Saturday, June 14, 2008

Benzodiazepines and Me

In my appointment this week Dr. X. and I spent a lot of time talking about me and Diazepam (Valium). I take a small dose of Valium everyday, along with 600mg Tegretol and 30 mgs Prozac.

This mixture seems to have been the first to do anything towards helping my mood disorder's symptoms. I have taken some form of benzodiazepines (Lorazepam, Clonazepam, Temazepam and finally Diazepam) both short and long term off and on ever since I began seeing Dr. X. 6.5 years ago.

The short acting ones (especially Lorazepam) are a nightmare for me, because I get what seems to be withdrawal effects each day as they wear off and become really irritable, anxious and angry. Diazepam (Valium) has been different. It has helped me immensely.

My Major Depressive Disorder( MDD) is also accompanied by constant and debilitating anxiety attacks and sometimes panic attacks, insomnia, non-stop worrying, and some OCD symptoms; checking/rechecking, contamination fears and obsessive worries and thoughts.

This time I began taking Valium to ease my mouth movement symptoms and obsessive thoughts and music in my head (I am worried it is Tardive Dyskinesia, my pdoc suggested it is bruxism, but recently began wondering about TD too). The Valium seemed to stop the obsessive thoughts, allowed me to be comfortable in my volunteer role teaching art, helped me sleep, basically calmed me down enough so I can live a more relaxed life and not have constant anxiety symptoms. It also helped slow the mouth movements down a bit; although they are still pretty bad.

I read other's comments about benzodiazepines. The Shrink Rap psychiatrists, whose opinions I am interested in, and respect, seem very opposed to using them), also, I belong to an online support group and many people psychiatrists seem opposed to providing benzodiazepines for long term usage. I get the sense that these psychiatrists see long term need for benzodiazepines as a slippery slope to addiction and drug seeking behaviour.

So, in keeping with not wanting to be addicted, and not wanting to be a drug seeker, also, because I was afraid the Valium was masking my possible TD mouth movements, three weeks ago I decided I should try to get off Valium.

I informed Dr. X that this was what I wanted to do. He supported the idea, but told me to go off it very, very slowly; 10% or less a week. He said this would help me avoid some of the withdrawal side effects.

So I began. Within a week my good mood began slipping. I became more and more stressed, more and more depressed. By the time I went into this week's pdoc appointment I was slipping back into a deep depression. I had began craving alcohol again (and drinking again to relieve my stress and anxiety; something that I had stopped almost immediately upon beginning Valium again (a common pattern for me). I began isolating, not wanting to leave the house, unable to sit and be creative without being completely stressed out about how bad I was at what I was trying to do...the list goes on.

I asked Dr. X. about long term benzodiazepine usage. I asked him why he so readily provided them to me when so many pdocs and people seem opposed to the idea of anyone using these medications for long periods of time. I told him I had wanted to stop taking Valium because I did not want to be addicted, or dependent and because I hear so much negative press about people on these medications.

He told me that many psychiatrists would say there is a population of people where the risks of dependency and addiction have to be weighed against those people's debilitating symptoms. He said for me taking a small amount of Valium seemed to relieve me so much of so many symptoms of my anxiety. It appeared to him that my continuing to take Valium was the right choice for me (He said it better and much more coherently than that).

I expressed my feelings that some of my memory and word finding problems, and perhaps some of my balance problems were associated with taking a benzodiazepine. He told me that is possible and perhaps likely. Unfortunately the alternative for me is irritability, inability to sleep, extreme anxiety and the return of depressive symptoms. I decided I would go back on the Valium dose I was on. He seemed to think that was a good idea.

I know I build up a tolerance for Valium. It seems to stop working after a period of time. At that point I need a small increase in my dosage. I also know I have really bad withdrawal effects every time I go off it, which I need to do every once in a while for a period of time to offset the tolerance. However, I also know I am far more functioning and able to enjoy life when I take Valium.

I really worry that one day something might happen to Dr. X. and I will need to get a new pdoc, and they will not understand this dynamic the way Dr. X. does. They will think I am drug seeking if I ask for Valium, or think I am an addict, when in reality I wonder if there are some of us for whom benzodiazepines are a much needed supplement to the other medications we take.

What is the difference between a medication that is needed to maintain balance in a person's life, and a medication that the person is addicted to. I do not really understand where I fit in or to which category I belong. Dr. X says I am not an addict, nor am I drug seeking when I ask for Valium. I have to trust and believe he is right.


Coco said...

