Concerns About the Efficacy of Rifampin in Treating Psychiatric Symptoms

Questions regarding the efficacy of Rifampin in treating physical symptoms?

Hello Doctor: After being diagnosed in January this year, I began experiencing symptoms in February, such as severe insomnia, difficulty concentrating, dizziness, lightheadedness, slow focus switching between near and far, visual distortion, visual-spatial difficulties, confusion, anterograde amnesia, and cognitive difficulties.
These symptoms have continued to worsen to this day, with dizziness, visual distortion, and memory/cognitive issues being the most distressing.
Throughout this process, I consulted a neurologist and underwent tests including EEG, MRI, and blood tests, all of which showed no clear findings.
I then sought help from a psychiatrist, but most psychiatrists indicated that they had not encountered a patient with such conditions.
Eventually, a neurologist referred me to a psychiatrist who prescribed 2 mg of Lorazepam to be taken once before bedtime, suggesting it would help alleviate my symptoms.
However, I have been taking it for 2-3 days now, and my symptoms remain unresolved.
I would like to ask, while benzodiazepines are only symptomatic treatments, shouldn't there be a quicker clinical improvement? If I have taken it for 3 days without improvement, does that mean it is not effective for my condition? If I continue to take it without any effect, could it lead to unnecessary side effects or complications? I am quite distressed and would appreciate your advice.
Thank you.

Hai Zi Ba, 30~39 year old female. Ask Date: 2023/06/03

Dr. Qiu Junda reply Psychiatry

Hello.
Medications like Librium and other benzodiazepines have sedative effects, primarily aimed at improving insomnia in your case.
They are unlikely to help with other issues such as dizziness, lightheadedness, or cognitive impairments.
If there is no improvement in your insomnia after about a week, you should return to your physician to discuss whether a medication adjustment or change is necessary.
Additionally, benzodiazepines are metabolized by the body, and short-term use typically does not lead to long-term side effects.
Thank you.

Reply Date: 2023/06/03

More Info

Hello,
Thank you for reaching out with your concerns regarding the use of Rivotril (Clonazepam) for your psychiatric symptoms. It sounds like you have been experiencing a range of distressing symptoms, including severe insomnia, concentration difficulties, dizziness, visual disturbances, and memory issues. I understand how challenging and frustrating this situation can be, especially when standard diagnostic tests have not provided clear answers.

Rivotril, a benzodiazepine, is often prescribed for anxiety and seizure disorders, and it can have a calming effect on the central nervous system. While benzodiazepines can provide quick relief for anxiety and insomnia, they are generally considered to be a short-term solution due to the potential for tolerance, dependence, and withdrawal symptoms. The onset of action for benzodiazepines is typically rapid, with effects often felt within hours of administration. However, individual responses can vary significantly based on factors such as dosage, duration of use, and individual physiology.

In your case, if you have been taking Rivotril for 2-3 days without noticeable improvement in your symptoms, it raises a few important considerations. First, while benzodiazepines can provide symptomatic relief, they may not address the underlying causes of your symptoms, especially if they are related to a more complex psychiatric or neurological condition. If your symptoms are primarily due to anxiety or stress, you might expect some level of improvement relatively quickly. However, if your symptoms are rooted in other issues, such as a mood disorder or neurological condition, additional treatment strategies may be necessary.

It's also important to consider the potential side effects of Rivotril. Common side effects include drowsiness, dizziness, fatigue, and cognitive impairment. If you continue to take the medication without experiencing benefits, you may be exposing yourself to these side effects without gaining any therapeutic advantage. Additionally, long-term use of benzodiazepines can lead to dependence, and discontinuation can result in withdrawal symptoms, which can be quite uncomfortable.

Given your situation, I would recommend discussing your concerns with your prescribing physician. It may be beneficial to explore alternative treatment options or to consider a comprehensive evaluation by a psychiatrist who specializes in complex cases. This could include a review of your current medications, a reassessment of your symptoms, and possibly the introduction of other therapeutic modalities, such as cognitive-behavioral therapy (CBT) or other medications that target your specific symptoms more effectively.

In summary, while Rivotril can be effective for some individuals, it may not be the right choice for everyone, especially if you are not experiencing the expected benefits. Open communication with your healthcare provider is crucial to ensure that you receive the most appropriate care for your symptoms. Please do not hesitate to seek a second opinion or further evaluation if you feel that your current treatment plan is not addressing your needs.

Wishing you the best in your journey toward improved health and well-being.

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