Ever notice how so much comedy is rooted in the suffering of others? This is the banana peel principle. So you know this is going to be darkly funny, because I have suffered, and I am not you.
“My battles with addiction definitely shaped how I am now. They really made me deeply appreciate human contact. And the value of friends and family, how precious that is.”
~Robin Williams, 1995
In the winter of 2014 I started taking Ativan (lorazepam) — a tranquilizer, an anxiolytic, one of the benzodiazapene family, sibling to Valium, spawn of Satan and Valeant Pharmaceuticals.
I took it because sometimes life really sucks. Even in Canada, the politest country on Earth. Good sewers and plentiful cheap food aren’t everything, you know!
More specifically, I took it to help me sleep during a bizarre medical crisis. I took it carelessly and erratically for months. Because it was the least of my concerns. By the spring, as I clawed my way back from a flu that would have flattened a Wookiee, I realized that I was in trouble — probably physically dependent — and I started trying to get off the drug.
The rest of 2015 was a blur of anti-tranquilized misery. I felt like I was living in a blender. 2016 wasn’t a lot better. There’s a 2018 update at the bottom of the page.
This is my benzo withdrawal story. I will tell it with as much black humour as I can muster. I hope it will be of use to other victims of this shitty class of drugs — which can be used safely and wisely, but often aren’t, and cause far more trouble than they solve for many people, including lots of actual dying. This story will be of particular interest to readers struggling with an anxiety disorder and chronic pain.
The this-is-not-medical-advice-but-here’s-where-to-go-to-get-it section
Although there is definitely some practical advice here, this is not a self-help guide, because I clearly have almost no idea what I’m doing. For actual expertise, you need The Ashton Manual at Benzo.org.uk. It seems to be awesome, and I’m eternally grateful to Dr. Ashton for her sane and soothing writing, even if she’s dead wrong about everything, which seems unlikely.
This is all more about “physical dependence” than “addiction,” an important medical distinction — I’ll break that down more in a while.
The BenzoBuddies forum is also the most useful thing I can suggest (short of a magic wand that makes benzo withdrawal feel like sex). There are more than 20,000 posts in their “Success Stories” section! Read ‘em and stop weeping!
The only thing worse than benzo withdrawal
…is benzo withdrawal while other problems are crashing into your life like poo meteors.
I couldn’t have picked a less tranquil time to try to stop taking tranquilizers. But that’s often how it goes with these drugs: tranquilizer dependence is notoriously nasty partly because people are often still swamped by the same crap that led to the prescription in the first place.
But my withdrawal experience was unusually difficult due to a particularly nutty run of bad luck. I had already been through the wringer with an insane career transition from massage therapy to science journalist, and my wife's terrible car accident in the previous few years. And then this, all in in about a year…
- a serious medical problem
- a proper ass-whuppin’ flu (sounds lame, but not to be underestimated, see below)
- a business in dire trouble
- a serious legal threat
- the death of a close friend
- one more major thing that I am simply not prepared to admit publicly, even though I’m the TMI guy
It was crrrrazy. I went to see a new psychologist in there and she said, “Any one of most of your problems could be the basis for an entire therapeutic relationship. You seem surprisingly normal considering. I’ve seen people reduced to shivering wrecks by one third this much trouble.”
I know, right? Preach it, doc. It’s because I’m hard. I’m a hard, hard lump of extremely tired and nervous protoplasm.
Attempting to break benzo dependence in these worst of times was traumatic, a nervous system catastrophe. Beware of doing this. Many times since I have smacked my forehead and cried out, “Why?! Why didn’t I wait until life was a little less crazy to try to quit benzos?”
And then I remember why: I probably had no choice, because I was effectively already withdrawing from the drug without dosage increases. I was adapting to the drug, and therefore suffering withdrawal symptoms if I didn’t take more of it each week. I had to get out of that trap whether it was good timing or not. That storm was perfect.
