My Tranquiliser History
This paper was originally written at the request of the local addiction team as part of the reduction therapy I did with them in 1999. They use my personal view of my situation as part of their training programme.
I have updated it as of November 2001.
THE START OF MY PROBLEMS
January 1971------ That year I was completing a post graduate degree in Psychology. I am a Chartered Psychologist. While travelling by train, to the University I felt very unwell. A visit to the toilet showed that I was passing blood indeed I had suffered an internal haemorrhage. This required emergency surgery in the middle of the night and, in all, it took 20 pints of blood to see me through.
February 1971------ Discharged from hospital in an extremely weak and emotionally shattered condition I returned home to recuperate and get ready for my final exams in May.
March 1971------I wasn't handling the stress of all I had been through and the pressure of the approaching exams. My Doctor suggested that Lorazepam, trade name Ativan, would act as an effective anxiolitic and that there would be no side effects, such as addiction, as there had been with the barbiturates of earlier years. Trustingly I commenced on 1mg twice a day.
April 1971------As the examinations approached and I was still in a very weak and anxious condition it was recommended that I increase the dose to 1mg three times a day. The anxiety certainly lessened.
May-June 1971------With difficulty I sat and passed all my examinations. The doctor recommended that I stay on the 1mg three times a day as it was certainly reducing any anxiety
1972-1973------Repeat prescriptions became the norm and I only saw the Doctor on rare occasions. Every time the advice was the same. 'You are doing well don't change things. These drugs are safe and only 'minor tranquillisers' Not at all addictive.
THE FIRST SIGNS OF ADDICTION
July 1973------Friday-----By a serious misjudgement of my prescriptions, 'Takes two days to process you know and we don't open Saturdays' I was left without any tablets. During the day on Saturday I coped OK but I did not sleep at all well that night and I started to have strange feelings all over my body and a sense of my arms being paralysed. Sunday was worse. The same symptoms but now serious headaches and muscular pains as well plus a definite sense of unreality. On top of that came a massive panic attack.
Phoned the Doctor.....'Couldn't be a reaction to the Lorazepam. Must be my underlying mental state..... possibly having a 'Nervous Breakdown' I'll see you tomorrow.'
Sunday night sheer hell... no sleep...severe panic attacks... sense of dying or going mad.
Monday and the Doctor agreed with his telephone diagnosis that it was my underlying psychological state that was causing the problems and he would refer me to a Psychiatist meanwhile I should go back on to Lorazepam right away.
By Monday evening, after three 1mg Lorazepam in my system I was almost completely back to normal functioning.
August 1973------My doctor totally refused to accept that the Lorazepam could affect me in the way that it did. 'Harmless.. non addictive ...minor tranquilliser' seemed to be all he knew. The Psychiatrist agreed and decided that I was a Manic Depressive. I knew that they were totally wrong but they would not listen to any argument I put forward. They made it quite clear that they were the experts and I was mentally unbalanced. I simply gave up and stuck with the Lorazepam. Scared now to even try to do without it.
It must be remembered that this was still the early days if the use of tranquillisers. Others found the same reaction from their medical practitioners that I did. We were simply not believed. It was not until the 1980s, when huge numbers of people were being handed out 'The Happiness Pill' that increasingly it was realised that they were not the safe 'magic bullets' that the public were led to believe.
Joy Melville, commenting on the huge overprescribing, says in her book 'The tranquilliser trap, and how to get out of it'. Fontana paperbacks 1984. 'Latest figures for Great britain show tranquilliser and sleeping pills are being prescribed to 21.4 million people a year.' The press started to report the tragedy of some peoples lives as a result of taking tranquillisers and gradually self help groups formed, some doctors began to question what was happening and help was at last available.
Before the various books about tranquillisers, Melville 1984, Trickett 1986, Neild 1990, were published and newspaper publicity became widespread I was to find out the hard way just how deadly tranquilliser withdrawal could be.
1977-1981------Over this period, due to circumstances, there was little incentive to make changes in my intake of Lorazepam so I stuck with the 1mg three times a day. I realised that I was chemically dependant and although I hated being so I knew that to stop taking the Lorazepam would require an enormous amount of stability and support.
