<h3>Tighter MHLW regulations have triggered a boom in drug reductions for &#8220;benzodiazepines.&#8221;</h3>
Benzodiazepines are widely used as sleeping pills and anti-anxiety drugs. In recent years, as the Ministry of Health, Labor, and Welfare (MHLW) has tightened regulations on the mass prescription of psychotropic drugs, a drug reduction boom is occurring among patients.
However, abrupt drug reduction carries risks. The writer, who has been taking benzo sleeping pills for a long time, decided to reduce or abstain from them herself.
In the second part, we will report on how to reduce and abstain from taking drugs while minimizing withdrawal symptoms, and how to deal with doctors to avoid being &#8220;addicted&#8221; to drugs.
<a href="https://friday.kodansha.co.jp/article/336535" target="_blank" rel="noopener noreferrer"> Click here for Part 1: &#8220;Sleeping pills suddenly become psychotropic drugs&#8230; I want to quit but I can&#8217;t.&#8221; A person who experienced withdrawal symptoms tells about the fear of withdrawal.</a>
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<figure id="attachment_336549" class="wp-caption alignnone" style="width: 640px;" aria-describedby="caption-attachment-336549"><a href="#" data-ident_hash="344593ca"><img src="https://res.cloudinary.com/fridaydigital/image/private/t_article_image/wpmedia/2023/10/bdd362903846fc5a9ee60e41a75dcc1a.jpg" alt=""></a><figcaption id="caption-attachment-336549" class="wp-caption-text">For the author, Depas was a &#8220;magic drug&#8221; that allowed her to sleep once she took it.</figcaption></figure>
<h3>How to fight withdrawal symptoms</h3>
“I never want to take Depas again.”
After 11 years of regular use of Depas, a benzo sleeping pill, it took her five years to get off the drug.
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It has been pointed out that benzos and other psychotropic drugs can cause withdrawal symptoms when people who have been taking them for a long time suddenly reduce or abstain from them.
Symptoms include insomnia, headaches, tinnitus, glare in the eyes, muscle stiffness, and many others. According to Tokio Tsukizaki, a medical journalist who has been covering psychotropic drugs, there are cases of nightmares, intense suicidal thoughts, and &#8220;dystonia,&#8221; in which various parts of the body move on their own. The duration of withdrawal symptoms varies depending on the type and amount of medication.
The duration of withdrawal symptoms is strongly influenced by the half-life of the drug (the time it takes for the drug&#8217;s concentration in the blood to decrease by half after entering the body). For example, Depas, which the author was taking, has a short half-life of 6 hours. It is said that symptoms of drugs with a short half-life usually appear quickly and do not linger long after the drug is reduced or abstained from, but the author suffered withdrawal symptoms for three months. The details of withdrawal symptoms at that time are described in Part I.
How can we reduce the dosage in order to minimize withdrawal symptoms?
“There are two ways to reduce the dosage: the &#8220;gradual tapering method,&#8221; in which the dosage is reduced gradually and regularly, and the &#8220;every other day method,&#8221; in which the period during which one does not take the drug is extended little by little. There is also the aqueous solution method, which is a type of gradual reduction. Which one is chosen is up to the individual, but many people reduce (gradual reduction method) by ‶a few percentage points‶ one type at a time, once every week or two,&#8221; says Tsukizaki.
“Most medical practitioners consider the minimum prescription unit for drug reduction to be one-quarter or one-half of one pill, but many patients tell us that even a minute reduction of 1 to 2% of one pill can affect them physically and mentally. Therefore, some patients try to reduce their medication by 1% each, even if it takes longer. There must be a unit of medication that works for you, and I think it is important to find it.&#8221;
 
