tolerance

[[be...]]

Can someone explain benzo tolerance to me please?  i'm wanting to see if maybe since i was on the same dose of xanax for so many years and wouldn't go up on it if maybe i had it and that would explain some things, thanks in advance.

[[bu...]]

Tolerance, like many terms here on BB, is very frequently misused.

 

Tolerance simply means the system has adjusted to the presence of the med, and it no longer has therapeutic effect.  And tolerance develops with many meds, not just benzos.  Tolerance does not cause any sxs.  It just means your med isn't working.

Folks on BB often talk about tolerance, when what they really mean is tolerance withdrawal.  According to BB, tolerance withdrawal is the emergence of withdrawal sxs even though you are NOT reducing your dose.

 

But tolerance withdrawal seems to exist only on BB (and a few other similar  message boards).  There doesn't seem to be reference tolerance withdrawal in any scientific or medical studies.  :

[[be...]]

awesome, thank you so much for clarifying for me.

[[Be...]]

If torance withdrawal did not exist, then it would be impossible for one to ever go below the tolerance level and be asymptomatic, which has occurred. Perhaps I am misunderstanding you.

 

The emergence of symptoms other than those for which the drug was originally prescribed should be proof enough that tolerance leads to tolerance withdrawal symptoms.

[[Be...]]

From Dr. Ashton:

 

 

Tolerance. Tolerance to many of the effects of benzodiazepines develops with regular use: the original dose of the drug has progressively less effect and a higher dose is required to obtain the original effect. This has often led doctors to increase the dosage in their prescriptions or to add another benzodiazepine so that some patients have ended up taking two benzodiazepines at once.

 

However, tolerance to the various actions of benzodiazepines develops at variable rates and to different degrees. Tolerance to the hypnotic effects develops rapidly and sleep recordings have shown that sleep patterns, including deep sleep (slow wave sleep) and dreaming (which are initially suppressed by benzodiazepines), return to pre-treatment levels after a few weeks of regular benzodiazepine use. Similarly, daytime users of the drugs for anxiety no longer feel sleepy after a few days.

 

Tolerance to the anxiolytic effects develops more slowly but there is little evidence that benzodiazepines retain their effectiveness after a few months. In fact long-term benzodiazepine use may even aggravate anxiety disorders. Many patients find that anxiety symptoms gradually increase over the years despite continuous benzodiazepine use, and panic attacks and agoraphobia may appear for the first time after years of chronic use. Such worsening of symptoms during long-term benzodiazepine use is probably due to the development of tolerance to the anxiolytic effects, so that "withdrawal" symptoms emerge even in the continued presence of the drugs. However, tolerance may not be complete and chronic users sometimes report continued efficacy, which may be partly due to suppression of withdrawal effects. Nevertheless, in most cases such symptoms gradually disappear after successful tapering and withdrawal of benzodiazepines. Among the first 50 patients attending my clinic, 10 patients became agoraphobic for the first time while taking benzodiazepines. Agoraphobic symptoms abated dramatically within a year of withdrawal, even in patients who had been housebound, and none were incapacitated by agoraphobia at the time of follow-up (10 months to 3.5 years after withdrawal).

 

Tolerance to the anticonvulsant effects of benzodiazepines makes them generally unsuitable for long-term control of epilepsy. Tolerance to the motor effects of benzodiazepines can develop to a remarkable degree so that people on very large doses may be able to ride a bicycle and play ball games. However, complete tolerance to the effects on memory and cognition does not seem to occur. Many studies show that these functions remain impaired in chronic users, recovering slowly, though sometimes incompletely, after withdrawal.

 

Tolerance is a phenomenon that develops with many chronically used drugs (including alcohol, heroin and morphine and cannabis). The body responds to the continued presence of the drug with a series of adjustments that tend to overcome the drug effects. In the case of benzodiazepines, compensatory changes occur in the GABA and benzodiazepine receptors which become less responsive, so that the inhibitory actions of GABA and benzodiazepines are decreased. At the same time there are changes in the secondary systems controlled by GABA so that the activity of excitatory neurotransmitters tends to be restored. Tolerance to different effects of benzodiazepines may vary between individuals - probably as a result of differences in intrinsic neurological and chemical make-up which are reflected in personality characteristics and susceptibility to stress. The development of tolerance is one of the reasons people become dependent on benzodiazepines, and also sets the scene for the withdrawal syndrome, described in the next chapter.

[[be...]]

Tolerance is simply the drug no longer works. Usually people end up taking more and more until the desired effect is once again achieved. Until finally that point can't be reached without other serious results.  Tolerance at its worst. Of course you feel dreadful but you're not in withdrawal. Simply tolerance. I think this potentially leads to other unforeseen symptoms and problems but not tolerance withdrawal. The withdrawal occurs when you begin actually tapering. The tolerance itself is a beast. Complications arise. Nasty ones. But they shouldn't be mistaken for withdrawal. Fine line maybe but still not quite the same. B

 

[[be...]]

thanks for your replies, clearing some things up for me.

[[bu...]]

