D.J. Jaffe

http://youtu.be/-CwM4wMOBiw


How to prepare for an emergency
by
D.J. Jaffe
Sometime, during the course of your loved one’s illness, you may need the police. By preparing now, before you need help, you can make the day you need help go much more smoothly. There are three things to do.
First, you should establish contact with your local precinct, before you need help. (That’s right. Violate your loved one’s privacy and get them flagged by the local cops. This way, they will know to show up with one hand on their balls and the other hand on their tasers.)
Secondly, you should have the attached info sheet filled out in duplicate, ready at all times.
Thirdly, you should read the article at the end of this page on how to make 911 respond to your calls. (The part where we explain how to make a false report and support it with “evidence” such as furniture we turn over ourselves to make it look like our loved one is violent.)
1. ESTABLISH CONTACT WITH PRECINCT
Someday your loved one may be missing from home or hospital. Normally, the police will not fill out a missing persons report & start looking for them until they are gone 24 hours. But by making arrangements beforehand, you can insure that if this happens to you, they will start looking immediately. Or, let’s say your relative is becoming increasingly agitated & uncontrollable & you have to call the police to take them to a hospital. It is very likely that the police will go to the hospital of their choice, not yours. But by making arrangements beforehand, you can have a say in where that person is taken. In addition, if your relative is picked up for some crime (drugs, let’s say); by making prior arrangements, you can help see that they go to a hospital instead of jail. Finally, it may make it easier for you to get someone involuntarily committed, if & when you have to do that.
The way to make these arrangements is to call the “Community Patrol Officer Program” (C-POP Officer) at your local police precinct, now, before you need help. If you do not have a C-POP program (i.e, outside NYC), call the station commander.
Tell them that you have a MI relative at home & that you want to make the police aware of it, in case you ever need help. Tell them you are worried that if they are ever missing the police won’t start looking until after 24 hours; or that if you need police to take your relative to a hospital, they won’t go to the one you want; or that if your relative is busted, they will go to jail, instead of to a hospital. Tell the C-POP (pronounced, “see-pop”) officer, that it was suggested that individuals with MI relatives contact the C-POP officers, before help is needed to make them aware of the situation, & that is why you are calling. The officer may think this is unusual, but you should do it anyway. FOLLOW THE CONVERSATION UP, WITH A LETTER ADDRESSED TO THE C-POP OFFICER & SEND A COPY TO THE PRECINCT COMMANDER.
If you ever do need help, call 911 if it’s an emergency. If not, call your local precinct. When the police come, mention the C-POP Officer & Precinct Commander by name. The police who come to your door do not know what to expect. By mentioning these names, you help calm them & help identify that it is not you who needs help, it is your relative. They will also be more likely to listen to you, & may even get the Commander on the phone or walkie talkie. Because you have prepared ahead of time, they are more likely to take the person where you want them to be taken, & to listen to you carefully. Be calm. (and bring donuts)
2. PREPARE INFORMATION & HAVE IT READY
If your relative needs emergency hospitalization, it will be extremely stressful to everyone. It is made more difficult by the myriad of questions that need to be answered. By having the answers to these questions written and ready, you can insure that the emergency hospitalization will not only be less stressful, but that your relative is more likely to get proper care. For instance, identify his doctor, & what medicines he is currently on, so those medicines can be continued, increased, or removed as appropriate. Indicate what hospital you use. Below is a form you should fill out. After filling it out, make two copies & keep one on hand (in your wallet) all the time. One for you, one for the police, one for the hospital.
FILL OUT THE FOLLOWING FORM AND KEEP DUPLICATES HANDY
CRISIS INFORMATION PAGE (FOR POLICE/HOSPITAL/EMS)
Please take this person to _____________________hospital.
This person is not a criminal. He/she has a mental illness. Please treat with compassion and dignity. Thank you. (That part is to assuage your conscience, so you can sleep without concern that your loved one has been arrested, hand-cuffed, four-point-restrained, or coerced under threat of physical force to remove them from their home to a locked facility where they will be drugged and, perhaps, restrained to a bed, placed in an empty room with a mattress on the floor, or even electroshocked against their will with your consent. Better yet, just invent your own definition of compassion and dignity to include these degrading human rights violations.)
Name__________________________________Age_________
Address____________________________________________
____________________________________________________
Telephone_______________________Birthday____________
Social Security #______________Blue Cross #_____________
Blue Shield #_____________Other Med Ins #_____________
Is on SSI?_________Is on SSDI?________Other?__________
Eye Color______Hair Color_________Skin______________
Blood Type_________Eyeglasses?_______
Height_______________Weight__________________
Tatoos? Other Identifying Marks_______________________
Military/VA Status?__________________________________
Current Primary Diagnosis____________________________
Secondary Diagnosis__________________________________
Name of Commanding Officer where patient lives______________
Name of Community Officer where patient lives_________________________
Precinct Phone Number______________________________
Name of Doctor______________________________________
Doctor’s Phone Number_______________________________
Name of Hospital____________________________________
Current Medicines and Dosages________________________
___________________________________________________
Suicidal?_____________Violent?________________________
