[Guest]

Hi all

Yesterday I had a follow up visit with my General Practioner to go over "blood work" I had from a recent complete physical. Seems I am in pretty good shape, fortunately.

As some of you may recall I have been trying to reduce my daily dose of Xanax. Recently for a few days I got down to 1.5 mgs for the entire day by extending the amount of time from my evening dose to the afternoon dose the following day. I reduced my daily intake by about 25%. But I am now back up to where I was, around 2 mgs per day. I talked to my pharmacist and she said that I was simply torturing myself by my reduction efforts. But it did definitely lower my tolerance level. I took 2mgs yesterday, 1mg twice that day and it felt like too much. So today I will knock it back down to 1.75 mgs. It may seem strange but one of the reasons I felt compelled to go back up to my original comfort zone yesterday was do to my anxiety about what would happen to me if my doctor cut me off the Xanax. Or if he moved out of this area and i had to find a new doctor who might turn out to be benzo-phobic or something.

As many of you are aware I have been taking it for many years on a daily basis and I am habituated. And on a certain level I don't care that I am habituated as the drug has allowed me to live my life (for what it's worth) in greater comfort than I would have been able to do without it. It has improved the quality of my life I feel. Of course if life would have dealt me a different hand I might not need a drug to feel comfortable.
And "in depth" therapy seems to me but a luxury for the few. I mean does anyone know any "analysts" who offer to do long term therapy on an ability to pay sliding scale?"

Well anyway I thought I would "grab the bull by the horns" and come straight out and ask the doctor his thoughts on my use of the Xanax that he has been prescribing for me for so long.

I said to him:

"It would be a great relief to me if I knew that I would be able to continue to recieve Xanax for the rest of my life if I wanted to. Barring any physical neccessity of stopping, such as poor liver functions etc. do you see any reason why I wouldn't be able to continue taking it indefinitely?"

His answer:

"No, I don't see any problem with that."

I said to him:

"What about developing a tolerance to the Xanax?"

His answer:

"Generally the developement of tolerance occurs during the first year of treatment."

I said to him:

"I worry sometimes that if you were to leave the area I might not be able to find a doctor willing to continue prescribing it for me."

His answer:

"Generally Xanax would not be "our" first choice, but as you have tried other drugs in the past without benefit, and as the Xanax seems to be working for you, I think many doctors, would likely adhere to that old adage 'if it's not broken - don't fix it.' Actually long term treatment with Xanax in cases like yours is really not uncommon."

Anyway I was somewhat relieved by what he had to say, and felt like sharing it here amongst fellow DP sufferers.

john

 

[AHuseman]

Wouldn't being on it for that long at that dose cause some discomfort for you? It helped me too but I couldn't stand being on it for more than a few weeks.

 

[Guest]

Thanks for your reply AHuseman

I am not sure what you mean by discomfort. The only side effect I have ever noticed were those times I took more than I actually needed to control anxiety, depression, or panic attacks associated with feelings of DP/DR. For instance, I have found that most often .5 or .75mgs per dose is as effective as taking 1+ mgs. And that taking over 1mg often makes me feel somewhat overly sedated. So I seldom do that.I mean it is not neccessarily more effective at higher doses than at lower doses. Particularly when one is on long term therapy and has developed a relatively stable tolerance level. I am taking a little bit less per day on average than I was taking a year ago. I seek a therapeutic dose strong enough to feel comfortable but not sedated, except perhaps at night to help with sleep.

Now if what you mean by "discomfort" is in reference to a psychological or moral discomfort brought about by habituation and dependency, I would have to say yes there are times when it bothers me. But I don't think my feelings would be much different than one who is on long term treatment with an ssri antidepressant drug, anti psychotic or whatever.

Being physically or psychologically dependant on any drug is no doubt a drag, but nowhwere near the misery of suffering from anxiety, depression, panic attacks and DP/DR. At least that is how I see it.

Does that answer your question AHuseman?

john

 

[Scattered]

I'll preface this by saying that I've never been on medication, so you can just say I don't know what the hell I'm talking about. You'd probably be right. I just don't understand how moving from a state of anxiety and dp/dr to drug dependency is a solution. If it helps, then I agree you should be on it. But what if alcohol helped me, and I started taking controlled "dosages" of alcohol to calm my nerves. Do you think that would be a real solution?

Once again. This is NOT meant to be offensive or judgemental. I'm just worried at the overprescription of drugs. The idea that these drugs are fixing the problem. Are they really FIXING you? It seems like they are just treating symptoms. Treating symptoms is fine, but is an indefinate state of drug dependency really a viable option? I mean some people have it very hard. Maybe you have it very hard. In that case, I agree in advance, I'm wrong and shouldn't have posted.

And then being very anxious and scared because of that dependency seems to be the kicker. Its just that I would think that changing the thought patterns that cause the DP/DR and anxiety in the first place would be better. Rather than continuing to experience the anxiety/dp/dr, and then treating the inevitable outcome of those thoughts with an increasing regimen of drugs.