From Dr. Ashton:

 

 

 

Tolerance is a phenomenon that develops with many chronically used drugs (including alcohol, heroin and morphine and cannabis). The body responds to the continued presence of the drug with a series of adjustments that tend to overcome the drug effects. In the case of benzodiazepines, compensatory changes occur in the GABA and benzodiazepine receptors which become less responsive, so that the inhibitory actions of GABA and benzodiazepines are decreased. At the same time there are changes in the secondary systems controlled by GABA so that the activity of excitatory neurotransmitters tends to be restored. Tolerance to different effects of benzodiazepines may vary between individuals - probably as a result of differences in intrinsic neurological and chemical make-up which are reflected in personality characteristics and susceptibility to stress. The development of tolerance is one of the reasons people become dependent on benzodiazepines, and also sets the scene for the withdrawal syndrome, described in the next chapter.

 

Yup, a detailed and correct discussion of tolerance.  There is no mention in that discussion of any phenomenon called "tolerance withdrawal".

 

That paragraph is pretty much identical to my much more brief description above:

 

"tolerance simply means the system has adjusted to the presence of the med, and it no longer has therapeutic effect.  And tolerance develops with many meds, not just benzos.  Tolerance does not cause any sxs.  It just means your med isn't working."

 

http://detoxanswers.com/questions/236/what-are-the-dea-schedules-for-controlled-substances

 

https://en.wikipedia.org/wiki/Benzodiazepine_overdose

[[Be...]]

Not to belabor, but I think there is a reference:

 

Many patients find that anxiety symptoms gradually increase over the years despite continuous benzodiazepine use, and panic attacks and agoraphobia may appear for the first time after years of chronic use. Such worsening of symptoms during long-term benzodiazepine use is probably due to the development of tolerance to the anxiolytic effects, so that "withdrawal" symptoms emerge even in the continued presence of the drugs.

 

This may go back to what is termed relative withdrawal by Colin. I'm not sure we are on totally different pages, but I don't want to claim tolerance withdrawal is just medicine no longer being able to cover underlying preexisting issues. There are too many unrelated, new symptoms arising at that time to be drug masking alone. Rather, when Ashton speaks of the return of excibitory mechanisms, I think she is talking about brain chemistry changes due to the drug. Note that she also talks about GABA activity decrease.

 

She says: In the case of benzodiazepines, compensatory changes occur in the GABA and benzodiazepine receptors which become less responsive, so that the inhibitory actions of GABA and benzodiazepines are decreased. At the same time there are changes in the secondary systems controlled by GABA so that the activity of excitatory neurotransmitters tends to be restored.

 

[[Be...]]

Beautiful trees, if you have not already, I would suggest reading Parker's post above entitled "What is happening in your brain?"

[[Te...]]

All I know is looking back, I developed weird symptoms early on in my klonopin use that I now know were benzo related, either side effects or early signs of tolerance. In my 4th year of use, I developed gastroparesis and had sudden unexplained weight loss and 12 bowel movements a day,  again, either a side effect of the drug as it deregulated my adrenal system and GABA receptors, or because of tolerance. I drank more alcohol as my anxiety was no longer controlled by the klonopin. What probably threw me into true withdrawal (before I actually tapered) was the intermittent increase from 1.0 to 1.5 mg. All hell broke loose and my body broke down. Many of the symptoms I experienced while tapering started when I briefly and was prescribed and erratically took an additional .5 mg as needed. I believe that when you reach tolerance, something happens to the body's systems and you start to break down because the body isn't getting what it needs. The body starts to misfire.  Call it what you will, but I believe the phenomenon is real.

 

[[bu...]]

Please note:  I did NOT say it isn't real, I did NOT say it doesn't exist.

 

 

What I DID say was 1)  the only place I see that term is on message boards, and 2) there doesn't seem to be any verifiable medical/scientific information about it.

[[Fe...]]

I do not really believe in "tolerance withdrawal." Yes, as Ashton states, you can reach a point where the same dose is no long effective. That is true, over time, with most any drug...opiates, cocaine, even Tylenol. So yes, there is a tolerance to the therapeutic effect of a particular dose after time.

 

When tapering, there is WD from reducing a dose the body has become used to. However, just bc a dose is no longer therapeutic, does not mean that dose suddenly causes WD. It's simply that...no longer effective on a therapeutic level.

 

I do believe what the drug was originally designed to help, over time, can worsen symptoms. I believe that has something to do with the re-wiring of the brain instead of "interdose WD."

[[Fe...]]

Not to be argumentative, but it is physically impossible to be addicted to a higher amount of drug than is actually taken. Your body can only be ACCOSTOMED to the amount it has been given. Yes, you reach TOLERANCE. You need more of the drug bc it is no longer effective. But you don't hit TOLERANCE WD, when that same amount the body is used to is still being consumed. You simply lose its therapeutic effect. When you lose the therapeutic effect, it feels miserable. It can feel like WD. But WD, in a medical sense, can only be applied when the dose is lowered that the body is dependednt upon. Effective and WD are not the same.

[[Be...]]

