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Plagued by anxiety and depression, Kelley McMillan unwittingly developed a dependency on the very meds that were supposed to help her.
Almost four years to the day after I quit drinking, I visited my gynecologist for a routine annual exam. It was July 2012; I was 33 and exactly where I wanted to be: in love, writing for national magazines, and living the kind of adventurous life I’d always dreamed of. Two years earlier, I’d moved from New York City to Denver. My health was excellent (I was even training for a half Ironman), so I hadn’t bothered to find a general practitioner in my new city. I relied on my gynecologist for my few medical needs: blood work, breast exams, birth control, and my psychiatric prescriptions.
After the standard poking and prodding, my doctor and I chitchatted for a bit; then she looked at me and said, “I’m worried you have a dependency on Klonopin. You’ve been on way too much of it for way too long.”
Klonopin is a benzodiazepine, one of a family of antianxiety medications that includes Xanax, Valium, and Ativan. The National Alliance on Mental Illness warns that physical dependency may result after only two weeks of use, but some psychiatrists, like the one I used to see on the Upper West Side, dispense it as a long-term treatment for anxiety. I’d been taking 1.5 milligrams of Klonopin a day, a moderate dose, since I’d stopped drinking, though I’d been on and off it throughout my 20s to help assuage the disquietude I’d long battled. And it worked marvelously. Any self-defeating thoughts and stress about work, family, relationships—the tightness in my chest where my worry takes hold—were almost instantly dissipated once I popped one of those little yellow tablets.
With my anxiety and drinking under control, my life bloomed. I traveled the world as a freelance writer—in a 24-hour span that spring, I’d heli-skied in Alaska, then jumped on a plane to go on safari in Uganda. After many years single, I was dating a handsome captain of a Special Forces team. I was happier and more grounded than I’d ever been. But my doctor was concerned that during the previous six months, I’d refilled my Klonopin prescription early a few times, something she had to approve at each instance. Those early refills, she said, had caught her attention for possible abuse. I was stunned. Sure, I’d refilled my scrip early on occasion, but only by a couple of days, ten days, tops. This was due in part to my hectic travel schedule, but also to the fact that I sometimes took a few more pills than prescribed, on nights when I couldn’t sleep or days when I felt particularly anxious. I never took Klonopin to get high; I took it “as needed,” as the label said to.
My doctor said that she no longer felt comfortable prescribing Klonopin to me, and she handed me the business cards of a psychiatrist, an addiction specialist, and a general practitioner. To my dismay, after I’d successfully kicked one habit, my doctor was telling me I had to kick another.
Alarming numbers of Americans are taking—and becoming hooked on—prescription pills, according to the Substance Abuse and Mental Health Services Administration (SAMHSA). With more than 47 million prescriptions in 2011, Xanax is the eleventh most prescribed drug overall and the most popular psychiatric medication in the country. That’s a 20 percent jump since 2007. Women are more likely than men to take antianxiety medications: 7.3 percent of women between the ages of 20 and 44 and 11 percent of women 45 to 64 are on them, twice the number of men, according to a 2011 study by Express Scripts, a health-care company that tracks data from more than one billion prescriptions a year. The fallout from our affinity for anxiety meds is startling: In 2012, nearly seven million people abused psychotherapeutic drugs, and rehab visits involving benzodiazepines tripled between 1998 and 2008, according to SAMHSA.
Part of the problem stems from the fact that we are the most anxious country in the world, or at least the country fastest to cling to medical diagnoses, with clinical anxiety affecting about 40 million American adults in a given year, according to the most recent figures from the National Institutes of Health. Anxiety is the most common psychiatric diagnosis in the United States, and one in three women will experience such a disorder in her lifetime. “If you wanted to design a culture that is anxiety-producing, stress-producing, mood disorder–producing, and stressful to the self-image of girls and women, you’d draw it up to look a lot like the United States,” says Colorado-based psychiatrist Scott Shannon, M.D., who founded the Wholeness Center, the country’s largest and most comprehensive integrative mental-health clinic.
