Experts in Prescription Drug Withdrawal
Hydrocodone limits may affect long-term-care patients: critics
Advocates of tighter painkiller control are praising the recent Drug Enforcement Adminstration decision to impose tighter restrictions on the prescription painkiller hydrocodone, but others say that as a result, it now may be more difficult for long-term-care patients to access pain treatment in a timely manner. Hydrocodone is the most frequently prescribed opioid in the United States, with nearly 137 million prescriptions containing the drug dispensed in 2013, said the agency. The DEA concluded abuse of those drugs results in adverse effects to public health and safety. It's decision moves hydrocodone—found with acetaminophen in drugs like Lortab and Vicodin, and in cough suppressants like Hycodan and Mycodone—into the Schedule II category, and requires these drugs be stored in secure vaults and that labeling be updated. “It was an anomaly that hydrocodone was scheduled differently than other potent opioids,” said Michael Von Korff, vice president of the advocacy group Physicians for Responsible Opioid Prescribing. The move closes the “Vicodin loophole,” which allowed patients to obtain up to six months of pills with one prescription and easy phone-in options for refills, but imposed low controls for tracking medication use. “This step is consistent with patient safety and high quality care,” he said. Vicodin manufacturer AbbVie said it will comply fully with the requirements and that prescription drug abuse or misuse should be stopped at every level. AbbVie will continue to look into the challenges of patients living with chronic pain and the benefits of access to appropriate pain management, said a spokesperson for the Lake Bluff, Ill.-based pharmaceutical company. When the comment period for the ruling closed in April, more than 570 respondents had weighed in; 52% were supporters, while 41% were in opposition. Some, like the American Society of Consultant Pharmacists, worried that tightened requirements would make it more difficult for long-term-care residents to receive adequate pain treatment in a timely manner. The benefits, they said in a letter to the DEA, “are far outweighed by the risks of creating access barriers and diminishing quality of care for patients suffering from chronic pain.” Others said rescheduling combination hydrocodone products would have “far-reaching consequences, resulting in serious medical and financial hardships,” and that there is no evidence to suggest the change would curb misuse or abuse. “It is highly unlikely that the DEA will achieve the desired outcome,” said a letter sent to the DEA in April signed by 11 organizations, including the American Academy of Pain Management, American Pharmacists Association, U.S. Pain Foundation, the Virginia Cancer Pain Initiative and the National Association of Chain Drug Stores. Calls to these organizations for additional comment were not returned. The National Association of Chain Drug Stores said it is reviewing the decision with members, but could not offer additional comment. Overdoses from opioid drugs more than tripled between 1990 and 2010, according to the CDC. A JAMA Internal Medicine study published in March found that those at highest risk for overdose from frequent nonmedical use of opioid painkillers were likely to have obtained the drugs from a doctor's prescription. Effort to curb abuse of prescription painkillers has typically focused on infrequent users—those who get the occasional pill for free from a family member or friend. The Schedule II change, some say, means both physicians and patients will become more aware of the strong potential for hydrocodone addiction. “It's a gateway drug,” said Alesandra Rain, co-founder of Point of Return, a group that helps patients break their dependence on medications like benzodiazepines, sleeping pills and antidepressants. “It's a very powerful drug, but too many people felt it wasn't dangerous.” Read original article
Written by Sabriya Rice | Twitter: @ MHSRice | Modern Healthcare
Regaining My Life After Medications
We often think of prescription drugs as safe and helpful. But what happens when someone is prescribed too many medications for innocent health issues? Alesandra learned the hard way, but can now help others regain their identity, just as she did after recovering and learning to accept who she is after the prescriptions.
I never dreamed that taking medications as prescribed could destroy my life, or that the medical community was so unaware how dangerous commonly prescribed drugs could be.
I haven’t had an easy life. An auto accident as a teenager led to a dozen surgeries. In spite of my physical trials, I went on to succeed in life.
But it was in my mid-30s, in the midst of a horrible marriage, that insomnia reigned. A simple trip to my doctor provided immediate relief through an anxiety medication. Within a few weeks I developed bronchitis and was prescribed antibiotics. Another month and my heart started skipping beats and a cardiologist prescribed blood pressure pills. Another bout of pneumonia required an antibiotic. My lungs declined making inhalers a necessity. Then I was referred to a psychiatrist for persistent insomnia. This is when the real hell began.
He prescribed Klonopin, a potent anxiety medication. Years later I read the account of Stevie Nicks of Fleetwood Mac, who stated that cold-turkey withdrawals from Klonopin was equivalent to being kicked into hell. I think she understated.
The Klonopin worked for a time, then the seizures started – wicked, horrible seizures that left me traumatized. A neurologist was consulted and more pills were added. I became permanently disabled, taking over a thousand pills a month. This continued for ten years.
Then my pain soared requiring the first of 14 spinal surgeries. A spinal device was implanted to block the pain signal from my brain.
One day I woke up and actually saw what I had become. I’m not sure why this day brought realization, but I wanted my life back.
I realized there was no exit strategy for pharmaceuticals and when I couldn’t get my doctors to help me, I went to a treatment center and went cold-turkey. There were unending weeks of screaming fear, pain, and altered perceptions. But I hung on, knowing my life was meant for more.
Quitting psychiatric medications is entirely different than illegal drugs and can bring down the strongest of us. It was in my third month, after the worst of the hallucinations passed that I realized the world needed help for people like me – innocent addicts.
That little seedling led to the formation of Point of Return, a nonprofit that assists the public escape pharmaceuticals. In the last eight years, we’ve helped nearly 20,000 people in 63 countries – the youngest being 4-years-old with the oldest 96. And by helping others I completely healed myself.
I will be 54-years-old in a few weeks and after 34 surgeries, I have no pain, anxiety, depression or insomnia, and I am not on any prescription or over-the-counter medications. I spend my days assisting others who are just as frightened as I once was. And through it all, I realized that my greatest adversity was actually a supreme gift.
See how Alesandra answers our Indentity Five Questions:
What have you accepted within yourself and/or within your life? Is there anything you are working on accepting?
I’ve learned to accept that all of life challenges have merit.
What do you appreciate about yourself or your life?
I appreciate every moment now and especially time with my border collie Sky
What have you achieved, or what are you working to achieve personally, physically, or mentally?
I have a purpose in life and that is everything.
What is your no-so-perfect way? We are all unique with quirks and imperfections, so why not flaunt them and embrace them!
