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2010-05-06T18:34:00.000-04:00

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HAVE WE OUTGROWN GOD?

2009-12-10T19:07:00.000-05:00

BE FOREWARNED..This is going to be a Sermon-type blog entry. It is sure to cause some controversy because it involves speculation in conjunction with Biblical reference.

Have we outgrown God? This is the question that has been on my mind lately.

There are four main CONCEPTS that leads me to believe that we are on the road taking us directly away from God and into the Last Days.

UNIVERSAL ACCEPTANCE
SECULAR MORALITY
SPIRITUALITY
UNIFICATION

At first glance these concepts seem to align perfectly with the Bible, yet upon closer observation, I believe that these are the basic foundation blocks to the rise of the False Church (the Great Whore of Babylon) mentioned in Revelations. I believe by looking at each one in minute detail and analyzing the eventual outcome from a Biblical perspective we will come to see that taking the current path, we, as humans, are headed for a fall.

UNIVERSAL ACCEPTANCE
We are confronted daily with select scriptures:
"Love your neighbor, as yourself" Lev. 19:18 and "Judge not, lest ye be judged" Matt. 7:1 as well as a myriad of others.

The subject of judging others is one that bothers and confuses many people. We are sure it is wrong to judge. It is important to understand what the Bible means when it says we are not to judge others. Are there occasions when it is necessary and right to pass judgment on another person for what he says or does? What must we understand to be biblical in this crucial area?

James 4:7-10 James gave ten sharp commands demanding change on the part of his readers. His basic command called for a humbling of themselves before God. James now forbids the judging of others because it involves usurping the authority that God has reserved for Himself. Again at issue is a selfish arrogance that sets itself above others.

James 4:11 Do not speak against (katalaleite) is the literal translation of this word. It carries the idea "to speak evil of," "to criticize," "to slander."

Paul recognized this fact and acknowledged that even his own judgment of himself did not count. Ultimate judgment rests with God. 1 Cor. 4:3-5.

There are many other passages that reiterate this theme of not judging. So since we know it is wrong to judge, does that mean we are to accept everyone?

2 Corinthians 6:14 "Be ye not unequally yoked together with unbelievers: for what fellowship hath righteousness with unrighteousness? and what communion hath light with darkness?"

2 Timothy 3:1- 5 "But know this, that in the last days grievous times shall come. For men shall be lovers of self, lovers of money, boastful, haughty, railers, disobedient to parents, unthankful, unholy, without natural affection, implacable, slanderers, without self-control, fierce, no lovers of good, traitors, headstrong, puffed up, lovers of pleasure rather than lovers of God; holding a form of godliness, but having denied the power thereof. From these also turn away."

At first glance these scriptures appear to tell the reader to "Avoid the Unbeliever", To "Shun Them" and to "Turn Away from those who Sin." But is that what it really says?

Looking at 2 Cor. 6:14 from an old farmers point of view, you cannot plow a field with a mixed team such as a horse and an ox. They each pull at a different pace and a different stride which would force the plow to twist and tilt, not allowing the proper work to be done.

For the believer to be "unequally yoked" with an unbeliever would put both at a disadvantage and eventually lead to arguments and animosity. There are certain actions and beliefs that the Bible states are wrong and inappropriate. To allow oneself to be a part of that belief system or act in such a way that is contrary to the nature of God is similar to carrying a heavy load on one side of your body and still try to walk a straight line.

Do we condemn the unbeliever? NO! By condemning we are placing judgment and that is God's job, not ours.

2 Timothy 3:1- 5 is both self explanatory and prophetic...With ONE exception. "From these also turn away." Timothy is telling us to turn away from these types of behaviors. If you would like to continue reading 2 Timothy, you will see what these types of behaviors lead to.

The most fearful part of this writing is "holding a form of godliness, but having denied the power thereof." Holding a Form of godliness (notice it isn't capitalized) Is To be "POLITICALLY CORRECT". To accept everyone.

From the Universal Declaration:

It is the safest foundation for a decent, civil society. Indeed, the fundamental duty of tolerance is woven into every form and fabric of secularism, freedom and democracy and the rule of law. We need the fundamentalism of tolerance and togetherness for the success of a decent civil society everywhere in the world. Here and now is the place and time for the talisman of tolerance to build a happier and harmonious future for humanity.

It is the "I'M OKAY, YOU'RE OKAY" mentality that leads me to the second concept.

