Having unwanted thoughts/feelings is a symptom that causes a lot of distress and confusion to a significant percentage of people in both benzodiazepine and antidepressant withdrawal. It occurs in more people than you imagine, but because it is frightening and embarrassing, it is seldom disclosed or discussed. I have included feelings here as sometimes the thoughts are accompanied by urges.
Actually, this is the one symptom that I have had more than a few doctors (in withdrawal) contact me to ask if I had heard of before. It is a scary symptom that can result in one being misdiagnosed and possibly medicated. If you have had it or still do, I hope what I write here will help.
How do I know they are due to withdrawal?
This symptom causes intrusive, ruminating, unwanted, sometimes repetitive thoughts which can include memories (good or bad), what if? thoughts, thoughts of imminent catastrophes and doom, thoughts of suicide, death and taboo subjects such as inappropriate sexual urges, images, thoughts and obsessions. They can vary or have just one persistent theme.
When I did my chemical dependency training in Houston, we were taught how to assess clients in order to determine when a thought warranted professional attention or when it was withdrawal-related and could be expected to go when recovery was attained.
• Were these thoughts experienced prior to withdrawal – whether due to tolerance or discontinuing the drug?
If this was an issue that arose prior to withdrawal, then the notion of it being caused solely by withdrawal should be dismissed, but withdrawal can make pre-existing thoughts more intense and more frequent.
• Are other symptoms present?
If you are experiencing a cluster of symptoms that surfaced around the time of the unwanted thoughts, then it is more than likely that the thoughts are withdrawal-induced. However, there have been a few instances where the person had just the thoughts and no other symptoms. The important criterion is that it was not a pre-existing issue.
What are some examples?
Caution: The following may sound bizarre, and they are. They are also very, very disturbing to the person experiencing them. If you do not have this symptom, do not think for one minute this will happen to you!
Here are some I have heard of over the years. (Please note that all the people I supported who had withdrawal-related unwanted thoughts went on to fully recover and the thoughts completely disappeared.)
1. Having inappropriate sexual thoughts about a family member or another person who would not normally be considered in that way.
2. Violent thoughts about a family member or another person by someone who, prior to withdrawal, had no anger issues or violent tendencies.
3. Thinking of an image that triggers a phobia – e.g. someone afraid of spiders having intrusive, repetitive thoughts about spiders, or in one case one man kept imagining he was a spider.
4. Thoughts of death and suicide. Repetitive thoughts or voices saying the person wants to die, needs to die, hopes to die, etc. Images of being dead or badly hurt. Flashes of how the person would look after an accident. Other thoughts and images of death. Fears of family members and/or friends dying. The thoughts cause extreme fear.
5. A single sentence, a line or chorus from a song, words from a movie, a news item or breaking news headline, a single word, a group of words – any of these – bombarding the brain for extended periods, repeated obsessively and in an intrusive way with no way of voluntarily stopping them. They can either come and go randomly or be triggered.
6. Flooded with memories of childhood or other times in life, or of traumatic events. Pleasant memories can also be present.
If you are having an unwanted thought that is not mentioned above, please don’t worry. The list is exhaustive and if I were to write every example, it would take too many pages. You would not believe the strange themes and scenarios that a compromised and unbalanced withdrawal-affected brain can conjure up. But the above ones are just to give you an idea. Some are even more bizarre, if that’s possible!
When are they dangerous?
The most important thing, if you are having unwanted thoughts, will be your ability to observe what is happening and your awareness that the thought is not a normal one. There should be an initial sense of discomfort about having them, alarm even. This is a safety mechanism and it means that your rational mind is still very much intact and that you are aware that these thoughts are abnormal and out of character. And this determines the difference between your being emotionally safe or unsafe.
When someone says to me, “I’m scared and extremely worried about these thoughts I am having. I think it must be withdrawal because these are thoughts I would never have had before,” I know she or he will be okay.
This is very important:
Unsafe: It is not good if someone says, “I’m phoning because I’ve become a spider and I’m scared of myself.”
Safe: It is better if s/he says, “I’m worried because I’m having thoughts that I’ve become a spider and I’m scared. Am I losing my mind?”
The latter means that the notion of having the thought, rather than a belief that the thought is true, is causing concern. The ability to observe what is happening in detached mode and to be in awareness remains. S/he knows that it is impossible to be spider. This usually indicates emotional safety.
Unsafe: It is not good if the person says, “I’m phoning because I want to take my life,”
Safe: It is better if s/he says, “I’m worried because I am having weird thoughts about taking my life, but I don’t want to die. Yes, sometimes the symptoms are so bad that I think I would be better off dead, but I know I don’t want to die; I want to get better. Taking my life is something I would never think of doing” (or something to that effect).
This ability to observe and detach from the thought and to be aware that there is no genuine yearning to carry out the act, could be the difference between coping well and acting on any ideation.
Note: With regard to suicidal thoughts, no matter the intensity, it is always advisable to make a safety plan with someone (a family member, your GP or a close friend) and keep The Samaritans (UK), National Suicide Prevention Lifeline (US) or another emergency number to hand, whether or not you believe the thoughts to be withdrawal-induced or non-related and authentic, safe or unsafe.
