Hello All,
I arrived at this forum via my Google search for "Benzo withdrawal induced mania." This thread began four years ago and continued for three years, so the subject may still have legs. In reading all of the previous posts I'm left with a yet more enhanced grasp of the general subject from both the medical and the patient's side. I thank all for contributing. (Yes even the confrontational posts. They're instructive and oh so human.) In the chance that the original poster, other medical students or professionals, or anyone from the patient's side does a search similar to mine in the future, I'll share my story in the hopes that it might help either doctor or patient, or one in the same as the case sometimes is.
On May 30th of this year, after 22 years of daily Klonopin use (2 mg TID), I was forced to go "cold turkey" for the very first time. I had missed a dose or even an entire day or two before, but for 22 years I was the quintessence of compliant, as my member name here implies. I was indeed a poster child "dream patient" of compliance. I lasted less than a week then without Klonopin before serious problems set in. You see, I had no idea what I was getting myself into by discontinuing the medication, and I simply couldn't get to my doctor for a prescription for the first time ever. Miss your appointment and you have to wait for another. I had no idea that I'd never make that one either. I began to mentally unravel quite quickly, and after three or four initial days that were very tense and yet worsening still with every horrific moment, I had but a day or two with a very vague awareness of reality as I'd always known it before I was finally hospitalized. Sleeping as well as eating went from being difficult to impossible prior to hospitalization. I have no recollection whatsoever of my being hospitalized. That might be a good thing.
The last day or two prior to hospitalization I can only now in retrospect remember as being well beyond mere anxiety. I was delusional and beginning to hallucinate for the first time in my life. I then lost two weeks of my life in the hospital. Two weeks gone forever, and perhaps quite mercifully so. All my memories now of that next two weeks are a seemingly endless series of somehow loosely connected nightmares of a magnitude I'd never known - yet disconnected as well all at once. I'll spare you the horrible details, but indicate that they were persecutory or grandiose by and large. It was a very real, unimaginably frightening and different world than I could ever imagine. I'd never believed in it before, but hell is a quick and useful word in describing it. Really the only word.
When I came out of this lost two weeks and first began trying to put together what had happened, I was in a soiled disposable adult diaper along with a catheter and IV, and totally clueless as to what had happened for what I only then learned had been two full weeks of my life. My point now in responding to this thread is that the attending psychiatrist, who I only got to see for perhaps 5-10 minutes afterwards, would only tell me that I'd had a severe manic episode. That was it. No other possible explanation. It was clear as could be to him with no doubts at all. I then spent perhaps another five days in the hospital for observation, was deemed well enough to be discharged, and left with no further recommendations from the hospital or any doctor on what I should do then as far as treatment was concerned. I'd never had a remotely similar experience in my life, manic episode, psychotic break - call it what you will. I have certainly never been hospitalized before or since. It was this and only this: my own experience with cold turkey benzodiazepine withdrawal as I now understand it to be. Period.
Perhaps what's of value here is the fact that the doctors treating me in the hospital had no idea of my previous psychiatric history or that I was in withdrawal from benzodiazepines, thus able to approach my condition in the hospital with no bias whatsoever. They had no idea that I was withdrawing, and were able to go on only what they they saw without a history or any knowledge of my withdrawal to color that. (I didn't know it either at the time. Yes, I was that naive, trusting, and poorly informed.) They saw only an extreme manic episode in full bloom. I too was unresponsive to any and all med's to arrest it, and they did not administer any benzodiazepines whatsoever, although my hunch is that they would have stopped it. My manic episode lasted full-blown psychotic (what else would one call it?) for almost two weeks and then inexplicably stopped. Yay.
I am a 55 year-old male, with a diagnosis of bipolar at age 32, and treated for 22+ years for such. I simply always did what my doctors told me to do. That meant strict compliance. I took Klonopin only per doctor's orders, and remained on it for 22 years without anyone batting an eyelash. My original dose remained unchanged for 22+ years, and that lack of tolerance over the years seemed to fortify my complacency in deeming it as "safe." Yes, prior to diagnosis I had hypomanic cycling as well as depressive. On the "Fieve-Dunner Manic-Depression Mood Scale" (very useful for bipolars and their doctors in communicating) I would have rated myself as being in a steady state between 50-55 during the days and weeks leading up to my running out of Klonopin. I have no reason to believe that my withdrawal simply served to somehow horrifically amplify any existing manic state whatsoever. I am far more toward the conviction that the withdrawal instead unleashed perhaps more at either a potential, possible, or predictable outcome for a true bipolar subjected to cold turkey benzodiazepine withdrawal, perhaps then again when dosed at my level or near it for as long as I was or at least long enough to have become addicted. That such cold turkey benzodiazepine withdrawal within a bipolar diagnosis either can or will present additionally as a frank manic/psychotic break. Whether this is the rule or the exception and/or dependent upon what variables in what percentage of what group and/or subgroup within bipolar and/or outside of it - I do not know. I can only share my experience.
From what you said (whopper in the original post to this thread) there was no indication as to your patient's history prior to her coming under your care, and no way to either rule in or out that she may have arrived at the hospital either as a result of her cessation of benzodiazepines or whether or not she may have been already further along in a withdrawal situation when she came under your care. Folks that end up in hospitals aren't always able to accurately convey either their histories or any reliable life routine prior to being admitted, and upon being hospitalized then fall under the care of the powers that be. After all, they're a psych patient, and not always able to do so. I know this personally. I went through it and I didn't know anything about anything until all was over. She may have been in an off and on stop and go twilight world re: her benzodiazepine cessation/withdrawal that you simply walked into quite possibly unable to ascertain reliably just where she was along the lines of her true withdrawal journey at that time. Much as those that attended to me didn't know. She was simply hospitalized with definitive and perhaps psychotic mania that could not be treated as well as simultaneously suffering from benzodiazepine withdrawal all at once.
So was I.
It is altogether very interesting, and I thank you once again for your sharing. You're a highly intuitive and empathetic professional. I can only hope that my story helps someone as well in any way.
It really doesn't surprise me to have found this thread though.
After all, I'm the one that Googled "Benzo withdrawal induced mania."
Cheers!
DreamPatient
