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35th AM (2025) - Poster Session
Withdrawal Precipitated by Another Withdrawal
Withdrawal Precipitated by Another Withdrawal
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Pdf Summary
A 76-year-old woman with hypothyroidism, depression, and anxiety, on long-term citalopram and propranolol, escalated clonazepam to 2 mg daily amid daily alcohol use linked to psychosocial stress. A trial of quetiapine was ineffective. Suspecting benzodiazepine withdrawal, she underwent detox/rehab, completed a clonazepam taper, had propranolol adjusted, and was started on gabapentin, buspirone, and mirtazapine, eventually achieving stability. A subsequent attempt to taper citalopram highlighted the complexity of withdrawal management, as SSRI tapering can mimic or exacerbate benzodiazepine withdrawal, complicating diagnosis.<br /><br />The case underscores the challenges in deprescribing benzodiazepines and SSRIs in elderly patients, who face heightened risks due to altered metabolism, comorbidities, polypharmacy, and psychosocial stressors. Benzodiazepines, commonly prescribed for anxiety and insomnia, carry risks of dependence, tolerance, cognitive decline, and withdrawal symptoms such as anxiety, tremor, insomnia, perceptual disturbances, and seizures. SSRIs, though less dependence-prone, are increasingly recognized to cause withdrawal symptoms including flu-like sensations, dizziness, anxiety, irritability, "brain zaps," and insomnia, which may overlap with benzodiazepine withdrawal symptoms.<br /><br />This clinical case highlights an important gap in research, as few studies explore combined benzodiazepine and SSRI withdrawal trajectories in geriatric populations. It emphasizes the necessity for individualized deprescribing protocols to minimize withdrawal risks and the vital role of non-pharmacologic supports like psychotherapy and psychosocial interventions as adjunct therapies. Overall, careful management and tailored approaches are crucial to safely navigate withdrawal in elderly patients with complex psychiatric and medical backgrounds.
Keywords
benzodiazepine withdrawal
SSRI withdrawal
elderly deprescribing
clonazepam taper
citalopram withdrawal
polypharmacy risks
psychosocial stress
gabapentin therapy
buspirone use
geriatric psychiatry
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