Why so few scientifically documented studies re: results from tapers/cessation?

[[La...]]

Yes, my guess is that there isn't a lot of funding for research on this topic, since no drug companies will benefit. And it may also be that few people want to participate in studies on withdrawal. Maybe they don't want to be involved in ongoing testing, poking and prodding while coming off a medication.

[[Ma...]]

 

 

.  Happy to agree to disagree there are not enough numbers to reliably investigate.  Not to mention research dollars and interest/need.

 

 

Not to mention an interest to disregard the issue

[[Fi...]]

 

 

.  Happy to agree to disagree there are not enough numbers to reliably investigate.  Not to mention research dollars and interest/need.

 

 

Not to mention an interest to disregard the issue

 

Which brings to the forefront the question: Is there an undisclosed agenda? re: speculatively and broadly supporting the discontinuation of benzodiazepines in dependent persons vs. rationally weighing the benefits to risk on a case by case basis.   

[[se...]]

 

 

.  Happy to agree to disagree there are not enough numbers to reliably investigate.  Not to mention research dollars and interest/need.

 

 

Not to mention an interest to disregard the issue

 

Which brings to the forefront the question: Is there an undisclosed agenda? re: speculatively and broadly supporting the discontinuation of benzodiazepines in dependent persons vs. rationally weighing the benefits to risk on a case by case basis. 

 

Again, it's not speculation or irrational to support and help a long-term user get off benzos.

[[Fi...]]

"Again, it's not speculation or irrational to support and help a long-term user get off benzos."

 

It is speculation and it may be detrimental to some people's lives to broadly support this treatment option in the absence of evidence that it is advantageous. Again, the best evidence indicates that a statistically significant number of  people continue to suffer from cognitive and physical damage even after withdrawal.

 

[[se...]]

"Again, it's not speculation or irrational to support and help a long-term user get off benzos."

 

It is speculation and it may be detrimental to some people's lives to broadly support this treatment option in the absence of evidence that it is advantageous. Again, the best evidence indicates that a statistically significant number of  people continue to suffer from cognitive and physical damage even after withdrawal.

 

The overwhelming amount of evidence suggests getting off.  Benzo dependence is not a good thing.  The paper you keep pointing to is weak evidence and just discusses cognition.  It's nowhere near enough evidence to support a clinical decision to stay on benzos long-term.  It hints at possible long-term consequences but that's it.  Don't be swayed by one article or even a few scattered pieces of evidence.  That's not how research and best practice works.

 

I would have liked your line of reasoning about two and a half months ago and even while I was on benzos.  I looked for anything and everything as reason to stay on.  That fear drove my beliefs.  Not anymore.  Having gone through it and coming this far in those 2.5 months, I'm seeing things I was blinded to while on the benzos including the stark facts that this stuff is bad for you long-term any way you cut it.  There's so much research out there to support this.  And I don't hear how bad these drugs are from you.  It's concerning and I felt that way too.  Just an acknowledgement that they cause a lot of problems would make me feel better about some aspects of your argument.  The further insistence that it's speculation to suggest it's better to stay on and that it's harmful or misguided to suggest one shouldn't get off is alarming.

 

I would suggest writing to the authors of that study and see if they intended for their research to be used as evidence to stay on, Fi.

[[Fi...]]

"Again, it's not speculation or irrational to support and help a long-term user get off benzos."

 

It is speculation and it may be detrimental to some people's lives to broadly support this treatment option in the absence of evidence that it is advantageous. Again, the best evidence indicates that a statistically significant number of  people continue to suffer from cognitive and physical damage even after withdrawal.

 

The overwhelming amount of evidence suggests getting off.  Benzo dependence is not a good thing.  The paper you keep pointing to is weak evidence and just discusses cognition.  It's nowhere near enough evidence to support a clinical decision to stay on benzos long-term.  It hints at possible long-term consequences but that's it.  Don't be swayed by one article or even a few scattered pieces of evidence.  That's not how research and best practice works.

