Psychiatry for primary care physicians
Xanax: why prescribing it may make anxiety worse
Xanax has a short half-life and is highly potent. It binds and then dissociates rapidly from endogenous benzodiazapine receptors, which are receptors that modulate anxiety in the brain.
Because of this fast and powerful "on/off" effect, Xanax can produce intense rebound anxiety; this may lead to dose-escalation and iatrogenic worsening of anxiety.
Because of this fast and powerful "on/off" effect, Xanax can produce intense rebound anxiety; this may lead to dose-escalation and iatrogenic worsening of anxiety.
Benzodiazapines: how to taper
Here is the Ashton protocol.
If you are not using this protocol and there is no urgent indication for rapid discontinuation, such as concurrent alcohol or opioid use, I recommend tapering at 10% or less per week for patients who have been on long-term benzodiazapine therapy.
If you are not using this protocol and there is no urgent indication for rapid discontinuation, such as concurrent alcohol or opioid use, I recommend tapering at 10% or less per week for patients who have been on long-term benzodiazapine therapy.
Why Soma (carisoprodol) may be more dangerous than a benzodiazapine
This clip discusses Soma/carisoprodol, which has an active metabolite called Miltown that is an intermediate between benzodiazapines and barbituates. Soma/carisoprodol may be prescribed as a muscle relaxant but possesses a side effect and toxicity profile similar to a benzodiazapine or barbituate.
How to avoid Effexor withdrawal
Effexor or venlafaxine withdrawal can happen with even a single missed dose and frequently occurs when patients stop their Effexor abruptly. The side effects of Effexor withdrawal - a profound malaise, anxiety and agitation, neurologic symptoms - are so unpleasant they often drive people to go to the emergency room. These side effects can be avoided by a gradual taper of the drug in combination with a Prozac bridge - 1 to 3 days of 10 mg of Prozac - to help stabilize the serotonin system.