That’s where the pills come in. Benzodiazepines were first introduced in the 1950s; today more than 94 million
benzo prescriptions are dispensed annually, according to a 2012 report by IMS Health, a leading health care–research company. The drug works by enhancing the effect of gamma-aminobutyric acid (GABA), a neurotransmitter that helps calm the mind and body. GABA roams the brain looking for the right receptor to latch onto. When it does, its soothing effects are unleashed. Benzos attach to GABA receptors, amplifying the neurotransmitter’s effects and creating an inflated sense of peace.
“Benzos are cheap, easy, and don’t require any effort on the part of the patient,” says Franklin Schneier, M.D., a research psychiatrist in the Anxiety Disorders Clinic at New York State Psychiatric Institute. “They work rapidly, and they are effective. But they have several disadvantages, too.”
For starters, there is little evidence that long-term benzo use cures anxiety. In fact, several small studies suggest that taking benzos on an ongoing basis can cause structural changes in the brain that may result in cognitive damage, according to psychiatrist Peter Breggin, M.D., author of more than 40 articles on the subject and an outspoken critic of psychiatric drugs. One meta-analysis examining patients who had gotten off benzos found deterioration in every area of intellectual and cognitive testing it studied and suggested that the damage may be irreparable. And benzos may actually make your condition worse than before you started taking the drugs because they compromise your ability to deal with it, Breggin says.
While benzo manufacturers and some doctors believe that the drugs are beneficial if they’re used properly, they’re often prescribed for the wrong reasons; after all, we are a quick-fix culture that seeks immediate alleviation of symptoms. On top of that, general practitioners prescribe 65 percent of all antianxiety medications, and they’re often unable to provide sufficient monitoring and may be unfamiliar with medication protocols. Even therapeutic use can lead to addiction, abuse, and physical dependence, which happens when the body adapts in such a way that it needs the drug to function properly. Withdrawal symptoms can range from panic attacks and nausea to the more extreme—seizures and suicidal thoughts. Studies show that between 15 and 44 percent of long-term benzo users will develop a physical dependency on the drug. According to Breggin, getting off benzos is harder than quitting heroin.
I was 29 and living in New York City when I gave up drinking. Mine wasn’t a rock-bottom falling-out but a gradual awakening to the realization that alcohol was getting in the way of the person I wanted to be. There were times when things could have gone terribly wrong and didn’t, but the most crippling part of my drinking was the massive anxiety hangovers I’d suffer after big nights out. The morning after, I would have a tightness in my chest that crept up my neck and into my head, where an electric sense of shame overwhelmed me to the point where being in my body was almost unbearable.
There was something else that had been scratching at the raw spots in me for a couple of years. My drinking was starting to remind me of my mother, who had her own complicated relationship with alcohol, mental illness, and psychiatric medications. Like me, she wasn’t a vodka-in-the-morning drinker, but when she drank—usually California Chardonnays—she couldn’t stop. She’d get high and silly and then, at the drop of a dime, she’d turn mean, lashing out at those closest to her. It was so contrary to her fundamental nature—kind, compassionate, sensitive—and she hated herself for the times she hurt our family. But ultimately, no pill or drink, no amount of love, could soothe her sadness. When I was 22, she took her life. I worried that her suffering was a warning, a glimpse of what my future might be if I didn’t change things.
After a fight with my boyfriend in July 2008, I woke up with a guilt-shame-worry hangover that was becoming all too familiar, and I decided to stop drinking. There was no AA or rehab—my drinking never got out of control to the point where friends and family were concerned—just my own steely desire for a better life and the memory of my mother driving me toward it. I committed myself to giving my psych meds, which I’d taken off and on since my teens, a shot to work (alcohol can counteract antidepressants’ effects and worsen depression and anxiety). I wanted to tease apart how much of my unhappiness was a result of my lifestyle—late nights and alcohol aren’t a recipe for achieving balance—and how much of it was me.
