Olanzapine Withdrawal

I began taking 2.5mg of Olanzapine in May 2020 at the advice of an ex-psychiatrist. Even the small dose made me sedated, and I discontinued. What I didn't expect was the insomnia that hit me over the next week. I couldn't sleep. This aggravated the psychosis that I was initially prescribed the Olanzapine for. I had a mental break, I checked into a mental hospital, and my wife divorced me. It was a terrible summer. In the hospital, I was put on 15mg of Olanzapine. After checking out, I reduced my dose to 7.5mg. I did not feel strong withdrawal from this, although I had a few wobbly days. But then when I tried to reduce further, the insomnia returned. It was then that I did some internet searches and realized that the insomnia was something a fraction of patients get when withdrawing from Olanzapine. There is literature on withdrawal from antipsychotic meds, which does not perfectly capture my case but is reassuring in the sense that some doctors are aware of this problem. I providesome helpful citations below.

The insomnia lasts weeks if not months, and can severely destabilize life. I would love input in the discussion as to how long your insomnia lasted, with details on how much sleep per night during the different periods of your recovery.

I found a psychiatrist who is helping me reduce my dose of Olanzapine and has initiated another anti-psychotic. In reducing Olanzapine, we went slowly at first. I found that in about a month, I could reduce from 7.5mg Olanzapine to 6.875mg. I used a precision scale and razor to cut down pills. To address the insomnia, we used 1mg of Ativan nightly. Sadly, Ativan (known as Lorezepam generically) is an addictive (but very effective) benzodiazepine. We tried a number of non-benzo sedatives (e.g., hydroxizine and trazadone), but these alternatives to Ativan did not work. We also tried to supplement the cholinergic and muscarinic channels, to reduce the effect of withdrawal -- but this also did not work (see articles below on cross-tapering antipsychotics with attention to receptor interactions).

After that initial foray from 7.5mg to 6.875mg, we decided to try a faster reduction. I am in the midst of it now, having recently reached zero Olanzapine. I am not sleeping well (about 4-5 hours a night) and using 2mg of Ativan. I'm keeping my fingers crossed that the insomnia gets better over a few months, and then I'll deal with Ativant withdrawal. To be clear, I am on another anti-psychotic (Latuda) and am mentally healthy.

I do not advise paying for the bibliography, but if you have access to these articles, they may be helpful background. Again, I have not found accurate depictions of my withdrawal in the literature. But the literature does recognize that insomnia may result from Olanzapine withdrawal (although many of the descriptions grossly underestimate its length).

1. John Muench and Ann Hamer, Adverse Effects of Antipsychotic Medications, American Family Physician (March 2010)
2. Johnny Su, Alasdair M. Barr, Ric M. Procyshyn, Adverse Events Associated with Switching Antipsychotics, Journal Psychiatry Neuroscience (2012)
3. Lasse Brandt, Tom Bschor, Jonathan Henssler, Martin Müller, Alkomiet Hasan, Andreas Heinz and Stefan Gutwinski, Antipsychotic Withdrawal Symptoms: A Systematic Review and Meta-Analysis, Frontiers in Psychiatry (Sept. 2020)
4. Rohan Ganguli, Jaspreet S Brar, Ramy Mahmoud, Sally A Berry and Gahan J Pandina, Assessment of Strategies for Switching Patients from Olanzapine to Risperidone: A Randomized, Open-Label, Rater-Blinded Study, BMC Medicine (2008)
5. Miriam Larsen-Barra, Fred Seymoura, John Readb, Kerry Gibsona, Attempting to Discontinue Antipsychotic Medication: Withdrawal Methods, Relapse and Success, Psychiatry Research (2018)
6. Joanna Moncrieff, Swapnil Gupta and Mark Abie Horowitz, Barriers to Stopping Neuroleptic (Antipsychotic) Treatment in People with Schizophrenia, Psychosis or Bipolar Disorder, Therapeutic Advances in Psychopharmacology (2020)
7. Nikolai Albert, Lasse Randers, Kelly Allott, Heidi Dorthe Jensen, Marianne Melau, Carsten Hjorthøj and Merete Nordentoft, Cognitive Functioning Following Discontinuation of Antipsychotic Medication, Psychological Medicine (2018)
8. Alicja Lerner and Michael Klein, Dependence, Withdrawal and Rebound of CNS Drugs: An Update and Regulatory Considerations for New Drugs Development, Brain Communications (2019)
9. C.U. Correll, From Receptor Pharmacology to Improved Outcomes: Individualising the Selection, Dosing, and Switching of Antipsychotics, European Psychiatry 25 (2010)
10. Hiroyoshi Takeuchi, Navot Kantor, Hiroyuki Uchida, Takefumi Suzuki, and Gary Remington, Immediate vs Gradual Discontinuation in Antipsychotic Switching: A Systematic Review and Meta-analysis, Schizophrenia Bulletin (2017)
11. T. Scott Stroup and Neil Gray, Management of Common Adverse Effects of Antipsychotic Medications, World Psychiatry (2018)
12. Ruth E. Cooper, Eanna Hanratty, Nicola Morant, Joanna Moncrieff, Mental Health Professionals’ Views and Experiences of Antipsychotic Reduction and Discontinuation, PlosOne (2019)
13. Richard Tranter and David Healy, Neuroleptic Discontinuation Syndromes, Journal of Psychopharmacology (1998)
14. J Staedt , G Stoppe, G Hajak, E Ruther, Rebound Insomnia after Abrupt Clozapine Withdrawal, European Archives of Psychiatry and Clinical Neuroscience (1996)
15. Nicholas Keks, Darren Schwartz and Judy Hope, Stopping and Switching Antipsychotic Drugs, Australian Prescriber (October 2019)
16. Joanna Moncrieff, Why is it so Difficult to Stop Psychiatric Drug Treatment?, Medical Hypotheses (2006)
17. Fiammetta Cosci and Guy Chouinard, Acute and Persistent Withdrawal Syndromes Following Discontinuation of Psychotropic Medications, Psychotherapy and Psychosomatics (2020)
18. Chouinard has written a number of other excellent works documenting withdrawal from psychiatric medications, including anti-psychotics
19. Anja Cerovecki, Richard Musil, Ansgar Klimke, Florian Seemüller, Ekkehard Haen, Rebecca Schennach, Kai-Uwe Kühn, Hans-Peter Volz & Michael Riedel, Withdrawal Symptoms and Rebound Syndromes Associated with Switching and Discontinuing Atypical Antipsychotics: Theoretical Background and Practical Recommendations, CNS Drugs (2013)

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