Xanax withdrawal?

[Sparkling_Fairy]

Hi all,

I was just wondering if anyone has experience with this and can give some advice.
I've been prescribed Xanax for many years. Initially I only took it when I had to fly. But the last year I took it a lot more. I took 0.25mg every day for 3 weeks around Christmas. But I stopped taking them after the holidays were over and had no issues.

A few weeks ago I started getting vertigo. I initially thought it was a symptom of anxiety so I took my Xanax which actually did clear up the vertigo. It took me a few weeks to get an appointment with my GP and be diagnosed with actual vertigo and get medication for that. So I took 0.25mg every day for about 5 weeks.
My GP didn't want to prescribe me anymore until my next flight, because she's worried I would take it too often. Which I didn't disagree with and I felt fine with that decision.
So I took my last one on Monday. Felt ok Tuesday but yesterday I felt super anxious! I have 3 left so I cut a 0.25mg in half last night and took that and it really helped, but I don't want to take anymore because now I'm starting to get worried that I'm going through withdrawal.
Is it possible to get addicted to Xanax from only taking the lowest dose once per day for a couple of weeks? Or is my fear of addiction possibly making me feel more anxious?
I can't exactly taper off because 0.25mg is already the lowest dose and that's all I was taking.

[nomorepanic]

Hi

This is just a courtesy reply to let you know that your post was moved from its original place to a sub-forum that is more relevant to your issue.

This is nothing personal - it just enables us to keep posts about the same problems in the relevant forums so other members with any experience with the issues can find them more easily.

Please also read this post:

http://www.nomorepanic.co.uk/showthread.php?t=213239

[panic_down_under]

It took me a few weeks to get an appointment with my GP and be diagnosed with actual vertigo and get medication for that.

Which vertigo medication are you on?

So I took 0.25mg every day for about 5 weeks.

...So I took my last one on Monday. Felt ok Tuesday but yesterday I felt super anxious! I have 3 left so I cut a 0.25mg in half last night and took that and it really helped, but I don't want to take anymore because now I'm starting to get worried that I'm going through withdrawal.
Is it possible to get addicted to Xanax from only taking the lowest dose once per day for a couple of weeks? Or is my fear of addiction possibly making me feel more anxious?

It is possible to develop a dependency to benzodiazepines (BZDs) within 5 weeks so you may be experiencing withdrawal, but it could also be psychological, or possibly a side-effect of the vertigo med.

While dependency can be an issue with BZDs, a far greater problem is that they actually worsen anxiety. Anxiety disorders and depression are emotional expressions of atrophy of parts of the two hippocampal regions of the brain caused by high brain stress hormone levels, mostly of cortisol, killing brain cells and inhibiting the growth of new cells. It is a type of auto-immune reaction which is why these disorders often worsen when the immune system is fighting infections. Both antidepressants and the cognitive, behavioural (CBT, REBT, etc) and mindfulness therapies stimulate the growth of new cells which create the therapeutic response.

The problem with BZDs is they have the same effect on hippocampal neurons as cortisol. They also reduce the effectiveness of antidepressants. [1]

Taking BZDs for a day or two for short-term problems such as fear of flying, or to ease the initial anxiety spike when beginning to take ADs is not usually a problem, but taking them daily for many weeks, or months often can be.

[1]

Boldrini M, Butt TH, Santiago AN, et al. (2014)
Benzodiazepines and the potential trophic effect of antidepressants on dentate gyrus cells in mood disorders.
Int J Neuropsychopharmacol. Dec;17(12):1923-33 (Abstract | Full text)

Sun Y, Evans J, Russell B, et al (2013)
A benzodiazepine impairs the neurogenic and behavioural effects of fluoxetine in a rodent model of chronic stress.
Neuropharmacology. Sep;72:20-8 (Abstract)

Song J, Zhong C, Bonaguidi MA, et al (2012)
Neuronal circuitry mechanism regulating adult quiescent neural stem-cell fate decision.
Nature. Sep 6;489(7414):150-4 (Article | Study full text)

Wu X, Castren E. (2009)
Co-treatment with diazepam prevents the effects of fluoxetine on the proliferation and survival of hippocampal dentate granule cells.
Biol Psychiatry. Jul 1;66(1):5-8 (Abstract)

See also: the 'Ugly' part of Benzodiazepines: The Good, The Bad, and the Ugly.

For more on hippocampal atrophy see (while these discuss depression, they are just as applicable to anxiety):

Chapter 6: What happens inside people's brains when they're depressed?

Chapter 7: Why do some parts of the brain atrophy during major depression?

Chapter 8: What is causing brain atrophy in depression?

Chapter 9: Some good news - anti-shrink molecules!

Chapter 10: All the Players on One Stage

Chapter 11: Can the Shrinkage Be Reversed?