Erratic dosing and half-lives
I was careless with my dosing because I was ignorant and too distracted. I got hooked on benzos in a particularly nasty way because of the way I took the pills “as needed” — so much room for interpretation! — but also the way I kept trying hard not to need them: I postponed doses for as long as I could, to avoid dependence, but the ironic result was a jagged pattern of usage with many episodes of partial withdrawal from the drug.
And nothing drives tranquilizer cravings like tranquilizer withdrawal!
Lorazepam is a bit special, a mean prankster of a drug, worse than most of the other benzos, though not the absolute worst.1 It’s special because it has such a short half-life that withdrawal symptoms can begin in less than 24 hours, prodding patients to medicate just a little earlier each day. At supper, you might feel like you can’t wait for your regular bedtime dose. Before you know it, your bedtime dose has become a lunchtime dose. And then you need another dose at bedtime. Congratulations, you’ve doubled your daily dose!
I didn’t know any of this. I was just trying to avoid getting addicted or physiologically dependent. “I think I can manage,” I’d tell myself. “I’m going to try to sleep without it tonight.” And then I’d sleep really badly, and the next day I’d feel seriously effed up — probably feeling the withdrawal and the sleep-deprivation — and I’d cave and have a desperate midday dose.
So I was regularly bombing my biology with the early stages of benzo withdrawal. And sometimes, of course, I took a larger dose when the need was greater. Which started to happen more often. Which made the roller coaster ride bigger and steeper.
In the early days, feeling “pretty fucked up” was indistinguishable from the health problems I already had, plus a lot of anxiety and exhaustion, all of which obscured my view. I couldn’t see what was happening. The frog was slowly boiling. But, as the weeks ticked by, feeling “pretty effed up” started to get pretty effing weird…
And then my tongue went numb
The first clear sign that lorazepam was messing with me was the day my tongue went numb.
I was just sitting at my desk working one morning — minding my own business, feeling normal — when suddenly the tip of my nose, my lips, and the front half of my tongue went numb. It was like I’d stuck my tongue out as far as I could and then dipped the front of my face into a pool of fast-acting anaesthetic.
I thought it was going to spread and swallow my whole head. But it slowly faded instead, gone by lunchtime.
The not-rightness of such an experience is extreme. Body parts shouldn’t go numb unless the cat has you pinned on the couch for way too long! But, strange as it was, I didn’t interpret it as a hallucinatory at all. I was already having a variety of head-o-centric medical issues, including a bunch of trigeminal neuropathy, so my interpretation was hypochondriacal: I thought it was a nerve thing. I assumed my medical situation was getting weirder and more serious.2
That kind of “thinking“ would prove to be a strong psychological theme for 2015.
I can’t prove the numbness was the benzos, but they are known for causing wacky sensations like that, and there was never any other plausible explanation. And there were many other similar sensory oddities in that period, all of which would be hard to explain without the benzos.
Like the time I felt a small balloon inflating rapidly underneath the skin on the side of my neck — a nightmare sensation. I don’t know how I could have thought that was anything but a drug-addled hallucination.
But there was really a lot going on. And then the flu was piled on top of that.
I’m fascinated by how history is just one damned thing after another, and how tiny twists of fate can change the world. Getting the flu when I did was unfortunate timing with disproportionate consequences.
People throw around the word “flu” too casually. “I think I have a touch of the flu.” There’s no such thing. Flu does not touch — it’s a battering ram. If you feel anything less than slammed around like a rag doll in a industrial washing machine, it’s probably not influenza.
With years between infections, we forget how vicious the flu can be. It gets confused with the common cold, but they are different viral animals, and influenza is no more like rhinovirus than a tiger is like a tabby. A cold can make life quite unpleasant for a few days. A flu can end you, and that’s what it feels like.3
So I had a spring flu…piled on top of Very Serious Problems in progress, like months of unnerving, undiagnosed chronic throat pain, and a business under siege with 60% revenue losses. It was a dark time. My escalating physical dependence on tranquilizers was masked by many unpleasant sensations in the foreground.