SECULAR MORALITY
aka SECULAR HUMANIST MORALITY

Secular humanists represent a significant portion of the American public and is a growing presence throughout the world. They comprise tens of millions of people who, though nonreligious, are morally committed. The term nonreligious can be used broadly to refer to those who do not belong to or identify with a denomination or do not claim to believe in God—they may be agnostics, atheists, or skeptics. They look to modern science, literature, philosophy, ethics, and the arts for inspiration rather than the traditional religious “sacred texts.” They do not attempt to follow the dictates of the Bible, the Qur’an, or other ancient documents.

They believe in human freedom and dignity; they are interested in living a full life of creativity and happiness; and they have an altruistic concern for the good of others. They are generally tolerant of diverse lifestyles and believe in the right of privacy.

Sounds like a Great Group of People, doesn't it? The problem with this way of thinking, if you haven't already guessed, is that it allows No Room for God! This belief is the core of the Babylonian Empire. Babylonian literature was well developed in the 3rd millennium B.C. Records have been found of highly developed humanistic religion, history and science, including medicine, chemistry, alchemy, botany, zoology, math and astronomy.

Adultery is a common OT metaphor for apostate religion.... The revelator declares that Babylon has "fallen" (Rev 14:8; 18:2), has seduced "the kings of the earth" to commit fornication with her (ch 17:2), has enticed 'the inhabitants of the earth' to become 'drunk with the wine of her fornication' (chs 17:2; 19:2), and has deceived the nations with her 'sorceries' (ch 18:23).

He represents her as 'drunken with the blood of the saints, and with the blood of the martyrs of Jesus' (chs 17:5, 6; 18:24; 19:2). He sees her 'sins' as consisting of pride and arrogance (chs 17:4; 18:7, 16), defiance of God, and the persecution of His people on earth (cf. chs 16:19; 17:6; 18:24), and an illicit alliance with the political powers of earth (chs 17:2,3; 18:9).

He notes that 'her sins' eventually reach 'unto heaven,' and the time comes for God to judge her (chs 16:19; 18:5,6; 19:2). God therefore summons His people to leave Babylon, in order to avoid complicity in her 'sins,' and the 'plagues' He is about to visit upon her (ch 18:4).

One other item of interest..this false belief system persuades "The kings of the Earth.." and "the inhabitants of the earth" It doesn't say "God's People" or "Christians" or "Jews" but ALL the inhabitants of the earth !! This core belief system will effect all of humanity.
Which brings me to the third concept.

SPIRITUALITY

Secular spirituality carries connotations of an individual having a spiritual outlook which is more personalized, less structured, more open to new ideas/influences, and more pluralistic than that of the doctrinal faiths of organized religions. At one end of the spectrum, even some atheists are spiritual. While atheism tends to lean towards skepticism regarding supernatural claims and the existence of an actual "spirit", some atheists define "spiritual" as nurturing thoughts, emotions, words and actions that are in harmony with a belief that the entire universe is, in some way, connected; even if only by the mysterious flow of cause and effect at every scale.

This thought process could very easily usher in the False Prophet, declaring that Spirituality comes from within and not from God.

Colossians 2:8 "See to it that no one takes you captive by philosophy and empty deceit, according to human tradition, according to the elemental spirits of the world, and not according to Christ."

UNIFICATION

With these three concepts into play, it is easy to see how World UNIFICATION can occur. The growing demand for unity to combat disease, global warming, poverty and social injustice will force the world's religions to work together, temporarily creating a Humanistic Society.

The thought of an Anti-Christ (Beast) who is Christian, Catholic, Jew or Muslim can be done away with. He merely needs to be someone who can keep the people unified long enough to make a name for himself. Perhaps by rebuilding the temple in Jerusalem around the Dome of the Rock, thus strengthening the unification between Christian, Jews and Muslims.

It will be then that humans will feel a Utopian Society has been created and they have outgrown God.

REV 19:11-21 I saw heaven standing open and there before me was a white horse, whose rider is called Faithful and True. With justice he judges and makes war. His eyes are like blazing fire, and on his head are many crowns. He has a name written on him that no one knows but he himself.

He is dressed in a robe dipped in blood, and his name is the Word of God. The armies of heaven were following him, riding on white horses and dressed in fine linen, white and clean. Out of his mouth comes a sharp sword with which to strike down the nations. "He will rule them with an iron scepter." He treads the winepress of the fury of the wrath of God Almighty. On his robe and on his thigh he has this name written:

KING OF KINGS AND LORD OF LORDS.

And I saw an angel standing in the sun, who cried in a loud voice to all the birds flying in midair, "Come, gather together for the great supper of God, so that you may eat the flesh of kings, generals, and mighty men, of horses and their riders, and the flesh of all people, free and slave, small and great."

Then I saw the beast and the kings of the earth and their armies gathered together to make war against the rider on the horse and his army. But the beast was captured, and with him the false prophet who had performed the miraculous signs on his behalf. With these signs he had deluded those who had received the mark of the beast and worshiped his image. The two of them were thrown alive into the fiery lake of burning sulfur. The rest of them were killed with the sword that came out of the mouth of the rider on the horse, and all the birds gorged themselves on their flesh.

ONE FINAL THOUGHT

ROMANS 12:9-21 Let love be genuine. Abhor what is evil; hold fast to what is good. Love one another with brotherly affection. Outdo one another in showing honor. Do not be slothful in zeal, be fervent in spirit, serve the Lord. Rejoice in hope, be patient in tribulation, be constant in prayer. Contribute to the needs of the saints and seek to show hospitality.

Bless those who persecute you; bless and do not curse them. Rejoice with those who rejoice, weep with those who weep. Live in harmony with one another. Do not be haughty, but associate with the lowly. Never be wise in your own sight. Repay no one evil for evil, but give thought to do what is honorable in the sight of all. If possible, so far as it depends on you, live peaceably with all. Beloved, never avenge yourselves, but leave it to the wrath of God, for it is written, “Vengeance is mine, I will repay, says the Lord.” To the contrary, “if your enemy is hungry, feed him; if he is thirsty, give him something to drink; for by so doing you will heap burning coals on his head.” Do not be overcome by evil, but overcome evil with good."

OVERCOMING GUILT

2009-09-30T17:19:00.000-04:00

Have you ever done something that you felt was so awful, so hideous, that it constantly haunts you and plagues you with feelings of guilt? Whether it was something very bad or just an unkind word that you said to someone who is now past and you have no way to make amends?

We all suffer from guilt occasionally, but once in a while we do something that we really regret and have a difficult time making peace with ourselves. Especially when there is no way to correct the situation, we end up carrying that burden throughout our lives.

UNDERSTANDING GUILT

First and foremost, we need to realize that guilt is a GOOD THING! Yes, it's true. Guilt works with our spirit the same way a sprained wrist or ankle works for our bodies. It warns us not to overdo ourselves or it will bring us pain. It keeps us out of dangerous territory. Guilt is there for a purpose.

Secondly, we need to understand that EVERYONE is guilty of something. You are not alone with these feelings of pain, remorse and heartache. Be thankful that it is there, because it shows that you are concerned over anothers welfare and well being.

DEALING WITH GUILT

A healthy understanding of guilt will lead a person to correct their lifestyle, their way of thinking or the way they treat others. It will also lead that person to correct their mistakes where ever possible, and where not possible, use the guilt as a mental Stop Sign to avoid entering that territory in the future.

But for so many, an unhealthy feeling of guilt can lead to depression, anxiety, substance abuse and other behaviors that are detrimental to their own well being.

OVERCOMING GUILT
There is only one healthy way to overcome guilt.

The first step in overcoming, is to admit to yourself that your actions or words were inappropriate.
The second step is to commit yourself to change. To overcome whatever brought on the guilt.
The final step is to seek forgiveness. Sometimes forgiving oneself is the hardest part.

      But what if the person you offended refuses to talk to you? Or What if the person you offended has passed away, and you can not tell them how sorry you are? And what if you are not able to forgive yourself?

This can be answered with 2 words. "Divine Intervention."

1 John 1:9 "If we confess our sins (guilt), He is faithful and righteous to forgive us our sins and to cleanse us from all unrighteousness."
1 John 2:1 "My little children, these things write I unto you, that ye sin not. And if any man sin, we have an advocate with the Father, Jesus Christ the righteous:"

    I am not writing this blog as a sermon, or to convert "sinners". I am merely stating that for a clear conscience, sometimes takes a little faith. To have someone to turn to and accept us for who we are, and to forgive us is an Awesome thing!
    And, when you are forgiven, even when you forgive yourself, LEAVE THE GUILT THERE! Don't pick it back up and re-hash old thoughts and feelings. For in doing so, you limit your own personal growth and can never move forward.
   Leave the guilt as a marker in your life to remind you not to tred on those forbidden grounds again and to learn from past mistakes. That way you can continue to grow both emotionally and spiritually.

As always, if you ever need to talk about guilt, or anything else that is troubling you, feel free to contact me.

Your Friend;
Gary

YOU ARE NOT CRAZY ! Klonopin Withdrawal

2009-09-22T22:21:00.000-04:00

Benzodiazepines are widely prescribed for a variety of conditions, particularly anxiety and insomnia. They are relatively safe and, with overdose, rarely result in death. However, used chronically, benzodiazepines can be extremely addicting. These agents are often taken in combination with other drugs of abuse by patients with addiction disorders. In such patients, alternatives to benzodiazepines may be preferable and may include antidepressants, anticonvulsants, buspirone, antihypertensive agents and the newer neuroleptic medications. Caution must be used when prescribing benzodiazepines to patients with a current or remote history of substance abuse.

(Am Fam Physician 2000; 61:2121-8.)

Neurochemistry
Benzodiazepine receptors are ubiquitous throughout the central nervous system. Benzodiazepine receptors are linked predominantly to g amino butyric acid (GABA) receptors, which sensitize benzodiazepine receptors to the neurotransmitter GABA, the most prominent inhibitory neurotransmitter in the central nervous system.

   Benzodiazepines enhance the affinity of the recognition site for GABA by inducing conformational changes that make GABA binding more efficacious. Activation of the benzodiazepine-GABA- chloride ionophor complex is responsible for producing the therapeutic anxiolytic effects of benzodiazepines and for mediating many of the side effects and, possibly, dependence and withdrawal from these drugs.
   Similarly, other sites for drug and neurotransmitter binding are associated with the GABA receptor complex, which serves as a primary site of action of benzodiazepines, barbiturates and other sedative-hypnotics, such as alcohol. Benzodiazepines and barbiturates act at separate binding sites on the receptor to potentiate the inhibitory action of GABA. They do so by allosterically altering the receptor (changing its conformation) so that it has a greater binding affinity for GABA. Ethanol modifies the receptor by altering the membrane environment so that it has increased affinity for GABA and the other sedative-hypnotic drugs. That benzodiazepines, barbiturates and ethanol all have related actions on a common receptor type, which explains their pharmacologic synergy and cross tolerance. Thus, benzodiazepines are used during alcohol detoxification.
   With long-term high-dose use of benzodiazepines (or ethanol), there is an apparent decrease in the efficacy of GABA-A receptors, presumably a mechanism of tolerance.6,7 When high-dose benzodiazepines or ethanol are abruptly discontinued, this "down-regulated" state of inhibitory transmission is unmasked, leading to characteristic withdrawal symptoms such as anxiety, insomnia, autonomic hyperactivity and, possibly, seizures.

So, what does all this mean? Basically, Klonopin and other benzodiazepines "Short Out" different receptors in the brain by destroying the chemical that relays signals to other parts of the body and replaces that chemical with it's own. This is called Psychomotor Retardation.

Psychomotor slowing may be especially profound following initial administration of a benzodiazepine or with a sudden dosage increase. It also may be noted in patients, such as the elderly, who have decreased rates of metabolism or greater susceptibility to central nervous system depression. Psychomotor symptoms include drowsiness, poor concentration, ataxia, dysarthria, motor incoordination, diplopia, muscle weakness, vertigo and mental confusion.Studies of the psychomotor effects suggest that benzodiazepines slow reaction time and impair driving skills, increasing the risk of motor vehicle crashes in patients who are taking these agents.

In addition, the following side effects are also evident in nearly 100% of the patients being treated using benzodiazepines.

Memory Impairment

Benzodiazepines induce anterograde amnesia, which accounts for the beneficial effects of benzodiazepines such as midazolam for presurgical medication. These specific amnestic effects appear to be separate from sedation. Episodic memory (the remembering of recent events and the circumstances in which they occurred and their time sequences) is particularly impaired and more markedly so in heavy alcohol drinkers who also use benzodiazepines. Specific deficits in visuospatial ability and sustained attention have also been described in patients who have taken therapeutic doses of benzodiazepines regularly for longer than one year.

Paradoxical Disinhibition

Increased excitement, irritability, aggression, hostility and impulsivity may occur in some patients who take benzodiazepines. This paradoxical disinhibition may, in rare cases, result in attacks of rage or violence, or other indiscretionary or antisocial behaviors. Such reactions may be due to disinhibition of behavioral tendencies normally suppressed by social restraints (as can also be the case with alcohol). These reactions occur most commonly in children, in the elderly and in persons with developmental disabilities.

Depression and Emotional Blunting

An association has been noted between benzodiazepine use and depressive symptoms and, in some cases, the emergence of suicidal ideation. Some evidence indicates that higher benzodiazepine dosages are associated with an increased risk of depression and that reducing the dosage or discontinuing therapy may resolve the depressive symptoms. Although the mechanism of this action is unclear, benzodiazepine-related depression might occur as a physiologic result of a reduction in central monoamine activity.
"Emotional anesthesia" may also be seen in clinical practice. This effect may be sought by drug addicts who become progressively more incapable of tolerating their emotions and life stressors.

Adverse Effects in Pregnancy

Benzodiazepines cross the placenta and are classified as class D teratogens. They may lead to the development of dependence and consequent withdrawal symptoms in the fetus. Benzodiazepines are excreted in breast milk and thus are usually contraindicated in breast-feeding mothers.

Tolerance

Tolerance to all of the actions of benzodiazepines can develop, although at variable rates and to different degrees. Tolerance to the hypnotic effects tends to develop rapidly, which may be beneficial in daytime anxiolysis but makes long-term management of insomnia difficult. Patients typically notice relief of insomnia initially, followed by a gradual loss of efficacy. Tolerance to the anxiolytic effect seems to develop more slowly than does tolerance to the hypnotic effects, but there is little evidence to indicate that benzodiazepines retain their efficacy after four to six months of regular use. Benzodiazepine therapy is often continued to suppress withdrawal states, which usually mimic symptoms of anxiety. Dosage escalation often maintains the cycle of tolerance and dependence, and patients may have difficulty discontinuing drug therapy.

Dependence

Benzodiazepine therapy can give rise to physiologic and psychologic dependence based on the drug's dosage, duration of therapy and potency. Thus, dependence will develop sooner (such as in one to two months) in a patient who is taking a high dosage of a high-potency agent such as alprazolam than in a patient who is receiving a relatively low dosage of a long-acting, low-potency agent such as chlordiazepoxide. As a result of physiologic dependence, withdrawal symptoms emerge with rapid dose reduction or abrupt discontinuation of the drug.

Psychologically, long-term use of benzodiazepines may lead to over-reliance on the need for the agent, loss of self-confidence and varying degrees of drug-seeking behavior. Patients may be reluctant to discontinue the drug because of misplaced fears or anticipatory anxiety. Some patients combine alcohol with benzodiazepines when they are not able to acquire the desired or "needed" effects.

Short-Term Withdrawal Symptoms

Withdrawal effects from therapeutic dosages of benzodiazepines are mainly anxiety symptoms. In addition, autonomic instability (i.e., increased heart rate and blood pressure level, tremulousness, diaphoresis), insomnia and sensory hypersensitivity are common. The most serious acute withdrawal symptoms are seizures and delirium tremens, which most commonly occur with abrupt discontinuation. The time frame for the emergence of acute withdrawal symptoms corresponds to the half-life of the particular agent being used.
Some elements of withdrawal are believed to occur in a majority of patients who have taken therapeutic dosages of benzodiazepines for more than a few months, although the severity of withdrawal symptoms generally depends on the amount of the original dosage, the rate at which the dosage is tapered, the selection of patients and the definition of withdrawal symptoms.

Protracted Withdrawal

A protracted abstinence syndrome has been observed by addictionologists who are familiar with benzodiazepine addiction. Symptoms include prolonged (for several months) anxiety, depression and insomnia. In addition, physical symptoms related to gastrointestinal, neurologic and musculoskeletal effects may occur. This abstinence phenomenon may develop despite long, slow, judicious tapering of the dosage and is hypothesized to result from chronic neuroadaptation.

This shows that the beneficial effects diminish over time,
while the addictions continue to build in a persons system!

Here is an actual letter of a klonopin patient in it's original form:

HI I WAS ON KLONOPIN FOR ABOUT 15 YEARS NOW AND I AM TRYIGN TO WEAN MYSELF OFF. I AM NOTICING I HAVE THE SHAKES, I CANNOT THINK STRAIGHT AT ALL, I CANNOT RETAIN MUCH OF ANYTHING, MY FACE GETS ALL TINGLY AND IT GOES NUMB.ALSO, MY MIND SEEMS OT FOCUS MUCH MORE ON OBSESSIVE THOUGHTS. SOMETIMES I EVEN FEEL LIEK IM GONNA LOSE MY MIND.I DONT FEEL LIKE MYSELF AT ALL

I am writing this blog for one reason and one reason only! And that is to help others who are suffering from this entrapment! I know how you are feeling, I really do, for you see, I too am weaning myself from kolonopin addiction.

Several years ago, my heart went into A-Fib (it has done it 3 more times since). But after the episode, I began experiencing Panic Attacks. My doctor, in his infinite wisdom, prescribed klonopin to alleviate the symptoms of the attacks. Like me, I suppose he was unaware that the panic attacks I was experiencing was normal as my body recovered from the A-Fib. But anyway, I am on those pills.

