Psychiatric Medication Tapers and Detox Service

It is unfortunately not too uncommon, for a physician to prescribe a psychiatric medication (for an FDA approved indication and with only the best intentions), but for that medication to become problematic for the patient (even when taken exactly as prescribed). Frequent culprits include benzodiazepines (Konopin [Clonazepam], Ativan [Lorazepam], Xanax [Alprazolam], Valium [Diazepam], Ambien [Zolpidem], Effexor [Venlafaxine] and Adderall [Amphetamine Salts].

Even when benzodiazepines, certain antidepressants and medications for inattention are taken as prescribed (and within FDA approved doses), patients may become physiologically dependent on these medications. This is why it is important for a physician to establish a plan with their patient of how they will taper off the medication (if it is not effective or tolerated by the patient), before the patient initiates treatment. This will not only help to educate the patient about physiological dependence, but hopefully prevent the patient from experiencing benzodiazepine withdrawal, antidepressant withdrawal and other withdrawal syndromes.

Benzodiazepine withdrawal (Klonopin withdrawal, Xanax withdrawal and others) may include insomnia, dizziness, tremor, stomach upset, poor focus, increased anxiety, panic attacks, unstable vital signs (elevated heart rate and blood pressure) and even seizures. Experiencing these symptoms (and realizing that one is physiologically dependent on a medication), can be extremely demoralizing, particularly because this state of “therapeutic dose dependence” came about by simply following a physician’s directions.

There is certainly no “one size fits all” treatment for patients suffering with mood disorders, anxiety disorders, insomnia or inattention. I also want to be clear that I am NOT judging providers for prescribing benzodiazepines (such as Klonopin, Ativan or Xanax) or other aforementioned psychiatric medications. In fact, these medications can be very helpful for certain individuals, and I have several patients in my practice, whom I prescribe these very medications for.

With that being said, I have been specifically trained at an inpatient unit at The Johns Hopkins Hospital, to taper individuals off of benzodiazepines (Klonopin, Ativan and Xanax), problematic antidepressants (Effexor) and other psychiatric medications (such as Ambien and Adderall). I have also been trained to use medications that do not result in physiological dependence or withdrawal, to aid in this process. I am also trained to transition patients from benzodiazepines and other medications with significant withdrawal syndromes, to medications that do not cause “therapeutic dose dependence,” when indicated.

Patient examples:

• A patient who was prescribed 2 mg of Klonopin (Clonazepam), twice a day, for 10 years for anxiety. She was completely tapered off of Klonopin over the course of 10 months.
• A patient who was prescribed 1 mg of Xanax (Alprazolam), daily for anxiety for 15 years. She was completely tapered off of Xanax over the course of 6 months.
• A patient who was prescribed Effexor (Venlafaxine) 225 mg for depression for 20 years. She was completely tapered off of Effexor over the course of 6 months.
• A patient who was prescribed Ambien (Zolpidem) 10 mg at night for insomnia for 7 years. She was completely tapered off of Ambien over the course of 3 months.

To set up an appointment with Dr. Pagnani, please call 267-358-6155.