The mask finally came off late in the flu when I had a particularly rough evening with some symptoms that didn’t seem so flu-like:
- a thick mental fog
- palpitations like my heart was spasming instead of pumping
- feet as cold and clammy as dead fish
- a sort of respiratory absent-mindedness, as though the reflex to inhale was gone and I had to make a point of it or suffocate
I suffered through this miserable crap for a couple hours, thought seriously about the numbers 9 and 1 and 1, and then I took some lorazepam…
…and felt 95% better within 20 minutes.
It was almost like my real problem was low blood levels of lorazepam.
The addiction penny had finally dropped.
“Addiction” versus “dependence”
I wasn’t really “addicted.” That’s a loaded word, full of mischief. Like benzos themselves, it must be used with caution. It’s often used refer to anything people overindulge in: chips, video games, shoes. But these terms have precise meanings that matter.
Addiction is a disease of craving and compulsive behaviour with complex causes. It includes what most people think of as “psychological addiction.” With addiction, the harm is mainly done by the behaviour, and addicts are often personally equated with their disease — blamed for it, in other words.
And so “addiction” is a stigmatizing concept that undermines, dilutes, and distracts doctors (hell, everyone) from benzo victims’ specific and medically important claim to “physical dependence.” If they are misdiagnosed as an addict, they may have trouble getting the medical care they need. Or just the damn sympathy.
Physical dependence is the biological need for a drug, caused by the drug itself, which does its damage only when the dosage is reduced. Physical dependence on a prescribed drug is always, by definition, an iatrogenic (doctor-caused) disease. You can be dangerously dependent on a drug without being an “addict” at all (exactly the case for many benzo victims), and you can get addicted without dependence (gambling is the classic example).
There were some elements of addiction in my experience, but mostly I was just blindsided by physical dependence. I was suffering serious withdrawal symptoms without even knowing what they were. I may use “addiction” informally here and there in the remainder of the article, but this is mostly about physical dependence.
You know nothing, you idiot
The sum of my knowledge about lorazepam when the addiction penny dropped:
- It does what it says on the tin: hoo boy, that stuff really tranquilizes!
- It can be addictive
I would not normally have been so careless with a drug like this, but I had been horribly distracted. (Remember that my main concern, constantly for months, was that something seemed to be stuck in my throat.)
I did some quick Googling about benzos and quickly levelled up. I learned three new things right away:
- Benzo withdrawal is more serious than Tywin Lannister. (Two GoT references in one section!)
- Benzo withdrawal is weird and suddenly a lot of my symptoms had a plausible explanation, which was sort of “good news” — evidence of a solvable problem instead of a mysterious disease.
- Lorazepam withdrawal is notoriously nasty, almost the worst of an entire class of notoriously dependence-causing drugs (trumped only by alprazolam). Wunderbar.
I spent a couple weeks experimenting, watching symptoms come in and out like the tide, nicely harmonizing with lorazepam doses. I decided it was essential to get off the drug ASAP to “simplify” my medical situation. I was in a hurry.
Do not rush benzo withdrawal!
Like too many other poor bastards, I discovered the hard way that you must not rush benzo withdrawal. But I survived, so it could have been worse.
I knew enough not to throw the pills down the loo, a cold turkey quit. But I did try to get off the drug in just five days, which was still stupid, stupid, stupid. Five days is nothing for a benzo taper.
On day four, I started hallucinating steadily, or something like it. I didn’t realize it at first — I just felt weird and bad. But then my brain started to shrink inside my skull, and that shit’s just not right.
Brain shrinking became a frequent caller for several weeks.
Recklessly quick benzo withdrawal isn’t a disaster for everyone, but it is for enough people to constitute a serious public health issue with vast costs and consequences. And it can be spectacular. The worst case scenarios include seizures, coma, and death. Benzos are one of the big three drugs that kill in withdrawal (see also alcohol, and opiates sort of4). For each victim who doesn’t end up at a hospital or in a morgue, there dozens more for whom it’s merely the worst thing they’ve ever experienced.
