MORE THAN A GLIMPSE OF HELL (PART 3): THE DOCTORS
As the world around me enjoyed a pleasant Saturday afternoon, I sat on my bed trembling, wondering if I was dying or going insane. While other people sipped lattes at coffee shops and ran casual errands or watched movies or college football, I fought to keep a faint grip on some sense of normalcy and well-being. I was 35-years-old and I felt utterly alone, as if I were some unfortunate astronaut whose tether to the mothership had been tragically severed while he was performing exterior maintenance on the craft.
Whoosh. Away I flew into a vast, empty darkness. As I careened by the occasional burning star or foreign sun, I could still see, faintly, the people and the life that I’d left behind. However, like a ghost, I could no longer touch my loved ones or share with them a laugh or a bit of sunny enjoyment on a weekend. I could only wonder about my murky place in the universe and hurt.
Two months or so earlier, I’d quit taking the Paxil that had been prescribed to me in college for that nebulous, modern affliction known as Generalized Anxiety. Since taking my last dose of those pink pills, the world had become a ghoulish place indeed. The physical symptoms of the drug withdrawal were uncomfortable—the constant nausea, chronic insomnia, and damned fatigue were draining—but it was the mental and emotional troubles that were truly frightening.
I could no longer make sense of or enjoy a normal day because my system was a toxic stew of depression, guilt, and dread. And I was routinely getting “trapped” in my own head, sequestered in uncomfortably close quarters with a motley mix of intrusive and negative thoughts. I was alone in such a way even when surrounded by loved ones. I was constantly slipping further and further into that empty darkness, and there only seemed to be one solution: I needed to get back on the Paxil.
Despite all the hard work I’d done up to that point to quit the potent medication—and despite the physical and emotional side-effects that had compelled my decision to quit in the first place—I reluctantly ran backward, back toward the prescription bottle that I still kept in my office, ostensibly in case I needed to pursue an emergency reinstatement such as this.
I fished a little pill from the orange, plastic bottle that had become such a familiar sight over the years, and I swallowed the bitter pharmaceutical hopefully. However, almost immediately I knew there was a problem. My bedroom started spinning and shifting, and I felt a nausea so profoundly upsetting that it seemed as if I were receiving some divine punishment from above—a punishment for crawling back to the devil instead of seeking God in my hour of need.
Because my body had fought so valiantly to rid itself of paroxetine’s chemical intrusions—after my tired mind had perhaps seen some reprieve in the near future—the entirety of my being protested the medication’s sudden return. My systems began to kick and scream, yelling at me, What have you done? My world seemed to be crashing down quickly, so I did what any married man in his midthirties would do under such duress: I called my mom.
“Please, please don’t think less of me for taking the pill,” I cried into the phone. “If I really need this medication because I’m sick, then please don’t think less of me.” I’d said that I was going to stop the medication and get healthy, but now I wasn’t sure what healthy was. Was it quitting the pills or taking them? Was I now sick because I’d been duped into taking the pills, or had I really needed the pills all along because I was born sick, the woeful and unlucky recipient of a deficient serotonin or norepinephrine supply.
As my mother listened to me cry and ramble, I felt like a scared little child who just pretended to be a man at times. Maybe I would never accomplish anything in life, not even the basic goal of sorting out my own wellness.
“You know that your dad and I would never think less of you,” my mom reassured me as only a mother can. Her words made me feel a little less like a failure, but I still felt gut-wrenchingly sick from the pill I’d swallowed. I wondered when the effects of that pill would subside, and I wondered when my wife would be getting home.
Dr. Feelgood was tanned and confident. He had a nice haircut and a paunch that seemed to speak of nice restaurants. He smiled often through the adornment of his goatee, and he often tried to reassure me that we were buddies more than anything. He acted casual and cool by throwing me winks and even the thumb-and-index-finger gunshot on one occasion, and he always gave me more pills when I asked for them.
Now that I was trying to get off the pills, Dr. Feelgood didn’t seem to fully understand me anymore. Either that or he didn’t want to admit to playing any part in the gruesome scene I was now presenting to him. I was in pain, all the time, and I was looking for answers and reassurance.
“Well, any withdrawal effects from the Paxil should have been relatively minor,” Dr. Feelgood said, “and they should have been over after a week or two.”
