Thursday, October 23, 2008

Stress and Ulcers — Just a Myth?

"You'd better relax — you're going to get an ulcer!"

Common wisdom holds that ulcers are caused by stress, and until recently, so did medical wisdom. The medical picture changed in the mid-1990s when the National Institutes of Health concluded at a major conference that most ulcers are caused by a bacterium called Heliobacter pylori (H. pylori) and should be treated with antibiotics.

Although the first antibiotic for treating peptic ulcer disease was approved in 1996, many patients and doctors remained unaware that most cases are caused by infection. In an attempt to educate the public and the medical community, government and professional associations launched extensive educational campaigns. The message was simple: ulcers are caused by infection, not by stress or spicy food.

But the pendulum may have swung too far, according to recent research. While it's true that many peptic ulcers are caused by H. pylori infection, many are not. And, only about 20 percent of those who are infected with H. pylori ever develop ulcers. So while recognizing that the bacterium is definitely a big part of the picture, researchers are turning again to look at the role of psychological factors, especially stress.

"Evidence linking psychosocial stress to peptic ulcer is too strong to be ignored," states Dr. Susan Levenstein of the San Camillo-Forlanini Hospital in Rome, Italy. "Psychosocial factors can be estimated to contribute to 30 percent to 65 percent of ulcers."

In a recent issue of Psychosomatic Medicine, Levenstein explains that although many of the studies linking ulcers to stress were poorly done, there are still many that weren't. Important among these are prospective studies that follow a group of people for a period of time to see what factors at the beginning of the study predict later development of ulcers.

These studies report that psychosocial factors such as stress, depression, trauma, job frustration and family difficulties all predict later development of ulcers. Other studies have shown that these factors slow the healing of ulcers. One problem, Levenstein points out, is that some other influence could be causing both stress and ulcers — socioeconomic status or medical conditions, for example.

But even when these factors are accounted for, it appears that stress plays an important role in at least some cases of ulcer. In an Australian study, for example, 44 percent of patients recently diagnosed with duodenal ulcers reported experiencing severe and often chronic stress during the previous six months. Among a comparison group of healthy subjects matched for age, gender and socioeconomic status, only nine percent reported such stress.

Levenstein points out that stress can contribute to the development of ulcers without actually causing them. For example, stress can influence health behaviors such as smoking, drinking and poor eating and sleeping habits — all of which are established risk factors for peptic ulcer. Research also suggests that people who feel stressed are more likely to take medications called non-steroidal anti-inflammatory drugs, or NSAIDs, such as aspirin, ibuprofen, naproxen and a number of prescription medications. These drugs definitely can cause ulcers; this is actually one of their most serious side effects.

But even after accounting for these stress-related health behaviors, says Levenstein, stress itself remains a risk factor for ulcers. A nine-year study in California found that participants with high levels of stress were more than twice as likely to develop ulcers than those without stress, even after accounting for smoking, drinking, eating and sleeping habits.

There are several ways that psychosocial factors might contribute to ulcers, explains Levenstein. Emotional distress and severe stress (as some mood and personality disorders) are significantly associated with increased production of acid in the stomach and small intestine. These psychosocial factors can also affect the body's immune system and hormone balances, impairing its ability to heal.

According to Levenstein, about 20 percent of ulcers appear to be unrelated to either H. pylori infection or taking NSAIDs — the two major causes. Recent studies report that only one-half to two-thirds of ulcer cases involve bacterial infection. Levenstein suggests that in some cases, individuals may be physiologically predisposed to develop ulcers, and the effects of psychosocial stress in the body activate this tendency. In fact, she suggests, some ulcer cases in which H. pylori is found may not actually be caused by the bacterium.

The bottom line, says Levenstein, is to look at peptic ulcers the way we look at cardiovascular disease: as a complex condition that's influenced by a variety of genetic, physiological and psychosocial factors.

"Stress and heliobacter may be two independent risk factors with additive effects, just as diabetes and smoking carry additive risks for coronary artery disease," the researcher suggests. "[Some] ulcers may be destined to develop regardless of the individual's psychological characteristics, but there is some evidence that light infections may be helped to evolve into ulcers by psychosocial factors."

As both the general population and the medical community turns to more complex explanations of diseases from heart attack to the common cold, we can expect to see more and more research showing that psychosocial and physiological forces interact in human disease.

Stress and Asthma: What's the Connection?

