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[Loperamide abuse in anxiety disorder]
N Langlitz1, K Schotte, T Bschor
1Psychiatrische Klinik und Poliklinik der Freien Universität Berlin.
Der Nervenarzt
|August 2, 2001
Summary
This case study highlights a woman with anxiety disorders who developed a loperamide (antidiarrheal) and benzodiazepine dependence due to self-medicating chronic diarrhea. Treatment resolved both her anxiety and digestive issues.
Area of Science:
- Gastroenterology
- Psychiatry
- Clinical Pharmacy
Background:
- Anxiety disorders frequently present with somatic symptoms, including gastrointestinal issues like diarrhea.
- Antidiarrheal misuse is rarely documented, despite its potential for abuse.
Observation:
- A 34-year-old woman with anxiety disorders self-medicated with loperamide for over a decade, escalating to 16 mg daily for chronic diarrhea.
- Her diarrhea, a somatic correlate of anxiety, initially responded to loperamide but later required benzodiazepine self-medication when loperamide became ineffective.
- This led to a secondary dependence on benzodiazepines.
Findings:
- Loperamide, an opioid acting on peripheral gastrointestinal receptors, was abused for anxiety-induced diarrhea.
- Benzodiazepine dependence developed as a consequence of escalating self-medication strategies.
- Inpatient treatment led to the resolution of anxiety symptoms and cessation of diarrhea.
Implications:
- This case underscores the potential for loperamide misuse in patients with anxiety disorders and somatic symptoms.
- It highlights the risk of developing dual dependence (loperamide and benzodiazepines) through self-medication.
- Effective management of underlying anxiety is crucial for resolving somatic symptoms and preventing medication misuse.