So, I know how terrifying it seems when you feel the panic or the fear. I understand the heart palpitations, the numbness or buzzing in your face, arms and legs. And I have also experienced the "Living in a Dream" state where everything seems unreal. Where you feel threatened and alone in a group of people, and sitting alone feels safer than going to work or to any public place. And other times when you are afraid to be alone. When your only alternative is to take another pill and lie down until it goes away!

By reading my previous post, you know that benzodiazepines are prescribed for different reasons.

So First and Foremost:
Consult Your Doctor before trying to wean yourself from any benzodiazepine!

There are alternative medicines on the market, ask you doctor if any are available for your condition.

DO NOT UNDER ANY CIRCUMSTANCES

Stop taking benzodiazepine Abruptly!

Over-rapid withdrawal and lack of explanation and failure to reassure individuals that what they are experiencing is withdrawal symptoms and is temporary have led some people to experience increased panic and fears that they are going mad, with some people developing a condition similar to Post Traumatic Stress Disorder as a result. A slow withdrawal regime coupled with reassurance seems to improve the outcome for individuals undergoing benzodiazepine withdrawal.

Detoxification of a benzodiazepine dependent individual is often carried out using an equivalent dose of either diazepam or chlordiazepoxide to the benzodiazepine the individual is dependent on and by reducing in steps of 10% every 24 weeks depending on the severity of the dependency and the patient's response to reductions. Those who have withdrawn slow enough but still experience withdrawal effects typically find that their withdrawal symptoms have largely disappeared after a few months.

Usually, for most people, once off the drug, a sense of relief and well-being can be felt after 23 months of total abstinence.

You see, it is not a short, quick solution. It will be a long journey so when you do begin a tapering off be sure you follow this advice!

And from time to time, you will NEED SOMEONE to talk to. I will be here and I am creating a forum for you and others to share your feelings, your triumphs and your setbacks. We can all learn from and support each other!

In the meantime,

You can contact me via e-mail at: sign_guy52@hotmail.com

Or on Twitter at: www.Twitter.com/Gary1980Arb

And remember You are Not Crazy!

Klonopin (Clonazepam) and the Adverse Effects

2009-09-22T20:56:00.001-04:00

Clonazepam (Klonopin) is in a group of drugs called benzodiazepines (ben-zoe-dye-AZE-eh-peens).

Benzodiazepines are widely prescribed, with four of them--alprazolam (Xanax), Clonazepam (Klonopin), diazepam (Valium) and lorazepam (Ativan)--listed among the top 100 most commonly prescribed medications for a variety of conditions, particularly anxiety and insomnia. They are relatively safe and, with overdose, rarely result in death. However, used chronically, benzodiazepines can be extremely addicting.

Benzodiazepines generally produce almost immediate effects, and thus may be prescribed for short-term, intermittent, "as-needed" use. Because many of the anxiety disorders wax and wane over time, patients with these disorders often prefer benzodiazepines because these agents can be taken intermittently, when patients feel the need to take them, and most patients can use benzodiazepines judiciously.

They are also widely prescribed for other reasons, such as muscle spasticity, convulsive disorders, presurgical sedation, involuntary movement disorders, detoxification from alcohol and other substances, and anxiety associated with cardiovascular or gastrointestinal conditions.

___________________________________________________________

TABLE 1

Clinical Uses of Benzodiazepines

Anxiety disorders
    Acute anxiety
    Generalized anxiety disorder
    Panic disorder
    Phobias (social, simple)
    Post-traumatic stress disorder
    Obsessive-compulsive disorder
Insomnia
Anxiety associated with medical illness
   Cardiovascular
    Gastrointestinal
    Somatoform disorder
Convulsive disorders
Acute status epilepticus
    Neonatal seizures or febrile convulsions Preeclampsia Tetanus
Adjunct to other anticonvulsants
Amnestic (before surgery or procedure)
Spastic disorders and other types of acute muscle spasm
    Cerebral palsy
    Multiple sclerosis
    Paraplegia secondary to spinal trauma
Involuntary movement disorders
    Restless leg syndrome
    Akathisia associated with neuroleptic use
    Choreiform disorders
    Myoclonus
Detoxification from alcohol and other substances
Agitation or anxiety associated with other psychiatric conditions
    Acute mania
    Psychotic illness
    Anxiety associated with depression
    Impulse control disorders
    Catatonia or mutism
Other adjunctive uses

____________________________________________________________________

Surgery Dentistry Diagnostic studies, such as computed tomography, magnetic resonance imaging and endoscopy Cardioversion Chemotherapy Information from Hollister L, Muller-Oerlinghausen B, Rickels K, Shader R. Clinical uses of benzodiazepines. J Clin Psychopharmacol 1993;13

____________________________________________________________________

Clonazepam is a high-potency benzodiazepine with a long half-life. Although clonazepam is perceived as "safe," addiction medicine specialists have found that it is also frequently abused as a street drug. On the other hand, oxazepam (Serax), clorazepate (Tranxene) and chlordiazepoxide appear to have lower reinforcing effects than other benzodiazepines.

