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PostPosted: Mon Feb 20, 2012 8:05 pm 
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Diary of a Quitter wrote:
Isn't Seroquel an antipsychotic? With really awful side effects and a bad "disontinuation syndrome"? Didn't the FDA recently recommend AGAINST approving Seroquel for anxiety and as a stand-alone treatment for depression?

I'm suprised to hear it suggested for anxiety. I've also heard of people taking it as a sleep aid. I wouldn't touch that drug with a forty foot pole.


Agreed about the anxiety. But big disagreements with everything else.

Anti-psychotic medications have more uses than just treating psychosis. Seroquel I think actually has more sedating properties than anti-psychotic ones. I've found it to be a pretty weak anti-psychotic compared to ... Zyprexa, Risperidone. These days it's often used as a sedating agent. A small dose - 25mg, is often enough to treat sleeping issues, with no dependence and little side-effects.

Anti-psychotics, including seroquel, do NOT have discontinuation syndrome akin to SSRI & SNRI medications. In fact, Seroquel I found was incredibly easy to come off compared to anti-depressants (esp SNRI's), benzos and opioids.

There's this really whack assumption out there that anti-psychotic medications are 'hardcore' and scary, as is lithium, and anti-depressants are relatively benign. I've been on all classes, and honestly they're all equally psychtropic / mind-altering in their own way. I'd MUCH rather be put on an anti-psychotic than an SNRI medication, if anything because of the nasty discontinuation syndrome (*cough* withdrawal) from the anti-depressants.

Anti-psychs often have sedating properties, so I'm sure pharma companies would push for the anxiety indication. But anyone with anxiety who's been on anti-psychs knows that a person CAN be both sedated, and anxious.

I'd encourage anyone on anti-psychotic medication to ask their doctor what 'tardive dyskenesia' is, and whether you're at risk of getting it. Preferably get their response in writing.


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PostPosted: Sat Apr 13, 2013 2:11 am 
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First, I quoted your entire post which might not be fully applicable. Next is my backstory. I never had issues with opiates. I was occasionally prescribed them for dental issues and would take one if needed. The rest went into the cabinet and not a single thought about them. Fast forward a few years and after a high speed moto accident. Shattered femur, surgical implant. I was given an ample amount of opiates and took them as prescribed for months. Every dr appointment I was just given scripts and got them filled. I never even noticed any great feeling. They just made me comfortable moderately. Then when I decided that I didn't want to bother with them, I noticed a dependency. But don't recall any withdrawal symptoms when I stopped taking them. Fast forward another moto accident and they sent me to a pain management dr. I knew it was fishy going in but they gave me 120 lorcets, 120 somas, and 120 Xanax. Now this went on and I can't really recall a moment that something switched in my brain but my life went to pills, pills, and pills. I would have 1000s of pills in my cabinet. I'll spare the details but I'm sure you can imagine to some degree. One thing I can say, in my personal case, I never overdosed. By the grace of God. So I finally decided that I wanted my life back. I got on the suboxone program and am presently at 1mg a day.

So now on to the topic. Bupe/benzo. I was informed today by my dr that he cannot give me my suboxone with my Ativan. Which I have been on for 2 years. Starting at 8mg bupe, 6 mg lorazepam daily. Worked down to 1mg bupe, 6 mg lorazepam. So in my personal case, never have I felt that I have been in danger with the combo. But now I am trying to figure out what to do about the Ativan since I am no longer getting it. I know that I can't abruptly stop, but that is what I am facing. Due to some sort of illegality for the dr to prescribe effective immediately?? I guess that just really bothers me because the government is now apparently acting as my prescribing dr? Because, as my dr worded it, "there have been a couple of cases where people have died because of the combination. Yet many drs are currently still prescribing the 120 "trio" making money hand over fist. And here I am trying to get completely off of all medications. Although looking back, I know I could have taken a more aggressive approach to tapering off of the Ativan. But I chose to focus more on getting my suboxone dosage down. It was the smarter choice financially. Suboxone is dang pricy versus 5 bucks for a month of Ativan. And the Ativan really helps with the anxiety of coming down on my bupe dosage. And yes meetings help. Prayer and meditation help. ACCOUNTABILITY helps. But I do have to be honest with myself. When I left the dr. I had the thought of, "man, wouldn't it be much easier to just go get 120 somas and 120 Xanax just to have in case of emergency..." Isn't it scary/crazy how quickly we can try to talk ourselves into stepping onto a trap door??

