Benzo withdrawal induced mania

Started by whopper
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whopper

whopper

Former jolly good fellow
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Anyone here ever treat this & find anything out of the ordinary?

I was transferred to a new unit-got a lady who was getting PRNs round the clock which included Ativan 2mg QID-PRN. As many of us know Haldol, Cogentin Ativan are given as a cocktail. Well this lady got the cocktail round the clock for weeks. She eventually became ativan dependent. Reason why I know is becuase I stopped her Ativan when I came to the new unit, trying to avoid iatrogenic ativan dependence, and the next day she had diaphoresis & tremors.

So I put her back on the ativan & tapered her off. Right when I start the taper down she became manic (I'm talking full blown manic with pretty much every symptom you see with mania) despite being on 3 meds at high doses that fight mania-Risperdal 4mg BID, Lithium 450mg ER BID & Depakote ER (dosage got her blood level to about 115 ug/ml).

The only thing that seems to stop her mania is a benzo. Give her haldol 10, zyprexa zydis, geodon IM, nope....nothing. I've even added Zyprexa at 20mg BID, nope--nothing. Give her 1mg of Ativan and her mania goes away.

So I'm pretty convinced she's got mania induced by benzo discontinuation.

Anyways, today, after about 30mg of Haldol PRN, with no success, I gave her 2mg of Clonazepam & the mania went away. Since nothing for standard mania seems to be hitting her, I'm going to keep her on Clonazepam for a few days then do a very slow taper down.

I've seen very little literature on this. Anyone have the same problem? I'm beginning to speculate that mania induced by benzo discontinuation may be very treatment resistant with standard meds for mania based on what I see with this patient.
 
I'm not thinking that the mania would be turned on & off like a switch. To me, it points less to a true mood disorder, and something more 'mixed.'

If you could ride out what we're for now calling mania, it would likely stop and no more benzos would be needed. Might take the opportunity since she's on inpatient, if you decide to go that way.
 
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The on/off aspect metioned by Sazi and the responsiveness to benzos makes me think complex partial seizures (which can present as pretty much anything). EEG would be helpful, if for nothing else than to confirm actual BZD withdrawal, but esp. since it might reveal epileptiform activity. If that's not feasible, might be worth an empiric trial of another AED alongside the VPA. Also worth mentioning that there's in-vitro evidence of neuroleptics lowering seizure threshold (though clinical evidence is scant), but might be a part of the lack of response to atypicals.

Out of interest, what's the lithium level?
 
this is a stretch but could this actually be a decent use of neurontin in bipolar disorder as an adjunct?

GABA activity has been implicated in bipolar dz. And there are several studies about the efficacy of BZDs in treatment-resistant mania and psychosis. Which presumably have their clinical effect through GABA-ergic action.

Plus, the sedative effect of neurontin wouldnt' be bad either way.
 
Out of interest, what's the lithium level?
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1.0.

She's now on 6 meds...
Haldol 30 mg a day
Zyprexa 40mg a day
Risperdal 8mg a day
Lithium 900mg a day
Depakote 2500mg a day
Clonazepam 2 mg a day

The Clonazepam did dampen her mania a bit. With the haldol, her mania is now to the point where she only needs a PRN (haldol & benadryl) 1-2 x a day vs 3-5.

I only gave her the clonazepam because my theory is her mania is benzo discontinuation induced, and haldol 10mg PRNs were barely touching her.

I checked her old records. Each time she was discharged, Zyprexa @ 20mg a day & Depakote about 1500mg a day were all that was needed. However one of her discharges, someone discharged her with the above & Ativan 2mg QID (idiotic).

Which presumably have their clinical effect through GABA-ergic action
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This has crossed my mind though the current data suggests that neurontin does not have any benefit in mania. However let's assume that my theory is correct & this mania is somehow related to her discontinuation of benzos. Then maybe it would work. I'd be willing to try this, but not at this stage.
 
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whopper said:
This has crossed my mind though the current data suggests that neurontin does not have any benefit in mania. However let's assume that my theory is correct & this mania is somehow related to her discontinuation of benzos. Then maybe it would work. I'd be willing to try this, but not at this stage.
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Agreed. IMO it'd only be something to try if she remains difficult-to-impossible to wean off the benzos.
 
whopper said:
1.0.

She's now on 6 meds...
Haldol 30 mg a day
Zyprexa 40mg a day
Risperdal 8mg a day
Lithium 900mg a day
Depakote 2500mg a day
Clonazepam 2 mg a day

The Clonazepam did dampen her mania a bit. With the haldol, her mania is now to the point where she only needs a PRN (haldol & benadryl) 1-2 x a day vs 3-5.

I only gave her the clonazepam because my theory is her mania is benzo discontinuation induced, and haldol 10mg PRNs were barely touching her.

I checked her old records. Each time she was discharged, Zyprexa @ 20mg a day & Depakote about 1500mg a day were all that was needed. However one of her discharges, someone discharged her with the above & Ativan 2mg QID (idiotic).


This has crossed my mind though the current data suggests that neurontin does not have any benefit in mania. However let's assume that my theory is correct & this mania is somehow related to her discontinuation of benzos. Then maybe it would work. I'd be willing to try this, but not at this stage.
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Although she is already on a lot of meds, how about trazodone (say 50mg QHS or 100mg QHS and 50mg PRNs for insomnia) -- this will give her the benefit of sleep, which in at least two cases I have seen was the #1 thing for breaking the patient's mania.

Good luck
 
whopper said:
1.0.

She's now on 6 meds...
Haldol 30 mg a day
Zyprexa 40mg a day
Risperdal 8mg a day
Lithium 900mg a day
Depakote 2500mg a day
Clonazepam 2 mg a day

The Clonazepam did dampen her mania a bit. With the haldol, her mania is now to the point where she only needs a PRN (haldol & benadryl) 1-2 x a day vs 3-5.

