depression, emergency rooms, sobriety

on detoxing without a net

Leaving Harlem Hospital’s psychiatric ER a little more than a week ago with a prescription for 42 two-toned green hydroxyzine capsules in hand—a far cry from the alprazolam XR I’d gone to procure—the idea of an at-home detox didn’t seem so far-fetched. Despite dire warnings flung to the farthest corners of the Internet telling me in every way possible (save for actual imagery of poison and death) that this was a sure recipe for disaster, my genetic makeup and Texan pride took over the ever-stubborn part of my brain that says, “Nah, you’ve got this,” when, really, I’ve got nothin’. 

***

The plan was to detox at my boyfriend’s place until Tuesday (I’d read online that the first 72 hours were the worst) before heading back to my place in Harlem. While he went to Rite Aid to fill my prescription, I rummaged around in his office supplies for a Post-it Note to write out the list of symptoms the ER doc had given me as signs of an impending seizure. Ever the perfectionist, it took me a few tries to get the list the way I wanted it for display on the refrigerator (my father had warned me I’d never find a good husband if I didn’t have perfect table manners or nice handwriting; I don’t think the people at Tinder have consulted with him as of yet).

When I stuck the note up on Saturday morning, I thought the list—loss of consciousness, full-body trembling/shakes, dizziness/loss of balance, worst headache ever, vomiting/unrelenting nausea, unable to think or talk coherently for more than 1-2 minutes—was a description of a situation that sometimes happened to other people, who happened to be unlucky, but that I wouldn’t be one of those people. I pointed out the list to my boyfriend, who looked relieved to see something that could serve as a guideline for knowing when he was in over his head. But, he said, we probably wouldn’t need it.

And we both promptly forgot about the list until earlier tonight, when I was in bed with an ice pack on my forehead—worst headache ever—and I had just five minutes prior stumbled over a few words after stumbling over them in my thoughts for the longest time—unable to think or talk coherently for more than 1-2 minutes—while discussing the in-patient detox options for the next morning, since after (1) falling asleep on the bathroom floor from vomiting so much it seemed convenient (vomiting/unrelenting nausea), (2) taking so long to wash my hair that the hot water ran out because I couldn’t stop shaking (full-body trembling/shakes), (3) continually and progressively more often sitting down in the middle of the floor because I’d lost my focus or center (dizziness/loss of balance), and (4) losing chunks of time but never falling asleep… just zoning out in a scary way (loss of consciousness?) I had decided that this at-home thing had broken me, possibly ruined my relationship with my boyfriend, and could no longer be handled by one very loving and well meaning but ultimately not-professionally-trained-to-handle-someone-in-full-blown-crazy man. Ironically (or perhaps dangerously and probably stupidly), I decided to go to detox yesterday because doing this at home was destroying me and upending my life—not because of any of the symptoms I’d so carefully written down.

It was almost comical when I said to my boyfriend, on the other side of the ice pack, I’ve had all of the symptoms on that list. He said, I know. It’s the detox. I was confused. But you know that those symptoms were the warning signs of an impending seizure, right? A little silence. Hmmm. Good thing you’re going to the ER. 

***

I don’t know why (well, I do, but I bet you can guess and it’s not worth spelling out), but I want to note that I didn’t become physically dependent on alprazolam XR (better known as Xanax extended release) because I’m a drug addict. Until 3-1/2 years ago, I had never taken a benzodiazepine in my life. But I have treatment-resistant depression, and I’m also particularly sensitive to certain of the newer antidepressants (in that, for unknown reasons, they have bizarre side effects that mimic serious diseases such as Parkinson’s and MS). I’m near the end of the line for SSRIs (I can’t take SNRIs), and the one I take requires a relatively high dose to be therapeutic. Unfortunately, along with that high dose came a severe panic disorder, and I had to choose whether to manage severe depression without medication (which I’m unable to do) or find a way to treat the panic attracts. And there were so many things we tried before the Xanax that came with their own side effects (including the beta blockers that almost had me severe hypoglycemia). We decided upon Xanax when my doctor at the time asked if I’d ever had a panic attack before the meds had started giving them to me. I said I had, once. When he asked what had worked, I said, “alcohol.” We had a good chuckle, but then he said he knew how to treat my problem. And thus my Xanax prescription was born.

