Talk:Benzodiazepine/Archive 1

different benzo's do not have different effects!
1. Benzodiazepines should not be distinguished as to their primary effects (e.g. "sedatives" vs. "hypnotics" vs. "anxiolytics" etc.). The only valid distinction between benzodiazepines is by elimination half-life (long, medium, and short-acting).

"Most medications used to treat anxiety also treat insomnia, often in the same dose. The myth of two separate treatments has largely been due to patterns of individual consumption and to the advertising patterns of pharmaceutical firms which want the public to think of a medication as a treatment for a specific condition and not as one of many that are broad in their effects. Thus, flurazepam (Dalmane) became a hypnotic while diazepam (Valium) became a tranquilizer, although they could easily have been reversed without sacrificing effectiveness."

2. Benzodiazepines should not be called muscle relaxants, because they have no specific effect on skeletal muscles. Their "muscle relaxant" effects are due entirely to their sedative/hypnotic action on the central nervous system - i.e. by relieving axiety and promoting sleep, they relieve stress and thereby relieve chronic muscle contraction. This should be corrected also in related articles (e.g. Librium).

Wwallacee 02:02, 4 February 2007 (UTC)


 * I beg to differ. Elimination half-life is NOT the only difference, at least not with me.  Alprazolam puts me to sleep, while clonazepam (at the same/equivalent dosage) does not.  In fact, it doesn't sedate me at all -- it just makes me feel less anxious.  That's why I take clonazepam by day, and alprazolam by night.  RobertAustin 12:52, 15 February 2007 (UTC)


 * No offence, but what absolute crap. I've had diazepam, alprazolam, oxazepam, temazepam, and nitrazepam, and i'm telling you now, they are not just different in terms of their half-life. They may all have the various effects on the body, but with one drug, one or more effect(s) will be FAR more obvious than the rest. Each of these drugs had a different effect on me, as they would for most others. Timeshift 13:04, 15 February 2007 (UTC)


 * Hi all, I'm not a doctor or have much experience using the benzodiazepines, but I believe they all have different chemical structures (different substituent groups off the three rings) that give them slightly different effects on the GABA receptor subtypes they bind to. They all depress the CNS in some way, but some may affect different areas/pathways differently. So clinically, it's like Timeshift9 above said, they may all do the same things, but each pill will vary in which of those things is more pronounced. Also, they will all lead to tolerance and dependency. —The preceding unsigned comment was added by 128.120.179.80 (talk) 11:45, 16 February 2007 (UTC).


 * Benzos all do pretty much the same thing. Alprozalem (Xanax) will have the most dramatic effect and make you relaxed and very sleepy. Lorazepam will also make you sleepy but has a longer half-life and you don't get the constipation and urinary difficulty that you would get with Xanax. Diazepam has one of the longest half-lives and works more gradually. It will give you constipation and urinary difficulty. They are all pretty much the same but work differently. However they all target the same parts of the brain. Never use these meds for any longer than a week. You could cause irrepairable damage to the brain. Jtpaladin 13:49, 13 June 2007 (UTC)


 * As a medicinal chemist with some experience in this area, I agree that currently launched benzodiazepines on the market have very similar effects but nevertheless these effects may be subtly different. A large number benzodiazepine analogs have been synthesized in the laboratory and many possess markedly different effects than the benzodiazepines that are currently prescribed.  In CNS animals models, a range of effects from the classical agonist response of currently prescribed benzodiazepines (anxiolytic/sedation) to antagonist response (no effect when administered alone but are very effective in counter acting the effect of a benzodiazepine overdose) to a partial inverse agonist response which may be useful for enhancement of memory and learning to full inverse agonist effects which produce convulsions.  In addition, there are many variants of the benzodiazepine receptor (BzR) with intriguing differences in distribution in different parts of the brain which if selectively activated by benzodiazepines may translate into striking differences in behavioral response.  Returning to currently prescribed benzodiazepines, these have similar but not identical functional and subtype selectivities and therefore have very similar, but not identical in vivo CNS effects. Cheers Boghog2 21:23, 25 June 2007 (UTC)

H E L P !
Would someone please work a bit on this article?

---mm


 * How does it look now? Comments/criticism welcome. Timeshift 09:15, 17 February 2007 (UTC)


 * It's looking very good! Could there be a section between "pharmacology" and "side effects" which gives just a bit more detail on appropriate uses?  For example, the intro mentions use during certain procedures. By implication these are procedures where the patient will be concious. So for example, in the U.S. at least some dentists offer benzodiazepines during surgical extraction of teeth. More info on their use for inducing amnesia during major surgeries would also be good. And of course the (proper) use to address anxiety could be described.... Sdsds 01:15, 18 February 2007 (UTC)

French
Why is the page in French..?

Hey there is a problem ! bezodiazepines are anxiolytics and myorelaxants as well. BTW let's avoid brand names so leave out Rohypnol.

172.209.111.18 15:06, 12 December 2006 (UTC)well.... if you are a Pharmacologist, then yes, you would leave out brand names. But the public use wikipedia too, and they might want to search for the brand name of the anxiolytic they or someone they know might use.

They are mentioned under anxiolytic. And I think Rohypnol deserves a mention, as the 'date-rape' drug.

--

Why is the image named 'bennies'? 'bennie' is a slang for Benzedrine, which is a form of amphetamine, and for any kinds of amphetamines in general. It has no connection to benzodiazepines.


 * "Bennies" is also mentioned in the main article as being slang for benzodiazepines. I can google a number of sites that back this up, but "bennies" was indeed the slang term for benzedrine and other amphetamines during the 50s and 60s. This is backed up in literature (Kerouac, Burroughs, et al), and googling. I'm not sure if benzodiazepines were also refered to as "bennies" during this same time period (as is claimed in the article), but it certainly does seem to be confusing as these drugs have opposite effects more or less.

172.209.111.18 15:06, 12 December 2006 (UTC) So? Slang has never been terribly intellectual or educated.


 * In an effort to make slang more "intellectual and educated," I hereby decree that "bennies" refers to benzedrine and its other speedy relatives, while benzodiazepines should be referred to, when using slang, as "benzos." Everyone got that?  Good.  RobertAustin 18:18, 8 April 2007 (UTC)

--

Hey. Bromazepam (Lexotan) is described (at the end of the article) as a Schedule I drug, not available on the US. This is not true, Bromazepam is Schedule IV, the same as Diazepam (Valium) or Alprazolam (Xanax).

http://www.usdoj.gov/dea/pubs/scheduling.html

-- If you have the links to back it up then by all means change it.

-Foolishben

Withdrawal of flunitrazepam from market
Flunitrazepam (rohypnol) is listed as withdrawn from the market. Here in the Netherlands however it is still available. Where is it withdrawn? In the USA? --WS 19:32, 9 July 2005 (UTC)


 * Probably US. Some Americans forget there are other English-speaking countries, or any countries for that matter :-) JFW | T@lk  22:49, 9 July 2005 (UTC)


 * Changed it into 'withdrawn in some countries' as I am not completely sure where, probably in the USA, but certainly not everywhere. --WS 12:01, 10 July 2005 (UTC)

According to the flunitrazepam page: Flunitrazepam has never been approved for medical use in the United States. So has it actually been withdrawn anywhere? --WS 14:08, 11 July 2005 (UTC)

Flunitrazepam is still available in australia, it is schedule 8 (same class as morphine) but the type that dissolved easily in drinks was withdrawn in march 2001. I have tested the new product, which is meant to make a drink taste salty, turn blue, and take longer to disolve, but all this only happened after almost 12 hours - so it could potentially be used as a date rape drug still.

Flunitrazepam is Schedule IV in the US, not Schedule I as was stated. Made edit.


 * The Flunitrazepam article says it is schedule III... which is it? --WS 10:02, 31 December 2005 (UTC)
 * I was mistaken it is a different classification. --WS 10:06, 31 December 2005 (UTC)

An American friend of mine is prescribed this drug for her narcolepsy, so the "withdrawal from the market" may not be total. She has her medication delivered by courier because it's not available in pharmacies, though. 86.140.49.134 12:28, 13 December 2006 (UTC)Trialia

Benzodiazepine fallout
I have a theory that ADHD or ADD may be caused by prenatal exposure to benzodiazipines. I've been looking for data but haven't found any. Mental health problems in children (and later as adults) could also be caused by being raised by a Benzo addict.

Despite clear stern warnings that Benzodiazipines should only be used for around 2 weeks maximum, many doctors wrote prescriptions on a permanent basis to patients. Addiction and withdrawal caused symptoms similar to the symptoms the drug is used to treat causing a viscious cycle of addiction.


 * Until you have collected a substantial amount of supporting data, the proper word is hypothesis, not "theory" Sinus 11:46, 9 October 2005 (UTC)
 * Do you have any observations to back up this hypothesis, and are you claiming that all cases of AD(H)D are caused by prenatal exposure to benzodiazepines? It's a very ...interesting... idea. I've a whole compendium of anxiety/depression/focus issues, and I've been taking a combination of 1 mg clonazepam and 18 mg methylphenidate fo just over a month now, and it's the first time in a long while I've actually felt functional. --squishycat71.202.124.98 03:25, 5 February 2007 (UTC)
 * Interesting, but wikipedia is not the place for original research. (For what it's worth, I suffer from ADD, but my mother was never addicted to anything but diet coke) Brianski 17:05, 28 March 2007 (UTC)

Hi. I currently suffer from severe GAD. I was prescribed .5mg alprazolam about two months as of this writting. I am 15 and not addicted. I take .5-1mg daily as needed. However I don't take them everyday. I sometimes go up to a week without taking any, and I'll take a break if I take them too much. It is true that benzodiazepines shouldn't be prescibed for more than two weeks. However with me I just found no other effective long term solution to manage my symptoms. I have tried many different treatments, but to no avail.