Most experts would agree that there is a connection between emotional stress and asthma but beyond that, a great deal of controversy still exists. Does emotional stress trigger asthma or make an attack worse? Or is emotional stress the result of asthma symptoms?

"I believe there's a link between people's emotions and asthma attacks," observes Stuart A. Tousman, Ph.D., associate professor of psychology at Rockford College in Rockford, IL. Nationally recognized for his work in this area, he conducted a workshop on the connection between asthma/allergies and stress at the 56th Annual Meeting of the American Academy of Allergy, Asthma and Immunology in San Diego

While studies show a clear relationship between emotional stress/anxiety, frequency of attacks, amount of medication needed to control symptoms and hospitalizations due to asthma, there are several possible explanations for this. Emotional stress could act as a trigger for asthma, and it could also make an attack worse as it is occurring. At the same time, symptoms and other factors associated with the disease could interfere with an individual's life to the point of damaging his or her self-esteem, and that can be very stressful.

Some researchers believe that individuals with asthma experience much of their stress as a result of asthma attacks or poorly controlled asthma. Many of these experts worry that seeing stress primarily as the trigger might lead health care providers to underestimate the impact that an individual's asthma symptoms are having on his or her emotional health.

On the other hand, researchers who believe that stress can trigger asthma symptoms or make them worse sometimes fear that other healthcare professionals aren't doing enough to help patients with asthma manage the stress in their lives.

While individual experts might focus on one explanation over others, the reality may be a combination of each, and recent studies suggest that adding psychological techniques such as muscle relaxation training and asthma self-management training to conventional asthma treatment can further improve a patient's response to asthma treatment.

Such programs work because they help patients identify and cope with stress related to their disease, and they provide education about asthma and its treatment so that patients can take better care of themselves. In addition, programs like this help patients and their health care providers to identify factors that might be keeping the patient from complying with treatment-- such as an inability to pay for prescriptions or the presence of unpleasant medication side effects.

Patients in one study experienced a reduction in asthma symptoms and anxiety level and an increased quality of life with the addition of psychological techniques to their treatment plan.

Another study, conducted by Dr. Tousman and his colleagues, examined 13 patients who completed a seven-week program that included interactive education, social support, relaxation training and humor therapy. Each week during the study, patients were asked to make a specific behavioral change such as exercising for 30 minutes or practicing relaxation for 30 minutes.

Study participants reported that the program relieved the tightness in their chest, made them feel less tired, improved their ability for achievement and improved their ability to control their asthma. These patients felt they had benefited most from education about medication options for their illness and learning how others cope with their asthma. The study also indicated that patients adhered to their medication plan better and felt more empowered to make lifestyle changes likely to improve their health.

Support and Stress: loving company of others can help reduce the negative health impact of stress

For most people, emotional well-being and life satisfaction are closely linked to the quality of their social life and close relationships. The loving company of others can help reduce the negative health impact of stress. Sharing one's life and heart is healing. Meaningful, close connections are associated with peace and well-being. Physical changes that result are the same that deep relaxation brings: lower blood pressure, artery wall relaxation and slower heart rate. The immune system works best and the heart thrives in this physical and emotional environment.

But what does it take to develop and maintain relationships? Whether with friends, family or a life partner, good relationships are based in mutual trust, caring and effective communication. Start by asking yourself what "you" like in a friend or partner. Chances are it will be a combination of qualities similar to those below.









Qualities Sought In Supportive Relationships
Loyalty
Warmth or Affection
Empathy
Honesty
A Sense of Humor, Lightness
Makes Time for Me
Independence
Keeps Confidence
Meaningful Conversations

The qualities you like in others, others will like in you. Unlike the common saying "opposites attract", truly supportive relationships are more likely when people with similar values for companionship come together. If you want to attract people who have the qualities you value, be sure to work on these qualities yourself. You will be more attractive as a friend to the type of person (people) you seek to meet. And, you will bring out the best in those who are already committed to supporting you.

Communication skill is another aspect of support. This term refers to our ability and willingness to talk about ourselves, to make reasonable requests, and to listen to another with an accepting attitude. Without communication skill, a caring connection with another will be hard to initiate and harder to maintain.

