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

[[id...]]

My understanding is that such research is extremely expensive. It would require CAT scans, MRIs, ideally fMRIs, EEGS, neurologist evaluations, sleep studies. All unbelievably expensive. It's cheaper to give someone a normal pill and a sugar pill, have them fill out some questionnaire, have a nurse take their blood pressure and call it a day.

 

But then again, how many of us actually had extensive medical evaluations? My doctors told me I was always this way.

 

So maybe it's not only financial obstacle, but just general belief in "magic bullets" and rigid psychiatric conditions.

[[Lo...]]

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.

 

There may not be much of a direct profit margin in Rx'ing benzos to the patients, but Rx's can definitely open the door to psychiatry and more psychiatric drugs via benzos alone or SSRI's and benzos. Benzos are frequently prescribed for conditions other than psychiatric, but may lead to psychiatrist visits anyway as the original prescribing doctors end up refusing to prescribe and referring a patient to the psychiatrist. Even in the world of mental health, both benzos and SSRI's are initially and often prescribed to people who are not considered to have severe mental health challenges. Yet, after a while, tolerance on benzos unrecognized can lead to more frequent psychiatric visits, hospitalizations, more tests, labs, X-rays as the emergence of withdrawal sympoms on benzos are so often misdiagnosed as a return of the original condition. Now this is where much more expensive Rx drugs can be prescribed, as the focus will now be to get the patient off the benzo and put on a mix of other medications to replace the benzos. It's not uncommon for someone to start with 1 or 2 medications (SSRI, SSRI + benzo, benzo) and end up on the following: additional SSRI, beta blocker, off label AP for sleep, anti-epileptic med #1, anti-epileptic med #2, anti-psychotic for Rx drug-induced mania, anti-histamine for panic attacks, etc.

 

Not saying that it's done on purpose or with malice. Just saying that, in order to be rid of an Rx that is a schedule 4 controlled substance (benzodizepine tranquilizer), a patient might find himself on a multitude of other Rx's, and if the patient ends up impoverished due to being unable to work in this weakened pharmacologically-induced state, he may end up going to a community clinic that refuses to Rx benzodiazepines, which either results in being put on even more Rx's to get rid of the benzo.

 

So someone who starts up on Zoloft and later Klonopin can end up on Tegretol, Trileptal, Seroquel, Depakote, Wellbutrin, Abilify, Trintellix, vistaril, propanolol, Remeron, etc. etc. All at the same time. 

 

All of a sudden healthcare industry is making a ton more money off of this patient, and if the patient is unable to pay, the government insurance plans will cover the cost.

 

Again not criticizing. Just saying how so much money is lost, because not only had the former employee lost his income and has to live off of saving/retirements/help of family/friends/disability, but the drug companies are now being reimbursed by the government insurance.

 

In the end, the local economy loses. The employee loses. His/Her family loses, his work suffers. Yet, the pharmaceutical companies make more money off of him/her. The local clinic makes money off of him/her. The long chain of doctors, hospitals, labs, etc all make money off of him/her.

 

So, yes. A lot of money can be made off of protracted benzo symptoms misdiagnosed as the return of the original condition(s).

 

Also. A treating psychiatrist may consider this patient as a success story in discontinuing a benzodiazepine. People get off of benzodiazepines all the time. We just don't know what other Rx liabilities they incure while getting off benzos or when off of them.

 

I think there's a financial incentive for prescribing cocktails of medications to stop a benzo, probably even more than a financial incentive for detox centers.

 

 

[[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.

 

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.

 

Examples of who could profit from one continuing to take benzodiazepines include, but are not limited to drug companies, medical professionals, clinics and hospitals and other health care facilities, pharmacies, and various employees of all aforementioned.  One could include those who manufacture the containers they come in and the labels printed on the medicine containers.  The list can really go on and on.  A pharmacy can make additional profit from those who shop around their pharmacy stores waiting for their Rx to be filled.  One can also think of those who indirectly profit who may provide support and services to those who directly profit and/or those financially dependent upon those who directly profit.  The big picture is quite big.  Hush incentives in re to research findings, etc. are possibilities as well.  Note I use the word "possibilities" as I'm not accusing. 

 

Re the argument benzodiazepines create only a small profit margin for a pharmaceutical company does not deter from the fact a pharmaceutical company may profit as well from add on drugs Rxd due to side effects from benzodiazepines and other drugs prescribed with benzos (in other words, a benzo considered as a necessary drug in a drug cocktail prescribed).  Not to mention, such said small profits per pill bottle can add up with great demand.