Benzodiazepine Alternatives

The problems with benzodiazepine dependence, tolerance, withdrawal, rebound and abuse limit their use for long-term treatment of anxiety disorders in patients with alcohol or drug addiction. A growing body of literature now supports the anxiolytic efficacy of numerous other agents. Antidepressants, anticonvulsants, buspirone (Buspar), certain antihypertensive agents and newer neuroleptics all have been shown to be effective in subsets of patients with anxiety.

Although benzodiazepines are effective in a wide range of medical and psychiatric conditions, caution must be exercised with their use, particularly when these agents are prescribed to patients with an active or remote history of substance abuse or addiction. Their greatest asset is also their greatest liability: drugs that work immediately tend to be addictive. Compared with benzodiazepines, antidepressants have a longer onset of action but are the best agents for long-term treatment of anxiety disorders. Anticonvulsants, antipsychotics, antihypertensives and buspirone also are effective but have an intermediate onset of action.

DRUG ABUSE AND DEPENDENCE: Withdrawal symptoms, similar in character to those noted with barbiturates and alcohol (e.g., convulsions, psychosis,, hallucinations, behavioral disorder, tremor, abdominal and muscle cramps) have occurred following abrupt discontinuance of clonazepam. The more severe withdrawal symptoms have usually been limited to those patients who received excessive doses over an extended period of time. Generally milder withdrawal symptoms (e.g., dysphoria and insomnia) have been reported following abrupt discontinuance of benzodiazepines taken continuously at therapeutic levels for several months. Consequently, after extended therapy, abrupt discontinuation should be avoided and a gradual dosage tapering schedule followed. Addiction-prone individuals (such as drug addicts or alcoholics) should be under careful surveillance when receiving clonazepam or other psychotropic agents because of the predisposition of such patients to habituation and dependence.

DRUG INTERACTIONS: The CNS-depressant action of the benzodiazepine class of drugs may be potentiated by alcohol, narcotics, barbiturates, nonbarbiturate hypnotics, antianxiety agents, the phenothiazines, thioxanthene and butyrophenone classes of antipsychotic agents, monoamine oxidase inhibitors and the tricyclic antidepressants, and by other anticonvulsant drugs.

Benzodiazepine withdrawal syndrome often abbreviated to benzo withdrawal is the cluster of symptoms which appear when a person who has taken benzodiazepines long term and has developed benzodiazepine dependence stops taking benzodiazepine drug(s) or reduces the dosage too rapidly. Benzodiazepine withdrawal is similar to the alcohol withdrawal syndrome and barbiturate withdrawal syndrome and can in severe cases provoke life threatening withdrawal symptoms such as seizures.

Chronic exposure to benzodiazepines causes physical adaptations in the brain to counteract the drug's effects. This is known as a tolerance and physical dependence. When the drug is removed or dosage reduced in an individual physically dependent on benzodiazepines, numerous withdrawal symptoms both physical and psychological may appear and will remain present until the body reverses the physical dependence by making adaptions to the drug-free environment and thus returning the brain to normal function Generally the higher the dose and the longer a benzodiazepine is used and the more rapidly a benzodiazepine is discontinued then the more likely severe withdrawal symptoms will occur. However, severe withdrawal symptoms can still occur during gradual dose reduction or from relatively low doses. In certain selected patient groups the occurrence of withdrawal symptoms is as high as 100% !!!

Protracted withdrawal

Benzodiazepine dependence is a potentially clinically serious condition and its withdrawal syndrome is complex and often protracted in time course. Patients often have persisting withdrawal symptoms for 6 months to year or more.

Protracted withdrawal symptoms refers to symptoms persisting for a protracted time, perhaps a year or more. Patients who experience protracted withdrawal from benzodiazepines, which more commonly occurs from over-rapid withdrawal, can be reassured that the evidence shows that symptoms do continue to fade and return to normal over a period of many months or several years. A figure of 10-15% of patients withdrawing from benzodiazepines may experience a protracted withdrawal syndrome. There is strong anecdotal evidence that a slow-withdrawal rate significantly reduces the risk of a protracted and/or severe withdrawal state.

