I apologize for the typos, fragments, and rambling. As stated, I amI'm very sorry for the situation that you are in.
It's interesting (thought not surprising) that your psychiatrist followed the Ashton manual for tapering but not the part that says that the decision to withdraw and the speed of withdrawal should be patient-directed due to the unique nature of benzodiazepines.
As far as diversity of opinion, there certainly remain doctors who believe that in some cases long-term benzodiazepine therapy is the right course of action. Doctors seem to follow either formulas or what they personally believe to be true. It's hard to be open to something that challenges your professional lens on a subject. It would be as if your students challenged your position on whichever subject you're a professor in--maybe not quite the same, as some medical doctors are even more protective. There's also a legal aspect that they worry about it when it comes to controlled substances.
There was a thread recently on this forum where a psychiatrist was writing about a patient who only felt relief of his depression with the use of opiates:
http://forums.studentdoctor.net/threads/fascinating-pt-conundrum.1131646/
Even though I am the OP of this thread (where I was complaining about the opposite experience you are having), I said in that other thread that I think it raises very interesting questions about quality of life.
My sentiment was that we each only have one life and I think to the maximum extent possible we should every right possible that allows us to find the greatest meaning in it.
The problem of course is that unlike finding what you need in a babbling brook, controlled substances are behind a walled door. You know what works best for you, but other people say they know better.
I am glad you were able to give informed consent. I was not. And even though I feel that way about my own experience, I wish for you that you could continue to do what you think is best for the rest of your life. And I always think that benzo withdrawal should be patient-directed.
There's a psychiatrist where I live (who is soon retiring) who is known among other doctors as the one you go to when you know what you want. He used to end my sessions by asking, "Do you need anything else?" That was his value. I have only seen one doctor who has been encouraging in my quest to decrease my benzodiazepine use. I see a neurologist about once a year, and he thinks I'm on a "peanuts" amount of benzodiazepines and says things like, "You're an anxious guy. You need them." I say this not to rant again (as I did my creating this thread) because as I've tapered (and I haven't gotten far), I've realized the practical realities and trade-offs. My biggest regret is the amnesia I have from the benzos. I have times where I think, well I'm lucky if I live another 50 years, so why not just stay on the benzos and if I have to updose 20 years from now, so be it. But I recently found some journals from before the period I got on heavier doses of the benzos. I saw how alive I was. And it re-affirmed what I already know: I can't remember much of my life. I can remember such vivid details of my childhood, but the degree of my amnesia coincides exactly with when I started on the benzos at the heavier doses (college, when a psychiatrist put me on Klonopin and Ativan at the same time--before that it was more moderate).
But I haven't made fast progress at all. And I'm not willing to be tortured in tapering. I am only willing to have discomfort. So, I support you. I am also very impressed that you did what you did (total withdrawal).
From what I've read on the forums, it takes a long while to recover even after completely tapering. Some people say flumazenil is helpful (after the taper is over). But I know that none of that is what you want to hear, and I shouldn't be saying it. I shouldn't be saying it because I haven't done what you've done. I'm a hypocrite. And I know you don't want to hear it because from all accounts there's no going back to normal that would be good for you--you took these meds because of a problem you had.
Given how severe the effects of withdrawal are, I wonder if you can take FMLA leave for some time and maintain your position at work rather than retire? I shouldn't give advice. If I were ever able to get off all my benzos but felt like there were no options but to go back on, I'm not sure what I would do or want to hear.
Lyrica and Neurontin are also addictive (I'm not sure how much so compared to benzos, but less so I believe) and may be meds that your psychiatrist would be more willing to prescribe. I thought of those because they are also GABA-ergic I hate to offer advice like that knowing that you've probably tried everything. I wish you well. And I am sorry. I wish there were something more I could say.
1.) There's no reason for you to apologize, although I realize that you are primarily empathizing. However, and I cannot stress this enough, my post was intended for the psychiatrists on this forum and while I will reply to your post (below), my final questions stand, and I am much more interested in speaking with medical practitioners since I am trying to understand their reasoning, and from my own psychiatrist, I have received fairly canned or vague replies.