Mid-evening on day 4, I was sitting in the corner of a room, my brain shrinking like Ant Man, my pulse pounding in every nook and cranny of my anatomy, each inhalation a project, and the room bending like a Hitchcock zoom. I assumed the next thing that was going to happen was a seizure at the least, likely a coma, and maybe death. I have never felt weirder or worse.
So I took some lorazepam. In 20 minutes, my brain stopped shrinking, the room stopped warping, my pulse and breathing eased, and I thought, Well, now I know why benzo withdrawal can be a really big deal.
Why is a benzo habit such a bitch to break? The freaky biology
Benzos are tranquilizers. There are many ways to tranquilize a human being. This way involves simulating a flood of an important neurotransmitter — GABA, gamma-aminobutyric acid — which is one of the body’s built-in sedatives.5
This is a gross oversimplification, but GABA makes neurons less sensitive, less sparky, less easily fired. And benzos enhance GABA’s effects…so it’s like a dimmer switch on your nervous system. This is why benzos are “downers.” And no wonder they help people sleep.
The effect goes beyond the nervous system. It’s a mistake to think of GABA exclusively as a neurotransmitter. Many other tissues produce and respond to GABA. For instance, GABA also suppresses muscle tone, which has consequences when the GABA pendulum swings the other way. And so the effect of benzos is widespread.
You don’t want your system to be too excitable or too relaxed. GABA boosting is a major disturbance to that balancing act, and the body gets up to all kinds of tricks to keep you alert and functioning normally. After a while, those stimulatory tricks become biological business-as-usual.
Imagine a tug-of-war between two teams: Team Inhibition and Team Excitation
Taking benzos gives Team Inhibition a massive artificial advantage. The body responds by giving Team Excitation whatever it can to hold its ground against that advantage. (It also tries to undermine Team Inhibition.) When you stop taking benzos, Team Inhibition suddenly loses its advantage and immediately gets yanked off its feet. It’s crippled and weak, but Team Excitation is fighting fit. It takes weeks or months before Team Inhibition is competitive again.
Life with a crippled Team Inhibition is fucking terrible. In benzo withdrawal, you are the opposite of tranquilized: you’re anti-tranquilized. Huge chunks of your biology are way too excitable. The list of potential side effects is endless, but they all revolve around a strong theme of jittery misery, like being over-caffeinated but more extreme.
Above all, if you were anxious before benzos, you’re probably going to be much more anxious when after benzos.6 And so this is both biological and psychological in a big way. Your nervous system is outta whack: modifications have been made to cope with the increased effectiveness of GABA, and it takes time to undo them. But at the same time, just imagine the ferocity of the cravings to return to the deep calm that the benzos provide.
Benzo withdrawal is like being on fire right next to a cool pond, and knowing that you can’t jump in to put the fire out. Instead, you just have to let yourself burn, and allow the fire to slowly fizzle. Unsurprisingly, many people just jump into the pool and decide to stay there for life. And pray they never have a benzo supply problem.
The only real defence against withdrawal to remove Team Inhibition’s advantage really slowly. Simple! But the opposite of easy.
“Success” in 30 days
I got off benzos in two tries — one five-day disaster, and then a thirty-day grind — but my victory was pyrrhic. It wasn’t a happy ending, and it still isn’t over a year later. I’m one of the unlucky ones: I appear to be suffering from long-term withdrawal symptoms.
Most people don’t suffer long term withdrawal symptoms from benzos. The risk is likely higher if you nuke your nervous system with the stress of a fast withdrawal.
And even a month of tapering off benzodiazapenes is recklessly fast. Experts recommend at least six months, which will make it will painless and drama-free for almost anyone. Taking it slow is the key to successful benzo withdrawal.
What are the other risk factors for a bad withdrawal experience?
