164400341 the Complete Ashton Manual Works PDF

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Ashton Manual Works
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  Preface BENZODIAZEPINES: HOW THEY WORK AND HOW TO WITHDRAW   (aka The Ashton Manual) ã Protocol for the Treatment of Benzodiazepine Withdrawal ã Medical research information from a benzodiazepine withdrawal clinic  Professor C Heather Ashton DM, FRCP Revised August 2002  ã  Ashton Manual Index Page ã Contents Page ã Introduction ã Chapter I: The benzodiazepines: what they do in the body ã Chapter II: How to withdraw from benzodiazepines after long-term useã Chapter II: Slow withdrawal schedules ã Chapter III: Benzodiazepine withdrawal symptoms, acute & protracted  CONTENTS PAGE   FOREWORD 2001   FOREWORD TO REVISED EDITION, AUGUST 2002 ABOUT PROFESSOR C HEATHER ASHTON, DM, FRCP SUMMARY OF CONTENTS MEDICAL DISCLAIMER CHAPTER I. THE BENZODIAZEPINES: WHAT THEY DO IN THE BODY Background About this chapter  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  - i -  Preface 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 Further reading 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 II. HOW TO WITHDRAW FROM BENZODIAZEPINES AFTER LONG-TERM USE Background 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 Further reading Slow withdrawal schedules  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  - ii -  Preface CHAPTER III. BENZODIAZEPINE WITHDRAWAL SYMPTOMS, ACUTE AND PROTRACTED   Mechanisms of withdrawal reactions   Acute withdrawal symptoms   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  Course of withdrawal   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?  - iii -  Preface Epilogue  Education Research Treatment methods Provision of facilities  Further reading  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  - iv -
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