In these years I did not have the stability and support that I would have needed to come off the drug. Over that period of time my wife left me, I had custody and care of four children as well as a 'top job' and a house to run. In 1979 I remarried and we attempted to weld two families, six teenagers !!!, into one unit.
MY FIRST ATTEMPT TO ESCAPE FROM THE ADDICTION
March 1982------I decided that life was now more stable and that it was time to really tackle the Lorazepam addiction. I sought medical help before starting to be met with the same response although we now lived in a different town 'These pills are not addictive. just cut them down and you will be off them'. So I did.
April 1982------Instinctively I knew, from my experience in 1973, that I should go slowly so I took twelve weeks to come off the 3mg per day. The withdrawal symptoms were bad but I stuck it out. Twice I consulted the doctor to be told that it was really the underlying 'mental instability ' that was causing my problems. I knew that it wasn't but that was all the help I got. Having a strong will power I was determined to succeed and by the middle of June I was totally off the drug. I felt pleased with myself. I had 'kicked the habit'
July 1982------After our holiday in France and during a Rogerian Counselling Conference I started not being able to sleep. Some nights not at all. I became anxious and fearful and had a sene of 'being not fully connected'.
August 1982------Symptoms became worse and worse, deep depressions, total exhaustion from lack of sleep, a deep sense of unreality, of being disconnected from other people, manic episodes with grandiose ideas, schizophrenic episodes where people were out to do me harm, suspicion and paranoia and , mosy frightening of all thoughts of suicide to end it all. Believe you me I was frightened and sure I was going mad..
September 1982-----Back to the Psychiatrist that I had been sent to in 1973. This, of course confirmed his earlier diagnosis. I really was mentally ill. For me this was a very strange time. It was as if I was both patient and, because of my training as a Psychologist, a Therapist at the same time. I knew that I was not crazy, I knew that it was the Lorazepam but convincing others was not so easy indeed it proved to be impossible. Admittance to mental hospital was a close thing. Saved really by the loving care and attention of my wife without whom I would not have survived.
The Psychiatrist was not impressive either sitting during one consultation with his feet up on the table eating a packet of crisps!!!!!
October 1982------The Doctor put me back on to Lorazepam and also an anti-depressant. Slowly things calmed down but I was now back to square one. Worse off really because now I was in a very emotionally damaged and vulnerable condition. Infinitely worse than I had been before I stopped taking the Lorazepam.
The help, support and understanding that I received from the professionals at this time was negligible and I was simply dismissed as going through a 'mental breakdown'. This was a summer of hell---a summer that I was convinced that I was going mad. At no time ever did anyone say that this was TOXIC PSYCHOSIS caused by the stopping the Lorazepam and that what I was going through was the effects of tranquilliser addiction and withdrawal. As a family we were left with the idea that I was mentally ill.
I even sought solace by consulting our local minister of religion in an attempt to get some support other than my family. His verdict ' You must have sinned greatly and you will not be well until you repent'. It was hard not to laugh out loud.
The stress on the family, at this time, particularly on my wife, was enormous and could easily have finished our relationship for good. Fortunately I have an exceptional wife who, despite the serious effects that my withdrawal had on her own health, stood by me and supported me.
1982-1988------It really took about six years to fully recover from the emotional devastation that I suffered at that time. Deep fears and anxieties kept surfacing and there was the constant fear that I might return to that horrendous state.
And still no one would confirm that my problems were due to tranquilliser addiction despite my asking. Eventually I was to find that coming off Lorazepam is almost as hard as coming off heroin. As an indication of how powerful it is 1 mg of Lorazepam is equivalent to 10 mg of Diazepam.(Valium)
In the late eighties and the early nineties the situation for tranquilliser addicts improved greatly . Media publicity and the formation of support groups became common. I saw then that, at last. the press and the medical profession were starting to talk about all the things that I knew from my own experience. It was a great comfort to me to know that I had been correct all along and my story was supported by thousands of other unfortunate people who, like myself, were caught in the 'Tranquilliser Trap'.
The memory of what I had been through was so bad that I simply couldn't bring myself to go through withdrawal again. So, always against my natural inclination, I played safe and remained on as low a dose of lorazepam as I could handle.
