xanax and BPD?

[maxsterling]

I'm sure this topic has probably been discussed - my apologies - but I don't have have time to search. 

Have any of your pwBPD taken Benzos/Xanax?  Any help/relief here?  My wife was just prescribed xanax after a major dysregulation yesterday.  She claims she took it before I met her and that it helped, but has been reluctant to take it again.  She also claims she abused it in the past. 

Anything to look out for/pay attention to here?   I'm to the point where I realize something has to change.

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[formflier]

Was this prescribed by her P? 

That is my biggest concern... .that this prescription is being done in context of her overall treatment... .not just to tamp down a symptom

[notdownyet]

My pwBPD has a paradoxical reaction to benzos and other hypnotics; meaning that she becomes over-stimulated and "high".

I also found that it made her BPD behaviours worse, with her becoming more impulsive, disinhibited and aggressive.  However, she did go on to abuse them, which I’m sure didn’t help, with any medicinal qualities being lost.

Having said that, everyone reacts differently to these drugs.  My pwBPD’s reaction, is likely to be less common one, though it’s worth bearing in mind.

[sweetheart]

Max benzodiazepines can be very helpful in a crisis. Your wife is clearly having a crisis triggered by issues around your mother and the prescription of Xanax will help her self-soothe as she is not able to at the moment. It will also 'hold her' psychologically and decrease the possibility of suicidal ideation by calming her. It should also give her a period of time where she can just recover herself.

Prescription of medication for someone with BPD is about symptom management and that can be as as therapeutically effective as therapy when someone presents in crisis. What your wife's doctor is seeking to avoid is any further escalation in symptoms and possible hospitalisation. However this as you know may still occur.

My h is prescribed regular benzodiazepines, these have been increased and decreased by his P as necessary. He has a well documented history of past addiction issues, and when in crisis recently has over medicated, but on the whole with tight prescription boundaries and careful monitoring they have been very effective. Your wife's P history will be well documented too.

It is positive that your wife is aware of her addiction issues and it is also important that this medication has helped her in the past. Sometimes symptom relief through medication is just as important as therapy. Sometimes in my experience with my dBPDh it is just as important not to talk about certain issues as it is to talk about them.

[Notwendy]

Benzos are very helpful to my mother. The downside is that they are addictive but you know that. Perhaps a plan to have her take something less addictive once she is out of crisis is in place ( antidepressants? ) Can you go with her to the doctor to ask about the long term plan?

[maxsterling]

Thanks, everyone.  She claims the benzos helped her simply function when she was on them a few years ago.  Side effects?  She only claims the side effects from withdrawl, but if she describes her life to me at that time it's clear the benzos solved nothing, and only enabled her to act out in other ways.  Basically, the benzos kept her from suicide. 

No question that yesterday was very, very serious.  I really think she needs the medication for times of crisis like that.  I don't know what other option there is except hospitalization.  Certainly she was waaay out of control.  Certainly I can't bring her back down, and it would be very, very bad for me to even try.  Crisis line was helpful, but I had to force the phone to her ear.  But even after talking with the crisis line, it's clear that the best it did for her last night was a more professional (not just me) voice telling her that she is having serious issues and needs help.

I did have a bit of a talk with her when she was calmer, telling her that she needs to have the medicine, and something fast acting for when she starts to spiral down.  I also told her to pay attention to the scenrios and signs she is spiraling down so that she can take the medicine before a full blown crisis.  As an example, I told her that I knew talking with my mother would distress her, and that had she had the medicine at that time, taking a pill after she talked to my mother and sister would have probably kept things within control yesterday.

Ultimately, I think her issue is the obsessive/racing thoughts.  I think that's her whole life - obsess over something until she eventually dysregulates over it.  She obsesses over everything and anything, not just big things.  It could be simply obsessing over a menu at a restaurant or a TV commercial.  I'm not sure how/when to discuss this with her.  I'm thinking of simply telling her my observations that she seems to obsess over things, and then suggest she talk with her T about ways of recognizing that issue and managing it.  She recognizes she obsesses, but I don't think she has any gauge of how much more she does this than most people and that is or how most people don't have that issue.  Most of her friends over the past decade have been thru 12-step programs, and I think most of them validate that obsessing over things is normal.