- Higher dosages to begin with. 2mg is roughly the threshold between lower and higher doses. I was at about 2mg. 7
- Long-term usage — and in benzo-land anything over a month or two is “long term.” But some people have been taking tranquilizers for years. I had “only” been taking lorazepam for about 6 months…not years.
- High background levels of stress and anxiety. Bonus points for chronicity, and for hypochondriac tendencies. (Benzo withdrawal can turn people hypochondriac. Heaven help you if you go into it that way.)
- X factors! Some people just have a longer, rougher ride for reasons nobody is ever going to be able to explain to anyone.
In theory, the danger of my fast taper would be blunted by my fairly small starting dosage and not-very-long-term usage. I kept telling myself I was going to be fine because I wasn’t one of those 5mg-per-day-for-years people.
In practice, the danger was still great and my my tapering speed was still stupid, stupid, stupid, because my erratic dosing was a major factor, and my levels of “background stress & anxiety” were off the charts, and I’d been that way for ages, and I was living in medical fear, so all the strange sensations of benzo withdrawal were guaranteed to worry me more than most people. In hindsight, bombarding myself with intense withdrawal symptoms for at least 6 weeks was so traumatic for me that it did lasting psychological harm.
Bizarre withdrawal symptoms
If you’re going through benzo withdrawal, and you’re wondering if something awful you’re experiencing is a withdrawal symptom, the answer is definitely probably. The temptation to attribute it to some other medical problem may be extremely strong, especially because it is possible. But benzo withdrawal is notorious for the freakish variety of symptoms it causes. Almost anything you can name is possible — or that’s what it feels like. In fact, it is mostly limited to what you can feel (which is plenty). You don’t bleed from the eyes, but you might go check in the mirror because you’re worried that you are. More technically stated, benzo withdrawal produces subjective symptoms, not objective signs.
Here are some of the most interesting symptoms I experienced. Some of these are still hassling and worrying me off and on now, almost a year later.
- supersensitive solar plexus (“can’t touch this”)
- aching, bloated eyes!
- my brain shrinking and squirming
- pharyngeal spasm (like I disappointed Darth Vader)
- powerful palpitations in peculiar places
- fat, sore armpits 8
- muscles that carry on contracting for a few seconds after they should have stopped (particularly alarming when chewing)
- deep, nagging chest pain, like there’s an alien growing in there
- waves of must-lie-down NOW
- absurdly disproportionate soreness after exercise (do five push-ups, regret it for five days)
I tracked my symptoms carefully, with an awesome spreadsheet. I am dork: hear me tabulate! Every significant symptom got its own column — 35 of them. Every day for months, I filled in those damn columns with ratings for how bad each symptom was on that day.
Maybe it was unhealthy to pay such close attention to my symptoms. (Ya think?!) But actually it did help me to think more clearly about what I was experiencing. It was useful for reality checks. Many times the horribleness seemed unrelenting, but my columns of numbers told me it was relenting, and I clung to that. On a fucking awful day, it was a real comfort to look back at the data and confirm that this fucking awful day was actually nowhere near as fucking awful as the awful fucking days I’d survived the month before. For a while there, it was my only clear source of hope: hard evidence that the ordeal would end, eventually.
The taper caper
I am nothing if not methodical. “Baby steps” is my motto: almost anything is possible if you break it down into little steps. This is the spirit of tapering a drug dosage from dependence levels to freedom.
But lorazepam makes tapering tricky, because the smallest piece of pill you can get is a huge papa step of 0.5mg.9 When you're tapering from 2-10mg — and it’s supposed to be spread out over months — dropping your dosage by 0.5mg is like jumping off the roof instead of taking the stairs.
I needed a way to take only 0.2mg less than the week before, and 0.1mg steps would have been wiser.
So I dissolved pills in relatively large and easy-to-measure quantities of water: if you dissolve 1mg of pill in 100ml of water, and then drink 20ml of the mixture, boom: 0.2mg of medication. This is simple in principle, but there were thick cobwebs of complications to get through. Just finding appropriate containers for mixing and storing was surprisingly difficult! I ended up buying more capers than I could eat in five years, just for the little jars they came in.
