Benzodiazepines and Bipolar Disorder

Benzodiazepines are sedative medications that are primarily used to treat anxiety disorders. Due to their potentially dangerous side effects and addictive properties, many doctors hesitate to prescribe them even for on-label uses like treating panic disorder. Prescribing benzodiazepines for bipolar disorder is especially rare because they can trigger or worsen symptoms of both depression and mania.

For people with bipolar, benzodiazepines are sometimes used to treat symptoms of a co-occurring anxiety disorder or symptoms of agitation during a manic or hypomanic episode. However, because of the risks involved, benzodiazepines and bipolar medications like mood stabilizers are rarely prescribed together on an outpatient basis and are more likely to be combined in the course of inpatient treatment for mania.

Researchers have found that prescribing benzodiazepines for bipolar disorder not only increases the risk that a person will have another mood episode but is a predictor of a more severe course of illness overall.

Ativan (lorazepam) is used more often than any other benzodiazepine in hospitals, so using Ativan for bipolar disorder is more common in inpatient settings. It may be used to treat agitation, withdrawal symptoms or anxiety.

Ativan and bipolar symptoms do not always mix well, but in the controlled environment of a hospital, side effects can be monitored more easily. Ativan may be administered when reducing agitation or extreme anxiety is immediately necessary.

Intravenous (IV) Ativan takes effect more quickly than other benzodiazepines but maintains its effect over a longer period compared to other fast-acting benzodiazepines. Ativan slowly and consistently releases in steady amounts until it is entirely out of someone ’s system six to eight hours later.

Doctors usually taper patients off of Ativan after mood stabilizers and other more typical bipolar medications start to take effect.

According to the Drug Enforcement Administration (DEA), alprazolam (Xanax) is the most frequently prescribed benzodiazepine in the United States, with doctors prescribing it nearly twice as often as Ativan and Klonopin. Rarer in inpatient settings, Xanax is more often prescribed by outpatient psychiatrists and primary care doctors to help people with anxiety symptoms.

Is Xanax used for bipolar disorder? While it is sometimes used to treat insomnia, Xanax is not used as often as it once was to treat bipolar agitation and manic symptoms. Xanax and bipolar disorder symptoms do not generally mix well.

The paradoxical excitement that follows from Xanax’s disinhibiting effects may be why Xanax can trigger episodes of mania or hypomania. The possibility of triggering manic episodes and its abuse potential are reasons why using Xanax for bipolar disorder is extremely rare both inside and outside of the hospital.

Prescribing Valium for bipolar disorder may be less risky than prescribing Xanax for bipolar disorder because Valium, while fast-acting, has a longer half-life than Xanax. This doesn’t necessarily mean its active effects last longer, but it does mean in most cases that:

  • It takes longer to be eliminated by the body.
  • Its residual effects last longer.
  • It causes less severe withdrawal symptoms.

Valium and bipolar disorder are not an ideal combination. Due to the risks that come with all benzodiazepines, people with anxiety and bipolar disorder are better served by alternative treatment options that are less likely to intensify depressive symptoms or trigger mania.

Klonopin for bipolar disorder has a similar profile as Valium for bipolar disorder. It has a more delayed onset, a longer half-life and stays active in the body for relatively long periods. This means it has less addictive potential and reduced withdrawal effects compared to Xanax and may be a better option for long-term management of anxiety. However, it carries similar risks as other benzodiazepines.

As with any benzodiazepine, discontinuing Klonopin can trigger serious medical withdrawal symptoms that can even be life-threatening. People who use benzodiazepines for long periods typically require medically supervised detox.

Benzodiazepines are sometimes used during inpatient treatment of bipolar disorder to reduce agitation and manic symptoms while waiting for mood stabilizers to take effect. In rare cases, people with bipolar disorder and severe co-occurring anxiety disorders may be prescribed benzodiazepines on an outpatient basis.

In general, doctors and psychiatrists avoid prescribing benzodiazepines to people with bipolar disorder. When people start using benzodiazepines, bipolar symptoms that were under control can return with higher intensity than before.

In summary, prescribing benzodiazepines to someone with bipolar disorder carries the following risks:

  • The sedative effects of benzodiazepines can worsen depressive symptoms.
  • The disinhibiting effects of benzodiazepines, especially short-acting formulations like alprazolam (Xanax), can trigger the onset of manic or hypomanic episodes.
  • Using benzodiazepines during a manic episode increases the risk that a person will engage in high-risk behavior with potential negative legal or medical consequences.
  • Benzodiazepines are highly addictive and have severe withdrawal effects that can be medically dangerous.

If you are concerned about your benzodiazepine use, you can take a self-assessment quiz to determine whether you are addicted to Valium, Xanax, or Klonopin. You can also read an overview of benzodiazepine addiction or learn more by talking to someone at The Recovery Village.

If you or someone you know requires immediate treatment for co-occurring bipolar disorder and addiction, contact a representative from The Recovery Village today. Many rehab facilities across the United States provide integrated treatment that can help you address bipolar symptoms while helping you get treatment for addiction to benzodiazepines.

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