akaky - Benzodiazepines like Klonopin™ (Rivotril™ - clonazepam) were unfairly given a very bad rap by the media in the 1970s and 1980s; its addictive properties were vastly overstated. A similar situation exists at this moment with SSRIs and suicide; not to mention SSRIs and children. I am not going to get into this second media "fallacy" at the moment,
although it is interesting to note that the backlash against these two classes of medication arise, at least in part, from an effect common to both classes of drugs.

Both benzodiazepines and SSRIs can cause withdrawl syndromes upon discontinuing the drugs after taking them for a relatively longer periods of time (ie. longer than a month in most instances, but this is not a hard and fast rule). The discontiuation (withdrawl) syndrome seen with the benzos can cause more serious health consequences than is seen with the SSRIs, but when managed correctly one can be weaned from even high-dose, long-term benzodiazepine therapy with little discomfort. When I say high dose I am referring to, for example, people who are taking daily doses of more than 4mg to 6mg of Rivotril ..... er, Klonopin (damn U.S. drug names).

Okay, now my "benzo mantra"!. When used properly (ie. as prescribed), especially in low doses, are extremely safe and effective. It has been my clinical experience, and that of most of the psychiatrists that I know who specialize in treating anxiety disorders, that people who use benzodiazepines as maintenance medication to treat excessive chronic anxiety will not, in a vast majority of cases, become addicted to these medications. A caveat to this is that when one begins to use the benzodiazepine more often and/or at ever increasing doses against doctors orders, problems will arise.

When the benzo becomes a crutch, a way to escape problems, or as a recreational binge drug, then yes, a psychological addiction to the drug becomes a definite reality. Daily dosages begin to escalate and drug-seeking behavior, with it's lying and deception starts occupying most of one's time. As a community pharmacist for over 20 years, I have heard every excuse imaginable (and some that are unimaginable) by the poor soul who has needs there benzo refill significantly early.

Now, I am not talking about having to take an extra Klonopin every now and then when a stressful situation arises or the anxiety breaks through for no apparent reason. I will always fill a prescription up to a week early on a monthly fill, as long as someone is honest to me about having to take the occasional extra tablet. No reasonable psychiatrist would see a problem with this. If a person is consistently a week early in asking for a refill every month, then the alarm bells go off in my head ('cause then I can't hear the voices very well .... sorry, bad joke ).

Another theory of mine (for which I have no scientific proof) regarding why people may increase their benzo dose is that as the body adjusts to the drug and, while the actual anxiolytic (ie. anti-anxiety) effects are maintained, the psychomotor effects do fade. The psychomotor effects include incoordination (eg. stumbling) and that feeling of excessive muscular relaxation, where the body feels like a bag of Jello™. Many people think that these feelings are part of the benzos anxiolytic activity, so when the psychomotor side effects disappear some people increase the dose to get the effect back, not realizing that the drug is still controlling the anxiety.

As for Buspar™ (buspirone), I have found that it does seem to either work or not. For me, there doesn't seem to be any middle ground with this drug. I have several theories of why this may be, but I won't go into them here. I will just say that it can take up to 2 months to get a decent anxiolytic effect from the Buspar, and a lot of people give up on it long before then. Also, Buspar does not have the psychomotor effects that the benzos do, so people who equate theses effects with anxiolytic activity and have taken benzos for anxiety in the past may feel that the Buspar doesn't work when it actually is.

My very good buddy, bptoo, is a classic example of someone who has taken benzodiazepines for years for the anxiety of bipolar disorder and, like me, has an addictive personality (hope I'm not giving away any secrets, beep) has not become addicted to Klonopin, nor has the drug any appeal as a recreational diversion. To tell you the truth, I was worried when bptoo started Klonopin, as I thought that I'd have to do an "intervention". Quite frankly bptoo helped me understand the activity of benzodiazepines and convinced me that the media's coverage of the drug's effects is on par with that of "Reefer Madness".

I hope that this long rambling rant is of some help to you. - Cam