 

Re your edit, even if rare, I'm happy to be and remain a long term cessation former patient of self-initiated quick detox following an uninformed cold turkey.  However, I'm not volunteering to toot any happy PR horns for the detox (mis)treatments I received and I suffered months after quick detox.  I also suffered the entire time I took benzodiazepines with tolerance withdrawals only worsening things.  I suffer no benzo related/withdrawal symptoms anymore aside from tinnitus and a slight hearing issue which started very shortly after being prescribed benzodiazepines long before tolerance withdrawals, cold turkey, detox, and further withdrawal. 

[[Lo...]]

Who may make money off of bzd-injured patients and bzd-related issues:

 

- Emergency Rooms

- Urgent Care Clinics

- Psychiatric Hospitals

- Health Clinics

- Psychiatrists

- Psychiatric groups (prescribing medication mixes due to bzd liability)

- Pharmacies

- Labs

- Specialists (making sure that something else isn't wrong. Treating other illnesses that arise)

- Cab companies/medical transport companies

- Insurance companies (by raising premiums on everyone to cover losses)

- Primary Care physicians (visits to correct worsening health due to bzd-related issues)

- Phamaceutical companies (other Rx's prescribed to counter bzd withdrawal)

- Local/online stores that sell supplements and OTC products people buy to aid bzd wd

- Liquor stores/alcoholic beverage sales

- Cannabis dispensaries.

- Psychologists (if you haven't had post-traumatic stress before benzo wd, you certainly have it now)

- Physical Therapists/Massage Therapists

- Detox/Rehab centers

- NAMI (National Organization for Mental Illness in America). By sending people into treatment

- SAMSHA (by calling everything substance abuse and providing referrals to treatment)

- Local Governments (citations, fines, etc. etc.)

- Mortgage Companies (by foreclosing on homes with equity where the owner lost everything)

- Auto Dealers (Reposessions)

- Utility companies and others (charging late fees, etc)

- Funeral Homes

- Hospice Care Facilities

- Health Coaches

- Alternartive Therapy Providers (medical devices, unorthodox therapies, etc.)

[[Rx...]]

I just noticed your posts, LF.  I think two heads are better than one in communicating some things. 

[[li...]]

LPF, 'but Rx's can definitely open the door to psychiatry and more psychiatric drugs via benzos alone or SSRI's and benzos.'

 

But those drugs won't help, will they ? Aside from some minor adjunct drugs for sleep etc. What I get is that the real problem cases won't tolerate hardcore psychiatric drugs.

[[Lo...]]

LPF, 'but Rx's can definitely open the door to psychiatry and more psychiatric drugs via benzos alone or SSRI's and benzos.'

 

But those drugs won't help, will they ? Aside from some minor adjunct drugs for sleep etc. What I get is athat the real problem cases won't tolerate hardcore psychiatric drugs.

 

No, those drugs won't help. Thanks for pointing that out. What I failed to mentioned is that the prescribers I had seen and the one that I do see now seem to desperately want to hold on to the idea that those drugs will help. Any protest on my end results in a very strong pushback and closing of the subject. I think I have definitely experienced the so-called retraumatization in this way.

[[ci...]]

"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.

 

Where do you get “...may increase the damage”?

[[Fi...]]

Where do you get “...may increase the damage”? a simple but complete example of that would be the finalization of a withdrawal symptom called suicide ideation. There are others but that should be sufficient.

[[La...]]

As far as I know, we have few, if any, studies that follow people in the long term, so there's no way to make a statement like that. Also, there's no before and after testing, so we can't say for sure whether the person already had issues before taking the medication. It would be unethical to round up a bunch of people, test their brains, then put them on benzos for years, then tell them to get off so that their brains can be studied again. That's not going to happen.

 

Unless a slew of people agree to be studied in the very long term, we may never have the kinds of information everyone would like to have. For now, we can use the info that's available to us, and each person can judge for him- or herself which course is best. There's no crystal ball right now. Genetics play a huge role too, so that means each person is different. What works for one won't work necessarily for another.

 

 

[[ma...]]

Where do you get “...may increase the damage”? a simple but complete example of that would be the finalization of a withdrawal symptom called suicide ideation. There are others but that should be sufficient.

 

Long term use of benzos and other psychiatric drugs will very likely result in premature death. One of my mother's friends died like that, from everything and nothing at the same time, and it was not nice I can tell you. And long before that your brain will be ****** up. So, unless you started already on an old age, you'd better taper it off and try to heal as much as you can.

[[Fi...]]

"As far as I know, we have few, if any, studies that follow people in the long term, so there's no way to make a statement like that."

 

Reference to a meta analysis of such studies has already been referenced in this thread:

 

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

 

"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."

[[La...]]

But they didn't keep studying people up to four years or five years, which may be what it would take for some people to get better.