Finally, social support depends on the community from which you draw. If you are alone much of the time, it may seem that support is not available at all. Or, if you spend a great deal of time with people who are unavailable for meaningful friendship, you may feel alone despite their physical presence. No one has to be lonely. While it is sometimes uncomfortable to begin the process, expanding your social circle may open up important new doors. Reaching out to make friends and joining new groups can make a big difference in your health and happiness.

Communications with Others

Communication is the task of helping another person see in their mind what we see in ours. What we need to communicate includes requests, instructions or information about our experiences and ourselves. We obviously use words to communicate, but also body movements, facial expressions, and various pitches and tones in our voice. By these means, others create pictures, feel feelings and understand our thought process.

There are also times when no action is communication. No words, no sounds, no gestures. In situations where the message is mute, the communication may be "I need to withdraw" or "I am not ready". At least, it could be interpreted this way.

So, here is the crux of so many communication errors: Interpretation! We interpret other people's verbal, non-verbal and even muted messages based upon our own experiences. They, on-the-other-hand, are usually relating to their own. Needless to say, ineffective communication can and does result. Miscommunication is often a barrier to understanding between people. When this happens, opportunity for support can be missed.

Reflect On Your Communication Style

One important skill in support building is communication style. There are four styles people use. While we use each of these styles at various times, most of us have one style of communication that is more comfortable and commonly used. However, of the four, the assertive style achieves the best results for building true support. This style respects both you and the one to whom you are speaking. It is an easy style to hear, and accept. It builds empathy and understanding, without compromising either party.

For passive individuals, developing assertiveness skills can be uncomfortable. It may help to remember that assertiveness is not aggressiveness. By speaking up and making reasonable requests of others, you do not imply that you are more valuable. You assert that you are "as valuable". It is also important to know that being assertive does not guarantee that you will get all that you want, or think that you need. It does insure that your cards, your needs, are at least on the table. Without that, you are unlikely to get find the support you need or help you desire.

For those who are aggressive, changing to a more assertive style can also be difficult. It is seductive to move through life with a sense of power or control. If we make demands, we usually get what we want. The problem with aggressiveness is that personal isolation often results. If others feel disrespected and unheard as a result of aggressive communication, they will eventually pull away. Others become resentful or angry, leading to open conflict. In the end, aggressiveness usually leads to loneliness, a lack of connection to others and no support.

Passive Aggressive communicators may be confused themselves by their difficulty in gaining support from friends and family. The problem is that initially, during a passive phase, true requests or expectations are not fully stated. As a result, a potential supportive ally may make false assumptions about the situation, and be unable to choose or change behavior based upon reality. A common pattern for passive-aggressive communicators is to let resentment build during a passive phase. Once they have "had enough", they switch to aggression or "blow up". This is a confusing communication pattern. It can lead to frustration and missed opportunities for support.

Poor communication can fuel stress, anger and depression. Frustration with self and others, as well as a lack of meaningful connections, is often the result of weak communication skills. To foster healthy relationships and create more positive emotional experiences for one's self, assertive communication skills are worth the effort they take to develop. One tool that can help guide the process of framing assertive statements is the DESC method. Don't expect change to come quickly, but practice with the techniques will improve your skill.

Meaning and Purpose

Consider the importance of meaningful activities and purpose in one's life. People who do not have a good reason to get up in the morning are less likely to thrive than those who do. Physical and emotional health both decline when we stop doing things we enjoy or we feel our life does not matter. Defining and pursuing what is most important can add to your life satisfaction, enhance your health and heighten your sense of well-being.

Meaningful activities make life worth living. They can be a lot of work, as are parenting, relationships, volunteering, or pursuing an education. They can also be light and fun, such as sports, dance, art, music, hobbies, humor, or travel. Both types are important. Balancing time should be an objective. Too much time spent in activities that are not satisfying, or avoiding activity altogether, will leave one with little enthusiasm, few smiles and more stress. It is important to routinely make time for things that bring satisfaction and enjoyment into your life.

Purpose refers to our belief that we matter, that our contributions are valuable. One's sense of purpose can be related to the lives of other people, the environment, discovery or invention, spiritual development or any number of other definitions. When positively defined, life purpose is a powerful reason to get up in the morning, to move forward in the face of challenge and contributes to life satisfaction. Positive goals and purpose are important to everyone, and there is no one path to realize them. A sense of purpose is personally derived, and must be personally pursued.

In Life's Odyssey, you have opportunity to evaluate the meaning and purpose in your life, as well as your current time priorities. From it, you can learn more about balancing activities to enhance quality of life.