I’m a workaholic now, and feel like I have 10 years to make up for. Balance is something I still struggle with.
How would you complete this sentence, “I Love My…” This has to be about you, physically or mentally.
I love my life in its entirety.
Article by Identiy Magazine, OCTOBER 12, 2011
The Next Nightmare May Lurk in the Medicine Cabinet
The next time you're outrunning a pack of hungry wolves, naked, and then wake up in a cold sweat, remind yourself it's only a bad dream—and that it could be a side effect of a prescription medication you're taking.
A wide array of drugs can cause nightmares. The list includes certain antidepressants, antibiotics, beta blockers, blood-pressure medications, statins for lowering cholesterol and drugs for Alzheimer's and Parkinson's diseases. Some drugs tend to cause bad dreams when they are first taken; others bring nightmares when they're stopped. Alcohol, over-the-counter antihistamines and some dietary supplements have the same effect.
"This is a very common complaint," says Andres San Martin, a psychiatrist in New York City. "You put a patient on an antidepressant and routinely, they'll say, 'You know I'm feeling better, but I'm having very vivid dreams.' The emotion and passion can be quite overwhelming."
Although the mechanisms aren't completely understood, sleep experts think drugs cause nightmares because they interfere with so-called sleep architecture—the stages of light, deep and rapid-eye-movement, or REM, sleep that people typically rotate through three or four times a night. The REM stages, during which the most vivid dreams occur, normally get longer toward morning. But some medications delay or decrease REM, and some create a "REM rebound" effect when people stop taking them, making the REM stage unusually long or intense.
"Whenever REM sleep is altered, that leads to nightmares," says Naresh Dewan, a professor of sleep medicine at Creighton University in Omaha, Neb., and co-author of a review of drug-induced sleep disturbances in June in the journal Consultant Pharmacist.
Sleep experts say medications particularly apt to bring troubling dreams are those that affect neurotransmitters, the brain's chemical messengers that influence sleep cycles, among other things. That includes most antidepressants, as well as antihistamines and anticholinergic drugs used to treat a broad range of conditions, from overactive bladder to bronchial spasms. Sleeping pills can also disrupt sleep cycles and cause nightmares.
Pinpointing how frequently medications cause nightmares is difficult because bad dreams are so common, and there's no way to prove cause and effect. Nearly 90% of people have nightmares at some point and about 5% of adults have them chronically, according to the American Sleep Association. Bad dreams may also be due to sleep apnea, insomnia, post-traumatic stress disorder or a carry-over from anxiety during the day. People should suspect a drug connection if weird or disturbing dreams have begun soon after starting a new medication or stopping an old one, sleep specialists say.
Some prescription drug labels have warnings of mention the possibility of nightmares, abnormal dreams or sleep disturbances, but some experts say nightmares they are probably underreported in trials and on labels because patients don't think to mention them, and doctors rarely ask.
"From a doctor's point of view, it's sometimes a Pandora's box because if you start routinely asking all patients about their dreams, you may be opening something that medicine cannot fix," says P. Murali Doraiswamy a neuroscientist at Duke University Medical School.
It isn't clear why disrupted REM sleep tends to bring nightmares rather than more pleasant dreams.
"The purpose, triggers and biology of dreams, both pleasant and frightening, are still some of the biggest mysteries in all of science," says Dr. Doraiswamy. "It could be an evolutionary defense mechanism or could be the brain's way of doing psychotherapy on itself."
Modern psychiatrists, led by Allan Hobson of Harvard Medical School, believe dreams are electrical pulses from the brain stem randomly bombarding the center of the brain where visual memories are stored, creating kaleidoscopes of images around which the brain concocts stories. Followers of Sigmund Freud believe dreams are repressed desires or threats.
Nightmares aren't necessarily harmful themselves, but if they happen frequently, they can set the stage for chronic sleep deprivation, which can hamper daytime functioning and increase the risk of diabetes and other health problems.
Some nightmares are so disturbing that the effects linger for hours or longer.
Alesandra Rain still recalls the dreams of suicide she had while taking a variety of sleep and pain medications nine years ago. In one, she went skydiving with a defective parachute; in another, she removed the lug nuts from her tires and gunned her car down a winding mountain road.
Ms. Rain, 54, was so disturbed by the dreams and the long list of drugs she was taking that she quit them cold turkey and started a nonprofit organization, Point of Return, in Westlake Village, Calif., to help others wean themselves off of multiple prescription drugs. "I haven't had a nightmare in nine years," she says.
Most physicians tell patients not to stop medications abruptly on their own. Tapering off can help avoid withdrawal nightmares. In some cases, taking a drug at a different time of day can improve sleep. Dr. San Martin tells patients to take some SSRIs (selective serotonin reuptake inhibitors) in the morning, but those that have a sedative effect closer to bedtime. Cutting dosages or switching to another brand in the same class may also be an option.
For severe sleep disruption, some doctors give patients yet another prescription to help them sleep. Common choices include Klonopin, an antiseizure medication; Trazodone, often used in sleep clinics for insomnia, or Prazosin, a beta blocker that helps quell anxiety. All three can bring on nightmares themselves, so some doctors see prescribing a new drug as a last resort.
Some chronic nightmare sufferers find relief with Image Rehearsal Therapy, a technique pioneered in the 1990s in which patients write out their typical nightmare, then imagine a new, benign ending for it.
Shelby Harris, director of the Behavioral Sleep Medicine Program at Montefiore Medical Center in the Bronx, N.Y., says her favorite example was a young patient who kept dreaming he was being chased by a scary man. In the new scenario he concocted, the setting was the theme park in Hershey, Pa. The man was made of chocolate and the boy ate him.
Patients practice visualizing the new dream several times a day for several weeks. Even if that particular dream never recurs, the nightmares typically end. "Once people believe they have control over their nightmare, that's when they start to get better," says Dr. Harris.
Experts say that people who are troubled by nightmares should let their doctors know. Disturbed REM sleep and vivid dreaming can also be an early warning sign of some types of epilepsy, dementia and Parkinson's disease.
"It's important to address whether [nightmares] are due to a medication or if something else is going on," says Dr. Harris. "Don't assume that nothing can be done." - written by Melinda Beck - Wall Street Journal View whole article...
The Good Patient - Are Your New Symptoms a Result of Medicine You're Taking?
