Q:  Mood Stabilizers & Withdrawing from Benzo's

I'm diagnosed with Bipolar 2..very mild. I wish to withdraw from my use of benzos. Would a mood stabilizer like Lamictal help me. I've tried withdrawing with several methods and have failed because of the intense stress and insomnia...which then can push me into a hypomanic state. Thanks for your consideration



Dear Mr. R' -- 
Mood stabilizers might indeed help.  Sounds like the current state of affairs is "mild bipolar II" treated with a member of the benzodiazepine family (Valium and its many cousins, usually, in this case, alprazolam (because of the company's remarkable marketing effort several years ago) (that's Xanax); or lorazepam (Ativan in the U.S.); or clonazepam (Klonopin).  As you've learned, mood stabilizers are the current standard treatment for bipolar disorder.  Some authors regard clonazepam, but not other benzo's, as a "mood stabilizer" of sorts, perhaps a weak one but sometimes useful as an add-on to other medications. 

So, yes, any mood stabilizer probably has a better chance at stopping the cycling that (if the diagnosis is correct) is potentially the basis, at least in part, of your stress-sense and your insomnia.  (Skeptics would balk at the "stress" being regarded as a bipolar symptom, rightly so in part; but anxiety has been described as a bipolar symptom; for more on that, you skeptics (good for you), here's a brief review of anxiety as a bipolar symptom). 

Lamotrigine is perhaps one of the least famous for being able to address "stress and insomnia".  Its strength is in treating the depression side of things, but it can also stop rapid cycling far better than a placebo so we might still consider it in some cases for these symptoms if "cycling" was prominent.  Otherwise there are other mood stabilizers on the list that would usually be thought of before lamotrigine.  As you may have learned already, you might need to try several different medications, all the while keeping in mind the goal of "100% symptom control, 0% side effects", looking for the one that gets closest to that goal.  Good luck with that process. 

Dr. Phelps

Published January, 2005