 

[Guest]

Hi Scattered

Yes it is all about symptom relief.

You ask:

"But what if alcohol helped me, and I started taking controlled "dosages" of alcohol to calm my nerves. Do you think that would be a real solution?"

I am not sure what you mean by a "real solution?" And yes I think that taking controlled dosages of alcohol to control ones nerves may be a reasonable decision, especially if it works consistently over the long haul like Xanax seems to have for me.

I do not believe that because one is able to find on going symptom relief through a particular drug or even alcohol that that necessarily precludes any endeavors one may have in seeking non pharmacological appraoches in addressing the issues one is trying to cope with. I have heard that there even "extremist elements" in the "therapy vocation" that won't even see clients until they are free of alcohol or drugs rather than work with the person from where they are at.

On a personal note in my case I have been dealing with feelings of DP/DR for over forty years since the time I had my first nervous breakdown back in the mid sixties and was hospitalised for a long time. I feel I lost a part of myself during that "breakdown" I have never been able to re capture. I have tried a variety of therapies and different therapists over the years and have learned a few things, but it would take, I beleive, many years of in depth psychotherapy with a highly skilled exceptional therapist to take me deep enough to engage in "Character Restructuring." See I don't believe that my transient-intermittent, stress-related feelings of DP/DR are the result of skewered superficial thought processes. Rather they are the result of deeply layered pre verbal disturbances which occured during very early childhood "ego" developmental stages. Particularly those stages of seperation and "self differientation" from the "mother." I feel I have never been able to make a clean break from the "maternal matrix." And under stress the sense of self, that I have been able to sort of patch together on top of an unstable foundation "or weak ego", gives way and crumbles temporarily and through psychological regressive tendencies I find my sense of self scattered (no pun intended) and physcially fusing with the environment. This is a very terrifying experience for me. Gradually (usually within minutes) the life force within me gathers up these fragments of self and disentangles from the fusion state and once again a wispy fragile sense of self is re established. And as long as i don't think too deeply, too introspectively about the reality or the illusory nature of my existence, I am able to carry on while yet feeling the constant presence of the monster(DP/DR) breathing down my neck.

I find that Xanax for me acts like a sort of psychic glue which holds the pieces of self together. Or like a magnet pulling the mental fragments back toward a center.

I have been diagnosed as suffering from a Depressive Character Disorder with psychotic tendencies (or severe) dissociative states when under stress. It is very difficult to "treat" Character Disorders because the pathology is built into the persons sense of self. For instance I have been thinking recently that to suffer from a Depressive Character Disorder it is like thinking and percieving and acting in the world the way a person suffering from depression would act but as the depression is built into the personality at a very early age one may not have any awareness of an "affect" or feeling of depression. It is very difficult to seperate such an intrinsic part of oneself from the rest of ones personality in order to work on it in a therapeutic situation. One therapist I was seeing some years ago said that I was carrying my mothers depression and that it had been built into my sense of self and was pretty much inacessible like something contained within a seamless hermetically sealed jar. Recently I came up with another analogy that works even better for me.

Some years ago I took a class in agriculture and farming and learned a technique used by orchardists to get hardy high yielding fruit trees which is known as grafting (you may be aware of this) For instance one plants a strong variety of fruit tree, say an apple tree, and then lets it grow for a couple of years until it has developed a good root system, then at the right time one can take a branch from a different type of fruit tree and graft it onto the stock of the apple tree and the tree will produce the kind of fruit of the variety of the kind which was grafted onto it lets say plum. After a while it is very difficult now to seperate the part of the tree which is now plum from the rest of the tree their particular natures are so intimately entwined.

Similarly it is very difficult to isolate and treat psychological problems that are built into the personality itself. That is why they exist as "personality Disorders" in their own category rather than amongst the neurosis or psychosis groups. At least that is my understanding.

Well in any case Scattered I hope you will forgive me for going on like this. Perhaps all I am trying to say is that sometimes one can be aware of the basic problem and the possible solution but still do to circumstances beyond ones control be unable to act.

I am at the age now (sixty) where I think few therapists would be willing to venture into deep psychological re structuring. Very few would even dare. Nor am I sure I would be up to it in any case as it seems a little late.

So in the mean time I will do the best I can and try and remain as comfortable as possible.

The main reason i posted about my doctors visit is because the continuing availability of xanax has been a concern of mine and a source of some ongoing apprehension. By knowing his favorable thoughts on the subject and discussing my concerns with him I feel I have one less stressor in my life. Of course i realize nothing is set in stone but still I found his current attitude somewhat comforting and reassuring.

Thats what I was hoping to share.

Sincerely
john

 

[Scattered]

That was a very good post. The only reason I even felt the need to respond is that it seems like alot of people are willing to skip real psychological treatment and head straight for a variety of drugs that they think may cure them. I wasn't aware of the complexeties of you're situation, and after that very informative post, it seems like the best treatment you can expect. It's just that I had thought that this was a post meant to offer long term Xanax use as an option for most DP sufferers.

Anyway, sorry for stirring up trouble. And good luck with you're DP.