Date of Last Hospitalization_________How Long?________
Date of Last Crisis____________________________________
Allergies?________________Hi Blood Pressure?__________
Name of outpatient program___________________________
Number of outpatient program________________________
Name of Case/Social Worker__________________________
Number of Case/Social Worker________________________
In Emergency Contact________________________________
Relationship to Patient________________________________
Address_____________________________________________
Day Phone__________________Eve. Phone____________
How to make 911 respond to your calls
(This article was based on information provided by Dr. Darwin Buschman, Chief Psychiatrist, Manhattan Mobile Crisis Intervention Services.)
Individuals with neurobiological disorders (“NBD” formerly known as serious mental illnesses) are occassionaly danger to themselves, suicidal and/or danger to others. When this happens, you may want to call 911.
It is often difficult to get 911 to respond to your calls if you need someone to come & take your MI relation to a hospital emergency room (ER). They may not believe that you really need help. And if they do send the police, the police are often reluctant to take someone for involuntary commitment. That is because cops are concerned about liability. They don’t want to be sued for taking someone to the ER involuntarily. Another reason is that they must stay with the person until he or she is admitted. This can take between 2-48 hours. Cops don’t want to sit in ER; sergeants don’t want to take two police off the streets. Following is how you can make 911 & the police overcome their reluctance to help.
When calling 911, the best way to get quick action is to say, “Violent EDP.” Or “Suicidal EDP.” EDP stands for Emotionally Disturbed Person. This shows the operator that you know what you’re talking about. Describe the danger very specifically. “He’s a danger to himself” is not as good as “This morning my son said he was going to jump off the roof.” Be specific. “He’s a danger to others” is not as good as “My son has just struck a neighbor for no reason.” Also, give past history of violence. This is especially important if the person is not acting up. Again, be specific. “Every time my son gets psychotic, he has hurt himself. Last spring, he cut his wrists. I think he’s going to do it again.”
When the police come, they need compelling evidence that the person is a danger to self or others before they can involuntarily take him or her to ER for evaluation. If the person stops acting out by the time police arrive, this can be difficult. Again, give specific recent examples of danger.
Realize that you & the cops are at cross purposes.
You want them to take someone to the hospital. They don’t want to do it. You need to get on common ground with the cops to gain their cooperation. Say, “Officer, I understand your reluctance. Let me spell out for you the problems & the danger. I understand that if you take my son to the ER involuntarily, you’ll have to wait with him until the doctors make a decision on whether to admit. I also understand your concern about litigation if you take him involuntarily. Therefore, why don’t we work together so my son goes voluntarily.” Cops will often change their attitude dramatically if you say this. If a person goes voluntarily, the cops don’t have to stay in the ER. They don’t have to use handcuffs. If a person goes involuntarily, they go the same way, except in handcuffs. This can often be used to convince a person to go voluntarily. You can say, ” I know you don’t want to go, but I think you need to go.” The cops can say, “You’re going to go one way or another, cuffs or no cuffs.” Usually the person will go voluntarily when faced with this choice. (Threats work! We call this giving them a “choice”. You can get a woman to “voluntarily” have “sex” with you using the same methods. “Either you let me put my penis in your vagina, or I hold you down and shove it in. Either way, you’re going to get fucked.” See how effective that can be? If you have a gun or a taser like the cops will have when they come for your loved one, you can very quickly get the woman to “voluntarily” have “sex” with you.)
Once the person is taken to the ER, cops leave. So it’s a good idea to have a family member accompany the patient. Let the ER security guard, triage nurse, & others know that the person is MI & a danger to self or others. When you go to ER, make sure you have the “How to Prepare for Emergencies” form that is in this newsletter (Note: This is a form with the name, address, SS#, Med history, current med, diagnosis, name and number of doctor, name and number of next of kin, insurance, etc. In other words, all the info you would be asked in an emergency).
911 should be first resort in an immediate emergency, & the last resort when it’s not. If your family member needs help, not necessarily hospitalization, try Mobile Crisis Intervention Services.
The fact is that some families have learned to ‘turn over the furniture’ before calling the police. Many police require individuals with neurobiological disorders to be imminently dangerous before treating the person against their will. If the police see furniture disturbed they will usually conclude that the person is imminently dangerous.
Read How and why to change involuntary treatment laws in your state.
THANK YOU FOR YOUR SUPPORT WHICH MADE IT POSSIBLE FOR US TO PROVIDE THIS INFORMATION TO THOSE WHO COULD BENEFIT FROM IT.
NAMI/ NYC (formerly AMI/FAMI) does not endorse any medicines or treatments. This info is a public service as part of our efforts to educate and help others affected by these disorders. Do not rely on it. Consult your doctor before making any decisions. NAMI/NYC is a non-profit dedicated to improving the lives of people with neurobiolgical disorders (“NBD”, formerly known as ‘mental’ illness) through education, advocacy, support, and research. If this has been useful to you, PLEASE JOIN US . Send a deductable contribution of $30 (or more) to NAMI/NYC, 432 Park Avenue South, New York, NY 10016 to get on our mailing list or call (212) 684-3AMI. To join chapter outside NYS: 1 800 950 NAMI. This was downloaded from http://www.schizophrenia.com/ami