 

I would have liked your line of reasoning about two and a half months ago and even while I was on benzos.  I looked for anything and everything as reason to stay on.  That fear drove my beliefs.  Not anymore.  Having gone through it and coming this far in those 2.5 months, I'm seeing things I was blinded to while on the benzos including the stark facts that this stuff is bad for you long-term any way you cut it.  There's so much research out there to support this.  And I don't hear how bad these drugs are from you.  It's concerning and I felt that way too.  Just an acknowledgement that they cause a lot of problems would make me feel better about some aspects of your argument.  The further insistence that it's speculation to suggest it's better to stay on and that it's harmful or misguided to suggest one shouldn't get off is alarming.

 

I would suggest writing to the authors of that study and see if they intended for their research to be used as evidence to stay on, Fi.

 

I have stated repeatedly & will state again that long term use of benzodiazepines can and very often does cause damage in people.

 

What you apparently are unwilling to recognize, even when presented with scientific evidence,  is that cessation from benzodiazepines does not always correct the damage , may never correct the damage, and may increase the damage.

 

 

[[Fi...]]

Can we define "Maintainance Dose" as opposed to just being "on med"..??

 

That's a very valid point. There is pharmacological definition & formula but, for me it is of limited use for long-term consideration in the use of benzodiazepines:

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

 

For me, I would consider a maintenance dose of benzodiazepine to be the minimum daily amount of the benzo I need to consume that will maintain my best functionality without causing increased toxicity.

 

I expect maintenance dosage changes over time and changes in response to changes to one's environmental circumstances.

[[Fi...]]

I totally support the idea of better scientific studies, but I would disagree that anecdotal reports are not, or can't be scientific The gold standard of placebo controlled, double blinded studies only apply to a particular scenario where individuals in one are given the tested  substance and another group a placebo and the aim is to look for results in specific markers This kind of science just does not generally apply in the real world. This is why studies on diets, or any any studies that require self reporting, are not up to the given gold standard. Now if you could get people to enter a facility where the test subjects can be observed and controlled then you have a chance to do well controlled studies that would likely meet the kind of science you are asking for.

 

In the meantime I would suggest we try to gather all the anecdotal reports we can with as much corroboration of their veracity as possible

 

You've made some good points. However, I don't place any confidence in anecdotal reports for which corroboration of their veracity is not obtained.

[[se...]]

"Again, it's not speculation or irrational to support and help a long-term user get off benzos."

 

It is speculation and it may be detrimental to some people's lives to broadly support this treatment option in the absence of evidence that it is advantageous. Again, the best evidence indicates that a statistically significant number of  people continue to suffer from cognitive and physical damage even after withdrawal.

 

The overwhelming amount of evidence suggests getting off.  Benzo dependence is not a good thing.  The paper you keep pointing to is weak evidence and just discusses cognition.  It's nowhere near enough evidence to support a clinical decision to stay on benzos long-term.  It hints at possible long-term consequences but that's it.  Don't be swayed by one article or even a few scattered pieces of evidence.  That's not how research and best practice works.

 

I would have liked your line of reasoning about two and a half months ago and even while I was on benzos.  I looked for anything and everything as reason to stay on.  That fear drove my beliefs.  Not anymore.  Having gone through it and coming this far in those 2.5 months, I'm seeing things I was blinded to while on the benzos including the stark facts that this stuff is bad for you long-term any way you cut it.  There's so much research out there to support this.  And I don't hear how bad these drugs are from you.  It's concerning and I felt that way too.  Just an acknowledgement that they cause a lot of problems would make me feel better about some aspects of your argument.  The further insistence that it's speculation to suggest it's better to stay on and that it's harmful or misguided to suggest one shouldn't get off is alarming.

 

I would suggest writing to the authors of that study and see if they intended for their research to be used as evidence to stay on, Fi.

 

I have stated repeatedly & will state again that long term use of benzodiazepines can and very often does cause damage in people.

 

What you apparently are unwilling to recognize, even when presented with scientific evidence,  is that cessation from benzodiazepines does not always correct the damage , may never correct the damage, and may increase the damage.

 

No, not at all and it makes sense to weigh risks on a case-by-case basis.  The stronger evidence here though is it's better to get off.

[[Ca...]]

Can we define "Maintainance Dose" as opposed to just being "on med"..??

 

That's a very valid point. There is pharmacological definition & formula but, for me it is of limited use for long-term consideration in the use of benzodiazepines:

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

 

For me, I would consider a maintenance dose of benzodiazepine to be the minimum daily amount of the benzo I need to consume that will maintain my best functionality without causing increased toxicity.