I hope we are not having an argument over Ashton's use of the word tolerance "withdrawal", which she put in quotations (assumingly because she knew the drug was not being lessened). However, the effect of decreased efficacy is to produce withdrawal-like symptoms. And, again, the symptoms are often new to the person, meaning they are the product of some brain chemistry imbalance.

[[Fe...]]

No, no argument. I "tap out." If a person hits tolerance WD, by all means they hit it. Every person's experience is unique.

[[Be...]]

Fearful, please believe that I meant "argument" in the most passive sense. None of us need to be riled up over anything. My apologies if that occurred.

[[bu...]]

I do not really believe in "tolerance withdrawal." Yes, as Ashton states, you can reach a point where the same dose is no long effective. That is true, over time, with most any drug...opiates, cocaine, even Tylenol. So yes, there is a tolerance to the therapeutic effect of a particular dose after time.

 

When tapering, there is WD from reducing a dose the body has become used to. However, just bc a dose is no longer therapeutic, does not mean that dose suddenly causes WD. It's simply that...no longer effective on a therapeutic level.

 

 

 

And that is tolerance.  And tolerance is well established and exensively-studied  medical phenomenon.  Nobody I know debates the occurance of tolerance.

 

But  the progressive process where a drug becomes less effective, or ineffective does NOT result in withdrawal sxs.

 

Maybe tolerance withdrawal is a real phenomenon,, but it is NOT the same as tolerance.

[[be...]]

thanks everyone for your replies, i have learned something from everyone, and i appreciate the input.

[[Be...]]

Builder, I have problems resolving your last two statements. The first is a given and I think none dispute that, nor does anyone seem to dispute that tolerance is not true withdrawal. However, how's is it that you can claim that tolerance withdrawal may be a real problem, yet also say that tolerance does not cause symptoms? I have given you examples of how new symptoms have arisen. If you prefer to say that those new symptoms are the result of GABA receptor down-regulation and associated brain chemistry struggles to adapt, I am okay with that, if that is what you mean. However, that does not change the observation of those new symptoms occurring in tolerance. I think that is what is meant by tolerance withdrawal.

[[Fe...]]

Fearful, please believe that I meant "argument" in the most passive sense. None of us need to be riled up over anything. My apologies if that occurred.

 

No offense taken!! Everyone has their own belief and experience about what is happening and the cause of why we feel so badly. What matters is that we support each other!

[[Te...]]

I do not really believe in "tolerance withdrawal." Yes, as Ashton states, you can reach a point where the same dose is no long effective. That is true, over time, with most any drug...opiates, cocaine, even Tylenol. So yes, there is a tolerance to the therapeutic effect of a particular dose after time.

 

When tapering, there is WD from reducing a dose the body has become used to. However, just bc a dose is no longer therapeutic, does not mean that dose suddenly causes WD. It's simply that...no longer effective on a therapeutic level.

 

 

 

And that is tolerance.  And tolerance is well established and exensively-studied  medical phenomenon.  Nobody I know debates the occurance of tolerance.

 

But  the progressive process where a drug becomes less effective, or ineffective does NOT result in withdrawal sxs.

 

Maybe tolerance withdrawal is a real phenomenon,, but it is NOT the same as tolerance.

 

Builder,

I agree tolerance and tolerance withdrawal are not the same. Tolerance refers to the reduced effectiveness at a given dose. But when some people reach tolerance, they describe things going awry in the body. They often self medicate (alcohol) or are given additional doses or  medications to compensate. But even if not, it seems people are consistently describing the breakdown of their bodies into a fairly consistent set of symptoms. That there is no scientific literature on this may simply be because it hasn't been studied. And doctors don't even look at the possibility of tolerance, much less to link symptoms to  benzo use. I was under the regular care of several doctors (apart from the prescribing pdoc) and not one of them brought up the dangers of long term benzo use, much less the question of tolerance.

[[bu...]]

  However, how's is it that you can claim that tolerance withdrawal may be a real problem, yet also say that tolerance does not cause symptoms? I have given you examples of how new symptoms have arisen.

 

Because tolerance, and tolerance WITHDRAWAL are 2 very different things. 

 

Tolerance is the declining effectiveness of the therapeutic effects of the med.  It doesn't cause sxs, it just no longer addresses your original disorder.

Tolerance withdrawal is defined as the emergence of withdrawal sxs even though you have not reduced your dose.

 

If you have new symptoms, that is NOT tolerance.  One more time, tolerance means the med no longer relieves the sxs of your original disorder. 

[[Be...]]

With that reply, I think we can all agree. If that is your position, then we've been saying the same things. I never disagreed with your separation of tolerance from tolerance withdrawal; however, I did have problems with the absence of symptom statements in tolerance "withdrawal." I acknowledge that you say it may be real. To me it is very real and, I think common to not just benzodiazepines, but other drugs. Oh well, dead horse at this point.

[[Ca...]]

Tolerance...

 

Medication related symptoms...

 

Withdrawal...

 

Post acute withdrawal symptoms...

 

Recouvery...

 

Perhaps,,, -Thats how my opiate sad story went anyway... -as best I can tell...