Expert: Peter L. - 8/22/2011

Question
Hi Dr. L,

I was prescribed Alprazolam (Xanax) for an acute panic reaction lasting six weeks.  I was told Xanax was addictive but I was not told in what way.  Let me state - I receive no physical enjoyment or "high" oriented benefit from the drug whatsoever.  In treating the panic however it was effective.  In trying under doctor's order to get off the drug I now understand HOW it is addictive.

As you know, people cannot quit Xanax "cold turkey" after regular use - I did NOT know this.  SO while I weaned myself down from 3mg to 1mg with no problems, I was very surprised to experience a traumatic seizure after spending 17 hours off the medication.

I am writing you about the seizures.  Firstly - every web directory you you could think to refer me to (for instance the Ashton Guide) is something I have already seen in the last month.  I know about the tapering schedule BUT - I am in the minority (4%) whose withdrawal symptoms include life threatening seizures.  If not for the seizures I would have no problem quitting at all because I hate everything about this drug's other effects.

I am writing you about the seizures because my doctor doesn't understand the problem - they have nothing to tell me but the tapering schedule I already know about.  Their only solution is less Xanax (which I have no objection to) - I need to prevail upon my doctor the need for some kind of anti-seizure medication (Carbamezeprine, Gabapentin, Beta-Blockers etc) to deal with the seizures.  I don't care about the withdrawals, I know the seizures are from the withdrawals, but all I care about is stopping the seizures so I can quit the drug.

In the ER (from a seizure) one doctor made the remark that anti-seizure drugs would not help benzo seizures - I have seen reports to the contrary.  I did persuade this doctor to give me 12 Clonodine to use (as needed) and it did help the heart palpitations that come with a seizure but it is not an anti-seizure drug.  My opinion is that if there is a medicine that will stop you from having a seizure, if seizures are the problem I have, I don't see why I shouldn't have these to keep me from dying during a seizure.  If drugs like Carbamazepine really help seizures, I don't see what the difference is or why I shouldn't take it.  Seizures are the only withdrawal effect I care about.

I know this is a complicated question but I and many others I'm sure would appreciate a response to the question because we need to know what to tell our doctors when this is happening.  My doctor is the one trying to taper me off the Xanax, glad as I am about it, so she should be ready to give me something that will stop the seizures it causes.  

If you would be so inclined to email me I would be glad to give you her phone number to make a phone call on my behalf, and I will be glad to read your advice here or elsewhere.  Urgently waiting for your kind response.

Answer
Kirk,

Physicians differ greatly on what approaches they take toward something like a benzo detox.  Since you've developed a dependence on Xanax, you need a physician who understands how to respond accordingly.  

In the addiction program where I work, we have two docs for which this would not present a challenge.  They know what to do.  As such, you need an addictionologist, as they are called, to assist you.  Why not contact a local addiction program and make an appointment?   There are other benefits to addressing this via a program, which have to do with behavioral changes, and tools to help stem cravings or urges, should they arise.

Best wishes,
Peter