MY SECOND ATTEMPT TO ESCAPE FROM THE ADDICTION
1993------After obtaining a copy of 'Escape from Tranquillisers and Sleeping Pills' Larry Neild (1990) Ebury Press. I decided that I could follow the lorazepam withdrawal plan that he laid down. The problem with lorazepam is to reduce the dose in small enough steps to avoid serious withdrawal symptoms. By this time my son had graduated as a Pharmacist and he undertook to take my tablets and dilute them with sucrose so that I could reduce by an eighth at a time.
Remembering my previous experience when I had come down from 3mg per day to zero in twelve weeks I took two years to reduce to 0.5 of a milligram in the morning and the same at night.
1994------ I felt pleased with myself for having cut down relatively painlessly. Falsely as it turned out because, on 0.5 twice daily I started to sleep extremely badly, had panic attacks from time to time and generally felt terrible in the early morning and in the late afternoon. Again I consulted a number of medics. had two full polysomnographies where electrodes are attached to the body and data fed to a computer all night. The conclusion 'You don't have a sleeping problem you have an inability to stay asleep problem.' The computer printout showed that I woke anything up to ten times a night. Mainly in the early morning. They could suggest no treatment but felt that my tranquilliser addiction could be at the bottom of the situation.
1995------October. Helicobacter Pylori was diagnosed---the bug that causes stomach and duodenal ulcers---the reason you will recall that put me on tranquillisers in the first place. Triple treatment undertaken. Two anti-biotics for one week and Losec, an acid reducing drug. The latter at double the usual dose for two months.
The treatment was fine with no problems but when I stopped the Losec and started having panic and 'nervous' attacks. (One massive one in a motorway holdup lasting over an hour) The doctor diagnosed anxiety and put me on a low dose of the anti-depressant Surmontil for night time and a low dose of the Beta Blocker, Propranolol, to reduce the anxiety.
Things improved only a little. I still had what looked suspiciously like withdrawal symptoms. It was not an easy time. The reason for all this was not to become clear for nearly two years.
1996/7------I suffered this situation. I was always able to do my job despite the fact that frequently my needs were greater than my clients. The 0.5 milligram of lorazepam I continued to take at 8.00am and 8.00pm. It was only much later I was to realise the folly of this.
1997-------In March an accident caused me great anxiety and the stress of this, in turn, upset my digestive tract producing an ulcer. The recommended treatment was, of course, our old acquaintance Losec the acid reducing drug (Again at double the usual dose). By May all was well and I stopped the Losec only to become extremely unwell with what I recognised as tranquilliser withdrawal symptoms. I started the Losec again and all settled down. On discussing this with my son, now a lecturer in pharmacy, who looked into the situation and came back with the information that Losec enhances the effect of tranquillisers. Taking the Losec was equivalent to increasing my dose of Lorazepam and the stopping the Losec was equal to a sudden withdrawal.
At last I understood all the panic attacks and problems that I had suffered when I completed the Helicobacter Pylori treatment two years before.
Indeed on reading the small print of the Losec notes it does say there is an interaction and doses should be altered. My Doctor was ignorant of this. This information was news to her.
AT LAST----THE WAY OUT ?
1997------June. I changed doctors and found myself one who was both knowledgeable and personable. I also made a self referral to the local Drug Addiction Unit as I felt that I was getting no support from the ordinary medical service.
These two moves were the best thing that I could have done. A urine test, taken at four o'clock one afternoon in the Unit, totally failed to show any Lorazepam at all in my system.Here, they suggested, was the key to many of the immediate problems that had occured since I reduced to 0.5 milligrams night and morning. Lorazepam is a short acting drug and, on my low dose, every day from two/three o'clock in the afternoon and at night until I took my next dose I was virtually out of tranquilliser and deeply into withdrawal. No wonder I was permanently unwell and having difficulty in coping.
1997------July, August and September were spent coping with permanent withdrawal symptoms. Systematically and slowly the team had me withdraw in turn from Losec then Surmontil and finally Propranolol. It had been agreed with the Drug Addiction Unit that the tranquilliser treatment proper could not start until I was clear of those other drugs.
