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Breaking through the benzos and booze blues

Old 01-25-2011, 11:27 PM
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Breaking through the benzos and booze blues

When I went to see my shrink today, I was armed. I didn’t have a weapon (I know many of us fantasize about taking one), but I did have a slew of notes, questions and doubts.

I was still taking what he wanted: 25 milligrams of Seroquel, 250 milligrams of Depakote, 50 milligrams of Zoloft. He knew that I’ve suffered since going cold turkey four months ago, going from 20 milligrams of Klonopin to zero. I quit the Mirtazipine and Belladonna with phenobarbital, too. And I stopped drinking.

He supports my desire to get off the meds. “Just stop taking the Seroquel and Depakote,” he said. I told him I’d rather slowly taper, and he was readily amenable to that – to appease me. He insists the level of Depakote in my blood would show that it was barely a therapeutic dose, doing little to stabilize my moods, and I could quit everything but the Zoloft. “Stay on the Zoloft for your depression.’’

“I put you on Depakote to stabilize your cravings’’ he said. Most people are on Depakote for seizures, migraines or bipolar disorder, and they’re on large dosages – from 800 to 1,500 milligrams. I passed on the serum test, which he said he offered to prove his point, “to make you more comfortable that you don’t have to taper these drugs.” I believe him; from what I’ve read, 250 milligrams of Depakote is a low dose. The manufacturer’s website suggests starting at 500 milligrams, then bumping up to as high as 1,500 milligrams.

So he switched my Depakote from an extended- to single-release tablet so I can slice the heck out of it, taper it as I see fit.

The Seroquel, an atypical antipsychotic, was prescribed for sleep. “That’s a common off-label use,” he said. Dosages of 300- to 500- milligrams are for schizophrenics. Yeah, that scares me too.

“Just take the Seroquel every other night for a few days and then quit,’’ he said. But I told him I was going to dice those puppies up, too, taper it nightly for a few weeks, and then work at the Depakote after I see where unhitching my caboose from Seroquel leaves me.

On his advice, I cut Seroquel from 50 milligrams to 25 milligrams in December. A few weeks later, depression slammed me to the mat. I’m just getting over it. Then again, it was Christmas, and Seroquel isn’t an antidepressant.

And then we went at it, hashing over the same thing: I’m trying to convince him that I’m suffering long-term withdrawal symptoms from benzodiazepines. And that yanking someone off of 20 milligrams of Klonopin was brutal.

In wobbly baby steps, I’m getting better. I don’t notice it every day, but this month is better than last month, and last month was certainly an improvement over November. October was rough; September a horror flick.

But the depression is pronounced. Since I quit booze the same time I quit benzos, I worry whether I’m trapped in two hells, experiencing protracted alcohol withdrawal while simultaneously recovering from a decade of benzo use. I can’t rule anything out; addiction equals denial.

Abstaining from alcohol isn’t a party. Do I irrationally think that a few beers would settle my nerves? Yeah. But tonight, here and now, isn’t the time to find out. Neither is tomorrow, but I’ll work that out then.

But I think it’s the benzos, not the booze, that’s wreaking havoc on my brain. Has removing alcohol from my life caused depression? Makes sense to me. Is it the lack of beer making my fingers cold and numb? I don’t know. Would this feeling that a tight metal cap is stuck to my scalp by a million hot needles go away with a stiff jolt? I doubt it, and I don’t want to find out.

The agoraphobia is getting better. I’m finding more and more that I have to drag myself out of this cocoon of an apartment to prevent the madness from taking root. The fatigue, more than anything else, stops me from exercising like I used to; or maybe I’m just lazy. So I chain smoke.

My shrink doesn’t buy into this benzo biz. He says I’m just getting used to finding my own answers, not those found in a little pill. I’ll give him that.

Look, I’ve tried to look at this benzo stuff with a detached eye, but even with an objective tack, I have to give credence to the people on this and other forums: What we are experiencing is very real – we have profound physical and psychological issues after coming off of benzodiazepine.

