Ann is twenty-seven years old and was prescribed Ativan (3 mg) when she was told her baby was mentally handicapped. She coped well, but felt very down. After about four months, she felt increasingly anxious. Her doctor suggested she doubled the dose of Ativan. The anxiety lessened, but she had frequent headaches and lost her balance very easily. She thought she was run down due to increasingly heavy periods. Her husband complained that she was not the same person, and suggested a holiday.
Ann thought she might have more energy if she reduced her pills to half the dose. Two days later she felt very ill. She had diarrhoea, vomiting, nasal congestion, and a sore throat. The doctor diagnosed a virus. Ann had not slept so she resumed her full dose of Ativan. The symptoms dramatically disappeared. She recognized the same symptoms nine months later when she forgot to pack her pills when she stayed with an aunt. She thought it could have something to do with the pills, but her doctor assured her they were safe and non-addictive.
The heavy bleeding persisted and she was admitted to hospital for investigations. The ward sister kept the pills. Her skin burned, she felt sick, and the world looked strange again. She was sure it was the pills this time. Her doctor was kind, but said that this was unlikely.
A phone call to a friend, a Community Psychiatric Nurse, gave her some hope. He advised her to cut down slowly. Three months through withdrawal she noticed her periods were not so heavy and the sinus pains that had plagued her for the two years on Ativan had gone. There were times during withdrawal when she felt unwell, but she felt her old self returning. Her husband remarked how different she looked. It is now nine months since she completed withdrawal. Getting off to sleep, and palpitations, are still a problem, but apart from these, she feels well and is delighted to be drug-free. She is also delighted that the hair she lost during withdrawal has grown in again.
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Changes in Body Temperature
Some people complain they are ‘on fire’. Others say they feel icy cold, or cold one minute and hot the next. Feeling hot, with or without profuse sweating is often a feature of drug withdrawal. If you are very cold perhaps moving more or massaging the affected parts would improve circulation.
Sore Mouth
There are frequent reports of painful/cracked/glossy/ swollen tongues; mouth ulcers; gum boils; cracks at the corners of the mouth and sore lips. These symptoms may be a reflection of the nutritional state of the body, particularly in the long-term user. Even if the diet seems adequate there is often so much disturbance in the digestive system that absorption of essential minerals and vitamins could be impaired.
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Depression Following Tension
How often have you heard people say that they were depressed when the examination finished, or after an unwelcome visitor had left. The depression does not arrive whilst the strain is still there, but comes when you have a chance to relax. Perhaps this is nature’s way of forcing you to slow down. Physical exercise and a conscious effort to relax during stress could prevent this type of depression.
How Does A Depressed Person Look?
If he is very depressed, he could look round-shouldered, head bowed, slow moving with a shuffling walk, and mask-like expression, or he could be the joke-a-minute person who tries hard to cover up his inner misery by being the life and soul of the party.
What do Depressed People Say?
‘My body is so heavy; life, relationships, work, have no meaning; I feel far away and isolated, even in a room full of people; I know I love my family but I cannot feel it; I have no interest in anything; I won’t read the papers or watch the news in case there is anything that makes me sadder; the smallest physical task seems beyond me; washing and dressing is such an effort; everyone else looks so normal; I dread a visitor in case they can see how abnormal I feel; my relatives would be better off without me; I see everything through a grey mist’.
How Can I Heal Myself?
If your doctor has ruled out physical illness, he may want you to have a course of anti-depressant drugs. These help some people dramatically, but cannot erase bad memories, or the way you feel about yourself. Acknowledge that by positive thinking, you can stop the past, or the present, circumstances hurting you.
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Repetitive thoughts form an important part of an anxiety neurosis. These are often provoked by awareness of autonomic over-activity; e.g. a patient who feels his heart beating fast may worry about having a heart attack. Thoughts of this kind probably prolong the condition.
The appearance of a person with an anxiety neurosis is characteristic. His or her face looks strained, with a furrowed brow; the posture is tense; he or she is restless and often tremulous. The skin looks pale, and sweating is common especially from the hands, feet and axillae (armpits).
Readiness to tears, which may at first suggest depression, reflects a generally apprehensive state.
The physical symptoms and signs of an anxiety neurosis result from either over-activity in the sympathetic nervous system or increased tension in skeletal muscles.
The list of symptoms is long, and is conveniently grouped by systems of the body. Symptoms related to the gastrointestinal tract include dry mouth, difficulty in swallowing, epigastric discomfort (under breastbone), excessive wind caused by aerophagy (air swallowing), borborygmi (rumbling of intestinal gases), and frequent or loose motions.
Common respiratory symptoms, include a feeling of constriction in the chest, difficulty in inhaling (which contrasts with the expiratory difficulty in asthma), and over-breathing and its consequences (which are described later).
Cardiovascular symptoms include palpitations, a feeling of discomfort or pain over the heart, awareness of missed beats, and throbbing in the neck.
Common genito-urinary symptoms are increased frequency and urgency of micturition (act of passing urine), failure of erection, and lack of libido.
Women may complain of increased menstrual discomfort and sometimes amenorrhoea (absence of menstruation).
Complaints related to the functions of the central nervous system include tinnitus, blurring of vision, prickling sensations, and dizziness (which is not rotational).
Other symptoms may be related to muscular tension. In the scalp this may be experienced as aching or stiffness, especially in the back and shoulders. The hands may tremble so that delicate movements are impaired.
In anxiety neuroses sleep is disturbed in a characteristic way. On going to bed, the patient lies awake worrying; when at last he falls asleep, he wakes intermittently. He often reports unpleasant dreams.
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