Eventually 4mg/day was the dose that worked best for me. It’s not the highest dose but it’s high enough that most professionals think it’s dangerous to go cold turkey, at home, with only a forgotten Post-it Note to remind anyone of the signs that failure is imminent. They’re right. (Also, it’s probably stupid.)

Over time I hated the feeling of the Xanax wearing off between doses, the agitation around noon and then 5pm and again before bedtime. It seemed to defeat the purpose of taking an anti-anxiety medication, getting anxious about not getting anxious. My then-psychiatrist suggested switching over to the extended-release version of the medication. It would have the same effect as the regular version, but I wouldn’t feel the roller-coaster ups and downs. I’d pretty much always just feel, well, non-anxious. Except when normal anxiety-producing stuff would happen, and then I’d of course be able to react normally. Or if I overslept and went 26 hours between doses. But, more or less, I didn’t have to feel agitated anymore. Until this past week. And holy crap has it been a redefinition of AGITATED. 

What a lot of people don’t realize about controlled substances is that it’s almost impossible to get them if you REALLY NEED THEM but DON’T HAVE LEGITIMATE ACCESS to them. If you don’t really need them, it’s not an issue. If you have great insurance and/or lots of capital, you’re good to go. But if you’re just, say, an unemployed chronically ill writer on Medicaid who finds herself between psychiatrists? And, say, the new psychiatrist, even though you started with the paperwork in late November can’t get you in until April 8. Let’s also say the old psychiatrist is unwilling to write prescriptions to get you past early March because you disagreed with an arguably unethical call he made on your treatment and you filed a complaint on his license. The new guy’s office, when you point out the lapse in medication, is nonchalant. Not a problem, his receptionist says, with the tone of voice one might use when describing the features of a luxury bathroom. Just go to one of the city’s psychiatric ERs and they’ll hook you right up. She’s so confident you actually believe her, right up to the point when you leave the third psych ER you’ve visited in two days, that prescription for 42 pills in hand that your boyfriend will fill the next day while you perfectly write out a list of symptoms you will both be all too happy to ignore.

***

I did everything right. I did it all the way I was supposed to. I always at least try to follow the rules. (Or at least the ones that matter, the ones that get the bills paid and the pantry full.)

It doesn’t matter.

I’m in the same boat as the kid who did it all on purpose, who stole Xanax from his mom’s medicine cabinet all through high school so he could feel normal with his friends. How and why I got here, and even whether it’s fair (it’s not; it’s absolutely not), don’t matter when I’m in child’s pose with my head under the faucet of a bathtub, my naked body trembling out of a combination of fear and anger and sadness and cold as I try to keep hold on just one tenuous thread of reality just long enough to wash my hair.

Later, after I ask my boyfriend to make love to me—sex remains the only grounding reference point, the one remaining thing that makes me feel human and unbroken—I put on his college sweatshirt in hopes that the soft fabric will comfort me and lie down next to him. I put one hand on his arm, and I try to meditate but, as has happened every night of this made-out-of-Popsicle-sticks detox, I’m jolted back to reality when I become aware that I’ve lost track of time and place. I wonder what the thing is that’s on top of my left arm; it’s the sweatshirt I’m wearing. I can’t tell what’s under my right hand; oh, that’s another person’s arm. Other people exist. I marvel that my legs are connected to the same being that my head sits upon. This goes on for I-don’t-know-how-long… until it, too, catapults me into another awareness of having lost track of time and place.

***

At one point this week felt like a slightly disorienting never-ending acid trip.

Then it felt like that plus a migraine.

+ random panic attacks

+ constant nausea

+ unrelenting pain and tension and body aches

+ whole-body clenching (who knew an entire body could tangle?!)

+ fits of anger & paranoia & rage (I’m a fabulous girlfriend…)

Now it just feels like the worst thing I’ve ever lived through in my entire life, and I cannot possibly imagine how anyone walks through a fire such as this and emerges as anything other than permanently and irredeemably scarred. I do not see healing or hope or anything remotely positive. The only thing I can imagine for myself right now is for the hurting to stop, for an incident report to be filed and maybe all of the pieces will be rearranged in approximately the right places in the distant future.

I do not think I will ever be the same. And I do not know if I can forgive the system (the people?) that (who?) allowed this to happen to me.

After all, I have been broken from the inside out. And that hurts like you can’t even imagine.

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