But he doesn’t think so. “People like you, who spend their time on those websites, are just craving the drug,” he said. “Their symptoms are simply your mind wanting a pill to solve their problems. It’s all psychological. You blame the big pharmaceutical companies for you problems. People on those forums are making themselves depressed. They’ve never faced the issues of dealing with their problems before the drug, and it’s the symptoms of those problems that they’re dealing with now.”

Ah…so he has finally looked at the websites. How else could he have zeroed in on our disdain for “Big Pharma?” That we blame money-grubbing corporations for pushing benzos on doctors and blame our doctors for giving us benzos like candy in a Pez dispenser.

OK. So I hit him with this: “Listen, I buy that quitting benzodiazepine is probably going to leave someone with the same problems they had before taking them – anxiety, insomnia, depression. But these people are reporting symptoms worse, far worse, than anything they experienced before taking the drug.

And they have symptoms they didn’t have before – tinnitus, vertigo, numb feet and hands, muscle pain, a pins-and-needles feeling, non-stop headaches – and people with a history of anxiety are now having panic attacks, people who just couldn’t fall asleep easily are now walking around like zombies, not sleeping for days or weeks.”

I found this website when looking for answers to my symptoms, and it was an eye opener. I never had tinnitus before, and I find it’s prevalent among many people getting off benzos. So is the crushing depression, heavier than we’ve felt before, along with wide-eyed anxiety and trembling fingers. I know you can read about a symptom and create it: the mind obsesses on a tick; the body follows with a twitch. I buy that. But I can’t buy that this is only a craving, especially since this appears to be unlike any addiction I’ve read about.

The heroin addict quits heroin, suffers, the drug leaves his body and then he’s left with the demons that caused him to take the drug in the first place. But the actual physical symptoms of heroin withdrawal are gone after the drug leaves his system. Are junkies anxious and depressed without a baby blanket of smack to protect them from life? I’m sure. But their physical withdrawal symptoms don’t persist, don’t ebb and flow, don’t diminish one day and creep up behind his back the next. He doesn’t develop physical and psychological symptoms he didn’t have before.

I have to believe that there is something to benzodiazepines that makes them unique from all other addictive drugs. I accept the theory that benzo use alters brain chemistry, that this class of drugs delays healing, delays the body’s ability to return to a normal state as quickly as it does after detoxing from other drugs. There are thousands of people on this forum who are truly struggling with symptoms they didn’t have before benzos. And other drugs you would think would quell those symptoms – alcohol or barbiturates or antidepressants – seem to makes the symptoms worse. Before benzos, we could drink coffee; now it’s like a strong amphetamine. Before benzos we could take cold medicine; now, if we do, our skin crawls. We could eat Chinese food; now, MSG sends us up the wall. Heck, the sugar in a candy bar can rattle us to the core.

I told him all of this.

But I was just confirming his diagnosis of my obsessive compulsiveness: I was only looking for answers because these thoughts persistently loll about my brain, a storm flag hanging in blue skies. God knows, I spend hours on these websites. But I didn’t quit:

“I can’t dismiss that people on this forum are unlike me, that they took nowhere near the dosage of Klonopin I was on for ten years, and they didn’t abuse alcohol like I did. These are hapless, hardworking, straight-as-an-arrow folks who were put on these meds by a general practitioner or a psychiatrist who left them on Xanax or Klonopin or Valium for years, and they grew to hate what the drug was doing to them. Or the drug petered out and they had to take more.

“And these persistent symptoms have hit people who were only on benzos for weeks, or a couple of months. There are a lot of people who fought the fight, stayed off, and after a year or more they finally come back online and say, ‘Hey, I’m finally better. I’m better, than before I took the drug. And that goes for being off of the antidepressant I kicked after beating the benzos.’ What’s up with that?”

Without hesitation, he said, “Don’t trust what you read on the Internet. These people are just whining about their problems instead of working to fix them. They blame everyone else. So, just like you, they sit on the Internet, just sit at their computers and obsess, which exacerbates their symptoms. And these websites make money, you know.”