 * I also suffer from what might be considered a sublimated anxiety disorder, social anxiety, avoidance, or social phobia (I try not to discuss DSM classifications with my psychiatrist, as I feel they're a little monolithic, but technically I avoid most physical expressions of anxiety yet still feel overwhelmingly 'internally' uncomfortable in certain situations). Clonazepam .75mg (delivered as three halves of .5mg tablets) in combination with bupropion (mainly helping me hold down any urges to avoid social situations so I can smoke!) has worked well for me over the past year, generally *increasing* my motivation to work or interact by suppressing my tendency to think forward to negative outcomes.  Paradoxically, an SSRI (escitalopram) increases my sense of unsettledness at rest, making me feel like I can't sit still, though I continue on a small (5mg) dose to take the edge off any major downswings in mood -- such as being chewed out by people who might benefit from some sort of therapy to control their quickness to anger. ;)  ....  Probably a bit confessional, but I hope that gives some sense of where a benzo can fit into a treatment regime.  What I wanted to mention is that, from discussion and perusal of the literature, many doctors are concerned about the risk of *seizure* upon withdrawal rather than the (predictable) psychological rebound effects -- anxiety is one thing, but they'd rather not test your susceptibility to that withdrawal symptom while you're alone or driving.  This, I think, is a major reason for long-term prescription, since a monitored cessation is expensive and inconvenient to the patient as long as the treatment is still working, even if breaks could lessen the chance of truly severe withdrawal effects.  (Every withdrawal event exposes the prescriber to liability, so they prefer to take a single risk at the end, when a patient's more likely to consent to a brief hospital stay for monitoring.)

half lives and onset of effect
"chlordiazepoxide (Librium®) - 5-25 hours "

I'm pretty sure this is wrong, but I'm just a med student. It should have a half life of over 100 hours. I know the onset of it's effect is fast, which might be what caused the confusion.

According to page 399 of First Aid for the Wards, the half life is over 100 hours.

I'll leave editing the article to fix this problem up to a doctor or pharmacist.


 * The 5-25hr halflife is correct, but (clinically more important) the active metabolites have a much longer halflife (>100hr). --193.172.33.211 14:42, 2 May 2006 (UTC)

Addictiveness
Needs more information on the addictiveness of them, the way it's currently phrased it makes it seem like it's no big deal. Nathan J. Yoder 19:25, 5 November 2005 (UTC)


 * I agree, but a good general source for this is essential. Have you got anything of that sort? JFW | T@lk  22:46, 5 November 2005 (UTC)


 * I am currently looking for good sources, they are hard to find with all the tertiary (and very unreliable!) information on the internet. I guess I'll have to search through journals.  I have heard nurses say that benzos have worse withdrawal than opiates (which may imply more addictiveness), but since they are not doctors I'm not sure how true that is.  I will try to look for more information on that, and see if I can tie information on addictiveness between all the different articles on addictive substances.  Do you know if there is a special name for the kind of studies that compare different classes of drugs like that?    Nathan J. Yoder 06:27, 6 November 2005 (UTC)

A recent edit changed the text from "potentially addictive" to "highly addictive". The addiction article is quite thorough on the definition of addiction and dependence. Given that the Benzodiazepine article covers all benzodiazepines, can we really say they are all "highly addictive", whatever that means. Do you become an addict after one pill or shot? Surely it depends on which drug you take, how much you take and for how long? --Colin 18:07, 6 February 2006 (UTC)

Yeah well, LSD is a DEA Schedule I drug, and it is not considered to be really "addictive." We all know that the DEA scheduling of a certain drug is a very poor (if any) means of judging addictive potential. --Seven of Nine 05:06, 10 May 2006 (UTC)

The addictive potential of Benzo's is indesputable. I have personally gone through this, and believe me, it is not pretty. I spent some time in the Priory hospital in the UK for Cocaine related problems, and these are minisclule in comparison to the problems created by these nasty little pills. I only took Librium and Valium for 3 weeks, and it very nearly destroyed my life. I did take several times the prescribed limit, (I had 3 months worth of pills, taken in 3 weeks), but still, when I stopped, (after my wife left me), I was unable to sleep for about a month. Check out http://www.benzo.org.uk for a list of further personal stories of lives destroyed by this evil drug.


 * I second that. I personally had a hellish experience myself withdrawing off of lorazepam. --Seven of Nine 23:21, 10 June 2006 (UTC)

I have gone through withdrawal from severe opiate (heroin) and flunitrazapam addictions. By severe i mean years of continous (illegal) use. Heroin withdrawal is worse, but never lasts more than 2-3 weeks. Flunitrazepam withdrawal took 8 weeks.

Not an "evil drug"; a magical drug when taken for anxiety. But one must titrate off/down! Three weeks of .5mg alprazolam [xanax] every six hrs. can be reduced first to .5 every 12 hrs., then .5 every 24 hrs., every 48 hrs., then to .25 every 48 hrs., & finally only "as needed." About a week at each stage. Moderate initial discomfort, but nothing too difficult nor enduring. (Of course, this presumes the cause[s] of the anxiety has been successfully treated [e.g., by an SSRI] or eliminated.)


 * Do NOT take this last post as tapering advice. The half life of alprazolam is WAY TOO SHORT to effectively taper by repeatedly doubling the time between taking doses of the same magnitude. The http://www.benzo.org.uk site posted by the earlier user is a very useful source of additional information including more info on why this sort of xanax taper would be impractical. The poster is correct, however, that benzodiazepines can be "magical" for crippling anxiety. —The preceding unsigned comment was added by 64.20.163.2 (talk) 14:19, 2 February 2007 (UTC).

Benzo's are not addictive in the same way as heroin. But this do not make them less addictive. They're more like alcohol. While on University, I drank a lot of alcohol every single day for a couple of years and I never become addicted. With my personal experience I could say that alcohol is not addictive. And this cannot be more far from truth. Alcohol is highly addictive and so are Benzo's. [unsigned]


 * Some people having problems with benzo addiction doesn't make them *more* addictive, either. Most people who are legitimately prescribed benzodiazepines do not become addicted and do not gain tolerance.  Problems with withdrawal is not the same as addiction--many drugs can lead to uncomfortable (and even dangerous) withdrawal but are not considered addictive.  As far as length and severity of possible withdrawal, I think that would be more appropriate on each individual drug's page as they vary quite substantially. --Sdfromage 20:28, 30 November 2006 (UTC)

Why is this even an issue? benzodiazepines are all 'addictive', and yes there is a nice 'addiction' page here; yet this article is about the properties of the chemicals and their uses. There does not seem to be a good Addiction Medicine reference throughout the article, but the content here is almost less than one page from the PDR. Is the word 'limbic' even used? These are medications utilized for the treatment of many disorders. Do you look for Fosamax before you look for Osteoporosis? The biochemical interactions of the pharmaceutical products and the human body result in a state whereby the continued administration of the drug, an alternate class of drugs, or gradual withdrawal from the medication are the only relevant outcomes. Instead of having a usable article this one is getting hung up in personal experiences that would be better placed in their appropriate areas. if you have DSM-IVtm 300.xx or whatever then find that page, cite any manual indicating the usage of the agents on this page for treatment of that disorder, then add the disorder to this page in an appropriate manner or to the specific linked pages when the drug is primarily utilized for the treatment of that disorder over other benzodiazepines. I am not demeaning any individual for their psychiatric diagnosis or withdrawal experiences, but I am of the opinion that this page is an informative hub as a pharmaceutical reference and can function cleanly as such while the concerns addressed above can be incorporated into the whole body of work through Wikipedia in a manner that does not detract from the focus of this page. Recreational use and abuse of these drugs do not deserve large sections in this article, unless they have some level of cultural relevance or a specific usage of one compound is outside the norm for these drugs. For example, date rape and 'roofys' (sp?) would fall under criticisms or another detractive heading. Instead of making this a mess of disorders, FDA/DEA/addiction comments, and other extraneous information we should keep the general section concise and remove the dispute and neutrality issues. What use is this article if it's flagged as such?


 * Dependance plus tolerance is totally different than addiction and all should understand this. An addict generally seeks drugs for illicit purposes, or to create euphoria. An addict takes drugs for no medical benefit regardless to their health and welfare. They generally take the drug long enough, and of enough quantity to produce tolerance, and physical or psychological dependance. This in turn leads to drug-seeking behavior, doctor shopping, etc.


 * Physical dependance and tolerance will develop in those who need the drug for genuine medical conditions such as leading a normal life even for long term use. However, in this case, the one taking the medicine does not crave the medicine, nor want to use it for its euphoric effects. It is used only for the the patient to conduct a normal productive life. Even though the patient is tolerant, and physically dependant, they are NOT an addict! One can be placed on a steroid like Prednisone for medical purposes and become both physically dependant and tolerant to the drug. Are they then an addict here? It's the same scenario which has been proven by several research groups. Before one says anything about addiction, this should always be understood.--Craxd


 * I disagree with premise that an individual who is physically dependent upon a substance is not an addict. Clarifying what you mean by tolerance within the context of benzodiazepine use would be helpful in understanding your point of view. Many people who abuse medications tolerate the side effects extremely well, many desire the side effects and thus increase their dosage to consistently surpass tolerance; there are also many drugs which are abused without causing physical dependence, thus tolerance is often irrelevant or unclear when discussing dependance. What all should understand is the difference between ABUSE and ADDICTION. Drug seeking behavior and doctor shopping, even increasing dosage beyond normally accepted therapeutic levels has occurred in numerous patients suffering from previously unknown, undiagnosed, or misdiagnosed, disorders, in these cases the clinician's failure to recognize that an individuals symptoms are consistent with a disorder or to further investigate complaints from the individual can be seen as a stimulus to legitimate self-medication. The often cited criteria for addiction are problematic to say the least, they are insufficient for the purposes of distinguishing between abuse and appropriate use. When considered in the psychiatric realm; where many addictive drugs with psychotropic properties are prescribed the purpose can be to purposely create a euphoric effect in a patient without the goal of that individual leading a 'normal life' ADL/Extended ADL.


 * Pain management is another realm where the physician encounters difficulty distinguishing between abuse and appropriate use when applying the addiction potential toolset (drug-seeking behavior etc). Furthermore, whether or not a moral compass or the legalities of a locale apply is irrelevant. Why state 'illicit' purposes? One may as well say drug dealers, gun runners, rapists, embezzlers, generally participate in their activities for illicit purposes. The fact that a medication may be illegal and determined to be morally reprehensible by a particular audience is merely a correlation.Those engaged in drug abuse do not, as a rule, do so to 'break the law'. In point of fact, the legality of drug use is completely irrelevant to the functions of addiction. Claiming that an addict takes drugs without regard for their health and welfare is also debatable, what you have presented is a laundry list of common criteria for assessment of addiction that has always been problematic within the realm of addiction medicine.


 * Were your first paragraph rephrased to use abuse with the goal of euphoria or even 'mood altering', or 'escape from reality', I would credit you more for the mostly concise, logical, and relatively well explained second paragraph that is accurate with the exception of terminology. I am not merely placing a semantic debate on the proverbial table with regards to tolerance and addiction, I am presenting the idea that abuse be utilized where appropriate in order to separate one broad category of drug users from an inherent property of the pharmaceuticals in question 'addiction'. As I stated before, "The biochemical interactions of the pharmaceutical products and the human body result in a state whereby the continued administration of the drug, an alternate class of drugs, or gradual withdrawal from the medication are the only relevant outcomes." Remove the second outcome and that is addiction. Granted, the closest relevant article is 'Substance Abuse'.