[Notwendy]

I'm not giving medical advice, but this is something you might ask her doctor for. Obsessions and OCD can be helped by some antidepressents that help with anxiety. They take some time to start working, but they may be good for long term use and are not as addictive.  So as she starts on Xanax she can also start one if the doctor thinks it is helpful.

[maxsterling]

Notwendy -

Agreed.  And she has already been given that advice.  She's already been on various antidepressants, and usually after a few months claims they don't work and the side effects aren't worth it.  To be fair, I don't think she really is experiencing severe side effects.  The side effects she speaks of may have as much to do with the untreated underlying illness (BPD) that she focuses on more when she is on the SSRIs.    When she claims they don't work, I think it is because she still feels the "crisis" issues.  So maybe having the SSRIs and then the benzos for high stress times is the way to go.  Actually, that is what the doctor suggested last night.

Part of her problem is that she does not have a psychiatrist ATM.  A year and a half ago when she was in the hospital, they classified her as "seriously mentally ill", and that opened the door up for a bunch of free services - psychologists, clinics, hospitalizations, and programs/group therapies.  So, she had been going to a clinic for her medications, and talking with a psychiatrist on staff.  The problem is, the psychiatrist was a busy man, and could not work with her as well on an individual level.  So, she started talking to the nurse practitioner there, who is able to give her med prescriptions, but really doesn't have as much medicine knowledge.  And being part of the clinic and having a history of drug abuse and suicide attempts, they would not give her benzos.  Now that she has my private insurance, she's having a problem getting psychs to see her because of her classification as seriously mentally ill.  When they hear that, they tell her she needs to work with her clinic.  Not sure why.  She's scheduled an appointment with a psych, but he is not taking new patients until march

[formflier]

 

That stinks... .not having a good P.

I think you have identified that is critical... .no idea what can be done about scheduling that.

I'm wondering if hospitalization is worth it to get her in front of a P a bit faster. 

However... .if it is not going to be a P that she can continue to work with... .might not be worth it.

[Notwendy]

It is hard that she doesn't have one. I hope they can get her helped until March.

[waverider]

My partner got into serious problems with Xanax. It is for crisis management of panic attacks, not for general ongoing medication. it wears off quickly as so brings on withdrawal, requiring another hit. Very soon it is being taken to combat withdrawal more than anything else.

In Aus it has now been put on a highly restricted schedule, to the point that that brand Xanax has been withdrawn from Aus only a couple of generics left. It cannot be prescribed for more than 8 weeks without a permit requiring approval by a psychiatrist, and an addiction specialist if there is history of addiction. It can take hospitalization or drug rehab to get off.

Diazapam (valium) is the preffered ongoing benzo as it last longer in the blood so doesn't bring on addiction craving the same, and is used for ongoing anxiety disorders. Again strict caution needs be exercised as it is still addictive. Too much for too long can have kick back issues causing further depression.

My partner is on 16 x5mg diazapam tabs (withdrawing 1/2 tab per month) as part of coming of Xanax 9 months ago. It is hard comming off benzos, add in the reluctance of a pwBPD and it is like storing dynamite in your basement... .STRICT KNOWLEDGABLE SUPVERISION REQUIRED. If your average GP starts handing them out as they would to any regular person then that is a red flag. A pwBPD will start acting out what is required to get them.

[sadeyes]

My uBPD has had a different and "positive" experience with xanex. He did have addiction issues (street drugs)as a teenager/young adult, but has been free (with no desire to return) from that for going on 20yrs.

He takes Paxil, an SSRI, and I do see some benefit. Mostly with anxiety, and high anxiety=very bad times here.

As for the benzo, he does take it pretty infrequently for "crisis" situations as well as sleeping when he has has a long bout of insomnia. For some reason, it has a unique effect in that within about 15 minutes he is out like a light. The only thing I can figure is that he is so ridden with anxiety all the time that when he is helped with that,  his body just crashes.

[waverider]

My uBPD has had a different and "positive" experience with xanex. He did have addiction issues (street drugs)as a teenager/young adult, but has been free (with no desire to return) from that for going on 20yrs.