Also, the medication didn't truly dissolve in the water, but was distributed in a cloud of fast-falling particles, like a snow globe. Even the smallest delay after shaking caused an uneven distribution of drug in the water, so it was essential to move from shaking to drinking in one smooth motion.
And so on. It wasn't rocket science, but it took some focus, and I wasn't exactly thinking clearly about anything for a while there. Who knows what I missed!
If I had to do it again, I'd probably ask a pharmacist for help.
And, you might reasonably ask, why wasn't I asking for medical assistance with this epic challenge?
Doctors and conflicting advice
You can hardly believe the range of knowledge, opinion, and feeling doctors have about these drugs. My family doctor is so relaxed about benzos that it’s like he’s taking them himself.10 He never educated or cautioned me about them in any way. Not a syllable of concern.
Meanwhile, at the other extreme, my first ear-nose-throat guy was so horrified by my benzo use that it was hard to get him to talk about anything else. He got super agitated! So much so that I considered asking him about his blood pressure and recommending a holiday. In retrospect, this was the one doctor who actually understood the danger I was in and tried to warn me. He was right, but I didn’t listen. Tragic irony. Why didn’t I listen? What was I thinking?!
I didn’t listen because I didn’t trust him, because this was also the specialist who was stereotypically dismissive of a painful problem he couldn’t easily diagnose. He didn’t believe there was anything in my throat causing my symptoms, and went straight for an “all in your head” diagnosis. So our clinical relationship had already degenerated to the point where he couldn’t reach me on the benzo topic. Plus I was reassured by my family doctor’s complete lack of concern.
I was determined not to give other doctors any more excuses to dismiss me as a head case than they already had.11 So I didn’t tell my various doctors that I was dealing with benzo withdrawal. And about 8 weeks into withdrawal, the very real cause of my throat pain finally became clear: a surprisingly symptomatic tonsil stone, which finally just came out one day, with a little help — August 5, 2015, a day I will never forget. My main throat symptom immediately resolved almost completely.
Unfortunately, it was too late. By that point, I had a lot of other problems.
Complications: caffeine and booze
Grandpa: Let me tell ya, don’t do that stuff. When you’re young, you’re crazy to do that shit.
Frank: Well what about you?
Grandpa: What about me? I’m old. When you’re old you’re crazy not to do it.
~Little Miss Sunshine
I was into purity in my youth. I was a non-drinker through university and beyond. I was vegetarian. I was holier-than-thou, of course. My body was a temple, blah blah blah.
In my 30s, I rebelled against myself. Vegetarianism was the first to fall: after about 15 years of salads and lentils, I decided it would be fine to eat meat in moderation, and that being a holier-than-thou vegetarian was the greater of evils.12
Then I discovered that I was a happy drunk who never got hangovers as long as I exercised any caution at all, so I started drinking quite freely. Because why not? I just felt good.
Then it was coffee’s turn to corrupt me. I had been even more uptight about coffee than booze (which is like worrying more about kittens than scorpions). But I tried it in desperation during a nightmarish spell of extremely severe insomnia… and I haven’t gone without daily caffeine ever since, for more than a decade now.
When I first took Ativan, I was already thoroughly addicted to both caffeine and alcohol, locked into a steady rhythm of stimulation and depression, using the most socially acceptable of the uppers and downers. The quantities were not extreme and there were never any overt signs that I had a problem.13 But if you’d cut me off, I would have lost my mind. And I was already leaning on both heavily as I cruised into Ativan withdrawal.
Alas, both caffeine and alcohol are poor bedfellows with Ativan withdrawal in their own nasty ways.
Booze + benzo withdrawal = very bad deal
Booze sabotages withdrawal at a biological level. It has a sinister synergy with benzos. Its infamous depressive effects are similar enough to what benzos do to us, biologically, that it’s almost like you’re still taking benzos, as far as withdrawal is concerned. Alcohol sustains benzo dependence, even while you continue to suffer from benzo withdrawal. It’s hard to imagine deal more raw than that. The booze is like Darth Vader saying, “I am altering the deal. Pray I don’t alter it any further.”