 * Although the Substance Abuse article has an addictive component, it is far more palatable than the Addiction or Drug Abuse articles with regards to neutrality. It seems obvious to me that this article will fail as a hub through too much information or neutrality. I propose that terminology likely to create bias or 'unbalance' the article be prefaced as a sourced specific point of view and linked within Wikipedia or dropped. —The preceding unsigned comment was added by 63.195.181.245 (talk) 11:13, 30 January 2007 (UTC).


 * I largely agree with the above contributor. I too equate physical dependency with addiction. However, addiction has come to mean illicit use and suggests antisocial behaviour to boot. It is unsurprising that many object to the term when they have taken medicines as prescribed by their doctor, or have felt driven into drug-seeking behaviour because of the very powerful effects of the medicine they have been prescribed. I think we need a new term, something that acknowledges the physical reality, but without the stigma of addict. Dependency just doesn't cut it for me - relegating addiction to the level of a habit, or suggesting that the person taking the drug needs it to survive or to lead some kind of normal life. Dependency does not suggest the often very real problems caused by the drug itself - this is why I object to the term. However, because some can object to either term, I'll generally write of addiction/dependency - it's rather satisfactory though. In the past I've suggested the term iaddiction, as a contraction of iatrogenic and addiction. Comments?


 * Colin Moran

Benzodiazapenes are not addictive! They have tolerance and dependence issues but as any pharmacologist will confirm, these are very different from addiction. Addiction is a specific behavioral reaction while tolerance and dependence have more of a pharmacologic dimension. Someone with a MD or Pharm.D. needs to review this article! Anecdotes about drug problems don't cut it -- peer-reviewed articles do.

G. Csikos, 5 November 2007 —Preceding unsigned comment added by 67.84.193.199 (talk) 22:16, 5 November 2007 (UTC)

Yes addiction is a behaviour but physical dependence can be the main driving force behind addictive behaviour. It is a very grey area addiction.--Literaturegeek (talk) 20:53, 10 April 2008 (UTC)

Members section
The members section could use a little reorganization into the categories it lists (i.e. short-, medium- and long-acting), with the appropriate members under their respective sections. Fuzzform 19:51, 12 February 2006 (UTC)

Half-Lives and Drug Testing
Do the listed half-lives relate to the period that the drug is detectable in a UA (urinalysis), or is it more related to the amount of time the effects of the drug will last? I think i once read that it's usually metabolites a drug that are actually detected in these tests, but I'm not sure. Any insight would be appreciated.


 * A biological half-life of a substance is its pharmacokinetic/toxicokinetic characteristic. It is simply said a period of time, in which 50% of the administered dose of the substance is eliminated (either metabolised or excreted). In many drugs with active metabolites, half-lives of these must be taken into account, and so, e.g. clorazepate, while itself beeing a very weak benzodiazepine agonist with very short half-life (about 20-30minutes p.o.), breaks down to nordazepam (1-desmethyldiazepam), which is a fairly potent BZD agonist with very long half-life (50-80 hours), so the active principle of clorazepate drugs is the main active metabolite nordazepam.

Half-lives greatly influences detectability in biological samples (urine, blood), but with modern sensitive methods, traces of BZDs and their metabolites can be detected for many half-lives of the given substance after single administration of the drug and longer if taken regullary for longer time.--Spiperon 18:48, 15 October 2006 (UTC)

Clonazepam and Alprazolam and a few other serious questions - Please Help!
Which of these 2 is stronger? I have a prescription for both for an anxiety disorder (social (not nearly as much anymore) and general anxiety) and I find Xanax is a lot more sedating but gives me headaches and is a strong anxiolytic, except Paxam (Clonazepam), I barely feel a thing from it. It says longer-acting agents have a persisting sedative effect and with Clonazepam, but I barely feel sedated? Weird, someone should change that. Also, in Australia, can General Practioners prescribe Rohypnol aka. Hypnodorm aka. Flunitrazepam the devil drug? It seems relatively useful in treating anxiety. It's also Scheduelle 8 drug in Oz, which is the same category as Dexamphetamine and only psychiatrist can prescribe that, so can GP's prescribe it? One other thing, my eyes are fucking up on me, like I'm seeing shit that ain't there like flashes and blue dots and just weird little zippy things, is this due to any benzodiazepene? (I've been on Ativan, Lexotan for short periods and Xanax for long period and just started Clonazepam while withdrawing from Xanax). Also, what is the most potent Benzo all round? I know Halcion, Xanax and Clonazepam are the most potent (.25 MG to 10 MG Valium) but which is the strongest all round (meaning strong as in strong anxiolytic, sedative, longer lasting etc.)? (I was thinking Rohypnol or Xanax?!?!) So please help me.....Also, I happen to smoke, does this affect the metabolism of any Benzos?


 * Alprazolam will sedate more than clonazepam, that's true. Ativan (lorazepam) is also quite sedating.  My advice is to see a real shrink about your benzodiazepines/anxiety (not a G.P., as you seem to want to do), and also consult an opthamologist about the visual disturbances to rule out anything serious there.  Regarding smoking tobacco, nicotine is a stimulant, and may decrease the effects of the benzodiazepines by promoting anxiety.  That by itself is a good reason to stop smoking tobacco.  If you're smoking marijuana, you may find that it causes excessive sedation in combination with benzodiazepines.  But, seriously, talk to your doctors about these things.  They're trained to give advice on such matters, unlike RobertAustin 18:29, 8 April 2007 (UTC).

I am on and off with my use of Lorazepam for GAD, Panic Disorder, and others. Before I began treatment at all with a benzodiazepine I saw things that aren't there, like trailers and dots and such. I don't think it's due to medication. I think it's symptomatic. Mild hallucinations almost. After administration of Lorazpem, these symptoms are sometimes dulled and sometimes more pronounced. As for smoking...what are you smoking?69.132.62.234 07:04, 29 October 2006 (UTC)CaL Alprazolam is more potent than clonazepam on a mg/kg basis but it's half life is shorter and she be dosed more frequently than clonazepam who's duration of action is greater than 24 hours (about 30hours or so). Your question however, is different on the merits of anxiolytic, sedative, half life etc. Without going into pharmacology too much, each benzodiazepene binds differently to subunits to a receptor, GABA. Benzos work by stimulating GABA which is an INHIBITORY neurotransmiter in the brain. Xanax (alprazolam) binds and exerts a greater effect on one of GABA's subunits that causes sedation and is a very potent but short lived anxiolytic. Klonopin (clonzepam) is longer-acting, less potent (contrary to the text) but more suitable as an anti-seizure drug due to its effects and confirmational binding to the GABA receptor that is different than xanax. In short, each drug while classified as being in the same "family" of drugs are not exactly chemically identical and are more like "cousins" in their image and actions, therapeutically. I'm unsure of the prescribing and scheduling of drugs in Austrailia but in the US all benzos are schedule 4 and can be prescribed by any MD or DO, resident or intern or nurse practioner if it is "within their scope of normal practice."

The OP might want to see the visual snow article regarding the visual disturbances. Of course, that just gives it a name without specific causation (since there can be so many poorly-related causes), but it does present some avenues to consider. I don't think it's a stretch to suggest that every real-world information-processing system, including the eye and the brain, is going to have some sort of intrinsic noise, and an anxious or agitated person is more likely to notice and worry about it, wherever it comes from -- while a stress reaction can influence everything from the brain's interpretation of the visual signal right on through to basic physical matters like blood pressure and cell metabolism, possibly exacerbating an underlying cause or inducing it outright (signal noise + overexcitability -> amplification of noise or error, whether psychologically or anatomically, right?). That said, I might just be a lucky git, since getting my astigmatism diagnosed and corrected happened to 'cure' my personal case of snow; less blur led to less noise and apparently less weird artifacts of my brain's attempt to compensate. Of course, with my glasses off, prescription failing, or under stress, symptoms return. I'd suggest any snow sufferer without other symptoms (like full blown hallucinations or migraines) should start by getting a really thorough ophthalmologic exam, and remember that even the best eye doctors won't always get their diagnosis perfect every time. Hopefully the new technologies that directly scan and map the cornea will make it easier to objectively detect simple optical defects (without waiting for you to say things are blurry or curved, especially if you're experiencing the aberration as 'snow' instead) or rule them out as the problem. :P --69.177.176.115 00:54, 3 December 2006 (UTC)

Withdrawal methods and support groups
I would like to create some links to some of the Internet's best known support groups for helping individuals get off of these drugs.

I am also considering creating a separate wikipedia page discussing known proven withdrawal taper methods that work. The two that I know of are Ashton's Valium cross-over taper method and water titration.

Would it be considered out of line or against wikipedias rules to create external links to the top support groups?

Would anyone object to placing an external link on the benzodiazepine page to support groups and if not why?

Would anyone object to placing a link on the benzodiazepine page that would link to an internal wikipedia page that would discuss known proven taper methods?

Would it be appropriate to create a short section in the benzodiazepine page that discusses known tapering methods? —Preceding unsigned comment added by Benzobuddy (talk • contribs)
 * First, I am quite active against external links on pages. I try to remove as many as possible, and am still busy with a process to make more go.  It may seem a bit harsh, and if that is the case, I am sorry.
 * Why I reverted these specific links, they do not provide specific information about the chemical itself, the relation is (at least) one step further, or one has to browse through the linked site to find the information.
 * What I would suggest is (if the subject is large enough), add a short paragraph about 'how to get off the drug', and (as you already suggest), write a main page about the subject, in the paragraph on the benzodiazepine-page you can add the to point to the main page for the subject.  In the full page about the subject the link to support groups would not necessarily be wrong (keeping a neutral point of view, of course).
 * An example of a page that uses this approach is inorganic chemistry. That page discusses in short paragraphs different subfields of the subject (which itself is immensily broad), and many of the subfields are linked via the template.
 * Happy editing (hope to see you around, many 'chemical' pages can use the eye of an expert). And if you want me to help you with some tips and tricks to setup the new page, drop me a line on my talk page when you have made a start (and give me the name of the new page).  --Dirk Beetstra T  C 20:49, 31 August 2006 (UTC)

Mess
This article, which could be a really reliable resource if we tried hard enough, presently looks like a dump. It doesn't cite many reliable primary sources, instead linking excessively to a UK benzodiazepine interest website (which is not verified by experts).

