31st January 2004
For many of us going through it benzo withdrawal is a hideous, protracted experience. Benzodiazepines damage our biochemical ability to quieten the nervous system and produce feelings of peace and calm.
Our response to our symptoms can and does cause a secondary biochemical dysfunction. Right now the brain is overwhelmed by normal day to day input. Stress adds to that load and will produce a marked increase in symptoms.
Every time we respond with a thought or alarm: "I can't take this", "Oh my God" or "I'm dying" etc., any of these thoughts cause the body to release more stress hormones. Since our brain can no longer cope with the most minimal amount of stress hormones anything we do through our thoughts to increase these will produce more suffering.
I know that the dysphoria of withdrawal makes it almost impossible to have a positive thought but you must work towards lessening endogenous stress. Most of the time these thoughts occur as a flash we are hardly aware of, the effect is the same.
Since the dysphoria makes it difficult to produce a positive thought at will I found having a thought "mantra" or several of them were a great help. Here are a couple:
"I can stand this"
"I can do this"
"A power beyond my understanding is healing me"
"Every second I am closer to relief"
"The only way out is through"
I strongly encourage everyone to develop a list of his or her own as a sort of rapid response statement for self-calming. If you have an anxiety disorder this is a major part of your healing work after benzos.
23. Sedative Hypnotics
Sleep is one of the most fragile processes the human brain engages in. Easily disrupted and often slow to recover.
All sedative medications, including Ambien, alcohol and Kava disrupt one or more phases of the sleep cycle leading to further mental compromise. None of the sedative hypnotics will ever restore normal sleep but merely anesthetize the brain.
Ambien, Kava and all typical sedative hypnotics create further neural dysfunction through tolerance or biochemical dysregulation. Simply the more you take them the more you will be unable to sleep without them.
In an emergency many patients have found antihistamines like Vistaril to be of use. They provide a sleep that is far from normal; usually have a lethargy period after awakening, but you will be unconscious.
The only way to have normal sleep is to allow your body to recover from these medications (which is usually protracted insomnia), develop good sleep hygiene and deal with the underlying stresses that disrupted the sleep in the first place.
24. When Your Back Is Against the Wall
The first thing the Psychiatric Diagnostic Manual states when making a diagnosis is to eliminate the possibility of medication induced symptoms. This means as far as possible get the patient back to a clean (no medication) baseline. Since benzodiazepine detoxification is the most problematic, other suspected symptom causing medications should be eliminated first. If you have been placed on more than one medication at a time it is impossible to know what you are responding to, and should cause you to question your physician (unless he is doing crisis management). If you are not stable before withdrawal it is a good idea to work with your physician to do trial eliminations of all other medications (related to anxiety or depression) before tapering.
I have seen patients suffer needlessly from medication side effects thinking it was withdrawal.
Most important and please do not pass right over this one!!! The neural changes made in the brain from exposure to benzodiazepines prevent the brain from properly responding to incoming stimuli. Often described as stress intolerance it is actually much more complex.
Your nervous system has lost a major part of its ability to slow the firing of nerve cells in response to stimuli. This can be an internal stimulus, such as thought or external as environmental stress. In florid withdrawal the brain reacts to minor stress almost to the point of a seizure like activity. A graphic example is a garden hose with an attached nozzle: a pulse of water comes through: you turn the nozzle off and on to properly place the water in the right amount and in the right place.
With benzodiazepine damage to the GABA-ergic system and the neurons themselves it is like an unattended hose without a nozzle. Turn the faucet on and the hose flails uncontrollably. This equates to neuron misfiring, excessive firing and hyperstimulation.
We can have some effect on this process by reducing dietary stimulants, daily aerobic exercise and meditation/relaxation exercises. The single most effective effort we can make is to eliminate stress. Learning to change our thoughts to positive, soothing, fear eliminating is critical. More critical, is to grasp that we must change our environment - if we just had a heart attack we would probably not arrange our home so we were compelled to go up and down stairs repeatedly.
In florid withdrawals our brain requires we severely limit the incoming stimuli. This may mean drastic lifestyle changes. Ask for help; reduce responsibilities to an absolute minimum - then cut those in half! Attempting to keep up the previous life style will only result in additional time to heal and more suffering.
Try not to see releasing these responsibilities as a depressive loss. It is a healing gesture towards yourself that will lead to a stronger, competent person in less time.
25. Tapering - Cold Turkey - Seizures
Benzodiazepine exposure causes major problems for the neurons to calm themselves. They not only lose the ability to damp down the hyperactivity because of brain chemistry changes, they are physically damaged in many patients so that even normal amounts of inhibitory transmitters (when they resume) are not able to stop the agitation.
The question: cold turkey or taper? Once you have a tolerance or are withdrawing the neurons take time to heal. Unfortunately neural tissue is the slowest of all body tissue to regenerate. Since benzodiazepine withdrawal often activates a form of seizure activity (not a seizure in the strict sense) the less you distress the neuron the less agitation and suffering.
Sudden medication withdrawal causes the most trauma to the neurons and once started takes longer to quiet down. Too rapid a detox may also start a hyperactive cycle. A slow detox is the best insurance to prevent the unnecessary agitation of the neurons.
