Anatomy of an Epidemic (21 page)

Over the next eight years, Geraldine cycled through an endless combination of anti-anxiety and antidepressant medications. None worked. The anxiety and panic remained, and she suffered from a medley of side effects—rashes, sexual dysfunction, weight gain, tachycardia (from the panic attacks), and excessive menstrual bleeding, the last leading to a hysterectomy. “All of the women I’ve known who were on Ativan long-term ended up having a hysterectomy, every single one of us,” she says, with evident bitterness. At last, in October 1996, she went to a new physician, who, after reviewing her medical history, identified a likely culprit. “He told me, ‘You are on one of the most addictive drugs known,’ and I thought,
‘Thank God.’ I was in tears. It was the drugs all along. I had been made iatrogenically ill.”

Geraldine spent two nightmarish years withdrawing from Ativan and the other psychiatric drugs she had been taking. Horrible smells came from her body, her muscles twitched, she lost weight, and at one point, she couldn’t sleep for weeks. “It was like hell opened up and swallowed me in,” she says. Although she did kick the habit, it took several more years for her to feel better physically, and she still suffers from a great deal of anxiety. The gregarious, socially-at-ease person she had always been before that fateful day in March 1988 when she was prescribed Ativan has never returned. “Am I back to my old self? No,” she whispers. “I mourn who I used to be. We all mourn. I am still so afraid of so many things.”

Three days before I was to meet with Hal Flugman, who lives in South Florida, he called to say that his anxiety had flared up again, and the thought of leaving his house to talk to me was too stressful. “I am not feeling right,” he said. “I’m over-breathing, I have these terrible gastrointestinal problems. I think I have to get my Klonopin dose upped…. This is what is happening to me.”

Hal, whom I’d interviewed by phone a few months earlier, first became anxious when he was thirteen years old. Overweight and small, he didn’t get along well with his classmates in middle school. “I had panic attacks, and a slight fear of being around people,” he recalls. For the next five years, he went to counseling, but he was not prescribed a medication. “I was living with it, dealing with it,” he says, but then one night at a rock concert, the panic hit so hard that he had to call his family and beg that they come get him. The following day a doctor gave him a prescription for Klonopin.

“I remember saying to the doctor, ‘Am I going to become addicted and have a really hard time coming off?’ I was worried about the side effects, too. But the doctor said that the side effects would go away in a couple of weeks, and didn’t that beat living with these unbearable panic attacks? I said, ‘Well, of course.’ And I knew from the first pill that this was going to solve my anxiety problem. It absolutely worked for me. I felt great.”

Hal’s life since then is a story of addiction. Shortly after going on the drug, he moved to San Francisco to pursue a career as a musician, and for a time it went well—he even got to hang out with Carlos Santana, the great guitarist. But his music career failed to take off, and today he thinks that the Klonopin was partly to blame, for it stifled his ambition and didn’t help his finger dexterity, either. Eventually, he fell into a deep depression—“I felt like a zombie,” he says—and at age twenty-nine he returned to Florida to live with his parents. At that point, he was diagnosed with bipolar illness, the government agreeing that he was so disabled by mental illness that he was eligible to receive SSI. The years slid by, his mother passed away, and then, in 2001, he began taking higher doses of Klonopin, as otherwise his depression would become unbearable. His doctor told him he was abusing the drug and sent him to a detox facility, where, over a period of ten days, he was withdrawn from the benzodiazepine he had been taking for sixteen years.

“What happened next was absolutely the worst thing in my life,” he says. “I could give you a list of symptoms, but that wouldn’t do justice to what I was going through mentally. Month after month I got worse and worse. I couldn’t sleep, and the symptoms—the most debilitating one was this feeling that I was dead. I felt that my brain was ripped out of my head, like I wasn’t even a living thing. I had depersonalization, my skin felt weird, my body felt weird. I didn’t even want to get into the shower. Even room-temperature water felt strange on my skin. If I put on mildly hot water, it felt like it was burning right through me. I couldn’t digest food right, I couldn’t go to the bathroom for weeks at a time, I couldn’t urinate right … I was in a constant state of panic attacks, and this doctor is telling me it’s all in my mind, that he won’t write me a script, and that withdrawal symptoms can last a maximum of thirty days. I was cracking up, going insane.”

