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What Causes Episodes Of Extreme Agitation?
Question: Hello
I am suffering from episodes of extreme agitation. The episodes are so extreme they are like torture. They last for several hours at a time.
I believe the cause of the agitation is down to a side effect of clonidine and/or topiramate that I take. (I was until recently on 1.2mg/day of clonidine and 200mg topiramate.) Agitation is a side effect of both of the drugs, especially clonidine. (I would be interested to know if you agree with me that clonidine is most likely the cause of the agitation.)
What I would like is for you to please list for me some drugs that I could get prescribed by a UK GP / psychiatrist that I could take that would help me when I next have an episode of extreme agitation. The drugs I have already tried are listed below:
Antidepressants: Mirtazapine, phenelzine, tranylcypromine, dosulepin, amitriptyline, citalopram, escitalopram, fluoxetine, sertraline, venlafaxine, lofepramine
Antipsychotics: Risperidone, olanzapine, quetiapine, aripiprazole, haloperidol
Benzodiazepines: Lorazepam, clonazepam, diazepam, alprazolam
Beta blockers: Propranolol
Anticonvulsants: Sodium valproate
Other: Buspirone
None of the above medications have helped in the past with the exception of the benzodiazepines, which I now have a tolerance to.
Also, I would like advice on how to come off topiramate. I currently am on 150mg. I wish to come off the drug as fast as possible but without incurring any of the severe withdrawal symptoms.
Many thanks
XXXXX
I am suffering from episodes of extreme agitation. The episodes are so extreme they are like torture. They last for several hours at a time.
I believe the cause of the agitation is down to a side effect of clonidine and/or topiramate that I take. (I was until recently on 1.2mg/day of clonidine and 200mg topiramate.) Agitation is a side effect of both of the drugs, especially clonidine. (I would be interested to know if you agree with me that clonidine is most likely the cause of the agitation.)
What I would like is for you to please list for me some drugs that I could get prescribed by a UK GP / psychiatrist that I could take that would help me when I next have an episode of extreme agitation. The drugs I have already tried are listed below:
Antidepressants: Mirtazapine, phenelzine, tranylcypromine, dosulepin, amitriptyline, citalopram, escitalopram, fluoxetine, sertraline, venlafaxine, lofepramine
Antipsychotics: Risperidone, olanzapine, quetiapine, aripiprazole, haloperidol
Benzodiazepines: Lorazepam, clonazepam, diazepam, alprazolam
Beta blockers: Propranolol
Anticonvulsants: Sodium valproate
Other: Buspirone
None of the above medications have helped in the past with the exception of the benzodiazepines, which I now have a tolerance to.
Also, I would like advice on how to come off topiramate. I currently am on 150mg. I wish to come off the drug as fast as possible but without incurring any of the severe withdrawal symptoms.
Many thanks
XXXXX
Brief Answer:
Olanzapine or Lurasidone can be tried.
Detailed Answer:
Hi, thanks for asking from HEALTHCAREMAGIC
I can understand your concern. Topiramate is a mood stabiliser drug and Clonidine is used to control anxiety and restlessness apart from a lot of other indications. Topiramate is used in extreme agitation and Clonidine too helps to control aggression. But both drugs in some rare situations can result in worsening of agitation. Its difficult to comment weather Clonidine is causing agitation in your case.
You have already tried Olanzapine and Sodium Valproate. But in my opinion you should give try to both of these drugs again. Olanzapine will help to reduce aggression and Sodium Valproate would stabilise the mood. Both these drugs will help to boost the actions of antidepressants too. So you can think of starting these drugs again.
Other choice is to add Lurasidone to your therapy. The drug is relatively newer drug, safe to use and has not much serious side effects. Lurasidone would help to control the agitation and will stabilise the mood. You can talk with your doctor for that drug.
Topiramate dose can be reduced gradually over about 6 weeks. You can reduce the dose by 25 mg every week and can reduce the dose completely at about 6 weeks. This will prevent any withdrawal symptoms.
Thanks, Take care
You are welcome to ask follow up doubts.
Olanzapine or Lurasidone can be tried.
Detailed Answer:
Hi, thanks for asking from HEALTHCAREMAGIC
I can understand your concern. Topiramate is a mood stabiliser drug and Clonidine is used to control anxiety and restlessness apart from a lot of other indications. Topiramate is used in extreme agitation and Clonidine too helps to control aggression. But both drugs in some rare situations can result in worsening of agitation. Its difficult to comment weather Clonidine is causing agitation in your case.
You have already tried Olanzapine and Sodium Valproate. But in my opinion you should give try to both of these drugs again. Olanzapine will help to reduce aggression and Sodium Valproate would stabilise the mood. Both these drugs will help to boost the actions of antidepressants too. So you can think of starting these drugs again.
Other choice is to add Lurasidone to your therapy. The drug is relatively newer drug, safe to use and has not much serious side effects. Lurasidone would help to control the agitation and will stabilise the mood. You can talk with your doctor for that drug.
