From the Guidelines
Managing extreme anger during Xanax psychosis or withdrawal requires immediate medical intervention, with a focus on benzodiazepine tapering under medical supervision, utilizing evidence-based psychotherapies, and considering the use of specific medications to stabilize behavior and reduce symptoms. When considering the management of extreme anger in the context of Xanax psychosis or withdrawal, it's crucial to prioritize approaches that minimize risks and maximize benefits, particularly focusing on reducing the risk of fatal respiratory depression and managing withdrawal symptoms effectively 1.
Given the potential for severe withdrawal symptoms, including rebound anxiety, hallucinations, seizures, delirium tremens, and in rare cases, death, a gradual tapering schedule is recommended, such as reducing the benzodiazepine dose by 25% every 1–2 weeks 1. Cognitive Behavioral Therapy (CBT) can increase tapering success rates and is particularly helpful for patients struggling with benzodiazepine taper 1.
For the management of extreme anger, evidence-based psychotherapies (e.g., CBT) and/or specific anti-depressants or other nonbenzodiazepine medications approved for anxiety should be considered 1. In cases where immediate stabilization of behavior is necessary, short-term use of antipsychotics or beta-blockers might be beneficial, but these should be used under medical supervision due to potential side effects and interactions.
Key considerations in managing extreme anger during Xanax psychosis or withdrawal include:
- Gradual benzodiazepine tapering under medical supervision
- Utilization of evidence-based psychotherapies like CBT
- Consideration of specific medications for symptom management under medical guidance
- Ensuring supportive care, including hydration, nutrition, and a calm environment
- Teaching cognitive behavioral techniques for anger management in the moment, such as deep breathing, progressive muscle relaxation, and avoiding triggering situations.
It's essential to communicate with mental health professionals managing the patient to discuss the patient’s needs, prioritize patient goals, weigh risks of concurrent benzodiazepine and opioid exposure (if applicable), and coordinate care 1.
From the FDA Drug Label
DRUG ABUSE AND DEPENDENCE Physical and Psychological Dependence Withdrawal symptoms similar in character to those noted with sedative/hypnotics and alcohol have occurred following discontinuance of benzodiazepines, including alprazolam tablets The symptoms can range from mild dysphoria and insomnia to a major syndrome that may include abdominal and muscle cramps, vomiting, sweating, tremors and convulsions. When necessary, immediate management of withdrawal symptoms requires re-institution of treatment at doses of alprazolam tablets sufficient to suppress symptoms.
To manage extreme anger in a person experiencing Xanax psychosis or withdrawal, re-institution of treatment at doses of alprazolam sufficient to suppress symptoms may be necessary, as stated in the drug label 2. However, this should be done under close medical supervision.
- The dose should be reduced gradually when discontinuing therapy or when decreasing the daily dosage.
- The daily dosage should be decreased by no more than 0.5 mg every 3 days, with some patients possibly requiring an even slower dosage reduction, as suggested in the drug label 2. It's crucial to approach this situation with caution and under medical guidance to avoid worsening the condition.
From the Research
Managing Extreme Anger in Xanax Psychosis or Withdrawal
To manage extreme anger in a person experiencing Xanax (alprazolam) psychosis or withdrawal, several strategies can be considered:
- Medication adjustment: According to 3, the use of high cumulative doses of longer-acting benzodiazepines can result in rapid improvement in symptoms, including full resolution of psychosis.
- Antipsychotic medication: Olanzapine, a second-generation antipsychotic, has been shown to be effective in managing acute manic and mixed episodes, and may also have mood-stabilizing properties 4, 5.
- Benzodiazepine treatment: Diazepam, a benzodiazepine, has been found to be effective in treating moderate to severe alcohol withdrawal, and may also be useful in managing Xanax withdrawal symptoms 6.
- Mood stabilizers: Lithium, sodium valproate, carbamazepine, and lamotrigine are mood stabilizers that may be considered for managing extreme anger in Xanax psychosis or withdrawal, although their relative toxicity should be taken into account 7.
Considerations for Treatment
When selecting a treatment approach, it is essential to consider the individual's specific needs and medical history. The following factors should be taken into account:
- Severity of symptoms: The severity of the individual's symptoms, including the level of anger and aggression, should guide the selection of treatment.
- Medical history: The individual's medical history, including any previous experiences with benzodiazepine or antipsychotic medication, should be considered when selecting a treatment approach.
- Risk of suicidal behavior: The risk of suicidal behavior should be assessed, and treatment selection should take into account the relative toxicity of different medications 7.