Insomnia and Medication Withdrawal in Mental Health

Insomnia and issues related to withdrawal from medication?

Hello, Dr.
Tsai! This February, I suddenly realized that I am already 45 years old.
Although I am married, I have not had children, which makes me anxious and unable to sleep.
Additionally, I am worried about my future because of a retinal detachment from an eye injury I sustained at 17.
I fear that if my husband were to pass away early, I would be left without children, which adds to my anxiety about the future.
As of July, my mindset has improved somewhat.
Initially, I visited a doctor who prescribed 2 mg of Alprazolam (Xanax) twice a day and 50 mg of Quetiapine (Seroquel) twice a day.
This regimen allowed me to sleep for about 6-7 hours, but I experienced severe headaches and felt uncomfortable throughout the day.
On weekends, I felt very tired but still could not take a nap.
During a follow-up appointment on June 29, the doctor suggested reducing the medication.
I have since decreased my dosage to 0.25 mg (1/8 of a tablet) of Alprazolam, but I can only sleep for about 4.5 hours, and I still feel too tired on weekends to take a nap.
I would like to know if this is a side effect of long-term use of Alprazolam.
After taking the medication, I often feel a sensation as if my head is being shaken, is this normal? Additionally, how long does it typically take to experience withdrawal symptoms after discontinuing Alprazolam? Thank you for your help!

beryl, 40~49 year old female. Ask Date: 2021/07/23

Dr. Cai Yunlin reply Psychiatry

Hello, Anxinping and Xinghuantuo belong to the benzodiazepine class and sedative-type antidepressants, respectively.
They are commonly used in clinical practice to address insomnia issues.
Anxinping generally has good safety profiles.
When tapering off sleep medications, it is advisable to follow a gradual approach and combine it with cognitive-behavioral methods for better outcomes.
It is also recommended to discuss any feelings or concerns regarding the medication with your prescribing physician.
Wishing you all the best, Dr.
Cai.

Reply Date: 2021/07/23

More Info

Insomnia and the effects of medication withdrawal are significant concerns in mental health, particularly for individuals dealing with anxiety and depression. Your situation, characterized by anxiety related to personal circumstances and the use of medications, highlights the complexities of managing mental health conditions and the potential side effects of pharmacological treatments.

Firstly, it’s essential to understand that insomnia can stem from various factors, including psychological stressors, medical conditions, and the side effects of medications. In your case, the anxiety stemming from personal life events, such as concerns about having children and fears related to aging and loss, can significantly impact your sleep quality. The medications you were prescribed, including the benzodiazepine (安安心平, or Lorazepam) and the antidepressant (杏緩妥, or Amitriptyline), are known to affect sleep patterns and overall mental health.

Benzodiazepines like Lorazepam are often prescribed for short-term relief of anxiety and insomnia due to their sedative properties. However, they can lead to dependence, tolerance, and withdrawal symptoms if used long-term. The symptoms you describe, such as severe headaches and a feeling of your head being "shaken," could be side effects of the medication, especially if you have recently reduced your dosage. These medications can also cause rebound insomnia, where sleep disturbances worsen after discontinuation or reduction of the drug.

Regarding your specific questions:
1. Long-term Side Effects: The side effects you are experiencing, including headaches and fatigue, could indeed be related to the long-term use of Lorazepam. While some individuals may tolerate benzodiazepines well, others may experience adverse effects, particularly with prolonged use. The sensation of your head feeling "shaken" is not a typical side effect but could be related to anxiety or withdrawal symptoms as you reduce the dosage.

2. Withdrawal Timeline: The timeline for withdrawal symptoms can vary significantly among individuals. Generally, benzodiazepine withdrawal can begin within a few days after reducing the dose and may last for several weeks. Symptoms can include anxiety, insomnia, headaches, and in some cases, more severe reactions. It’s crucial to taper off these medications under medical supervision to minimize withdrawal effects.

3. Sleep Duration: The reduction in sleep duration to about 4.5 hours after decreasing your medication is concerning. It’s not uncommon for individuals to experience changes in sleep patterns when adjusting medication, but if this persists, it’s essential to discuss it with your healthcare provider. They may consider alternative treatments or adjustments to your current regimen.

4. Alternative Treatments: If you find that your current medications are not providing the desired effects or are causing significant side effects, it may be worth discussing other options with your doctor. Non-benzodiazepine sleep aids, cognitive behavioral therapy for insomnia (CBT-I), or lifestyle modifications (such as improved sleep hygiene, regular exercise, and stress management techniques) can be beneficial.

5. Monitoring Symptoms: It’s crucial to keep track of your symptoms and communicate openly with your healthcare provider about any changes you experience. They can help you navigate the complexities of medication management and provide support as you work through your anxiety and insomnia.

In summary, managing insomnia and the effects of medication withdrawal requires a comprehensive approach that includes careful monitoring of symptoms, open communication with healthcare providers, and consideration of alternative therapies. It’s essential to prioritize your mental health and seek support as needed.

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