For some patients the neurons refuse to heal until all benzodiazepines are out of the system - this makes a prolonged detoxification counterproductive. If you make small dosage reductions and do not have a significant symptom reduction in 30 to 60 days you are probably in that class. It will avail nothing to draw the process out for these patients.
If you have made too large a cut and find yourself in trouble you may also discover that resuming your previous dose will not return you to your previous comfort level. Starting a florid withdrawal is again like a seizure or pain; it takes more to control it after the fact. If you cannot endure the symptoms you may need to ramp back up to a much higher dose and wait until the withdrawal settles down.
The million dollar question patients used to ask at the clinic was: did I go too fast and is this why I'm suffering so? No one knows how you would have been had you done it differently. We do know that for some even long, two year detoxes do not prevent a significant symptoms emergence.
If you have been off medication for a period of a month or more you will probably not benefit from reinitiating the benzodiazepine medication; in fact many patients become much worse. If your withdrawal is extremely severe at this point it is better to use Tegretol or another anti-seizure medication.
Anytime we are in pain it is a normal response to search out what could be done differently and we should! For a high percentage of benzodiazepine patients there is no way other than white knuckles, support and time.
28. Parenthood
Most people come to benzos from a history of anxiety or failed coping strategies. We find things in our lives to distract us from internal cues that our core selves are suffering and need attention. Work, eating, high risk behaviors, co-dependencies, constant activities, relationships with drama, etc.
This creation of masking "static" behavior prevents us from having to sit with the uncomfortable feelings and for many, the past wounds. The burial of core knowledge and the dance we do to escape it sets the stage for needing a chemical or other addiction to stop the murmurs of inner screaming.
Anxiety is only the end stage of ignoring our spirit, failure to nurture ourselves and a lifetime of denial. The more out of control and the more our inner selves are suffering the larger the required distraction. For some we are drama junkies, always being involved in a dysfunctional situation, for others it is engaging in socially acceptable behaviors: like parenthood.
If you have come to the point you have needed a chemical to make your life manageable there is a good chance that your motives and drives for having a child are not pure. Children totally capture our attention, providing for their constant needs, normal parental concerns and the blur of daily responsibilities. Parenting can often be the next drug, especially for women!
We arrived at this point through genetics of sensitivity, unmanageable stress and a host of dysfunctional thoughts and behaviors. It is impossible to recover to full peace and happiness without some major internal work...to the degree we choose to distract ourselves will be the degree that we engage in the old destructive behaviors of denial and escape. These are not the things that should be passed to our children! Those of us who need this work the most are usually the ones who consider themselves OK.
Our response to our symptoms can and does cause a secondary biochemical dysfunction. Right now the brain is overwhelmed by normal day to day input. Stress adds to that load and will produce a marked increase in symptoms.
Every time we respond with a thought or alarm: "I can't take this", "Oh my God" or "I'm dying" etc., any of these thoughts cause the body to release more stress hormones. Since our brain can no longer cope with the most minimal amount of stress hormones anything we do through our thoughts to increase these will produce more suffering.
I know that the dysphoria of withdrawal makes it almost impossible to have a positive thought but you must work towards lessening endogenous stress. Most of the time these thoughts occur as a flash we are hardly aware of, the effect is the same.
Since the dysphoria makes it difficult to produce a positive thought at will I found having a thought "mantra" or several of them were a great help. Here are a couple:
"I can stand this"
"I can do this"
"A power beyond my understanding is healing me"
"Every second I am closer to relief"
"The only way out is through"
I strongly encourage everyone to develop a list of his or her own as a sort of rapid response statement for self-calming. If you have an anxiety disorder this is a major part of your healing work after benzos.
23. Sedative Hypnotics
Sleep is one of the most fragile processes the human brain engages in. Easily disrupted and often slow to recover.
All sedative medications, including Ambien, alcohol and Kava disrupt one or more phases of the sleep cycle leading to further mental compromise. None of the sedative hypnotics will ever restore normal sleep but merely anesthetize the brain.
Ambien, Kava and all typical sedative hypnotics create further neural dysfunction through tolerance or biochemical dysregulation. Simply the more you take them the more you will be unable to sleep without them.
In an emergency many patients have found antihistamines like Vistaril to be of use. They provide a sleep that is far from normal; usually have a lethargy period after awakening, but you will be unconscious.
The only way to have normal sleep is to allow your body to recover from these medications (which is usually protracted insomnia), develop good sleep hygiene and deal with the underlying stresses that disrupted the sleep in the first place.
24. When Your Back Is Against the Wall
The first thing the Psychiatric Diagnostic Manual states when making a diagnosis is to eliminate the possibility of medication induced symptoms. This means as far as possible get the patient back to a clean (no medication) baseline. Since benzodiazepine detoxification is the most problematic, other suspected symptom causing medications should be eliminated first. If you have been placed on more than one medication at a time it is impossible to know what you are responding to, and should cause you to question your physician (unless he is doing crisis management). If you are not stable before withdrawal it is a good idea to work with your physician to do trial eliminations of all other medications (related to anxiety or depression) before tapering.