He takes Paxil, an SSRI, and I do see some benefit. Mostly with anxiety, and high anxiety=very bad times here.

As for the benzo, he does take it pretty infrequently for "crisis" situations as well as sleeping when he has has a long bout of insomnia. For some reason, it has a unique effect in that within about 15 minutes he is out like a light. The only thing I can figure is that he is so ridden with anxiety all the time that when he is helped with that,  his body just crashes.

My partner is on SSRI too and is probably the most useful of her many tabs. Benzos can become sleeping tabs they can't do without. I have taken the odd one for a good sleep when chaos was reigning around me. diazapam was ok OCCASIONALLY. Xanax would knock me out dead. Its just too potent.

[Cole]

Understand what you are going through with the P. There is a serious shortage of MD's going into that field.

Check for a partial hospitalization program in your area. Several of our hospitals have them around here. They fill the gap between folks who need admitted and those who have minor issues and can wait a while.   

[notdownyet]

My partner is on 16 x5mg diazapam tabs (withdrawing 1/2 tab per month) as part of coming of Xanax 9 months ago. It is hard comming off benzos, add in the reluctance of a pwBPD and it is like storing dynamite in your basement... .STRICT KNOWLEDGABLE SUPVERISION REQUIRED. If your average GP starts handing them out as they would to any regular person then that is a red flag. A pwBPD will start acting out what is required to get them.

Totally agree.  My pwBPD knew exactly how to play the system to get hold of benzo's and hypnotics.

She developed a clever strategy, where she wouldn't ask for them directly, but would go into the Dr, saying that she was having trouble sleeping, or couldn't go out of the house due to anxiety.

When one Dr was hesitant about prescribing them (diazepam), my pwBPD played the tactic of saying, “I’ll leave it up to you to decide, as you’re the professional”.  This was to appease their professional integrity and demonstrate some level of personal responsibility.

As she ran out of tablets, the game plan changed, and she'd say that she'd lost a packet, or was going on a holiday, so needed an extra supply.  She also said that I’d confiscated them so need a replacement.  She also walked into an emergency care centre and managed to obtain some lorazepam, having already taken an over-dose.

She even went as far as writing a praising letter to the Dr, in order to keep him on side, and therefore the supply channel open – ruthless.

My experience of Dr’s and the prescribing of benzo's and hypnotics here in the UK is not a good one.  Even after multiple overdoses and respective hospital admissions, the Dr’s failed to monitor her properly and continued to supply the very same drugs that were bringing about the OD's and hospital admissions.

Hope I haven’t gone too off topic there.

[Cole]

If your average GP starts handing them out as they would to any regular person then that is a red flag.

Any GP prescribing these drugs is a big red flag.

Our drive down this dark road started with BPDw's GP prescribing anti-depressants for what he thought was postpartum depression. This threw my bipolar/BPD wife into extreme mania, the repercussions of which we are still trying to deal with.   

I would not go to a podiatrist for a heart murmur or a dentist because I have blurry vision. There is a shortage of P's, but they are the only ones who should be dealing with these issues. 

[notdownyet]

Any GP prescribing these drugs is a big red flag.

Our drive down this dark road started with BPDw's GP prescribing anti-depressants for what he thought was postpartum depression. This threw my bipolar/BPD wife into extreme mania, the repercussions of which we are still trying to deal with.  

I would not go to a podiatrist for a heart murmur or a dentist because I have blurry vision. There is a shortage of P's, but they are the only ones who should be dealing with these issues.

Wow!

This is the exact same thing that happened to us.

My wife was prescribed a tricyclic antidepressant, prior to being diagnosed with bipolar/BPD, when she was going through a depressed period.

The Dr wrongly assumed that she had unipolar depression, even though he had himself, dealt with one of her psychotic episodes years earlier (which too, was bought about during a course of tricyclic antidepressants)

Unbeknown to us at the time, she then switched into the manic phase of the illness. Without going into detail, all I can say is that this nearly destroyed our family life and marriage.

Along with the antidepressant, he also threw in both diazepam and sleeping tablets, both of which my BPDw abused (together with alcohol)

This all happened in 2013, and we’re still picking up the pieces now.