 

I expect maintenance dosage changes over time and changes in response to changes to one's environmental circumstances.

Thanks... I have only just started seeing the term around here...

I guess for my "other" reinstatment MY maintainance dose is the minimum amount needed to be able to survive the SX over the longer term... -its not without its problems..!!

 

[[Fi...]]

If you read "In the News" threads, there are more than ample scientifically conducted studies being published re: the risks associated with the use of benzodiazepines, deprescribing protocols, etc. But, I haven't seen many scientifically conducted studies documenting the cognitive & physical impairments or improvements associated with deprescribing protocols and benzodiazepine taper/cessation efforts. There are plenty of opinions but few scientifically documented results.

 

The studies that have been published show rather dismal cognitive & physical results for the people who have discontinued benzodiazepines. There are two such mega data studies published "In the News" thread.

 

Fi, I actually can't recall seeing one such study focused on quality of life after withdrawal.  You say there are two posted here, are you able to share the links.  Thanks.

 

abcd: Both studies are mentioned in this very long & controversial (among bb members) link:

 

http://www.benzobuddies.org/forum/index.php?topic=209847.0

 

The authors state, “These results are indeed significant, for they challenge earlier findings that benzodiazepine users who are successful in withdrawing from benzodiazepine can expect recovery in cognitive functioning.”

 

Here's the full study, FYI, from the above Mad in America article.  I haven't read it yet, but the cited references might be helpful in your research.

 

https://sci-hub.tw/10.1093/arclin/acx120

 

 

 

(Wrong link, edited post to add the correct one )

 

Thank you abcd for providing that link. I've read that meta analysis many times but, it's always good to refresh my memory of its content.

 

It is the best documented scientific analysis I have found regarding the effects of long-term benzo use & the results of those who have ceased the use of benzos. Unfortunately, the prognosis doesn't appear to be very good for either scenario.

 

Of significant importance to many and what appears to be lacking in those studies are the physical effects and damages caused by long-term benzo use and cessation of use.

 

"Abstract

 

Objective: This study presents an updated meta-analysis of the effects of benzodiazepines on cognitive functioning in long-term, current

users of these agents, those who have recently withdrawn and on those who have successfully abstained following withdrawal. The study represents

an update of the previous meta-analyses published by our group.

 

Method: A comprehensive search of the computerized databases Medline and PsycINFO was undertaken to identify studies that assessed

the cognitive effects of benzodiazepines published up to 28 November 2016 (the date of the last update). Nineteen studies (eight studies

published since the previous meta-analyses and 11 studies included in the previous studies) were included.

 

Results: The results of the analysis for current users revealed statistically significant, negative effects for the cognitive domains of working

memory, processing speed, divided attention, visuoconstruction, recent memory, and expressive language. For those who had withdrawn

and successfully abstained following withdrawal, deficits were observed for the domains of recent memory, processing speed, visuoconstruction,

divided attention, working memory, and sustained attention.

 

Conclusions: The results of the study are important in that they corroborate the mounting evidence that a range of neuropsychological

functions are impaired as a result of long-term benzodiazepine use, and that these are likely to persist even following withdrawal. The findings

highlight the residual neurocognitive compromise associated with long-term benzodiazepine therapy as well as the important clinical

implications of these results.

 

[[La...]]

Please read this 2010 study on benzodiazepine tapering. It found four different patterns in the 50 weeks following benzo withdrawal.

 

"Benzodiazepine tapering: a prospective study"

 

Abstract

 

BACKGROUND:

 

Benzodiazepines (BZD) are the most widely used sedative-hypnotics, and evidence is rapidly accumulating suggesting potential BZD dependence, association of chronic use with adverse effects and a definite abstinence syndrome produced by withdrawal.

 

AIMS:

 

The present investigation followed prospectively long-term BZD users over 1 year following graded BZD withdrawal in terms of clinical and withdrawal symptoms.

 

METHODS:

 

Clinical symptoms were measured by the Comprehensive Psychopathological Rating Scale (CPRS) and by the Newcastle Anxiety and Depression Diagnostic Index (NADDI) in a sample of BZD users over a 50-week period following graded BZD withdrawal.

