Question:
ABSTRACT: Long-Term Treatment with Benzodiazepines ?
Answer:
Benzodiazepine receptors are ubiquitous throughout the central nervous
system. Benzodiazepine receptors are linked predominantly to g amino
butyric acid (GABA) receptors, which sensitize benzodiazepine receptors
to the neurotransmitter GABA, the most prominent inhibitory
neurotransmitter in the central nervous system. Benzodiazepines enhance
the affinity of the recognition site for GABA by inducing
conformational changes that make GABA binding more efficacious.
Activation of the benzodiazepine-GABA- chloride ionophor complex is
responsible for producing the therapeutic anxiolytic effects of
benzodiazepines and for mediating many of the side effects and,
possibly, dependence and withdrawal from these drugs.6
Similarly, other sites for drug and neurotransmitter binding are
associated with the GABA receptor complex, which serves as a primary
site of action of benzodiazepines, barbiturates and other
sedative-hypnotics, such as alcohol.6 Benzodiazepines and barbiturates
act at separate binding sites on the receptor to potentiate the
inhibitory action of GABA. They do so by allosterically altering the
receptor (changing its conformation) so that it has a greater binding
affinity for GABA. Ethanol modifies the receptor by altering the
membrane environment so that it has increased affinity for GABA and the
other sedative-hypnotic drugs. That benzodiazepines, barbiturates and
ethanol all have related actions on a common receptor type, which
explains their pharmacologic synergy and cross tolerance. Thus,
benzodiazepines are used during alcohol detoxification.
With long-term high-dose use of benzodiazepines (or ethanol), there is
an apparent decrease in the efficacy of GABA-A receptors, presumably a
mechanism of tolerance.6,7 When high-dose benzodiazepines or ethanol
are abruptly discontinued, this "down-regulated" state of inhibitory
transmission is unmasked, leading to characteristic withdrawal symptoms
such as anxiety, insomnia, autonomic hyperactivity and, possibly,
seizures.
many people, doctors included suffer from narcissistic epistolmology-
"it must be true becuase I believe I say so" even more people suffer
from an authoritarian epistomology-someone of authority claims
something to be true so it is believed without evidence or credible
empirical validation-science starts with a question about what is and
then proceeds to disect the relationships between events-a hypothesis
is formed to answer he questions, measurments and validations are
obtained to test the hypothesis-most medical personel have failed to
develop this type of system to propose a hypothesis and test it uncer
strict observational criterea
see above-in addition part of their authoritarian epistomolgy is
gained from drug techies from big pharma and from their teachers in
situ-if their teachers are poorly trained or lacking in clinical
skills and evidence, they pass it on-like the old proverbial hot
potato
all drugs create a physiological dependence-improper training creates
the misinformed idea that drugs listed under the c-4-and lower are the
worst culprits and deserve some special relationship to prescribing
habits-I have seen terminal cancer patients denied effective doses of
narcotics because they may become addicted-it is only Hospice care
that trespasses beyond the norm of medical practice in this
regard-teetering on "mercy"
Since I wrote the previous post I have tapered gradually from 2 x .25 to 1
1/4 x .25. It has not been easy but it is working. The key was to take it
daily and not go into really bad withdrawal, i.e. a strong panic attack.
Then with each cut to wait long enough till the body adjusts. I can feel it
is adjusting now. I took this path because they were not working anymore to
actually help me. They were causing rebound anxiety worse than I had before.
