• The Dark Side 💕 Welcome Guest 💕
    Posting Rules Bluelight Rules
    Notable Threads Urgent Hotlines
    Bereavement Mindfulness
    Suicide Support Anger Management
  • TDS Moderators: AlphaMethylPhenyl | Eligiu | deficiT

Mental Health DESPERATELY NEED HELP: Paradoxical Reaction to Benzo?s

S

Sexykylla

Greenlighter
Joined
Jan 30, 2019
Messages
10
I have been struggling with MDD and panic disorder for more than half of my life. The onset was when I was 18 years of age and I am now 39 years old. My PDoc has tested out numerous medications, but they have been to no avail or ?poop out? fast. My PDoc recently suspected that I am on the spectrum for BiPolar Disorder because they only way I am able to tolerate SSRI?s is when I am on a mood stabilizer, otherwise I experience a mixed state. I am presently on Citalopram 15mg, and Lamictal 150mg (2x/ daily), which has stabilized the depression and helped with cognition and concentration, but the anxiety has persisted, so my therapist is stumped on what to prescribe next. She has prescribed three different benzo?s in the past and they made me more agitated and anxious (Klonopin, Ativan, Restoril), so I had a paradoxical response to those as well. I don?t sleep because my heart is palpitating constantly and I get tension headaches from the anxiety. She has prescribed every sleep medication under the sun, including Doxepin, so the anxiety won?t disrupt my sleep, but they have no afffect, even at high doses. The only thing that ever worked to alleviate the anxiety is Chloral Hydrate, but it is no longer available in the US. I am dealing with a lot of stressors right now, so I feel hopeless and am in despair: single parent of a child with ADHD, taking care of a father with Alzheimer?s, running a family business . Is there an alternate Benzo I could try or another medication that might be effective?

Thank you!
 
Hi Sexykylla (love your user name ;) ), welcome to Bluelight. Sorry to hear about your predicament, it sounds like you're having a right shite old time at the moment. I'm not a medical professional so cannot advise you, but there are doctors dotted around the site that might be more help. I'll confer with the other mods to see if there's a better subforum for your post and if so, I'll move it over.

But just as a matter of interest, are you in a location where medical cannabis is available? If so, have you ever tried it or considered trying it? I'm thinking a low THC variety may be some help.

I'll get back to you. :)
 
Thank you so much for responding, you are so thoughtful! Thank you for the compliment also. I did attempt to use marijuana for the anxiety because I started growing for my father after viewing research studies that concluding that it removes plaque from the brain. Weed used to make me feel very subdued and increase my appetite in college, but surprisingly now I feel more on edge and overstimulated to the point where it worsens the insomnia. I was not on medications in college, so it could be an interaction with the medications. I have also tried CBD oil that I purchased in Amsterdam and the outcome was the same.
 
I forgot to mention they I am on Latuda as well, so my regimen is as follows:
Citalopram (15mg x once daily)
Lamictal (150mg x twice daily)
Latuda (30mg x once daily)
 
If it's ok with you, I'm going to move this thread over to the 'Mental Health' subforum. I think your situation is too complex for BDD. If you have any objections, please drop me a PM and we'll try an alternative.

All the best,

Fubz
 
Sorry to hear that you are having a rough time! Messing around with a fourth medication definitely would mean you should see a psych with better experience. Tricky business. You could still be activated with medications or have some interactions. Some people get a weird insomnia with lamotrigine but you were on that for some time it seems.

Do you have any good non-pharmacological anxiety measures in place? Different therapy, reasonable sleep hygiene (light, electronics, intention to sleep, routine etc...) I'm guessing you have fairly good pieces in a stressful situation, but sometimes good to go back to basics and really slow down. Take a step back. Realign what is doable and work on perspectives.

I had a friend with striking paradoxical reactions to benzos, had to have a different agent for a surgery because the midazolam or whatever hyped her up. Also was activated on seroquel of all things. But she was more OCD-driven and managed with upping her clomipramine and perhaps clonidine. Clonidine can be helpful for some anxiety but it can be tough with depression. Prazosin mixed. Beta-blockers could help with palpitations but could have issues in sleep.