Topiramate dose can be reduced gradually over about 6 weeks. You can reduce the dose by 25 mg every week and can reduce the dose completely at about 6 weeks. This will prevent any withdrawal symptoms.
Thanks, Take care
You are welcome to ask follow up doubts.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hello
Thank you for your reply.
I have already tried olanzapine and sodium valproate, so I wouldn’t like to try those again.
My problem with lurasidone is that a) I assume being an anti-psychotic it will take a while to build up in my system to be effective in fighting the episodes of extreme agitation and b) it is quite high risk for causing dystonia which I am very concerned about because I had a case of it when I started taking haloperidol when on the second day of being on it I had to go to A&E.
So if possible I would like you to recommend a choice of a few drugs that I could take that would work instantly when the episodes of extreme agitation strike and that can’t cause dystonia.
As for the topiramate, could you reduce it by 25mg every 5 days without incurring any severe withdrawal symptoms?
Many thanks
XXXX
Thank you for your reply.
I have already tried olanzapine and sodium valproate, so I wouldn’t like to try those again.
My problem with lurasidone is that a) I assume being an anti-psychotic it will take a while to build up in my system to be effective in fighting the episodes of extreme agitation and b) it is quite high risk for causing dystonia which I am very concerned about because I had a case of it when I started taking haloperidol when on the second day of being on it I had to go to A&E.
So if possible I would like you to recommend a choice of a few drugs that I could take that would work instantly when the episodes of extreme agitation strike and that can’t cause dystonia.
As for the topiramate, could you reduce it by 25mg every 5 days without incurring any severe withdrawal symptoms?
Many thanks
XXXX
Brief Answer:
Lithium can be tried for aggression.
Detailed Answer:
Hello again
If you don't want to use Olanzapine and Sodium Valproate or Lurasidone then we can think of other drugs like Lithium Carbonate.
I am not sure if have been given this drug or not. Lithium has proven anti-aggression effects and a lot of studies have shown its efficacy in controlling severe aggressive episodes. The drug if started with proper advise has very less side effects and is tolerated with ease.
But the drug will help if you take the drug regularly. In events of extreme agitation the drug will not help much in single dose.
Benzodiazepines like Lorazepam or Clonazepam can be utilised on SOS basis for acute aggression and SOS dose will not cause tolerance or dependence too.
Yes you can reduce the dose of Topiramate 25 every 5 days without any worries. This will also not cause withdrawal.
Thanks.
Lithium can be tried for aggression.
Detailed Answer:
Hello again
If you don't want to use Olanzapine and Sodium Valproate or Lurasidone then we can think of other drugs like Lithium Carbonate.
I am not sure if have been given this drug or not. Lithium has proven anti-aggression effects and a lot of studies have shown its efficacy in controlling severe aggressive episodes. The drug if started with proper advise has very less side effects and is tolerated with ease.
But the drug will help if you take the drug regularly. In events of extreme agitation the drug will not help much in single dose.
Benzodiazepines like Lorazepam or Clonazepam can be utilised on SOS basis for acute aggression and SOS dose will not cause tolerance or dependence too.
Yes you can reduce the dose of Topiramate 25 every 5 days without any worries. This will also not cause withdrawal.
Thanks.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you for your reply.
You said lithium is effective in treating aggression but is it effective in treating acute agitation? And how long will it take for lithium to build up in my system?
And unfortunately I have a tolerance to benzodiazepines. Is there anything that works as effective as benzodiazepines that relaxes you that isn't a benzodiazepine?
You said lithium is effective in treating aggression but is it effective in treating acute agitation? And how long will it take for lithium to build up in my system?
And unfortunately I have a tolerance to benzodiazepines. Is there anything that works as effective as benzodiazepines that relaxes you that isn't a benzodiazepine?
Brief Answer:
Lithium will take time to act.
Detailed Answer:
Hello again
Yes Lithium has great efficacy in controlling aggression and if taken regularly will help to control anger episodes. But if we consider in acute condition then I am afraid Lithium has not much roles.
In around 2-4 weeks time Lihium start showing its effectiveness.
If Benzodiazepines resulted in tolerance then for aggression in my opinion you have to take drugs regularly like Lithium. This will control your anger.
Chlorpromazine can be given a try. The drug has good sedation and will calm you in anger outbursts. But its role in aggression has not been studied much. The drug is relatively safer as compared to other drugs you have taken.
Thanks. Take care
Lithium will take time to act.
Detailed Answer:
Hello again
Yes Lithium has great efficacy in controlling aggression and if taken regularly will help to control anger episodes. But if we consider in acute condition then I am afraid Lithium has not much roles.
In around 2-4 weeks time Lihium start showing its effectiveness.
If Benzodiazepines resulted in tolerance then for aggression in my opinion you have to take drugs regularly like Lithium. This will control your anger.
Chlorpromazine can be given a try. The drug has good sedation and will calm you in anger outbursts. But its role in aggression has not been studied much. The drug is relatively safer as compared to other drugs you have taken.
Thanks. Take care
Note: For further guidance on mental health, Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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