Withdrawals or over anxious?

[LisaCM]

Hi,
I had a bad time over Christmas and was given 15 x 2mg Diazepam tablets which I took on and off but not everyday at first.
Four weeks later the CPN came and recommended I take them 3 times a day until Psychiatrist can review ADs (I'm on Mirtazapine).
In the past 60 days, I've had 39 of those days where I took Diazepam but mostly only 2mg on a given day. I've had 3 days over the past 5 weeks where I've had 2 tablets and 2 days where I took the 3 and that is included in the 39 days. In total I've had 50 tablets in that time.
In the past 4 weeks I've had 2 x 12 day spells of taking them daily and in between stopped them for 3 days and felt really unwell ( I was told this wasn't withdrawals by pharmacist at NHS24).
I missed a day last week and felt horrendous too.
So in total 8 weeks and I haven't had nearly what I was supposed to have and yet seem to be having withdrawals.
Due to my worries, the past two days I cut back to 1.5mg daily and last night had horrendous stomach cramps, diarrhoea, nausea and was jumpy and unable to sleep.
I'm so worried and want to stop them and the CPN said I wasn't and couldn't be addicted 2 weeks ago as did a GP and a pharmacist.
I know I am worrying a hell of a lot about this but don't want another problem to add to my recovery which I know will take me time this time.
Any advice and reassurance would be greatly received. I got up and took a 2mg this morning because I was frightened of how I felt.

[panic_down_under]

I'm so worried and want to stop them and the CPN said I wasn't and couldn't be addicted 2 weeks

You are not addicted, but you may have developed a physical dependence. And no, they are not the same thing (see below). If you've been taking it for several months you also almost certainly have a dependence on mirtazapine too. In both cases you will need to wean of the med rather than quitting cold-turkey.

I missed a day last week and felt horrendous too.

...Due to my worries, the past two days I cut back to 1.5mg daily and last night had horrendous stomach cramps, diarrhoea, nausea and was jumpy and unable to sleep.

These suggest it is more likely to be anxiety, plus maybe a stomach bug, rather than a withdrawal issue. Why? Because of the rapidity of onset of the symptoms. Diazepam has a long half-life so it takes several days for withdrawal symptoms to appear. On the other hand its anti anxiety effect is fairly short.

Back in the 1980s there were a couple of studies conducted in which the participants were told their benzodiazepine dose had been reduced. Many promptly developed some of the common withdrawal symptoms even though the dose had remained the same. Expect to suffer and an anxious mind is quite capable of delivering the nightmare.

As for the difference between addiction and dependence, would you continue to take diazepam if it caused you physical harm which required invasive surgery to correct? How about if you were told that if you continued to take it you risked death within a year? No? Well contrast that answer with what 30 patients addicted to a common otc painkiller did when faced with this scenario.

[LisaCM]

Hi Panic Down Under,
Thankyou so much for your reassurance and information.
I know that if I was told I had to stop it that I could and I and I know I'm not taking more and more of it and trying to be very careful with it (even though I have been advised to take it more).
I just feel afraid right now of how bad the anxiety got this time and feel overwhelmed about getting better. I think you are right that this has made me worse.
I also realise that now is probably not the best time to stop taking it given that I am still just starting to feel a little better than I was. It just feels like another thing I'm not in control of I suppose and I need to be more positive I think.
I also spent the whole weekend googling and scaring the living daylights out of myself but today, that will stop I promise because it just gets me nowhere.
I've been a nurse for many years and know the rationale for many things but I find that rational thinking goes right out of the window at times like this and I suppose alot of us are the same.
I know I will get there because I have done before.
Thanks again,
Lisa

[panic_down_under]

I've been a nurse for many years and know the rationale for many things but I find that rational thinking goes right out of the window at times like this and I suppose alot of us are the same.

Yes, on all counts, Lisa, and not helped by the pill phobia many of us get as a freebie along with the primary anxiety disorder. I'd have preferred the steak knives!! My pill phobia get so bad I've had to be hospitalised when changing antidepressants.

When do you see the psychiatrist?

[LisaCM]

Hi Panic Down Under,

I'm not sure when I will see Psychiatrist. CPN said she had remembered me from seeing her before and was going to look at my notes and suggest something. That was afew weeks ago. CPN due tomorrow so will ask if any progress then.
I think she remembered my pill phobia too and was waiting for the GP to give a list of everything I've been on before. I had bad experiences with SSRIs so that's where the fear has stemmed from I think.
Had a great sleep last night which was fab and I think your reassurance and support really helped, thanks. 😊

[panic_down_under]

I had bad experiences with SSRIs so that's where the fear has stemmed from I think.

Well SSRIs are not the only antidepressants, they are arguably not even the most effective. Doctors just prefer them because, with maybe a couple of exceptions, they are safer in overdose, deliberate or accidental.

The older tricyclics class antidepressants (TCAs) are generally more effective, less prone to poop-out and often produce less severe initial side-effects and withdrawal symptoms. OTOH, they can seriously interfere with the electrical system of the heart in overdose and they can produce more ongoing nuisance side-effects such as dry-mouth and constipation.

I can also make a pretty good case for trying the even older MAOI class drugs now that modern food processing techniques have reduced much of the risks that plagued their use 40-60 years ago. They are the most effective drugs I've tried by a considerable margin. If they are still available they are going to be my first option should my advancing years render my current very cardio toxic TCA too risky to take.

[Chronic911]

A month is not too bad. These drugs should not be rx'd for more than 2 weeks max. They are worse than heroin trying to detox and I am living proof. I have been on these drugs nearly 30 years. 10 years on xanax, 10 years on klonopin, and now 10 years on valium. I have been to drug withdrawal hell many times and back in my life. Now, I have become tolerant to Valium and the withdrawals are horrid. I am not trying to scare you but please (anyone) carefully consider before you decide to take these drugs long-term to manage your anxiety and panic. I wish I could go back in time and do things completely different in my life but I can't.

I do not know if I am going to survive this or not.