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What Causes Severe Anxiety, Leg Twitching And Hand Tremors After Discontinuation Of Xanax?

Posted on Tue, 1 Sep 2015

Question: My mom is 87, recently diagnosed with bipolar. Prior to that, she was very addicted to xanax, prescribed for anxiety. She had what appeared to be a very manic episode, and tried to overdose (would've succeeded if not found quickly). They got her off all benzo family meds, started her on Latuda and 50 mil zoloft. She has fallen into a severe catatonic type depression, and horrible anxiety, with twitching legs from knees down, hand tremors, cannot sleep, no appetite, and completely expressionless with the feeling of being totally "empty". I can't believe this is the right Med for her. Its been 2 1/2 months now, and she's getting worse.

Answered by Dr. Dr. Chintan Solanki (1 hour later)

Brief Answer:
Possibility of xanax withdrawal,neurological aspect to be checked

Detailed Answer:
Hello,

Thanks for writing to us.

I can understand your concern for your mom.

Old age diagnosis of bipolar must be checked with MRI brain scan to see neurological abnormality.If MRI done already please upload the report if not done in my opinion she needs it.

Xanax is a benzodiazepine.If she was taking it for long (more than a year or so), sudden stopping of this medicine can cause withdrawal symptoms which are same you mentioned your mother is suffering from.

In that case she should be treated with another long acting benzodiazepine like clonazepam or some mood stabilizer like carbamazapine or sodium valproate.

As she is diagnosed with bipolar disorder zoloft is not an alternative as it should not be used alone in bipolar depression. Mood stabilizer would surely help.

Discuss above aspect with her treating doctor and move forward.

Hope I have answered your query, I will be happy to help further.

Regards,
Dr.Chintan Solanki.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Chintan Solanki (10 hours later)

no, she is not taking zoloft alone, they have her on 60 mil latuda, and she hasn't taken xanax in almost 3 months

Answered by Dr. Dr. Chintan Solanki (10 hours later)

Brief Answer:
yes I know she is taking latuda, but still she needs lithium or valproate

Detailed Answer:
Hi,

Yes I read that she is taking latuda. It is an anti psychotic drug mainly used for schizophrenia as well as in bipolar depression.

She is not improving even after 2.5 months means either medicines are not effective or some diagnostic query.As I mentioned first of all MRI is needed.

If MRI comes normal without any infarct adding valproate or lithium would help.

If there is any specific lesion in MRI, treatment will be modified accordingly.

Xanax withdrawal depends on for how much duration she has taken xanax and in which dose.It can last up to 6 months or more if past used is high.

Maximum dose of zoloft is 200 mg and that of latuda is 120 mg so option if increasing her dose is also there.

-- To diagnose bipolar disorder there should be one episode of mania or hypomania. Was it there in her case and how that episode was treated /subsided?

Let me know above answer to comment more.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Chintan Solanki (1 hour later)

Yes she had an MRI, and it showed multiple XXXXXXX strokes but those haven't seemed to affect her. All else was fine. And yes, she had an episode of mania, determined by a mental health facility. She had been on xanax for many years. This depression is so severe she can hardly function. I'm trying to get her in to be seen, with no luck so far. I will mention the lithium.

Answered by Dr. Dr. Chintan Solanki (10 minutes later)

Brief Answer:
yes lithium or sodium valproate will be good

Detailed Answer:
Hi,

Thanks for information.

For many years xanax means withdrawal should be there.She has not been given any treatment for that. I think sodium valproate and/or clonazepam will help for that.

If depression continues lithium or lamotigine will be good option in bipolar depression according to my clinical experience.

I wish she recovers soon.

Take care.

Note: For further guidance on mental health, Click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar