I feel so light today--not because I'm flying high on benzo's--because I finally feel the weight of desperation, frustration, hopelessness, depression, suicidal ideation, anxiety and panic lifting. I can't even recall the last time I felt, for lack of a better term, normal. Like I could cope with life and enjoy waking up in the morning to face the day.
I knew exactly what I needed to get better and so I wrote out a treatment plan and presented it to my psychiatrist. And it worked. Be firm. Stand up for yourself. I was ready to be shot down by my psychiatrist and had that been the case, I would have moved on to someone else until I got what I wanted.
Since Blogger won't let me upload a word doc or pdf file, I will post my Treatment Plan below as an example. I tend to go on and on, lol. Your letter does not need to be as long.
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Treatment Proposal
Prepared for: Dr. R******
Prepared by: Sonja J*****
Date: June 11, 2016
Objective
To minimize anxiety and panic attack symptoms as to allow me to fully commit to group therapy and exposure therapy.
Proposal
Clonazepam 0.25mg per day for three to six months in conjunction with CBT, exposure therapy and mindfulness meditation.
Rationale
Since the December 2015, as an adjunct to my current meds (Effexor 225mg and Quetiapine 50mg) I have first tried Escitalopram, which worked for barely a week before it suddenly stopped. Then I tried Buspar and that had no effect whatsover. Finally, I tried adding Prozac. The side effects were immediate but I stuck it out for nearly two months without any noticeable effects.
Besides these three medications, I have, through the years, tried almost every antideppressant out there, including tricyclic antidepressants, tetracyclic antidepressants, atypical antipsychotics and even an anticonvulsant. None of these helped with my anxiety and panic attacks, not to mention my agoraphobia.
Recently, I have tapered off Quetiapine and have replaced it with Amitriptyline 25mg for my insomnia. The only other medication that I am currently taking is Effexor 225mg per day, which only works for my depression. I know this because I twice went off Effexor thinking that it did nothing for me only to have my depressive symptoms return. Once I was back on it at my usual dosage of 225mg, the depressive symptoms ceased.
At this point, I am wary of trying any antidepressants for my anxiety as I have no hope that these drugs will have any effect on my severe anxiety. The only medications that work for my anxiety, panic attacks and agoraphobia are anxiolytics.
Having said that, my proposal to you is to prescribe me a very low dose of Clonazzepam (0.25mg/day) for a short period of time, two to three months. This would allow me to immediately commence group therapy here at Burnaby Hospital Mental Health. It would also allow me to start exposure therapy as well as mindfulness meditation. I believe that the reason I have not been successful with the above therapies is because my anxiety is severe. I am unable to concentrate on anything, I have trouble sleeping, feel restless most days, have difficulty eating due to constant nausea.
I need something to take the edge off. Just a little so that I can think straight and concentrate on my therapies. Every time I try exposure therapy, I panic. My body feels disconnected from my rational brain and before I can even try to calm myself down, my legs are spiriting me away from the “threatening” situation. The terrifying thoughts come so fast and with such conviction that my body just reacts and I flee. In that moment it’s impossible—or at least feels that way—to stop and think rationally. I don’t know what to do anymore.
For the last few weeks I have felt hopeless about the future, hopeless about ever being able to cope with my disorder and have felt an almost complete lack of motivation to even try as my anxiety just keeps getting worse. But I’ve been fighting it every single day. I am certain that I would greatly benefit from a small dose of Clonazepam. About a month ago Dr. Brar, my family physician, prescribed me 0.25mg for a few days because I was overwhelmed by intense anxiety and it helped me so much. I was able to concentrate again, to sleep soundly and a sense of hopefulness returned that I haven’t felt in almost sixteen years on antidepressants and antipsychotics.
Exposure sessions build on each other. One session every week or so doesn’t do much good in the long run but that is all I have the energy for right now. I am hoping to make exposure a daily practice and Clonazepam would make that possible. After a while I will have the necessaty skills and confidence to continue exposure and other therapies without the use of a benzodiazepine.
Conclusion
For me, the benefits far outweigh the potential risks of benzodiazepine use. I have never abused drugs, prescription or otherwise. I have take Ativan on an as needed basis for years without problems. But Ativan is only effective in emergencies and that’s how I take it. Clonazepam, on the other hand, is longer acting and works much better for my severe anxiety. Being able to take a low dose for a couple of months would give me the opportunity to fully commit and carry out a variety of therapies that in combination will help me to regain a sense of control over my anxiety and allow me to cope again.
I have tried exposure therapy many times but it just does not work when my anxiety level is so severe. After exposure sessions I would feel so mentally and emotionally exhausted that I lacked the energy, strength and motivation to try again.
In case you are worried about me being able to come off Clonazepam, that will not be a problem. I was on Ativan 2mg a day for months and I had no difficulty tapering off. It is not my intention to stay on benzos for the rest of my life. All I am asking for is a low dose on a short term basis to help me kick start exposure and cognitive behaviour therapy.
Thank you for considering my proposal.
Sincerely,
Sonja J*****
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