I hope your recovery is going as well as it can be.

Private message me if you’d like to.

[MissyM]

 I wish I was shocked but I have seen this happen too many times by doctors that have no understanding of addiction.  Unequivocally, no addict should take xanax.  It is highly addictive and would not be surprised if it lead to the use of other substances.  My dBPDh was very addicted to this and just started adding in other drugs once he was taking this.  Does her sponsor know she is taking this?

[Cole]

Any GP prescribing these drugs is a big red flag.

Our drive down this dark road started with BPDw's GP prescribing anti-depressants for what he thought was postpartum depression. This threw my bipolar/BPD wife into extreme mania, the repercussions of which we are still trying to deal with.  

I would not go to a podiatrist for a heart murmur or a dentist because I have blurry vision. There is a shortage of P's, but they are the only ones who should be dealing with these issues.

Wow!

This is the exact same thing that happened to us.

My wife was prescribed a tricyclic antidepressant, prior to being diagnosed with bipolar/BPD, when she was going through a depressed period.

The Dr wrongly assumed that she had unipolar depression, even though he had himself, dealt with one of her psychotic episodes years earlier (which too, was bought about during a course of tricyclic antidepressants)

Unbeknown to us at the time, she then switched into the manic phase of the illness. Without going into detail, all I can say is that this nearly destroyed our family life and marriage.

Along with the antidepressant, he also threw in both diazepam and sleeping tablets, both of which my BPDw abused (together with alcohol)

This all happened in 2013, and we’re still picking up the pieces now.

I hope your recovery is going as well as it can be.

Private message me if you’d like to.

I am guessing we are not alone and our spouses are not the only victims of what I would have to call malpractice.

In our case, the anti-depressants caused extreme mania, resulting in an affair, $20k in credit card bills, and two very young children who's mom was never home when they needed her.

The mania is under control thanks to a P and Depakote, but she is now a pwBPD & bipolar trying to deal with extreme guilt over what she did years ago and things she has done since because she just cannot cope with who she has become.         

[maxsterling]

Thanks for all the warnings and advice, everyone.  I'm pretty sure her sponsor knows she is taking it.  And i am pretty sure she doesn't really want to take it.  She was even suggesting that I hold on to the pills and I give her one only when she is having an out of control episode.   Initially I thought that was a good idea, but I also pointed out that many of her attacks happen when I am at work.  

Any warning signs that she is switching from responsible use to irresponsible use?

[Cole]

Thanks for all the warnings and advice, everyone.  I'm pretty sure her sponsor knows she is taking it.  And i am pretty sure she doesn't really want to take it.  She was even suggesting that I hold on to the pills and I give her one only when she is having an out of control episode.   Initially I thought that was a good idea, but I also pointed out that many of her attacks happen when I am at work.  

Any warning signs that she is switching from responsible use to irresponsible use?

How about holding onto them, like she suggested, and leaving only what she may need in your absence? Then if she needs it she has it, and you can monitor use (keep a written log). If the use becomes questionable in your mind then you can contact the doctor for feedback.  

Warning signs of dependence would be: use beyond what the doctor thinks is reasonable, hiding use from you, begging or manipulative behavior to get the pills, or an increase in episodes/faked episodes to justify a fix.   

[notdownyet]

I am guessing we are not alone and our spouses are not the only victims of what I would have to call malpractice.

In our case, the anti-depressants caused extreme mania, resulting in an affair, $20k in credit card bills, and two very young children who's mom was never home when they needed her.

The mania is under control thanks to a P and Depakote, but she is now a pwBPD & bipolar trying to deal with extreme guilt over what she did years ago and things she has done since because she just cannot cope with who she has become.         

Again, this is incredibly similar to my situation, though not surprising, as it fits in with typical bipolar manic behaviour.

We also have 2 children

My BPDw too, had an affair and is now having to live with the consequences of her destructive actions.  This is the hardest aspect to deal with, though I appreciate that she wasn’t in touch with reality of the time.  Our finances were also wrecked though her excessive spending.

