CHAPTER 14 – #The-TOs-and-BEs-of-Drugs-and-Withdrawal

As I continue on my New Year tangent, and before I go back to the Making of a Hot Mess, I wanted to share with you an important milestone in my life. I have finally stopped taking Xanax (clinical name: Alprazolam) and Klonopin (clinical name: Clonazepam), for good hopefully, after a series of ‘starts and stops’ and a final run of 5 years. (The introduction may be slightly long-winded and I apologize in advance however, it is useful because it make the symptoms of withdrawal slightly easier to understand. But by all means, feel free to skip all the jibber jabber to get right down to joys of withdrawal.)

 

Xanax and Klonopin are part of the Benzodiazepines family, otherwise known as “benzos” or “class C drugs.”

https://www.drugs.com/article/benzodiazepines.html (for reference to text in ” “)

Benzodiazepines are a class of medications that work in the central nervous system and are used for a variety of medical conditions. As a class, benzodiazepines are similar in how they work in the brain but have different potencies, durations of actions, and receptor site affinities. Because of this, some benzodiazepines work better than others in the treatment of particular conditions.

 Benzodiazepine Uses:

– Sedative-hypnotics for sleep

– Adjuncts to anesthesia to induce relaxation and amnesia (procedural memory loss)

– To reduce anxiety (anxiolytic)

– Panic disorders

– To treat or prevent seizures

– For alcohol withdrawal

– Muscle relaxant”

 

Xanax is short-acting and Klonopin is long-acting. So if I were to feel an intense panic attack coming on I would first take a Xanax to calm myself as quickly as possible, but then might also take a Klonopin so that the symptoms of the panic attack are kept at bay for as long as possible. If necessary, I would take additional doses of one or both, depending on the situation. Furthermore, if I were at work I would only take a Xanax since Klonopin makes me drowsier.

“Some benzodiazepines … have active metabolites that remain in the system (long acting), and this can be problematic for patients – especially older patients. Elderly patients may have liver impairment and trouble eliminating the drugs from their system. Side effects, such as dizziness, confusion or unsteadiness may persist in the elderly who are prescribed long-acting benzodiazepines. On the other hand, short-acting benzodiazepines are often preferred for insomnia because they theoretically produce less next-day drowsiness, although many patients still experience these effects.”

There are several uses for benzodiazepines, and if you are of the curious nature please check the website listed above or rather ask your doctor. I was prescribed them for anxiety, panic disorder, and insomnia. I have taken medication (including antidepressants and sleeping pills) on 3 occasions in my life: during my undergraduate studies in 2001, soon after I first moved to DC from 2010, and in Istanbul from 2014. In this chapter I will focus primarily on the effects of stopping medication and later on in the blog I will talk about my experience with the drugs. After all talking about how one got “addicted” is a shade of withdrawal.

Anxiety and worry is a common problem in adults; however, when chronic, unwarranted worry lasts for a period of six months or longer and interferes with normal daily activities, this may be diagnosed as Generalized Anxiety Disorder (GAD). GAD is the most frequent anxiety disorder, affecting about 5% of adults in the primary care setting. The occurrence of three out of six symptoms listed below constitutes a diagnosis of GAD.

Excessive anxiety for at least six months not due to another mental condition, medication, or substance abuse

Sleep disturbances, insomnia

Fatigue

Restlessness

Difficulty concentrating

Irritability

Muscle tension

Drug treatment will depend upon the level of anxiety, patient characteristics such as age and organ function, and patient preference. For patients who do not want to use medications, cognitive behavioral therapy and relaxation therapy have been shown to be effective. Antidepressants (SSRIs/SNRIs) are considered first-line therapy for most patients, and benzodiazepines may play an adjunctive role in the treatment of GAD to address acute symptoms while the antidepressant takes effect. Short-term use of benzodiazepines (2-6 weeks) is recommended.

Common benzodiazepines used for GAD include alprazolam, diazepam, and lorazepam. Benzodiazepines should be used with extreme caution in the elderly due to the risk for excessive sedation, confusion, and risk for falls and fractures. Mirtazapine and buspirone are also effective in GAD for patients who do not respond to at least two trials of SSRIs or SNRIs. Long-term use of benzodiazepines for GAD should be avoided, when possible.

The benzodiazepine hypnotics shorten the time it takes to fall asleep and prolong the sleeping period. The main differences exist in how long they might remain in the body, possibly leading to prolonged side effects. For example, triazolam has a much shorter duration than diazepam, allowing quicker clearance of the drug and theoretically less side effects. On the other hand, diazepam can remain in the system for days, and especially in the elderly, this can boost the risk for long-term side effects.

Benzodiazepines should be used for a short period of time (usually 2-4 weeks) for insomnia. In general, patients should reassess their sleep habits – avoiding caffeine late in the day, limit electronics (TV, computer, tablets) in the bedroom, and avoiding alcohol late in the evening. Exercise early in the can often help to promote a more restful sleep.

The benzodiazepines that were initially FDA-approved for insomnia, such as temazepam (Restoril) or triazolam (Halcion), are not used as frequently today due to the availability of the newer nonbenzodiazepine drugs, such as eszopiclone (Lunesta), zolpidem (Ambien), or zaleplon (Sonata). All of the nonbenzodiazepine agents are approved only for treatment of insomnia.”

