Advice on Haldol (Haloperidol) withdrawal symptomes
April 28, 2020 12:50 PM   Subscribe

A close relative was hospitalized for 2 months with a diagnosis of bipolar mania with psychosis. He was prescribed Haldol since atypicals didnt work. As he was discharged, he immediately stopped all meds. A week later, he has delusions of grandeur and possibly hallucinations. Also, he's very slow cognitively. Obviously, the assumption is the his illness is back. But, could it simply be withdrawal symptoms? I see Hallucinations, confusion and delusions listed as withdrawal symptoms and Return of psychosis as a separate entry in withdrawal symptoms. Is there any chance that he has these "withdrawal symptoms" go away and the original illness would not return? How long would these types of withdrawals last? (He has not told his doctor that he's off meds. I want to be sure that there's no chance of being OK and not being on meds before I notify the doctor.)
posted by kirsti to Health & Fitness (12 answers total)
 
Bipolar disorder and Psychosis are chronic. They do not go away. If you trust the doctor's diagnosis, then there is zero chance that the "original illness" is gone. You should absolutely warn his doctor, immediately, that he has quit his meds cold turkey. Even if he wasn't mentally ill, it's very dangerous and very awful to go through psychiatric withdrawal. He needs help. I have not personally been on any antipsychotics, though I regularly take SSRIs (paroxetine) and have had to endure withdrawal on several occasions. It really is mentally agonizing.

But, more importantly, being on the medication has saved my life. I have a steady, respectable job. I do not self harm. I have meaningful relationships, I engage in many hobbies, I make art, I go to school. Medication is not an enemy. It is in his best interest for you to contact his doctor.
posted by FirstMateKate at 1:02 PM on April 28, 2020 [14 favorites]


(He has not told his doctor that he's off meds. I want to be sure that there's no chance of being OK and not being on meds before I notify the doctor.)

There's no chance of being OK and not being on meds, and his doctor needs to know ASAP, for his own safety. (I am also bipolar and take antipsychotics.)
posted by fiercecupcake at 1:25 PM on April 28, 2020 [14 favorites]


Is there any chance that he has these "withdrawal symptoms" go away and the original illness would not return?

No there is not. You are free to contact his doctor, but you should also be aware that as agonizing as mental illness can be for the friends and family of someone with a bipolar illness, you cannot force someone to take their meds. Anti-psychotics can be tough and Halodol can be shit. Non-compliance is high, and in order to minimize non-compliance, very careful monitoring of side-effects and tuning of doseage is required.
posted by DarlingBri at 1:27 PM on April 28, 2020 [3 favorites]


Also, I think you're confused about what they are listing as withdrawal symptoms. They're saying that a consequence of stopping the meds is that the illness returns. That is what you are seeing now, in addition to whatever other actual withdrawal (GI symptoms, insomnia, whatever) is being caused by the meds.

Some things you should know about treating bipolar disorder are that the meds can suddenly stop working, that psychosis can come back any time even when you're on meds, that you can feel so good and normal on your meds that you stop taking them, and that it's very common for people to do that.

The other thing is a really cruel one: that if you stop taking a med that is working for you, it may not work again if you restart it. There are only so many meds out there. His doctor needs to know NOW.
posted by fiercecupcake at 1:28 PM on April 28, 2020 [10 favorites]


Many/most people with bipolar need to be on meds for life. People who are stable and under consistent medical oversight with a longstanding and trusted care team can reduce or change meds or perhaps even try life without them. But stopping meds cold turkey immediately after a long term hospitalization is not going to be a safe or healthy situation, and he needs a care team who will work to keep him on some appropriate medication while he transitions out of the hospital.

I don’t know what your situation is re: whether he has given his doctors permission to talk to you. But if you do have a line of communication to a doctor this is the time to use it.

If he’s been discharged to some kind of partial outpatient program, that might provide a good structure for him and would typically include medication oversight. This is a weird time for IOPs but some are still meeting, and it would be worth looking at whether there is a good program in your area that might be a good fit for him.
posted by Stacey at 2:25 PM on April 28, 2020 [4 favorites]


If it took 2 months to stabilize his acute psychosis while hospitalized, it is likely this next episode could be worse if he doesn't get back on meds as quickly as possible. Perhaps consider discussing the long acting injectable version, Haldol deconoate with his treatment team due to history of medication noncompliance.
posted by IndigoOnTheGo at 2:45 PM on April 28, 2020 [4 favorites]


There's no chance of being OK and not being on meds

I'm sorry, I need to amend this. I meant to say, there's no chance of HIM, RIGHT NOW being OK and not being on meds. There are of course people who, to various degrees of OKness and with varying amounts of backup and help, can be OK and not on meds, but they are few and far between and well-supported (and may still need help sometimes).
posted by fiercecupcake at 3:16 PM on April 28, 2020 [5 favorites]


Even if he hasn’t given permission for his doctors to talk to you, you can still tell them this information.
posted by kerf at 3:21 PM on April 28, 2020 [1 favorite]


I had problems with mania and psychosis for most of my adult life and now take a minimal dosage of an anti-psych (clozapine) that successfully prevents these. I don't have a direct answer to your question, but I wanted to make a few comments:

1) I've taken haldol at various times, sometimes as part of hospitalizations, and it is a horrible, horrible drug for the mind and the spirit. It is completely natural for someone not to want to take it. My own psychiatrist feels that it is barbaric to prescribe haldol. You say atypicals haven't been effective. Are you absolutely sure that clozapine has been tried? Some psychiatrists are reluctant to use it because it can hurt white blood cell count and the patient needs to have regular blood labs to make sure this isn't happening. But in itself it's very effective and is, in my experience, much less awful on the mind and spirit than other anti-psych meds, and I've taken quite a few.