I only gave her the clonazepam because my theory is her mania is benzo discontinuation induced, and haldol 10mg PRNs were barely touching her.

I checked her old records. Each time she was discharged, Zyprexa @ 20mg a day & Depakote about 1500mg a day were all that was needed. However one of her discharges, someone discharged her with the above & Ativan 2mg QID (idiotic).


This has crossed my mind though the current data suggests that neurontin does not have any benefit in mania. However let's assume that my theory is correct & this mania is somehow related to her discontinuation of benzos. Then maybe it would work. I'd be willing to try this, but not at this stage.
Click to expand...

So the new news here is that she's now on 3 meds that could potentially lower the seizure threshold, whereas in the past she was on one (the mildest of the 3) and held by the VPA. I still like seizure for this, especially with the klonopin helping. You could try several things here but I'd favor EEG - if not possible then perhaps a trial of tapering the neuroleptics and LiCO3 while adding an AED.

For your perusal:

http://www.ncbi.nlm.nih.gov/pubmed/...nel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum
 
The seizure idea has crossed my mind. I'm fishing for zebras at this point. I'll talk to the neurologist because the institution will not allow the psychiatrist to order an EEG, and the neurologist here is ahem--well not very cooperative. I had a patient with trigeminal neuralgia and he blew me off for a few weeks when I asked him to prescribe something to help her (per the rules of the place). I got sick of waiting & seeing my patient cry in agony on almost an everyday basis so I just treated it myself.
 
whopper said:
The seizure idea has crossed my mind. I'm fishing for zebras at this point. I'll talk to the neurologist because the institution will not allow the psychiatrist to order an EEG, and the neurologist here is ahem--well not very cooperative. I had a patient with trigeminal neuralgia and he blew me off for a few weeks when I asked him to prescribe something to help her (per the rules of the place). I got sick of waiting & seeing my patient cry in agony on almost an everyday basis so I just treated it myself.
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Your neurologist will almost certainly NOT agree that this could be seizure related. In the US (outside of behavioral neurologists) most neurologists are strict "no fit, no seizure" types. Maybe you could talk him into the EEG anyway. Otherwise, you might want to try adding the AED - polypharmacy seems to be a moot point in this case.
 
Benzodiazepines are very useful as augmenting agents in preventing mania. This is an underemphasized factor due to the stigma associated with using benzos. There is a study-(I don't remember the author off-hand), which showed that patients with lower rates of relapses used more clonazepam or another benzodiazepines. I think this patient probably has a true mania or mixed disorder which relapsed with a quick benzo taper, in addition to usual withdrawal sxs.
 
TheWowEffect said:
Benzodiazepines are very useful as augmenting agents in preventing mania. This is an underemphasized factor due to the stigma associated with using benzos. There is a study-(I don't remember the author off-hand), which showed that patients with lower rates of relapses used more clonazepam or another benzodiazepines. I think this patient probably has a true mania or mixed disorder which relapsed with a quick benzo taper, in addition to usual withdrawal sxs.
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I agree with the use of BZDs in mania (and the unfortunate stigma generally associated with them), but I'm not sure that true mania would respond in the on/off fashion that Whopper described.
 
Doc Samson said:
I agree with the use of BZDs in mania (and the unfortunate stigma generally associated with them), but I'm not sure that true mania would respond in the on/off fashion that Whopper described.
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I should have mentioned true mania as one of the possibilities only. Of course, there is a strong possibility that this is withdrawal which can manifest from simple trembling to tremors to seizures.
 
but I'm not sure that true mania would respond in the on/off fashion that Whopper described.
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I understand.
I had a case where a lady become psychotic after being in the hospital for a non-psychiatric reason. She was addicted to Xanax and after a psyche consult discovered this, her benzos were tapered down while she was on the medical floor. She became psychotic despite having no history of any previous psychiatric disorder. One of the only things that seemed to make her psychosis go away was benzos. Antipsychotics barely touched her. A rare case of benzo discontinued-& the patient became psychotic.

I'm not 100% certain mania can be caused by discontinuation of benzos. After the above event I did some literature searches, couldn't find any at first, but later on found 2 cases. 2 cases isn't exactly proof positive that this phenomenon happens.
 
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The point I am making is that the use of benzos in pure bipolar patients may not be such a bad thing as they have been shown to prevent relapse due to their effect on circadian rhythms and sleep. If this or another patient has bipolar mania, it is likely that they may relapse quicker in due course if a stabilizing medication like a benzo is discontinued. It is true that this patient most likely has withdrawal associated symptoms, but if she had a true bipolar disorder, it would have been better to continue the benzo.

I found the study I was talking about-

Temporal relation between sleep and mood in patients with bipolar disorder.
Bauer M, Grof P, Rasgon N, Bschor T, Glenn T, Whybrow PC.
Department of Psychiatry and Psychotherapy, Charité--University Medicine Berlin, Campus Charité Mitte (CCM), Berlin, Germany. [email protected]

BACKGROUND: Early recognition of the prodromal symptoms of bipolar disorder, combined with a patient action plan, may help to prevent relapses. Sleep disturbances are frequent warning signs of both mania and depression. This study used cross correlation analysis to characterize the relationship between mood, sleep and bedrest in longitudinal data. METHODS: Self-reported mood, sleep and bedrest (mean 169 +/- 59 days of data per patient) from 59 outpatients with bipolar disorder receiving standard treatment were analyzed. The cross correlation function was used to determine the latency between the changes in sleep and/or bedrest and mood for time shifts of between -7 and 7 days. RESULTS: For sleep and/or bedrest, a significant inverse correlation was found with the change in mood, most commonly with a time latency of one day. Sleep plus bedrest had the strongest relationship with a change in mood, with a significant correlation in 24 of 59 patients (41%) for the night before or night of a mood change. The patients with a significant cross-correlation between mood and sleep plus bedrest reported about two thirds of all large sleep changes of >3 h and three fourths of all large mood changes (>20 on 100-unit scale). Patients with a significant cross correlation were more likely to take benzodiazepines. CONCLUSION: In most patients with a significant cross correlation between sleep and/or bedrest and mood, the mood change occurred on the day following the change in sleep and/or bedrest. Sleep changes from a previous pattern, especially those of more than 3 h, may indicate that a large mood change is imminent.
 