I couldn’t believe what I was hearing. I’d been off the Paxil—with the exception of that one, ill-advised reinstatement dose—for about four months, and nothing felt close to being over. If my harrowing pains and mental fog weren’t withdrawal, then I was seriously ill with something that seemed willing and able to kill me.
“It sounds like your pains are mostly stress related,” Feelgood said. “We all channel stress in different ways. If you don’t want to take an SSRI antidepressant, then maybe you’d have some luck with Wellbutrin.”
During that first, confusing half year of withdrawal, I ended up trying Wellbutrin, a norepinephrine-dopamine reuptake inhibitor that can apparently be prescribed for just about anything. I would later learn that the medication is marketed as both an antidepressant and as a smoking cessation aid (in addition to being used in an “off-label” manner for ADD and anxiety), and at Feelgood’s suggestion I took the multitalented pharmaceutical for about a week, until I could no longer stand how it filled me with useless adrenaline and agitation.
After the Wellbutrin, I almost tried other prescriptions, too. Every so often at work—when the withdrawal had me feeling as if I were about to lose my mind or go into cardiac arrest—I’d step outside and place a frantic phone call to Feelgood’s office. "Maybe Pill X or Pill Y will help," I’d suggest to his nurse hopefully, but I never followed through on those suggestions, because the thought of eventually having to tackle yet another pill withdrawal was more than I could stomach. In addition to quitting the Paxil, I’d begun a tapering schedule to quit the Xanax that had been prescribed alongside the Paxil so many years ago (for acute instances of panic), and it was starting to seem like more than coincidence that my body pains and mental confusion increased as my levels of medication decreased.
After a while, I wanted nothing more to do with medications. I just wanted my doctor to define my situation and offer me hope that it would get better. I just wanted to know that I wasn’t dying, really. I wanted expert guidance that would take me through the prescription drug withdrawal process, but unfortunately, Dr. Feelgood didn’t have much to offer in that department.
“You should have quit the Xanax first,” was about all Feelgood had to say when I outlined my situation for him and pressed for withdrawal-specific information. I’m still not sure of the logic behind that statement, but I think he was giving a sly nod to the pain he knew I was yet to endure if I continued to cut my Xanax dosage. I’m almost certain that he had seen my sort of situation before (how could he not have?), but he never came out and said so. Instead, he acted a little confused.
I was starting to feel hopeless. Was I somehow imagining it all? Where besides the Internet could I find information regarding the strange physical and mental symptoms that had been torturing me for months? Where could I turn for help?
Oh, how I wished that I’d never left my first doctor. Some time earlier, when that primary care physician whom I’ll call The Good Doctor had started to get squeamish with my Xanax levels and refused to increase them any further, I’d sought a replacement for him and quickly found a sympathetic goatee in Dr. Feelgood. But now I desperately wished that I’d never switched loyalties.
The Good Doctor was a man who truly cared about his patients. He had a healthy BMI, a clean-shaven face, and a compassionate demeanor. He’d truly seemed to care about me. The Good Doctor had preached about the need to attack anxiety and other illnesses with methods other than pills, and when he didn’t understand something—as was the case when he admitted to being a little green about clinical levels of anxiety—he acknowledged his ignorance and tried to make a wise referral (in my case, a referral to a therapist whom I don’t remember ever calling).
The Good Doctor had been so kind and concerned. He’d talked about total wellbeing and things like exercise and a healthy diet. Appointments with him might last upwards of 40 minutes—well, well past the 15 minutes or 20 minutes that I’m sure the clinic held as sacrosanct “best-practice” parameters—and he was not a man who relished reaching for the prescription pad, which seemed to be a last resort for him.
The Good Doctor was the opposite of Dr. Feelgood in nearly every way—you would never be able to picture him going on the lecture circuit for big pharmaceutical companies or complying with calloused appointment time limits—and after a while, I think he was forced out of the medical establishment because of his unique posture.
One day, after I’d already been seeing Dr. Feelgood for some time, I received a letter from The Good Doctor, a communication he must have sent to all current and former patients. The letter said that he was leaving the medical profession to teach middle school. The Good Doctor said that he was looking forward to helping children learn about the planets.
