Question:

these people are rare to the point of becoming extinct.

well put my friend the training in psychiatry in the past 10 years has lent itself to a more medical model as the original degree included both (usually) analytical training plus nuerology-a psychiatrist used to be both a nuerologist medical doctor and therapist. Since the advent of behaviorism and the consolodation of many purer fields of psychology and their various schools of thought the psychiatric roles have diminished as did the training-people prefered to get a phd level or similar in psychology (clinical) as oppossed to psychiatry who basicaly became the medical case managers of inpatient care in hospitals. As medicine plays a greater role in the treatment of so called psychiatric disorders the role of the md level doc starts to change-but as managed care opposses this specialty it cannot change as the gp level doc can also administer drugs and this is usualy the case as its cheaper. So the training of the psychiatrist today is still limited by lack of motivation to go into it-lack of direction based upon funding schools-lack of therapeutic training due to all the above and a plethora of docs graduating with little clinical training or experience in therapy as oppossed to medicating-some of this has been addressed in congress to allow phd level psychologists to rx meds with some additional medical training-but imo their training is not enough nor could it be without a full rotation of residency in all fields of medicine. Like an optometrist who can prescribe meds vrs an opthomologist who can perform surgery. This is why I found my initial training as incomplete and continued with a graduate degree in psychology as well. Shipko uses a more analytical approach based upon some of his training in ericksonian psychology that I am sure he has formulated and pursued well beyond the surface of what he was taught in med school. The older docs of yesteryear who were trained analyticaly and then expounded within post grad programs and a pretty heady medical training to boot are indeed becoming extinct-unfortunately. Perhaps what comes around goes around and this too shall change again as we grow tired of poor medical care. just my thoughts. LM

Response:

I must be be one lucky person to have a private doctor and therapist that are full of updated information pertaining to anxiety disorder, panic disorder and depression. I find it hard to believe toget the best advise elsewhere.

I am happy for you, unfortunately it’s rather rare as we can read here every day… Philip, have you had problems with your doctor or therapist? I am sorry if you did.

I have seen a number of therapists/pdocs in the course of the last 31 years and they were invariably nice people whom I could get along with very well. Of course thirty years ago PD was called *anxiety neurosis* and they gave youy psychoanalytic treatment. *PD* in its current definition wasn’t *invented* until 1981. At this moment I have a pdoc who prescribed me the meds I want <g and I don’t see him at all unless I feel I need to which I don’t. I haven’t seen him for over a year. I would call him when I feel something should be changed regarding my medication but there is no reason for that now. Then there is the CB-therapist, a very nice guy, but I don’t seem him often either as I have to *practice* exposure now and should be able to do that on my own. In the past I had pdocs trying weird meds on me because of lack of knowledge but I don’t hold that against them as not much was known about PD in those days. I am, however, concerned abnout the division between *therapy* and *medication*. I feel it would be better is the therapist would also be the one to prescribe medication, IMO this should be a psychiatrist. These days it seems as if the beautiful profession of psychiatry, a truly humanistic discipline combining care for the body with care for the soul, all too often is reduced to mere pill-pushing. Fortunately there are the likes of Stuart Shipko or LM Margrove <g whose approach of things gives one some hope but as a rule it seems that these people are rare to the point of becoming extinct. Sometimes the best advise is not heeded, thus making recovery difficult. Or  reaction to the medication. All of us are unique individuals with different levels of toloerance. But the more that we communicate with our private doctors. the better it will be for us.

Absolutely. And for them. We can read here *every day* accounts of PD-ers started on a much too high dose of an antidepressant or being denied a benzodazepine and these are just *basic* things, there is so much more to treating PD than just handing out medication. This is why we *have to* educate ourselves and educate our doctors in the process. Philip – Hide quoted text — Show quoted text –

Response:

- Hide quoted text — Show quoted text – Benzodiazepine      Comparative    Time         Half-life                    dose           to peak                                   plasma                                   level Alprazolam            .5           1   – 2       9   –  20 Bromazepam           3.0            .5 – 4       8   –  30 Chlordiazepoxide    25             1   – 4      24   – 100 Clonazepam            .25          1   – 4      19   –  60 Clorazepate         10             variable      1.3 – 120 * (unreliable absorption) Diazepam             5             1   – 2      30   – 200 * Estazolam            1              .5 –  .6     8   –  24 Flurazepam          15              .5 – 1      40   – 250 * Halazepam           40             1   – 3      30   –  96 * Ketazolam            7.5           3.2          30   – 200 Lorazepam            1             2 4           8   –  24 Nitrazepam           2.5            .5 – 7      15   –  48 Oxazepam            15             2   – 3       3   –  25 Prazepam            10             2.5 – 6      30   – 100 Quazepam             7.5           1.5          39   – 120 * Temazepam           10             2.5           3   –  25 Triazolam             .25          1   – 2       1.5 –   5                                                           * metabolites Quantam in una hora imputas? I’m posting this as have had a few requests for it. (NB: I’ve had this list for ages and can’t guarrantee its accuracy.) ——- Generic             Trade        Half-life of         Mg equivalent Name                names        drug or              to 10 mg                                 active metabolite    diazepam                                 S:    <  12 hr                                 M: 12 –  40                                 L: 40 – 200 ——- Alprazolam          Xanax        S                    1 Bromazepam          Lexotan      S – M                6 Chlordiazepoxide    Librium          M – L           25                    Nova-pam Clobazam            Frisium          M – L           20 Clonazepam          Rivotril             L            2                    Klonopin Clorazepate         Tranxene         M – L           15 Diazepam            Valium               L           10                    D-Pam                    Pro-pam Flunitrazepam       Rohypnol         M – L            1 Flurazepam          Dalmane              L           15 – 30 Loprazolam          Dormonoct    S                    1 –  2 Lorazepam           Ativan       S – M                1 –  2                    Lorapam                    Lorzem Lormetazepam        Noctamid     S                    1 –  2 Medazepam           Nobrium          M – L           10 Prazepam            Centrax          M – L           10 – 20 Nitrazepam          Mogadon          M               10                    Insoma                    Nitrados Oxazepam            Serenid      S – M               20                    Serepax                    Serax                    Benzotran                    Ox-pam Temazepam           Euhypnos     S – M               20                    Normison                    Somapam Triazolam           Halcion      VS (2-4 hr)          0.5                    Hypam                    Tricam ——-

Maybe I am a little confused, but it seems like the first chart says that Klonopin is twice as strong as Xanax, whereas in the second chart the reverse seems to be true.  Am I just misreading?

Response:

**If anyone replies with medical information, it is best to post the site and the author, so that the persons may look up the information. A person had asked for comparisons of Ativan and Valium and I found this chart. As always your private doctor is your best source of information!

This is the classic benzo equivalence chart. The thing with these charts is that you have to take them with a small grain of salt as different meds may affect different people in different ways. It’s very good as general information but it is really important how it is used and I wish I could agree with you that one’s private doctor is *always* the best source of information… Philip – Hide quoted text — Show quoted text – Benzodiazepine Equivalence Charts      Brought to you by George Davidson      Courtesy of Felicity Plunkett BS FRCPC) A while ago people were interested in relative doses of benzodiazepines. This is a table which I find useful. It is difficult to compare them on the same scale since they differ in their anxiolytic, sedative, and antipanic effects, but this table provides a rough comparison useful for managing benzodiazepine taper or withdrawal. Thus, oxazepam 15 mg is roughly similar to diazepam 5 mg. edition, Bezchlibnyk-Butler et al. editors (Clarke Insitute of Psychiatry, Toronto), Hogrefe & Huber. Benzodiazepine      Comparative    Time         Half-life                     dose           to peak                                    plasma                                    level Alprazolam            .5           1   – 2       9   –  20 Bromazepam           3.0            .5 – 4       8   –  30 Chlordiazepoxide    25             1   – 4      24   – 100 Clonazepam            .25          1   – 4      19   –  60 Clorazepate         10             variable      1.3 – 120 * (unreliable absorption) Diazepam             5             1   – 2      30   – 200 * Estazolam            1              .5 –  .6     8   –  24 Flurazepam          15              .5 – 1      40   – 250 * Halazepam           40             1   – 3      30   –  96 * Ketazolam            7.5           3.2          30   – 200 Lorazepam            1             2 4           8   –  24 Nitrazepam           2.5            .5 – 7      15   –  48 Oxazepam            15             2   – 3       3   –  25 Prazepam            10             2.5 – 6      30   – 100 Quazepam             7.5           1.5          39   – 120 * Temazepam           10             2.5           3   –  25 Triazolam             .25          1   – 2       1.5 –   5                                                            * metabolites Quantam in una hora imputas? I’m posting this as have had a few requests for it. (NB: I’ve had this list for ages and can’t guarrantee its accuracy.) ——- Generic             Trade        Half-life of         Mg equivalent Name                names        drug or              to 10 mg                                  active metabolite    diazepam                                  S:    <  12 hr                                  M: 12 –  40                                  L: 40 – 200 ——- Alprazolam          Xanax        S                    1 Bromazepam          Lexotan      S – M                6 Chlordiazepoxide    Librium          M – L           25                     Nova-pam Clobazam            Frisium          M – L           20 Clonazepam          Rivotril             L            2                     Klonopin Clorazepate         Tranxene         M – L           15 Diazepam            Valium               L           10                     D-Pam                     Pro-pam Flunitrazepam       Rohypnol         M – L            1 Flurazepam          Dalmane              L           15 – 30 Loprazolam          Dormonoct    S                    1 –  2 Lorazepam           Ativan       S – M                1 –  2                     Lorapam                     Lorzem Lormetazepam        Noctamid     S                    1 –  2 Medazepam           Nobrium          M – L           10 Prazepam            Centrax          M – L           10 – 20 Nitrazepam          Mogadon          M               10                     Insoma                     Nitrados Oxazepam            Serenid      S – M               20                     Serepax                     Serax                     Benzotran                     Ox-pam Temazepam           Euhypnos     S – M               20                     Normison                     Somapam Triazolam           Halcion      VS (2-4 hr)          0.5                     Hypam                     Tricam ——- * Sent from RemarQ http://www.remarq.com The Internet’s Discussion Network * The fastest and easiest way to search and participate in Usenet – Free!

Response:

**If anyone replies with medical information, it is best to post the site and the author, so that the persons may look up the information. A person had asked for comparisons of Ativan and Valium and I found this chart. As always your private doctor is your best source of information! Benzodiazepine Equivalence Charts      Brought to you by George Davidson      Courtesy of Felicity Plunkett BS FRCPC) A while ago people were interested in relative doses of benzodiazepines. This is a table which I find useful. It is difficult to compare them on the same scale since they differ in their anxiolytic, sedative, and antipanic effects, but this table provides a rough comparison useful for managing benzodiazepine taper or withdrawal. Thus, oxazepam 15 mg is roughly similar to diazepam 5 mg. edition, Bezchlibnyk-Butler et al. editors (Clarke Insitute of Psychiatry, Toronto), Hogrefe & Huber. Benzodiazepine      Comparative    Time         Half-life                     dose           to peak                                    plasma                                    level Alprazolam            .5           1   – 2       9   –  20 Bromazepam           3.0            .5 – 4       8   –  30 Chlordiazepoxide    25             1   – 4      24   – 100 Clonazepam            .25          1   – 4      19   –  60 Clorazepate         10             variable      1.3 – 120 * (unreliable absorption) Diazepam             5             1   – 2      30   – 200 * Estazolam            1              .5 –  .6     8   –  24 Flurazepam          15              .5 – 1      40   – 250 * Halazepam           40             1   – 3      30   –  96 * Ketazolam            7.5           3.2          30   – 200 Lorazepam            1             2 4           8   –  24 Nitrazepam           2.5            .5 – 7      15   –  48 Oxazepam            15             2   – 3       3   –  25 Prazepam            10             2.5 – 6      30   – 100 Quazepam             7.5           1.5          39   – 120 * Temazepam           10             2.5           3   –  25 Triazolam             .25          1   – 2       1.5 –   5                                                            * metabolites Quantam in una hora imputas? I’m posting this as have had a few requests for it. (NB: I’ve had this list for ages and can’t guarrantee its accuracy.) ——- Generic             Trade        Half-life of         Mg equivalent Name                names        drug or              to 10 mg                                  active metabolite    diazepam                                  S:    <  12 hr                                  M: 12 –  40                                  L: 40 – 200 ——- Alprazolam          Xanax        S                    1 Bromazepam          Lexotan      S – M                6 Chlordiazepoxide    Librium          M – L           25                     Nova-pam Clobazam            Frisium          M – L           20 Clonazepam          Rivotril             L            2                     Klonopin Clorazepate         Tranxene         M – L           15 Diazepam            Valium               L           10                     D-Pam                     Pro-pam Flunitrazepam       Rohypnol         M – L            1 Flurazepam          Dalmane              L           15 – 30 Loprazolam          Dormonoct    S                    1 –  2 Lorazepam           Ativan       S – M                1 –  2                     Lorapam                     Lorzem Lormetazepam        Noctamid     S                    1 –  2 Medazepam           Nobrium          M – L           10 Prazepam            Centrax          M – L           10 – 20 Nitrazepam          Mogadon          M               10                     Insoma                     Nitrados Oxazepam            Serenid      S – M               20                     Serepax                     Serax                     Benzotran                     Ox-pam Temazepam           Euhypnos     S – M               20                     Normison                     Somapam Triazolam           Halcion      VS (2-4 hr)          0.5                     Hypam                     Tricam ——- * Sent from RemarQ http://www.remarq.com The Internet’s Discussion Network * The fastest and easiest way to search and participate in Usenet – Free!

Response:

I must be be one lucky person to have a private doctor and therapist that are full of updated information pertaining to anxiety disorder, panic disorder and depression. I find it hard to believe toget the best advise elsewhere. Philip, have you had problems with your doctor or therapist? I am sorry if you did. Sometimes the best advise is not heeded, thus making recovery difficult. Or  reaction to the medication. All of us are unique individuals with different levels of toloerance. But the more that we communicate with our private doctors. the better it will be for us. WRiting a list of questions and concerns prior to the appointment will help you ask the most important questions. This way all you needs should be covered. * Sent from RemarQ http://www.remarq.com The Internet’s Discussion Network * The fastest and easiest way to search and participate in Usenet – Free!

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