I know this is an old post, but found it interesting. It sounds like the woman became an accidental addict of benzos. To give you a little background I went through a very large cross taper from 4mg Xanax and 3mg Klonopin OVER to 120mg of Valium. The taper was for 60 days, and even then it was too fast and should have been done in 6 months. I never abused the medication however after 4 years it stopped working for GAD at 3mg of Xanax and the doctors moved me all the way up to 7 mg of high potency benzos. The ratio is 1: 20 and actually there is a different ratio for Phenobarbital to Valium or to Klonopin, Xanax, Ativan and even Gabapentin. You have to find the exact ratio or you will spike this woman and further annihilate her GABA receptors making recovery a very protracted withdrawal which will take months to recover from. The problem lies in when a patient reaches tolerance and normally the withdrawal should be no more than 60 days. However when a person is spiked on Phenobarbital to Gabapentin they will almost always have an immediate psychotic breakdown - you called this mania. I have scene this way to many times and have been in touch with many other accidental addicts like your patient.

Why does the patient react the way it did? Well to answer that you have to understand that benzos interfere with our instincts of fight or flight. If you read the studies of how benzos were first developed you will realize that they first used this on two male fighting BETA fish. They actually stopped fighting, but how did that happen when that is their instinct? Once the damage is done to the fight or flight receptors in the brain a person has lost a true sense of their identity for a temporary period while one heals.

Unfortunately there is no extended stay detox unit that doesn't push AA or that isn't run by ex-street drug addicts. Most people who get a good dose of GABA restrictive meds as discussed above will unfortunatley take 15 months to 2 years to fully recover. The use of helper meds unfortunately makes a patients healing process more extended.

For more information on this topic please see the below studies and manual from the UK on how to taper someone off of benzodiazepines, phenobarbital, and gabapentin.

http://www.benzo.org.uk/manual/

Medications to avoid during a taper from benzodiazepines:

http://www.benzodocs.com/meds_to_avoid.php


-I hope the patient is doing well.

regards,

Ziggy
 
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Wow. Time certainly does change perspectives. I remember this lady's case. I also remember there was an "eye of the storm" period during her mania where she lost her voice due to her continual screaming. So while she continued to be manic, we actually had peace on the unit for 2 days because she couldn't talk.

That same person I eventually did end up discharging--on several several medications. About 6 months later she came back, was not placed on benzos and needed a lot less medication to stabilize her mania.

Since then, I've had 2 cases where people were benzzo-dependent, and went through a period of psychosis/mania when taken off their benzos. In each case the person was on high levels of Xanax that would not be provided in jail. The jail doctor could provide other benzos but not Xanax. The patient had to be transferred to the hospital because nothing was touching them (high levels of Thorazine, Haldol, Ativan, etc).
 
I can remember when the medication stopped working and my instincts told me to go to the hospital for help, however my conscious knew this was a bad idea. I drove around the hospital many times while experiencing a drug induced 32 hour panic attack. I remember thinking that I would never be normal.

I have begun to heal myself now at over 8 months off. It's a very long and lonely process for the accidental addict, however there are support forums for people in benzodiazapine withdrawal where many members stay online all day long for 15 months to 2 years. These medications are very unusual as we want support, but don't want to be around anyone. AA or NA simply do not work, and will actually induce benzo rage (mania). We can hardly tolerate ourselves during this peroid, but it is not healthy to be alone and stuck with severe intrusive thoughts so many of us stay online in support room while we chat with the elders who have blazed a path before us. (FACT: Did you know OJ Simpson was on benzodiazapines. I believe he did commit the murders, however I also do believe that he didn't remember doing it because these medications erase our memories) I have lost 5 years of my own life, as I feel like I just woke up out of a coma. These meds never gave me a high, and I actually started becoming more active on them as I was very functional. However all bets are off when you reach toxicity and then no dose of benzodiazapines will tranquilize us. The GABA receptors have been damaged and need to heal. The only way for them to heal is to no longer be on benzodiazapines. I realize this makes your job as a medical professional very difficult, but the best thing I could tell you to do is to attempt to find a long term detox that will gradually taper the patient off using Valium.

I no longer have anxiety attacks and I experience emotions as a human being should. I still have a way to go as my dopamine and seritonin levels are very low. I was on Pristiq before the taper and then I switched to Cymbalta to address the pseudo Fibromyalgia symptoms that were occurring while trying to combat the depression. I soon realized that GABA receptors are not just in the brain- but are in the entire body and they had been damaged so severely by benzodiazapines. The antidepressant's were actually making my withdrawal symptoms worse and revving me up. They were not effective because they were causing me more pain, thus making my depression worse. I quickly switched over to Lexapro and tapered off in 2 weeks. I actually didn't even notice the withdrawal from an antidepressant because the withdrawal of benzos trumped what I was going through.