When her doctor tore a sheet off the prescription pad and handed it to Alesandra at the end of her annual check-up, Alesandra never imagined that the treatment would lead to a 10-year nightmare she would be lucky to survive.
Before that doctor's visit Alesandra, age 35, was healthy. She was not taking any medicine. She didn't smoke. She didn't drink. Working for an engineering firm based in San Diego, she traveled extensively, handling clients around the world. Alesandra reported, "I was successful. I was doing quite well."
That life ended with her annual check-up. It wouldn't have occurred to Alesandra to have made an appointment to seek help for her insomnia, but when her doctor asked if she had any complaints, she mentioned it.
Her doctor did not ask if Alesandra wanted a drug to help with her trouble sleeping; she just handed Alesandra a prescription. Always one to follow the rules, Alesandra obediently took the prescription and stood in line at the pharmacy to get it filled, without thinking much about it.
Soon after, Alesandra recalled, "Everything began to come apart."
First, she developed bronchitis. She thought that this situation was strange, because she never got sick. However, she simply took the prescription she was given to treat the infection, not learning until much later that lung problems were a side effect of the sleeping pills. Then the potent antibiotic she was given for bronchitis caused bizarre heart arrhythmias. Because no one realized at the time that this condition was a side effect, it too was treated by adding another drug to her regimen.
And so it went, for 10 years.
Each of Alesandra's new medical problems was treated as if it had arisen in isolation. Alesandra was sent first to one specialist, and then to another. Each treated the new problem in yet another body part as if it were the only medical issue she had.
Each prescribed more drugs. None mentioned that drugs have side effects.
Eventually, Alesandra was taking more than 30 pills a day. For many years, she suffered from repeated seizures, lung infections, breathing problems, urinary tract infections, muscle weakness, back pain, insomnia and depression.
In the prime of life - her 30s and 40s - she ended up living on disability checks.
She didn't realize that all of her problems were caused by the drugs she was taking, because she didn't get sick right away when she started a new prescription. It was typically several weeks after she started taking a drug before a major new symptom developed.
Too frequently, doctors also don't realize the connection between drugs they've prescribed and new problems that crop up afterwards.
Dr. Beatrice Golomb at the University of California at San Diego identified patients who had talked with their doctors because the patients felt that they were experiencing side effects of a drug. She discovered:
1) In nearly 80 percent of the cases when patients thought that new symptoms they were experiencing might be side effects of a prescription drug, the scientific evidence strongly suggests that they were right.
2) In up to 98 percent of the cases in which patients were experiencing side effects, it was patients - not doctors -- who suggested a possible connection between a drug they were taking and a new symptom.
3) When patients were experiencing common and well- documented side effects, doctors acknowledged that there might be a link to a drug as infrequently as 19 percent of the time.
In about half of the cases when patients were experiencing common and well-reported side effects of a drug, doctors said things like:
• You're just getting old.
• There's nothing wrong with you; it's all in your head.
• These drugs don't have side effects.
• It's impossible for this symptom to be caused by this drug.
• There's no research linking this drug to this problem.
What happened to Alesandra? After 10 years of needless suffering, she rebelled. Through a near-fatal process she wouldn't recommend to anyone, she stopped taking all of the pills and reclaimed her life. (She has since learned better ways to transition from taking multiple drugs to taking none, and advises others how to do so on her website, www.pointofreturn.com.)
Now, she reports, "I am nearly 54. I am perfectly healthy. I can walk fine. I have no pain. Today I am not on any medicines - just nutrients and good food and exercise."
What can you do to avoid a nightmare like Alesandra's?
Ask questions. Do some research. Read the package insert. Never assume that a new symptom is just a coincidence, unrelated to medicines you are taking. Talk to your doctor or pharmacist. Be persistent.
Elizabeth L. Bewley is president and CEO of Pario Health Institute and the author of "Killer Cure: Why Health Care is the Second-Leading Cause of Death in America and How to Ensure That It's Not Yours." - Written by Elizabeth Bewley (columnist), The Daily Courier - View article
Are You Taking Too Many Meds? - CNN News
Editor's note: Americans have been led to believe -- by their doctors, by advertisers and by the pharmaceutical industry -- that there is a pill to cure just about anything that ails them. This week, the networks of CNN go deep into the politics and the pills.
(CNN) -- For Alesandra Rain, it all started with sleeplessness. In 1993 she was having marital troubles and her business wasn't doing well. Anxiety kept her up at night, so her general practitioner prescribed sleeping pills.
"It worked fabulously. I felt very relaxed and I would sleep better," Rain remembers. "I thought this was certainly the right prescription for me."
Then a few weeks later, another symptom developed.
"It was so unusual. I started having bronchitis and lung infections," she recalls. She went to a pulmonologist who prescribed an antibiotic.
Another complication soon followed.
"My heart started skipping beats, so I was referred to a cardiologist," explains Rain, who says other than a series of surgeries after a car accident, she had been completely healthy until this point in her life. The cardiologist ran a few tests and prescribed medication to treat arrhythmias.
It didn't end there.
Eventually she developed seizures. At this point, she was already taking at least six different prescriptions from three separate specialists. She went to see a neurologist who prescribed an anti-seizure medication on top of that.
"My whole day became pills and doctors and shots," she says.
Rain's insomnia returned as things continued to spiral out of control. Despite all the testing and prescriptions, she says no one could figure out the problem. She was put on temporary disability. Depression followed.
"When I finally got to a shrink of course I was depressed, because no one could figure out what was wrong with me! It never occurred to me that it might be the pills themselves."
Too many drugs, too little communication
At her worst, Rain was under the care of a general practitioner, pulmonologist, cardiologist, pain management specialist and a psychiatrist. She was spending more than $900 a month, taking 12 different types of medication, amounting to about a thousand pills a month.
"That's what I call prescription multiplication," says Michael Wincor, an associate professor of clinical pharmacy, psychiatry and the behavioral sciences at the University of Southern California.
He says it is not uncommon for patients to receive multiple prescriptions from different specialists, each focusing on a specific symptom. Wincor says it can be potentially dangerous for the patient, especially if the various physicians aren't communicating with one another.
"A patient could have adverse effects and think the medical condition is getting worse, when in fact it is a side effect of several different medications which are all interacting in a negative way," Wincor says. "When you're on more than 20 drugs all at the same time, you'd want to question whether or not that's really necessary."