When I added the history of Leo Sternbach and librium I was quietly hoping someone would work in some more detail on the remainder of the material. I won't be doing this alone, but let me know if my help is needed. JFW | T@lk  20:41, 14 September 2006 (UTC)

some minor edits
I added following "uses" of diazepam: (apart anxiolytic) hypnotic (in higher dosis taken to empty stomach, it is in fact one of the most prescribed BZDs for insomnia), anticonvulsant (one of first-line options for status epilepticus, along with lorazepam and clonazepam IV), muscle relaxant (given in doses 5-10mg t.i.d.-q.i.d., f.e. by posttraumatic spasticity). Keep in mind that diazepam is the BZD with the broadest spectrum of uses of all. I also changed the use of midazolam from "anxiolytic" (a nonsense, it is used almost exclusively in anesthesiology) to "hypnotic".--Spiperon 00:01, 15 October 2006 (UTC)


 * Given the shift in prescriptions being consistent with patient information I think it might be beneficial to state dosage in as 't.i.d' and '1 tablet daily' formats. —The preceding unsigned comment was added by 63.195.181.245 (talk) 11:25, 30 January 2007 (UTC).

I took out a line which was repeated again underneath it and added the word with drawal symptoms as a heading instead. i think it has made it look better and does not have a sentance with no answer or purpose hanging in mid air. Hope this is ok. Delighted eyes 18:38, 23 July 2007 (UTC)

Comments
I agree with JFW, the page is a mess, and it apparently has been a mess for several months now. Here are my comments on the state of the page, as of November 11, 2006.
 * References - Citing the website "www.benzo.org.uk" is unacceptable, because the website is not a reputable source, nor does it reference any other sources. For all we know, all of the data could have been thought up by the website's creator. Although it isn't false data, it is still a very poor source. I recommend using DrugBank, PubChem, or other well-known, reputable sources for referencing.
 * General information chart - We need to find a reliable source for the information contained in the disputed section, and its usage must be agreed upon by the majority of this page's editors. The information in the chart is correct, but as I have said above, the source is dubious at best.

Fuzzform 23:06, 10 November 2006 (UTC)

Since the 'general information chart' is closer to the 'dose equivalency charts' I'd suggest using any of the charts citing:

1 Micromedex 2003 2 Nelson J, Chouinard G. Guidelines for the clinical use of benzodiazepines: pharmacokinetics, dependency, rebound and withdrawal. Canadian Society for Clinical Pharmacology. CanJ Clin Pharmacol. 1999 Summer;6(2):69-83. 3 Rickels K, DeMartinis N, Rynn M, Mandos L. Pharmacologic strategies for discontinuing benzodiazepine treatment. J Clin Psychopharmacol. 1999 Dec;19(6 Suppl 2):12S-16S. 4 Teboul E, Chouinard G. A guide to benzodiazepine selection. Part II: Clinical aspects. Can J Psychiatry. 1991 Feb;36(1):62-73. 5 Teboul E, Chouinard G. A guide to benzodiazepine selection. Part I: Pharmacological aspects. Can J Psychiatry. 1990 Nov;35(8):700-10.

Obviously there are some older studies and the half life of some medications, notably diazepam, will be listed at +/- 100% on charts citing the same sources; but the table is useful. It should however be renamed Dosage Equivalency Table or something to that effect, as that is what the chart generally depicts.

Half-Life of Ketazolam
Currently this is shown as 2 hours. Surely that can't be correct, can it? See e.g. this pubmed abstract, which says, "half-lives of up to 100 h (flurazepam, ketazolam)." Sdsds 07:36, 4 January 2007 (UTC)

Should DMCM be on the list?
DMCM is a very obscure compound, and it is almost the only thing on the whole list in the "Members" section that isn't a full benzodiazepine agonist (clobazam is a partial agonist). Probably the only BZ antagonist that is worth mentioning is flumazenil, and I am not even sure that the page should list non-agonists (as there is no way to say the equivalent dose, and it is confusing). DMCM should probably be removed, at least. Fluoborate 11:46, 4 January 2007 (UTC)

Is DMCM another name for R015-4513? Or are they different inverse agonists? If so, maybe the article would benefit from a separate table for these? Sdsds 21:58, 4 January 2007 (UTC)

DMCM is a beta-carboline derivative, and Ro 15-4513 is a benzodiazepine derivative, so their chemical structures are quite different. In my personal opinion, Ro 15-4513 is the most interesting BZ partial inverse agonist, because of the specific antagonism it exhibits against the effects of ethanol. Ro 15-4513 has been used in a lot of interesting studies on many topics, but I have never seen a particularly interesting study on DMCM.

A separate table for atypical benzodiazepine receptor ligands might be nice, it could include zolpidem, (es)zopiclone, zaleplon, flumazenil, clobazam, Ro 15-4513, and DBI (diazepam binding inhibitor, an endogenous protein). Fluoborate 06:41, 5 January 2007 (UTC)

OK, I started a new table with a few entries. I hope the terminology is correct. Should we instead be calling them "GABA(A) receptor benzodiazepine binding site ligands?" And why is there no mention of GABA(A) in this article? Sdsds 07:38, 5 January 2007 (UTC)

negative allosteric modulator?
Is it correct to describe benzodiazepines as "negative allosteric modulators" of GABA(A) receptors? Sdsds 20:43, 14 January 2007 (UTC)

Reply

Benzodiazepines are positive allosteric modulators of the GABA(a) receptor. A negative allosteric modulator would be an inverse agonist which would cause anxiety, seizures, muscular spasm and tension and insomnia etc. The opposite of what a benzodiazepine would do. Carpetman2007 8th April 2007 (UTC)

Edit to External Links
I'm open to discussion of what constitutes suitable links, but I consider some of the links that were removed (including the links to my own website) to be not totally disimilar in content and value to some of the links that remain.

In the interests of clarity and openess, I created a username that relates to my website, and have not edited links to other benzo-related websites. If the links I have provided have violated guidelines, I apologise, and look forward to reading a clarification of policy in this regard. Additionally, please note that Benzobuddy is a different contributor.

I'd like to take this oportunity to thank the authors/contributors of the Benzodiazpine entry.


 * External links states what should and shouldn't be linked, Specifically avoid "Links to social networking sites (such as MySpace), discussion forums or USENET." you linked to a forum so I deleted the link.
 * Links should also not be added to advertise or promote websites. This includes both commercial and non-commercial sites. You should avoid linking to a website that you own, maintain or represent, even if the guidelines otherwise imply that it should be linked. If the link is to a relevant and informative site that should otherwise be included, please consider mentioning it on the talk page and let neutral and independent Wikipedia editors decide whether to add it.
 * Mr Bungle 04:33, 8 April 2007 (UTC)


 * Hi,


 * I must admit to not reading the guildlines before adding my link - I purley followed what appeared to be the accepted form. I will take on board what you have said, raise this within the discusion area, and let a neutral editor add a link if deemed appropriate. I note that another contributor has raised the issue of support sites, and how this they be added to the entry, or a new entry - I will probably add my thoughts to that discusion.


 * Thank you for your full and speedy reply.

Hello everyone, I put back the link to pharmamotion.com.ar because I believe it is a very useful and accurate site. --190.172.181.136 (talk) 04:22, 18 December 2007 (UTC)


 * Colin Moran

The Drug Mentioned in "Prison Break"
Benzodiazepine is mentioned in the #19 episode of Season 2 of "Prison Break". In the conversation between Agent Mahone and Sara Tancredi, Mahone admitted that he is taking this drug. Should this be added into this article under a new section "Popular Culture"? -- HkQwerty 13:05, 11 April 2007 (UTC)


 * I don't have a problem with you adding that to the benzodiazepine article. I will keep the popular culture section below the pharmacological and other similar data though, as it is now. I don't think the other editors will have a problem but they can chip in their comments/opinions. Add it. -- Carpetman2007 1:50 am Saturday 15th April 2007 (UTC)


 * I removed the popular culture section, Wikipedia is not a compendium of trivia. Also, I hate to say, the information included in that section wasn't notable or interesting. TheDapperDan 20:35, 22 April 2007 (UTC)

Chart?
What the hell happened to the table showing all the common benzos? Don't tell me it was removed because people were arguing with each other over equavalencies. If that's what happened... well... that's completely moronic. I'll try to find it and put it back (it's useful to have a LIST of benzos on a page about them). Fuzzform 21:31, 19 April 2007 (UTC)

Not to mention... whoever deleted it didn't even talk about it here, first. Please don't do that again, whoever was responsible. Fuzzform 21:43, 19 April 2007 (UTC)

I think you should calm yourself down. I didn't delete it and I don't know who did. You would have to go through the history to see who deleted it. Anyhow the dispute about the equivalencies if you read through the discussion page here was to do with the ketazolam half life. That turned out to be a typing error which has been corrected both in print and online. The half life of ketazolam is no longer listed as 2 hours in Professor Ashton's equivalency table. See this page http://www.benzo.org.uk/bzequiv.htm If you want to add the half life and equivalency table listed on that page I have no problem and I don't think the other editors would have a problem. I think that an equivalency and half life table would be of great value to this wiki page on benzodiazepines.

Carpetman2007 13:31, 22nd April 2007 (UTC)


 * Since the user User:Timeshift9 deleted the Chart on 17. Feb 2007 without giving any reason, I restore the whole "Members" section as of the last revision of article before his action on 17. February 2007. I also ask and please all users that will edit this section to discuss this properly in advance here on discussion page. Thank you.--84.163.87.66 12:05, 28 April 2007 (UTC)

Chart restored. Unfits current version, but is useful and better arranged than plain text enumeration of data on particular drugs
I restored the whole section "Members" as of 16. February 2007; it fits not really good with current form of article, but is in my opinion very useful as a frame of giving pharmacological data easy to compare between numerous benzodiazepines; I would like to please you not to delete it again; instead, be creative and modify this section, possibly giving backup information for data given. First step would likely be to re-name the whole section; "Memebers" isn't really a good title for enlisting of most of the substances used; maybe "Chart of commonly used benzodiazepines"? What do you think?--84.163.87.66 12:18, 28 April 2007 (UTC)
 * Ow my fault, I saw the "List of Benzodiazepines" only after restoring the "Members" section....ok, so I'll delete it, my fault. Sorry.--84.163.87.66 12:23, 28 April 2007 (UTC)

Help!
Hey people do u know if caffeine with librium is toxic?? Thanks. Tourskin.