1997------October and the decision was made to go ahead with the actual withdrawal from the Lorazepam. Initially the Unit wanted me to come in for a day and, within 24 hours, they would trensfer from Lorazepam, the short acting drug, to Diazepam, a longer acting drug. After my experiences of the past there was no way that I was prepared to do this so quickly and proposed cutting down the lorazepam and substituting Diazepam a little at a time. After much debate this was agreed to.
As noted above the biggest problem was that twice a day there was no tranquilliser in my body and therefore I was into permanent withdrawal symptoms twice daily. To overcome this the first Diazepam was introduced while still on the Lorazepam
This produced almost dramatic results as, for the first time in years, I was actually covered for the full 24 hour period. No withdrawal symptoms whatsoever. Life became easier, calmer and less distressing. OK I had increased my tranquillisation ------ but for a definite purpose. Now the job was to substitute the longer acting Diazepam totally for the short acting Lorazepam.
TABLE SHOWING THE METHOD OF SUBSTITUTION
This was carried out over a period of 2 months
|7.OO AM ||3.00 PM ||11.00 PM
|0.5 mg Lorazepam || nothing ||0.5 mg Lorazepam |
|0.5 mg Lorazepam ||5 mg Diazepam ||0.5 mg Lorazepam |
| 0.25 mg Lorazepam |
3 mg Diazepam
| 6 mg Diazepam |
5 mg not enough
| 0.5 mg Lorazepam |
| 0.25 mg Lorazepam |
3 mg Diazepam
|6 mg Diazepam || 0.25 mg Lorazepam |
3 mg Diazepam
|6 mg Diazepam || 6 mg Diazepam || 0.25 mg Lorazepam |
3 mg Diazepam
|6 mg Diazepam || 6 mg Diazepam ||6 mg Diazepam |
Over this period I had spells of being very sleepy and would fall asleep watching TV or reading. Frequently I couldn't drive the car and just slept while my wife drove. It was as if my body was catching up on all the lost sleep that it had missed for years. Simply balancing out the level of tranquilliser in my body and getting on to the longer acting one was like a miracle in my life. Fine..... I accept that I was now on a much bigger dose of tranquilliser than I had been but there was now a chance to withdraw slowly and in small steps. This process was scheduled to start on the 12th of January 1999 and I will report here how I progress.
1999------As agreed on the 11th January I reduced my dose by 1 mg to ;
|6 mg Diazepam || 5 mg Diazepam ||6 mg Diazepam |
I experienced extremely mild withdrawal symptoms for about four days but absolutely nothing to even bother about. Merely a sense of not being just as good as I had been. In the light of this reaction the plan is to reduce by 1 mg every two weeks.
1999------January My dose is now ;
|5 mg Diazepam || 5 mg Diazepam ||6 mg Diazepam |
That was the theory. By accident I broke one of the first rules of tranquilliser withdrawal
KEEP YOUR DOSES EQUAL. Busy working with clients I forgot to take my afternoon dose and did not realise it until 11.00pm at night when I was about to
take the third dose of the day.
This meant that on that day I was actually 6mg of Diazepam short. A third of my daily dose. For the next three days I had withdrawal symptoms.
I knew that that was what was going on in my body and that either I increase the dose (Definitely Not) or work through the withdrawal. I chose the latter
alternative and, although it was not at all comfortable, I survived and am now back on an even keel.
I know that it WAS withdrawal symptoms that I was going through but the doctor at the addiction unit assured? me that it couldn't be and it must be
psychological. Believe you me I have been there often enough to know what I was suffering.
1999------1st February. Meeting with the Addiction Unit staff. Apart from the comment above they are happy to only see me every month now. and will leave me to come down
1mg every two weeks. Originally the doctor wanted me to come down 1mg every week but I simply refused to do so knowing that it would be too fast.
In this business you can see that even with advice you NEED to be in charge. After all it is your body and mind that is being treated.
1999------9th February another reduction in my dosage. Now taking :
|5 mg Diazepam || 5 mg Diazepam ||5 mg Diazepam |
Again four or five days of just not being right----nothing like the last time when I missed my dose----really coped very well.
