Diphenhydramine Abuse and Withdrawal-Reply

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In Reply.— We are delighted to comment on Dr Glickman's response to our report. In view of the features common to withdrawal from many sedating drugs, we find it difficult to ascribe our patient's irritability and insomnia specifically to rebound from the anticholinergic and not the sedative effects of diphenhydramine. Similarly, akathisia or a related syndrome could not be established in this case, so Dr Glickman's extrapolation from antidepressant and neuroleptic withdrawal to diphenhydramine withdrawal must remain speculative, although intriguing. If akathisia had in fact occurred, however, the patient's thiothixene use would be a more likely cause. It is important to note as well that rituals may indeed be of great magnitude, and our patient's bedtime behavior was characteristically repetitive, stereotyped, compulsive, and calming. Dr Glickman's final suggestions certainly merit avid consideration. The point of our publishing this case was not to offer a recipe for diphenhydramine tapering but to

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