Benzodiazepines and Paradoxical Reactions: What is the cause?

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Ceke2002

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Yes, I know, I know, it's another benzo thread ;)

Having gone through it myself, I'm just curious to understand the mechanism for paradoxical reactions to benzodiazepines and also whether or not that mechanism changes between the types of paradoxical reactions that are seen almost immediately and those that seem to develop over a longer period of time. Is there any way to predict which patients are more likely to have a paradoxical reaction?

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Is there any way to predict which patients are more likely to have a paradoxical reaction?

Patients with a history of head injuries may be more prone to paradoxical/ weird unexpected reactions.

When are you going to get your MD? :)
 
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Which paradoxical reaction you talking about? You mean when the patient instead of calming down gets more irritable? That's the one I see docs talking about the most.

Benzos like alcohol cause disinhibition in many because it depresses frontal cortex function. It's a reason why some docs don't recommend benzos be given to TBI or intellectually disabled patients when they are agitated.

It's also a reason why some people are happy drunks but some are just plain mean when drunk.
 
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I don't think there is a way to predict necessarily. Some patient populations may be more prone to an unintended effect of the medication. Example: person with a borderline type of personality and benzos - can lead to increased anger/impulsivity, I guess. I've had a couple of patients also tell me this and ask to never be placed on a benzo (I know, I thought I'd never hear those words lol).

I liken benzos to alcohol a bit. Couple drinks, maybe you feel kind of relaxed. Couple more: you have people who are less inhibited, and you get either: someone who can 'finally let loose,' 'here come the tears,' 'who wants to fight,' etc.
 
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What about the mechanism by which benzos lifts people out of catatonia? I've always found it interesting that benzos can reverse that. Actually, I'm fascinated by catatonia itself because it seems to bridge psychiatric and neurological boundaries. It also seems to erase the idea a bit that one can will oneself out of mental states, which makes it particularly interesting to me.
 
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When are you going to get your MD? :)

Shh, don't jinx it. :laugh: I'm looking into doing a foundation studies course next year, which will allow me direct access to an under grad degree program if I meet the requirements. It's just a matter of finances. :cat:

Which paradoxical reaction you talking about? You mean when the patient instead of calming down gets more irritable? That's the one I see docs talking about the most.

Benzos like alcohol cause disinhibition in many because it depresses frontal cortex function. It's a reason why some docs don't recommend benzos be given to TBI or intellectually disabled patients when they are agitated.

It's also a reason why some people are happy drunks but some are just plain mean when drunk.

That makes sense, and I suppose you'd have to factor in that people metabolise different medications differently as well, for example I can get away with taking what most would consider sub-therapeutic doses of antidepressants and antipsychotics because I still get quantifiable beneficial effects on low doses. I've always figured it had something to do with the way my brain/body responds to drugs in general, because I was the same with illicit drugs, I could easily take 50% less of a dosage than what the average user would be taking, and I'd still be as dialed off my face as if I'd taken 3 times that amount.

The type of atypical reaction I'm talking about is the most common one with benzos, or at least what I understand to be common - when you take a dose and it more or less has the complete opposite effect. I've seen a rapid atypical reaction once in a close friend, who could take any other benzodiazepine and be fine, but one dose of Klonopin and he lost it. I received a rather frantic phone call from his girlfriend, and turned up to their house to find him with a knife held to his chest, sobbing and shouting about how his girlfriend was cheating on him , and planned to leave him, absolutely none of which was true. He claimed to have no memory of the event after the fact, so I'm not sure if he was in some sort of dissociative state or if he was just conveniently choosing to forget.

In my case the paradoxical reaction seemed to form over a fairly long period of time (around 8 years). When I first started Xanax everything was great, better than great even, but then the longer I stayed on it and the higher up they kept pushing the dosage, the more I gradually started to feel that something wasn't right, and that something eventually turned into a paradoxical reaction which consisted of agitation, insomnia, paranoia, extremely disregulated mood, sudden rage attacks (can't find the shirt I want to wear, time to rampage and start smashing the house up :rolleyes:), etc etc.
 
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, but then the longer I stayed on it and the higher up they kept pushing the dosage,
Like I said, medstudents know enough to know this will happen, so a doctor doing this type of practice is usually just not giving a damn that he's putting the patient down that dependence-hole.

It's quite anti-social if you ask me. We psychiatrists use the term differently than laymen. The laymen term means some guy at a party that's not a smooth talker. Psychiatrists use it to describe someone that has an impaired conscience and doesn't give a damn or as much of a damn if they hurt people so long as in doing so it gets them ahead.
 
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Like I said, medstudents know enough to know this will happen, so a doctor doing this type of practice is usually just not giving a damn that he's putting the patient down that dependence-hole.

It's quite anti-social if you ask me. We psychiatrists use the term differently than laymen. The laymen term means some guy at a party that's not a smooth talker. Psychiatrists use it to describe someone that has an impaired conscience and doesn't give a damn or as much of a damn if they hurt people so long as in doing so it gets them ahead.

Precisely, and I've never understood why anyone would go into the profession of medicine just to turn their backs on its very core beliefs of do no harm - although I suppose some people have a looser definition of what harm is, or maybe I have a tendency towards being a bit of an idealist.
 
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