This went on for ten months. He found Geraldine Burns on the Internet, as she had started a benzodiazepine support group, and she would console him for hours at a time. Ten, twenty times a night he would call his sister Susan, screaming that he was going to kill himself. He desperately sought to get a new prescription for Klonopin, but the doctors he saw didn’t believe that his torment
was related to benzodiazepine withdrawal. Instead, they figured that he had abused the drug in the past and so they refused to put him back on it. “They don’t understand that the drug changes the whole biology of your brain, and that your brain doesn’t work right anymore,” Hal says. Finally, his sister found a physician who agreed to write him a script, and “within hours, the nightmare was over. Every single side effect, every single withdrawal problem I had been going through was gone. Completely. Like magic. I was jumping up and down I was so excited.”

Hal has never tried going off Klonopin again. His brain adapted to the drug, he says, and now it can’t adapt back. “Klonopin ruined my life. It takes away your drive, and in the morning, you don’t want to get out of bed, because you feel so groggy. I don’t even know what it’s like to feel normal. This is my world. Things don’t get me as excited as most people because I’m in a constant state of sedation. It should never have been prescribed for long-term use.”

Susan sees it much the same way. “My sister and I have talked at length about how our brother is very good-looking, and how when he is acting normal, you would not know there is anything wrong,” she says. “He is adorable, charming; he carries on conversations. He could have been with a nice woman and had a family. But now? He has no friends. None whatsoever. He stays at home most of the time, except when he has to go to the store. He is trapped. He can’t get off Klonopin. I feel terrible for him, and I feel terrible for my dad, who when he dies will never have seen his son do well. It kills us that he could have had a life.”

If a picture is worth a thousand words, the photos that Jill, an Ohio woman in her mid-thirties, sends me tell her story in a very succinct fashion. There is the “before” photo in which she is smiling and looking confidently into the camera, posed like a model in a fashionable black dress. One hand is posed gracefully on her hip, a pearl necklace adds a touch of elegance, and she is a bit dolled up—the makeup and styled black hair tell of a woman who presents herself carefully to the world. And then there is the “after” photo, her eyes hollowed out and bloodshot, her face taut and drawn, her hair
thinned—she looks like a somewhat crazed methamphetamine addict who is now getting her photo taken following an arrest.

We first spoke on the phone in July of 2008, three months after she had taken her last dose of a benzodiazepine, a drug she had been on for thirteen years. Here’s how she starts her story: “My head is feeling crushed. It’s like horses are kicking my skull.”

Jill, who asked that I not use her last name, grew up in an affluent suburb of Columbus, Ohio, where she attended private schools and excelled in multiple ways. She sang competitively, won school awards for her art, and was a top student. Petite and pretty, she was asked by a representative of the Miss Ohio pageant to enter that competition. “I was a vibrant, creative, fun person,” she says. However, she did occasionally struggle with anxiety and depression, and during her sophomore year at Ohio State University a psychiatrist put her on an antidepressant. Unfortunately, that drug seemed to increase her anxiety, and so eventually the psychiatrist added Klonopin to the mix. “He said it was a gentle little pill used to help old ladies sleep. He said that it wasn’t addictive and that if I wanted to stop, at most I’d experience a few nights of bad sleep. But he said I would probably need to take it for life, just like a diabetic needs insulin.”

For the next ten years, Jill functioned okay. She graduated summa cum laude from Ohio State University in 1996, earned a master’s degree in counseling, and after various adventures, in 2002 she began teaching fourth grade in a public school. However, throughout this period, her anxiety returned again and again, and each time it did, her psychiatrist upped her dose of Klonopin. And as the dose increased, her ability to function declined. “I would wonder, What is wrong with me? Why am I becoming so withdrawn? Why am I losing interest in everything? I was getting sicker and sicker.” Then, in late 2004, the anxiety, panic, and depression returned worse than ever, and new symptoms—obsessions and suicidal ideation—appeared too. She was told this meant she was “bipolar” and she was prescribed an antipsychotic, Abilify. “That’s when I flipped out. My anxiety went through the roof, it was like being injected with stimulants, and I was teaching one day and I
started crying in class. I couldn’t take it anymore, and I was hospitalized in a psychiatric ward.”