1999------25th February. Another reduction of 1mg from my total dose. Now taking :
|5 mg Diazepam || 4 mg Diazepam ||5 mg Diazepam |
A LESSON LEARNED
As I have been doing so well lately that I have taken on a lot of work and other interests. I was to learn the hard way that this withdrawal is
leaving me not as robust as I thought. My exercise class on Wednesday left me more tired than usual and I had a very busy afternoon with
clients and a full evening preparing for a days lecturing that I was doing on the Thursday.
The lecture session proved to be very stressful
with a projector breakdown complicating the situation. I arrived home in the late afternoon drained physically and emotionally and spent
the whole of Thursday evening in bed more or less comatose. The next two days were almost like a reliving of some of my worst times in miniature.
anxiety, not depressed but very low, almost a panic attack, very tired and exhausted.
In a highly sensitised condition I simply used all
the techniques that I recommend, lived very quietly and let my body/mind get on with sorting things out. By Sunday I was almost back to normal. It has left me, however, realising
that this Diazepam reduction programme is taking more out of me than I thought. While I can cope well with day to day living, without too
many problems, I really must not put myself under too much additional stress.
1999------8th march. Another reduction of 1mg from my total dose. Despite the events of last week I have decided to 'go for it'
but to make sure that I have a quiet couple of weeks this time. I have therefore cancelled my exercise class for Wednesday and also a conference that I was due to
go to on Saturday and Sunday. Hopefully by taking care of myself I will offset any withdrawal problems that I encounter. Now taking :
| 4 mg Diazepam || 4 mg Diazepam ||5 mg Diazepam |
1999------22nd March. Time for another reduction but my sleep pattern has gone again. On top of a tranquilliser addiction problem
I also have a sleep disorder that, while thoroughly investigated by two sleep labs, no treatment suggestion has been offered. One of
the effects of tranquilliser reduction is to create sleep disturbance so I guess it is not surprising that my condition should get worse.
Because of this, I decided to only come down a half mg today and then come down the other half next week. Pharmacologically it probably
doesn't make much difference but I feel better about trying it this way.
1999------29th March. Now down the other half mg. Certainly seemed easier last week.
Now taking :
| 4 mg Diazepam || 4 mg Diazepam ||4 mg Diazepam |
I want to shout it out because I am proud of my achievement;
I HAVE NOW REDUCED BY A THIRD THE DIAZEPAM DOSE THAT I WAS ON AT THE
BEGINNING OF THE YEAR AND I AM WELL ON TARGET
February 23rd Now taking :
| 3.5 mg Diazepam || 4 mg Diazepam ||4 mg Diazepam |
March 9th 1999 Now taking :
| 3.5 mg Diazepam || 3.5mg Diazepam ||4 mg Diazepam |
March 23rd 1999 Now taking :
| 3.5 mg Diazepam || 3.5 mg Diazepam ||3.5 mg Diazepam |
April 6th 1999 Now taking :
| 3 mg Diazepam || 3.5 mg Diazepam ||3.5 mg Diazepam |
April 20th 1999 Now taking :
| 3 mg Diazepam || 3 mg Diazepam ||3 mg Diazepam |
May 4th 1999 Now taking :
| 2.5 mg Diazepam || 3 mg Diazepam ||3 mg Diazepam |
REGRESSION AFTER DOING SO WELL
Over the past few weeks my sleeping pattern has been getting worse. This is a serious problem in my life anyway and I have had two full
polysomnographies and full assessment by a Professor of Psychology who specialises in sleep disorders. The conclusion of them all is that I have a sleep disorder
but no one knows what to do about it. This week everything went critical and I found myself only able to sleep two hours per night. It was as if the
last reduction was just too much for me. The old spectre of the time I withdrew from the Lorazepam in 12 weeks back in 1982 loomed large and
I started to fear slipping back into all the old 'Toxic Psychosis' symptoms that had had been so horrendously frightening.
In retrospect we should have reduced at a slower level. 1 mg every two weeks now seems to have been too fast
and pushed me too far too fast. Probably 1 mg every month from 12 mg onwards would have been a better rate. It is easy to see this in retrospect.
May 18th 1999 Symptoms of withdrawal being so bad it was agreed to go back up to 10.5 mg Diazepam for a 'holiday' from the reduction schedule.
June 30th 1999 Now, some six weeks on, although generally well balanced again, my sleeping pattern is still not back to normal. Better but still very distressing. I am back
to wakening up every hour and a half and rarely get any sleep after 4.00 am. Diazepam remains at the same 10.5 mg per day.