I have met Dr's, Lawyers, CPA's, and average people who became victims of this medication. Most of us were all very lucky because we were able to figure out what was causing the damage by doing research and informing our families before we handed ourselves over to them. I fear that people who do not get adequate support and knowledge on how to care for themselves will actually turn the lights off. This process causes Psychosis, Detachment, Depersonalization, and De-realism to name a few immediate symptoms that can last several months. Unfortunatley this knowledge is not in the medical community in the USA, thus causing further damage to patients. Not many people have managed to get off of these medications successfully because the Protracted Withdrawal is so intense and long that a person can literally lose themselves. I have witnessed many people still on benzodiazapines come down with the strangest illnesses and have gone to the best specialist in the US to only be misdiagnosed. The ONLY medication for people who have reached toxicity of benzodiazapines is TIME. Any medication or supplement can cause irreversible consequences. A simple Vitamin D caused me to get adrenaline rushes, and I was taking this supplement because my levels showed up low on my bloodwork. For some reason benzo withdrawal causes low Vit B, D, and magnesium levels. I did get Vit B injections in the arm for over 2 months and it was a battle with my instinct and mind on how I reacted to the energy shots that were given to me. To be honest - It was complete HELL on EARTH. I was arguing with myself constantly in my own head about how I should be acting as a human being because the flight or fight instinct in my brain had become temporarily defective. I thought I had become a psychopath / sociopath with suicidal / homicidal idealism. This is not uncommon at all and many of us never talk about it because we don't want to be locked away into a hospital where more medications will be given - Thus making healing virtually impossible. Fortunately most of us who went through withdrawal were very educated about this journey; we may not have believed that we would think the things we did but we never reacted on any of the thoughts.

Why don't we know about this medication yet and how dangerous it is? Most likely because the patient is not able to speak for themselves or they have lost their social status in this world to be considered trust worthy. I realize there was an epidemic with Valium in the US which went away briefly to only be replaced by drugs from Pfizer that are 20 times more potent, faster acting, and with a shorter half life. Valuim has become the protocol now for tapering anyone off of benzodiazapines because the half life is 150 - 200 hours. It will take 2-3 weeks to build up in the system, but from my own experience a week is sufficient enough.

-I am not a doctor, but when I went in to detox myself I was able to work with the RN by educating her of the protocol to be used. I was in control of my own taper, and I actually chose to speed it up because if I spent anymore time around street-drug users I would have lost my mind. I was the first patient that this RN came across with such knowledge in this field that she allowed me to educate her on how to taper off of medication. I still stay in contact with her today and help her out with future patients who have not abused the medication. While I was still in a huge fog I witnessed heroin and meth users playing basketball 7 days later. This medication is horrible in my opinion and needs to be used with extreme care. Yes, I am in awe that Pfizer was able to get Xanax XR approved by the FDA with 2 six week clinical studies. That was all it took to cause so much damage in a person's life. It cripples the entire family unit and many families refuse to deal with it for this long.

I'm not a radical or anti-med person, though I still stay active in the community and provide support where I can - as this was one of the hardest things I have done in my life and the journey still isn't over. My own father was president of a worldwide consumer healthcare / pharmaceutical company, so I have been exposed to this industry for quite sometime. I don't hate him, though at times during my acute withdrawal I would be lying if I didn't despise the pharmaceutical empires while I continued to learn more about these medications. Even he is perplexed by this medication and what it has done to his own son. I had to drop out of my PhD program for Psychology @ UVM when this medication took a hold of me. It has crushed a lot of dreams, however I know that one day I will be able to continue on with life.


Ziggy

PS: Be careful using any anti anticonvulsants off label to treat these people as yes they will stop a person from having a seizure, but more importantly it will spike their gaba receptors. Also the use of Ativan will actually make things worse as it causes interdose anxiety. The half life of this medication is too short and will actually start to make the patient worse. Switching over to Klonopin is usually what I have seen most medical facilities do, however this medication was not originally developed for anxiety. Klonopin was originally spelled with a C, however it got confused with Clonidine and was rebranded under its current name. The use of this medication was to treat seizure disorders and nerve pains. From my own experience Klonopin and even Gabapentin cause one of the worst protracted symptoms in which a persons nerve endings burn continually for many months This pain is what induces detachment and derealism because the brain cannot endure the torment for such an extended period of time. This is all very tricky business, and the only safe protocol is to use a longer active agent such as Valium to stabalize your patients. None of us are alike and by adding a different agents that act on the GABA receptors in different ways can make this puzzle very difficult to piece together.
 
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This is an old post but I am compelled to respond. I am a doctor of psychology who has been on clonazapam for 17 years. Given for anxiety/panic disorder. I now run a forum and blog about withdrawing from benzos. I am slowly making my way to being benzo free but at an enormous cost. If you read Ziggy's replies, you have more of the truth about benzo use and dependency.

Once your GABA receptors down regulate from benzo use, you are dependent on the drug. Detoxing a patient from a benzo is NOT like any other detox. The goal is not to get the drug out of the body as much as it is to allow the brain to heal itself.

It is shameful that this day in age, medical students and current doctors are not taught the truth about benzo use. You can not place a patient on them for more than a few weeks. They are NOT meant to be used long term.

It is known in the benzo community at least, that benzo withdrawal psychosis is NOT helped by current meds. Adding more drugs to an already broken, fragile brain is criminal.

PLEASE, every medical student learn more about benzos before you start writing scripts for them. If I could go back and avoid the day I sat in the doctors office and accepted his script and his lecture that I would need to be on benzos the rest of my life, I would in a heart beat. The ill health I have suffered due to tolerance withdrawal and now this slow and agonizing taper was not worth the reduction in my anxiety.

What I am experiencing now makes my old anxiety a walk in the park.

Psych meds are all addictive as they change the brain. It takes time for brains to heal. Please write less scripts and apply more care and and compassion for your patients. Pills mask the real reasons people suffer most of the time. Not all, certainly but most.
Klonopin was marketed as a med in the 1990s as a pill to help women who had been sexually abused. How horrific when those victimized women hit tolerance and had to go through the agony of withdrawing and putting their lives back together again from a "cure" for their victimization. It is tragic. And it goes on every day still. Docs write scripts and have no idea the damage waiting down the road. And it is waiting. Trust me.
 
whopper said:
1.0.