According to the Kaiser Family Foundation, prescription drug usage in the United States is continuing to rise. A recent report finds the number of prescriptions filled each year increased by 39% between 1999 and 2009, and the amount of money spent was $234 billion in 2008. The average American fills 12 prescriptions each year.
"Many side effects from drug interactions (not all) are exacerbations of known side effects of the single drugs that are made worse by the two drugs together," says Dr. Russ Altman, a professor of bioengineering, genetics and medicine at Stanford University.
He co-authored a study in the journal Clinical Pharmacology and Therapeutics that found a widely prescribed antidepressant used in conjunction with a common cholesterol-lowering medication caused unexpected increases in blood sugar levels.
Altman says most drugs are tested and approved independently, and it can be difficult to predict the side effects of drug combinations.
"It is very hard to find these in advance of release of the drug, because sometimes these effects will only manifest in the context of large numbers of patients," he explains.
"I don't think people really understand the nature of medication; the (drugs) will, by definition, have some toxic, collateral side effects," says Dr. Douglas Bremner, a professor of psychiatry and behavioral sciences at Emory University. His 2008 book "Before You Take that Pill" warned patients of the risks and benefits of some commonly prescribed drugs.
Bremner says medications clearly do a lot of good and are needed in many situations, but warns that when a patient is on too many at once, there are serious questions about whether the therapeutic benefits outweigh the collateral. "When you end up on 12 prescription medications you need to seriously look at what the situation is," he says. "At that point, there's no way of knowing what's causing what anymore."
"I don't want to do this anymore"
Wincor recommends patients fulfill all their prescriptions at one pharmacy, especially if they are receiving treatment from multiple practitioners.
"Often the pharmacist is the best point person because they're the last stop before the prescription hits the hand of the patient and are ready to be taken."
He says the most important thing is to have one person who is keeping track of the various drugs and how they could interact.
If you can't have a single overall manager of treatment, experts suggest keeping a list of all your prescriptions and showing the list to any physician introducing a new medication.
Altman says, when possible, introducing new medications one at a time can help you recognize side effects and interactions earlier. You can potentially trace them to the most recent drug added, he says.
Bremner also advises patients to check out websites like Medication.com and Askapatient.com and read the experiences others have had with the medication you have just been prescribed. "Patients should become more educated about the effects and not just blindly take what is given to them."
Alesandra Rain says she reached her tipping point in 2003.
"I opened my medicine cabinet and saw it lined with prescription pill bottles," she remembers. "I looked at myself in the mirror. My skin was gray, I was hunched over in pain, my eyes were swollen and I had no quality of life. I thought, 'I don't want to do this anymore.' "
She decided to quit taking all her prescriptions cold turkey -- something neither she nor other experts recommend for any patient. "You can't go cold turkey off that many pills without doing some damage," Rain says. She eventually enrolled in a drug rehab facility that helps victims of substance abuse.
Today, Rain runs a company called Point of Return, which educates patients about the effects of prescription medications and helps them outline an "exit strategy" for safely tapering off highly addictive varieties of prescription drugs.
"I spent 10 years on the pills before I realized there was no exit strategy. It was always more drugs, never less." says Rain, who later learned the cause of her initial insomnia was a B-12 vitamin deficiency. She is now taking one daily multivitamin. "My life became nothing but a bag of pills, and I just thought there has to be a different way." Written by Sabriya Rice, CNN Medical Producer, May 31, 2011 10:22 a.m. EDT- View article.
High Doses of Prescription Painkillers Up Risk of OD Death
Study Suggests Max Doses of Opiate Drugs Increase Accidental Death Rates
Prescription painkillers may be FDA-approved and doctor-recommended, but that doesn't protect patients from the risk of lethal, accidental overdose, especially for those prescribed high doses.
Adding to the growing concern over abuse and over prescribing of painkillers, a new study published Tuesday finds that those on high or maximum doses of prescription opioid pain relievers are at a significantly increased risk of accidental, lethal overdose.
A high-dose cocktail of prescription pain killers, sedatives, mood regulators and muscle relaxants meant to help Alesandra Rain, 53, cope with chronic pain left her on the verge of overdose for years.
"I was liberally prescribed painkillers and anxiety meds and nearly died from the combination of pills. Several times I OD'ed inadvertently, once [while] in the hospital [and] my breathing stopped," she says.
"You lose track of what you're taking because a lot of the time I was advised to 'take as needed.' My sister says she would stay up all night with me to make sure I kept breathing" when it appeared she had taken too much, Rain says.
After surviving a car crash at age 19, Rain underwent 34 surgeries in attempts to fix injuries to her crushed legs and spine. As time when on and her pain persisted, she was prescribed higher and higher doses of painkillers, but the pain persisted. She became so desperate that she had a device implanted in her spine to help control the pain.
The abuse and overuse of prescription painkillers and sedatives have become a major medical issue as the rate of overdose deaths from these drugs increased by a staggering 124 percent, according to the Centers for Diseases Control and Prevention. From 2004 to 2008, emergency room visits associated with prescription drug overdose more than doubled, and among those aged 45 to 54, these overdoses are now the second leading cause of accidental death, according to the Substance Abuse and Mental Health Services Administration.
"Based on recent evidence, it seems we have been guilty of promiscuous prescribing in the context of non-cancer pain," says Dr. Richard Deyo, professor of Family Medicine and Internal Medicine at Oregon Health and Science University.
"[The] CDC now estimates that there are 13,000 deaths a year related to unintentional overdoses involving opioids.”
Medicated Americans: High Dose Leads to Overdose in Some Cases
When it comes to chronic and/or severe pain, opioid painkillers, including morphine and morphine-like drugs such as OxyContin, Codeine, and Vicodin, are among the most powerful tools in a doctor's arsenal. They are also among the most addictive and potentially dangerous, doctors note.
Because they are more likely to lead to addiction and abuse than other non-opioid painkillers, many physicians are reticent to prescribe them at all, referring patients instead to pain specialists, says Dr. Lloyd Saberski, medical director of Advanced Diagnostic Pain Treatment Centers in New Haven, Conn.
At the same time, other physicians are prescribing these painkillers without proper monitoring tactics such as requiring regular office visits, timely (not early) refills, and urine drug testing, according to a study published last month in the Journal of General Internal Medicine.
Tuesday's study only adds to the concern that these drugs are not being properly managed and patients not properly monitored. The study, published in the Journal of the American Medical Association, looked at more than 150,000 veterans on opioid prescription painkillers and found a link between those who were given high doses and those who suffered accidental fatal overdoses.
