Discontinuing Valium - Cold Turkey

**Note: I am NOT condoning anyone go off Valium this way. From what I have read it can be dangerous, even life threatening, to do this if you are on a high dose of any of the benzodiazepines. (Although for the life of me I never could find out Why...If anyone knows I'd like to know too) Please work out a schedule with your pdoc if you want to stop any of your medications.

I am not exactly sure, but I think I am on my 8th or 9th day of no Valium. I tried to go off it by slowly lowering my dose, but as soon as I had any side effects I would take more Valium and eventually I ended up taking more than prescribed, just so I did not have to deal with the stress of stopping it. I don't know if I feel psychologically afraid, or if physiologically I was becoming more tolerant of higher doses. Probably both. I always seem to have this pattern after having been on Valium, or any other Benzodiazepine, for a while.

Valium definitely helps me in a number of ways, but it also makes me tired and (I think) apathetic. Dr. X and I have decided I slowly go off all my medications as he says it is not clear they are helping me. To some degree I agree. I am not sure if they help or not.

I still seem to have mood swings/unstable moods and much of the time I feel extremely depressed and anxious, sometimes I feel moderately depressed and anxious, sometimes I feel only depressed and sometimes only anxious and some of the time I feel hopeful. This is the best I have ever been in 7 years, so it is hard to say my medicine is NOT working. I think at best it is sort of, at times helping. Other times I think it is my changing life and therapy that has lifted me a bit. If it were the medication wouldn't I feel hopeful at least most or much of the time?

Anyways... I discontinued Valium cold turkey about 8 or 9 days ago. It has been both uplifting and brutal, but I simply could not manage to lower the dose slowly.

The uplifting part is that I seem to have an increase in energy and, at least part days I have had more energy. The brutal part has been and continues to be (maybe even worse now than the first few nights) the withdrawal side effects I have been experiencing:

Not sleeping. The first 4 days I did not sleep more than a couple hours, in increments of a few minutes here and there, each night. By Christmas Eve my mood was great...probably due to sleep deprivation. However, by 1:30 am that night, having gone to bed at 10:15 and finding myself at 1:30 am increasingly wired, twitching and clenching my teeth and more I broke down and decided I needed to take something to help me sleep. I took 50mgs of Trazadone and at least I slept part of the night. The next day I felt so much better, except for feeling like I was dazed. I have continued to take Trazadone as it is at least partially helping me sleep.

Twitching...my muscles are twitching and my hands shaking. The twitching seems to be getting worse and is really annoying. It is almost like the feeling of reflexes when someone taps your knee, except it is all over...in my hands, arms, legs, torso...very annoying.

Mouth movements are back with a vengeance. I began taking the Valium to stop these mouth movements that began shortly after I started taking Prozac. I was getting extremely stressed because I was worried it was tardive dyskenesia. The Valium really helped them slow down and mostly go away (at least I wasn't noticing them as much). Now they are back full force...My mouth is making weird semi-controllable movements. If I focus really hard I can stop them, but the second I stop focusing on stopping them they come back...the movements are things like sucking motions, pursing my lips tightly, my tongue is moving in my mouth to the point that it is sore in numerous places from rubbing up against and pushing on my teeth and my jaw is clenched so tightly (especially in the evenings) that I have been getting massive headaches from the tension in my jaw and neck muscles. I have had to take 600mgs of Advil a couple times a night to lessen my headaches.

Toes tapping/moving It is like they are beating to a different drummer than me. "Tap, Lift, Tap, Lift, Tap, Lift...quickly, then slowly, then quickly, then ploddingly. They do not seem to want to stop (at least when I am noticing them). I can stop them if I focus on stopping, but a few minutes/seconds later I notice I am doing it again.

Anxiety/Bad Energy: Tight chest/back/jaw. Difficulty getting to sleep because I feel like I can't breathe. More energy, but it feels bad, like agitated energy, feel overwhelmed by small things, or things that are even the least bit difficult for me.

Irritability: Noises are annoying. It feels like sensory overload if the music at home is too loud, or it isn't the music I want to hear, or the t.v. is too loud, or people are talking to much. It is almost like the auditory equivalent of bright, relentless sunshine in your eyes when you are not wearing a hat or sunglasses.