 

RESULTS:

 

The results showed that the frequency and severity of clinical symptomatology measured by both scales significantly decreased over time. A detailed analysis of possible patterns of symptoms on both scales revealed four patterns: 1) a gradual decrease over the 50-week time period; 2) an increase in the severity of symptoms at the onset of tapering and a decrease in severity post-tapering; 3) an increase in the severity of symptoms 4 weeks after the cessation of BZD tapering; and 4) no change over the 50-week time period. Rate of BZD withdrawal was associated with CPRS ratings of global illness at admission and at end of treatment, but was not associated with duration or dosage of BZDs, type of BZD, prescriptive and/or non-prescriptive drug use prior to admission, marital status, sex or age.

 

CONCLUSIONS:

 

The results of the present study provide a detailed picture of the pattern of symptoms, their time course and multidimensional determinants of the BZD withdrawal symptoms.

 

 

 

 

Abstract:

 

https://www.ncbi.nlm.nih.gov/pubmed/20629611 

 

Full Study:

 

http://sci-hub.tw/https://www.ncbi.nlm.nih.gov/pubmed/20629611

 

 

[[Fi...]]

Thanks Lapis, I really do appreciate your effort in finding this study.

 

It will take me some time to more fully digest it.

 

Some of the authors of this study are referenced in the meta analysis that you & abcd previously provided but, I don't see this particular study included in that meta analysis. I may have missed it. If indeed this study was not included in the meta analysis, I wonder why?

 

I hope the conclusions reached in this study are a true reflection of nonclinical withdrawal and that symptoms may decrease over time, after cessation from benzodiazepines.

 

Thanks again!

 

Edit: I'm still reviewing & comparing. Perhaps this study wasn't included in the meta analysis because it didn't include one or more of these criteria of the meta analysis?

 

"The initial search yielded 8,251 search results. Of these, 78 papers were selected for further analysis as to whether they

met the inclusion criteria, based upon their title and abstract. Of these, 70 papers were excluded for the following reasons;

three had an inappropriate study design, eight did not provide sufficient data to allow for the calculation of effect sizes,

eight did not incorporate a healthy control group, eight did not incorporate any objective cognitive testing measures, two

were not empirical research studies, and 41 included participants who were not current or previous long-term users of benzodiazepines.

This selection process identified eight new studies, which were not included in the previous meta-analyses.

No additional papers were found when scanning the reference lists. In addition to these studies, 11 papers from the previous

meta-analyses conducted by Barker and colleagues (Barker et al., 2004a, 2004b) that met the inclusion criteria were

also included."

 

 

[[La...]]

My pleasure, Fi. You're welcome.

 

Something else to consider, Fi: This study is looking at more than just cognition. Perhaps the meta-analysis was only searching for studies of effects on cognition. As you know, many other things can be affected by benzos.

 

I posted this abstract years ago, and a friend was able to email me a Word document of the full study, but I haven't, until now, been able to provide a link to the study online. I've posted the full study in the News section for all to read, and I do hope people will take the time to do so. It's been awhile since I read it, but the four-pattern outcome has remained in my mind since the time I first read it.

[Guest [sa...]]

Why study it?

 

 

Edit: anti psychiatry comments removed

 

 

Please see:

Anti-doctor, Anti-psychiatrist and Anti-medicine Comments

 

[[Fi...]]

"Why study it?" .. and other issues you raised: 

 

For some, including myself, a benzodiazepine was prescribed for a non psychiatric medical condition. If I knew then what I know now (the internet was not available) i.e. if I had the resources to study it, I would not have filled the first prescription for a benzodiazepine let alone continued its use. The only reason I continue its use is because of the adverse effects that discontinuation has upon my quality of life.

 

As for the remainder of your post, I believe your comments are not in compliance with bb's policies, the comments probably should not have been posted & I won't respond to them.

 

best wishes

[[ci...]]

Please read this 2010 study on benzodiazepine tapering. It found four different patterns in the 50 weeks following benzo withdrawal.

 

"Benzodiazepine tapering: a prospective study"

 

Abstract

 

BACKGROUND:

 

Benzodiazepines (BZD) are the most widely used sedative-hypnotics, and evidence is rapidly accumulating suggesting potential BZD dependence, association of chronic use with adverse effects and a definite abstinence syndrome produced by withdrawal.

