Can Antispychotics like Seroquel make Benzo withdrawal harder? Is Wikipedia right?

[[Al...]]

An intuitively crazy thing recently happened! And I'm wondering if Wikipedia's info is any good on this.

I am on Seroquel, XR100 + 100 regular (total 200), and 2mg of Cloanzepam (1mg twice a day).

I decided, this time, rather than getting Seroquel down to about 75mg or so, and then starting clon withdrawal, I'd start with the Benzo first.

The hope was that the Seroquel would keep the insomnia and severe anxiety at bay.

Now the strange part.

After months of being stable on both doses, by reducing Clonazepam from merely 2.0mg per day to 1.94mg per day, and holding, while I was able to sleep decently for the next few days, on the third and fourth day, the anxiety was so bad that I went back to 2.0mg.

On Wikipedia, it currently states:

 

• Antipsychotics are generally ineffective for benzodiazepine withdrawal-related psychosis.^[26][77] Antipsychotics should be avoided during benzodiazepine withdrawal as they tend to aggravate withdrawal symptoms, including convulsions.^{[67][78][79][80]} Some antipsychotic agents may be riskier than others during withdrawal, especially clozapine, olanzapine or low potency phenothiazines (e.g., chlorpromazine), as they lower the seizure threshold and can worsen withdrawal effects; if used, extreme caution is required.^[81]

I checked some of the references for the sentence that they (antipsychotics) "tend to aggravate withdrawal symptoms". It looks ilke there's some indirect evidence for this, but less than handful of studies hardly makes anything conclusive.

However, even without the studies, the fact is that I've never been even close to this sensitive to benzo withdrawal.

Q1: Have you ever encountered actual peoeple who felt their benzo withdrawal was harder because of the antipsychotic they were on?

Q2: If you have scientific or academic expertise, and can read the abstracts and conclusions of studies, please have a look at references 67, 78, 79, 80. https://en.wikipedia.org/wiki/Benzodiazepine_withdrawal_syndrome

And let me know what your interpretation of the studies are.

Thanks so much everyone!!

 

[[De...]]

yes, absolutely start the benzo first. I think you are right about that.

I personally don’t think any drug helps with benzo withdrawal. Things like seroquil or gabapentin can maybe help soften the blow a bit and help you sleep but nothing will really help except getting off the benzos. 

I don’t think these drugs make it WORSE but if they help you sleep a bit I think the benefits outweigh the downsides. I also know from firsthand experience it’s far easier to get off seroquil than benzos.

Just my 2 cents.

[[De...]]

I also did 35 days in treatment and monitored by a world class team of psych team. They kept me on sq during my stay while I tapered off the benzos. I was on 100mg of Seroquil and tapered off .5mg of K.

Edited August 18 by [De...]

[[Li...]]

1 hour ago, [[A...] said:

Q2: If you have scientific or academic expertise, and can read the abstracts and conclusions of studies, please have a look at references 67, 78, 79, 80.

Tip of the hat for recognizing that one should always check the supporting references cited in Wikipedia entries, @[Al...].  Oftentimes the claims made are not supported by the references.   In this case, only one of the four references you identified is an actual research study and it has nothing to do with the use of antipsychotics and benzodiazepines.

[[vo...]]

41 minutes ago, [[L...] said:

Tip of the hat for recognizing that one should always check the supporting references cited in Wikipedia entries, @[Al...].  Oftentimes the claims made are not supported by the references.   In this case, only one of the four references you identified is an actual research study and it has nothing to do with the use of antipsychotics and benzodiazepines.

I was taught in college to not rely on Wikipedia at all. Apparently, anyone can write anything they want. So what you read may or may not be credible. This is a guide to help determine scholarly type sources of information.

 https://content.bridgepointeducation.com/curriculum/file/008f763b-f608-4af5-8a05-84f711b24ae8/1/What is CRAAPO.pdf

[[Al...]]

@[De...] Appreciate your comments.

There's no hard evidence (meaning multiple studies to make something conclusive) of any particular drug being very helpful for benzo withdrawal. But like you said, it appears (not conclusive) that some drugs soften the blow.

Where I might disagree with you is whether there are any drugs that make benzo withdrawal worse. An obvious one that comes to mind is caffeine (in sensitive people, it can wreak havoc in withdrawal, while in people who aren't too sensitive, drinking some tea or coffee isn't the slightest issue). 

For me personally, the idea that I got the withdrawal symptoms that I did, which were hardcore, in the beginning of withdrawal, is totally new to me. I should note that in multiple previous attempts of benzo withdrawal, when I was only at 75mg Seroquel, nothing like this ever happen until I was at least a third or more into withdrawal.

I'm not saying that it happens to everyone. But this is going to make consider reevaluating strategy

Thanks again!

@[Li...] Appreciate your comments as well.

31 minutes ago, [[L...] said:

Oftentimes the claims made are not supported by the references.