 

In August of 2009 I moved to Washington, DC as part of my MBA program. I was required to do an internship so off I went. I was living in Rome at the time, so prospects of a long-term career were basically non-existent. I was in a relationship, but I was at a time in my life where my career was more important than anything or anyone else. Sure I thought I was in love and I figured why not long distance. What a fucking mess. My ex did not have anywhere near the amount of life experience that I had nor responsibilities, and he therefore became a burden and a financial strain. I shouldn’t have let it go on for as long as it did, and that was my fault. Since I was already a person prone to depression and “addictive” habits, it was only a matter of months before I went to see a psychiatrist. I was stressed about being in a new city, knowing no one, about job security, about my career prospects, about not knowing where I was going to live – what country I was going to live in, my relationship was weighing on me, I had found a new job with the IMF and I was extremely overworked and overstressed so as to prove myself. Not to mention I still had a lot of unfinished “shit” from the when I first started taking medication and seeing a shrink back in 2001, shit that I had never dealt with. Shit that went even further back and was hidden way deep down inside of me. It felt like college all over again (the very first time I started taking meds). I was alone again with my thoughts and without much of a support system. A very dangerous situation for me.

It has now been 16 days since I stopped Xanax and about 2 months since I’ve stopped Klonopin. Since I was being weaned off of them and did not stop cold turkey (which is dangerous and something you should not do, so please speak to your doctor before deciding to stop your medication), the symptoms of withdrawal have not been so short lived. It has been at least one month if not more. It’s a very strange feeling. Your body starts to awaken, to come to life, to feel things as if you have never felt them before.

For more than a month taking a shower has felt like torture. My nerves are extremely heightened and sensitive. Everyday it feels like knives slicing into my skin for the first minute until my body realizes that it I just hot water. I’ve been sweating profusely from my feet even when they are ice cold, which I believe to be a result of toxins leaving my body. I’ve been scratching like a ‘crack head’ all over my body. Sometimes all day long and for no apparent reason at all. It’s been manageable until the past week or so where the insomnia has kicked in. I had already started sleeping less, and was actually sleeping good which for me means being able to sleep soundly for a good 3-4 hours without waking up. I managed to tire myself out during the day so that when it came time for bed I was able to fall asleep quite easily. A first for me in forever!

Why was I prescribed benzodiazepines and why did I continue to take them for so long? Simple. TO be able TO do the following things… (Which seem “normal” and “second nature,” but when you are depressed, anxious, in panic; it is not. It is a struggle just to get through the day. You are in so deep. The darkness has consumed you and become your norm. Light, any kind – artificial or natural, is your worst enemy. ] …and they are (not necessarily in order, and I may have forgotten many of them-will update as my brain continues to function):

To open your eyes willingly. To be able to get out of bed. To use the bathroom let alone shower. To get something to drink. To order delivery. To force myself to eat. To open the curtains. To open the window. To breathe fresh air. To make a phone call. To check an email or a text message. To get dressed. To put on shoes. To fix my hair. To work from home. To step foot out of the house. To walk down the street to the corner shop. To walk across the street to get into a taxi so I could get to work. To make it through a few hours at the office. To make it until lunch time. To make it the whole day. To concentrate and be a functioning part of society. To go to doctors appointments. To go for coffee. To go for lunch. To go for drinks. To hang out. To go for a walk. To go grocery shopping. To be able to be out of the house for a full day. To hold a conversation about nothing and everything. To open up. To let others in. To tell the truth about how I feel (it’s easier to say “I’m fine” by the way). To not concentrate on the future. To not be in control all the time.

To survive.

 

What did the pills do for me?

Block everything out. Feel nothing. Know nothing. Be numb. Be immune. Focus on the here and now. Hide away the past. Store away the past. Be a robot. Be in control. Be vulnerable. Put down my walls. Know that I am not invincible. Be weak. Be strong. Be ok with who I am. Like myself. Get out of my head. Have peace of mind for a while. Focus. Go to work. Be present at work. Be able to hold a conversation. Have a social life. Meet people. Talk to strangers (not the scary ones LOL).

Survive.

 

The moral of the story is that drugs, or no drugs, nothing is black and white. What may work for you does not work for me and vice versa. I don’t regret taking the pills. I do believe that if I had not taken them in 2015 after my radiotherapy when all the emotions around having cancer finally kicked in and engulfed me like wet cement, I can honestly say that I do not know if I would be here today writing this chapter. I had never been so low (and I will go into that period of my life in due time) in my life. I was on the verge of a nervous breakdown and so ready to give up. I was so fed up with how life had treated me up until that point. I’m only one person. I can only handle so much.

If I can leave you with anything it is this (and this is just me talking): what you may think is the end all be all, it is not. Find what it is that makes you tick, that makes you happy. Try to find something, everyday if possible, no matter how small or insignificant you may think it is, that takes you out of that place. It can be whatever you want it to be. For example, for me it started with opening the curtains; whether it was in the morning or at night. But that instance of accomplishing something so minimal, made me feel like I accomplished a lot that day. We all have very different walks of life, whether we feel we deserve it or not, is irrelevant. I am not a religious person at all, but I do believe that there is a higher power in some shape or form. My experiences have taught me to accept whatever is thrown at me because if it is being thrown at me, then it’s because I CAN TAKE IT. I CAN OVERCOME IT. I CAN COME OUT STRONGER AND WISER. AND I CAN SHARE MY EXPERIENCE TO HELP OTHERS.

 

Stay strong my friends. Love you!

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