 

AIMS:

 

The present investigation followed prospectively long-term BZD users over 1 year following graded BZD withdrawal in terms of clinical and withdrawal symptoms.

 

METHODS:

 

Clinical symptoms were measured by the Comprehensive Psychopathological Rating Scale (CPRS) and by the Newcastle Anxiety and Depression Diagnostic Index (NADDI) in a sample of BZD users over a 50-week period following graded BZD withdrawal.

 

RESULTS:

 

The results showed that the frequency and severity of clinical symptomatology measured by both scales significantly decreased over time. A detailed analysis of possible patterns of symptoms on both scales revealed four patterns: 1) a gradual decrease over the 50-week time period; 2) an increase in the severity of symptoms at the onset of tapering and a decrease in severity post-tapering; 3) an increase in the severity of symptoms 4 weeks after the cessation of BZD tapering; and 4) no change over the 50-week time period. Rate of BZD withdrawal was associated with CPRS ratings of global illness at admission and at end of treatment, but was not associated with duration or dosage of BZDs, type of BZD, prescriptive and/or non-prescriptive drug use prior to admission, marital status, sex or age.

 

CONCLUSIONS:

 

The results of the present study provide a detailed picture of the pattern of symptoms, their time course and multidimensional determinants of the BZD withdrawal symptoms.

 

 

 

 

Abstract:

 

https://www.ncbi.nlm.nih.gov/pubmed/20629611 

 

Full Study:

 

http://sci-hub.tw/https://www.ncbi.nlm.nih.gov/pubmed/20629611

 

Following

[[Ma...]]

Afraid to read the anti doctor posting rules I don't trust myself when bent out of shape, and I like it here

[[Rx...]]

It seems odd to me that if deprescribing & cessation of benzodiazepines is such a wonderful thing, including the cognitive & physical effects on patients, why isn't there more scientifically documented evidence being published to support those efforts? Anecdotal evidence such as success stories on bb, facebook, etc. isn't scientifically documented evidence.

 

There could be financial incentive to sweep good news under the rug.  I am not attacking any profession or industry as a whole.

[[Rx...]]

It seems odd to me that if deprescribing & cessation of benzodiazepines is such a wonderful thing, including the cognitive & physical effects on patients, why isn't there more scientifically documented evidence being published to support those efforts? Anecdotal evidence such as success stories on bb, facebook, etc. isn't scientifically documented evidence.

 

There could be financial incentive to sweep good news under the rug.  I am not attacking any profession or industry as a whole.

 

Additional disclaimer: I'm actually attacking nobody.  It's a logical possibility.

[[Fi...]]

It seems odd to me that if deprescribing & cessation of benzodiazepines is such a wonderful thing, including the cognitive & physical effects on patients, why isn't there more scientifically documented evidence being published to support those efforts? Anecdotal evidence such as success stories on bb, facebook, etc. isn't scientifically documented evidence.

 

There could be financial incentive to sweep good news under the rug.  I am not attacking any profession or industry as a whole.

 

Additional disclaimer: I'm actually attacking nobody.  It's a logical possibility.

 

I know this isn't an attack on anyone.

 

It 'could' be associated with financial incentive to sweep good news under the rug but, I don't think that's likely. There isn't much profit margin in cheap generic drugs like benzos that have been on the market for over 50 years and most reputable doctors nor pharmacological researchers have much incentive to sweep good news under the carpet. imo, a) it's more likely there are not many good results to report & b) it's not a glamorous field for research. 

 

Edit: However, based upon the number of returns from google searches there must be a big financial incentive for commercial quick detox programs/corporations even though those programs apparently do not have great long-term patient cessation records.

[[Ma...]]

 

 

I know this isn't an attack on anyone.

 

It 'could' be associated with financial incentive to sweep good news under the rug but, I don't think that's likely. There isn't much profit margin in cheap generic drugs like benzos that have been on the market for over 50 years and most reputable doctors nor pharmacological researchers have much incentive to sweep good news under the carpet. imo, a) it's more likely there are not many good results to report & b) it's not a glamorous field for research. 

 

.

 

 

I guess I don't understand You seem to acknowledge there is little incentive to promote or further research old drugs, but then the conclusion implies something different?

[[Fi...]]

There isn't much incentive (financial or otherwise) to sweep good news under the carpet.

[[Ma...]]

How so?