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2 different benzos
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Lucysmomma posted:
I have bipolar II and have been on Xanax for about 20 years. 1 mg 3x as needed for anxiety. I've switched to klonopin 1 mg 2x morning and night. I just switched today and have had a horrible headache most of the morning. Is it withdrawal and can I take a .5 Xanax even though I took the klonopin this morning? Thanks for any help I can get.
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Joseph F Goldberg, MD responded:
Dear Lucysmomma,

Xanax and Klonopin dosing are about 1:1 equivalent, so if I follow correctly you've been (consistently?) taking 3 mg/day of Xanax and are now taking 4 mg/day of Klonopin...which, if that's the case, it would be quite unlikely that a higher dose of benzodiazepine-equivalent dose is causing withdrawal. It is alternatively possible that one medicine (eg, Xanax) could be better tolerated than another for a given individual. If a patient of mine called me to report a headache in this context I would be inclined to advise traditional over-the-counter headache/pain remedies (Tylenol, Advil) if there was no reason not to, and if the problem persisted then I would probably ask them to come in so I could assess in person. Certainly though yours is a reasonable question to ask your own doctor.

Dr. G.
 
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An_252051 replied to Joseph F Goldberg, MD's response:
Can Bipolar also cause someone to be controlling? My son's exgirlfriend will not allow my sone to have his visitations with his daughter, she wants to controll when and if she want him to see and or be with his daughter. The exgirlfriend knows she has this but refuses to take any meds for it, she feels she can controll herself without them. When my son and her split up about 2 years ago they both agreed to having there daughter with one week with him and one with her, she still wanted to have controol of what he was allowed to do during his time while he had his daughter. During the time they were living togther she would try and fight with him all the time and was always suspicious of him on everything he would do or where he would go. My son has gotten on with his life and the controll issues have gotten way worse. She would send him strang and not very nice text messages to his phone about how she thinks of him while she is having sex with someone else and so on. I am trying to find more info on the computer as to more about Bipolar and just what all damage it can cause and things that a person with this is like but not being able to get much so I am hoping you can help me out, I have seen many times the way she would act out and things she would say. Hope you can help me out with this. Thank you...Sue.
 
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Joseph F Goldberg, MD replied to An_252051's response:
Dear Sue,

If someone is in the midst of a manic episode -- not sleeping, doing many projects at once, talking very fast, overenergized -- then their judgment can be impaired and they could do things that are excessively confrontational or provocative, which usually they would then look back on after the episode has resolved and see as quite different from their usual behavior.

When someone is not manic or depressed, personality traits (such as being interpersonally controlling and provocative when there are no other current mood symptoms) can manifest themselves; this would be a key distinction between things that are attributable to bipolar disorder versus traits that are more defining of someone's personality than an illness.

Dr. G.


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Joseph F. Goldberg, MD, is a Clinical Professor of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY. He also maintains a private prac...More

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