Because my interactions with Dr. Feelgood had been disappointing—because the medical establishment didn’t seem to recognize prescription drug withdrawal as a condition that might last for months or years—I stayed away from doctors for a while, hoping that my situation would resolve itself so that I wouldn’t feel the need to talk to people in white coats anymore. However, when every new cut to my Xanax dosage brought with it otherworldly pains that left me searching for answers, I relented and made an appointment with Dr. Dipstick, a colleague of Feelgood’s who worked at a clinic across town.
By this time my situation had become more confusing than ever. I was often depressed, perplexed, fatigued, paranoid, and anxious, and new and fantastical body pains arrived on my doorstep regularly like taunting packages that had been sent by GlaxoSmithKline or Pfizer.
When I arrived for my appointment with Dr. Dipstick, I was broken, fragile, and nervous. I was desperately looking for someone to help me, but would he be the one? I tried to remain optimistic. Maybe he would smile and tell me, “The truth is that we see this all the time. We prescribe A LOT of these medications, so we have to help a lot of people get off them, too. Don’t worry, you’re not dying (friendly chuckle), you’re just going through withdrawal. You’re going to be all right, and I’m going to help you until you are fully recovered.”
But Dr. Dipstick didn’t say any of that. Instead, he was at first indifferent and then insulting. He actually made me feel foolish and ashamed for coming to him, and he often seemed confused as to what I wanted out of the visit. I tried to explain to him how I’d been suffering since quitting Paxil and then embarking on a Xanax-reduction schedule, but my words hit a wall. Maybe he was ignorant of prescription drug withdrawal, but if he was, he could have admitted that ignorance and providing a referral to someone else like The Good Doctor would have. Instead, he began to fill the void with blame.
“Do you ever need an eye-opener?” Dipstick asked me accusingly. His full beard made him appear gruff and even menacing.
“I don’t know what that is,” I told him.
“It’s when you need a drink to get going in the morning,” he explained, certain that he wasn’t telling me anything new.
“I don’t understand,” I said.
“Well, you said on your intake form that you drink beer pretty regularly, and just going through your medical history here, I see that you’ve had some elevated ALT and AST liver function numbers in the past.”
I tried to steer the conversation back to the Xanax taper that I was in the midst of—back to the anxiety and pains that increased with each step in that reduction schedule—but he just didn’t seem interested.
“Maybe you could refer me to someone who could guide me through this?” I asked, shaking. “Maybe to someone in your psychiatry department who specializes in anxiety and the medications used to treat anxiety.”
“I don’t know of anyone like that in particular,” Dipstick said flatly. “I can give you the general triage number for psychiatry, and they’ll probably have you speak with a social worker who will assess your needs.”
“How would a social worker help me?” I asked desperately.
“Well, maybe they’d refer you to a substance abuse treatment facility.” Dipstick answered, and my stomach sunk to previously unknown depths of despair.
I was beginning to see a disturbing picture emerge. When I’d been dutifully taking the medications, I’d been a valued patient. The doctors had happily provided with information about “transition periods” and side-effects. But now that I was quitting the medications, I was nothing to them but an addict or neurotic who needed to help himself. They had no medical information for me, and they seemed to have no insight into the many symptoms that were making my life hell.
The visit to Dr. Dipstick was beyond disheartening. I could have gotten more sympathy for my situation by talking to the clerks at the corner gas station, and I could have gotten more information by staying at home and using Google, which would ultimately prove to be an invaluable resource during my ordeal.
The visit to Dipstick was bad, but the paperwork I received from his office several days later was almost worse. Under Reasons for Visit, Dr. Dipstick had written Alcohol Abuse. My mind raced, wondering why he was doing this. Was he a friend of Dr. Feelgood? Was he trying to protect his friend—the one who had seen my Xanax prescription balloon under his watch—from some sort of lawsuit? Whatever the case, the comments he’d added to my official medical record had just further muddied the waters of my situation at the clinic. Those comments would be the first thing that a new doctor would read (if I went to one), so there was now zero chance that I’d get any educated help.
A few days after my visit with Dr. Dipstick, I called his office and spoke with a nurse, relaying to her my concerns about the Reasons for Visit remarks that Dipstick had stamped onto my record. I asked her if she could please have the doctor remove those remarks, and a short while later she got back to me.