 

And they didn't study other aspects of benzodiazepine effects, including dizziness. So, for someone like me, where staying on a benzo was NOT an option, then that study is irrelevant. I don't have major cognitive issues. I have balance issues. I'd like to see a study on that, but I understand that it can't happen because vestibular testing isn't able to reflect certain types of dizziness. There are a bunch of people who are dizzy as a result of taking benzos and/or ADs, and their symptoms do NOT show up on CAT scans, MRIs, vestibular testing, etc. So, a study is impossible at present for people like us.

 

For those who continue to take benzos, vestibular issues will always be a risk. And that may lead to other things, like falls and fractures. I can speak from experience on that.

[[ma...]]

"As far as I know, we have few, if any, studies that follow people in the long term, so there's no way to make a statement like that."

 

Reference to a meta analysis of such studies has already been referenced in this thread:

 

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

 

"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."

 

"Corroborate" and "likely" are weak terms used when results are not strong enough to reach proper conclusions. Indeed, these are highly speculative conclusions, which is OK for research purposes where progress is incremental and often nonlinear, but that cannot guide practice.

 

[[se...]]

"As far as I know, we have few, if any, studies that follow people in the long term, so there's no way to make a statement like that."

 

Reference to a meta analysis of such studies has already been referenced in this thread:

 

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

 

"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."

 

It would be inappropriate to interpret this as proof since it's only one study.  Additionally, the comparisons are with healthy controls.  They don't include another comparison group that has continued long-term use which may address the question of whether or not cognitive impairment would have gotten worse if they stayed on.  The only clinical language used is the following statement: "More specifically, it is clear that the residual neuropsychological sequelae must be considered when making treatment decisions for these patients."  It's not an implication it's better to stay on.

[[Ma...]]

"As far as I know, we have few, if any, studies that follow people in the long term, so there's no way to make a statement like that."

 

There are studies that showed an increased rate of Alzheimer's and dementia for benzo users. Increase rates of said diseases equal deceased life span

 

 

"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."

 

So many problems with this First one report refers only to 6 months after cessation with one case at 3.5 years No mean average for the duration of cessation is given Nor is their any reference whether the subjects CT'd, rapid tapered, etc

 

[[Fi...]]

"As far as I know, we have few, if any, studies that follow people in the long term, so there's no way to make a statement like that."

 

Reference to a meta analysis of such studies has already been referenced in this thread:

 

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

 

"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."

 

It would be inappropriate to interpret this as proof since it's only one study.  Additionally, the comparisons are with healthy controls.  They don't include another comparison group that has continued long-term use which may address the question of whether or not cognitive impairment would have gotten worse if they stayed on.  The only clinical language used is the following statement: "More specifically, it is clear that the residual neuropsychological sequelae must be considered when making treatment decisions for these patients."  It's not an implication it's better to stay on.

 

It is not proof, it is evidence that led to the conclusion. We discussed this meta analysis at length, it is a follow up of a previous meta analysis which included many studies.

 

"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."

[[Fi...]]

"The only clinical language used..." Read the study. If you don't believe the authors' clinical expertise, take it up with them.

 

I've shared scientific published evidence, how people choose to use it is up to them.

[[Ma...]]

those who have recently withdrawn and on those who have successfully abstained following withdrawal.

 

 

These are one and the same as far as I can tell

 

From Crowe and Stramks

 

The findings indicated that long-term benzodiazepine users significantly improved in many cognitive areas when they discontinued (i.e., visuospatial, attention/concentration, general intelligence, psychomotor speed, andnon-verbal memory

 

 

 

So there it is, scientific evidence of improvement upon cessation

[[se...]]

The article discussed here does not provide proof or evidence that any long-term user should continue their use of a benzo.  Overwhelming evidence shows that benzos are harmful when taken long term.

[[Ma...]]

"The only clinical language used..." Read the study. If you don't believe the authors' clinical expertise, take it up with them.

 

I've shared scientific published evidence, how people choose to use it is up to them.

 

What is this in regard to if I may Sounds like a good way to avoid the shortcomings of specifics

[[Fi...]]

those who have recently withdrawn and on those who have successfully abstained following withdrawal.

 

 

These are one and the same as far as I can tell

 

From Crowe and Stramks

 

The findings indicated that long-term benzodiazepine users significantly improved in many cognitive areas when they discontinued (i.e., visuospatial, attention/concentration, general intelligence, psychomotor speed, andnon-verbal memory

 

 

 

So there it is medical evidence of improvement upon cessation

 

Read the entire study. A person may need to carefully read & analyze it in its entirety (including the tables) to understand it.

[[Ma...]]

I have read it A good way to deflect questions you don't like

[[Fi...]]

I have read it A good way to deflect questions you don't like

 

I'm not deflecting questions, I'm directing readers' attention to a scientific published source document because the quote you provided was taken out of context and is misleading.

[[Lo...]]

I just noticed your posts, LF.  I think two heads are better than one in communicating some things. 

 

I do agree, Rx