100% Agree

 

32 minutes ago, [[L...] said:

In this case, only one of the four references you identified is an actual research study and it has nothing to do with the use of antipsychotics and benzodiazepines.

One of the four studies has an outdated link.

One of the studies is to a book, which is not avaliable online

"Enhancement of drug withdrawal convulsions by combinations of phenobarbital and antipsychotic agents" seems like it may be, at least indirectly, related to the topic and contain meaningful insight.

 

"Neuroleptic Malignant Syndrome After Antipsychotic Drug Administration During Benzodiazepine Withdrawal" seems like it may be, very indirectly, related to the topic. I don't have access to the journal article though (and even if I did, I may not be able to determine). 

Even if the two articles report evidence that atypicals can aggravate benzo withdrawal in some people, again, the statement wouldn't be conclusive (too few studies).

But, in my case, I'm at a point where I don't care what any of the noted studies show. I have never had such notable anxiety, in a dry taper, going from 2mg to 1.94, after so many months of being stabilized on both Seroquel and Clon.

So it may be time to reevaluate strategy (once again, so frustrating!).

Thanks again!!

 

 

 

 

 

[[Al...]]

@[vo...] Thanks for the comments.

3 minutes ago, [[v...] said:

I was taught in college to not rely on Wikipedia at all. Apparently, anyone can write anything they want.

Anyone can write anything on wikipedia, and it's up to their moderators to accept it or decline it.

For me, wikipedia is mixed bag. On some topics I have found absolutely excellent overviews or write ups. On other topics, the information can be questionable or completely false.

Important to check references and other sources :)

[[Li...]]

15 minutes ago, [[A...] said:

Important to check references and other sources

Yes it is.  My experience with Wikipedia is that they do a particularly poor job of checking references to determine if they actually support the claim made.  For example:

 

“Enhancement of Drug Withdrawal Convulsion by Combinations of Phenobarbital and Antipsychotic Agents” is an old study from the early 1980s.  It is about the use of phenobarbital and antipsychotics, not benzodiazepines and antipsychotics.

“Neuroleptic Malignant Syndrome After Antipsychotic Drug Administration During Benzodiazepine Withdrawal” is a letter to the editor. 

 

[[Al...]]

@[Li...] Thanks for your response.

1 hour ago, [[L...] said:

Yes it is.  My experience with Wikipedia is that they do a particularly poor job of checking references to determine if they actually support the claim made.

That's completely fair. Even if I have come across entries that are good, I'm on the same page as you: check references and check other sources.

1 hour ago, [[L...] said:

“Enhancement of Drug Withdrawal Convulsion by Combinations of Phenobarbital and Antipsychotic Agents” is an old study from the early 1980s.  It is about the use of phenobarbital and antipsychotics, not benzodiazepines and antipsychotics.

Great observation. I don't know anything about psychopharmacology, but if phenobarbital is a barbituate, and has a perhaps similiar (which is very different from 'same') effect as benzos, perhaps some change in wording might be appropriate.

If wikipedia was being careful, it should note any relevant observation to barbituates and antipsychotics (from only one study), and depending on whose authoring the entry, if there might be relevance to benzos, note how it might be relevant to benzo withdrawal (based on only one study). 

Still, it's not enough to make the statement that wikipedia makes on the topic, I think both you and I are on the same page on that.

Though it's worth noting that both barbituates and benzos, from what I read, at least act in very similar ways (anyone can correct me if I'm wrong).

Withdrawing from both can cause seizures, though perhaps it was more prevelant in barbituates?

And there's evidence of atypicals lowering siezure threshold.

And, for what it's worth, thorough investigations of the relationship between atypicals and benzos in the context of benzo withdrawal don't seem to exist.

Even if they did, while I'd be very curious to see what they say (eg. if they mention that in uncommon instances, atypicals can aggravate benzo withdrawal), trying things under medical supervision is my go to.

And my most recent attempt revealed that higher dose of Seroquel, for me, produced way more pronounced symtpoms of clon withdrawal versus all the times I've started clon withdrawal in the past (when I've been on only 75mg).

1 hour ago, [[L...] said:

“Neuroleptic Malignant Syndrome After Antipsychotic Drug Administration During Benzodiazepine Withdrawal” is a letter to the editor. 

You're right again here. While it would be nice to read the letter to the editor out of curosity, a letter to the editor doesn't constitute any definitive evidence or anything like that.

I wanted to end this comment ont that note because for anyone reading, I think your broader view about being careful when it comes to evaluating sources (which I share), is extremely important.

And that includes scientific sources! I've heard about the replication crisis in at least one discipline, but I won't get into that.

Thanks again!!

Edited August 18 by [Al...]

[[De...]]

