Free Ashton Manual
Table of Contents
Contents
Introduction
Chapter 1: The benzodiazepines: what they do in the body
Chapter 2: How to withdraw from benzodiazepines after long-term use
Chapter 2: Slow withdrawal schedules
Chapter 3: Benzodiazepine withdrawal symptoms, acute & protracted
Supplement
THE ASHTON MANUAL SUPPLEMENT, APRIL 2011
IMPORTANT MESSAGE FROM PROFESSOR ASHTON, JANUARY 2007
FOREWORD TO REVISED EDITION, AUGUST 2002
ABOUT PROFESSOR C HEATHER ASHTON, DM, FRCP
CHAPTER 1. THE BENZODIAZEPINES: WHAT THEY DO IN THE BODY
The benzodiazepines
Potency
Speed of elimination
Duration of effects
Therapeutic actions of benzodiazepines
Mechanisms of action
Adverse effects of benzodiazepines
Oversedation
Drug interactions
Memory impairment
Paradoxical stimulant effects
Depression, emotional blunting
Adverse effects in the elderly
Adverse effects in pregnancy
Tolerance
Dependence
Therapeutic dose dependence
Prescribed high dose dependence
Recreational benzodiazepine abuse
Socioeconomic costs of long-term benzodiazepine use
Table 1. Benzodiazepines and similar drugs
Table 2. Therapeutic actions of benzodiazepines
Table 3. Some socioeconomic costs of long-term benzodiazepine use
Fig. 1. Diagram of mechanism of action of the natural neurotransmitter GABA (gamma aminobutyric acid) and benzodiazepine on nerve cells (neurons) in the brain
CHAPTER 2. HOW TO WITHDRAW FROM BENZODIAZEPINES AFTER LONG-TERM USE
Why should you come off benzodiazepines?
Before starting benzodiazepine withdrawal
Consult your doctor and pharmacist
Make sure you have adequate psychological support
Get into the right frame of mind
Be confident
Be patient
Choose your own way
The withdrawal
Dosage tapering
Switching to a long-acting benzodiazepine
Designing and following the withdrawal schedule
Withdrawal in older people
Withdrawal of antidepressants
- 1. Withdrawal from high dose (6mg) alprazolam (Xanax) daily with diazepam (Valium) substitution
- 2. Simple withdrawal from diazepam (Valium) 40mg daily
- 3. Withdrawal from lorazepam (Ativan) 6mg daily with diazepam (Valium) substitution
- 4. Withdrawal from nitrazepam (Mogadon) 10mg at night with diazepam (Valium) substitution
- 5. Withdrawal from clonazepam (Klonopin) 1.5mg daily with substitution of diazepam (Valium)
- 6. Withdrawal from clonazepam (Klonopin) 3mg daily with substitution of diazepam (Valium)
- 7. Withdrawal from alprazolam (Xanax) 4mg daily with diazepam (Valium) substitution
- 8. Withdrawal from lorazepam (Ativan) 3mg daily with diazepam (Valium) substitution
- 9. Withdrawal from temazepam (Restoril) 30mg nightly with diazepam (Valium) substitution
- 10. Withdrawal from oxazepam (Serax) 20mg three times daily (60mg) with diazepam (Valium) substitution
- 11. Withdrawal from chlordiazepoxide (Librium) 25mg three times daily (75mg)
- 12. Withdrawal from zopiclone (Zimovane) 15mg with diazepam (Valium) substitution
- 13. Antidepressant Withdrawal Table
CHAPTER 3. BENZODIAZEPINE WITHDRAWAL SYMPTOMS, ACUTE AND PROTRACTED
Mechanisms of withdrawal reactions
Individual symptoms, their causes and how to deal with them
Insomnia, nightmares, sleep disturbance
Intrusive memories
Panic attacks
Generalised anxiety, panics and phobias
Psychological techniques
Complementary medicine techniques
Exercise and other techniques
Sensory hypersensitivity
Depersonalisation, derealisation
Hallucinations, illusions, perceptual distortions
Depression, aggression, obsessions
Muscle symptoms
Bodily sensations
Heart and lungs
Problems with balance
Digestive problems
Immune system
Endocrine problems
Fits, convulsions
Extra medication during benzodiazepine withdrawal
Antidepressants
Beta-blockers
Hypnotics and sedatives
Other drugs
Benzodiazepine use during and after withdrawal
Diet, fluids and exercise
Smoking
Protracted withdrawal symptoms
Anxiety
Depression
Insomnia
Sensory and motor disturbances
Possible mechanisms of persisting sensory and motor symptoms
Poor memory and cognition
Do benzodiazepines cause structural brain damage?
Gastrointestinal symptoms
Coping with protracted symptoms
How long do benzodiazepines stay in the body after withdrawal?
Epilogue
Education
Research
Treatment methods
Provision of facilities
Table 1. Benzodiazepine withdrawal symptoms
Table 2. Antidepressant withdrawal symptoms
Table 3. Some protracted benzodiazepine withdrawal symptoms
Table 4. Some possible causes of protracted benzodiazepine withdrawal symptoms