Dr Edell, I am a 36yr old male that experiences severe problems when trying to stop using marijuana. I started smoking it recreationally as a young teen. It made me feel good and more relaxed in social situations. When I was 22 I fell off a cliff while climbing and suffered fractures of my ankle and thoracic vertebrae. I found the marijuana to also help with the pain. I live in California where medical marijuana is legal and with a doctor's recommendation 5 years ago I purchased a vaporizer and used his recommendation to gain access to very high quality marijuana at legal dispensaries. I have been vaporizing 2 ounces of marijuana a month for 5 years, preceded by 17 years of smoking on pretty much a daily all day basis. The problems I am experiencing follow: 2 years ago I experienced a "Panic Attack" and ended up in the hospital. The attack helped me to decide to make major life changes and quitting pot was one of them, cold turkey. Life became surreal in a bad way, near hallucinogenic in that everything was in a "dream/nightmare" state. Constant anxiety over nothing, occasionally feeling like I can't breathe/am not getting enough oxygen from the air, overwhelming feelings of impending doom, suicidal thoughts, sweating constantly, jittery, unable to sleep, complete lack of appetite, extremely vivid dreams and nightmares, and going from rage to sadness and back. I thought I completely lost my mind, and I honestly did not attribute this to any sort of physical withdrawal from my body's dependence on marijuana since "pot isn't addictive" and I had not yet separated mental addiction from physical dependence. I went to therapy once I week, started exercising regularly, eating healthier, and as time wore on I slept better, stopped sweating all the time, and regained my appetite. After 4 months I was no longer experiencing panic attacks, but I always felt I high level of anxiety and never felt like I could just breathe a sigh and relax. I felt jittery all the time, and also felt a deep sense of loss. Nothing in life was as interesting, or tasted as good, or looked as good as before. I constantly felt deprived. Then came a very stressful time, I was having difficulty dealing with it and my therapist suggested talking to a doctor about anti-depressants to help through this period of adjustment. I decided that instead of that I would go back to vaporizing marijuana and moderate my use this time. I probably don't need to tell you that didn't work and I am back to using 2 ounces a month. I can't sleep through the night because I wake in the early hours anxious and sweating, and shortly after I vaporize anxiety disappears and sweating stops. Here's where I need your advice: I have seen a few well respected doctors and they have similar yet differing opinions. An addiction specialist says I really need to go to an inpatient center for at least 30 days where I will probably be placed on anti-depressants and benzodiazapenes. He believes the marijuana is the problem, and I need to continue counseling once I get out of inpatient. The psychologist has a slightly different take: He thinks I have an underlying chemical imbalance that I have been addressing with marijuana but that it isn't working for me anymore. He thinks I should start low level anti-depressants, and after that kicks in that I may find it easier to quit marijuana, and that quitting suddenly now might do more damage than good. He recommends I stay at home with the support of my family as opposed to the expense of an inpatient stay. I would greatly appreciate your thoughts on whether or not anti-depressants are a good idea and if so should they be started before, after, or at the same moment I quit marijuanna. Also your thoughts on whether inpatient detox to start or outpatient is better, and any prognosis for my brain chemistry recovering with or without pharmaceutical help.
Thank You,

Jason