I have seen patients suffer needlessly from medication side effects thinking it was withdrawal.
Most important and please do not pass right over this one!!! The neural changes made in the brain from exposure to benzodiazepines prevent the brain from properly responding to incoming stimuli. Often described as stress intolerance it is actually much more complex.
Your nervous system has lost a major part of its ability to slow the firing of nerve cells in response to stimuli. This can be an internal stimulus, such as thought or external as environmental stress. In florid withdrawal the brain reacts to minor stress almost to the point of a seizure like activity. A graphic example is a garden hose with an attached nozzle: a pulse of water comes through: you turn the nozzle off and on to properly place the water in the right amount and in the right place.
With benzodiazepine damage to the GABA-ergic system and the neurons themselves it is like an unattended hose without a nozzle. Turn the faucet on and the hose flails uncontrollably. This equates to neuron misfiring, excessive firing and hyperstimulation.
We can have some effect on this process by reducing dietary stimulants, daily aerobic exercise and meditation/relaxation exercises. The single most effective effort we can make is to eliminate stress. Learning to change our thoughts to positive, soothing, fear eliminating is critical. More critical, is to grasp that we must change our environment - if we just had a heart attack we would probably not arrange our home so we were compelled to go up and down stairs repeatedly.
In florid withdrawals our brain requires we severely limit the incoming stimuli. This may mean drastic lifestyle changes. Ask for help; reduce responsibilities to an absolute minimum - then cut those in half! Attempting to keep up the previous life style will only result in additional time to heal and more suffering.
Try not to see releasing these responsibilities as a depressive loss. It is a healing gesture towards yourself that will lead to a stronger, competent person in less time.
25. Tapering - Cold Turkey - Seizures
Benzodiazepine exposure causes major problems for the neurons to calm themselves. They not only lose the ability to damp down the hyperactivity because of brain chemistry changes, they are physically damaged in many patients so that even normal amounts of inhibitory transmitters (when they resume) are not able to stop the agitation.
The question: cold turkey or taper? Once you have a tolerance or are withdrawing the neurons take time to heal. Unfortunately neural tissue is the slowest of all body tissue to regenerate. Since benzodiazepine withdrawal often activates a form of seizure activity (not a seizure in the strict sense) the less you distress the neuron the less agitation and suffering.
Sudden medication withdrawal causes the most trauma to the neurons and once started takes longer to quiet down. Too rapid a detox may also start a hyperactive cycle. A slow detox is the best insurance to prevent the unnecessary agitation of the neurons.
For some patients the neurons refuse to heal until all benzodiazepines are out of the system - this makes a prolonged detoxification counterproductive. If you make small dosage reductions and do not have a significant symptom reduction in 30 to 60 days you are probably in that class. It will avail nothing to draw the process out for these patients.
If you have made too large a cut and find yourself in trouble you may also discover that resuming your previous dose will not return you to your previous comfort level. Starting a florid withdrawal is again like a seizure or pain; it takes more to control it after the fact. If you cannot endure the symptoms you may need to ramp back up to a much higher dose and wait until the withdrawal settles down.
The million dollar question patients used to ask at the clinic was: did I go too fast and is this why I'm suffering so? No one knows how you would have been had you done it differently. We do know that for some even long, two year detoxes do not prevent a significant symptoms emergence.
If you have been off medication for a period of a month or more you will probably not benefit from reinitiating the benzodiazepine medication; in fact many patients become much worse. If your withdrawal is extremely severe at this point it is better to use Tegretol or another anti-seizure medication.
Anytime we are in pain it is a normal response to search out what could be done differently and we should! For a high percentage of benzodiazepine patients there is no way other than white knuckles, support and time.
28. Parenthood
Most people come to benzos from a history of anxiety or failed coping strategies. We find things in our lives to distract us from internal cues that our core selves are suffering and need attention. Work, eating, high risk behaviors, co-dependencies, constant activities, relationships with drama, etc.
This creation of masking "static" behavior prevents us from having to sit with the uncomfortable feelings and for many, the past wounds. The burial of core knowledge and the dance we do to escape it sets the stage for needing a chemical or other addiction to stop the murmurs of inner screaming.
Anxiety is only the end stage of ignoring our spirit, failure to nurture ourselves and a lifetime of denial. The more out of control and the more our inner selves are suffering the larger the required distraction. For some we are drama junkies, always being involved in a dysfunctional situation, for others it is engaging in socially acceptable behaviors: like parenthood.
If you have come to the point you have needed a chemical to make your life manageable there is a good chance that your motives and drives for having a child are not pure. Children totally capture our attention, providing for their constant needs, normal parental concerns and the blur of daily responsibilities. Parenting can often be the next drug, especially for women!
We arrived at this point through genetics of sensitivity, unmanageable stress and a host of dysfunctional thoughts and behaviors. It is impossible to recover to full peace and happiness without some major internal work...to the degree we choose to distract ourselves will be the degree that we engage in the old destructive behaviors of denial and escape. These are not the things that should be passed to our children! Those of us who need this work the most are usually the ones who consider themselves OK.