Let me step back a minute. He obviously glanced at these websites, but he sure didn’t dive into them. I told these websites are nonprofit efforts. I said that the owners and administrators and moderators for this site and others I frequent are unpaid, that the sites have no advertising, that their volunteer effort was responsible for saving many a soul who thought they were going crazy, people in need, people who were surprised to stumble on the site and find they were not alone. People like me, who found assurance and support on the Internet, something we couldn’t find in a doctor’s office.

I said this wasn’t a patients’ movement; the only agenda was to heal. I told them of Dr. Ashton’s research and work, of her slow-tapering method, and that few if any medications have been found to address the symptoms – unlike drugs for the alcoholic, or methadone for the heroin . I said I could find no other doctor or scientist who seemed to understand what we were going through other than Dr. Ashton.

Sure, we trash the medical establishment and “Big Pharma,’’ and why not? I’ve read – albeit obsessively – the drug information from every benzo manufacturer. Drug trials last for weeks, but people take benzos for years; it’s not that great of a logical leap to surmise science hasn’t learned the entire lesson from the guinea pig.

And maybe people are biased against money-sucking corporations – labels didn’t warn them they shouldn’t take benzos longer than a few weeks. “And when they rail against their doctors,” I said, “perhaps it’s because they heard – nearly verbatim – exactly what you’re telling me. That it’s in my head. Well, where else would it be?”

To his credit, he is very anti-benzodiazepine. “It’s a dangerous drug,’’ he’s said a dozen times. He’s been very hesitant to bash my former shrinks, but during my last appointment, he did question the wisdom of a doctor prescribing anyone 20 milligrams of Klonopin, let alone giving them any dosage of the drug for the 11 years I took it.

I have learned to admit that I played the docs to medicate my discomfort; after all, it’s not hard to pull a woeful tale from my past. I still damn them for listening to me. And I ignored the label on the bottle saying to stay away from the other bottle – the phrase “alcohol may intensify the effect of this medication” was a beer commercial to me.

It’s not my new shrink’s fault that I had to withdraw cold turkey; he insisted that in order to “safely’’ withdraw, I would have to do so as an inpatient. After I stopped drinking and taking Klonopin for a week, I went to his office with my bag of clothes, ready to be admitted. He had changed his mind. He said I had done well over the weekend and that he decided he would treat me as an outpatient.

I did well? That weekend I went to the emergency room three times – shaking, shivering, and stammering incomplete sentences through clenched teeth. My heart pounded – I could feel the staccato beats in my head. My blood pressure soared – I saw the veins in my wrists pulse.

I hadn’t slept for five days. Lying on the couch, I would watch a calf muscle twitch – see the muscle bulge – a tiny alien poking, testing the thickness of the skin. In the same instant, a bolt would zap through my leg to my heart to my shoulder and make my entire arm jerk. And it did it again and again, from one part of my body to another, up and down, sapping my strength.

You know that first, whole-body stretch in the morning, when you tense every muscle in your body? And after you yawn like a bear, how that wave of warmth and feeling of rest washes over you? Put yourself at the broadest point of that stretch, when muscles from your neck to your calves are fully clenched, and then wait for a yawn that never comes. When you’re totally wound up, tight as a drum head, imagine every fiber of your flesh, every sinew, on fire, the membrane of every cell stretched to the ripping point. Hold that feeling right there – that’s what my body felt like.

Are those seizures? If so, I had dozens.

Each time I went to the emergency room, the nurses asked these questions: “What happened? Were you in an accident?”

I guess you could say I tripped up a few decades ago.

“Have you ever had a heart attack?”

Well, no, but this could be the first…I’m pretty darned certain I’m dying here, and I would kindly appreciate ANYTHING YOU CAN DO TO SAVE MY FREAKING LIFE.

Each time I was given an EKG, then a beta blocker, and I was told I needed to be admitted. When I told them I had no insurance, that I just needed drugs, they shot me up with Valium and sent me home. When the Valium wore off, I was worse than before.

The Monday I showed up at my shrink’s office to be admitted, damned the cost and damned the consequences. I had my son and daughter-in-law in tow – the poor kids who had watched me shake and shudder and panic and sweat and moan for the past 72 hours.