"Until recently, many have taught that there is no unsafe maximal dose of opioids, as long as doses are increased gradually. However, there is growing evidence that this is often not a terribly effective approach, and the safety concerns are growing," says Deyo.
"In the past, patients and physicians thought that the solution to pain was to give ever increasing doses of opioid medications [and] the risk of higher doses has been viewed as 'only' sleepiness or sedation, and rarely respiratory problems," says Dr. Timothy Collins, assistant professor of Medicine/Neurology at Duke University.
This research suggests that adverse outcomes, especially accidental overdose, could be in part related to the high doses given to some patients, which should cause physicians to reconsider whether higher doses are really the answer to patients' pain complaints, he says.
Unhooked on Drugs: Getting Off Opiates
For Rain, the escalating doses of painkillers and other meds were not the answer to her chronic pain. After 25 years on multiple medications, the breaking point came when her doctors, in hopes of finally managing her constant pain, suggested a morphine pump to deliver powerful painkillers directly and regularly into her spinal cord fluid.
"I was already on so many pills, so I'm not sure why this was where I drew the line, but I went cold turkey," she says. Eight years ago Rain checked herself into a drug rehab center where she would be supervised while she went through withdrawal. She also went through years of intensive physical therapy to treat the many musculo-skeletal problems she had developed from her injuries, contributing to her pain.
Today, she says she has no pain, and has started a nonprofit, Point of Return, in California in hopes of helping others kick their dependence on painkillers.
If opioids are not improving the pain at a reasonable dose, another treatment should be discussed, adds Collins. - Written By COURTNEY HUTCHISON, ABC News Medical Unit, April 6, 2011 - view article
Charlie Sheen: What's Next, Who Can Help?
Rehab, Jail and Death Realistic Fates for Fired Actor, Experts Say, as Skeptics Say It's All for Show
Actor Charlie Sheen last night took to his online program, "Sheen's Korner," to lament his recent firing from "Two and a Half Men" and blast his former bosses. Sheen has dismissed widespread suspicion that addiction or mental illness might be fueling his antics, claiming earlier to be on the drug "called Charlie Sheen" and not bi-polar but "bi-winning."
But his increasingly erratic behavior, which cost him his job Monday on the hit CBS comedy, has many health professionals concerned about his well-being even as skeptics say it's all for show.
"When addicts are high on drugs, or a manic person is high due to the biochemical changes in his brain, they reject help because they truly believe that they are 'winners' who know better than everyone else what is best for them," said Dr. Carole Lieberman, a psychiatrist at the University of California, Los Angeles.
But the job loss and the removal of his 2-year old twins, Max and Bob, from his home last week might signal the end of Sheen's "winning" streak.
Eric Braun, a friend of Sheen's, told GQ magazine "there are just three options" left for the fired actor: "rehab, jail or death."
Mental health experts agree. "Frankly, we really don't know what leads one person to a specific end," said Dr. Eric Caine, chair of psychiatry at the University of Rochester Medical Center. "No doubt, this man is a mess and his 'destiny' may not be a happy one." While Sheen's conduct in media interviews and in his online show has shocked viewers, psychiatrists say they've seen it all before. "There is nothing so unusual about what we are seeing -- for those of us in the mental health field -- just that we are seeing it so publicly," Caine said.
Sheen's long track record of offenses -- from drugs and violence to rumors of trouble on set -- might have hinted at mental health problems in the past. Yet he has consistently avoided major repercussions that could have "tempered his grandiosity," according to Alesandra Rain, co-founder of Point of Return, a nonprofit organization in Westlake Village, Calif., that helps people escape pill addiction.
"Now the consequences are beginning to hit him, but he is still working from the perspective that he is untouchable," Rain said. "His media blitz is being misinterpreted as public support and he is not in the frame of mind to realize the damage he is doing."
To repair the damage to his health, his career and his relationships, Sheen will need a dedicated network of support; one that will likely include many of the people he has publicly offended.
"This may require ex-spouses, family members, friends and colleagues who don't always work together or even get along, to present a uniformed front and work together," said Joshua Klapow, a clinical psychologist at the University of Alabama, Birmingham School of Public Health.
Having everyone on board is critical, Klapow said.
"This is a huge undertaking in a situation like Charlie's," he added. "He has huge social networks."
The long-term effects of what might be a public decline for Sheen are uncertain.
"The world can be very forgiving, especially if his behaviors are viewed by others as victimless," Caine said. "Having a powerful negative impact on the people around him would tip the balance. Short of that, many are allowed to recover from being fools or buffoons."
Sheen reportedly threatened to cut off ex-wife Brooke Mueller's head and send it to her mom. He also called "Two and a Half Men" creator Chuck Lorre a "clown," a "stupid, stupid little man" and a "p***y punk that I never want to be like."
But acknowledging past mistakes is part of the recovery process, said Martin Binks, clinical psychologist and CEO of Binks Behavioral Health PLLC, citing the 12-step program from Alcoholics Anonymous. Sheen's media frenzy might therefore aid in his recovery, said Binks, such that "he will have lots of data to look back on and remind himself of his bottom."
Sheen called Alcoholics Anonymous a "bootleg cult" with a 5 percent success rate in a Feb. 24 interview on "The Alex Jones Show."
As for Sheen's future, learning to live with the consequences of the past is part of recovery, said Mark Williamson, a psychiatrist at Memorial Hermann Prevention and Recovery Center in Houston.
"It is often quoted in treatment circles, 'You cannot save your behind and your face at the same time,'" Williamson said. "With appropriate treatment, people will be informed by their past behavior as it relates to their everyday lives moving forward."
Sad Reality or Reality TV?
Although Sheen's behavior on TV and online might appear to be his last act, they could be his best performance ever, according to Randy Roberts, author and distinguished professor of history at Purdue University in West Lafayette, Ind.
"Beyond rehab, jail or death, I think there's a fourth option here," Roberts said. "A realty-TV show."
Roberts said Sheen "pressed the limits of what can be done on TV and now he'll press the limits of realty TV.
"Everybody's playing their part in this made-for-TV drama," Roberts said, adding that the tape of the police taking his kids away should have tipped everyone off.
George Santo Pietro, another friend of Sheen's, said Sheen is still in control.
"There's a method to his madness," Pietro said. "There's a bigger story to Charlie than everyone has seen."