Signs and Symptoms of Magnesium Deficiency

With thanks to Sepp Hallberger, who posted this on his blog - go visit him!
http://www.newmediaexplorer.org/sepp/

Dr. Ashton's Benzodiazepines Co-operation Not Confrontation (BCNC) Group

http://www.bcnc.org.uk/

"Do You Have a Problem with Benzodiazepines or Z drugs?

Do You Need Help and Support?

The group is known as: Benzodiazepines Co-operation Not Confrontation (BCNC). It is primarily aimed at prescription supplied benzodiazepines, although help will be given wherever it is needed...

We need people to join us in helping to run this group which will be a local branch of what will eventually be a nationwide group whose aim amongst others is to challenge current knowledge of benzodiazepine and Z drugs in the medical profession and to change it for the better. This will include reducing prescribing rates for benzodiazepines and Z drugs beyond 2 - 4 weeks to new patients and improved withdrawal guidance and knowledge for managing long term users of benzodiazepines or Z drugs.

The benzodiazepine problem is largely a medically induced one and if it is to ever change it will require the medical profession to change. This website it is hoped will provide knowledge for the long term users of benzodiazepine or Z drugs internationally, to recruit volunteers to take up the task of changing the medical professions views on benzodiazepines and Z drugs and as well as to serve as a platform to get our views across to the medical profession.

Long term use of benzodiazepines is associated with considerable numbers of both general and mental health problems Included amongst these are over sedation, which has contributing effects on Road Traffic Accidents, accidents in the home and also accidents at work, forgetfullness, depression, anxiety, panic attacks, emotional blunting, suicidal thoughts, and an extreme or irrational fear of open or public places (agorophobia).