“I was thinking about you over the weekend,” my shrink said. (I would think so, since the emergency room doctors called you in the wee hours of the morning for the past three nights.) “And I think we can accomplish this as an outpatient. You’ve shown your determination by not drinking for a week and not taking Klonopin (I don’t have any Klonopin, you twit) so I’m now willing to work with you this way.”

I went home. I e-mailed my old shrink. He wrote back: “Reducing Klonopin as you have is going cold turkey, and in going cold turkey, your chance of having a seizure is 50-50. Regardless, you’re going to be very sick.”

He didn’t mention that I’d become a walking, talking, raving psychotic. I’m lucky I didn’t hurt someone or kill myself. The hallucinations weren’t like the delirium tremens – I don’t think. The hallucinations didn’t start 24 to 48 hours after cessation of alcohol, nor did they end within five days, as the literature about the DTs suggest. I’m absolutely certain that detoxing from alcohol contributed to my fingernails slipping from the ledge of sanity, but it wasn’t until the seventh or eighth day after I quit drinking and taking Klonopin that I became certifiably crazy.

It started with auditory hallucinations.

Not just a tune rolling around in the back of my brain, but actual music coming from a distinct place in my dining room, an invisible stereo hanging at a specific point, emitting some cool Santana jams. Then it changed – to Barry White. I hate Barry White. I suppose it could have been worse – I would have jumped from the window if it was Wayne Newton.

I won’t go into detail about the psychosis part, other than to say it was the most frightening time of my life. I snapped out of a few of those episodes, got lost in others. I now recall each as a vivid dream. After the taxi rides to the emergency room, my son had to call an ambulance to take me to the hospital. I don’t remember the ambulance attendants tying my ankles and wrists together with soft cloth, placing me on a gurney. My son made a video with his smart phone of that seminal moment – a digital postcard from beyond the edge, something to call your friends and family over to watch.("Call the kids! Look – this is where he foams at the mouth – it’s pink! Blood mixed with spit from grinding his teeth! Let’s order pizza.”)

I dreamed:

My 14-year-old daughter needs me, needs to be saved; she needs my arms around her. I strain to reach her, but my arms are pinned by invisible weight. I pull, heave my entire body against the weights on my arms, trying to reach out, gain an inch, another inch, and just as I get close, my arms snap back, as if invisible elastic cords reached their limit. Now she’s only four. She looks at me, crying: “Just scoop me up, Daddy.”

Both girls are here now, my oldest 19. I’m a pile of broken glass, each a vibrant color. They’re trying to piece Dad together, one shard at a time, and when they’re almost done – every single piece of the puzzle has to fit just right – I fall apart again.

I woke up in the hospital three days after my ambulance ride. I don’t remember the trip, or anything that happened during the first two days. I had deep, raw cuts on my wrists and ankles from the restraints. The hallucinations were over.

Since then, it has been a very slow, humbling trek back. I’m climbing a ladder out of a sewer and see a slim, oval crack of light around the manhole cover. I couldn't walk when I first got home. I could barely talk – one word just didn’t bring to mind the second or third. Using the bathroom was a victory. I broke glass tumblers until I finally switched to plastic, dropped those, and watched the water dry on the floor – a meaningful way to bide the time until I died. Brushing my teeth was a marathon, each tooth a mile.

Two weeks later I could go outside. The sidewalk gave way like wet sponge. I smelled the sulfur of distain among people I passed. A car horn was a whip smacking my brain. Air tasted like tin.

Some background: I’m in the Philippines. I came here to see if I could slowly eliminate prescribed drugs and booze from my life, to get away from a toxic environment, to reduce stress. Why I thought moving halfway around the world was a solution is the reasoning of an insane man. I had a letter from my
U.S. shrink supporting the move, and I arrived in style: Let’s just say I was in an airplane for 24 hours slamming rum and cokes to wash down Klonopin and I flamed out over Aquino International Airport without a parachute. Thank God my son was here to catch me.