But that deal was unacceptable to me. I was addicted, but I wasn’t so addicted that I was willing to face such serious consequences. I quit drinking for about three months, and then gradually resumed. It seemed adequate at the time. In hindsight, resuming alcohol so “soon” may be partly why I’ve had such long term trouble with withdrawal.
Caffeine + benzo withdrawal = the screaming jitters
The problem with caffeine is more obvious: it’s just like throwing gasoline on the anxiety bonfire. In benzo withdrawal, you’re already over-stimulated, anti-tranquilized. And caffeine is a stimulant. Whoomph.
I ramped down my caffeine intake to a bare minimum when I started my withdrawal, but it wasn’t enough. Several times I ended up suffering the double-whammy of caffeine jitters and withdrawal jitters, which feels like death by vibration and twitching. After a few terrifying doses of that, I switched to decaf, which still has about the same amount of caffeine as tea. And then, slowly, I started blending, working my way up to a half-caf habit, which is where I’ve been ever since (almost a year as I write this).
Occasionally I try full power coffee again, and this is how I know that I am probably still suffering from benzo withdrawal to some degree (or that it damaged my caffeine tolerance long term). I have yet to drink a mug of normal coffee without regretting it. I now seem to have a low, low tolerance for caffeine. Which is tragic. And expensive! Half-caf Americanos are about double the price of a regular drip coffee. I’ve definitely spent more than a thousand bucks on those by now.
Can’t live without coffee, but can’t really drink it either.
2018 update: An unhappy ending
Six months after the last lorazepam, in the fall of 2015, some of the acute withdrawal symptoms had eased, but I still felt wrecked and continued to suffer from an absurd variety of worrisome symptoms: spasms and cramps and tremors, difficulty breathing, tingling and numbness, allodynia (intense pain in response to light touches), randomly inflamed patches of anatomy, thunderclap headaches, swollen armpits, crazy carotid artery palpitations, diarrhea, multiple bouts of tendinitis… and that’s just about a third of the symptoms, the ones that are easy to list off. There were plenty more without convenient labels.
It was a parade of weird miseries.
I continued medical investigation, checking out one system after another, trying to eliminate scary causes, mostly wrapping up by early 2016. Unable to diagnose anything else, all that remained was the story that I was a twitchy hypochondriac basket case, rationally aware that I probably didn’t have any disease, but still routinely hallucinating pain and dozens of other weird and worrisome sensations. Everything hurt, and hurt weird.
And it continued. There is no happy ending yet.
There is some good news, a small ray of hope: my case has simplified some, a gradual trends towards fewer and blander symptoms, with longer and better good patches. Soreness and fatigue have become the only major constants, and the "weirdness" factor is definitely down. But if it’s a slow recovery, it’s the slowest recovery evar, and as of summer 2018 I am still a hot mess.
And so, perhaps, I am one of the minority of people cursed with seriously lasting benzo withdrawal symptoms. Or I’m sick with something very, very hard to diagnose.
After a rough 2016 and 2017, I finally accepted my ironic fate and I “came out” as a chronic pain patient, with another confessional blog post much like this one, but focused on the pain. If you’re appreciating this sad tale, that’s the horrifying sequel: “Chronic Pain and Tragic Irony: I started out helping people with chronic pain and now I have it.”
How to manage to symptoms of benzo withdrawal syndrome
I didn't have a clue what I was doing when I got into this mess. But after years of experience, I have earned some opinions on how to deal with it.
Do everything you possibly can to calm and soothe your nervous system. Every single day. Basically.