Thursday, October 9, 2008

"withdrawal was one of the worst weeks of my life, nausea, confusion, rage, sadness, incredible dizziness and horror"

Just wanted to follow up with my post from last week. I took my last dose of Paxil on a Thursday, with dizziness starting to take place on Sunday, becoming worse through Thursday the following week. It is now Saturday and I feel I've come through the worst of it. The withdrawal was one of the worst weeks of my life, nausea, confusion, rage, sadness, incredible dizziness and horror that it went on for five days relentlessly. I was bed-ridden, and feared it would never end. I have been successful in getting off of this poison and would never take it again. I found that my experience with prozac was much more positive in treating my depression and did not have the horrendous withdrawal. And I encourage all those who are having trouble getting off this medication to get lots of rest and persist through it. My withdrawal took about nine days, and I still have a little lightheadedness here and there, though it's been manageable. Good Luck to you all!

"I have now lived three years with social anxiety disorder and panic attacks."

First I have to say that I am not currently going through withdrawals and after reading this, I won't ever go through them because I won't start this terrible drug! About three years ago, I was given a three week sample of Paxil for what my "then" doctor prescribed as panic disorder. He told me that he would make sure that I got "my life back". I went to work that afternoon and started taking the drug. The very first day I felt worse than normal. I felt like I was floating and had tunnel vision. I also could not concentrate. I knew that this was not for me. I have now lived three years with social anxiety disorder and panic attacks. Going to the E.R. once with a panic attack. My job and family have suffered because of my "anti-social" behavior. But I am very blessed to have them constantly supporting me. Yesterday, I went to a new doctor, feeling like I just can't take this anymore. I am not depressed, but I want my life back. He gave me a three week sample of 10mg. a day of Paxil and told me to get back with him in two weeks. I thought maybe I was just being silly the last time, but before I took it, I wanted to see if there was anything on the Internet regarding Paxil. I am so thankful that I did! My heart goes out to each and every one of you. We are all fellow sufferers of anxiety or panic attacks, and it is really a crime what doctors are doing to us, or trying to do. I point blank asked my doctor if there would be any side effects and he answered "no". A good friend of mine suggested BuSpar for me, and I found nothing negative through the Internet regarding that drug. But I am so frightened now to take anything, that I guess I will continue fighting this anxiety battle on my own. I welcome anyone to write me with suggestions. I will pray for you all.

-- submitted by hrdfwsouth, 38

"I began having vivid, anxiety filled dreams, and lightheadedness"

I switched from prozac to paxil in June. I tried tapering the dose until I was at 15 milligrams every other day for a month. I took the last dose a week ago. After 3 days, I began having vivid, anxiety filled dreams, and lightheadedness. The dizziness has been severe for the last three days, an is accompanied by a feeling that my heart is pounding when I move suddenly, mental confusion, nausea, pounding sensations in my head and ears, emotional surges and the overall feeling that I have the flu. I am determined to stay off of this poison, but I don't know how long this withdrawal will last. Previously, I had ended a cycle on Prozac with no side effects whatsoever.

-- submitted by KJHSF, 35

"I am hoping I can come off Paxil cold turkey with the help of this drug"

I am on my fourth or fifth day of withdrawing from Paxil and I am very nauseous some of the time and my head spins now and then. Sometimes it is extremely bad and sometimes its not as bad but today I went to the drug store and got some thing for motion sickness and nausea and it helped tremendously. It makes me sleepy though but it is much better than the alternative. I am hoping I can come off Paxil cold turkey with the help of this drug. Also my hands and feet are icy cold and I am alternating rage with sadness but I felt so much better to read other accounts which described the same thing. This is the second time I have come off Paxil 20 Mg. and before I weaned myself by taking less and less but it took 3 or 4 weeks i think. I am hoping taking none at all might get me off faster. Paxil has worked pretty well for me but I don't have any sexual desire or much ability to have an orgasm.I also thought it would help me control my overeating and it certainly hasn't.