In the Philippines, a bottle of benzodiazepines carries a red label with bold-black lettering – “Dangerous Drug.” If it’s a benzodiazepine, the number of pills dispensed each month is 30, whether it’s Ativan, Xanax or Valium, whatever the dose. That’s a bit shy of the 300, two-milligram pills I would score at a U.S. pharmacy every month for $47.69. The only way to get more is in a hospital, where they can inject you with liquid Valium. So I decided to get clean; like I had a choice.

I took my last Klonopin Sept. 10, 2010. Today is January 26, 2011.

Aside for slipping up once seven days after my last pill, I haven’t touched alcohol since September 10. The night I screwed up, as the shakes began and the sweat spewed and my muscles twitched, I made one drink. It didn’t do a damned thing for me. I dumped it down the sink, followed by the rest of the bottle. I left the bottle sitting there, neck-first in the drain, a sinking ship, its stern sticking in air. I left the bottle there for two weeks.

Just as people here and on other forums have told me that I’m lucky to be alive, I’m equally amazed that I continue to get better. Even though my shrink said, “Enjoy life – you can have a drink or two now,” I’m scared to death to touch the stuff. I figure if I don’t touch it with my hands, it’s not going to make its own way down my throat. I walk by the isles of good booze for little money and no longer break into a sweat. I can go to a dinner and enjoy my iced tea while others drink premium beer and I only crave the great food.

But I wasn’t going to back down with my shrink.

“I know Depakote is an anti-seizure medication, but it’s also for bipolar disorder. Am I bipolar?”

“Yes.’’ He didn’t bat an eye.

Listen, I don’t mind labels. I’ve applied enough of them to others and I’ve had enough of them glued on me. They suck. I’ve decided labels are great when stuck on a jar of mustard, but don’t mean squat when slapped on humans – although I think I have one pasted on my forehead.

“But bipolar disorder is defined as having manic episodes followed my bouts of depression. Right now, I’d kill for mania. I would shout for joy to be manic, to be crazily happy. I can’t recall a period of sustained exuberance. That isn’t me. So please, define mania.”

“Impulsive thinking, obsessive thinking, grandiose thinking, irrational euphoria, motor mouth, inability to control compulsions,” he said. “Those symptoms were kept at bay by the dosage of Klonopin and other medications you were on.”

“OK. And I understand that it’s the cycling, to use the jargon, between these states – the ups and the downs -- that distinguishes bipolar depression from unipolar depression, right?

“Yes. But there’s also hypomania.”

I had to look that one up at home: basically, it’s a “mood state characterized by persistent and pervasive euphoria or persistent and pervasive irritability.” I certainly have the irritable part. Bipolar people “have little need for sleep, have a great deal of energy, are creative, and are described as ‘the life of the party.’” That seemed like me years ago, but it sure doesn’t feel like me now.

I was told I needed a benzodiazepine in 1991; Xanax was the first, along with Imipramine, an old-school antidepressant. Back then, my life-long anxiety exploded into repetitive panic attacks. In my book, that isn’t uncontrolled euphoria. When overwhelming fear would strike – without a rational reason – I would sweat, huge wet blotches forming on the front and back of my shirt. Sweat poured from every pore, my hair looking as if I just stepped from the shower, drops dripping from my hair onto the lenses of my glasses. All while I sat in a friendly meeting in an air-conditioned room. I would flee.

The day after an attack, my shoes would have salt stains from dried sweat.

And that began nearly 20 years of being prescribed a smorgasbord of psychotropic drugs: Prozac, Effexor, Wellbutrin, Sinequan, Mirtazipine, Trazodone, and Neurontin. Breakfast was Belladonna with phenobarbital for irritable bowel syndrome. For dessert I added alcohol and marijuana.

I pressed on with my shrink. “My depression is profound and relentless,” I said. “I’m always down. I’m either can’t-get-out-of-bed down, or sad. Sad is a good day. I’d kill for OK. Drunk, doped up – I was good for a few laughs sometimes, just numbing the pain most of the time. Every psychiatrist and psychologist I’ve seen – you’re the third psychiatrist, and I had two long-term psychotherapists – diagnosed me as having major depression with panic disorder and generalized anxiety disorder.