The University of Alabama's Klapow said it is possible that Sheen's behavior is calculated.
"We don't know what is orchestrated, we don't know what is drug induced, and we don't know what are his demons coming to the surface," Klapow said. "All we can do is sit, watch and hope and pray that we are seeing a performance and not the real Charlie Sheen." - BY KATIE MOISSE, ABC NEWS MEDICAL UNIT - view article
Don't Go Cold Turkey - Reducing your reliance on antidepressants requires patience and a doctor's involvement.
When the weight of her husband's cancer and the stress of her corporate job became too heavy to bear, Karen Huber did as many of her friends had done and started taking an antidepressant.
What she didn't realize was how difficult it would be to stop.
After a year of taking 10 milligrams of Lexapro daily, on top of 50 mg of Trazodone that she had been taking for a decade to help her sleep, Huber tried to quit cold turkey. The withdrawal symptoms were insufferable: anger and frustration so overwhelming she "could have chewed through a brick."
When Huber tried quitting again in March, she attacked it with a three-pronged strategy: She split her pills in half every couple of weeks, took nutritional supplements to mitigate her irritability, and ultimately checked into a detox center for three weeks. It took more than two months, but it worked.
"If I had known how hard antidepressants are to get off of, I would have tried to avoid them," said Huber, 54, of Little Rock, Ark.
Antidepressant usage doubled between 1996 and 2005, to 10 percent of the U.S. population, according to a study published last year in the Archives of General Psychiatry. That boom means masses of patients who face the challenges of stopping.
Though antidepressants are the most commonly prescribed medications in the U.S., there are no official published guidelines for when and how to come off them, said Dr. Michael Banov, a psychiatrist and author of the new book "Taking Antidepressants" (Sunrise River Press, $16.95).
Generally, patients should stay on antidepressants for at least nine to 12 months to reduce the likelihood of a depression relapse, Banov said. But beyond that, it's up to patients to work with their doctors on whether and how to wean themselves off the drugs. Sometimes the process is unpleasant.
About 20 percent of people who try to quit suffer what the drug companies coined "antidepressant discontinuation syndrome," which can cause symptoms including depression, anxiety, irritability, dizziness, nausea, light-headedness and electric shocks known as "brain zaps."
Symptoms can be more severe the longer you have taken antidepressants, the higher the dosage and the more sensitive your body happens to be, Banov said. They also depend on the drug. Paxil and Effexor are associated with some of the worst withdrawal symptoms because they clear out of your system quickly, leaving little time for your body to adjust to the sudden drop in the neurotransmitter serotonin. Prozac, meanwhile, takes a long time to leave your body, diffusing the withdrawal effects.
Though drug companies warn of potential withdrawal symptoms in their literature, physicians don't always alert their patients when they prescribe the meds, and many people start taking antidepressants not knowing it's so hard to stop.
"It made me angry. I felt like I hadn't been told," said Katherine Perry, 40, an English professor in Cumming, Ga., who became uncomfortably irritable and anxious when she tried to wean herself off Paxil and Wellbutrin on separate occasions.
A cruel catch to discontinuing antidepressants is that it can be hard to tell if the symptoms are from withdrawal or a return of depression, so you have to wait it out, Banov said. If it's withdrawal, the symptoms should begin to clear up in one to two weeks, though sometimes it takes six to eight. If it's depression, they'll get worse.
The key to managing withdrawal is to taper the dosage gradually. But some people need more help, especially when they're trying to come off several prescription drugs.
Wendy Honeycutt was put on antidepressants after the suicides of her mother and brother. It proved a "doorway to disaster," she said, as the side effects later prompted her to take sleeping pills and anti-anxiety medication. At the peak, she was taking seven prescription drugs.
When she decided to clear her body because she felt like "a toxic mess," the Texas woman went into a debilitating withdrawal that left her sleepless, anxious, shaking, sweating and emotionally numb, with electrical zaps feeling like "red-hot pokers in my head." She was incapacitated for two months and sick for three years.
It wasn't until Honeycutt found Point of Return, a nonprofit based in Malibu, Calif., that helps people come off their prescription meds, that she began to improve. In addition to offering tapering schedules, information on how drugs interact with each other and emotional support, the organization swears by a schedule of nutritional supplements to temper withdrawal, including omega-3 fatty acids to support brain function and glutathione to enhance the immune system.
Honeycutt, 44, a pastor who now volunteers at Point of Return, said she has been medication-free for three years.
Of course, some people need to be on antidepressants and shouldn't quit. Long-term untreated depression is bad for your brain and body, causing parts of the hippocampus to shrink and hurting the immune system, Banov said. The goal is to be depression-free, not medication-free, he said.
But for Huber, who used the Point of Return program for the six weeks she tapered her dosage, life is better without them - though not necessarily easier. The Lexapro had protected her like a "hard shell," keeping her from being weepy all the time, especially after her husband died last summer.
"Since I've been off them, I cry much easier, I'm much more tender," Huber said. "But that's OK. That's part of the grief process." - Article by Alexia Elejalde-Ruiz, Chicago Tribune, August, 29, 2010 More...
I Can't Sleep
Los Angeles, CA December 2010. I can't sleep - those three words began a nightmare that lasted a decade.
I had many reasons for my insomnia - nearly three-dozen surgeries on my legs and spine, seizures, and extreme life stressors. It was after popping my first sleeping pill that my world imploded.
Klonopin was prescribed early on, then Restoril was added as my sleep declined. Both medications are benzodiazepines (benzos for short), one of the most widely prescribed drugs today, highly addictive and for many, horrifying to stop.
A New Report by Britain's National Newspaper The Independent states, "the Medical Research Council (MRC) in Britain agreed in 1982 that there should be large-scale studies to examine the long-term impact of benzodiazepines after research by a leading psychiatrist showed brain shrinkage in some patients similar to the effects of long-term alcohol abuse." Rather than investigate the effects of benzodiazepines, the MRC appears to have marked the documents "closed until 2014". It is estimated there are approximately 1.5 million involuntary benzo addicts in the UK, a country with a population 1/5 that of the United States. Benzos are prescribed as freely in the U.S., which could mean there are nearly 8 million innocent addicts here. To date no studies on the long term effects have been done in the United States, and the warnings that exist do not adequately address the danger.