I have MDD and benzos didn't help me sleep and made it worse in some ways, but seroquel helped. Adding that on might be tricky, and you probably already tried it? Same with trazodone. The z-drugs. Mirtazapine as well but again tricky with bipolar. And the gabapentinoids may or may not be similar and likely you tried.

Some people get help with magnesium and some dose of melatonin (smaller can be better) in addition. Valerian root as OTC too, but could be somewhat similar to benzos. I would be careful with any herbal route with multiple medications and bipolar. I'm just putting that out there for general suggestions, I realize saying magnesium vs. Chloral hydrate would be a stretch.

I've heard some mixed things on Belsomnra the new orexin antagonist, and hard to say how it would interact. You might get an old psych to mess around with barbituates and clomethiazole, but they have been pushing against that, especially in bipolar Also not a good therapeutic index and not great for depression having pills around that could easily kill you, let alone tolerance and dependence. Moving away from the pill to go, pill to sleep, mood stabilizer era.

Hope you can get good help and recognize what you are doing, the control that you do have in your life. You are running and operating in your world, and doing what you can. Try to give yourself some kindness and recognition, especially if there are these demands in your life and you don't have others giving it to you.
I would also investigate whether the medications you are taking are adding to your sleep/anxiety issues and if necessary talk with a competent outside psych for an outside view. And definitely some non-pharmacological approaches. Best of luck and a hug!
 
Honestly if your doctor is stumped I don't know how much help any of us can be on the medication front.

If you want to talk about how it's effecting your life and vent. Emotional support is probably the best we can give you. Hopefully your doctor refere you to a specialist that can help.
 
Last edited:
Checktest has made some very good points a couple of which I will try to expand upon - I am no expert but as a former mental health professional and a life long drug abuser of the worst kind I will give it a go.

Fubar brought your original post to my attention and although I realise my platitudes are of no practical help, I can only begin to empathise with the terrible situation you are in.

While I am sure that you are aware that benzodiazepines are only effective as anxiolytics if used on an 'as required' basis they are arguably the most effective medicines in general use for the short term management of anxiety and if you are one among the significant minority who experiences paradoxical effects from these drugs it is difficult to identify alternatives.

While all benzodiazepines (BZD's) are similar in their chemistry and effect profile (the main difference between them is usually the duration of action - clonazepam and diazepam for instance can be effective for up to 18 - 24 hours as opposed to alprazolam (Xanax) and lorazepam (Ativan) which usually wear off after 6 - 8 ) there are chemical subtypes. Both Ativan and Restoril (temazepam) belong to the '3-hydroxy' group where as clonazepam (Klonopin / Rivotril) belongs to the '7 - nitro' group. There are a number of further subtypes but as your Psychiatrist has already tried 3 drugs belonging to 2 separate groups it appears (IMO) unlikely that any other BZD's will be any more effective (diazepam, the 'OG' of BZD's is classed as a '2 - Keto' and Xanax a 'Triazolo' so you may want to give one of these a go as final try but I would not hold my breath..)

The only real alternative, as Checktest has highlighted, would be phenobarbital, arguably the only barbiturate still in common use (as they are very dangerous and easy to overdose on) but as your doc has already trusted you with 3 very potent BZD's, they may be open to prescribing it as it is still indicated for use as a day time sedative where diazepam cannot be used (it also has an insanely long duration of action.)

One last note is with regards to your primary mood stabiliser. While it is unwise to mess with this if generally stable, very little is known about the mechanisms of lamotrigine (and valporate) other than the general notion that they at least partially, rely on pathways that use gamma-aminobutyric acid (GABA), the same neurotransmitter responsible for the anxiolytic effects of both BZD's and barbiturates. There are second line mood stabilisers such as carbamazepine that do not appear to rely on 'GABAgenic' pathways and of course this also applies to lithium, but as my grasp of neurochemistry is so limited it is unclear as to whether or not your current treatment has any bearing with regards to the lack of efficacy you appear to be having from the BZD's you have been prescribed so far.