One way to reduce medication is to cut pills with a cutter or knife, but the ingredients of the medication are not always averaged into a single pill. It is safer to crush the pills and then use a medicine spoon to reduce the amount of pills to be taken. It is a good idea to ask your doctor for a prescription order so that the pharmacy can crush the pills for you.
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<h3>Photophobia, also a side effect of Depas.</h3>
Incidentally, when the author reduced his medication from two Depas tablets to one in 2018, she suffered from rebound insomnia, so she shelved the reduction and continued to maintain the status quo for two and a half years.
She resumed in 2021, and came up with the idea of reducing the dosage to one-half a pill, which she cut in half with a petty knife and. Her sleep was shallow, but she was convinced that she could tolerate it. Over the next two years, she gained confidence that she could sleep on one-half the dosage, taking a little more than half a pill on busy days or days when she was sick.
Then, in April of this year, she took the remaining half pill every month. She made a plan to reduce the remaining half pill by a quarter (of a half pill) every month. If all went well, she would be able to get off the drug in four months. The plan went almost as planned, and she was finally able to abstain at the end of July this year.
 
“During the reduction and now that I am sober, it still takes me more than an hour to fall asleep on some days, and I often wake up in the middle of the day. However, when I seek a satisfying sleep, I cannot help but take the help of the medication. If I can sleep to some extent, I am satisfied. This change of mindset may be one of the reasons why I was able to get off the drugs.”
<figure id="attachment_336550" class="wp-caption alignnone" style="width: 640px;" aria-describedby="caption-attachment-336550"><a href="#" data-ident_hash="b7b903a6"><img src="https://res.cloudinary.com/fridaydigital/image/private/t_article_image/wpmedia/2023/10/ecd07bb5756aaca213108c8adc02dafc.jpg" alt=""></a><figcaption id="caption-attachment-336550" class="wp-caption-text">Withdrawal symptoms are said to be strongly influenced by the half-life of the drug.</figcaption></figure>
So, have withdrawal symptoms completely disappeared?
“In fact, I am suffering from unprecedented ‶stiffness in the shoulders″ and dryness and photophobia (glare in the eyes) to the point where it is hard to keep them open, even to the point of going to acupuncture for the first time in my life. I thought it was just my age, but after reading Tsukizaki&#8217;s book, &#8220;The Tricks to Slowly Reduce Drug Use,&#8221; I learned that these could be withdrawal symptoms.”
Withdrawal symptoms are said to show up in a person&#8217;s natural weak points. If the patient had had severe shoulder stiffness since he was young, I think it means that while he was taking Depas, the muscle relaxant effect relieved the stiffness in his shoulders, and where it was no longer bothering him, the muscle tension returned with the reduction or abstinence of the drug.
Photophobia is another withdrawal symptom that I often hear about from patients, and it could be drug-induced eyelid spasm. Some patients have severe symptoms and cannot open their eyes by themselves.
 
