Before You Fill That Benzo Prescription: READ THIS

A Cautionary Tale: Benzodiazepine Withdrawal

A 63 year old librarian, Jayne, came to me 6 months into a Klonopin taper. She had long ago abandoned her original prescriber – the one who put her on Remeron and Klonopin eight years ago after she had discovered her husband’s infidelity.

“He never once told me there might be an issue with taking these meds long-term. In fact, he told me I probably needed them after I tried stopping them cold turkey and felt so sick I thought I was dying.”

When she arrived in my office, she had been using a jeweler’s scale to measure micrograms of shaved Klonopin tabs to approximate 1-2% dose decrements per month. She told me of a hell that she had never envisioned possible before her tenure in the world of psychiatry.

The dark side of pill popping

I have countless stories like this from my work with women dependent on psychiatric medications. Women started on one, maybe two medications, that turned into three, maybe five medications over years of their lives. Years in which they never felt fully well and may have even struggled just to function. Just a little more of this medication…maybe this new one will help…they were told. No one ever discussed with them true informed consent: risks, benefits, and alternatives, perhaps because we as clinicians are not told the full story in our training.

In fact, there’s a bill on the floor in Massachusetts that would mandate this discussion, complete with a brightly colored prescription to warn the patient that their doctor is dealing them a potentially harmful substance. Better late than never?

I remember, as an intern working in the Bellevue ICU, treating a patient who presented after having suffered a grand mal seizure in the CVS parking lot on the way to fill his Xanax prescription. He had missed one dose before heading to the store.

Because of this, I never prescribed Xanax again, but reassured myself that Klonopin and Ativan were safe because of longer half-lives and slower onset.

Now I suffer the poetic justice of caring for dozens of women who are moving through the birth canal of Klonopin withdrawal, and I am here to guard the gates through which more may pass.

The history of “just taking the edge off”

How did we get here? There are a reported 100 million prescriptions for benzodiazepines written annually with long-term prescriptions written for 14.7% of 18-35 year olds and 31.4% of 65-80 year olds, and with women twice as likely to be prescribed.1

Beginning with the glamorization of Miltown in the 1950’s, the “I don’t care” pill was a way to ease the growing awareness that the world is indeed unsafe, and that something is deeply bankrupt in the promises of burgeoning science, technology, and industrialization. Still, we sought to heal these wounds through application of more of the same mentality – one of dominance, management, and suppression of all obstacles into submission. The 1960’s brought Valium, aggressively marketed to housewives for everything from their existential to everyday angst, the first drug to gross over $100 million in sales. In the 1980’s, Xanax was offered as a cleaner Valium and rode the activating and uncomfortable side effect wave of the newer antidepressants.

“The reason that conventional psychiatry – whether pharmaceutical or psychoanalytic – is powerless to substantially help the vast majority of patients is that it does not, and cannot, recognize the wrongness of the world we live in.” – Charles Eisenstein, The Ascent of Humanity

Should we be worrying?

These medications are the centerfold of our “opting out” portfolio. As our bodies, minds, and spirits became more and more separated from nature, each other, and ourselves, the worry, discomfort, and unease mounted. Now that the going has gotten really tough, we are reaching for these drugs more than ever. Surely turning off the smoke alarm is not the best way to deal with this fire!

What if anxiety is telling us something? Something about the food we are eating. The water we are drinking. Something about the relationship we are in or the job we are going to every day. Something about our lack of connection and purpose.

If we medicate ourselves into submission, who and what are we serving? Survival at all costs? Are we really just here to punch the clock until we die?

But what if you’re struggling and you don’t feel like there’s room in your life to examine and investigate these symptoms?

Maybe you’ve always been a worrier, but recently, it feels like you can’t catch your breath, you can’t listen to what people are saying, and you’re crawling out of your skin. Maybe you just need to sleep. Maybe you’ve just started on an antidepressant and it’s not “working” yet. Maybe someone you love just died, you just lost a job, or your house just burned down. Maybe you were attacked, or perhaps your husband makes you feel like you’re losing your mind.

Xanax, Klonopin, Ativan, Valium spell simple relief.

