![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by jgmw on February 28, 2008, at 19:48:14
my sister is a rapid-cycle bi-polar with psychotic features (when manic). She did not respond to many medications, so after years of searching, we came to clozaril. It works GREAT for her! It's been about 10 years now. Every once in a while she goes down on the medication to try to lose weight (gained from the medicine). She takes a relatively small amount for stabilization (200mg at night only). Everytime she goes down on her med, she becomes delutional, hears voices, can't sleep for days, is anxious, etc... TAkes her 6 weeks to recover (the voices last the longest). She just recently did it again, went down on her med. I noticed she exibited alot of the symtoms that I had when I had a axniety breakdown (no delutions or psychosis), so I gave her .25mg of xanax once in the afternoon for 5 days. We titrated back up to her normal Clozaril level (this has never gotten immediate results in the past). But, 3 days into xanax, all her delutions and voices, everything was gone and she was completely normal again. I am completely floored. I don't know what to make of it, and neither does her psych. Anybody have any answers to this. Is she miss-diagnosed, or could her condition somehow changed?
Posted by your#1fan on February 28, 2008, at 20:40:58
In reply to xanax has unbelievable affect, posted by jgmw on February 28, 2008, at 19:48:14
Xanax is a medition that is good for anxiety, and depression. But im glad that you found it good for this episode. Usally Xanax doesnt calm down a psychosis, it makes it sometimes worse.. BUT ITS GOOD to hear that your sister benefited from this.
I take .5mg through out the day for anxiety, i have been on every anti-anixety agent there is.
Xanax is good, but Clonazepam (even i dont like this medicaiton because the depression it causes!!) is best for manic.
Im very sorry that your sister has to go through this. At the same time, i go through alot too, just BAD things tend to happen to me....on conidence...
Wish me luck, im struggling through a time in life where i just dont know where i am....
your#1fan
Posted by Phillipa on February 28, 2008, at 20:54:00
In reply to xanax has unbelievable affect, posted by jgmw on February 28, 2008, at 19:48:14
Amazing you mean even her doc feels the xanax helped the clozaril to work better and sooner? Love Phillipa
Posted by Phillipa on February 28, 2008, at 20:57:01
In reply to xanax has unbelievable affect, posted by jgmw on February 28, 2008, at 19:48:14
And I see by the green flag next to your thread that you are new to babble. Let me welcome you and be assurred that many knowledgeable people post here bet they are along shortly. As babble is all over the world so posting all times of day and night all time zone. Welcome again. Glad you are with us. Phillipa
Posted by your#1fan on February 28, 2008, at 21:03:05
In reply to Re: xanax has unbelievable affect » jgmw, posted by Phillipa on February 28, 2008, at 20:57:01
yes yes, We care about you, and your sister. You never tell you name, just your posting name. You can get great advice here, i've been here for years, its really better than any medical help website i've ever seen.
There are many people here (i hope that care about me and my current life situation)
your#1fan
Posted by bud on February 28, 2008, at 23:06:48
In reply to Re: xanax has unbelievable affect, posted by your#1fan on February 28, 2008, at 21:03:05
I'm also new here but have been lurking for awhile. Xanax works so well to make me feel "normal" that I'm not surprised that it helped your sister. Good luck.
Posted by Quintal on February 29, 2008, at 6:45:24
In reply to xanax has unbelievable affect, posted by jgmw on February 28, 2008, at 19:48:14
I had a psychotic episode back in December and I'm still trying to convince my pdoc that it was the lorazepam and zopiclone that helped me most in hospital. They seem to have an exaggerated faith in dopamine blockers. Anything that calms and soothes like Xanax does will have an 'antipsychotic effect' to some degree. I think sleep and anxiety levels are critical in managing bipolar disorder, because the more anxious you get, the more your thoughts race, and the faster your thoughts race, and the more anxious you are, the less you are able to sleep. Sleep deprivation is a major risk factor in precipitating mania. Mania leads to psychotic symptoms. So it's a viscious circle, and Xanax can break the cycle that leads to psychosis. It can be hard to find a doctor who appreciates this.
I'd bet your sister could lower the Clozaril safely if she had a sleeping pill to make sure she got plenty of rest at night, with maybe some Xanax p.r.n for anxiety during the day.
As for the diagnosis, there is some overlap between Bipolar I and Schizophrenia. I was given a book by my mental health team "Madness Explained: Psychosis and Human Nature" which describes how the diagnostic categories were invented. Some psychologists believe Schizophrenia and Bipolar Disorder are different manifestations of the same process. They recommend treating complaints symptomatically, according to whatever works best for that particular individual. I would strongly recommend a read if your life, or someone in your family has been affected by psychosis.
Q
Posted by rvanson on February 29, 2008, at 10:40:52
In reply to Re: xanax has unbelievable affect, posted by your#1fan on February 28, 2008, at 20:40:58
> Xanax is a medition that is good for anxiety, and depression. But im glad that you found it good for this episode. Usally Xanax doesnt calm down a psychosis, it makes it sometimes worse.. BUT ITS GOOD to hear that your sister benefited from this.
------------------------------------------------
Too bad there are so many Pdocs that wont try a benzo FIRST because there is an anti-benzo tirade amongst many younger Pdocs.
Back in the early 1980's when Xanax was a new med they were passing it out like candy as a wonder-drug, which it really is, in fact.
