45 year Benzodiazepine Induced Iatrogenic Illness

Arthur's Story of how he beat a 45 year prescription addiction to benzodiazepines

When librium was first prescribed for me in 1962 it was new on the market and said to be a wonder drug. In fact it was very effective, it controlled anxiety well with few obvious side effects and I was delighted with it. I was assured that it was not addictive. However after a while it was clear that it was becoming less effective, although my GP was still adamant that it was not addictive. Inevitably the dose was increased over time and eventually I was taking 75mg as well as a couple of Mogadon at night. This was the equivalent of 34mg of diazepam. The side effects of this amount were considerable and it soon became difficult to sit for very long or to concentrate on a simple task. Realising that the drug was causing more problems than it resolved I made the first of three attempts to withdraw.

The pills were stopped over a few days and the consequences were severe, it was very unpleasant and more than a little frightening. Of course this was a cold turkey withdrawal, not dissimilar to that which occurs after the abrupt cessation of a hard drugs such as heroin or cocaine. Although things were very difficult returning to a high dose of librium was not an option because of the side effects. So all I could do was to wait for some improvement in the belief that nature would eventually heal. Progress seemed very slow but after eighteen months I was able to resume at half the previous amount. This lower dose caused fewer side effects and it was possible to function reasonably well, but clearly this amount could not be significantly increased. It was also apparent that it was essential to withdraw slowly but at the time I had no idea just how slowly.

Twenty years after introduction the patent expired and this prompted a considerable amount of research which concluded that benzodiazepines are in fact very addictive. This was well publicised and I realised that I needed to withdraw completely.
The second attempt was much more leisurely, I asked my GP to switch the prescription to the equivalent amount of diazepam in order to start a slow taper. He tried to contact a self help group but it had closed due to a lack of funding, at which he left me to manage on my own. The equivalent to the 40mg of librium is 15mg of valium in 5mg tablets and I started by cutting a quarter from one tablet, this was a reduction of 1.25mg. Cutting these tablets was very fiddly and not very precise but eventually I heard of the 2mg size which made it much easier. A pattern immediately became clear, two to three days after a reduction life became quite difficult but then after a week or so things improved and at the end of three weeks were back to normal. Recognising this enabled me to control the whole process, and meant that the withdrawal did not have to be done in one continuous attempt . All went well until on reaching 5mg and believing such a small amount to be relatively harmless I made the final reduction over a couple of months, without waiting to stabilise after each reduction. This caused vicious withdrawal symptoms and I abandoned the taper, resuming with a daily dose of 6mg of diazepam. At the time I believed that such a relatively small dose would not cause too many problems.

Some years later, when I had acquired, and learned to use, a computer it became apparent that this was a serious mistake and that in fact 6mg can cause as many problems as a higher dose. There may be plenty of rubbish on the Web but there is also lots of really useful information and I do believe that had home computers been available thirty years earlier then the benzo disaster might have been avoided. On finding this web site it became possible to finally understand the problems caused by benzos and how to withdraw from them. With the help of Professor Ashton's book I could start a new taper with every chance of success. At around this time the surgery wrote to all its patients who were being prescribed benzodiazepines suggesting that it would be possible to withdraw the medication over several weeks. This was probably an attempt to reduce the number of benzodiazepine prescriptions and with the possibility of the repeat prescription being withdrawn after twelve years it seemed a good idea to have a chat.

My GP was keen to help and he prescribed anti depressants. It took about eight weeks before they were fully effective and I did not notice any significant benefit. Like benzos they cannot be stopped abruptly and it may well have been simply duplicating the existing problem. Although in one respect they were useful, as they do cause significant drowsiness and by taking them at night it was possible to mask the very vivid dreams that can occur before sleep patterns return to normal. It had been natural to involve my GP but in response to what I perceived as pressure I made the early reductions too quickly and this led to a build up of withdrawal symptoms. There are no shortcuts. Had I not received a letter offering help I would probably have managed on my own and with hindsight this would probably have been much simpler.

The withdrawal taper which I followed was:
Reduce from 6mg to 3mg by one mg at a time.
Reduce from 3mg to 1mg by half a mg at a time.
Use syrup to taper to 0.4mg

It took just over nine months in all and it would have been difficult to have done it any quicker. It was a balance between my desire to be drug free and the rather unpleasant withdrawal symptoms that take time to ease. No doubt this can vary between individuals but for me they were varied and plentiful, including muscle stiffness, acute anxiety, agoraphobia, light sensitivity and tinnitus. Professor Ashton's book proved invaluable as it helped me to understand what was happening. Without it I really would have thought that I was going mad.

After completing the taper I expected that things would gradually improve over the next few months but it was not to be. Probably because the drug had been taken for such a long time (45 years) recovery was going to be a very slow process. It was in fact further delayed by the need to withdraw from the anti-depressants although with the brain still raw after the taper this was not the right time to do so. I now realise that they should have been continued for at least another six months. However, my GP wanted to stop them straight away, and dismissed the continuing symptoms as personal trauma. In fairness anti-depressants are normally used for months not years and the prospect of being entirely free of chemicals was tempting, so I reluctantly agreed. This was of course a big step backwards, the reaction was as severe as at any time during the taper and it was another eight months before I started to feel better. By this time it was a pleasant surprise to realise that things were in fact improving, as the temporarily unpleasant had appeared to be the norm. Once the recovery had started I felt much happier and the improvement continued, albeit quite slowly, month by month.

Was it worth it? Having been resigned to taking a small amount of valium for the rest of my life I am grateful that the surgery decided to reduce it's benzodiazepine prescribing, but I could have done with a bit more support. In particular the prescribing of anti-depressants and their premature withdrawal effectively lengthened the whole miserable business by several months. There appears to have been a failure to appreciate that significant physiological changes were taking place, and I suspect that this lack of understanding is pretty common throughout the medical profession. Benzo withdrawal is not going to rate very high on the average GP's list of patient needs. Maybe before long someone will get around to scanning the brain during withdrawal and this may provide a better understanding. However despite the difficulties I am in no doubt that it was worthwhile and there is something almost delicious in the ongoing improvement, possibly because it is a very personal success.

If you are thinking of tapering do not be put off by my experience, protracted withdrawal symptoms are pretty unusual and the taper does not normally take more than a few months. There is absolutely no reason for you to fail and a lot to be gained. A couple of suggestions that may help. Do not try to hurry the taper, make sure that you are have fully stabilised before making the next reduction. If you don't you risk being hit by a build up of symptoms when you reach the last tablet. Find an activity or pastime which will provide a balance, something else to think about, in order to distract from the taper. Try to get out of doors, fresh air is really helpful. Oh, and don't expect too much from your GP. Good luck.