The U.S. Government estimates 12 million people use illicit drugs on a regular basis. This includes heroin, methamphetamine, marijuana, crack, cocaine, hallucinogens and others. Yet benzos are only one class of psychoactive medications that are frequently prescribed.
I reached tolerance on Klonopin and Restoril, where my body became dependent and it took higher doses to induce sleep. Invariably they stopped working and more pills were added under the care of a psychiatrist.
Benzos increase pain, so as mine soared and my depression deepened (also a side effect of benzos), other pills were added. At the end I was on a cocktail that included Ambien (Zolpidem), Klonopin (Clonazepam), Restoril (Temazepam), Effexor (Venlafaxine), Sinequan (Doxepin), painkillers and muscle relaxers. This was considered reasonable treatment and I complied for ten years. I withdrew from life and became one of the quiet souls who lived in silent misery. More...
All the Pretty Pills – Prescription Drug Withdrawal Help
Deaths from prescription pills have reached epidemic proportions.
Los Angeles, CA Nov-Dec 2010 It’s impossible to watch a television show or open a magazine without seeing a drug ad. The images of perfect families, happy, successful men and women in romantic relationships are strong lures. The ability to soften stressful times is enticing and the idea of sleeping soundly is appealing. And although the side effects and some of the hazards are provided, Americans continue to reach for pills at an alarming rate.
The downturn in the economy has left many struggling with insomnia. Enter sleeping pills (Ambien, Lunesta). Stress has become a painful symptom in such uncertain times. Anxiety medications (Xanax, Ativan, Klonopin, Valium) are waiting to ease the pain. If struggling to start your day, then add a stimulant (Adderall, Ritalin). When financial woes are affecting your mood, then a slew of Antidepressants are available (Paxil, Wellbutrin, Prozac, Zoloft, Lexapro, Pristiq, Effexor, Celexa). Of course if the antidepressant isn’t enough, add an antipsychotic (Abilify, Seroquel). As high blood pressure ensues, then a pill for hypertension is in order. The stomach clenches and a proton pump inhibitor is required to reduce the acid production (Omeprazole, Lansoprazole, Pantoprazole). Pain increases as a side effect of the other pills and of course an opiate is appropriate. Then join a friend for a few drinks or take an antihistamine for allergies or a cold.
What is the personal cost of all these pills?
Adverse reaction to medications are taking lives daily yet too often the public believes that being legal all pills are safe. Many combinations of medications suppress the central nervous system, depressing respiration or adversely affect heart rhythms. And unfortunately if the combination proves lethal, too often it is deemed ‘natural causes’ and the pills are not held responsible. Even small amounts of central nervous system agents can diminish lung capacity and over time leave an individual susceptible to pneumonia. The addition of antibiotics and antihistamines with existing prescriptions can further complicate the situation and stop breathing. Brittany Murphy, Corey Haim and many others may fall into this category.
It isn’t just the interaction between medications that poses a risk, it is the declining health caused by many pills for sleep, anxiety and depression. Pain can increase, the immune system breaks down, worsening sleep and anxiety can ensue, weight gain, hair loss and eroding mental symptoms. Yet often these side effects are misinterpreted and more pills are prescribed. It is a vicious cycle that millions are caught in.
It’s time for a paradigm shift regarding our health. Our current model is based on illness and until we approach our health with a wellness perspective, injuries and deaths from pills will continue to soar. Our bodies are miraculous and deserve much better than what we have all received through cocktails of pharmaceuticals. #
Sales of Sleeping Pills have soared, but studies have shown they have high risks.
Los Angeles, CA October 2010. Sleep, that magical and misunderstood state that restores and nourishes. We crave sleep and in the midst of a poor economy, it's in short supply. Yet sleep-promoting drugs are plentiful and come with a host of side effects that include sleep-driving, night eating and night walking without memory. The public is inundated with ads that promote pills and although the side effects are cleverly delivered, the warnings are clear. So why do the sales continue to climb?
According to Alesandra Rain, the co-founder of a California non-profit called Point of Return, millions of people are addicted, as she once was. "Sleeping pills work initially and create a sense of well-being," states Rain, "But invariably our sleep erodes and the insomnia that ensues is excruciating. We become desperate to sleep and stay on the pills." Sleeping pills are only recommended for short-term use, yet many people are given them for years.
Insomnia is a big business and the sales of sleeping pills are soaring. But is this trend toward more pills hurting us in unseen ways?
The University of California, San Diego School of Medicine found that REM sleep (dreaming sleep) enhances creativity and problem solving. Sleeping pills have been proven to limit the time we spend in REM sleep.
Throughout history are stories of artists and scientists waking from sleep to their most notable contributions. The Russian chemist Dmitri Mendeleev discovered the periodic table of elements and the British poet Samuel Taylor Coleridge had his idea for his epic "Kubla Khan" in their sleep. As a result of the dramatic increase in sleeping pill usage, is America losing its creativity and intelligence? Eminem stated that during his years on sleep medications his music was stifled while his brain was shut off. How many are suffering the same fate without any idea how to break their addiction?
Elixirs for sleep have been around for centuries - the Greeks used Opium and a tincture from Opium called Laudanum was regularly administered in the 1800s. But it wasn't until the mid 1950s that the discovery of REM (Rapid Eye Movement) brought sleep into the realm of psychiatry, and in the 1960s insomnia became a disorder. It is now estimated that 40 million Americans suffer from chronic sleep issues with another 30 million experiencing intermittent problems. Children are now taking sleeping pills at alarming rates. This is a concern considering they are the future leaders of our nation.
Many medications today are used for sleep: Sleeping Pills (Ambien, Lunesta), Benzodiazepines (Xanax, Ativan, Klonopin, Valium, Restoril), Antipsychotics (Seroquel, Abilify) and others. According to Alesandra Rain, it can be extremely uncomfortable and often dangerous to just stop medications. Rain went cold turkey in a treatment center and stated it took months before the debilitating symptoms began to ease. Seven years ago, Ms. Rain began a non-profit to assist people with prescription pill addiction.
"The medication must be tapered properly under the assistance of a qualified medical professional," concludes Rain. Rebound insomnia, an unsafe increase in blood pressure, fear, anxiety and depression are just a few of the withdrawal symptoms.
Desperately Seeking Sleep - why michael jackson took anesthesia...
Malibu, California – August 14, 2009 - The King of Pop died on June 25, 2009 and the media have addressed every aspect of his life and death. One question still remains - Why would Michael Jackson risk his life for a few hours of sleep with a potentially lethal anesthetic?