These side effects as well as others are more pronounced in the elderly often causing mental confusion and dizziness which results in falls and fractures which often leads to hospitalisation.

There are over 1.2 million people dependent on this class of drug in the UK. Are you or any of your family affected by the dependency on long term prescription supplied benzodiazepines, which can be used by the medical profession for a variety of illnesses both of the physical and psychological nature?"

PROTOCOL FOR TREATMENT OF XANAX WITHDRAWAL

Our friend Gwen Olsen talks about the dangers of highly addicting tranquilzers and how to withdraw safely.

Gwen Olsen spent fifteen years as a pharmaceutical sales rep working for such health care giants as Johnson & Johnson, Bristol-Myers Squibb, and Abbott Laboratories. She enjoyed a successful, fast-paced career until several conscious-altering experiences began awakening her to the dangers lurking in every American medicine cabinet. Her most poignant lessons, however, came as both victim and survivor of life-threatening adverse drug reactions. After leaving pharmaceutical sales in 2000, Gwen worked in the natural foods industry first as an Account Manager for Nature's Way, and then as a Regional Sales Manager for Gaia Herbs. She is currently a writer, speaker, and natural health consultant.
In this video Gwen discusses anxiolytics (anti-anxiety medications). These medications are sometimes also called minor tranquilizers. These drugs include the benzodiazephines such as Valium, Xanax and Ativan. Buspar is also non-benzodiazephine anxiolytic.
These drugs are highly addictive and people experience severe withdrawal symptoms when coming off of these drugs.
Gwen specifically talks about her own Xanax addiction.
She also discusses "rebound syndrome" and "discontinuation syndrome", which are basically just withdrawal symptoms.

http://www.gwenolsen.com/

http://www.youtube.com/psychtruth

Food for thought... seems to be in keeping with the approach of Dr. Heather Ashton, though taking a different tack.

Reposted from http://www.benzoliberty.com/information/xanaxwd.php

"PROTOCOL FOR TREATMENT OF XANAX WITHDRAWAL
By: Ronald A. Gershman, M.D. 

PLEASE NOTE THAT WE DO NOT HAVE A DATE FOR THIS ARTICLE
BUT THERE IS VERY VALUABLE INFORMATION IN IT.
ADDITIONAL DUE DILIGENCE SHOULD ALWAYS BE DONE TO TRY TO CONFIRM RESEARCH
SUCH AS THE FOLLOWING EVEN THOUGH THE DOCTOR
APPARENTLY PRACTICED AT CEDAR SINAI HOSPITAL IN LOS ANGELES 


BACKGROUND 


Xanax is a triazolobenzodiazepine that is very similar to other benzodiazepines
in most of its properties, but does have some properties that distinguish it from
the group in general, which are specifically its anti-panic and anti-depressant properties.
As an anxiolytic or anti-anxiety agent, it functions more or less indistinguishably from other benzodiazepines.
In that capacity, it is a relatively short-acting anti-anxiety agent with a half life of somewhere between 8 and 12 hours. 

Xanax, when administered on a regular basis, will produce physiological dependence
with a severe withdrawal syndrome that relates to both dose and duration of usage,
with duration being more important than actual dosage.
Higher doses will produce more rapid physiologic addiction than lower doses,but severe levels of physical addiction can occur in even the low therapeutic range of dosaging at 1 mg. or 2 mg. per day.
Average length of time necessary to occur to the extent that the patient will clinically experience clearly noticeable symptoms of withdrawal is approximately four to six months at dosages between 2 mg. to 4 mg.
If there is a history of addiction to benzodiazepines, an addiction can occur
much more rapidly over a shorter period of time, with a more intense withdrawal. 

Since Xanax is a relatively short-acting agent, the symptoms of withdrawal have a relatively rapid onset and rapidly accelerate, producing severe dysphoria and symptoms of withdrawal in the patient beginning at approximately six hours from the last dose and generally peaking at
approximately 24 to 72 hours after discontinuation.
What has become clinically apparent with Xanax which appears to be somewhat different than the other benzodiazepines is that the patients ability to self-detox or be able to be gradually tapered off of the medication is markedly more difficult. Thusly, once the physiologic dependence has occurred with Xanax, the ability of the patient to discontinue use successfully on their own is quite low, and medical assistance becomes of significant necessity in the majority of cases. 