Unfortunately, there is no magic pill. Like antidepressants, mood stabilizers, and antipsychotics, the many invitations to the world of benzos all bring you to the same room. It’s a room that many spend years trying to escape. It’s one of dependency, depression, forgetfulness, and detachment from self.

That’s if you live to endure it.

Many celebrities have died with benzos in their blood. The Germanwings pilot who took down a plane full of passengers had Ativan (and Citalopram, Mirtazapine, and Zopiclone ) in his bloodstream. The worst part of the attendant risks of these medications is that they stop having any predictable sedative effect after a few weeks. After that point, you’re just stuck with a monkey on your back.

The real risks

Psychiatrist Peter Breggin, MD, has devoted his career to sounding the alarm on psychotropics. He enumerates that documented risks of benzodiazepines in his paper on the subject:

1. The primary clinical effect of inducing sedation (tranquility) or hypnosis (sleep), which is indistinguishable from a toxic effect except in degree;
2. Cognitive dysfunction, ranging from short-term memory impairment and confusion to delirium;
3. Disinhibition (dyscontrol) or loss of impulse control, with violence toward self or others, as well as agitation, psychosis, paranoia, and depression;
4. Withdrawal emergent symptoms, in which the individual experiences a range of symptoms from anxiety and insomnia after routine use to psychosis and seizures after the abrupt termination of long-term, larger doses;
5. Rebound symptoms, an aspect of withdrawal, in which the individual re-experiences pre-drug symptoms – anxiety, insomnia, or other serious emotional reactions – but more intensively than before drug treatment began. Withdrawal and rebound can take place between doses, causing anxiety and other symptoms during the routine administration of benzodiazepines, especially the short-acting ones;
6. Dependency and abuse or addiction that range along a continuum from feeling dependent on the drug to self-destructive behavior associated with drug abuse.

He goes on to quote:

“Rail (1990) summarizes the adverse behavioral effects of the benzodiazepines as follows:

Adverse psychological effects: Benzodiazepines may cause paradoxical effects. Nitrazepam frcquently and flurazepam occasionally increase the incidence of nightmares, especially during the first week of use. Flurazepam occasionally causes garrulousness, anxiety, irritability, tachycardia, and sweating. Euphoria, restlessness, hallucinations, and hypomania behavior have been reported to occur during the use of various benzodiazepines. Antianxiety benzodiazepines have been reported to release bizarre uninhibited behavior in some users with low levels of anxiety; hostility and rage may occur in others. Paranoia, depression, and suicidal ideation occasionally also accompany the use of these agents.”

As a young psychiatrist, I certainly don’t remember being trained to have that discussion with my patients! Furthermore, investigative journalist Robert Whitaker has collected data that implicates treatment with benzos in worse outcomes, including:

1. Benzodiazepine usage leads to a four-fold increase in depressive symptoms.2
2. Patients taking high doses of benzodiazepines for long periods “perform poorly on tasks involving visual-spatial ability and sustained attention. This is consistent with deficits in posterior cortical cognitive function.” 3
3. Long-term benzodiazepine users are “consistently more impaired than controls across all cognitive categories,” with these deficits “moderate to large” in magnitude. The “higher the intake, dose and period of use, the greater the risk of impairment.”4
4. Long-term use of benzodiazepines leads to “malaise, ill-health, and elevated scores for neuroticism.” The drugs contribute to “job loss, unemployment, and loss of work through illness.”⁵

How to kick the habit

Let’s say you bought into the promise of these meds, survived the Russian Roulette of catastrophic adverse effects, and now you want off. The bad news is, it’s not clear that a slow taper actually helps ease the suffering of withdrawal.  The worst news is that an abrupt taper can be life-threatening. Sometimes, knowing what is possible helps to frame expectations and to clear space in your life for this transition. Breggin quotes:

Withdrawal can develop two to twenty days after abrupt termination of the drug, depending on the half-life of the particular benzodiazepine. First signs of withdrawal may be insomnia, anxiety, agitation, irritability, and nervousness. Persistent ringing in the ears or other abnormal sounds (tinnitus) and abnormal visual perceptions may develop. Withdrawal symptoms can progress to include abdominal cramps, muscle cramps (including persistent, severe neck pain), orthostatic hypotension with fainting, nausea or vomiting, diarrhea, decreased appetite, weight loss, trembling, fever, sweats, hyperarousal and hypersensitivity to environmental stimuli, blurred vision, “buzzing” or “electricity” sensations inside the head, confusion, depersonalization, anxiety, frightening obtrusive thoughts, obsessional states, and psychosis with hallucinations, and delirium or organic brain syndrome, as well as seizures and death (Jacobs, 1995; Nishino, Mignot, and Dement, 1995;Pecknold, Swinson, Kuch, and Lewis, 1988; Silver, Yudofsky, and Hurowitz, 1994).