Yea I would definitely agree that caffeine and many drugs could make it worse.

i do know that 200mg is a moderate dose and I think it gets up to 300mg before it’s used specifically for anti-psychotic, so it’s likely your dose could be lowered and help with your withdrawal. I know that after 100mg, I don’t find it helps more with sleep and I feel fairly cloudy at higher levels above 150mg. 

Im assuming you are using this medication primarily for sleep (and not as an anti-psychotic), so if you can sleep on the lower dosages, I’d tend to believe that would help your recovery.

i am fairly sure SQ comes in 25mg pill form, which would make it very easy to drop the meds as an experiment.

 

[[Al...]]

@[De...] Thanks for your response.

3 hours ago, [[D...] said:

i do know that 200mg is a moderate dose and I think it gets up to 300mg before it’s used specifically for anti-psychotic, so it’s likely your dose could be lowered and help with your withdrawal.

What you're saying is exactly consistent with the information that I had long ago when I started seroquel.

3 hours ago, [[D...] said:

Im assuming you are using this medication primarily for sleep (and not as an anti-psychotic), so if you can sleep on the lower dosages, I’d tend to believe that would help your recovery.

Serious chronic insomniia as well as some anxiety (which the chronic insomnia is attributed to, because, well there's nothing else in the DSM that comes close to explaining my insomnia). Before going on to Seroquel, I tried many medications, including SSRIs and SNRIs, which are recommended as first line treatment for anxiety. None of the many medications went with me. Even some other atypical antipsychotics didn't go with me. 

That's how I landed on seroquel.

3 hours ago, [[D...] said:

i am fairly sure SQ comes in 25mg pill form, which would make it very easy to drop the meds as an experiment.

Yes, it comes in 25mg tablets. On a related note, I forgot to mention that for insomnia specifically, I remember seeing studies that generally found 25mg to 100mg effective for it, though some studies basically said tay away from the drug, because of its side effects, unless your options are limited.

I only withdrew off seroquel once. I went from 300mg to 25mg, tapering 25mg PER WEEK. This was in the first year of taking it. Then down to 7.5 mg in three weeks, and dealt with teh rest tapering micro doses every week.

Now, after being on it for more than a decade, I usually come down 6.25mg ever TWO WEEKS.

Also, as some might imagine, I've built a lot of tolerance. Doesn't make me sleep like I used to.

So my plan now will be to consult with my specialist, and try to come off Seroquel completely, while using another non-benzo related med to sleep if I can get away with it.

This will take well over a year, so as of right now, looks like I won't be revisiting benzo withdrawal anytime soon.

Thanks again for your comments (and everyone elses).

If anyone feels like asking or saying anything, please don't hesitate!!

Edited August 19 by [Al...]

[[Ar...]]

On 19/08/2024 at 05:40, [[A...] said:

An intuitively crazy thing recently happened! And I'm wondering if Wikipedia's info is any good on this.

I am on Seroquel, XR100 + 100 regular (total 200), and 2mg of Cloanzepam (1mg twice a day).

I decided, this time, rather than getting Seroquel down to about 75mg or so, and then starting clon withdrawal, I'd start with the Benzo first.

The hope was that the Seroquel would keep the insomnia and severe anxiety at bay.

Now the strange part.

After months of being stable on both doses, by reducing Clonazepam from merely 2.0mg per day to 1.94mg per day, and holding, while I was able to sleep decently for the next few days, on the third and fourth day, the anxiety was so bad that I went back to 2.0mg.

On Wikipedia, it currently states:

• Antipsychotics are generally ineffective for benzodiazepine withdrawal-related psychosis.^[26][77] Antipsychotics should be avoided during benzodiazepine withdrawal as they tend to aggravate withdrawal symptoms, including convulsions.^{[67][78][79][80]} Some antipsychotic agents may be riskier than others during withdrawal, especially clozapine, olanzapine or low potency phenothiazines (e.g., chlorpromazine), as they lower the seizure threshold and can worsen withdrawal effects; if used, extreme caution is required.^[81]

I checked some of the references for the sentence that they (antipsychotics) "tend to aggravate withdrawal symptoms". It looks ilke there's some indirect evidence for this, but less than handful of studies hardly makes anything conclusive.

However, even without the studies, the fact is that I've never been even close to this sensitive to benzo withdrawal.

Q1: Have you ever encountered actual peoeple who felt their benzo withdrawal was harder because of the antipsychotic they were on?

Q2: If you have scientific or academic expertise, and can read the abstracts and conclusions of studies, please have a look at references 67, 78, 79, 80. https://en.wikipedia.org/wiki/Benzodiazepine_withdrawal_syndrome

And let me know what your interpretation of the studies are.

Thanks so much everyone!!

Because my local hospital decided to cover up the fact that they had caused all of my ill health and disability by inducing benzodiazepine withdrawal I only found out a few months ago. Now it makes perfect sense why I went into convulsions during subsequent treatment with seroquel. Thanks very much for that.