She's now on 6 meds...
Haldol 30 mg a day
Zyprexa 40mg a day
Risperdal 8mg a day
Lithium 900mg a day
Depakote 2500mg a day
Clonazepam 2 mg a day

The Clonazepam did dampen her mania a bit. With the haldol, her mania is now to the point where she only needs a PRN (haldol & benadryl) 1-2 x a day vs 3-5.

I only gave her the clonazepam because my theory is her mania is benzo discontinuation induced, and haldol 10mg PRNs were barely touching her.

I checked her old records. Each time she was discharged, Zyprexa @ 20mg a day & Depakote about 1500mg a day were all that was needed. However one of her discharges, someone discharged her with the above & Ativan 2mg QID (idiotic).


This has crossed my mind though the current data suggests that neurontin does not have any benefit in mania. However let's assume that my theory is correct & this mania is somehow related to her discontinuation of benzos. Then maybe it would work. I'd be willing to try this, but not at this stage.
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So ignoring the random benzo rant that revived this threat, quick question for whopper. I've always been taught that Risperdal at doses > 4mg day is no different than Haldol in terms of side effects and whatnot. If the patient was already on Haldol 30mg daily, why did you also have her on Risperdal 8mg? Could you not have increased the Haldol instead of adding another med?

Thanks! (Asking not to criticize, but because you usually have good answers!)
 
Man, this is why i would never like being a psychiatrist (neurologist i would like though 😛). I would never like to deliver these 6-drugs polypharma cocktails. Zyprexa, haldol, lithium, depakote what the heck lol.... Can't someone get a similar result with 2-3 drugs and an intensive behavioural-type program and psychotherapy?
 
I think what you experienced is an excited catatonia induced by benzo withdrawal. Probably one of the more common causes of excited catatonia along with brain insults and ETOH withdrawal. That is why it responded to ativan and perhaps have gotten even worse with atypicals or depakote since both can further push them to a malignant catatonia and even further excitment.

Maybe someone mentioned this already I wasnt able to read every post in this thread (I just saw this thread).

I have had a few and unforuntely these leave you in a bitch of a place to treat. You have to wean VERY slowly or just do ECT and be done with it if you want them off benzos more quickly.

But I would bet the bank that is the phenomonon which you experienced
 
Was also going to say, if you give it long enough a patient like this can just burn out or start to improve with nothing so if enough time went on and they finally "responded" to atypicals or what not than its possible they were just getting better anyway. But interesting, I have had 3 of these in my time as a resident this past 4 years and to be honest it is never recognized by staff, psych docs or other docs/nurses. It looks just like mania!
 
I'm over a year off this junk. And guess what I'm on nothing. No A/D no Adderal, and no Benzos. Not even a helper drug. I never needed it before and hence why I have healed to 100% with nothing but time.

The body and the mind are amazing instruments that don't need to be mucked with. Proper nutrition and exercise is all I needed along with time. Had I seen a DR they would have put me on a medication attempting to help me - however I would have been set back another 3 years. I now have an amazing life without being held back by medications and therapists.

I can tell you this - I figured out what I'm made out of

Therapy was not necessary because what I was feeling was not psychological. The physical issues however did have a psychological effect on me while I was healing - but they disappeared once the physical torture lifted.

Ziggy
 
Ziggy1977 said:
I'm over a year off this junk. And guess what I'm on nothing. No A/D no Adderal, and no Benzos. Not even a helper drug. I never needed it before and hence why I have healed to 100% with nothing but time.

The body and the mind are amazing instruments that don't need to be mucked with. Proper nutrition and exercise is all I needed along with time. Had I seen a DR they would have put me on a medication attempting to help me - however I would have been set back another 3 years. I now have an amazing life without being held back by medications and therapists.

I can tell you this - I figured out what I'm made out of

Therapy was not necessary because what I was feeling was not psychological. The physical issues however did have a psychological effect on me while I was healing - but they disappeared once the physical torture lifted.

Ziggy
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"no adderal, benzos or helper drugs" Do you think this is some type of achievement. With that general spread of meds it sounds like you were simply abusing drugs and not taking them for legit purposes.

People I see have tried excercise, diet and other non-medicinal things but are severely impaired by their degree of anxiety or insomnia. Benzos are magic but have to be used correctly. When people like yourself get a hold of them and clearly had a problem abusing them of course they are dangerous.
 
Do you think this is some type of achievement. With that general spread of meds it sounds like you were simply abusing drugs and not taking them for legit purposes.
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Why yes it is an achievement to not rely on western medicine.

No - I did not abuse them. I was put on xanax for GAD. I reached toxicity at 3MG - meaning the drug had a reverse effect on me. It gave me more energy rather than calming me down. You may be thinking this is interdose anxiety- but I tell you it was not. The doctors were completely baffled and dumb founded much like you. They tried making their special cocktail of drugs to "fix" me and only made me worse. They put me on 1 more mg of xanax and then an additional 3 mgs of klonopin over the span of a year. No improvements were made. I saw the same doctor and did not switch because I wanted to feel better. When she saw how much energy I had she put me on 60mg of Adderall. It helped, but if I was off schedule by 30 minutes. I never abused it and actually used it to sleep.

It wasn't until I read up on this and took matters into my own hands and got off all these medications because I wanted to "live."

Thank you for your accusations - but perhaps you need to look within yourself and polish up on some self esteem.


