Protracted Benzodiazepine Withdrawal

I am getting calls from all over the country and sometimes from out of the country and some of the videos that I do. Some of those have been on the concept of benzodiazepine tapers, withdraws, protracted withdrawals, and so forth. Out of that group, I am getting quite a few patients, and they are stacking up. And again, this is my experience, so it’s limited to the numbers that I see, and it’s not literature-driven.

I’m getting a large number, quite a few females, but there are some males, but maybe they’re not presenting, but quite a few females age 32 to 85. But if I was going to take a stab at it in their 30s, 40s, 50s, 60s, and some males. And they’re calling because there was a certain degree of desperation and concern of being able to get off of the benzodiazepines that they’ve been on. And this is not your ordinary patient because it’s not like, hey, I’m on Adavan, two milligrams twice a day, whatever it is. One milligram twice a day, or I’m abusing in the street. These are citizens from all walks of life. Some highly educated, some not so highly educated. Enough of them are well to do enough and high functioning enough where they are traveling from other states just to be able to see me. And like I said, it is not an issue that my benzodiazepines has been. I need to get off it.

It turns into this very complicated history of either protracted withdrawals, which they are underdosed for at this time for the benzodiazepine and trying to get off, or a certain set of signs and symptoms wherever they are at with their benzodiazepines. And they attributed to the benzodiazepines. Usually, the issue has been going on for many, many years with some inciting event or episode.

Recently I had a female that this has been going on for several years, and inciting episode was her use of psychedelics, I believe in college. She had not a flashback, but that experience really almost opened the portal for her and set her off in a little bit of a depression or anxiety, and she was started on benzodiazepines. And from that point on, she’s been on all kinds of medications. She’s been admitted to rehab centers. Psychiatric hospitals. Has seen many, many psychiatrists, psychologists, et cetera, et cetera. And they ended up in my office essentially debilitated, literally, in this particular case. And I have many, and again, different ages, different issues at the end of it is debilitating. They have been on many different medications, even jumping around from different benzodiazepines, but they are all miserable. They are all genuine.

And there is a set of symptom complex that seems to be relatively consistent with most of them. And I just simply think of it as protracted benzodiazepines withdrawal because usually, they’re under dosed, under current benzodiazepine after years of almost being desensitized, for some reason, to some of the psychotropics, including benzodiazepines. But the key here is that list of symptoms that I see with most of them. I like to call it a neuroticism, and I don’t necessarily mean it in the classical traditional sense of the Freudian, sense the psychologist’s use, and so forth. And I like to add to that a constant state of dysphoria every day, every night, seven days a week of their lives. There’s a dysphoric neurotic presentation, or we can call it protracted benzodiazepine withdrawals. But if we want to call the neuroticism and the dysphoria a symptom, fine, I don’t really care.

The issue is to formalize it and categorize it in my mind. But some of the things that you do find otherwise are listlessness. The usual anxiety with the depression, and you can have that. You can have a depression that presents with an anxiety. You can have an anxiety with panic attacks, and these are all classified differently with the psychiatrist, but essentially, they come with all of that. They have the depression. They have the anxiety. They have the panic attacks. Most of them have sound sensitivity, which is classic for protractor benzodiazepine withdrawals. Most of them come with light sensitivity. Many of them come with things like agoraphobia and other kinds of phobias that induce panic. Many of them come with maybe a cognitive fog or a slight decline where processing might be a little slightly jumbled up, not too different than the type you see with multiple sclerosis patients.

They come with a distorted sense of time and I think I also named being listlessness and this is what I get. And sometimes they are only under benzodiazepine, and oh, and I should add, you often see different varying degrees of obsessive-compulsive presentations. They’re all wonderful people, and most of them are extremely genuine. And most of them have a life partner or loved one, a family member that is extremely supportive, and many of them have walked away or left their jobs, their professions, their education, because depending on when this happened in time. There’s a hint of a cluster Bs idea in this, and somebody might be listening to it and make that judgment or evaluation. I don’t because it doesn’t serve me clinically for what I need to do. I see this cluster of symptoms and presentation. I see similar histories, and some of them you see are very against drugs and medications.