You know how relaxation and stress relief is probably important for absolutely anyone? Well, it’s ten times more important for those of us with nervous systems that have been dialed up to 11 by benzo withdrawal! It’s a disease of neurotransmitter-driven overstimulation — roughly like permanent caffeine jitters — so you fight back with whatever calming forces you can muster. You need every possible source of natural, healthy sedation. It's especially critical to “reassure” your brain in every possible way that these terrible sensations and spasms are false alarms.
More generally, you need to get all body-is-a-temple and start working on eliminating every emotional, physical, and biological stress from your life that you possibly can. Pursue every way there is of getting fitter, healthier, and saner. So you exercise in the Goldilocks zone a lot — always some, never too much! You eat as healthily as you can possibly manage, you abstain from things that challenge your biology like booze and smoking, you ditch toxic relationships immediately, you take whatever time off you can afford, etc… getting the idea? Taking care of yourself becomes your new religion.
All of this, by the way, is basically the same as what most chronic pain patients need to be doing — reducing general biology vulnerability — but the need is more dramatic and obvious, and with a greater emphasis on calming and soothing.
I thought it was Ativan, but a friend with expertise corrected me: “The undisputed heavyweight benzo withdrawal champ of the world is alprazolam (Xanax), with even higher potency and a shorter half life than lorazepam (Ativan).” ↩
This is a sinister example of a cognitive distortion (confirmation bias) at work in a medical situation, with serious consequences. I was actually hallucinating, but instead of seeing it for what it was, my interpretation of my sensations was easily, perfectly custom-fitted to my fears. ↩
I’m kind of spouting bullshit there. I looked this up after writing the last two paragraphs, and discovered that it’s actually almost impossible to tell what kind of virus is causing an upper respiratory tract infection. Influenza probably is worse than rhinovirus on average, but the severity of any infection is determined by many, many variables. Anyway, whatever type of virus was harassing me, it was damn bad. ↩
Withdrawal from opioid dependence is exceedingly unpleasant but not directly lethal, as with benzos and alcohol — it’s a combination of complications and consequences that actually does the killing. A hair-splitting difference, you might think, and so do some credible experts: see “Yes, people can die from opiate withdrawal.” ↩
Benzos make cells more sensitive to GABA, by enhancing the effect of GABAA receptors. It’s not the same as actually having more GABA, but it might as well be. Benzos are effectively like a GABA supplement. Benzos boost the effect of GABA. ↩
This is one of the main reasons people can’t get off the drug: because it makes them not just uncomfortable or on edge, but fully freaked right out. Many withdrawal experiences are so unpleasant that they scare people, but with benzo withdrawal the fear is actually a symptom (not just a normal reaction to a scary situation). ↩
Sort of. Part of my problem was that my daily dosage had been wildly variable from 0 to 5mg per day. But I guessed my average daily intake had been about 2mg per day. ↩
Not literally swollen, as far as I could ever see or feel, but they sure felt swollen… and even seemed to be chafing like they were swollen. Very strange. ↩
In Canada (and most places) the smallest lorazepam pills you can get are: (1) A teensy 0.5mg sublingual tablet that just crumbles to dust if you to cut it; (2) A 1mg pill that you can break in half, give or take a couple tenths of a milligram, but forget trying to quarter it accurately. ↩
Totally plausible actually. As I’ve grown older and wiser, I’ve come to understand that addiction and self-medicating is something nearly everyone does to some degree, and that a lot of the human behaviour that makes us raise our eyebrows is basically because so many people are fucking high. I’m not saying my doctor is blasé about benzos because he’s actually a tranq junkie himself… but it wouldn’t shock me. ↩
Anxiety disorder severely aggravated by benzo withdrawal was much too convenient an explanation for all my symptoms. I knew it could well be the correct explanation, but — for safety — I didn’t want that to sabotage continuing medical investigation. Just in case there really was something in my throat/neck — and there was — I wanted proper medical investigation to continue. ↩
Apparently it didn’t occur to me that I could be a vegetarian without being holier-than-thou. ↩
Even my wife was largely oblivious to it, other than the occasional “Have you had enough?” to which the answer was usually, “Yeah, probably.” ↩