Ziggy
 
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Considering you were proud to not be dependant on adderall, I am guessing your problem came when abusing adderall and xanax. That will make ya anxious everytime but blame it on some paradoxical xanax reaction. Whatever makes you feel proud of yourself I am happy for you! Congrats on not snorting adderall and xanax. Three cheers!:laugh:

Clearly you are not a doctor by the way you speak so I really do not respect a thing you have to say regarding a MEDICAL topic. You were an addict, get over it
 
I was an accidental addict because of ill informed "doctors" such as you. I never did or have abused any drug. Have you even bothered to read up on Heather Ashton's manual? She studied benzodiazepines for over 20 years. I was dependent on the medication - not an 'addict' as you envision one to be.

Here's the link:
http://www.benzo.org.uk/manual/index.htm
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Perhaps you can learn to spell being that this is a medical forum.

I don't go to AA or NA and can drink an occasional glass of wine on the weekends with good friends. Can you explain this?

With a name like 'Wallstreet' I envision someone with a rather small weenie. Narcissist say what?

You really have no confidence do you
 
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Derailment.

While I congratulate these new posters on getting benzo free, I think you'd be surprised most recently trained psychiatrists use relatively little benzo's. Particularly not as a standing medication. Even fewer Psychiatrists prescribe xanax. Not impossible, but rarer.

There are some exceptions, and I'd appreciate my colleagues filling in other uses or correcting me if I'm out of line --
1. Bipolar, current state manic - pt's are typically hospitalized, impulsive, dangerous to themselves or others, and require extremely high doses of medications (temporarily)
2. Panic disorder (isolated, without comorbidities, and NO substance dependence)
3. Catatonia. Most catatonia's are due to a mood disorder, rather than schizophrenia.

Benzo's, especially xanax, are considered quite a Poor choice for GAD. GAD involves high baseline anxiety. First line medication treatment is an SSRI.

Xanax has a short half-life, quick onset, and is particularly addictive.

If a benzo were to be used for GAD, I'd go with a longer acting one like Klonopin. But only as a 4th line medication, likely adjunct, after going through many others, and never as monotherapy.

As a side case discussion, I have seen a subset of patients who have an incredibly difficult time tapering off of benzo's. Often high functioning individuals with no substance history, got started by a PCP, and feel incredibly uncomfortable and anxious when trying to come off. Another quirk is they often have some other marked difference about them, such as being a cancer survivor or s/p chemo, HIV, or other comorbid medical illness.
 
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Thank you Nite Magi

I initially was on an Anti Depressant for situational depression, which for some reason triggered GAD. The GAD eventually was accompanied with panic attacks. I had seen the same psychiatrist for 10 years and even she said that she very rarely if ever uses xanax. This is because of the Valium scare in the 70's. However, It was Xanax XR and well it was new and was supposed to be longer acting. My stable dose was 3mg of XR, which worked for 2 years.

Life interruption and the xanax stopped working and actually seemed to magnify my anxiety / panic attacks. My doctor added 1 additional MG of Xanax XR by splitting my dose into 2MG in the AM and 2MG in the PM. This failed to provide any results. Baffled she then added klonopin this time because she felt I was experiencing interdose anxiety. Little to any improvements were seen by adding an additional 3mg over a period of 6 months. She then added Adderall and I finally stopped getting panic attacks.

I do not have a history of drug addiction although I sure felt like one with all of these medications. I then researched benzos and realized what I was experiencing was called a Paradoxical Reaction. I had to do a valium taper to avoid a seizure, but I needed help because I had lost my memory and brain power to taper on my own. As you could imagine I wasn't sleeping and I became very OCD and called my parents and told them I would be gone for 3 months. I spent 2 months looking for a facility and was able to educate one in particular about the "Ashton Method". They agreed to do a 90 day Valium taper and allowed me to work with the RN to put together a taper plan. I went into a detox unit in California that is for "drug addicts'. It was horrific however thank god they were able to accommodate me by being open to the "Ashton Method". The RN was amazed by the results and uses it to this day. I eventually asked them to speed my taper up to 54 days to get out of the detox house sooner because it was a loony bin. This was a private facility so basically if you can afford the treatment that you want - they will honor it.

-After the detox and 9 additional months of healing from DT, DP, and major Depression I returned to a much better state. I did have Adrenal Fatigue but this too passed. I had a complete check up by every major specialist because the nerve pain from Klonopin was particularly uncomfortable and I actually felt like a hypochondriac during this process. I then caught MONO (EBV) on month 3 and quite frankly I didn't know I had it because I could no longer tell when I was sick. This caused a minor set back however it has now been confirmed that it kick started Rheumatoid Arthritis. It is in the very early stages and I now refuse to take any medications after this experience. Holistic medication in now my primary source of relief - And it works!

Ziggy

PS: thank you for moving this post forward.
 
It's tough to say any more, as by talking about your individual case and the problems with it, this is bridging on medical advice. SDN is explicitly NOT for getting or giving medical advice.

In general I'd say that if you were dissatisfied with care, seek a second opinion.

All medications have risks and benefits. That doesn't make them evil. Antibiotics can lead to allergic reactions, anaphylaxis, and death in some cases. That isn't a reason to not use them, but to use them wisely.
 
Understood.

Antibiotics saved my life from a staph infection that was making its way towards my heart. I do take an occasional naproxen for the arthritis but I don't like to. I lost 3 years of my life because of psych drugs in particular so I'm rather cautious now. Not angry nor blaming anyone. It is what it is.

Psych drugs have their uses if it is psychological at the core. Understanding that a death / loss (psychological) can trigger a physiological disorder if gone untreated by proper counseling. It simply amounts to untangling the human mind before you reach a point of no return.

Too often I've seen patients and doctors simply choose the easy way out of a situation by throwing a medication at a psychological issue that would have occurred in any normal human being. Whatever happened to being able to be sad, angry, and depressed. How do you ever get to know what true happiness if you were never able to experience the opposite emotions?

Ziggy
 
Ziggy1977 said:
Whatever happened to being able to be sad, angry, and depressed.
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Most of my depressed patients on medication and/or in therapy are still sad, angry, and depressed. But they're alive, some of them are able to make it to work, and their relationships are in less danger of falling apart (of course, if they didn't feel that way, they wouldn't be coming back).
 