Daytime exhaustion is common. I need to sleep for a short while every afternoon. Evenings are much better than mornings.
August 15th 1999 Little change in the pattern ------ still struggling ----- sleep pattern still as bad. I find I now have a
degree of apprehension about coming down further. This I will overcome but the experience of the past two months has caused me to loose confidence.
A TRAGIC REGRESSION
At the beginning of September I developed a phlebitis in my leg and all my worst fears were realised. The NSAIDs treatment for the condition had a serious reaction to my
hypersensitive 'gut' and the resultant nausea, sickness and inability to eat resulted in a one and a half stone weight loss in ten days. with an endoscopy and enormous fears about my health surfaced that
I thought had been effectively dealt with years ago. The sad result of this was, agreed by the Addiction Unit, an increase to 15 mg of diazepam to allay the high level of anxiety.
December 8th 1999 ....... I am well stabilised again BUT the gut problem left me on Zantac, to reduce the acid levels caused by the irritation of the NSAIDs.
All very well but, when I was coming off losec, the same type of drug, after the H. Pylori treatment
that I found withdrawal symptoms rearing their ugly head. The same again. All these acid reducing drugs can potentiate
the effects of the tranquilliser. So now that I do not need the Zantac I cannot just stop it but have to slowly reduce it BEFORE
I can start to come off the diazepam again. This will seriously delay the reduction. I tried reducing by one quarter of the dose and found myself in serious withdrawal so
clearly it will need to be much more gradual. Needless to say my G/P knows nothing about this. It is however confirmed by both Shirley Tricket's
book and by CITA the tranquilliser helpline. Good to know that it is not 'all in my mind' as some would have me believe.
As a result of this situation I was referred to the local Cognitive Behavioural unit and for some months a saw a C.P.N. trained in Cognitive Behavioral Therapy. He worked on helping me to cope with my underlying health anxiety problems. Very successful and I learned a lot of coping skills but no effort to reduce the diazepam.
He left to work in the private sector. As they had no one else I was discharged and the Addiction Unit did not wish any further contact as they said 'Tranquilliser addiction is not really our main job and you know how to reduce the dose yourself'. I was therefore left without any support and, with physical problems to deal with I did not reduce from the 15 mg per day that the unit had recommended.
While the phlebitis is now cured the only treatment in the absence of NSAIDs was rest. The result was muscle wastage of the leg plus sciatica and
slight , x-ray cofirmed, wearing of an intervertable disc and knee joint. So JUST reducing my tranquillisers is not the only agenda my body
needs to deal with at present. From August 2000 I simply remained on 15 mg.
Update for Chris Idzikowski June 2001.
July 2001. ------ My leg is still pretty weak despite exercise programme and physio. Since November 2000 I have been off Zantac and settled on 1 X 5mg diazepam TID.
This has resulted in lack of exercise and the consequential putting on of weight. Slowly I am increasing the amount of walking I do. Present level two 15 min walks per day.
A 'flare up' of the old ulcer problem was treated by 'Protium' this time as my son,now a Lecturer in Pharmacy, pointed out that it did not interact with
diazepam as do the other acid reducing drugs. It didn't and the gut problem resolved, is well and I am now off protium.
Currently I am ready to reduce the diazepam again but I am well aware that in doing so I will have to cope with the negative psychological and physical situations detailed above. My feeling, Chris, is that simply halving the dose, as you suggested, is to much too quickly going by my past experiences. My G/P is aware of my 'chemical sensitivity'
as he calls it and usually prescribes half the usual dose of anything that I have to take.
Update for Dr. Fraser. The Priory Hospital, Glasgow.
November 2001 ------ Under Chris' guidance I have been slowly reducing my diazepam as agreed above and tomorrow 27th November 2001 I will be 4 mg down from the starting point of 15 mg when I reduce to 3 mg at 7.00am, 4 mg at 3.00 pm and 4 mg at 11.00 pm.
There has been, since the summer an increase in my health anxietyand sleep disorder problems but I feel that this is due to my altered lifestyle situation rather than the diazepam reduction. My wife and I have now both retired.