Dear Psychiatrist: I Almost Died Under Your Care

Dear Psychiatrist,

As an educator of 20 years, I often reflect on the good and bad semesters I’ve had. I sometimes cringe at some of the silly or stupid comments I said and also think about things I included in lessons that didn’t have much to do with the unit we were studying at the time. I ask myself, What was I thinking?

But what you do is far more important and far-reaching, literally involving the lives of your patients. It requires much more self-scrutiny and reflection than, let’s say, the layout and instructional delivery of an expository essay.

Please reflect on the questions below if you plan to stay in practice. But first, it’s important you know that just before I ended my long-term patient-doctor relationship with you, I had to leave my neighborhood of 23 years locked in the back of a sheriff’s car (an ambulance was not available). I had written a suicide note to my husband and boys telling them I couldn’t take it anymore. I even threatened to take a bottle of pills because I was in so much pain. I had been through six long months of various medication trials, heavily drugged on Xanax and BuSpar, as prescribed, and you never laid eyes on me. Thankfully, my sister came to my rescue and the ER staff and hospital psychiatrist saved my life by getting me off the medications you carelessly put me on.

What were you thinking when you prescribed me nearly 800 pills of Xanax in under seven months? Did you not see the signs that I was developing a dependency, especially given your background in addiction? I learned from the emergency room that I had “developed a significant tolerance to Xanax” and that my BuSpar dosing had been “increased far too quickly.” I will never forget these words as long as I live. I finally had an answer to so much of my pain. Did you forget that Xanax is one of the most addictive drugs in the world? I’ve since learned that many local professionals limit prescriptions to no more than 10 pills per patient per year. Please consider this if you continue to prescribe Xanax.

What were you thinking, not looking at the current medical literature on the dangers of Xanax? I know you have 30+ years of experience, but the literature overwhelmingly points to the dangers of long-term Xanax use. Yes, benzos may have an important place in psychiatry, but only when used short term. The literature also points to the fact that these drugs actually make anxiety worse — much worse. Once again, benzo rebounding is that bad. You and all psychiatrists should look at the horrifying accounts of patients on long-term benzo use. Please visit the BenzoBuddies and BIC (Benzodiazepine Information Coalition) websites. These sites alone will forever change how, and if, you prescribe benzos.

What were you thinking, not listening to my physician husband who requested a medication change? We had to learn from the hospital psychiatrist, with his 20 years of practice, that Xanax was making everything worse. He stated how he never used Xanax and never would because, to him, the drug was far too dangerous. Within days of getting off the drug, with the temporary use of Klonopin (something we had even asked you for), I got markedly better. My brain was no longer on the torturous Xanax roller coaster. In the weeks that followed, I felt more like myself than I had in months. Family and friends were stunned — and thrilled — to see my improvement. But alongside the relief, I was also overwhelmed with deep sorrow for what I had endured, and profound regret for not heeding the warning signs sooner, particularly those from the staff at the well-respected facility that I went to. They urged me to get off Xanax but I didn’t listen. Essentially, the darker things got, the deeper my trust grew, trusting your opinion only.

What were you thinking? When I kept saying that I needed more Xanax, didn’t you see this as a sign of dependency/tolerance? I now know that when you doubled my nighttime dose of Xanax, it was knocking me out only to leave me with the worst next-day anxiety I’ve ever felt. I kept calling you, saying that my anxiety was getting worse in weird and unusual ways such as shaking, shortness of breath, and OCD-like behaviors. Morning and daytime Xanax use was something I had never done in my life. Didn’t you think this was odd? You should have been concerned.

What were you thinking, not seeing me in person for more than seven months when I was really struggling (because of the Xanax, I now know)? We could have used masks. You never even thought to use screens for our teletherapy. If you continue to stay in practice, please look at the current literature on telepsychiatry. It has its upsides, as well as downsides. Therapists have been amazed at what they miss not seeing a patient in person. Therapist Sean Grover describes how the emotional experience with in-person sessions is very different because the benefits include access to nonverbal communication, building a more intimate personal relationship. And, while I briefly saw a therapist at your office, all I kept asking her was when will my need for Xanax stop? She said she couldn’t answer my questions because she was not an MD. Did you ever touch base with her about this? Why couldn’t I see you at your office?

What were you thinking when you recommended an out-of-state facility that would cost $90K out of pocket when I had already been to one, locally? Do you understand how demoralizing it was to hear that? It was this suggestion that drove me to write the suicide note to my family. I couldn’t face another treatment center, another round of medications, or another round of false hope. You just kept pushing me off.

What were you thinking when you shared with me that you wanted to “kill” your already deceased mother? Building rapport is one thing, but that was disturbing. A big red flag that I should have given more attention to early on.

What were you thinking when you repeatedly mentioned how good my insurance was, offering phone-call therapy? My husband urged me to bring this up to you because of how much it bothered us. Was I an easy and lucrative case to you?

What were you thinking, telling me for a long time not to worry about taking Xanax for sleep because I was on a “pediatric dose”? Hopefully, young children are never prescribed Xanax in the first place, and once again, it should never be prescribed long term. Yes, it worked for me for years, but it was your job to ‘do no harm’ and ultimately, advise me to take a different course of action. I have a girlfriend who, in a tough time, was prescribed a benzo but her psychiatrist said it was her job to help her taper and try something different because long-term benzo use is dangerous. It’s ironic that a hospital psychiatrist saved my life, turning things around in a few days, whereas my six torturous months with you didn’t help at all.

I understand that psychiatry is complex and nuanced. But your decision to increase my Xanax dosage and never see me in person during my most challenging moments turned my life into a nightmare. The bottom line is that your approach to patient care was convenient for you but dangerously harmful to me. Please reflect on the questions above if you plan to stay in practice. I will always regret trusting you, my specialist, for so long.

Sincerely,
Your former patient, now medicine-free and feeling better than ever.