From high life to low life to then back to high life again I can tell you the only thing that ever helped me was when I made the decision that I wanted to live. I had to then untangle my mind and my emotions as well as repair my body from the damage done from psych drugs. No amount of therapy actually worked nor did medications. Perhaps I had to realize this myself before I knew it to be fact.

What did work was peer journaling on a Forum type website. I would write out my situation and others would reply with similar experiences. Not alone - right. Then you help others - to give is to receive. Then you would also get advise on how to continue through your journey - acceptance. Finally one can then move on and become the ruler of thier life once again. With this I was able to give myself new 'software' for my brain and then hit the physiological elements with nutrition and fitness. I'm not talking scientology - simply common sense and a lot of hard work.

My points are if you didn't need a psych drug when you came into this world you don't need one on the way out. PTSD is a real thing - I had it myself and got to the other side. Time is the only cure. Our society is too impatient for time to pass as it is a drain on our economy. However - if the mind is in a state of utter hopelessness and needs a boost then by all means try an SSRI. Lexapro was by far the safest one available on the market and it leaves room for an easy D/C. However, I prefer 400-600mg of 5-HTP myself, but this of course cannot be used with an AD unless you want to induce Serotonin Syndrome.

Ziggy
 
We make the distinction of treating patients whose problems cause "functional impairment."

Normal sadness doesn't necessarily require treatment. If it meets criteria for Major Depressive Disorder, it does.

If someone is walking down the street with auditory hallucinations, but they have no functional impairment from it (have a family, career, no distress), I don't necessarily need to treat it. If they think they might do BETTER if treated, I'll still give it a chance.

The medicalization of normal emotions isn't always pushed by psychiatrists. There's a whole other group of factors including pharmaceutical company propaganda (with direct to consumer marketing), those with less education, other physicians prescribing with a lower bar, and patients coming in requesting meds for their sub-syndromal symptoms that ALL factor in.

It comes down to individuals to rise above this simplification and make informed choices.
 
Believe me I am all to familiar with Pharma propaganda. My father ran one of the largest pharma companies in the world. I don't hate him and quite frankly when it comes to medications we simply agree to disagree. He's now retired and we have a great relationship.

A/D's help him - but unfortunately hurt me.

He went through a similar experience with medications in his 40's and was completely out of whack from multiple medications over prescribed by psychiatrists. He ultimately landed on Pamelor and will be on it till the day he dies. He was dumb founded when I ended up on nothing - I'm a fully functioning human being with no anger, depression, anxiety, or rage. I have benzo's to thank for this. Hell is simply a word until you experience it. Benzos are great for a quick fix - but should never be a long term solution. My only point for coming on here was to help our next generation of doctors to become more familiar with benzos. The UK knows about the dangers but because of big Pharma cover-ups in the US the actual truth about the dangers of long term benzo use will never be fully released to the medical community.

Look what happened to Valium - We stopped using it after the 70's crisis and its use for Hey Fever. Only to have it return 20 times stronger and shorter acting. It amazes me quite frankly what money and good advertising can do.

Ziggy
 
I very often use benzos such as klonopin. I pretty much never use anything except klonopin other than ativan in catatonia due IV usage and more data on it.

I frequently use them in these scenarios and relatively often. I believe they work with very little long-term effects and low abuse potential if you are screening the people (no druggies or alcoholics) and you are using it at the right dose and the right purpose
-Antipsychotic naive patients, usually bipolar, when i start an atypical I will use a benzo schedule as especially with abilify which I like in young people, the akathesia really scares them off and limits the titration.
-insomnia I use klonopin as my first choice if there is any component of anxiety as well
-In my bipolar patients who have had catatonic episodes I keep them on scheduled benzos. I think this is the most misunderstood problem in psychiatry--catatonia and managing it. Although obviously not clear studies address this, I agree with expert concensus that depending on the reason for catatonia, keeping a benzo indefinetly is a good choice. Eespecially in my mood disorder people who get catatonia, and especially if they have had 2 or more episodes. Scheduled benzos for life.

Also agree with above other uses.
 
I've always been taught that Risperdal at doses > 4mg day is no different than Haldol in terms of side effects and whatnot. If the patient was already on Haldol 30mg daily, why did you also have her on Risperdal 8mg? Could you not have increased the Haldol instead of adding another med?
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Risperdal is very similar to Haldol. This case I handled over a year ago. If I remember correctly, the patient was already placed on Risperdal and Haldol before I saw her. I recall raising the Haldol and only keeping with it because there was some improvement.
 
I never had catatonia although I did have:

[FONT=verdana, arial, helvetica, sans-serif] Insomnia, nightmares, sleep disturbance
Intrusive memories
Panic attacks
Generalised anxiety, panics and phobias
Sensory hypersensitivity
Depersonalisation, derealisation
Hallucinations, illusions, perceptual distortions
Depression, aggression, obsessions
Muscle symptoms
Bodily sensations
Heart and lungs
Problems with balance
Digestive problems
Immune system
Endocrine problems.

Klonopin left me with severe nerve pain that took 4 months to recover from. And with the list of the symptoms above I thought many times about going to a hospital - however I knew that would only result in more medications further damaging the GABA receptors in my brain and body.


Every variation of a benzo, phenobarb, and even neurontin will bind to the gaba receptor in a slightly different way. Long term use will eventually fry the gaba receptors thus making any cocktail ineffective. This is what reaching toxicity means in the benzo world. Its a point in which the patient must stop all treatment and be allowed to heal. I can tell you I have met over 300 people in the past 1.5 years that encountered the same issues as I did. Many of them have healed and probably 5% were true addicts. It was the non-addicts that encountered the real issues because of everyday use. The real addicts would go off and on the medication allowing for time to lapse in between dosing. It's like comparing an everyday drinker to a binge drinker. After all a benzo is basically synthetic alcohol.