Michael had serious pain requiring years of painkillers, but the raging insomnia he experienced is not indicative of opiates, but is common with long-term use of anxiety medications like Xanax, Ativan, Valium, Klonopin or sleeping pills like Ambien and Lunesta.
For anyone who has taken these medications, you know how quickly your sleep erodes and the pills consume your existence. I've had 34 surgeries and spent ten years on a cocktail of pills for anxiety, insomnia, depression and pain. Six years ago I went cold turkey and nearly died.
I never doctor shopped. I didn't have to. My doctor was more than willing to prescribe a plethora. At the end of my nightmare I thought it impossible to ever sleep naturally again. I craved sleep and had I been offered an anesthetic, I would have taken it without hesitation.
Jackson had physical pain and after being burned in the filming of the Pepsi Commercial in 1984, he produced exquisite music. In 1987, Bad sold over 30 million albums and in 1991 Dangerous became the most successful new jack swing album of all time. His last album, HIStory became the best-selling multiple disc album in 1995. So why did his ability to create music dwindle?
In 1992, after facing molestation charges, Michael began taking Valium, Ativan and Xanax, and by 1993 his health deteriorated and he went to treatment. But going cold turkey from anxiety pills is a blood curdling experience that can bring the strongest to our knees. It is also extremely dangerous. Most will reinstate the pills to stop the horrific withdrawals.
Sources close to Jackson told CNN that Michael traveled with an anesthesiologist who would "take him down" at night and "bring him back up" during a world tour in the mid-90s. By 2004, documents from the Santa Barbara County Sheriff's Department detailed Jackson's attempts to battle his insomnia by taking 20-40 Xanax a day.
Anxiety medications can increase pain, induce insomnia and kill our creativity. My pain soared and always more pills were added. It is a never-ending cycle of anxiety, insomnia and pain, and a hell I wouldn't wish on anyone. It is the trap I believe Michael found himself in. I predict the toxicology will reveal multiple anxiety medications, an antidepressant, sleeping pills, painkillers, stomach acid pills, and of course the anesthetic.
I was fortunate to find my way out of the chemical straightjacket. Today I have no pain, insomnia or anxiety, and help people worldwide to regain their lives. I wish someone had helped Michael Jackson. He thought a short-acting anesthetic could give him a few hours of relief. Instead he lost his life.
Worried You're on a Similar Path? Malibu, California - February 25, 2008 - The death of Heath Ledger brought the danger of sleeping pills and anxiety medications to the public. Many people are concerned that their medications are putting them at risk, and unfortunately, there are those that think what happened to Heath is an isolated incident and couldn't happen to them. Even Lindsay Lohan was recently quoted as saying, "I'm not them", referring to Marilyn Monroe and Heath Ledger, "… I sure as hell wouldn't let it happen to me." However, pill usage is climbing at an alarming rate among people of all ages, and adverse reactions to prescription drugs is now the fourth leading killer in the United States.
As a nation, we are spending billions on sleeping pills, and although they are only recommended for short-term use, most stay on them for many months or years without realizing the danger. But pills that force us to sleep also affect us during the day – impairing our judgment, memory and intelligence. So why have we become addicts to drug-induced sleep?
Many news stories stated that Heath created his own downfall, and yet the medications he was taking are among the most commonly prescribed worldwide. Alesandra Rain, author of Deeds of Trust, maintains that Heath Ledger's combination of medications is very typical today. "I was on a similar cocktail for over ten years, including Oxycontin, Hydrocodone, Temazepam, Clonazepam, Effexor and Ambien. It started with only one pill and when it stopped working, others were added. It became a living nightmare. My insomnia and anxiety raged and it never occurred to me that the drugs themselves were the cause," says Rain.
Medications are commonplace in our society. Pills claim to cure insomnia, anxiety, depression and pain. Yet few understand that the side effects of these medications can be a worsening of the original symptoms. The over prescribing of medications has spiraled and has left millions at risk. "I can only imagine the way Heath must have felt," declares Rain. "Day after day feeling horrible anxiety and less connected to the world, and yet unable to sleep," she continues.
Rain eventually went to Cirque Lodge Treatment center in Utah and quit cold-turkey. Her experience prompted her to start an organization that allows people to step down on their pills, rather than abruptly stop.
"We've helped people worldwide to regain their lives. We get to watch them return to life, regain normal sleep patterns and feel a part of this world," concludes Rain.
Heath Ledger's journey should serve as a warning to all of us. He wasn't weak, but was rather seeking a way to alleviate anxiety and insomnia. Instead, the world lost a gifted actor and his family and friends are suffering a needless loss.
Maybe if he had known the drugs were contributing to his symptoms, he could have reached for help. But it's not too late for you.
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ALESANDRA RAIN - co-founder, author, drug expert
Books by Alesandra Rain
Rise, a riveting true story of hope, inspiration and redemption. Alesandra Rain captures her torment and subsequent growth in a way that has the reader experiencing every emotion as her compelling story unfolds. You will find yourself laughing, crying and ultimately applauding her strength of spirit. Coming Soon.
Deeds of Trust A compelling chronicle of betrayal, loss and the overwhelming strength of the human spirit. Alesandra Rain captures her riveting true story of deception and intrigue while putting a face on a worldwide issue. More...
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Dr. Bill CodeAnesthesiologist, Integrative Medical Advisor, Author
Doctor weighs in on so-called Liberation Therapy
It's not unusual to hear from people in Saskatchewan with Multiple Sclerosis who've had the so-called liberation procedure. Guest host Amanda Marcotte speaks with a doctor who has MS and who had the treatment. More...
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Reversing aging, reducing pain, improving energy and brain function.
Find out how to naturally reverse the negative effects of aging, reduce pain, improve energy and brain function this week on Transforming Health. I will be discussing this and so much more with Dr. Bill Code who is the author of Youth Renewed A Common Sense Approach to Vibrant Health. More...
The Star Phoenix Doct, MS Patient Urges ‘Liberation’ Trials
Dr. Bill Code returned to Saskatchewan with a message for his home province, where the highest rate of multiple sclerosis in the world is found. More...
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In withdrawal from antidepressants, sleeping pills or anxiety medications, these jolts of electricity can worsen and become debilitating, although there is no current evidence that the zaps present any danger to the individual. So what causes brain zaps? MORE...
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