clonazepam and diazepam are the first benzo choices in epilepsy. Obviously clonazepam is an anxiolytic too, but I'm under the impression that alprazolam, lorazepam & diazepam are more popular choices for anxiety. Although when depression and anxiety occurs together, an SSRI/SNRI is often combined with alprazolam. I'm guessing because alprazolam appears to have short-term antidepressant effects. However, since clonazepam somehow decreases neuronal serotonin utilization, it would make sense to use it as an anxiolytic along with an SNRI(/SSRI) in depressed people suffering from severe anxiety.

"Depot" in this context is the same as "extended release" or "sustained release" (often adding "XR" or "SR" to the name, like in this case "Xanax XR"). Providing prolonged relief from symptoms. Possibly also a means of reducing habitual re-dosing throughout the day. Such a preparation could give the same relief with 1-2doses/day as 3-4doses/day with regular instant release (or "IR") tablets. They come in 0.5, 1, 2 & 3mg.


Take care!

 

[jonny11007]

You're most welcome!

I'm not sure what it is approved for, but we know it is an effective anxiolytic. I don't think there has been long term studies of that efficiency though, still it remains an effective antidepressant.

Thanks again PVMD for a very informative reply! This paragraph above is regarding the Effexor, correcet?? Sorry, but I just got confused it's been a long day Thanks again!

 

[PVMD]

You're most welcome!

I'm not sure what it is approved for, but we know it is an effective anxiolytic. I don't think there has been long term studies of that efficiency though, still it remains an effective antidepressant.

Thanks again PVMD for a very informative reply! This paragraph above is regarding the Effexor, correcet?? Sorry, but I just got confused it's been a long day Thanks again!

That is correct.

Glad to help!