-- submitted by John, 46

"accumulative effects of the drug (30 mg/day) had me sleeping most of my life away"

I began taking Paxil in 1996. It seemed like a God-send at the time. Last year, the accumulative effects of the drug (30 mg/day) had me sleeping most of my life away. With a 6 year old daughter, I felt very guilty about not spending enough time with her. I also had to quit my job because I could not get enough sleep to function. My house was a disaster area- laundry piled up, dishes piled up, dirty clothes piled up, what's worse is that I didn't even care! So I've tried several times to wein myself off the drug. I would like to be drug free in order to have a second child. However, every time I've tried I get off the medication, the exact same types of hellish withdrawal symptoms as described in your story occur within 3 days. Ironically, I'm more depressed now, losing the battle against this addiction. I feel defeated and robbed of the blessing of ever being able to have another baby! So far I'm unsuccessful. Right now I'm at 5mg/day and too afraid to cut it off for fear of the horrible withdrawal symptoms. My prescribing doctor says "just quit now" Yeah easy for her to say! The sickness is just as you described!!!! Aren't doctors aware of this or are they? I feel like I'm the victim of a guinea pig experiment.

-- submitted by traci, 32

"After two years I was weaned off the Prozac, but my Panic Attacks started again"

I was diagnosed with Panic Disorder 5 years ago. I was first treated with Prozac and Xanax. After two years I was weaned off the Prozac, but my Panic Attacks started again. I was then put on Paxil 40 mg per day. I felt wonderful on the Paxil and the Panic Attacks stopped. After a year I was weaned off the Paxil. With each decrease in dosage I suffered terrible withdrawal symptoms, from trembling, nausea, spacey feelings,anxiety etc. It has taken me three years to be at 10 mg and I have stopped there. I'm not ready to deal with the withdrawal again! I must say Paxil was very helpful with my disorder and without it I may have been a prisoner of my house. I have spoken to several doctors about this medication and none of them are aware of the withdrawal symptoms. Many times the symptoms of withdrawal are the same as the symptoms of our disorder so even the patient may be fooled. I'm trying my best to educate my doctors, but it is a slow process.

-- submitted by myers

"diagnosed me with this social anxiety disorder and gave me a large stack of paxil"

I started working in a retail business about 2 years ago and started eating more and smoking more after gaining about 40lbs I became concerned and went to my doctor with no physical exam and just asking a few questions he diagnosed me with this social anxiety disorder and gave me a large stack of paxil sample packs and gave me instructions on bringing my dosage up from 10 to 40 mgs. in just 12 days after being on 40mgs for about 4 days i had no energy any more just getting out of bed in the morn was a battle and my head became foggy and I had to stop and think about everything that always just were just every day life things I could not even drive. I decided this was not the drug for me and stopped taking it I guess I just assumed that if there were any problems with this that the doctor would have warned me about it or there would have been some sort of warning on the package. this is when my horror began 2 days after quitting came the loss of apatite sweating nausea and all the other things i have been reading about after missing two days of work I was fired from my job and a means to support my wife and son. after a week of sever withdrawals I went back to see my doctor and he told me that he had never heard of any adverse withdrawal effects its been three weeks since I have still bad effects nausea , vertigo cant drive if its not obvious writing and typing are a struggle I feel as though my brain has been fried the people who have had there lives ruined by this drug need to get together and sue smithkline beecham for doing this to us

-- submitted by robert arnson

"I felt on paxil that I couldn't have a great orgasm or none at all"

Well I have just gone off paxil, I had been on it for 10 months for panic disorder. This is one full week without paxil and first attempt at going off of it, The only problem I experience is what people seem to be describing as brain shocks when ever I turn my head a certain way I feel very strange, like in my head, and nausea from time to time. I was on 20mg then 10 for three weeks and for the last week 10 every other day. I feel ok, for the most part except when I dropped down to 10 I was like whooooa, I had feelings again, I felt on paxil that I couldn't have a great orgasm or none at all, and I had no real emotion towards things, although it has helped me immensely, I have decided regardless of what withdrawal I feel, I am going drug free.

