Q:  Withdraw from Xanax & Substitute More Trileptal?

Dear Dr Phelps
I've read your recent book and it was very helpful. I've been taking xanax (.75 mg) and a small amount of trileptal(300mg) for sleep. Most of the time  I feel as if I'm experiencing a mild mixed state. My question is: since xanax isn't really the best drug for BP2, should I withdraw from it and substitute more trileptal. Just cutting back a little on the small amount of xanax I take sends me into bad benzo withdrawls and activates my mixed state. Feeling trapped


Dear Mr. R' --
Hmm, perhaps you've already tried turning up the Trileptal further before you lower the Xanax? I've not seen evidence that Xanax can make bipolar disorder worse, so there's less pressure there to try to get off it. Rather the focus could be on getting symptoms controlled, using mood stabilizers (including non-medication mood stabilizer approaches such as described in my book, as in the following list (adapted from a newsletter by Alan Swann, M.D.)).  

Then after mood cycling or mixity is controlled, you could presumably taper off the Xanax much more easily.  Generally "withdrawal" should not be a problem if you go down by 0.25 mg steps no more frequently than weekly, perhaps as much as a month in between to be sure; rather, what you're seeing could be your symptoms showing up more prominently. 

However, to be thorough here, when Xanax (alprazolam) first came out it was touted as having some antidepressant effect. So, there's a sliver of a chance (I don't think I've ever seen this clearly, but I don't use Xanax  much) that it's part of the mixed state problem. That's easily addressed by switching to another benzodiazepine like lorazepam or -- many mood experts' favorite as it may actually have some true anticonvulsant-like effect, more than the others -- clonazepam (Klonopin). 

Dr. Phelps

Published October, 2006