“Again, I’m not against labels, but the distinction is important because I think that’s how you arrived at the decision to put me on Depakote and Seroquel after my benzo and booze withdrawal, and that’s the only reason I want clarity on it. So am I bipolar?”

“A diagnosis is only a doctor’s impression,” he said. “And that was initially my impression with you. But the more I get to know you, and my impression is only from our one-hour visits – maybe it’s persistent unipolar depression.”

“Would you still have put me on Depakote and Seroquel if you would have known me better?”

“Yes.”

So I sat there, my pen in one hand, my small notebook of questions between us.

He smiled. Then he said, “Look at you with all of your questions written down. So what if you get your answers? What if benzodiazepines have a long withdrawal period? What if it’s bipolar depression or not? Would it change the way you feel? Would it change your awareness of what you have to do to be able to move on, to rebuild your life?”

And that’s why he’s the shrink and I’m the patient.

My withdrawal from benzos was brutal, singularly the hardest think I’ve been through in my life. Not drinking is a struggle, but the horrors of withdrawing from both benzos and booze haven’t faded: That memory is forever embedded in my mind, bathed in the flashing emergency lights of an ambulance.

That I have symptoms to this day is tough. But my shrink had my back to the wall: What if this insidious drug called Klonopin was the culprit for all of my angst? So what if doctors prescribed benzos willy-nilly and all my friends on Internet support forums were accidental addicts? Would it change the years I lost to benzos and booze? Would it change all of the impaired, irrational thoughts and decisions that landed me where I’m at today? Would it change what I have to do to be able to live within my own skin for the remaining days I’m alive? Or should I just wallow around, waiting for the day this irritable skin of mine dries, rots, and decomposes in my coffin.

So I came home from my shrink and wrote this. Then I went to an AA meeting, my first in a decade. There, I said, “My name is MemphisBluesk, and I’m an alcoholic and an addict.’’ And they said, “Hi, MemphisBlues.” They accepted me. Turns out a third of them were drunks, a third were drug addicts and a third both. They all looked like normal sorts to me. All I have to do is “keep coming back.” Since I’m learning not to do anything rash, to let my thoughts simmer before I act, I read this again several times, wondering if I should post it.

And then I realized this: The entire time I was writing it or reading it or fiddling with it, the damned ringing in my ears never went away.
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Old 01-26-2011, 02:41 AM
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I'm afraid I don't know much about benzos, or psychiatrists, MB - and even if I did, I don't know there's much I could say in response to your post...

but I'm glad you're here, and committed to moving forward, and to building a new life

D
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Old 01-26-2011, 03:41 AM
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Man sorry to hear about what they have done to you. I wish I was allowed to talk to you properly about what I think regarding this subject. What I will say is that any doctor who said this to me:

But he doesn’t think so. “People like you, who spend their time on those websites, are just craving the drug,” he said. “Their symptoms are simply your mind wanting a pill to solve their problems. .”
would be left in the rear view mirror in seconds.


As for drinking, alcohol and benzos work on the exact same GABA receptor (this is not medical advice nor speculation, simple scientific fact just as the earth goes round the sun), so drinking might alleviate the benzo WD symptoms, it might exacerbate them too. Ashton claims a few drinks months into recovery is harmless, I know people who have had setbacks from a couple of beers. Personally I wouldn't risk it.


If you would like to talk in depth about benzos, please feel free to PM me.


MHH
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Old 01-26-2011, 04:28 AM
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So what if you get your answers? What if benzodiazepines have a long withdrawal period? What if it’s bipolar depression or not? Would it change the way you feel? Would it change your awareness of what you have to do to be able to move on, to rebuild your life?”
Wow. It would certainly determine the course of treatment. I'm not a doctor, but I imagine treatment for withdrawal (or, quite possibly, long term or permanent effects from drug usage) would be quite different for treatment of depression.

I would get a second opinion and be completely honest about everything I've done and everything I'm doing now. Complete history.

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