Now came the drug merry-go-round. During the next two years, Jill was put on Lamictal, Lexapro, Seroquel, Neurontin, lithium, Wellbutrin, and other drugs she can’t remember, with Klonopin always part of the cocktail. This treatment caused her eyes to swell, her skin to break into rashes, and her eyebrows and hair to fall out. “My poor brain was being treated like a mixing bowl,” she says. Only when she asked doctors whether the cocktail might be making her sick, “they would say, ‘We have tried the drugs and they are not helping, and so the problem is you.’” Indeed, since the drugs weren’t working, her psychiatrists gave her electroshock, which took its toll on her memory.

Growing ever more desperate, toward the end of 2006 Jill concluded that “it was the drugs that were making me sick.” She began withdrawing from the medications one by one, and although she was able to get off the antidepressants and antipsychotics, every time she tried tapering off Klonopin she suffered a long list of torments: hallucinations, horrible anxiety, vertigo, painful muscle spasms, perceptual distortions, and derealization, just to name a few. Finally, in the spring of 2008, she adopted a new strategy: She would get off by progressively switching to less potent benzodiazepines. Klonopin was replaced by Valium, the Valium by Librium, and then, in April 2008, she withdrew from Librium. She was now drug free, yet three months later, when I spoke to her on the phone, she was still in withdrawal torment. “What I’ve been through … the trauma,” she says, breaking into tears. “I feel dizzy all the time. It is like the floor is tilting one way and I am spinning the other way. It is horrific. I have had hallucinations, I have to wear sunglasses in the house, sometimes I scream from the pain.”

At the end of our interview, I asked her to think back to what her life had been like before she was put on a benzodiazepine, and once more she began to cry.

“My anxiety then was like a mild case of asthma, and today it’s like I have end-stage lung disease. I’m terrified that I’m not going to make it. I’m so, so scared.”

• • •

Those interviews provide a snapshot of three lives, and several months later I spoke to each of the subjects again to see if anything had changed. Geraldine was doing much the same. Hal had become much more distraught. The Klonopin no longer seemed to be working, his anxiety had returned with a vengeance, and he felt physically sick. “I’ve come to accept this is my life,” he said, his voice filled with what seemed like bottomless despair. There was, however, an encouraging postscript to Jill’s story. Not long after our phone interview, her withdrawal symptoms began to abate, and in early 2009, she had this to report: The hallucinations, the vertigo, the seizures, the hair loss, and the blurry vision had all disappeared. The muscle spasms, the tinnitus, and the hypersensitivity to light and noise had become less severe. The feeling that her head was “packed in cement” had lessened.

“I have a few good days now, and my bad days are not all that bad anymore,” she says. “I think I can see the light at the end of the tunnel. There is no doubt I am going to be better. I am going to move to Boston, and although I’ll have to start from scratch, I know it will be okay. I now value life like nobody else I know. I enjoy being able to walk in a straight line again, and being able to see again, and even having a normal heartbeat. My hair is beginning to come back. I am getting better; I am just waiting for the cement to completely leave my brain.”

At least to a degree, we can track the toll that the anti-anxiety drugs have taken over the past fifty years. As was noted at the beginning of this chapter, once the Miltown craze erupted, the number of people turning up at mental hospitals, outpatient centers, and residential facilities for the mentally ill began to sharply rise. The U.S. Department of Health and Human Services dubs this number “patient care episodes,” and it soared from 1.66 million in 1955 to 6.86
million in 1975, when Valiumania was near its peak.
⁵⁰
On a per-capita basis, that was an increase from 1,028 patient-care episodes per 100,000 people to 3,182 per 100,000, a threefold jump in twenty years. While many factors may have contributed to that increase (the emotional struggles that some Vietnam veterans experienced is one possibility that comes to mind, and illicit drug use is a second), Valiumania was clearly a major one. In the late 1970s, Betty Ford’s physician, Joseph Pursch, concluded that benzodiazepines were the “nation’s number one health problem,” and that was because he knew they were driving people to detox centers, emergency rooms, and psychiatric wards.