After interviewing Tsukizaki, she visited a neuro-ophthalmologist, who diagnosed her with drug-induced eyelid spasm. In fact, about eight years ago, when she visited an ophthalmologist for dry eyes, she was diagnosed with fatigue, not dry eyes, but according to the neuro-ophthalmologist, she should have developed eyelid spasms at that time. The doctor told her that if she had stopped the Depas earlier, she might not have developed it. In other words, the author&#8217;s eyelid cramps were diagnosed as a side effect of long-term use rather than a withdrawal symptom.
For the author, who suffered from insomnia, Depas was a &#8220;magic drug&#8221; that was extremely effective. “That is why, although I was aware of my dependence on it, I had come this far without taking its side effects seriously.”
“In the first place, benzos, including Depas, were designated as psychotropic drugs in 2016, and their administration period was restricted to 30 days. This prescription limitation should have meant that the drugs should not be prescribed in a haphazard manner over a long period of time. However, the doctor prescribed Depas at each of my visits to the hospital, and I eagerly and gratefully took it. I am left wondering why I did not ask my doctor more about the reason for the prescription restrictions and why I did not ask about the side effects.”
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<h3>The reality is that many physicians &#8220;disregard risks&#8221;</h3>
Dr. Tsukizaki points out the current situation in which prescriptions are being carelessly made in departments other than psychiatry and psychosomatic medicine.
“In recent years, I have been paying close attention to cases in which women who have just given birth are prescribed benzos in obstetrics and gynecology departments.”
“Childbirth is physically and emotionally taxing for women, and many women experience problems with sleeping and breastfeeding. Some doctors easily diagnose this as ‶postpartum depression″ and prescribe benzos.”
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“If benzos are taken immediately after delivery, the patient will be forced to stop breastfeeding.”
“Psychiatrists, as well as physicians in other medical specialties, need to fully understand the risks of benzos in order to handle them.”
“However, I must say that many physicians underestimate the risks. From the patient&#8217;s point of view, it is not easy to find a doctor who can use the drugs correctly for treatment.”
<figure id="attachment_336551" class="wp-caption alignnone" style="width: 640px;" aria-describedby="caption-attachment-336551"><a href="#" data-ident_hash="953278d9"><img src="https://res.cloudinary.com/fridaydigital/image/private/t_article_image/wpmedia/2023/10/8a74602b318b91c7d34e35c45d20b978.jpg" alt=""></a><figcaption id="caption-attachment-336551" class="wp-caption-text">Doctors should be reassuring companions.</figcaption></figure>
What should patients who still have no choice but to rely on medical care do?
“What each individual can do is to keep asking the doctor why the medicine is necessary and for how long it should be taken.”
“Due to the way reimbursement works, some doctors do not welcome patients&#8217; questions, but if the doctor looks uncomfortable or gets angry, it means that he or she is &#8216;not a reliable companion. &#8216; I think that&#8217;s one way to think about transferring to another hospital.&#8221;
Before submitting a prescription to a pharmacy, it is also important to check the efficacy, side effects, and other information in the ‶appendix‶ by yourself. If you search on the Internet, you can type in the name of the drug followed by the ‶appendix‶ and it will come up right away.
“I want you to tell your doctor repeatedly that you are not going to be involved in taking drugs for the rest of your life.”
*Aqueous solution reduction (water titration) is a method in which water is added to the medication and stirred uniformly, and the solution is taken in several ml increments using a syringe and discarded, and the remaining solution is then taken.
 
Tokio Tsukizaki is a medical journalist and facilitator. After working for a publishing company, he studied under writer Naoki Inose and contributed medical articles to Nikkei Trendy, Nikkan Sports, Weekly Asahi, and other publications. In 1993, when a family member developed mental illness, he began covering mental health and welfare. He is the author of &#8220;How to Get a Psychiatrist Right&#8221; (published by Shogakukan). His most recent book is &#8220;How to Reduce and Abstain from Psychotropic Drugs,&#8221; a how-to book based on interviews with patients. He also organizes workshops to discuss psychotropic drugs.
<figure id="attachment_336552" class="wp-caption alignnone" style="width: 240px;" aria-describedby="caption-attachment-336552"><a href="#" data-ident_hash="129109e3"><img src="https://res.cloudinary.com/fridaydigital/image/private/t_article_image/wpmedia/2023/10/6f465211b416b13455e6d2641af21051.png" alt=""></a><figcaption id="caption-attachment-336552" class="wp-caption-text">Ms. Tsukizaki&#8217;s book, &#8220;Shimban: The Tricks to Slowly Reduce and Abstain from Psychotropic Drugs,&#8221; includes specific methods for reducing and abstaining from psychotropic drugs and tips for communicating with doctors and pharmacists.</figcaption></figure>

 After working as an editor for a women's magazine, she became a writer. She has 40 years of experience with chronic diseases. This time, she interviews and writes from the perspective of a patient who has received medical care for many years.

 Koiko Tsumaike

 Benzodiazepines are widely used as sleeping pills and anti-anxiety drugs. In recent years, the Ministry of Health, Labor, and Welfare (MHLW) has tightened regulations on the mass prescribing of psychotropic drugs, and this has triggered a boom in drug reduction among patients. However, abrupt reductions in dosage carry risks.

How to Escape from the Hell of Withdrawal Symptoms from Sleeping Pills, as Told by a Person Who Experienced Them.

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