2.) My psychiatrist was not making his decision to taper me based on the Ashton manual but on the fact that he stated that taking xanax, and other benzodiazepines, for anxiety was outdated. This attitude was the same attitude that I found amongst numerous other psychiatrists whom I then consulted. Eventually, I gave up looking for someone to treat me and discontinued medication via the taper method. I found zero psychiatrists even remotely interested in assisting me, and I found this same attitude on this forum, essentially confirming that it wasn't simply a geographic issue, which was what I had suspected at first, and what you suggest since in other posts. Perhaps the psychiatrists who will still treat psychiatric disorders simply do not post online. That's possible. They certainly do not live near me.
3.) You say that doctors "seem to follow either formulas or what they personally believe to be true." Of course they do. There is no such thing as a full objective knowledge of the human psyche, so all treatment will be highly subjective. Either the prevailing wisdom is a rigid adherence to a pre-conceived formula -- which one can see in totalizing statements about benzodiazepines, on either side of the fence, and there is quite a history to how this has changed dramatically over the past two decades or so, which is perhaps part of what frustrates patients -- or else the choice is made based upon something that is subjectively ethical or else ideological. All of these are insufficient, however, when a patient is an intelligent human being. In four U.S. States, one can choose to participate in physician-assisted suicide, a point that you, yourself, raised at some point, perhaps in another thread, and yet one cannot choose to take medication that improves his or her quality of life. All psychiatric medication is a matter not of life and death, other than in the most extreme cases, but of quality of life. If quality of life is what's at stake, and it is the only thing at stake (along with the greater welfare of other individuals or else the economy of a society), surely all patients should have a say in what that quality of life is like rather than having to rely so wholly on someone else's subjective ideology, ethics, or limited neuropsychiatric understanding, which is no fault of anyone; the current understanding of psychiatry is simply based on incomplete scientific data, which is precisely why I stated earlier that to fail to recognize this was sheer hubris, which is actually someone's fault.
4.) Students often challenge me. That's good. It either makes them think or else it makes me think. The vast majority of university professors would tell you the same thing. I do not take personal offense to it, and the outcome of being challenged is either that the student reconsiders his or her position and knowledge, or else I do. Thus said, being a professor involves far more than students. If my academic peers challenge me, there is a different psychological reaction involved, although again, the net outcome is to either see that they come to agree with me, I discard my point of view, or else I accept the discrepancy for some reason. When it comes to psychiatry, the issue is a quality of life issue, as stated, so the stakes are not academic but moral. This is the reason why I created an account on this site and decided to post about my situation here, amongst people making decisions on behalf of other human beings, with the hope that it might generate a little moral consideration about the topic of rational benzodiazepine use in stable, informed, non-abuse-inclined patients.
5.) I would hope legality would not compromise a medical health care provider's integrity. I am not aware of any laws limiting the prescription of
benzodiazepines in the United States at this time, provided that the patient has an appropriate medical reason to be prescribed them. If there are laws concerning this, I would be interested in hearing what they were so that I better understood the prevailing attitude towards benzodiazepines in psychiatry right now towards panic-disorder patients, who are compliant patients in general from all that I've read. I know that I've humored more psychiatrists than I can count when I was young by diligently taking some awful medication that gave me unacceptable side effects. By "unacceptable," I mean things like trazadone making me too orthostatic to stand up or doxepin causing a heart arrhythmia, not subjective side effects, but very objective signs that impaired me. I was compliant with medication which did not do these things, like taking a year's worth of SSRI's without any change in my symptoms.
6.) You express doubts when you say that one is unlikely to find what one needs in a "babbling brook." Perhaps there's a bit of self-projection there. Personally, I've been quite well for a long time until recently. Thus the babbling brook was a gusher. It's now quite dry.