--------------------------------------------------------------------------------
THE WITHDRAWAL SYNDROME
The withdrawal syndrome from Xanax and other benzodiazepines are quite similar, with the exception that Xanax has a much higher incidence of panic attack and a bereavement type of emotional lability that is singularly more severe.
Since the symptoms are almost all internal, with a few physical or objective manifestations,
the diagnosis of it can be very difficult. Patients have a difficult time verbally describing
what is occurring, and much of the descriptions often take on a quality or character
reminiscent of the emotional or psychiatric problem for which they originally
began taking Xanax, and is not understood or elucidated as withdrawal symptomology. 

The withdrawal syndrome, though, is quite clearly different and can be easily diagnosed
with a clear understanding of some of the more defining features.
In the early stage of withdrawal, there is a presentation of a sense of anxiety and
apprehension associated with increasing subjective sense of tremor and mild bifrontal headache.
This rapidly progresses to feelings of panic-like anxiety with tachycardia and palpitations,
as well as a rapidly progressing feeling of de-realization, which is an altered sense of reality, additionally associated with marked startle response and a general amplification of most sensory input. As the withdrawal syndrome progresses, there is a marked disturbance of proprioception, with difficulty in ambulation relative to feeling "dizzy" and "unsteady,"
needing to use reference and physical objects to steady oneself. With the proprioceptive problem increasing in severity simple acts such as swallowing, signing one's name, talking or even buttoning a shirt can become extremely difficult. Many patients at this stage describe
hot/cold sensations and generalized myalgia. 

There is also a progession of extreme emotional lability with sudden outbursts of crying or near panic levels of anxiety and fearfulness which will have sudden onset without clear connection to external events.
Associated with this are frequent hypochodriacal fears of morbid consequence from the sensations they are feeling, such as fear of heart attack or stroke.
Patients will also experience a type of emotional dysphoria which is very difficult for them to verbalize, but which come very close by cumulative description to a bereavement type of feeling that is very painful emotionally.
Additionally, the amplification of almost all sensory information coming into the brain,
other than that of taste, can produce many bizarre misinterpretation of sensory stimulation ranging from feeling one's teeth rotating in their sockets to parts of their bodies disassociating or "falling off". 

As the withdrawal symptom further progresses, illusionary and hallucinatory phenomena, predominately of a visual nature, will begin to manifest themselves, initially with patterns and geometric shapes, and then into full-formed complex visual hallucinations. These also often will become associated with delusions of bodily dysfunction or discorporation.
It is very frequent and common for the patient to conclude that he is having a nervous breakdown, or "going crazy" as an attempt to try to understand the process at hand,
not understanding it as withdrawal phenomena.
With further progression, disorientation to person and place will occur with full delirium, and eventually withdrawal will finalize with tonic-clonic major motor seizure activity,
generally singular in nature, although several cases of status have been reported. 

The last triad of symptoms--of hallucinosis, delirium and seizure--are classified as major symptoms of Xanax withdrawal, with the others classified as minor symptoms.
The withdrawal syndrome can take from six months to two years to fully resolve and is well-documented in literature regarding this.
Not all patients will experience withdrawal symptomology for that length of time, but most will have withdrawal for at least several months. 

TREATMENT APPROACH 

The treatment approach is focused primarily on the utilization of Tegretol, which has been shown to be extremely effective in preventing and of the major symptoms of Xanax withdrawal, as well as attenuating significantly most of the minor symptoms.
The Tegretol is utilized along with Klonopin as a cross-over benzodiazepine to stabilize and
to create control of withdrawal until adequate Tegretol blood levels have been achieved,
then allowing one to discontinue the Klonopin.
The total length of treatment will span somewhere between 10 to 30 days which, relative to the natural course of this withdrawal syndrome, actually represents a short period of time. 