So I guess this really isn't an answer to the question of bupe/ benzo question. Except that it hasn't seemed to be the least bit dangerous and caused any problems. I wake up early, am active, am loving life. And through my trials, have been given a passion to see others succeed just as I am going to succeed.

I must state that I am by no means a chemist, dr, or pharmacist. And just have my own experience to go off of. But I do wonder, if it is known how these deaths occurred. If they were injecting. Their age, their overall health, etc.

I hope this isn't too long and rambling.

suboxdoc wrote:
It makes me feel so useful when I come across a question I can answer! There are two considerations as I see it—the bupe/benzo interaction issue, and the ‘benzo/addiction’ issue. On the first issue, there is nothing special about buprenorphine that makes it lethal with benzos. You are always safer mixing a partial agonist like buprenorphine with a benzo than you are mixing a full agonist like oxycodone with a benzo. Realize, though, that Suboxone has a HUGE dose of buprenorphine in it- I encourage thinking in ‘micrograms’, as the potency is in micrograms. Buprenorphine is potent at 5-10 micrograms, and one tab of Suboxone contains 8000 micrograms! Even so, I don’t think a person could die from buprenorphine alone, even if the person has no tolerance to it at all—he/she would need to mix in another respiratory depressant to have fatal effects. If an opiate-naïve person takes 8 mg of Suboxone, he will puke all night but won’t die—unless he takes a bunch of Xanax. If that some opiate-naïve person takes 30 mg of methadone, he MIGHT die even without the Xanax, and almost certainly would WITH the Xanax. You need two things to die from buprenorphine--- first, you cannot be completely tolerant to the effects, and second, you need a second respiratory depressant. With an agonist you don’t need the second one.

A couple points related to this issue--- benzos and alcohol are interchangeable. They bind to different subunits of the same (gaba) receptor, so taking Xanax is like drinking a shot. BOTH are respiratory depressants.

The other thing is that once a patient is ‘stable’ on buprenorphine/Suboxone, and is not getting a ‘buzz’ from it, the risk from benzos essentially goes away. Once tolerant to a ceiling dose, I doubt a person could die from buprenorphine even with a second respiratory depressant—at least not any easier than from the other substance alone.

The other issue is more difficult. I do prescribe benzos for my patients on Suboxone in some cases, but it always makes me cringe a bit. The treatment of choice for all forms of anxiety is an SSRI or SNRI, not a benzo… benzos are good for the short-term, but long-term their effectiveness goes away and the person gets stuck in a cycle where there is anxiety from the ‘mini-withdrawal’ from the benzo that the patients thinks is HIS anxiety. He then needs to take another benzo for THAT anxiety—that he wouldn’t even have if he wasn’t taking anything. It isn’t the patient’s ‘fault’—it is just how addiction works. People want them SO badly sometimes that I feel bad if I don’t give in… but if I know that it would be a disservice, I can’t go along with it. My recommendation is for people with any addictions to avoid benzos if at all possible; first use an SSRI or SNRI; consider a beta blocker, consider Seroquel, consider remeron… if you DO need a benzo, try to avoid daily use (as that causes tolerance). And use it only for the worst episodes—that way it will keep working for you.


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PostPosted: Sat Apr 13, 2013 10:57 am 
If you feel like your doing well and you are considering quiting subs than you are ready buddy! So many people put their life back together and then decide they have no reason to quit taking subs. In reality you have every reason in the world to stop, you are on a dangerous drug that will take away your ability to produce testosterone this happens between 2-5 years on suboxone, I can't prove this but do some research this drug royaly fucks you up the only people who are happy on suboxone have only been on it for a few years and don't want to even think about the day this med will quit doing the job....people who have been on it longer are miserable they have destroyed their endocrine system and increased their opiat addiction big time...suboxone should only be used long enough to get well and to fix relationships, it's easy to quit taking it if you only take it short term but if you take it long term sorry but there is no way in hell your ever getting off opiats.


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Dr. Jeffrey Junig, M.D., Ph.D.

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