-- submitted by shelagh

"I started taking Paxil about 5 years ago for depression"

Believe it or not but this is my third time to wean myself off of Paxil. I started taking Paxil about 5 years ago for depression. I took 20 mg a day for 2 years. I decided to get off and went cold turkey. It was not a pleasant experience to put it mildly. I had severe nausea, dizziness and was extremely distressed emotionally. I felt like I would never feel right again. After a couple of grueling weeks I felt better. I got back on it again about a year later because I had started getting depressed again and the Dr. encouraged me to. I took it for about a year and got off again. Same lousy symptoms getting off. Oh how we forget! I got on it again because I was having panic attacks. The Dr. told me that this was the best medicine for the panic attacks and that studies show that there are no long term effects from staying on the medicine indefinitely. I thought I possibly had mitral valve prolapse, but in fact it was panic attacks because the Paxil immediately took the symptoms away. Which at the time was a good thing. I just wonder how good it is for your body if it causes such a toxic reaction when you quit taking this drug. I've been on it a year and have just had it with this medication. I have put on 30 lbs. and feel horrible. The Dr. said that for some reason people who have been on it for a while sometimes experience weight gain. In my case I feel like it makes me hungry. I also feel like it gives me a feeling of complacency about my eating and weight gain, even though at times I feel disgusted with myself. Anyways, I've been off for 5 days and feeling lousy. I've been extremely nauseated, hot and cold (my hands have been like ice cubes), dizzy, and I feel like an emotional wreck. I ended up taking 10 mg today because I have a party scheduled at my house in 2 days and have too many things to do. My plan is to get through the next 2 days as best I can on the least amount of medicine possible. After that I will continue to refrain from the medicine and get off of this for good!!!!!!!!!!!!! I am going to hire someone to clean my house and I told my husband that he and the kids are on their on for the next week. I had him read all the testimonies so he would understand better. I don't think he really understood how bad I felt until he read what others were experiencing trying to get off this medication. The last 2 times I got off I tried to maintain my same pace with the kids and school and the house and tryed to put on a 'good face' when all I wanted to do was tell people, "Hey I feel like you know what so just get out of my blanketey blank face!" It was brutal. The last couple times I got off I remember after a couple weeks I felt better and after about a month I was back to normal. The first week is really rough. It's hard to get off this medicine but I have done it and I will do it again!

-- submitted by Dr. Marso

"I was experiencing anxiety due to some overwhelming situations in my life."

I began taking the 20 mg of Paxil approximately 15 months ago when I was experiencing anxiety due to some overwhelming situations in my life. I began trying to wean myself off the medication about nine months ago. I started taking 10 mg per day and then 10 mg every other day. Everytime I went more than three days without taking the medication, I began feeling sick at my stomach and somewhat disoriented. I would feel better if I took another 10 mg pill. I asked the doctor who told me that if it makes me feel better, it does not hurt to continue taking it. It has made me gain over 25 pounds and I do not want to take this drug for the rest of my life. I am now taking 10 mg every other day.

-- submitted by Dday, 35

"symptoms I had prior to taking this medication seem like a minor annoyance compared to what is happening to me now"

I am a 42 year old female diagnosed with severe depressive disorder accompanied by manic episode. I have been on paxil about 2 years over the course of the 2 years my dosage has had to be increased several times until the most recent increase to 40 mg ...this is the point where I decided I no longer wish to live on this drug... under the guidance of my doctor - who I must tell you said "the withdrawal is bad from paxil" would have been nice if that was told to me in the beginning or if the information was provided with those handy little inserts that accompany your prescription....anyway I am on my 3rd day drug free and the symptoms are getting worse by the day....the symptoms I had prior to taking this medication seem like a minor annoyance compared to what is happening to me now...I am dizzy, I have the swimming feeling in my head, unprovoked rage, uncontrollable crying spells on and on ...unfortunately my appetite is fine and the food is tasting good and staying down(kidding) I am actually waiting for the nausea to set in because all the testimonials I have read include nausea...I will keep you posted on my progress....because I will be damned if I ever take another Paxil..or any other prescribed antidepressant ...

-- submitted by Pam, 42

"I decided to get myself off the Paxil"

I had been on 20mg of paxil for almost 4 years. About 2-weeks ago I decided to get myself off the drug. Anyway, I dropped down to 10mg a day for 2-weeks and last Wednesday took my last pill. At first I thought I was losing my mind and falling back into depression, but after reading postings of others' experiences I am relieved that what I am going through is "normal". Overall, the drug was beneficial and helped me through a difficult period in my life. The withdrawal symptoms are rather brutal - nausea, brain-shocks, periods of intense sadness. However, I am determined to manage without it. I am on day 4 with no meds and am feeling a little better. At times I just want to go back on it. But, I do believe there is a light at the end of the tunnel and bravely I will face each day. Thanks to all the postings for shedding some light on getting off this drug. It has certainly alleviated some of my fears.

-- submitted by Lisa, 32