Chapter 12: Putting it all together
Genes, Stress, Depression and Atrophy - Conclusion

[Sparkling_Fairy]

Thank you so much! I do think I'm making it worse by being afraid of it being withdrawal. It may be, it may not be. But so far I haven't felt anything that I haven't felt with anxiety before, the feelings are just very strong at the moment.
I have no choice but to power through it anyway. I don't have enough Xanax to taper. And I'm pretty sure my GP won't prescribe me more.

The vertigo medication is an anti-histamine but I haven't taken it yet. So my symptoms can't come from that.
I did just come off Pantoprazole after 9 months because it was starting to affect my stomach in a bad way. But that has caused my stomach to be quite upset as well so I don't know if that's contributing to it.

[Scissel]

I have no choice but to power through it anyway. I don't have enough Xanax to taper. And I'm pretty sure my GP won't prescribe me more.

Yikes ... I'm really sorry to heat this! I once had to go "cold turkey" off Xanax and I remember it quite well - I'll never forget it and I did just what you wrote - powered through it (the hellish nightmare). I was addicted to it for years, actually. Is there any chance you could tell the med provider or APRN your situation and perhaps they might offer you an alternative? Such as Clonazepam? Here, providers in the USA are loathed to prescribe Xanax or Valium anymore, but Clonazepam is better than nothing and I'm on a regular daily dosage of .5MG per day and this was a taper and I feel (somewhat) stable. If not, just be kind to you body and understand the first week can be rough, but it does get better. I hope the new anti vertigo medication (anti-histamine) will at least offer some relief from the symptoms. I also started to fell better once they started me on Sertraline 100MG.

I really wish you luck, Sparkling_Fairy, and I have faith in you - you are strong.

Sincerely Yours

~Salvatore

[Scissel]

...but I don't want to take anymore because now I'm starting to get worried that I'm going through withdrawal...

Hi again ... just read this and I agree you are quite likely to be going through WD; but as I said, it gets better.

[Scissel]

Hang in there, Sparkling_Fairy; I'll keep you in my thoughts. You'll get through it, I promise.

[panic_down_under]

The vertigo medication is an anti-histamine but I haven't taken it yet.

It may also eases your anxiety levels due to the sedating effect of many antihistamines. The older TCA antidepressants owe some of their efficacy to also being potent antihistamines and less potent ones such as hydroxyzine (Vistaril) have proven to be about as effective as BZDs for mild anxiety.

[Scissel]

It may also eases your anxiety levels due to the sedating effect of many antihistamines. The older TCA antidepressants owe some of their efficacy to also being potent antihistamines and less potent ones such as hydroxyzine (Vistaril) have proven to be about as effective as BZDs for mild anxiety.

Hi, panic_down_under. How are you doing? Just wanted ask you - how long will it take for the GABA receptors to level off and balance when tapering off the BZDs? I've tapered farther than even I expected and I'm on a low dose daily now 1 time a day and I refuse to increase even if anxiety is through the roof. I also take Gabapentin but honestly I'd also like to one day get off that but I'd also need to taper and I'm not ready yet ... maybe I'll never be ready and maybe there's never a "good time". I don't know what to do now because I'm back to square 1 as the Sertraline has pooped out at 100MG and the sexual side effects increase when to dosage increases and that is a 'no-no' even though I'm not sexually active.

Sorry to hijack this thread; but I wonder if this could help the OP, as well.

Thanks you in advance,

Sal

[panic_down_under]

How are you doing?

I think I'm doing reasonably okay, but my GP isn't so sure. Time will tell which one of us is right. That's if all the blood tests being ordered don't desiccate me to a dried out husk first! I can see the headstone now, "Here lies Ian, we buried what was left of him in a match box"

how long will it take for the GABA receptors to level off and balance when tapering off the BZDs?

It isn't only GABA receptors, but the BZD binding sites on them. BZDs activate the binding sites, not receptors directly, which increase GABA receptor activity. Taking BZDs causes a reduction in both as a bio-feedback response. Unfortunately, there isn't good data on how long the receptors and binding sites take to rebound. It probably varies greatly from person to person. The other factor is the half-life of the BZD. If you're on diazepam it takes a long time to be eliminated, both because of its own long half-life, but many of its metabolites are also active.

I also take Gabapentin

Which is a further complication because it will also impact GABA receptor and binding site rebound.

I've tapered farther than even I expected and I'm on a low dose daily now 1 time a day and I refuse to increase even if anxiety is through the roof.

Maybe the antihistamine hydroxyzine would help, Sal. It has fairly good anti anxiety properties. Not quite in the same league as the BZDs, but it's often potent enough to make a difference. Worth discussing with your doctor anyway.

I don't know what to do now because I'm back to square 1 as the Sertraline has pooped out at 100MG

How long were you on it and have you taken any other ADs in the past?

and the sexual side effects increase when to dosage increases and that is a 'no-no' even though I'm not sexually active.

It is, unfortunately, a common problem. But there are ways of reducing the impact. BTW - in addition to the positive effect on SSRI sexual dysfunction noted in the link, small doses of buspirone (Buspar) may boost the effectiveness of SSRIs and restore function to ones which have pooped out. No guarantees, but it might 'kill two birds" for you.