“Dr. Dipstick says that he won’t do that,” she said, not unkindly. I was both heartbroken and furious. I wanted to drive to the clinic and confront the doctor in person, but of course, withdrawal had left me too timid and weak for such a heroic effort. Instead, I wrote a letter to the clinic a few months later.
As I wrote my letter, I tried to channel my frustration and righteous anger. I told the clinic about Dr. Dipstick’s dismissive and judgmental demeanor, and I told them about how the increase in my liver enzyme numbers—the increase that Dipstick had attached, along with my withdrawal pains, to beer drinking—appeared to have been just another dangerous effect of the medications I was quitting. Those numbers had returned to normal once I’d quit Paxil and started reducing Xanax dosages, so I felt that such a fact needed to be entered into some official record. I wanted to enter every last bit of my situation into some official record so that future withdrawal cases wouldn’t be dismissed so easily.
But I never sent the letter, just in case I needed an appointment in the future.
As it turned out, I did make another appointment with the clinic, a final visit to Dr. Feelgood that would be my last doctor appointment to date. By that time I’d been off Paxil for nearly 16 months and completely free of Xanax for about four months. New physical and mental pains were still arriving every week, and although I doubted Feelgood had any new insights for me, I wanted him to run some tests to make sure that I wasn’t seriously ill with something other than withdrawal.
“I could prescribe you something for Fibromyalgia pain,” Feelgood suggested almost sheepishly, “but it doesn’t seem like you want to go the medication route anymore.”
I shook my head. “I just want to make sure I’m not dying,” I said.
“Well, we can definitely run some tests,” Feelgood said. “We will definitely try to rule things out.”
“And I want to start cutting back on my blood pressure medications, too,” I said. “Now that I’m getting healthier, I just don’t think I need them anymore. Certainly not three of them.”
“We can start reducing those and see how it goes,” Feelgood said without much hesitation. He demeanor was friendly, and I even thought I sensed a newfound respect coming from him. I don’t know if he’d ever seen a patient of his successfully quit multiple medications or not, but now that he’d seen me do it, maybe he would have something hopeful to tell future patients who were suffering through similar scenarios. Or maybe I was just imagining increased attention and thoughtfulness on his part. Maybe I just wanted to see something positive in the situation.
Thankfully, my lab results from that last visit to Dr. Feelgood all came back normal. However, the pain of prescription drug withdrawal continued for a good while. Even the blood pressure medications that I was able to give up after getting back to a healthy lifestyle came with a ridiculous amount of withdrawal effects, things that could lead a person to believe that he was losing his mind or dying if he didn’t know better.
Pills do have consequences, even if a trusted doctor is prescribing them and even if health insurance is paying for them. Prescription drug withdrawal is real, even if a relatively small number of people are talking about it. It’s as real as any purported benefits of the medications that are so readily given out nowadays for every ailment under the sun. Think about it: if a designer mix of chemicals is introduced into a person’s system with the intent purpose of altering how the mind and body function, then why wouldn’t there be severe physical and mental repercussions when that mix of chemicals is taken away? I'm now of the opinion that patients should almost always look at prescriptions as a last resort: there are simply too many known instances of modern drugs making people's physical, emotional, or mental health worse.
Recovery from prescription-drug withdrawal is possible: that's important for people to know. I’ve now been free of Paxil for almost four years and off of Xanax for a little more than three. I consider myself mostly “cured” of withdrawal (time and healthy self-care habits seem to be the only remedies, by the way), but I still occasionally wonder if I might have some lingering fatigue, confusion, or other symptoms that are the result of taking or quitting the medications (although I realize that such complaints might also just be a common part of approaching 40 in a competitive and stressed-out society). And about the anxiety? I still get flustered and worried at times, but I've found that there are ways to fight through such emotions (or avoid them) without making a Faustian deal that involves sacrificing parts of my greater well-being.
I often wonder how different my life might have been if I’d never taken those damned pills in the first place. But such wondering is useless, as useless as the idea that doctors and their pills can keep a person healthy in the first place. True health requires nutritious eating, regular exercise, adequate downtime, meaningful relationships, spiritual enrichment, and professional fulfillment. The Good Doctor would probably tell you that, but unfortunately, he’s not practicing anymore.