 * I would be quite surprised if there was any dangerous interaction between caffeine and Librium. A PubMed search didn't turn up any mention of a pharmacokinetic interaction, and the pharmacodynamic effects are more or less opposite. When these two drugs are mentioned in the same paper, it is often in the context of Librium blocking caffeine's side effects.Fluoborate 06:36, 18 May 2007 (UTC)

Power Surge
I deleted reference to power surge web site. I spent several hours doing an extensive literature search on all the major medical search engines, including pubmed, medline, google scholar and others. I also ran a search on google itself using various keywords phrases which could possibly locate the supposed 20 year follow up study for alprazolam users. The study was alledgedly published by Lessor, et al. Even using the broad search term "lessor alprazolam" in literature search engines failed to find any such study. Other search terms I tried were ucla alprazolam 20 year, ucla alprazolam twenty year and many other search phrases to no avail. I tried using xanax instead of alprazolam in keyword searches. I conclude that no such study exists and the web site article on power surge web site cannot be trusted at all, whether it is genuinely written by a doctor or not (which is debatable). Also the article on power surge does not even give citations/references for anyone to cross check the validity of the claims and the supposed doctor states that "he remembers reading a study". "Remembering a study" (which no one as yet can find), is not good enough for a wiki citation. If anyone can locate this supposed study feel free to cite it. Even a simple abstract or reference to it in a peer reviewed publication or other trusted source and I will be happy to see it undeleted. Until then as far as I can tell the study simply does not exist and never happened and the reference must be deleted. Of concern also is the power surge web site if you browse it you will see that it has hundreds of links mainly to buy supplements or books from contributers to the web site. The supplements and "hormone testing" all seem to link heavily to one or two other websites which raises suspicion that they own the comerical websites or have some sort of advertising contract with them. The power surge "reference" I believe was placed in this wiki article to boost visitors to their web site and perhaps for comericial activities. It is also has a large message board/forum on the website so their link on this wiki entry is probably there simply to boost their "community numbers", visitor numbers and for financial gain in my opinion. Totally unsuitable and unacceptable for an important pharmacological wiki entry on benzodiazepines.

I also deleted the reference to Handbook of Clinical Psychopharmacology, as it was an old reference which seemed to be put there in relation to an old argument about whether 10 mg of diazepam equals 0.5 or 1 mg of alprazolam. The person had written, argumentatively, beside the reference (10 mg diazepam = 1 mg of alprazolam). Arguments should not be included beside references anyhow. Arguments, "editor politics" or disagreements should be kept on the talk page and not included in wiki entries/articles. So it was obvious to me that the reference was there only to resolve an old argument, about old content which no longer exists in this wiki entry for benzodiazepines. I deleted reference because it is no longer related to this wiki entry for benzodiazepines, as equivalent doses of alprazolam to diazepam are not discussed or listed in the article anymore and therefore it is an irrelevant reference, which was placed for argumentative reasons.

Carpetman2007 16:59, 26th May 2007 (UTC)

Liver
I deleted the following paragraph from the benzodiazepine article:

"In long term and high dosage therapy, periodic liver function tests should be administered and the dosage of any benzodiazepine should be carefully titrated in patients with impaired hepatic function and renal clearance. While liver damage may be limited when these drugs are prescribed at the recommended dosage, the possibility of such harm should be considered in all individuals; especially individuals utilizing other medications including over the counter analgesics and/or alcohol."

I deleted the above paragraph from the main article because simply benzodiazepines have a low organ toxicity level (except in very rare isolated cases), i.e. benzodiazepines do not cause organ failure or damage, except exceptionally rarely. So there is no reason to have warnings about the need for routine liver function test even at the high dose end of prescribing therapy. Only thing that is true is that those with severe or very severe liver disease may have significantly more accumulation with long half life benzodiazepines eg diazepam or librium and will either need to have a much smaller dose given than a healthy person or else the usage of short half life benzodiazepines etc. If anyone disagrees and there are reliable sources that show me to be wrong that benzodiazepines do commonly cause organ damage and there is a routine need for liver function tests in patients prescribed high therapeutic dose benzodiazepines then cite your source and add it. Otherwise for now I am just going to leave it deleted. I don't know which editor added this in about organ damage but if anyone has any disagreements with this deletion, I will be happy to listen to your disagreements and discuss them here.

I may however add in a line about the risk of accumulation of long half life benzodiazepines in those with significant liver impairment.

Carpetman2007 13:46, 19th July 2007 (UTC)

Abuse vs. recreational use, POV issue
I have changed the name and rewritten some thing in the "abuse" section. Please refrain from writing in such a way that it appears wikipedia takes the stance that all recreational use is abuse. Also, please refrain from using the word "addiction" or "addict", defining addiction is very difficult and must be done on a case by case basis. This is beyond the scope of wikipedia. Please use the terms physically and psychologically dependent/ance. This will prevent many POV issues from arising. In the mean time, I feel that the tag should remain as this section is quite sloppy.24.20.158.3 07:02, 21 September 2007 (UTC)


 * I've changed it to "non-medical use", but I disagree with your stance. In most Western countries, non-medical use of such substances is illegal; it is therefore a legal rather than a moral issue.
 * If you find the tone of the paragraph too sloppy, how about you improve it yourself rather than leave a tag? In my experience, these tags should be placed only if efforts are being made to rewrite the content in question. If not, people leave tags and then disappear, leaving it for others to tidy up behind them. JFW | T@lk  10:35, 21 September 2007 (UTC)

use of benzodiazepines in anxiety disorders
I propose the following addition to the indications section.

Any comments or discussion?

"According to the experts' judgements, the BZs, especially combined with an antidepressant, remain mainstays of pharmacotherapy for anxiety disorders."

reference abstract: PMID: 10356648 [PubMed - indexed for MEDLINE]

http://www.ncbi.nlm.nih.gov/pubmed/10356648?ordinalpos=14&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

--Arrowsmith36 (talk) 20:19, 19 January 2008 (UTC)


 * Looks OK to me, but please cite using standard template. Boghog2 (talk) 21:46, 19 January 2008 (UTC)

Thanks for the tip about the citation template, Boghog2.

How did you locate the doi?

--Arrowsmith36 (talk) 02:44, 20 January 2008 (UTC)


 * I used User:Diberri's Wikipedia template filling tool to generate the template and find the DOI. Given a PubMed ID, this tool generates a filled in wikipedia in-line citation template which you can copy and paste into a Wikipedia article.  This tool will also generate book citations and a couple of other useful WP templates.  In the template filling tool form, I checked the "Add URL if available" if available option and transferred the DOI that was in the URL field to the DOI field.  This one was particularly tricky since there were three special characters "<", ">", and ":" that had to be replaced by their hexidecimal equivalents "%3C", "%3E", and "%3A" respectively in order for the link to work.  I will suggest to User:Diberri that he modify the template tool in order to make these substitutions automatically.  Cheers.  Boghog2 (talk) 09:30, 20 January 2008 (UTC)


 * Thanks for all the help, Boghog2. It will take awhile for me to figure out how to use all the templates! --Arrowsmith36 (talk) 20:14, 20 January 2008 (UTC)


 * The problem I mention with the special characters has now been fixed so that is one less thing to worry about. Don't be too intimidated with the template formating.  If you want to experiment, use the Sandbox.  And finally, be bold!  The addition to the article that you proposed above certainly sounds reasonable and in my opinion would be a worth while addition.  Boghog2 (talk) 23:07, 20 January 2008 (UTC)


 * Thanks for the encouragement, Boghog2. --Arrowsmith36 (talk) 21:20, 21 January 2008 (UTC)

what happened to the material I added???
The below material (which I contributed) was deleted from the page on benzos. I consider the material important because it disputes the notion that one becomes tolerant to the anxiolytic effects of benzos. People with anxiety disorders have stayed at the same dose for years without becoming tolerant.

If a significant part of the description of benzos can be deleted like this, I see no reason why myself or anyone would want to contribute to Wikipedia.

Arrowsmith36 (talk) 19:04, 6 May 2008 (UTC)

However, in 1992 Romach and colleagues reported that dose escalation was not a characteristic of long-term alprazolam users, and the majority of patients indicated that alprazolam continued to be effective. [45] A 2003 study did not support the hypothesis that long-term use of benzodiazepines frequently results in notable dose escalation. [46]

In a 1-year follow-up study of patients with panic disorder continuing treatment with clonazepam, 90% maintained a positive response without developing significant tolerance. In a 2.5-year follow-up study of alprazolam therapy, little evidence of tolerance emerged. [47]

^ Romach MK, Somer GR, Sobell LC, Sobell MB, Kaplan HL, Sellers EM (1992). "Characteristics of long-term alprazolam users in the community". J Clin Psychopharmacol 12 (5): 316–21. . ^ Soumerai SB, Simoni-Wastila L, Singer C, et al (2003). "Lack of relationship between long-term use of benzodiazepines and escalation to high dosages". Psychiatr Serv 54 (7): 1006–11. . ^ Pollack MH (1990). "Long-term management of panic disorder". J Clin Psychiatry 51 Suppl: 11–3; discussion 50–3. .

Arrowsmith36 (talk) 19:04, 6 May 2008 (UTC)

That cited data was moved to Benzodiazepine_withdrawal_syndrome. There is a limit to how big articles can be on wikipedia. See this Article_size. There was no bias against your edits because the withdrawal symptom list which listed severe withdrawal symptoms including death, convulsions, psychosis etc and the part saying benzos can worsen or cause anxiety from long term use was also moved to the Benzodiazepine_withdrawal_syndrome. Moved material is not exactly the same as deleted.--Literaturegeek (talk) 19:13, 6 May 2008 (UTC)

The wikipedia page was huge, it was over 100 kb in size so material had to be moved into the benzo withdrawal article. 100 kb is the absolute maximum an article can be in size. Very few articles are justified in or allowed to exceed the 100 kb limit. Unfortunately these are wikipedia article rules.--Literaturegeek (talk) 19:16, 6 May 2008 (UTC)

I just had a quick glance over your edit history and see that most of your edits still remain in the main benzodiazepine article. The following edits are still contained in the main benzodiazepine article.