Increased eating: (not sure if this is a side effect, the holiday season, or if it is happening at times my mood is down), but I have gained more than 12 pounds in the last 3-4 weeks...and I can't seem to stop eating bad food.

Balance problems: Falling, tipping, slipping. It may be the weather conditions (snow and ice), but I feel completely off balance, even inside.

Memory problems: Not sure I can remember the bizarre things I have been doing, but I remember saying "huh" to myself numerous times a day...Let me think...

spending a lot of time staring at things I pull out to do and wondering why I have them in my hand or on the counter. (Eg: pull out vodka and juice to make a drink and I keep looking at them both unsure of what they are and unsure of what I am to do with them, or find myself in a room and not knowing why, or putting the juice in the microwave instead of the fridge etc...

forgetfulness/carelessness

Stuttering/word finding: I have a phrase or sentence in my head. I go to speak and different words come out. Sometimes it takes me 3-4 tries to get the right statement out. I have done this numerous times while speaking with my husband. The words that come out wrong are usually associated in some way (they rhyme or have something to do with the topic...eg./ topic is strawberries and the word "tomatoes" comes out instead ...both are fruits). The other example of this problem is pure stuttering...where I have to try numerous times for the entire word to come out of my mouth correctly. I can't remember exact examples, (despite meaning to each time it happens), but my husband is making fun of me when I do it, because it is happening regularly.

Depersonalization/dissociation...I am "disappearing" a lot.

How Well is Well Enough?

Today's post was a toss-up between two topics:

• Existentialist ideas in psychotherapy and their role in my becoming well
• Medication and wellness

I'm going to write about Medication and wellness first, because it seems to play a big role in my becoming well.

Contrary to what some of my readers may think, or I suspect my pdoc sometimes thinks, and I know my husband and family think, I do not believe medication is the end all, be all for my becoming well. I recognize there are numerous factors that need to come together for me to achieve anything close to wellness.

In fact, the first thing I recognize is that for me (...I am only talking about me and my experiences in this post), for me I likely will have some symptoms throughout my life. I think even if Dr. X and I find the best combination of medications for my mood is such that there will always be underlying cycles that require medication changes, increases, decreases etc. Also, my symptoms seem to fluctuate..from extreme depression, through to anxiety, anger and sometimes rage.

I am beginning to see that these fluctuations of symptoms may, in part, be why my depression is hard to treat. Sort of like that old cliche: "You can't please all of the people all of the time, but you can please some of the people some of the time". Exchange the words "mood states" for "people" in the sentence and you pretty much can see where the difficulty lays.

Part of my theory is that anxiety is on one end of the spectrum and depression on the other. Given that almost consistently I have both mood states at the same time it makes sense that my mood is hard to treat.

With the depression ALWAYS comes fatigue...a huge and cumbersome symptom. The problem is if I take any dose of a stimulant, or stimulating medication, that is strong enough to help with my fatigue, it increase my anxiety. If I take a high enough dose of an anti-anxiety medication to treat my anxiety, it always increases my fatigue. On top of that it seems every antidepressant I have tried has increased my fatigue. The only one that I can think that didn't (Moclobemide) made me intensely agitated.

So, what are my realistic expectation for medications, which symptoms are the most important for me to address, and which symptoms might I need to accept, and learn to live with?

My Realistic Expectations for Medications (vs. Psychotherapy and my motivation/actions to change):

1. A decrease in mood cycling by 50% (which I think would decrease anger/rage and mood fluctuations
2. An increase in mood by 50%
3. A decrease in anxiety so I have NO anxiety attacks

The Most Important for Me to Address:

1. I would like my mood, at the very least, to be such that I am not severely depressed most of the time (say 75%). I believe some of my depression will not be addressed by medication, but by my becoming a more active participant in my therapy. I'd say approximately 50% of my depression is caused by my inability to become the person I want to be. (an existential struggle...more on that in another post)
2. I would like to stop having suicidal thoughts. Especially the violent imagery of stabbing, shooting and hanging myself. I would like to WANT to live...so not just stop having suicidal thoughts, but also I would like to stop wishing I would die. (although some of these may need to be addressed by my working harder in therapy to create a life I believe is worth living)
3. I would like to have enough energy to work at least the equivalent of 4 full-time days a week.
4. A reduction in my feelings of guilt would be good. I suspect working again would remove a large part of my feelings of guilt, but some of that is either genetic, learned, or biochemical.
5. I would like to be less apathetic/amotivated to do my own art, my housekeeping, and work a job. It would be nice to have the energy to do other things like exercise and garden, but I am willing to have some inability to do some things.
6. I would like to stop having anxiety/panic attacks. I am willing to put up with all the worrying I have done my whole life. To me that is normal, but I cannot manage the not being able to breathe, the chest pains, the fear and discomfort of the actual anxiety attacks.
7. The huge mood cycles...where I go from high and unstoppable and crash into suicidal depression.
8. I'd like to have at least a bit better memory/cognitive functioning....enough to both be able to read a book and to be able to remember it.

Symptoms I Need to Accept:

1. Some fatigue...I am getting older and it has pretty much been 10 years since I really felt well. A decade can add to a person's fatigue. I think I need to accept that I may have some fatigue (say needing an hour nap a day).
2. Some depression...25%...I lived with that before. I can live with it again. As long as most of the time I want to live, and feel my life is worth living, I can put up with some really bad days.
3. Worries/OCD stuff (except my obsessive suicidal thoughts), but things like like checking my doors to see if they are locked over and over, or freaking out that I left the iron on, washing my hands many times a day etc. I have been like that most of my life.
4. Insomnia...I have never slept well. I have almost always had a pattern of waking in the middle of the night and having difficulty getting back to sleep due to excessive worry, anxiety etc. I survived until now without sleeping that well. I can live with not sleeping that well.
5. Some mood cycling. Maybe the cycling can be addressed by increasing/decreasing Tegretol/Antidepressant/Stimulant based on the cycling? (i.e. Decrease or Increase doses based on my cycling?)
6. Some anger/irritation. I think part of this is attached to a hyperthymic temperament(genetic), and/or is learned behaviour. Both my Dad and my paternal Grandma had high expectations of those around them, and for themselves. They had go, go, go personalities. I see most of my Dad's relatives have the same kind of "frustration intolerant" personalities.
7. Some memory problems/cognitive functioning problems....I need to learn ways AROUND this (e.g. day timer, notes to self, set alarm etc.

Basically I would like to go back to at the minimum, the functioning level I had before this MDE started. Which is probably a "Worry filled Dysthymia". I'd accept that.

I know medication will not help me reach that goal 100%. I have to work harder and do the work I talk about in my therapy sessions. I have to somehow get on track, stay on track and build up my abilities to do more and more.

This means:

1. Continuing to teaching classes at the Art Clubhouse I teach at, despite my really wanting to stop
2. Eating more balanced meals, taking vitamins, and eating way more vegetables than I do
3. Cleaning the house EVEN when I feel tired and unable to
4. Taking the dog for at least one LONG walk EVERYDAY (at least an hour) and two smaller walks everyday too.
5. Taking on MORE, not less responsibilities, maybe by volunteering to teach somewhere else (after school programs, or seniors programs etc.)
6. Going off Valium and staying off it
7. Stop drinking alcohol...period.
8. Do the things I say I will do in therapy.
9. Work on my art EVERYDAY for at least 1 hour.
10. Become more social, and increase my social activities.

Getting "better", (more resilient, achieving at least my minimal requirements for a life worth living) will take more action than I have taken these past 7 years. Approaching my life with a more active role in my destiny is partly a medication finding struggle, but more than that it is an existential struggle. I need to somehow create the will, the desire, the ability to become the person I want to become. To do that I need to define that person, and begin taking steps towards implementing changes in my life to become that person.

C.T. Scan Results

Re: my Post about going in for a C.A.T. scan...it was actually a CT scan (not sure what the difference is but nothing showed up on it. I asked Dr. X. what they would have been looking for. He said tumours, signs of brain damage etc. So I guess my increasing word finding, mixing up words and memory problems are either related to being depressed, or they are side effects of my medicine.

I do feel like I am far more confused and having more memory retrieval and word retrieval and word mix-up problems than ever before. It is so frustrating.