Paradoxical Reaction to Alprazolam in an Elderly Woman witha History of Anxiety, Mood Disorders, and Hypothyroidism

With less than 1% of patients who use benzodiazepines being affected, paradoxical responses to benzodiazepines are rare. Inthis case report, we outline the course of an 80-year-old female who developed a paradoxical response to benzodiazepines.Significant medical and psychiatric history includes anxiety, mooddisorder, hypothyroidism, bilateral mastectomy, goiter removal,and triple bypass. The patient presented with mental status changes, anxiety, motor restlessness, and paranoia. Over time, a temporalrelationship between the severity of the patient’s motor agitation and intake of alprazolam was observed. As doses of alprazolamwere decreased, her motor agitation became less severe. In addition to motor agitation, the patient also demonstrated increasedaggressiveness, a subjective feeling of restlessness, and increased talkativeness. As her dose of alprazolam decreased, many of thepatient’s symptoms were observed to decrease. This case report also discusses theories regarding the pathophysiology of paradoxicalreactions to benzodiazepines, known risk factors, and appropriate treatment.