Withdraw from Xanax & Substitute More Trileptal?
[Home] [Bipolar News] [Bipolar Disorder] [Medications] [Treatments] [Bipolar Disorder/Job/School] [Disabilities] [Ask the Doctor] [Ask David] [Self-Injury] [Personal Stories] [Graham's Column] [Steven's Column] [Storm's Column] [Columnist Archives] [Suicide] [Community Support] [Family Members] [Expressions] [Greeting Cards] [Books] [Awards] [Links & Rings] [About Us] [Contact Us]


Q:  Withdraw from Xanax & Substitute More Trileptal?

Dear Dr Phelps
I've read your recent book and it was very helpful. I've been taking xanax (.75 mg) and a small amount of trileptal(300mg) for sleep. Most of the time  I feel as if I'm experiencing a mild mixed state. My question is: since xanax isn't really the best drug for BP2, should I withdraw from it and substitute more trileptal. Just cutting back a little on the small amount of xanax I take sends me into bad benzo withdrawls and activates my mixed state. Feeling trapped

Dear Mr. R' --
Hmm, perhaps you've already tried turning up the Trileptal further before you lower the Xanax? I've not seen evidence that Xanax can make bipolar disorder worse, so there's less pressure there to try to get off it. Rather the focus could be on getting symptoms controlled, using mood stabilizers (including non-medication mood stabilizer approaches such as described in my book, as in the following list (adapted from a newsletter by Alan Swann, M.D.)).  

Interpersonal         Predictability, Consistency, Firm Limits
Environmental Minimize overstimulation
Ensure adequate and routinely timed sleep
Systems Optimize resources, minimize problems: 
     Family, friends, employer/school, legal

Then after mood cycling or mixity is controlled, you could presumably taper off the Xanax much more easily.  Generally "withdrawal" should not be a problem if you go down by 0.25 mg steps no more frequently than weekly, perhaps as much as a month in between to be sure; rather, what you're seeing could be your symptoms showing up more prominently. 

However, to be thorough here, when Xanax (alprazolam) first came out it was touted as having some antidepressant effect. So, there's a sliver of a chance (I don't think I've ever seen this clearly, but I don't use Xanax  much) that it's part of the mixed state problem. That's easily addressed by switching to another benzodiazepine like lorazepam or -- many mood experts' favorite as it may actually have some true anticonvulsant-like effect, more than the others -- clonazepam (Klonopin). 

Dr. Phelps

Published October, 2006


Bipolar World   1998, 1999, 2000, 2001, 2002, 2003, 2004, 2005, 2006, 2007, 2008, 2009, 2010, 2011, 2012, 2013, 2014
Allie Bloom, David Schafer, M.Ed. (Blackdog)
Partners:  John Haeckel, Judith (Duff) 
Founder:  Colleen Sullivan

Email Us at Bipolar World


About Us  Add a Link  Advance Directives  Alternative Treatments  Ask the Doctor   Ask Dr. Plyler about Bipolar Disorder   Ask The Doctor/ Topic Archives  Awards  Benny the Bipolar Puppy  Bipolar Chat  Bipolar Children  Bipolar Disorder News  Bipolar Help Contract  Bipolar World Forums  Book Reviews  Bookstore  BP & Other mental Illness   Clinical Research Trials & FDA Drug Approval   Community Support   Contact Us  The Continuum of Mania and Depression   Coping   Criteria    Criteria and Diagnosis  Criteria-World Health Disabilities,  DSMV-IV   Dual Diagnosis  eGroups  Expressions (Poetry, Inspiration, Humor, Art Gallery, Memorials  Family Members   Getting Help for a Loved One who Refuses Treatment  Greeting Cards  History of Mental Illness  Indigo  Job and School  Links  Manage Your Medications  Medications   Medication and Weight Gain    News of the Day  Parent Chat  Pay for Meds  Personal Stories  Self Help  Self Injury  Significant Others  Stigma and Mental Health Law  Storm's Column  Suicide!!!  The Suicide Wall  Table of Contents   Treatments  Treatment Compliance  US Disability  Veteran's Chat  What's New?