2) Psychiatrists routinely over-prescribe anti-psychs. Very high dosages make some sense during and immediately after hospitalizations, because one is trying to bring the patient down from mania / a psychotic high. But often the maintenance doses are unnecessarily high, which can ruin life-chances and destroy personal relationships, just as surely as what they are supposed to treat does. This over-medication appears to be built into psychiatric dogma. Just looking at my own experience with clozapine, I started it years ago at what was considered a moderate dose of 150 mg a day. The official dogma holds that 100 mg a day corresponds to the lowest therapeutic level for a person of my body weight - i.e. that it is the lowest level of clozapine in the blood stream that can control psychosis and mania. I am now at a dosage of 50 mg a day and there is no mania or psychosis in sight. These differences in dosage make a very, very real difference in what the psychiatrists call 'quality of life' but which includes effects on all manner of life skills.

Since anti-psych meds are so harmful to mind and spirit, it is very important for the sake of life chances to not be over-medicated. And the more tolerable a particular dose is, the less motivated a patient will be to cease taking the medication.

3) In general, psychiatrists don't really know what they are doing. Their diagnostic conclusions are based on a pretty much pseudo-scientific manual, the DSM, that purports to identify underlying 'diseases.' But psychiatrists don't have any real knowledge about said diseases. All they have is psychiatric disturbances and a bunch of drugs that they only partially understand to throw at the patient. One psychiatrist I saw compared the prescribing of psych-meds to "whacking the television set" when it isn't getting good reception. Sometimes a whack brings about better reception, but the whacker doesn't really know why. Not all psychiatrists are so honest.

It is therefore very important to work with a psychiatrist who has some humility and is able to allow treatment to be driven by the patient's engagement in their own well-being. An authoritarian approach has no place in good psychiatric treatment, and it's even for this reason somewhat a misnomer to refer to someone as a psychiatric 'patient'.

But, to emphasize the point closest to a response to your question: haldol is just awful. The idea of taking the long-acting injectable version, as suggested above, is even more horrible to contemplate - and I've met people whom that's been done to with haldol, and taken injectable versions of another anti-psych myself in the past. Do everything you can to ensure your relative truly has tried all other options, especially clozapine, which is widely used and, again, much less awful.
posted by bertran at 5:26 PM on April 28, 2020 [6 favorites]


In a world where psychiatric medicine was as precise as quantum mechanics, where therapists were cool compassionate avatars of the goddess of mercy and where both were available easily and without judgement the above suggestions might be valid.
I doubt that you and your friend live that world and I have grave doubts that anyone who would prescribe haldol on an outpatient, and presumably indefinitely ongoing, basis can be trusted to be doing anything more than handing off a problem.
Haldol is not even remotely comparable to an ssri. As bertran says it is a seriously bad medicine although it has it's place in critical, short lived, situations.
Take haldol on the long term and you are guaranteed to cut a decade off your lifespan due to obesity, diabetes and a host of other fun side-effects. You won't care about that though, because you won't care about anything. In a sense you won't even be there to care.
Clozapine, again, as bertran said, is far better but is hard to get a prescription for because it can kill without close white cell monitoring.
Unless your friend is a danger to himself or others please don't throw him back to the people who wanted to do this to him. Help him find a doctor who can accept that a stunned distant silence isn't a sign of successful medication.
posted by thatwhichfalls at 8:18 PM on April 28, 2020 [2 favorites]


I was prescribed Haldol as an outpatient and it definitely wasn't passing the buck. You are overgeneralizing and in a dangerous way.

I took Haldol because of the side effects of the atypicals (the side effects you are referencing are those of atypicals, not Haldol). I was already humongous (topped out at 440 lbs). It also isn't true that you're not there. I was a functioning human being with feelings and motivation and the ability to hold down a job, even at a dosage of 10 mg, which is quite high.

Yes, I had the tremors and those were a PITA. But they were much better than the weight gain of the atypicals. I wouldn't trade Haldol for the world because it got rid of the horrible voices I was hearing. I was not schizophrenic or bipolar. I had such severe depression, it caused psychotic symptoms.

Over a long period of time, I weaned off the Haldol. The first time was unsuccessful. The second time was. And when I say a long time, I mean years.

It's not uncommon for people to stop meds once discharged. And I understand why your relative would do it. Please let their doctor know. Understand the doc won't be able to talk to your without your relative's permission. Psychiatrist don't prescribe Haldol for shits and giggles. Please don't listen to people who try to make you think that. Yes, psychaitry is a crap shoot. We're learning more everyday. Unfortunately, that's the state of some medical specialties. Being on Haldol or any psych med is usually better than living in the psychological pain and having the ramifications of mental illness.

Sorry if this comes off as a rant. I'm trying to be helpful but also dispelling some misconceptions about Haldol specifically and psych meds in general.
posted by kathrynm at 7:39 AM on April 29, 2020 [5 favorites]


well, for one, it's not "back" - if you are bipolar you are bipolar forever, though we can experience a sort of remission.

if he is bipolar with psychotic features, none of those things will go away when he's not on meds. it's most likely that he's experiencing a resurgence of symptoms and not withdrawal. he will not be okay without meds.

haldol is a brutal drug. it's kind of like using a wrecking ball to destroy...something easily destroyed. lots of times it's used to stabilize people when they first enter treatment, but it's very rare these days for it to be taking it regularly (although it is cheap, and all that works for some people.)
posted by megan_magnolia at 12:51 PM on April 30, 2020


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