Looking for answers

Hello doc,

I love this forum.  I think I will be as open with you as I can be with any doctor.  I recently turned 28, married 4years (12 years together with my wife), and I'm nearing my 5th year at my current position as Supervisor over 6 people in a high stress job.  I have been a supervisor for 1 and a half years.

I've had two DUI's in my past, the last one occurring in 2004.  I did not quit drinking immediately, but eventually quit drinking after hitting rock bottom with my wife, my job, and my life.  I got black out drunk and called my biological father that I am estranged with.  My brother came, and got me into a treatment program.  After the program I cleaned up my act, no more drinking.

After treatment I began seeing a psyciatrist, and I have been taking the same meds for nearly 3 years, seeing the same psychiatrist.  Citroprolam for depression.  Lorazepam for anxiety.  Temazapam for insomnia.  Recently, I have been feeling terribly depressed.  It reminds me of how I felt before I hit my bottom.  I have scheduled an appointment to meet with my psychiatrist, but I will not be able to meet with him for over a month.  

For the past year I have been smoking marijuana.  I have difficulty taking my meds as prescribed.  I realize I have an issue with controllong my behavior.  The problem is, all of these meds make me feel so much better than when I am "out" of meds.  I'm never out of the depression med, but the benzos go faster than what I have prescribed.  I have not told the psychiatrist this, because I know the result will be him not prescribing me those drugs.  Instead I want a higher dosage.  

My question is, is it possible that I need that medication to be normal?  What do I need to do?  The depression is not going away, and seems to be intensifying.  Please help me.

  

[J T Junig, MD PhD]

The short answer is 'no'-- the problem with benzos like lorazepam and temazepam is the tolerance that inevitably develops.  You then get caught in a nasty cycle where you have horrible anxiety when they wear off, so you take more and more... but run out eventually and feel miserable.  You then go into denial about what is going on;  you minimize the situation, when what is really happening is that you are just as 'controlled' by the benzos as you were by the alcohol.  Benzos work, by the way, at the exact same receptor as alcohol does-- just at a different subunit-- and so the effects of using them will be the same effects as when you were drinking.  You feel miserable and trapped because you are miserable and trapped.

When I worked at TCI,  max-security prison for women, almost every woman come in on xanax it seemed.... they all felt that they couldn't live without it.  But a couple months after stopping it they would finally admit that they felt so much better off those medications.

One thing is certain with that class of medication-- no matter how much more you get, at some point you will want another increase in dosage.  The way to get off is to change to clonazepam and have your doc give you scripts that last only a few days each.  I write for two or three days worth, with 5 refills-- that way you have to stick to schedule.  Clonazepam lasts long enough to self-taper if you do use them too early.

The pot is less straightforward, but to be happy, a person has to respect himself.  Do you respect yourself for what you are doing, smoking pot all the time?    My guess is that there is somewhere in side of you the realization that you are wasting your life away with that ****.  Consider getting some therapy to address the situation-- meds alone have significant limitations.

As an aside, I do psychodynamic  psychotherapy;  it is often hard to get insurance to pay for it, but if you have an 'M' on your insurance card for 'multiplan', or if your card says 'health Eos', I can see you for therapy for almost nothing.  That goes for anyone else, by the way... I love doing psychotherapy, and Multiplan joins up with many other insurers;  it is the only plan I completely belong to, as they are more than fair to me.  I submit other claims for other insurers, but there is more of a balance left for the patient with most other plans.  My telepsychiatry practice is at http://telemedtherapy.com.