About 10 to 15% of people who discontinue benzodiazepines develop protracted withdrawal syndrome. There is no known cure for protracted benzodiazepine withdrawal syndrome except time. The post withdrawal syndrome may linger for many months in 10-15% of people and for a smaller number of unfortunate patients for several years. Studies following people up beyond the initial acute withdrawal stage have shown that for many patients symptoms continue to improve the longer they stay off the drug, often to the point where they can eventually resume their normal lives even after years of incapacity imposed by chronic benzodiazepines. The causes of persisting benzodiazepine withdrawal symptoms are a combination of pharmacological factors such as persisting drug induced receptor changes, psychological factors both caused by the drug and separate from the drug and possibly in some cases, particularly high dose users structural brain damage or structural neuronal damage.

Disturbances in mental function can persist for several months or sometimes longer. Psychotic depression persisting for more than a year following benzodiazepine withdrawal has been documented in the medical literature. The patient had no prior psychiatric history. The symptoms reported in the patient included, major depressive disorder with psychotic features, including persistent depressed mood, poor concentration, decreased appetite, insomnia, anhedonia, anergia and psychomotor retardation. The patient also had paranoid ideation believing she was being poisoned and persecuted by co-employees, and sensorary hallucinations. Symptoms developed after abrupt withdrawal of chlordiazepoxide and persisted for 14 months. Various psychiatric medications were trialed which were unsuccessful in alleviating the symptomatology. Symptoms were completely relieved by recommencing chlordiazepoxide for irritable bowel syndrome 14 months later. Another case report, reported similar phenomenomin a female patient who abruptly reduced her diazepam dosage from 30 mg to 5 mg per day. She developed electric shock sensations, depersonalisation, anxiety, dizziness, left temporal lobe EEG spiking activity, hallucinations, visual perceptual and sensorary distortions which persisted for one year.

Sensorary withdrawal related disturbances which can be acute or protracted in duration and are among the clinical features of the benzodiazepine withdrawal syndrome. Protracted tinnitus has been found to be a complication of discontinuation of benzodiazepines with tinnitus persisting for many months or up to a year or more after discontinuation of therapeutic doses of benzodiazepines. Appearance of the tinnitus occurs during dose reduction or discontinuation of benzodiazepines and is alleviated by recommencement of benzodiazepines. A clinical trial of patients taking the benzodiazepine alprazolam (Xanax) for as little as 8 weeks triggered protracted symptoms of memory deficits which were still present after up to 8 weeks post cessation of alprazolam.

ADVERSE REACTIONS: The most frequently occurring side effects of Klonopin are referable to CNS depression. Experience to date has shown that drowsiness has occurred in approximately 50% of patients and ataxia in approximately 30%. In some cases, these may diminish with time; behavior problems have been noted in approximately 25% of patients. Others, listed by system, are:

Neurologic: Abnormal eye movements, aphonia, choreiform movements, coma, diplopia, dysarthria, dysdiadochokinesis, "glassy-eyed" appearance, headache, hemiparesis, hypotonia, nystagmus, respiratory depression, slurred speech, tremor, vertigo.
Psychiatric: Confusion, depression, amnesia, hallucinations, hysteria, increased libido, insomnia, psychosis, suicidal attempt (the behavior effects are more likely to occur in patients with a history of psychiatric disturbances).
Respiratory: Chest congestion, rhinorrhea, shortness of breath, hypersecretion in upper respiratory passages.
Cardiovascular: Palpitations.
Dermatologic: Hair loss, hirsutism, skin rash, ankle and facial edema.
Gastrointestinal: Anorexia, coated tongue, constipation, diarrhea, dry mouth, encopresis, gastritis, hepatomegaly, increased appetite, nausea, sore gums.
Genitourinary: Dysuria, enuresis, nocturia, urinary retention. Musculoskeletal: Muscle weakness, pains.
Miscellaneous: Dehydration, general deterioration, fever, lymphadenopathy, weight loss or gain.
Hematopoietic: Anemia, leukopenia, thrombocytopenia, eosinophilia.
Hepatic: Transient elevations of serum transaminases and alkaline phosphatase.

These reactions are also present in the withdrawal stages,
if not done correctly.

EXTREME CARE should be taken when coming off Klonopin. Under NO Circumstances should you ever allow your doctor to make you stop "Cold Turkey"! In my next blog, I will explain the hows, whens and whys and I will introduce you to a concept that will aid you in your recovery.
Be Assured that you are not going crazy and you are on the road to a freedom that has long been denied to you.