The other thing I will get on a spectrum as some of them have become so obsessive, oh, rumination, I’m sorry. Rumination is another thing you see in quite a few of them and insomnia. Then you see, as far as the medications they’re on a whole list of varying degrees of amount of medications around. Some of them might have become so anxious and paranoid of medications. They’re just only down to the minimum and, but they can tolerate just to barely cope. And other ones you see with the litany of medications, and some of them don’t make sense, meaning a lot of psychotropics and so forth. And this is what I get, and many of them are almost in a state of desperation. As I said in another video earlier, our practice has gotten quite robust, in many ways and my own personal time, I have decided it’s better spent focusing in other areas of our general practice.

I have been trying for the last few months, not to spend so much time with patients, and Alexis who has taken over a large chunk of our practice is so amazing. But nevertheless, when I see stuff like this, I’m very interested, and it’s difficult to say no. I have been doing it for some time, and I do see results. So it’s almost unbearable to say no to people. So what do I do with this type of patient? And if you’re one of those or a loved one is one of those out there. I guess, find somebody that has had the same experience and a comfort level with dealing with these kinds of patients. What do I do? I have to get a great, great history. And so you got to get a great history going all the way to childhood.

I try to spend quite a bit of time with them upfront, multiple episodes because, essentially, this is what I do with all patients, but to varying degrees. But with these patients, they need extra care. I try to really attend to their needs initially, and I always try to attend their needs, but they need that contact initially repetitively, over the next few weeks. I start with education, and I’m giving my thoughts on whatever medications they’re on, and whatever they’re feeling. I start with dressing issues of trauma. Childhood trauma at which most of them have, especially the females, and some of these into early adulthood and even longer and express the importance of eventually getting to that in a meaningful way. I always remind people, I’m not a psychologist. In fact, by training, I’m not even a psychiatrist, but I explain all of this stuff and say I’m not the one to be able to treat that component in a therapeutic fashion.

But the cornerstone of what we need to do here is I built that rapport and do major medication management, overhaul, and clinical support. And so, if the pencil needs to go up a little bit, it will. If the cycle tropics need to be reduced by a whole bunch, which they often do, they will. If the benzo needs to go down a little bit, which usually is not the case in this interest group. They will diet changes, and hydration advice is also what I give. And I start working on building rapport over the next several weeks while I manage the medication, in particular, the Benzodiazepines or anything I’m taking people off of very closely. And as they relax and see the results of what we’re doing and feel that they are in compassionate knowledge care, they themselves initiate and become empowered to get up and stand up, and they do.

Because most of them are really neat, wonderful people as most people actually are somewhere inside and they just needed somebody with a white coat. I don’t ever wear my white coat, but you get the point. To really give him that professional clinical support. Also, they needed to the medication. That’s really, again, I emphasize that. The cornerstone of this is the medication, and these patients have ended up this way for multiple reasons. Besides the trauma, it’s quite a bit of medication mismanagement over many years, misdiagnosis, too hard of a diagnosis, wrong advice. I feel that this is what’s happening with our healthcare system over many years is it’s becoming an assembly line and the product of what we’re seeing from so many cases of childhood trauma, which we’re starting to recognize now live trauma mismanagement, and throwing something as deadly as medications into that mix.

Well, now we have the new substance abuse client. I hope you’re not one of those. It’s pretty tough. If you are one of those, let me tell you, there is hope. You can get better, no matter what age you are. There is somebody wherever you are. It’s important to find the right clinician that’s extremely comfortable with the medication management. And really, I don’t want to say, thinks outside the box, but unfortunately, our care has become a box. So I’ll just say really understands the medications. Their effects. Their relationship to each individual. Human did different dispositions people have physiologically and psychologically with their life experiences, and you can get better. I’ve seen it. I’m starting to treat it more and more. I really enjoy it. But at the same time, it does smell like effort, which I don’t like, but it’s a lot of fun.

Be wary of that. Be cautious of that. You may be one of those patients or loved one. Maybe one of those patients you’ve been going to doctor after doctor trying to figure out what’s going on. This may be the situation. I hope that gave you a little bit of information. I hope that was expanded your knowledge base. Whether you’re the patient, loved ones, friend, or a clinician, please go ahead, press the like and subscribe button if you enjoyed that. This is the first video I’ve done like this, but there are many videos in the series that can probably contribute to this. Otherwise, leave your comments below. I really want to see if I can generate a discussion on this topic for those suffering out there, which I think of as the new phenotypic substance abuse patient from as a outcome of shifts in our culture and society. This is Dr. [inaudible 00:17:15] must have a great night. I will see you soon.