I hope that makes at least some sense and I pray that you find a solution and the comfort you deserve sooner rather than later.

Stee x
 
Last edited:
Just spitballing here but what about GHB for sleep? I know it's available by prescription in the US. Or would it likely be paradoxical as well since it effects GABA?

How does alcohol effect you Sexykyla?
 
Thank you guys all so much, you are very helpful and it is greatly appreciated. God bless you all!

So far I have tried: Imipramine (pooped out at highest dose, tachycardia) Doxepin (no affect), Wellbutrin (no affect) Paxil (mixed state adverse response with mood stabilizer) Zoloft (mixed state) , Lexapro (mixed state without mood
stabilizer; depersonalization and feeling “flat” with mood stabilizer), Luvox (helped with anxiety somewhat and cognition and then pooped out) , Celexa (mixed state and hallucinations without mood stabilizer at lowest dose), Lyrica (no affect), Gabapentin (no affect), Clonodine (no affect), propranolol (no affect), the sleep medication prescribed for nightmares (NIGHTMARES..lol), Seroquel (initially very woozy and sleep but terrible for cognition; now it makes anxiety worse), Trazadone (don’t remember), Abilify (no affect), another antipsychotic (could not
even remember the month but knocked me out), Depatoke (gained 40 pounds), Lithium ( poor cognition and memory), Trintellix (worked like a charm and had no panic attacks but I was throwing up all day so the PDoc could not titrate up), Ambien (no affect at highest dose), Lunesta (no affect at highest dose), Bellsomra (no affect at highest dose), Sonata (no affect), Roserem (no affect), Ativan (adverse response), Klonopin (adverse response), Restoril (adverse response). I also did a trial of Ketamine (helped somewhat with cognition and concentration but not with anxiety and depression) and TMS (no affect).

I am so tired of living this way that I wholeheartedly believe I will not be here in the next five years. I am not living life right now, I am just getting through days. In addition to the palpitations and headaches, my mind is never quiet. I have also been diagnosed with OCD, so I am very paranoid about germs and practice sets of words from my “vocabulary” in my head 90% of the day. The word thing is a major catalyst for anxiety because when I was initially diagnosed with panic disorder my cognition got really bad and I started to lose a lot of words. It progressively got worse and was to the point where I could not retrieve words I had used all the time to put to together to form sentences, so I started to isolate myself and tried to avoid talking to people as much as I could. I was an avid writer in high
school,was very articulate, and could carry a conversation effortlessly, so it is frustrating and disconcerting for me. There are a million thoughts and replays of conversations with people and dilemmas going through my head ALL DAY, even when I am sleeping for the three to four hours I sleep a night, so I don’t sleep restfully. Sometimes I feel like I am on fast forward or moving ahead of myself, so I feel so depressed and have zero incentive to do
anything but stay in the bed (I was out of work three days this week) and am not even grooming on a daily
basis.

The only good thing that has happened is my cognition is getting better on the Citalopram and I am not having perpetual thoughts about people molesting my daughter anymore ( I was molested and physically abused by my
mother’s boyfriends for years, so the PDoc thinks these thoughts are some
form of PTSD) and I can remember words (but still practicing word finding obsessively all day).

The fact that I am a Christian and I have a child that is 12 are the only reasons I am still here because right now I am not able to do much efficiently and I am living in my own personal hell. I am sssoooo fatigued mentally and physiologically.
 
I go to therapy once a week in NY. She recommended Mindfulness. I was not able to redirect the word finding practicing after 30 seconds almost each time and my mind would not stay “quiet”, so it was not fruitful. Plus, I was having palpitations.
 
I have no adverse reaction to alcohol. I just feel tipsy or drunk, depending on how much I drink. Only coffee and weed make me feel overstimulated now.
 
Ah so a lot of obsessive thinking and replaying. Disrupted cognition can be such a bugbear, especially when environmental and family instances come into play. Sorry to hear about the trauma. Efficiency thoughts, meta thinking, self and situational analysis are interesting constructs of the mind.