The first step is to estimate the total daily dose of Xanax and start the patient on an equivalent amount of Klonopin, which relates to Xanax on a ration of 2 mg. Klonopin to 1 mg. of Xanax.
Thusly, a patient with a daily dose of 4 mg. of Xanax would be givena single bedtime dose of Klonopin at 8 mg., which will quickly and effectively stabilize them and prevent further symptoms of withdrawal. Additionally, the patient is started on Tegretol at 50 mg. three times a day and is increased by 50 mg. increments until a total daily dose of 400 mg. daily, in divided doses q.i.d., is achieved, at which the first Tegretol blood level will be ascertained.
It will generally take four to seven days to reach therapeutic blood levels. 

Since Klonopin has an extremely long half life of 40 to 60 hours, the patient is well covered with a single bed time dosaging, and this benzodiazepine has shown little abuse potential for drug seeking behavior and provides smooth, steady serum levels during the course of treatment.
Generally, beginning day 2 or 5, the dose of Klonopin is decreased as the dose of Tegretol being increased. Since therapeutic levels of Tegretol can often be achieved while the patient is being titrated to a therapeutic blood level of Tegretol, the Klonopin is reduced at a rate of approximately 1 mg. per day. generally, with doses in excess of 6 to 8 mg. per day of Klonopin,
there is enough time with this rate of withdrawal to slowly establish a Tegretol level without neurotoxicity during the cross-over, and there is little probability of any breakthrough major symptoms of withdrawal due to Klonopins very long half life.
Since both Klonopin and Tegretol are very potent anti-convulsants, the incidence of seizure has been essentially 0 in over 300 cases that we have treated so far. The Klonopin is thusly being
decreased at 1 mg. daily until one reaches 1 mg., at which point decreases are then done by 0.25 mg. increments anywhere from once a day, on average, once a week. 

It is important to understand that Tegretol has a significant impact on auto-induction of liver enzymes, and initially, for the first exposure to Tegretol, a dose as low as 200 mg. may produce a blood level in the therapeutic range of somewhere between 4 to 10 mcg/L necessary for control of seizure and withdrawal; but as liver enzymes are induced, increasing doses will be necessary over the necessary weeks to maintain an adequate blood level. The average dose eventually that is achieved in steady state with induction of liver enzymes is somewhere between 400 mg. and 800 mg. daily, with an average of approximately 600 mg.
Additionally, the half life of Tegretol will be essentially 20 to 26 hours when initially used,
but will progressively shorten as liver enzyme induction takes place, approaching a half life as short as six to eight hours and requiring multiple daily dosaging at that time. 

The major complications with Tegretol are neurotoxic effects when blood level will be generally too high, or above the level of 10 mcg/L, or due to an accumulation of its first order epoxide metabolite.
These complications of neurotoxicity present themselves as nauseousness and vomiting, significant sedation, dizziness and dyscoordination.
Also frequently reported is a sense of significant gastric retention with delayed gastric emptying.
Although the side effects of Tegretol can be successfully treated with Reglan, Tigan and/or Antivert, it is far better to slowly titrate the dose and avoid developing these side effects.
The presense of them can be ascertained to represent blood levels that are unacceptably high and
to slow the rate of increasing of the Tegretol dosage.
There is a small percentage of the population of people who simply do not tolerate Tegretol because of the GI side effects. 

As noted, Tegretol is almost 100% effective in controlling major symptoms of Xanax withdrawal,
but will very in its effectiveness in attenuating the minor symptoms,
thus requiring sometimes slower titration down off the Klonopin.
It is infrequent that one needs to go slower than once a week in the 0.25 mg decreases,
and often one can be decreased on a daily basis without symptoms of withdrawal, but at times the decrease may have to be as slow as once a month.
Once the patient is off the Klonopin and on the Tegretol in a steady state basis, the patient is maintained on Tegretol for approximately one to two months after achieving this state, and then tapered off of the Tegretol over a four to five day period of time.
Should there be a recurrence of withdrawal symptomology, then the Tegretol is reinstated for an additional month, and then the process repeated. 