Ziggy
 
Ziggy you are not a physician and you clearly embarrass yourself with each further post. Talking with terms like "frying" your nerves just makes you seem less and less credible. Not to mention nobody gives a crap that you were an addict. Mention it once, we all say congrats and get on with it. Why would you keep posting in a thread that nobody cares to hear about your addict problems.

Your fault for taking multiple benzos. If you were so smart about everything why did you continue taking a bunch of different meds.

Why are you even on this forum in general? I would go to one of the recovering addicts forums to share your story-nobody here is an addict and we do not care about your story
 
Having a non-medical professional is going on some grey territory. We certainly should not a non-professional if that person wants to discuss their own situation. Nor should we tolerate medical professionals giving that person individualized medical advice.

But if that person is not doing the above, it's a grey area and can get real real confusing in what to do.
 
393656 said:
Considering you were proud to not be dependant on adderall, I am guessing your problem came when abusing adderall and xanax. That will make ya anxious everytime but blame it on some paradoxical xanax reaction. Whatever makes you feel proud of yourself I am happy for you! Congrats on not snorting adderall and xanax. Three cheers!:laugh:

Clearly you are not a doctor by the way you speak so I really do not respect a thing you have to say regarding a MEDICAL topic. You were an addict, get over it
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You disgust me. I seriously hope that if you hold a medical license, it is revoked ASAP. How dare you treat a human being like that in your line of work. I have no respect for uncompassionate, small minded, half wit, hacks, such as yourself. You are what's wrong with the medical world of today. You are mocking and accusing a person who has clearly been affected enough by this medication that they felt it neccessary to join this forum in hopes of creating awareness and possibly helping patients through better education on the extreme effects benzos can have on a person when withdrawn too rapidly. You sir are an idiot.
 
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This is a very interesting read. I have been working with people for the last 3 years who are in the throws of benzo withdrawal. Much of what Ziggy has posted is actually quite true. I have seen this symptomology over and over again in well over 50 people. Most of the people I have dealt with suffer protracted symptoms well up to and beyond a year. Benzos are very serious business. I'm not going to rant and rave here, I will only suggest that research is very important. Currently due to misinformation from drug companies and a lack of ineterest by the doctors who prescribe these drugs, the folks suffering from benzo withdrawal are looked upon as nuts. The fact of the matter is that daily use of benzos can in fact have a patient appear as manic. The tendency is to prescribe other medications, this however ususally just makes things worse. A very slow managed taper is the only way to safely remove benzos from the body , the brain has a lot of damage to undo.

As with Ziggy, most of these people are met with disdain and their integrity is in question. Benzo withdrawal is real. Benzos do have there place in medicine, long term, meaning more than two weeks, use is very dangerous business. Do some research on Heather Aston's work, or Dr Reg Peart. The UK is currently pulling people off benzos left and right, there is a reason for that. There is a wealth of information out there. It's important to be educated about this issue. People withdrawing from these medications need to be met with compassion and respect.

It takes a lot of courage Ziggy to post what you posted here.
 
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393656 said:
Ziggy you are not a physician and you clearly embarrass yourself with each further post. Talking with terms like "frying" your nerves just makes you seem less and less credible. Not to mention nobody gives a crap that you were an addict. Mention it once, we all say congrats and get on with it. Why would you keep posting in a thread that nobody cares to hear about your addict problems.

Your fault for taking multiple benzos. If you were so smart about everything why did you continue taking a bunch of different meds.

Why are you even on this forum in general? I would go to one of the recovering addicts forums to share your story-nobody here is an addict and we do not care about your story
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YOu should care, if you are going to be in the business of patient treatment and care, then you should care. YOu may be at the other end of a lawsuit one day if you don't.
 
I think this is a teachable moment.... most patients don't have knowledge of pharmacology like we do, and put a lot of trust in us. I'm sure if ziggy's doc had told him to kill a chicken, drink it's blood, and bury the head at the crossroads he might have done it. Extreme example, but it makes a point. Patients are going through a lot of crap or they wouldn't be at a doctor, and they are vulnerable. The one with the medical license should be making the big decisions about drugs taken. *this is the point where we all think about Requiem for a Dream and Ellen Burstyn's character*

Since this thread has been revived... I think I had a patient last month going through benzo withdrawal psychosis in the ICU. Incredibly agitated, pulling out his NG, extubated himself, etc. Had been in b/c he had a bike accident which caused him to get a massive hemothorax/empyema, and we put him on ativan for alcohol withdrawal precautions. Got his thoracotomy, came back to the ICU and completely lost his **** as above after an attending covering went on a rant about ICU oversedation on benzos. Since we called it ICU psychosis at first we were using haldol as a first measure, but it didn't touch him. Neither did fentanyl boluses b/c we thought maybe postop pain was a component, but nothing. Only ativan IV calmed him down. I will always wonder a little if his restlessness/agitation was from akathisia or benzo withdrawal.
 
From experience, most docs don't explain the pros and cons with meds. I mentioned this before in other threads but it's actually Federal Law to do so. The law specifically says you aren't expected to explain every single thing, and that could take days, but give a reasonable warning of some of the bad things that can happen, and let the patient be aware of any alternatives.

Most doctors I've seen simply hand out a script, and don't explain anything.

During fellowship, I did moonlighting and took over another doctor's outpatient caseload. I had pretty much every single patient with the exception of less than 5 off of benzos within 6 months and none of them were told (per them) of the risks of benzo use. Those I kept on it, I gave them warning and referred them to sources explaining the risks of long-term use. I only kept them going on it because it was a low dose and they appeared to be treatment resistant.
 
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