Well if the trintellix worked you could do vilazodone or add on buspirone to your current drugs. Again as guided by a psych. Maybe a 5ht3 antagonist for nausea/vomiting. It can get better over time and might be worth it to balance out if you had dramatic effects. I found the trintellix helped the out-of-sync feeling and some sleep.

Yeah my friend with the benzo reaction has complex PTSD and OCD. High dose clomipramine and lots of intensive therapy was her deal, inpatient and intensive outpatient.

Memantine is being used in some cases as an add-on. I'm currently trialing 10mg memantine as an adjunct. Trials are mixed in depression, but some case studies are promising with OCD. Along that line glycine and sarcosine have also had interesting positive case studies, and glycine site agents are in the works. A different line of approach.

Oh yes, mindfulness. Hopefully they emphasized the practice and development of thinking and connection, rather than the outcome or expectation of a 'quiet' mind. Change in time. People are different and experience things differently. I've certainly never had a fully quiet mind and couldn't focus on my breathing without overthinking for the life of me. DBT ACT other therapies.

Yeah TMS is weird. I had it once and I thought it helped (L DLPFC protocol) and another it did nothing (R DLPFC). Adjunct stimulants in OCD and depression require a careful balance. I find methylphenidate helps my anxiety significantly, but I wouldn't touch that with sleep issues.

Sometimes getting through the days is enough. I know that is a lot to say when we are suffering, but persevering can help guide us to a new future. Taking care of yourself and your child, comfort in faith. You have been strong for some time!
 
cj said:
Honestly if your doctor is stumped I don't know how much help any of us can be on the medication front.

If you want to talk about how it's effecting your life and vent. Emotional support is probably the best we can give you. Hopefully your doctor refere you to a specialist that can help.
Click to expand...

Oh yes stumped because every doctor on earth has a complete and utter understanding of every chemical interaction that exists.
 
JK25 said:
Oh yes stumped because every doctor on earth has a complete and utter understanding of every chemical interaction that exists.
Click to expand...

I don't know why your coming at me like that. I was just trying to manage his expectations for what this forum could offer. It sounds likes his/her phychiatrist through the kitchen sink at it so to speak so I wouldn't call them incompetent..

That said I'm really glad people had helpful advice. Though I didn't see you post any
 
cj said:
I don't know why your coming at me like that. I was just trying to manage his expectations for what this forum could offer. It sounds likes his/her phychiatrist through the kitchen sink at it so to speak so I wouldn't call them incompetent..

That said I'm really glad people had helpful advice. Though I didn't see you post any
Click to expand...

I'm sorry, the only advice I can give is to skip the normal MD's and even psychiatrists and go directly to a neuro-psychopharmagologist. It will be the only way to discover exactly why your GABA pathways does not react normally to benzodiazepines and which other drugs may produce the same effects.
 
Yeah, random schmucks on the internet aren't the best resource relative to professional help, but hopefully we can provide some support on a forum.

I'm not sure our understanding of the brain is at the level where we discover exactly why a drug affects someone the way it does, and the fully interacting pathways.

Neuropsychopharmacologist and heavily academic psychiatric researchers certainly have their flaws as well. As with everyone, some go off of the knowledge they know and can have a particular focused direction and area that they lean towards, and drug-heavy use. Sometimes they can treat people a little more like lab rats and can be blinded in some diagnostic/clinical skills. And if you don't react like they expect to a drug some can be a bit defensive, though this is heavily biased by personal experience. Everyone has flaws. Some are absolutely brilliant and caring, definitely, if you can get in contact with them.

I guess I remember a friend who was put on a sixth or seventh agent, and the guy didn't even ask how she was really or where she got her bruises from. Neurochemistry is vastly complex, but human behavior and states are even more so, so we do need to recognize and give some respect to our humanity while striving to learn and understand more. Or something like that.
 
For what it's worth, I wish you the best and hope you can find the right kind of help to get you out of this mess. I know thats not much but you are in my prayers.
 
You must log in or register to reply here.
Top