Though I can’t blame anyone for my BPDw’s BPD/bipolar, if she’d been referred to and assessed by a p, instead of being plied with inappropriate medicines, a lot of this mess could have been avoided.

[waverider]

Thanks for all the warnings and advice, everyone.  I'm pretty sure her sponsor knows she is taking it.  And i am pretty sure she doesn't really want to take it.  She was even suggesting that I hold on to the pills and I give her one only when she is having an out of control episode.   Initially I thought that was a good idea, but I also pointed out that many of her attacks happen when I am at work.  

Any warning signs that she is switching from responsible use to irresponsible use?

No this is not a good idea, if addiction kicks in it is like standing on the railway tracks trying to stop a runaway train that is heading for a cliff. The train will go over and you will get flattened in the process.

I tried this, pills where locked in a steel box, inside and another big steel tool box, this was padlocked away in the shed. I had to keep upgrading this security as she would break in, even to the point of going and getting bolt cutters. Found her hacking the shed door with a pick axe once.

You do not want to risk addiction, and you do not want to be between an addict and their supply. There is no blacker place to be, if you want your RS to survive.

As MissyM says once you start down the path of the "magic pill" once it stops being effective then they will look for a different magic pill, and so it compounds, as the "magic pill" mentality sets in, something/someone else can fix her.

All my partners tablets are now dispensed in blister pack doses from pharmacy. If she "looses" any than she does without until next dispensation. Keep yourself well out of the line of responsibilty and blame.

I can deal with BPD but I cannot live through hard core addiction again. That is one of my boundaries.

[formflier]

 

Wow... .waverider... .that is quite a story.

But I can understand that you would not want to be the one "saying no" to an addict.

[maxsterling]

Un update here - the Xanax has made a difference.  Things that used to send her to level 5+ have barely been a blip over the past week.  My parents even dropped by somewhat unexpectedly this morning - and I didn't even hear a peep about it (A week ago would have been WWIII).  Yes, she has been doing more things to take care of herself such as eat better, walk, and go to yoga.  Yes, she had a bit of an emotional revelation that she is abusive and vowed to change.    Yoga and walking and one T session won't take her from level 10+ down to level 1-2 in a week's time.  It's gotta be the Xanax. 

My push now is to use the opportunity to encourage her into healthy habits while she is calm.  Discourage her from trying to get a job while encouraging her to choose not to work and take care of herself.  Discuss with her that earning money means nothing if she is stressed out, and encourage her to learn to manage stress and anger first.  Discourage her from planning/projecting to the future and encourage her to take care of herself today.  Problem is, she's starting to get back on that "baby" obsession, and I really don't know how to do what I stated above without making her feel invalidated in that area.  Truth?  last Friday reminded me there are very serious issues still at play, and having a baby is not a good idea until something gets resolved there.  Maybe that could be a MC session.

[waverider]

Yes xanax is a very effective quick results drug. Hence the reason it is used for crisis management. If she requires it to function long term that is where the problem kicks in

What is the plan for its use and what dosage?

[maxsterling]

The plan for it's use - use as needed.

Dosage?  When needed.

My plan?  Make it NOT my business.  I don't want to get involved in her medication.  I only want to protect myself with boundaries if it gets out of control.  As of right now, she is at least conscious of how much she is taking.

[waverider]

If taken in the correct dose to counter panic and anxiety, she will seem normal. if she takes  too high a dose then the effect will be a quick onset of what seems drunkenness. It will come on quickly then disappear in about half an hour. This is the first  

[SlyQQ]

Been there big time 5 xanax an two to three rivotil a day disadvantages

1 addictive but coming off fairly managable 2 use over time makes them worthless making you lift and lift dosage eventually becoming more addictive an worthless 3 REDUCES inhibitions big problems with impulse control! 4 Basically is good for Sporadic use to handle very stressfull circumstances

[waverider]

Been there big time 5 xanax an two to three rivotil a day

disadvantages

1 addictive but coming off fairly  managable

2 use over time makes them worthless making you lift and lift dosage

eventually becoming more addictive an worthless

3 REDUCES inhibitions big problems with impulse control!

4 Basically is good for Sporadic use to handle very stressfull

circumstances

Was that 5mg?