Posted by Phillipa on February 29, 2008, at 11:42:51
In reply to Re: xanax has unbelievable affect, posted by bud on February 28, 2008, at 23:06:48
Bud welcome to your new status as posting on babble if lurking awhile you have seen the knowledge of the posters here thanks for sharing yours. Phillipa
Posted by your#1fan on February 29, 2008, at 13:20:06
In reply to Re: xanax has unbelievable affect » your#1fan, posted by rvanson on February 29, 2008, at 10:40:52
yea, well. I've been on lexepro, klonopin, ativan, nuerotin, my doctor finally said ok. There there is only two medications that will work for panic attacks "clonazepam" and "alprazolam"
I had been on clonazepam for nearly 2 years and the amount of depression it caused me, it help no buts about it with anxiety. But i just couldnt take the depression it gives.
Xanax is good, but it can be addicting, and im sorry not more people are prescibed it.
Thanks for responding to my post!
fan
Posted by yxibow on March 1, 2008, at 23:31:51
In reply to xanax has unbelievable affect, posted by jgmw on February 28, 2008, at 19:48:14
> my sister is a rapid-cycle bi-polar with psychotic features (when manic). She did not respond to many medications, so after years of searching, we came to clozaril. It works GREAT for her! It's been about 10 years now. Every once in a while she goes down on the medication to try to lose weight (gained from the medicine). She takes a relatively small amount for stabilization (200mg at night only). Everytime she goes down on her med, she becomes delutional, hears voices, can't sleep for days, is anxious, etc... TAkes her 6 weeks to recover (the voices last the longest). She just recently did it again, went down on her med. I noticed she exibited alot of the symtoms that I had when I had a axniety breakdown (no delutions or psychosis), so I gave her .25mg of xanax once in the afternoon for 5 days. We titrated back up to her normal Clozaril level (this has never gotten immediate results in the past). But, 3 days into xanax, all her delutions and voices, everything was gone and she was completely normal again. I am completely floored. I don't know what to make of it, and neither does her psych. Anybody have any answers to this. Is she miss-diagnosed, or could her condition somehow changed?
Generally benzodiazepines are contraindicated with Clozaril.However small scale studies have shown that Valium can help in schizophreniform disorders.
Perhaps the Xanax is helping in that way, or maybe its helping in a completely different way.
I just noticed that -you- gave her the Xanax. Be careful. As I said, benzodiazepines are contraindicated with Clozaril because of CNS depressant (coma and respiratory depression, i.e. lung collapse) possibilities.
As drugs.com says:
[!!]
"alprazolam and clozapine (Major Drug-Drug)
MONITOR CLOSELY: Benzodiazepines and clozapine may have additive effects on respiratory and cardiovascular function. Ataxia, excessive salivation, hypotension, collapse, respiratory depression, respiratory arrest, loss of consciousness, cardiac arrest, and sudden death have been reported. The mechanism is unknown and causality has not been clearly determined.MANAGEMENT: Caution is advised if concurrent therapy is necessary. Vital signs should be closely monitored."
Posted by Quintal on March 2, 2008, at 8:44:48
In reply to Re: caution will robinson, about Clozaril and benz » jgmw, posted by yxibow on March 1, 2008, at 23:31:51
Your post surprised me Jay because I was in hospital just recently with a man who was taking Clozaril and 1mg lorazepam p.r.n for panic attacks. The BNF only advises of the possibility of increased sedative effects when combined with anxiolytics and hypnotics, no contraindications, nothing sinister there, though it's not the most exhaustive manual in the world.
http://www.bnf.org/bnf/bnf/54/41001i364.htmI note that 'causality has not been clearly determined' re: (coma and respiratory depression, i.e. lung colapse) possibilities.
Q
Posted by jgmw on March 2, 2008, at 16:55:11
In reply to Re: caution will robinson, about Clozaril and benz » jgmw, posted by yxibow on March 1, 2008, at 23:31:51
Yes, we did look up the contradictions before the xanax was given. I actually read the exact info you posted from "drugs.com". She takes what is considered a low dose of Clozaril,200mg at night only. The theraputic range is 350-450mg divided. You know, when you go through this kind of thing time and time again, like a Nurse Practioner, you learn enough to be the doctor yourself. It's been 10 years now, and I have a stack of research about a mile high on illnesses and meds. My sister doesn't even go into the hospital anymore when she goes too low on her meds (rare, but has happened a few times)and she becomes psychotic. We just treat her at home ourselves.
Posted by yxibow on March 2, 2008, at 18:43:25
In reply to Re: caution will robinson, about Clozaril and benz, posted by Quintal on March 2, 2008, at 8:44:48
> Your post surprised me Jay because I was in hospital just recently with a man who was taking Clozaril and 1mg lorazepam p.r.n for panic attacks. The BNF only advises of the possibility of increased sedative effects when combined with anxiolytics and hypnotics, no contraindications, nothing sinister there, though it's not the most exhaustive manual in the world.
> http://www.bnf.org/bnf/bnf/54/41001i364.htm
>
> I note that 'causality has not been clearly determined' re: (coma and respiratory depression, i.e. lung colapse) possibilities.
>
> QIt most definately has here in the US. My doctor will not give me Clozaril until my Valium is pretty low. But 1mg Ativan and .25 Xanax is "pretty low". I'm still on a higher dose and it -is- potentially dangerous to slip away.
That doesn't mean very low amounts haven't been combined. But as one goes up and one has multiple CNS depressants (AEDs or benzos, etc) there is a definite risk, perhaps greater than the blood draw risk. Its a definate watch and wait thing in the hospital and for newly started outpatients I would think prudence is unfortunately required to prevent irreversible comas.
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.