Given my mother’s mental-health history, I believed that I was genetically predisposed to depression and that psychiatric medications would right my chemically unbalanced brain. My issues, I was told by several doctors throughout my life, were like diabetes. You take medication to balance your brain as a diabetic would take insulin to manage blood glucose levels. (This notion, in fact, has never been proven, nor has the chemical-imbalance theory of depression and anxiety, says Breggin.) My mother gave me my first benzo, Valium, when I was sixteen and came to her one night, unable to sleep. In the world I grew up in, psychiatric drugs promised healing, salvation, a cure—and I bought into all of it. So I didn’t hesitate when my psychiatrist prescribed me 100 milligrams of Zoloft and 1.5 milligrams of Klonopin. I was ready to do anything—give up drinking, recommit to my psych meds, run a marathon—to silence the voice of criticism and doubt that lived in my head; anything to be happy.
Fast-forward four years, and I left my gynecologist’s office frightened by the word dependency and immediately, rashly, cut my dose in half. I also made an appointment with Mary Braud, M.D., a psychiatrist well known in Denver for her holistic approach toward mental wellness.
On a hot day in late July, Braud explained to me that my story of inadvertently becoming dependent on benzos was all too common. “I’ve seen a lot of people who are shocked and surprised that a medicine that they were given that they thought was OK is now creating a big problem for them.”
In her view, one that is gaining popularity among progressive psychiatrists and supported by new research, anxiety is a complex problem caused by an array of factors including genetic predispositions, digestive health, diet, and trauma. It’s not something you’re just born with, and it’s not something that benzos can truly fix. “The benzo is never going to heal anything or give the body what it truly needs to function better. And, in fact, it may actually stand in the way of that happening for people,” Braud said.
Together, we started to unravel the roots of my angst, and I came to better understand how my mother’s instability had planted the seeds of my condition. The question of whether she would be there the next day was often very real, and it helps explain the irrational uncertainty I feel about my future and relationships.
I also started to realize there were incidents along the way that, in hindsight, should have been alarming. In 2012, two days into a ski trip in Telluride, Colorado, I ran out of Klonopin. That night, my brain felt like a bundle of frayed electric wires shooting sparks across my skull, I was overwhelmed by self-loathing, and I couldn’t sleep, despite the fact that I was exhausted after a day on the slopes and that I’d dosed myself with Tylenol PM. The next morning, I cut my trip short and drove home. What I didn’t understand then was that I was in benzo withdrawal.
Some studies suggest that long-term benzo use may impair the body’s natural ability to produce and access GABA. When benzos are discontinued or the dose is lowered, the central nervous system may go into overdrive, causing withdrawal, which can even occur between pills if your body has developed a tolerance to your dose.
More than a year after my gynecologist refused to renew my prescription, I’ve started to slowly taper my dose, with Braud’s guidance, and I’m down to .62 milligrams a day. I’ve revamped my diet, cutting back on refined sugar and caffeine, which really rev up my anxiety, as well as gluten and dairy, which recent studies indicate may cause inflammation in the gut that triggers mood disorders. I’ve started taking supplements like Pharma GABA (amazing), magnesium, and fish oil, which studies suggest help the brain make the good chemicals that moderate mood and anxiety. I try to get at least eight hours of sleep a night. I ski, bike, run, climb mountains, and spend time in nature every chance I can.
Here I am nearly six years alcohol-free and staring down a different beast, benzodiazepines. For the most part, giving up alcohol was easy and the results were almost immediate. But whenever I lower my Klonopin dose too rapidly, my world starts to teeter out of control. If I had known back in 2008 what I know now about benzos, I don’t think I would have filled all those prescriptions. Yet amid the fear of quitting, there’s a familiar feeling: that same desire for a better life and my mother’s whisper urging me toward it.
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