A panel of over 50 peer-nominated internationally recognized experts in the pharmacotherapy of anxiety and depression judged the benzodiazepines, especially combined with an antidepressant, as the mainstays of pharmacotherapy for anxiety disorders.[21][22][23][24]

''Despite increasing focus on the use of antidepressants and other agents for the treatment of anxiety, benzodiazepines have remained a mainstay of anxiolytic pharmacotherapy due to their robust efficacy, rapid onset of therapeutic effect, and generally favorable side effect profile. [25] Treatment patterns for psychotropic drugs appear to have remained stable over the past decade, with benzodiazepines being the most commonly used medication for panic disorder.[26]''

''However, it is important to distinguish between addiction to and normal physical dependence on benzodiazepines. Intentional abusers of benzodiazepines usually have other substance abuse problems. Benzodiazepines are usually a secondary drug of abuse-used mainly to augment the high received from another drug or to offset the adverse effects of other drugs. Few cases of addiction arise from legitimate use of benzodiazepines.[51]''

The other edits like I say were moved into the main benzo withdrawal article.--Literaturegeek (talk) 19:45, 6 May 2008 (UTC)

"Most of your material was moved to Benzodiazepine_withdrawal_syndrome."


 * None of my above comments or references were moved to the benzo withdrawal page. I checked that page before I posted to this page. Besides, my comments had nothing to do with benzo withdrawal. They addressed tolerance to the anxiolytic effects of benzos.

"There is a limit to how big articles can be on wikipedia."


 * If that's the case, anything I might contribute can be arbitrarily deleted at any time in the future. Therefore, I will no longer be contributing to the benzo page.


 * I've learned my lesson with Wikipedia. There can be paragraph after paragraph on the HORRORS of the benzos (eg date rape, crime, terrible withdrawal, death, etc, etc, on and on), but when it comes to how much they help people with anxiety disorders, and continue to help them without the devolopement of tolerance to the anxiolytic effects.....there's a void on Wikipedia.

Arrowsmith36 (talk) 21:02, 6 May 2008 (UTC)

I moved this over to the benzo withdrawal article. This was not deleted.

''However, in 1993 the New England Journal of Medicine published a paper which claimed that there is no reliable evidence to support the existence of a persistent benzodiazepine withdrawal syndrome, and this alleged syndrome has been described only in anecdotal reports, with patients typically reporting "withdrawal" symptoms not present during or before benzodiazepine treatment that persist for many months or years after treatment is stopped. Experimental neuropharmacologic studies document that all the side effects of benzodiazepines, whether behavioral or neurochemical, disappear within several days or weeks after the drug is eliminated. The weight of evidence indicates that any new symptoms that persist for more than two months after the last dose of a benzodiazepine either are part of the premorbid condition or have appeared by coincidence or as a consequence of the natural history of the underlying illness.[48]''

I thought that I had moved over the all of the tolerance stuff to the benzo withdrawal artice but I had deleted it, but if you check my edits that I made in order to shorten the article down in size, you will see that I also deleted material which was very negative of benzos. Infact I deleted more so called "benzos are bad" stuff than "benzos are good" stuff. My edits were neutral. Check them out. and. There was simply far too much emphasis on tolerance and dependence, about a third of the article and my deletions were neutral because I deleted both citations which talked favourably and unfavourably about benzodiazepines. From my previous post above in italic writing you will see that there are several of your additions to the article which remain which speak very favourably of benzodiazepines. I intentionally deleted neutrally content including positive and negative content in order to shorten the article. Had I only deleted negative content I would have been accused of bias. You can't win on wikipedia. You are right though material may be deleted if an article exceeds 100 kb, especially from sections which are too big such as the previous huge size of the tolerance and dependence and withdrawal section. Although to be honest your content could have been deleted anyway regardless because government health reports eg from the MHRA (committee on safety of medicines), FDA, world health organisation etc are considered a stronger evidence base than the individual peer reviewed studies that you used to refute tolerance and dependence. Also withdrawal symptoms of a drug are considered to be a result of drug tolerance and to be a mirror image of a drug's properties and anxiety is one of the most common withdrawal symptoms from benzodiazepines regardless of whether someone took benzos for muscle spasms, insomnia, irriatable bowel etc. If anxiety is a classical benzodiazepine withdrawal symptom then that means it is typical that tolerance occurs to the anxiolytic effect otherwise anxiety wouldn't be a withdrawal symptom. However, like I say that was not why your content was deleted. The article exceeded 100 kb and the section on tolerance and dependence and withdrawal was previously huge taking up a third of the page and there was no choice but to shorten it with a neutral bold edit. Yes unfortunately that is the nature of wikipedia, content that you contribute can be deleted. I made a contribution today to another article actually and it was deleted within an hour. Content gets added, altered or even deleted all the time on wikipedia. I just move on and continue editing.--Literaturegeek (talk) 21:48, 6 May 2008 (UTC)

Also, if you take a look at this large section at the start of the article it talks about all of the important, useful and beneficial uses of benzodiazepines.Benzodiazepine.--Literaturegeek (talk) 22:15, 6 May 2008 (UTC)


 * I just thought I would play devil's advocate for a moment. I read the abstracts of your three sources: The first source shows that benzodiazepines don't cause *any further* increase in tolerance after the first three months of use, the second source says that benzodiazepines don't cause *any further* tolerance after two years, and the third one is unclear about what time period is studied. All the evidence I have ever seen indicates that there is some tolerance gained at the beginning of treatment. However, your sources indicate that all of this tolerance is built up within the first three months of treatment, and no further tolerance builds up. This agrees very nicely with my general sense of the literature.


 * The tolerance developed during the first three months of treatment could conceivably be troubling, even if it does not worsen during continued treatment. First of all, many doctors try to limit benzodiazepine treatment to a few weeks, and a popular suggestion is four weeks. Tolerance could theoretically build up after four weeks but before three months. In reality, I don't think this is happening very much, and I don't think it impacts dependence liability. I am basing this on the fact that most patients (and rodents and primates) experience all of their tolerance buildup before their first refill. Plus, people on benzodiazepines for only three months have relatively low rates of dependence compared to people who have been treated for five or ten years, suggesting that the difference between four weeks and three months is not "magical" in any way.


 * The other reason that quickly formed tolerance is troubling (even without a longterm dose escalation trend) is because tolerance indicates a change in physiology, and that is scary and significant on some level. If you adapt to a drug in *any way*, even if you adapt quickly, it means that you have reached a new homeostasis which includes the drug and you might experience rebound upon discontinuation.


 * There is good evidence that lab animals become tolerant to the anxiolytic effects of benzodiazepines (not just the sedative effects). This study (PMID: 10494573) shows tolerance in anxiety models that are not also measuring sedation by proxy (which is a problem with many animal models of anxiety). This study (PMID: 18277461) considers benzodiazepine anxiolytic tolerance so well documented that it mentions it in stride, and goes on to investigate how serotonin receptors are involved.


 * Tolerance is not an unequivocally bad thing. Diphenhydramine (Benadryl) causes very rapid and fairly dramatic tolerance to its psychotropic effects, but it very rarely causes dependence. Cocaine, on the other hand, actually causes sensitization (sort of reverse-tolerance), and cocaine is highly addictive. (Cocaine will cause tolerance, too, if it is used on a more frequent schedule and in larger doses than those doses that tend to cause sensitization.)


 * In the end, I think people should worry less about benzodiazepine dependence. It is not extremely common, and it is not a "devastating addiction." Worst case scenario, you find it absolutely impossible to come off the benzodiazepine (this is rare), and you have to think of ways to minimize the side effects (this is often possible with dose or drug changes).


 * Benzodiazepines are not evil and addictive drugs, but they DO cause tolerance, even to the anxiolytic effects. I should also point out that this is not nearly the same magnitude as, say, heroin tolerance. Heroin doses can often escalate to 20 times the original dose, sometimes more.Fluoborate (talk) 13:18, 7 May 2008 (UTC)

-- "Benzodiazepines are not evil and addictive drugs, but they DO cause tolerance, even to the anxiolytic effects" User:Fluoborate


 * "The developement of tolerance to the anxiolytic effects of benzodiazepines is a subject of debate. However, many patients can maintain themselves on a fairly constant dose. Increases or decreases in dosage appear to correspond with changes in problems or stresses."


 * from: Goodman and Gilman's "The Pharmacological Basis of Therapeutics", eleventh edition, 2006


 * chapter on benzodiazepines by Dennis Charney, MD, Professor, Departments of Psychiatry, Neuroscience, Pharmacology, and Biological Chemistry, Mount Sinai School of Medicine, New York, NY

Arrowsmith36 (talk) 23:42, 29 May 2008 (UTC)

You have to bare in mind that doctors supply the pills at a set dosage. Patients can't increase the dose or else they will run out. I smoke more when I am stressed and smoke less when I am not stressed.-- Literature geek |  T@1k?  00:10, 30 May 2008 (UTC)

-

"If anxiety is a classical benzodiazepine withdrawal symptom then that means it is typical that *tolerance occurs to the anxiolytic effect* otherwise anxiety wouldn't be a withdrawal symptom"

source: Literaturegeek, 6 May 2008

"The developement of tolerance to the anxiolytic effects of benzodiazepines is a subject of debate"

source: Goodman and Gilman's "The Pharmacological Basis of Therapeutics", eleventh edition, 2006, chapter on benzodiazepines by Dennis Charney, MD, Professor, Departments of Psychiatry, Neuroscience, Pharmacology, and Biological Chemistry, Mount Sinai School of Medicine, New York, NY


 * 1) A reasonable person would be more inclined to believe the opinion expressed in a world reknowned textbook on pharmacology than the opinion of an editor of a page on Wikipedia.


 * 2) Scientific evidence (see below) supporting the lack of tolerance to the anxiolytic effects of benzodiazepines has been deleted from the Wikipedia page by the editor.


 * 3) When both sides of a debatable issue are not presented, a reasonable person would conclude there is BIAS.


 * Arrowsmith36 (talk) 21:13, 31 May 2008 (UTC)

However, in 1992 Romach and colleagues reported that dose escalation was not a characteristic of long-term alprazolam users, and the majority of patients indicated that alprazolam continued to be effective. [45] A 2003 study did not support the hypothesis that long-term use of benzodiazepines frequently results in notable dose escalation. [46]

In a 1-year follow-up study of patients with panic disorder continuing treatment with clonazepam, 90% maintained a positive response without developing significant tolerance. In a 2.5-year follow-up study of alprazolam therapy, little evidence of tolerance emerged. [47]

^ Romach MK, Somer GR, Sobell LC, Sobell MB, Kaplan HL, Sellers EM (1992). "Characteristics of long-term alprazolam users in the community". J Clin Psychopharmacol 12 (5): 316–21. .

^ Soumerai SB, Simoni-Wastila L, Singer C, et al (2003). "Lack of relationship between long-term use of benzodiazepines and escalation to high dosages". Psychiatr Serv 54 (7): 1006–11. .