Not pretty.

Preparing yourself and your loved ones

Psychotropic withdrawal symptoms feel real. They feel egosyntonic, as we say in the field. They feel like your feelings, thoughts, and emotions, rather than what they can be, which is the marionetting of your brain chemistry by chemical withdrawal. Ideally, work with a clinician who can reflect this back to you during the process. Make sure you surround yourself with supportive and informed energy.

Instill resiliency

I have learned the hard way that optimizing mind-body health BEFORE a taper makes a world of difference. If you imagine yourself to be a bucket that is almost full, the stress of a taper is likely to make you overflow.

If you first drain the bucket with lifestyle changes (like those outlined in the Vital Mind Reset course), then the taper can be a relative breeze. I enumerate these steps in A Mind of Your Own and the deeper dive, Vital Mind Reset.

There are a number of supplements that can be helpful support as well, including kava which has been studied for this purpose, l-theanine, and GABA (I like pharmaGABA).

I always recommend kundalini yoga meditation for nervous system balance as well as coffee enemas for accelerated detox. Here’s a meditation for Health, Energy, and Radiance to support you daily.

Join communities

Peer and/or professional support is an essential piece of this process. For many, the real world experience of others who have walked this path first is THE most essential component to staying the course. Sites like www.benzobuddies.com and www.madinamerica.com host gathering places for similarly-intentioned patients that have been injured by psychiatry. You get this same level of real-time peer support through our private Vital Mind Reset Facebook group.

Through the process of my awakening to the truth about psychiatry, I have learned to remain humble about every person’s journey. Maya Angelou said, “When you know better, you do better.” If a challenging relationship to a pharmaceutical is part of your life path, then you must embrace that. For all of us, I hope that we get to a place of less fear, and greater alignment with our purpose and power than can ever be afforded by the current model of conventional medicine.

“What we have to discover is that there is no safety, that seeking is painful, and that when we imagine that we have found it, we don’t like it.”
― Alan W. Watts, The Wisdom of Insecurity: A Message for an Age of Anxiety

World Benzodiazepine Awareness Day

Each year, we honor the victims of benzodiazepine effects and their families. To those who’ve lost loved ones or personally suffered inconceivable damage as a result of taking these drugs, we pay tribute to you – and hope to raise awareness to both prescribers and patients of the unfathomable dangers involved.

The following video features the personal stories of people all around the world, whose lives have been turned upside down by these pills.

If you know anyone who is currently suffering or is considering taking a benzodiazepine, I strongly encourage you to share this article with them. If you’ve been injured – I want you to know that you are not alone. And I wish you strength and fortitude in your journey ahead.

Interested in a comprehensive, drug-free approach to healing anxiety, depression or chronic stress?

The Vital Mind Reset program walks you through my 44-day healing protocol, which combines diet, detox, and meditation practices for long-term resolution of chronic symptoms. The tools implemented also help to establish a readiness for psychiatric medication tapers. Click below to learn more.

• ¹ http://www.ncbi.nlm.nih.gov/pubmed/25517224
• ² http://www.madinamerica.com/wp-content/uploads/2011/12/Self-reported%20depressive%20symptoms%20following%20treatment%20with%20corticosteroids%20and%20sedative-hypnotics.PDF
• ³ http://www.madinamerica.com/wp-content/uploads/2011/12/Cognitive%20impairment%20in%20long-term%20benzodiazepine%20users.PDF
• ¹ http://www.madinamerica.com/wp-content/uploads/2011/12/Cognitive%20effects%20of%20long-term%20benzodiazepine%20use.pdf
• ⁵ http://www.madinamerica.com/wp-content/uploads/2011/12/Tranquillisers.pdf