Hi Aqua, I really don't know the issues you're dealing with, other than from the perspective of having a sister who has been on benzos long-term. I don't see her dealing with it favorably. I don't want to appear pushy, or like I know what's best for you, but if you have any questions in regards to benzo withdrawal or any of the issues laid out in your post I know that Gianna at Beyond Meds is willing to talk to you abou them
Best of luck in this.

I also get feelings of panic at the idea of something happening to my pdoc. Mine isn't meds related, more attachment issues I guess you could say. ~coco

Coco said...

But rather than a link to yourself, allow me to give you the right one for Gianna! :P

Michelle S. said...

Hi there - I have been reading your blog for a bit now and wanted to say that until March of 2008 I had been on Clonazepam for the last 8 years. It helped me with many of the same things that you write Valium is helping you with. I was on a pretty low dose and I had a terrible 6 week experience weaning off of it.

I completely agree with your doctor it is a situation to weight carefully but if you need it to function and if Dr.X is verifying this for you, I personally would continue to take it as warranted for your situation.

One solution to the fear of Dr. X ever leaving might be to find a back up doc now - someone who can talk and get your history from Dr. X and is a scary process to think about changing pdocs...I need to start thinking about it too - after 8 years of going to the same pdoc who is not on my insurance, I simply cannot afford it for much longer. Luckily I only see her every three months, but still she has the most history of me.

Aqua said...

Just to clarify, I am FAR more afraid of losing my pdoc for reasons of attachment than I am for losing access to Valium. This pot just happens to be about ho Valium helps me despite so much bad press and my fears the bad press is right.

I have gone off Valium successfully numerous times and for log periods of time. It has always been difficult to go off them, but I do not find myself craving them when off them necessarily. I find myself craving alcohol when my anxiety returns (sometimes after being anxiety free a while)...and then I usually begin taking Valium, either instead of drinking, or to stop the anxiety, that leads to the drinking (self-medication)

Annie said...

Aqua, I worry about the meds I am on at times but I trust my pdoc and that is the best plan I can have for now. It sounds like you trust Dr.X and working with him seems to be helpful. Other folks will have strong opinions but it is less confusing to ultimately trust the relationship with your pdoc. Take care! Annie

Anonymous said...

Hi Aqua,

Have you read It states you reduce 10% of current dose every 3 to 5 weeks or longer if need be. Your Psych Dr. suggested the 10% over one week. Now wonder you relapsed. 2 years ago, I reduced Lithium very quickly and hence went into a very hyper state.

Aqua said...

Hi Annie: Thanksfor the supportive comment...I think you are right. That feeling was partly why I wrote the show my struggle between my fears and desires to do the "right" thing, and my struggle to trut that my pdoc is knowledgeable and caring and that I should trust his opinion.

Anon: Your advice is good. My pdoc told me to reduce 10% a week until I reached the 1/2 way point and then to reduce 10% every three weeks after that. He was expressing concern over how quickly I was reducing. I am the kind of person that just wants all the side effects to go away NOW...and often reduce too fast thinking "better to be short and painful, than long and drawn out". I did go off Valium very quickly last summer and ended up in a really protracted hypomanic I should know better. Plus the whole idea of going off was mine. My pdoc supports my decisions and my autonomy when it comes to these things, which I believe is VERY important...but I could see he was relieved when I decided to stick to my regular regime

Jazz said...

This is such a tough call to make, isn't it? I think that if you are comfortable with your ability to come off of the valium when you need/want to, then I would say if it's helping you, go for it. You do have to weigh quality of life issues against perceived stigma.

Valium Prescription Medication said...

My name is Paul Harris and i would like to show you my personal experience with Valium.

I am 55 years old. Have been on Valium for 20 days now. I decided to get off of all benzos after much reading and having a friend who was abusing Xanax kill himself (may have been other issues, too). I was taking about 4 mg of Klonopin daily. I read a lot of the reseach on benzos by Dr. Heather Ashton, one of the world's leading authorities on benzos. I was shocked to see her equivalency table for Klonopin and Xanax. 1 mg of Klonopin or Xanax is equel to 20 mg of Valium. That's right, 20!! Plus, Klonopin and Xanax have nasty side effects. That did it for me. No more benzos!! Because Valium has the longest half-life of any benzo and the least side effects, I'm using it and water-titration to get off Klonopin, a method widly used in Europe. 10% reduction every 10-14 days. So far so good.

I have experienced some of these side effects -
Headache, drowsiness in the morning. Hard time getting my Dr. to prescribe and go along with treatment program. Valium supposedly is far less addicting than some other benzos, with far fewer side effects. I hope that turns-out to be true.

I hope this information will be useful to others,
Paul Harris

Anonymous said...

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