^ Pollack MH (1990). "Long-term management of panic disorder". J Clin Psychiatry 51 Suppl: 11–3; discussion 50–3. .


 * Arrowsmith36 (talk) 21:13, 31 May 2008 (UTC)

Hi Arrowsmith

Dennis S. Charney

Financial disclosures Bottom of this paper read financial disclosures. More financial disclosures Dennis Charney is heavily involved with multiple pharmaceutical companies including some of which who make benzodiazepines. It would be expected that a consultant for the drug companies would challenge whether tolerance occurs to benzodiazepines. This is why individual papers and individual doctors should not be used to challenge say FDA or committee on safety of medicines findings. It is only natural that some doctors many of whom work for the drug companies would say tolerance does not occur with benzos.-- Literature geek |  T@1k?  13:02, 8 June 2008 (UTC)

Pollack MH

Pollack works for Roche pharmaceuticals, pfizer and wyeth et. al., Conflict of interest the manufacturers of klonopin/rivotril, valium, ativan and xanax. Basically he is employed by just about every drug company that makes benzodiazepines. More conflicts, -- Literature geek  |  T@1k?  13:27, 8 June 2008 (UTC)

Elderly
I have added a section on the elderly because although many elderly people take benzodiazepines, there was not a section addressing this topic. Elderly people who take benzodiazepines face more pronounced side-effects such as cognitive problems and dementia-like symptoms, which is especially relevant with this age group because sometimes it is mistaken for true dementia. WarmRegards (talk) 22:35, 7 June 2008 (UTC)


 * I have reviewed your contribution, and agree that this is an issue worth covering. However, you didn't mention a recent observational study limiting the benefits from reductions in benzodiazepine use. Could it simply be that benzos are used in elderly who are restless, and that it is the restlessness that makes them fracture?
 * I would like you to replace the 1987 Ancill reference. There are much better sources available than a 21-year old paper descriptive paper including only 20 patients that is not on PubMed.
 * might need to be included too. JFW | T@lk  10:04, 8 June 2008 (UTC)

Thank you. I have replaced the 1987 reference with a review article that is more current. I did not know of the observational study and look forward to reading it. --WarmRegards (talk) 00:59, 23 July 2008 (UTC)

Peripheral Benzo Receptors
I added a paragraph about PBRs to the mechanism of action section, including a couple of references. This can be expanded, perhaps in a separate section, or probably should just be put in the existing PBR article)

More specific references may be desired, I got tired of tediously entering information in too-small type in my browser window.. Is there a tool (or perhaps a full wiki-specific web-browser based on Apple's cross-platform webkit?) for automatically generating references from, say, a page in PubMed, SpringerLink, SceinceDirect, Blackwell-Synergy, JBC, Wiley Interscience, etc, etc? —Preceding unsigned comment added by 216.9.143.129 (talk) 18:04, 19 June 2008 (UTC)

banner
I have added this banner because there have been quite a few significant additions from many users/IPs to the article in the past few weeks. I am not an expert on the subject but I feel that a quick review by an expert on the topic (possibly from the Pharmacology WProject) could improve this article. Katanada (talk) 20:05, 19 June 2008 (UTC)

I have been debating to myself that it may be worthwhile moving the tolerance and dependence and wthdrawal information all over to the benzodiazepine withdrawal wiki article and just having a short section perhaps the size of a couple of paragraphs with a main article link to benzo withdrawal above it. If that is done then I was thinking that a couple of short sections such as special precautions, contraindications would do nicely below the side effects section. What do you think? At a later date some of the sections could be split. For example overdose is very large and could have some of it's content moved to a drug overdose article. Can I have some comments on my ideas?-- Literature geek |  T@1k?  03:35, 20 June 2008 (UTC)

Currently this article is 100 KB in length and according to WP:SIZE, articles above 100 KBytes in size should "almost certainly should be divided". Hence I would support moving most of the material contained in the Physical dependence and withdrawal section to the benzodiazepine withdrawal syndrome article. Concerning adding information about special precautions, contraindications, etc., I would be support this as long as it were kept relatively brief. Boghog2 (talk) 04:49, 20 June 2008 (UTC)

Thanks boghog for your views. I have moved it over there. I will do special precautions and contraindications sections soon. If someone else wants to do it feel free.-- Literature geek |  T@1k?  05:15, 20 June 2008 (UTC)

Katanada, I am not sure though that the article needs flagged though. The reason for the flag given is because there have been several recent edits made by different users. This is probably the case for 50% of wiki articles. I propose removing the flag. If people have problems with the article they could raise those issues on the talk page as a way to improve the article.-- Literature geek |  T@1k?  06:09, 20 June 2008 (UTC)

I see the article is flagged for wiki pharmacology. I don't see any inaccurate pharmacological data.-- Literature geek |  T@1k?  06:13, 20 June 2008 (UTC)

Better late than never, I finally got around to adding the contraindications and interactions section. The article is looking more complete now I think.-- Literature geek |  T@1k?  15:56, 11 December 2008 (UTC)

Different articles for the chemical "benzodiazepine" and the benzodiazepine drug class?
Having the same article seems a little confusing, a bit like having to share one article between "opioid" and "morphinan". Admittedly, there is little to say about the chemical benzodiazepine, but the current page could conceivably be misread to contain molecular data about individual drugs, which would be wrong ...

RandomP (talk) 14:37, 19 November 2008 (UTC)

Yea but this is a class of medicinal drugs which are called benzodiazepines, hence why the article is called benzodiazepines and why it focuses on the therapeutic as well as the adverse effects of the drug.-- Literature geek |  T@1k?  12:55, 20 December 2008 (UTC)

Major updates to benzodiazepine article
I did some bold edits to the article. The article was huge and needed shortening. It was before my 90kb in size before my bold edits. I deleted virtually no material but moved it to other relevant pages. I moved a lot of the drug misuse, drug related crime, legal status data over to the newly created benzodiazepine dependence article. I felt that there was too much info about this in the article and that a healthy chopping down of these sections would benefit the article. I also felt the history section was too big and that most readers would get bored or tired reading all of it and give up. I have where ever relevant added "main article" or "see also" links to where more info and where info has been moved to for those who want to explore certain aspects of benzos in more depth. I think that it has brought improvements to this article.-- Literature geek |  T@1k?  13:02, 20 December 2008 (UTC)

Appropriate infobox?
I'm not sure what value the current infobox has. First of all, the data in the box is for a phenyl-substituted benzodiazepinone, not benzodiazepine as the title of the box suggests. See for one isomer of benzodiazepine itself. Secondly, although the compound shown represents a core chemical structure of some benzodiazepine drugs, it doesn't have any significant pharmacology associated with it (as far as I know), so it's relevance to the article is questionable. Perhaps instead of a chembox, the article should just show the chemical structure of a respresentative of the drug class, such as alprazolam. -- Ed (Edgar181) 00:32, 8 January 2009 (UTC)
 * Yes, I've taken the infobox out. The molecule displayed is not itself a marketed pharmaceutical, but several substituted compounds are. It might be useful to show the benzodiazepine isomers at some point in the article, but not anywhere where it would cause confusion between the unsubstituted heterocycles and the pharmaceuticals. Physchim62 (talk) 10:44, 28 January 2009 (UTC)

vandalism, insertion of misrepresented sources
Please check out the edits inserted into Europe-illegal use. The claims about Russian druglabs don't check against the ref, the ref doesn't mention temazepam at all. Two other refs are journalistic sources. These are not reliable as such. The ref "Hammersley et al." dates back to 1990. We have 2009, almost 20 years later. The Africa section is totally lacking citations. This abuse chapter is material, which did cost us weeks of work to check out and remove from the Temazepam article. 70.137.130.4 (talk) 19:25, 7 February 2009 (UTC)

If the references are false then they should be deleted or adjusted.-- Literature geek |  T@1k?  22:51, 7 February 2009 (UTC)

fact tags, nonbenzos, triazolam, temazepam
Inserted fact tags in North America, as I do not see the refs directly mentioning decline of temazepam or triazolam prescriptions in North America, neither the abuse of triazolam or temazepam. One ref describes Norway, in Norwegian. The other is some ER statistics, the third also unrelated to the statements by abstract. Don't have full text. I do not dispute a shift by the new medications, appears plausible, but these refs seem insufficient and only remotely connected to topic at hand. 70.137.165.53 (talk) 09:58, 6 April 2009 (UTC)

Thanks for spotting that. I deleted it. The main reference mentions "other benzodiazepines" unclassified so one would assume they include temazepam and triazolam. I deleted the data anyway as it was not backed up.-- Literature geek |  T@1k?  10:08, 6 April 2009 (UTC)

There is another insertion by somebody else, which I edited. It is the connection of temazepam to violence and trouble with the police, which I then correctly cited as "among Scottish young single homeless." Before this correction it sounded like a general phenomenon, making me fear that now the elderly are coming out of their retirement homes to beat up people with their crutches and then get busted by police. After my correction it is now a primary source of low importance about some local fad among certain Scottish homeless, Sarcasm on: who were probably upset that they only can afford lousy pills instead of a bottle of Scotch. End_Sarcasm. I would delete it for lack of general importance. As I previously said, the phenomenon of Scottish zombie flocks, who are stumbling through the streets with stretched arms, bitching, moaning, beating people up and raiding medicine chests is largely unheard of elsewhere. Except in the movie "The fog" and the likes. And I tell you they were pissed off because of no Whisky. 70.137.165.53 (talk) 11:25, 6 April 2009 (UTC)

Ya I know. I edited it after the entire abstract was copied and pasted and wrote in the edit summary that it probably wouldn't survive the good article review as it is a weak and unnecessary primary source. It might be relevant to the temazepam article. I left it in anyway and see what the outcome of review suggestions are.-- Literature geek |  T@1k?  11:41, 6 April 2009 (UTC)

Medicare, plan D
The restrictions on coverage of benzos under Plan D are not actually restrictions of availability. It just means they don't get subsidized with tax money. This is conceptually something else than a restriction on availability and doesn't belong into the context of that chapter. You just have to pay for them yourself, if you need them. I don't know what they prescribe instead, probably something horrible and inexpensive. Or they hit a rubber hammer over your skull instead of giving a tranquilizer. ;-) 70.137.165.53 (talk) 11:38, 6 April 2009 (UTC) 70.137.165.53 (talk) 11:38, 6 April 2009 (UTC)

