oxazepam and tranxene EP II

[SophieShine]

Dear Dr Junig,

I did post you on Jan. 9 concerning the modification of my treatment from oxazepam and tranxene to tranxene only.
I followed your advice and with the consent of my doctor here in Holland, we raised the dosage of tranxene from 25mg up to 35mg. It was Hell !!! Still no sleep -even less, waves of intense sadness, depression like never before, suicidal  thoughts, the whole 9 yards. Went up to 50 mg at a point !!!
The only positive points were that my hyper sensitivity literally disappeared from one day to the other. You see, I live very close to a highway and I can feel the vibrations of the traffic in my legs!!! Go figure.
And also, the sweating I always have when I have to go "out in the world" decreased a lot too.
But those were the only positive points.
The negative ones were so overwhelming that I panicked and I made another appointment at my Doc's last thursday. He put me back on the combo oxa/tranxene. And to top it all he told me that some people that have been thru a whole lot like i did could not live without meds. He wanted to put me back on anti depressant or some kind of inhibitor. I told him that was not in my chip and that I really wanted to get off them benzos. I could not believe what I was hearing, What a way to motivate people to quit !!!!!!!!!!
So since january 6, I'm fumbling with the meds again. I am so pissed off that he changed my treatment, I was doing so good....only 6 weeks to go and I was free... at last.
Now I am confronted with the problem that I don't know how much I have to take anymore. He put me on the same doses that I was on before the change but I feel so bad. I had to increase that too!!!!
I'm lost Dr Junig, I don't know anymore how, what, when and how much. I'm so ashamed I failed. And I'm so scared of all this. I don't even remember what happiness feels like. I'm in the hole ....again and I really do not know what to do.
Can you help me putting some order in that messed up brain of mine?
Thanx a whole lot.

[SophieShine]

thanks a lot for your time.

[J T Junig, MD PhD]

I am glad that you are going through your regular doctor;  as always, I can speak in generalities, but people should not use any internet doc comments as their own 'medical care'.  In your earlier post, the issue was that your physician had taken two benzodiazepines and replaced then with one-- the one with the longer half-life.  You were having significant withdrawal, and after comparing potencies of the medication, I informed you that you were changed to a much lower potency of medication, thus explainng your withdrawal.  

You are saying that even at the higher dose, you continued to experience withdrawal. I am unsure whether you continued to try to taper, or whether you simply went much higher... but at any rate, you are still stuck on benzodiazepines.

Your doc has a point-- benzos alone are not really harmful, providing you are not a pregnant woman, where they can cause miscarriage and other effects, and providing you don't keep running up the dose.  If you keep running up the dose, you may need to just do a detox in the hospital and get off them once and for all-- you would need to be some recovery program after the detox to prevent relapse.

There are several ways to 'detox' out of the hospital; you tried one, which is to do a slow taper.  Some people can't do that, as they cannot resist the medication to do the taper.  I have helped patients with a taper by prescribing only two or three days at a time with multiple refills, so they have to go to the pharmacy every couple days.  You cannot, though, blame your doctor for giving you pills and spoiling your detox.  If you truly intend to stay clean, it is only YOUR responsibility.  There will always be doctors who dispense too freely, and there will always be grandmothers with medicine cabinets filled with little surprises when you pop in for a visit and use the bathroom...  Addicts who stay clean develop an attitude where they are always on alert for risks to their sobriety, and they are always trying to stay several steps away from using.  It shouldn't take one phone call to use-- it should take three or four.  You want as much time as possible to allow for reason to step back in, to stop an impulsive decision to use.

Other ways to detox include using non-benzodiazepines to replace the benzos and prevent seizures, and then tapering those medications.  Some docs will put patients on phenobarbital, or valproic acid, for example.  WHATEVER is used, it will be difficult.  You will have many physical sensations that will push you back toward using.  That is why a 'rock bottom' is useful;  you need the understanding that using is simply out of the question.  You need to realize that if you use, even once, you will die.  If you understand that, your urge will largely be gone.  That is why, though, people can suddenly quit things like cigarettes after a big scare--  the reason you keep going back to using is because you think that you can use, and survive.  Maybe you need to really ask yourself--  what kind of life are you living, and how long do you want to live this life?   Then the secret is to keep that thought in mind.  That is why you need to keep going to meetings-- to keep that awareness of powerlessness in mind.  Otherwise the addict in your brain will convince you that it wasn't all that bad, and just a few more times won't really matter.

I have never known anyone first-hand who could just quit a serious addiction the way that most people who visit this site want to do it-- by just stopping on their own.  That does not work!  Find a meeting, and get some help from others who understand.