Unsafe: It is not good if the person says: “I’m phoning because I want to have sex with my ……”
Safe: It is better if s/he says, “I am so scared. I don’t know what’s happening. I keep having these awful thoughts of wanting to have sex with my…… How sick is that? Have you ever heard of this before? I don’t know what to do!”
It means that, again, the ability remains to observe the thought from the perspective of someone who would never, in a non-withdrawal situation, even think anything remotely close to this.
I hope this explains the differences. In a nutshell, being able to identify and observe the thoughts as abnormal and not a part of your reality, being able to put them into context and separate from them, and finding ways of coping with them are the key factors.
My experience with the person who thought when I was saying “It’s withdrawal” that I was being sexual made me think I need to explain this symptom – just so you can understand better and know whether you are safe or not.
If he had said, “I am worried that my mind is telling me you are coming on to me when you say, “It’s withdrawal,” or “When you say, ‘It’s withdrawal’ it makes me think you are coming on to me. But that would not make sense. Are you coming on to me or has my mind gone a bit weird?” It is being aware that the thoughts are not normal, and being able to put them into context and cope with them, that will ensure emotional safety.
With regard to the suicidal thoughts, your safety is priority. Don’t try to self-assess whether you are at risk or not, and don’t take your ability to manage them for granted. Have a safety plan, as mentioned above. There is nothing to lose by doing so.
If you support someone in withdrawal who has rage and anger issues and becomes abusive and/or violent, this is not acceptable. In this case, your safety comes first.
Provided you are emotionally safe, it is possible to cope successfully with unwanted thoughts. Yes, they can be extremely distressing but being able to put them into context – that they are withdrawal-related, that you did not have them prior, and that you don’t have to believe them, act on them or own them – will make you better able to manage.
If you can consider them in the same way you consider the other symptoms – pain, tinnitus, gastric problems, etc. – you will cope well. Eventually they will either lessen in intensity and frequency, or they will completely go spontaneously. Whichever pattern unfolds, this symptom does not last, as many who have had it and are now better will confirm.
What can happen is that the more resistant you are, the stronger the thoughts will dominate and torment. They become all-encompassing until it is difficult to remember a time you didn’t have them and you start to believe they will never go away. Instead of resisting them and struggling against them, they can be observed and accepted.
The concept of mindful acceptance works very well in dealing with these unwanted, distressing thoughts.
“When we are more practiced in using mindfulness, we can use it even in times of intense distress, by becoming mindful of the actual experience as an objective observer, using mindful breathing and concentrating attention on breathing with the body’s experience, listening to the distressing thoughts mindfully, recognising them as merely thoughts, breathing with them, allowing them to happen without believing them or arguing with them.
If thoughts are too strong or loud, then we can move attention to our breath, the body, or to sounds in the environment. We can use kindness and compassion for ourselves and for the elements of the body and mind’s experience. May I be filled with peace and ease. May I be safe.” (Brantley 2007).
A good way of looking at this is to imagine there are two layers:
1. The first layer is that you are having these thoughts. This is a symptom. You are in a situation that you cannot prevent and have no control over.
2. The second layer, over which you have control, is how you interpret having the thoughts and how your interpretation affects you.
f you struggle against the thoughts: “I want these thoughts to go. I hate having them. I hate how they make me feel. I won’t have any peace until they go,” this will create a neurochemical reaction in the brain that will increase your anxiety and distress.
If you are able to detach and observe the thoughts without judgement, without resisting and with acceptance, and put them into context, “I am in withdrawal. This is a known withdrawal symptom. I don’t like having these thoughts but there is nothing I can do. I understand that they are thoughts and will eventually go.”
See if you can imagine the thoughts as a large wave coming towards you and as it makes contact, instead of struggling against it, you calmly ride it by taking your attention to your breath. With practice, this will help. All you do is you observe the thoughts, without judgement, and take your awareness to your breathing, you will notice a difference. Try it and see. Don’t analyse or become preoccupied with the content or process, just breathe. All you need to do is breathe.
Another good coping technique is to distract yourself. As with the mindfulness, you are not trying to resist the thoughts or get rid of them. You observe them, you normalize and accept the fact that you are having them: “I am in withdrawal and this is a symptom. There is nothing I can do but wait it out.”
Then you play an online game, watch a movie, or find some pleasant and absorbing activity that captures your attention. The thoughts will more than likely still be there, but just as with the mindfulness where your focus is on your breathing, in this case it will be on the game, movie, painting or whatever you’re doing.
Mindfulness is a cognitive behavioural technique approach and there are others that can be used. But the above concept of being non-resistant and accepting is most important as it will make any other technique more effective.
More than anything, remember that provided your thoughts are withdrawal-induced – i.e. surfaced during withdrawal – they will go when withdrawal ends. All you need to do is accept them as being a part of the healing process, find a way of coping, and trust that you’ll be okay. This, too, shall pass.
Brantley, J. (2007). Calming Your Anxious Mind: How Mindfulness and Compassion Can Free You from Anxiety, Fear and Panic. California: New Harbinger.