CBC and checks of white blood count should be done periodically while the patient is on Tegretol.
There often will be mild leukopenia with white count at 3000 to 4000 found with Tegretol, which is benign.
The incidence of agranulocytosis is extremely rare with Tegretol, and there is support in the literature for the lack of need for rigorous routine white count testing while on this medication.
Prudence, though, would require some periodic evaluation of white blood count while the patient is being maintained on the Tegretol. 



--------------------------------------------------------------------------------
POST WITHDRAWAL TREATMENT
Once the patient has been successfully detoxed off Xanax and/or the Tegretol, the issues of underlying conditions, such as Agoraphobia, Panic Disorder, Generalized Anxiety Disorder, or Major Depressive Disorder, often must still be dealt with.
Whereas Buspar is of no utility in managing Xanax withdrawal or Xanax-generated anxiety,
it can be quite helpful for anxiety that is non-benzodiazepine withdrawal related, and patients, after completion of withdrawal, can be, and often have been, successfully maintained on Buspar at 40 to 60 mg. daily as a final dose with good control of underlying anxiety.
Treatment of Panic Disorder and/or Agoraphobia will often require a tricyclic anti-depressant in conjunction with Buspar, with essentially good success.
The introduction of the anti-depressant can be begun at the time withdrawal is started,
or can be deferred to a later date, depending on the intensity and frequency of panic attacks that the patient may be having. 

It should be kept in mind that a patient with underlying Agoraphobia or Panic Disorder
will have a marked exacerbation of his/her pre-existing illness during the course of withdrawal.
It is often then of necessity to start an anti-depressant to stop panic attacks in order to get the patient through the withdrawal process successfully.
The presence of a tricyclic will not interfere materially in any way with the medications for withdrawal. 

Patients having gone through this process will generally need a significant degree of emotional support and constant re-assurance during the withdrawal stage that they are indeed in withdrawal and are not suffering some morbid physical or psychiatric disorder other than the withdrawal process.
Weekly visits with medication management, plus frequent phone consultation generally is what is required and generally produces a successful outcome on an outpatient basis.
In more severe cases, and in situatioons where time or efficiency is paramount, then inpatient treatment is the most effective route to be travelled, and the detoxification can be accomplished much more rapidly in that modality.


It is critically important during the course of this that the patient refrain from use of all psychoactive drugs, particularly alcohol and stimulants, as well as over the counter preparations that contain pseudoephedrine and phenylpropanolamine.
Lastly, caffeine must be avoided by the patient for a period of approximately six months to one year.
Caffeine is a benzodiazepine antagonist and will occupy the receptor site, blocking Klonopin or other agents and intensify withdrawal markedly. Innocuous or inadvertant ingestion of high doses of caffeine is often a major complication to the withdrawal process,
and patient education in this area is very important, as well as reassurance should it happen that it will wear off within a relatively short period of time. 

Lastly, for patients who have severe symptoms of tachycardia or palpitations as an attendant withdrawal symptom, the addition of a beta blocker such as Atenolol at 50 mg. q. day is highly effective in stopping this and generally does not need to be continued for more than 4 to 6 weeks."

"Cold turkey" withdrawal from Xanax can be a very harmful thing to do. You may feel as if you are having a heart attack, a seizure, or rebounding (needing more than what you were originally on). And studies indicate that "cold turkey" has a lower success rate than tapering.

Tapering schedules here for Xanax and other kinds of medications:
http://www.benzo.org.uk/manual/bzsched.htm

Info on Xanax
http://en.wikipedia.org/wiki/Xanax

DOCTOR YOURSELF by Dr. Andrew Saul - Audiobook

http://www.archive.org/details/DoctorYourself
Free to download - DOCTOR YOURSELF by Dr. Andrew Saul - a wonderful audio book about how to build health with good food.