Well spotted again. I got rid of that sentence. They probably don't cover benzos because of the lack of long term effectiveness and the problems with side effects and dependence. Probably antidepressants and maybe risperidal they would prescribe instead. There was only a smallish increase in older drugs like chloral when New York restricted benzo. Anyway I took it out the part saying they were restricted legally.-- Literature geek |  T@1k?  11:45, 6 April 2009 (UTC)

Benzo addiction by dopaminergic reward
Deleted. This is a highly speculative in-vitro experiment with patch-clamp technique on mouse brain slices - bunched up to the fully general answer of the long standing question why the Finnish (and Swedish) are drinking themselves to death in spite of tight prohibition, and why they are throwing in "goof-balls" like hell, if no booze, perfume or hair tonic spirit is available. I can answer that question, it is due to Calvinism, like with the Scots. 70.137.165.53 (talk) 12:17, 6 April 2009 (UTC)

Yea I know it was animal studies and a primary source. I didn't delete it because it is hard to find mechanism of action studies done in live humans and this seems to be a recent finding so tracking down a secondary source is rather difficult for new limited research. Even most review papers draw their info from animal lab studies when it comes to receptor activity. The reason I included it was that it was interesting from the point of view of why animals and humans will self administer benzos in drug abuse liability studies.-- Literature geek |  T@1k?  14:55, 9 April 2009 (UTC)

Now this is only a patch-clamp study on mouse neurons, and as such it only offers conjectures. Self-administration studies with animals have also delivered a mixed message, primates differing from mice and rats. Also there are some observations that the behavior of lab animals (i.e. mice and rats) is distorted by lab-typical very unnatural living conditions with a lack of space and natural stimuli in very crammed quarters under unnatural stress. There is a conjecture that the ratties are actually self-medicating under such conditions, and show unnatural response patterns to the chemicals, going even into the electrophysiology. Ratties in a spacious stimuli-rich and interesting environment and a with family around them and reproducing and nursing and sniffing around etc. couldn't care less for narcotics in these experiments and would self administer nothing but sun-flower seeds and cheese bits. It turns out that "rattie animal abuse victims self-administer drugs", analog to the fashion in which "socially deprived minority ghetto inhabitants self administer drugs". The conjecture is that stress-workers in low social positions are also more prone to sedative abuse than e.g. well off entrepeneurs with a shitload of money and a high social position. So to say benzos etc. are drugs for socially deprived underdogs and relieve their suffering. (Not to talk about religion as the opium of the people.) Indeed assembly line workers working against the clock do find benzos helpful. Why in hell would somebody without nagging existential fears self-administer anxiolytics? Attributing this all to brain chemistry is just a myopic view, which totally negates collective social-psychological diseases of the society. It parallels much the way in which previous generations tried to attribute the suffering of "ghetto-niggers" to their allegedly inferior genetic material in the racist theories of that time. Now it is not that the culprit any more, but the drugs are guilty of making them addicted. Fact is, a racist and merciless society makes those deprived of their natural right to the pursuit of happiness prone to drug abuse. And the arrogant shit science still tries to find biochemical excuses for these facts, hoping to find some natural law that would chemically explain why ghettos are swamps of vice and disease and ignorance. No, it is never the society, which became guilty on them by oppressing them for centuries. It is these satanic molecules in their brain, or their genes, depending on whom you ask, and when. So with this in mind the scope of patch-clamp electro-physiological studies on mice brain isolated neurons is rather limited and the results may be totally an artifact, keeping in mind that the functional brain of the healthy animal or human is a system in homeostasis. (-: No, homeostasis is not what the British think it is :-) 70.137.165.53 (talk) 04:41, 10 April 2009 (UTC)

Thank you for your explaination of your views. I agree and I am aware of the limitations of rat studies. When you deleted the primary source rat research discussing benzos and the reward center I did not revert you. So I am happy to leave it deleted from the article.-- Literature geek |  T@1k?  09:09, 13 April 2009 (UTC)

Slangy terms at the get go.
As a retired Physician - I can tell you that BENZOS is a bad opening look. I spent 43 years in US clinical practice and I have never ushered the term.

I have heard drug seeking patients use all kinds of fun street expressions - but not fellow professionals - no GP/MD would use benzo - if they did their colleagues would be rather shocked.

For those prescribed a benzodiazepine - ask your own GP or Physician.

It should not be in the opening sentence of an encyclopedic article. The DEA has a whole section on 'street slang' - though I have seen benzo in some web lit - Cleveland Clinic - but this is targeted at a specific audience - not WP. It reads BADLY. BeingObjective (talk) 15:22, 27 October 2023 (UTC)


 * Your personal experience does not decide what is deserving of mention in the article. Physicians, psychiatrists, and the like have and do use the term, as do non drug-seeking people in everyday language. Street-specific slang belongs in, but colloquial and literature-specific terms belong where they are. Moreover, see MOS:LEAD regarding the inclusion of those terms where they are, specifically considering the redirects.
 * I would agree with you if the article included words like "crank" (in the context of methamphetamine) that would never be used except in a recreational drug context, but these terms do belong here, where they are.
 * I would also ask you to please read WP:NPA, specifically regarding your attempts to shut down me and other editors by saying things like "you're not a doctor". The article includes a specific example along the lines of "You're a train fan, how could you know anything about fashion?" and mentions how that is behavior to be avoided. It is not constructive to collaborative editing.
 * Kimen8 (talk) 15:29, 27 October 2023 (UTC)
 * Not at the get go - makes this article look odd from the start - propose a compromise - not at the beginning - and provide a clinical citation - please stop pretending to be medical or clinical - we established this previously and I am trying to be respectful to your clear comical stalking of me - this is very easy to prove and many other editors are concerned about your stalking. BeingObjective (talk) 15:33, 27 October 2023 (UTC)
 * It does not look odd, because articles, by convention, include such terms in their opening sentence, as laid out in MOS:LEAD. Again, attempting to attack my credentials does nothing constructive (WP:NPA). Also, please WP:AGF, because an accusation of staking is obnoxious and disingenuous. Kimen8 (talk) 15:37, 27 October 2023 (UTC)
 * You could not comprehend the PROPOFOL emulsion dialog - I spent a lot of time explaining this to an audience of ONE - you sir/madam. And your edits - of typos and wording are of great value and I even thanked you for this - I asked you to stop the pretense - citing WP policy will not inform you of the subject. Recall this is all audit trailed and we can ALL see the pattern of stalking people - please, stop this behavior. See WP editing pols. BeingObjective (talk) 15:39, 27 October 2023 (UTC)
 * I just saw this in passing. One comment I have to make. If there is a consensus, please do not add the references a as bare link. See WP:CITE on formatting references. In any case, it's pretty standard include informal terms in the lead sentence, including terms that professionals in the relevant fields would consider incorrect. TornadoLGS (talk) 15:45, 27 October 2023 (UTC)
 * Understood - I made my case - the only objective here is to make the encyclopedic and NPOV. I agree this disputed language belongs in the article - NOT AT THE GET GO THOUGH - when I first read this, it did demean the article - cheers BeingObjective (talk) 15:51, 27 October 2023 (UTC)
 * My issue with how you've attempted to compromise is that it reads poorly. Instead of a handful of characters that are perfectly clear and concise, i.e., "(BZD, BDZ, BZs), colloquially called 'benzos',"
 * You've instead made an entire paragraph, in the opening section, that is needlessly verbose:
 * "clinical expression" is not very meaningful or particularly accurate,
 * the "sometimes referred to in some settings and even patient directed literature" is implied by putting it in the opening sentence where it was previously, and
 * the mention of street names is more in context in.
 * I think the original way the alternative names were presented was clearer, more concise, and consistent with convention.
 * Kimen8 (talk) 15:51, 27 October 2023 (UTC)
 * SLANGY and sets a poor imprecise tone from the get go. Can you not put it lower in the article section - I did try to compromise on this but you are blindly adamant it needs to go at the opening - I see no reasons for this.
 * I even explained in painful detail to you - as I have had to do in many medical articles.
 * You did not even write this - you appear motivated just to create conflict - please stop doing this.
 * I'd discuss the stalking issue - this is really now a concern. BeingObjective (talk) 15:55, 27 October 2023 (UTC)
 * There is a difference between alternative names and "slang". "Slang" terms belong in the society and culture part as has been said repeatedly. The terms here are not that.
 * My insistence that they go where they were is clearly motivated: clearness and conciseness, and consistency with convention. I said why your change makes it less clear and less concise, and why the original location was better in my opinion.
 * Moreover, I am not sure why you feel the need to assume bad faith. You are consistently ignoring WP:AGF, and assuming that I'm here to create conflict. You're correct that I didn't write this, but I am interested in making changes that make it more readable or keep it readable, as I assume you are. You didn't write this either, and yet I'm not assuming that you're here just to create conflict, because I WP:AGF. This entire attitude makes collaborative editing excessively difficult.
 * Likewise, you need to stop accusing me of stalking. I don't know why you feel that is happening, but your accusation is inappropriate and offensive.
 * Please re-assess your approach to collaborative editing, WP:AGF, and please WP:NPA.
 * Kimen8 (talk) 16:00, 27 October 2023 (UTC)
 * I think reviewing your edits of mine - tell all editors that you are targeting me and stalking - I asked you to politely stop doing this. You seem polite - but we all traced your last several edits - it is clear you are going to my change list - most of your edits are small typos - and I thanked you for this diligence - other editors have also noted this. Go and look at the edits you made in the last three days - most are corrections that I made - random - perhaps, I think an Admin might see the clear pattern. You missed the fact that one compound was not even marketed anymore - but belabored this article unnecessarily - prime example of non-constructive editing - please stop this now! BeingObjective (talk) 16:10, 27 October 2023 (UTC)
 * See the ICI correct of yours. See the NSAID corrects - and at least seven other articles - you are stalking - stop this behavior. BeingObjective (talk) 16:11, 27 October 2023 (UTC)
 * If I see ONE more clear act of stalking from you or this account - I will file a complaint - I feel this is almost BULLYING - my perception - it is VERY easy to prove - the are many articles to mess with and I have been following the newcomer recs. YOU HAVE BEEN FOLLOWING me - stop now - please!!! BeingObjective (talk) 16:20, 27 October 2023 (UTC)

Jordan Peterson vs Benzodiazepines
3 videos on this channel: https://www.youtube.com/watch?v=hKw4orqKkVY — Preceding unsigned comment added by 80.99.194.58 (talk) 23:02, 30 August 2020 (UTC)

Add it, IF you can find a reliable source.Dgndenver (talk) 05:04, 22 January 2022 (UTC)