7.) Not everyone has amnesia from benzodiazepines just because you have journals you do not remember. Personally, my Latin is quite good, as are my memories of ages 17-25, etc. I've had neuropsychiatric testing which lasted three days, and which cost 5K out of pocket, and I was deemed just fine, mentally, which I could have told you for free. Most people would say I was intelligent other than the occasional student whom I fail. I've noticed zero decline in my memory or cognition. As mentioned, I've spent much of the past near-decade attending international academic conferences where I present regularly with no one ever once noticing that I was on benzodiazepines, nor have any of my colleagues, whom I interact with daily, complained that I'm mentally dull, nor has my ability to publish been reduced, and I am, or maybe I should say was, an active member of my university governance as well. The very sad thing here is that I am now giving this up. I cannot take FMLA because that's irrelevant to me and my work, which is a life-long project, not a semester-long issue. I would just take a sabbatical if that were the case. I'm not overstating the issue when I say that the return of my original condition due to being discontinued from benzodiazepine medication is forcing me to consider an early retirement, which in my case means the loss of an entire twenty-odd year career. However, my situation should not be held up as a shining exemplar for the rationale for why benzodiazepines ought to be acceptable in "some cases" since obviously human beings from all walks of life, backgrounds, socio-economic, and educational backgrounds do deserve to have the basic ability to flourish to his or her maximum capacity. Someone like Martha Nussbaum would be the first to point this out. I am not special. I do not deserve special treatment. I do, however, deserve individualized and considerate treatment, something which all psychiatric patients deserve.
8.) If you want to discontinue your medication, it's not actually all that hard if you taper off of it very slowly. I had no particular symptoms for most of the taper. I managed several international conferences and a year of teaching. At the lower end of the medication taper, I began to find that I could no longer leave my house, and I also had a return of very severe panic attacks, which I had before. I'm pretty good at coping with them since I've had a lot of practice, and they won't kill me or anything, but they are a constant mental and physical drain, and I've grown extremely chronically anxious as well as depressed. I no longer leave my home. I no longer speak to anyone else. I have tried to go to a colleague's barbecue this week and only lasted a few minutes before stammering out some idiotic excuse and then fled home. While at the barbecue, I endured around ten distinct waves of panic attacks, trying to ride out each one, and when I realized they weren't subsiding, I tried sitting in the bathroom to collect myself, and when I emerged, they simply resumed without abating. They remind me a bit of the contractions you have during labor since sure, you can get through one, but when you have panic disorder, there's another one, and your entire psychic and mental being is enmeshed in this whole battle that is frankly exhausting. I'm highly depressed by my current state and the endless inward battle. Anxiety has, from what the literature states, as high of a suicide rate as depression does, and the two can become comorbid. The thing is, the actual discontinuation with the taper wasn't difficult at all, and if you do not have some pre-existing disorder, it shouldn't be that hard to get off medication with a slow taper. Just be rational through it and realize that your brain is adjusting to the lack of a chemical so you will feel off. There's nothing to be afraid of, however, in terms of discontinuing if you don't have some terrible condition to find on the other side. I've read some absurd reports online, and I tend to think some people are confused by their symptoms, somatizing because you will feel hyperaware of yourself for a while, as your brain adjusts. That's normal. Don't be fooled by it. Toward the lower end of the medication taper, I had episodes of feeling shaky and some headaches. The brain is highly plastic and adjusts. The problem again only arises when your original problems, depending on what they were, could come back, as they have in my situation, and then one has no treatment for them. And for what reason? For what reason? Why? Why is this state preferable to the state I was in before? Why is this "good"? Why is this "the best treatment option"? As I stated in my introductory remarks, my psychiatrist provides me only with vague, canned answers to these sorts of questions, and I would be interested in hearing whether other psychiatrists think similarly -- especially when I hear it opined on this forum quite regularly that indeed, they do -- as well as if so, then why?
I will add that I am not wholly sure of what to make of my situation, but that I would like prescribing doctors to be more aware of the very thing that this post calls for. It asks, "Why aren't benzodiazepines taken seriously in this country?" This is a good question, but for reasons which far exceed what this thread was initially premised upon. I too would request that you take benzodiazepines, and their rational and justified usage, quite seriously, more seriously than what I see happening here on this forum, amongst prescribing psychiatrists. I should only add a final note that I'm sorry that I cannot publicly endorse my post, because I would genuinely like to, and posting anonymously online hardly carries the weight that it would were I to post this with my name on it, which is, unfortunately, not possible. However, hopefully in reading this, you will note my absolute sincerity of both my statements as well as my questions. Much appreciated.