Would you like to read the passages too? Dr Saul's website is here: http://www.doctoryourself.com/

Treatment for Benzodiazepine Withdrawal by Charles Gant, N.M.D., Ph.D.

http://www.alternativementalhealth.com/articles/benzo.htm  Link

Treatment for Benzodiazepine Withdrawal by Charles Gant, N.M.D., Ph.D.   
 

(This protocol should not be used in place of a recommended treatment provided by your health care provider and should only be used with their approval.  I have found this protocol to be useful for many of my patients but I cannot guarantee that it will be effective for everyone.  Normally, I would recommend a full integrative medicine workup including amino acid plasma levels, RBC minerals, essential fatty acids and other diagnostic testing to determine precisely which of the interventions noted here are actually needed.)

Benzodiazepines are a class of drugs often used as tranquilizers. Full information on "benzo" problems is available at www.benzosupport.org
 
Here is my current and ever-changing protocol for benzodiazepine withdrawal. 
 
1) GABA 500 to 2000 mg., two or three times a day (GABA, like tyrosine, may not cross the BBB unless the patient is very stressed and it appears that the studies that suggest that GABA does not cross were done on unstressed subjects.) 
 
2) Theanine 200 to 600 mg., two or three time a day (Theanine competes with glutamate receptors to mitigate the neuroexcitatory effects. In another elegant balancing mechanism, the brain balances glutamate (excitatory) which is made into the generally inhibitory GABA (requires B6) The theanine in green tea may be one reason that the also present caffeine does not seem to stimulate tea drinkers as much.) 
 
3) P5P (pyridoxal-5-phosphate) 50 mg. - One capsule two or three times a day (Some people don't phosphorylate B6 well). (Vitamin B5)
 
4) Glutamine powder - One level teaspoonful twice a day to three heaping teaspoonfuls a day, dissolved in water, one hour before meals, last dose at bedtime (Especially important for hypoglycemic patients, as glutamine deficiency is by far the main immediate cause of hypoglycemia and glutamine is the precursor for glutamate). 
 
5) Magnesium taurate - 1000 mg. twice a day to 2000 mg. three time a day 
 
6) Salt food lightly with NuSalt/NoSalt (potassium chloride) 
 
7) 5HTP - 100 mg. twice a day to 200 mg. three times a day 
 
8) Purified soy lecithin - 1000 mg. three times a day (B5 (pantethine (not pantothenic acid) needed to acetylate the choline to acetylcholine, generally relaxing and downregulating of catecholamines) 
 
9) Pantethine 500 mg. - One twice a day 
 
10) Optizinc - 20-30 mg. twice a day. (Lowers the commonly high copper, which inhibits 5HTP decarboxylase. Activates digestive enzymes to help with amino acid absorption.) 
 
11) Lipoic acid - 300 mg. twice a day (oral chelation for neuroexcitatory heavy metals, especially mercury) 
 
12) Mutivitamin/multimineral 
 
13) Distilled fish oil (omega 3) 4000 mg a day and Borage oil (omega 6) 1000 mg. a day (Essential fatty acids ultimately increase the neuroplasticity of cell membranes, possibly assisting receptor activity). 
 
14) Add herbal "sedatives" if necessary 

http://www.understand-andcure-anxietyattacks-panicattacks-depression.com/5-htp-Melatonin.html Did you know that sleep deprivation is used as a torture technique? Sleeplessness can occur during meds withdrawal, and Melatonin and 5HTP can help - this article explains need-to-know biochemistry.

Another Doctor on Big Pharma’s Payroll

When Dr. Victor Tapson, a Duke University researcher, wrote the Food and Drug Administration urging that the agency delay the approval of a generic blood thinner, it was a recommendation that carried some clout. Tapson, after all, was writing on behalf of the American College of Chest Physicians. But now it seems Tapson has some explaining to do. A Senate Finance Committee report released last week found that Tapson was on the payroll of a pharmaceutical company that was trying to protect its profits by blocking the release of a generic rival. POGO Investigator Paul Thacker explains how Tapson was part of a major lobbying push by drugmaker Sanofi-Aventis. Link