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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 25 of 53. This is the beginning of the thread.
Posted by hildi on January 19, 2003, at 11:49:03
In the med book it states a bit of a difference between neurontin (gabapentin)side effects and those from gabitril (tiagabine). So, is one of these meds more effective, and one less effective for anxiety? Plus, are these for anxiety only, or also for mood stabilizing abilities?
Less activating, better, or worse -how different from each other and from lamictal?
Posted by Ame Sans Vie on January 19, 2003, at 12:32:07
In reply to Is there difference between gabitril neurontin? , posted by hildi on January 19, 2003, at 11:49:03
I really can only speak from personal experience (as I've tried all three of these drugs), though there are some generalizations that can be made about these drugs-- effects that are pretty common, it seems, when one reviews the threads on this board.
For me, side effects for Neurontin were mild and transient. For the first few weeks on the drug, and with each increase in dose, I would find myself feeling very sleepy around mid-day... sometimes even dozing off for a few hours. I also had horrible dry mouth... but both of these adverse effects disappeared within three weeks' time. As an anxiolytic, it did absolutely nothing for me... but I was on a fairly low dose (1200mg). Studies have recently shown that Neurontin is a very poor mood stabilizer.
Lamictal I just discontinued a few weeks ago when I began feeling very strange "detached", "fuzzy" feelings in my head all the time. I actually found it to be overly sedating... not to mention that it made me constantly irritable. And of course, it did nothing for my anxiety. It can be wonderful for mood-stabilization though, especially in combination with lithium.
As for Gabitril, all I can really say is *proceed with caution*. First of all, the anxiolytic effects that most of us expected from Gabitril are all but nonexistant, as tiagabine is a reuptake inhibitor of GABA-B, not GABA-A. Even at a dose of 4mg twice a day (the maximum recommended daily dose is 64mg) I found urination to be practically impossible... but I was so desperate that I foolishly stuck with it. My dose was eventually raised to 8mg x2/day, and my first 8mg dose set me right off into a catatonic state, followed by a 3-hour episode of status epilepticus. None of the anticonvulsants administered to me in the E.R. brought me out of it; they say it's literally a miracle I'm alive. And apparently mine was not an exceptional case... I've read of similar instances involving this drug. Not sure of it's usefulness in bipolar disorders.
If you're considering one of these drugs for anxiety, I'd suggest Neurontin, based on anecdotal evidence more than anything. Hope this helps some-- good luck!
--Michael
Posted by hildi on January 19, 2003, at 12:46:22
In reply to Re: Is there difference between gabitril neurontin? , posted by Ame Sans Vie on January 19, 2003, at 12:32:07
Thank You for your reply. You really had some extreme and scary experiences, and you really gave me much to think about.
I hoped neurontin would be the 'perfect' anxiety med, now I'm nervious about trying it, and what you said about gabitril scares the wits out of me.
If lamictal did nothing for anxiety that would be no help at all for me. Plus, the SE of lamictal scares me-that rash and some other things.
What are you taking now?
Have you found any relief through another med? I'd love to know.
Thanks, Hildi
Posted by Ritch on January 19, 2003, at 13:09:03
In reply to Is there difference between gabitril neurontin? , posted by hildi on January 19, 2003, at 11:49:03
> In the med book it states a bit of a difference between neurontin (gabapentin)side effects and those from gabitril (tiagabine). So, is one of these meds more effective, and one less effective for anxiety? Plus, are these for anxiety only, or also for mood stabilizing abilities?
> Less activating, better, or worse -how different from each other and from lamictal?Hi, never tried Lamictal (yet). Depakote, Neurontin, Klonipin, Gabritril, and Topamax all have had anxiolytic effects for me (in varying ways and degrees). Depakote was the most powerful at controlling hypomania and hostility. Neurontin and Klonopin worked the best for panic/GAD type stuff. Neurontin or Topamax worked the best for sleep. Gabitril had some mood elevating effect to it and was relatively decent for sleep/anxiety. YMWV especially with side effects. Unfortunately, tolerability often determines my meds rather than effectiveness. As far as my own personal experience vis a vis Gabitril and Neurontin... Neurontin didn't cause as many cognitive side effects as Gabitril, and I felt more sociable on the Neurontin. Just my 2 cents.
Posted by Ame Sans Vie on January 19, 2003, at 13:34:43
In reply to Re: gabitril neurontin? » Ame Sans Vie, posted by hildi on January 19, 2003, at 12:46:22
I don't mean to try to scare you away from trying any medication... after all, we're *all* taking a gamble with every pill we toss down our gullet. I just thought it was necessary for me to relay my own truthful experiences with these meds.
Actually, just several days ago I was placed on a regimen of 20mg Valium 2xday, 2mg Xanax 3xday, 4mg Ativan as needed, and 4mg Klonopin 2xday + 30mg twice every other Sunday. I have avoidant personality disorder, very severe-- these meds have totally relieved my symptoms. And no, I'm not feeling 'drugged' all the time. =)
--Michael
Posted by Ame Sans Vie on January 19, 2003, at 13:37:35
In reply to Re: gabitril neurontin? » hildi, posted by Ame Sans Vie on January 19, 2003, at 13:34:43
I also take 100mg 5-HTP each day, and follow a restricted carbohydrate diet, which has been an enormous help. I weight train 3-4 times per week. Just wanted to throw this in there, as I consider it part of my treatment. =)
Posted by hildi on January 19, 2003, at 20:41:22
In reply to Re: Is there difference between gabitril neurontin? » hildi, posted by Ritch on January 19, 2003, at 13:09:03
Hi Ritch. Thanks for your response. I thought the benzos would be the magic bullet I was looking for, but here I am again!
Did you try klon and neurontin together? Can they mix?
I have read posts about being careful with what you take when taking lamictal- but I guess that's really similar to many medications. One med can affect the others. It is hard to tell how things work until you try them, then often cannot tell if something is the med alone, or a synergistic reaction with another med also being taken.
The Gabitril scares me silly after one of the posts I just read on it- and I thought it was the Lamictal that could be dangerous!
I tried depakote once-then went into a crying frenzy the next day. It may have been due to not taking my AD, though- I have been 'experimenting' again and cannot remember if that had been a time I was trying other meds w/o AD's. Cannot remember, but it was scary and I am not in a hurry to try depakote again.
My boyfriend is on dep alone-and it has changed him tremendously for the better. I cannot believe the transformation. So I do believe it is a good med.
Are you still on depakote and klon? How about neurontin? Also, how much neurontin did you have to take to notice an effect? And finally, how would you compare the effects (for anxiety) of neurontin compared to the benzos, or klon?
Oh, one last thing- a stimulant for anxiety/depression was mentioned in some posts. What are your thoughts on that? (neurontin and a stimulant, for example) Kind of scares me- but I'm willing to try almost anything at this point.
Hildi
Posted by hildi on January 19, 2003, at 20:50:30
In reply to Re: gabitril neurontin? » hildi, posted by Ame Sans Vie on January 19, 2003, at 13:34:43
Hi Michael. You didn't scare me away from trying meds, just giving more useful information as I see it. I am at this website for honesty and information, and I appreciate you taking the time to relate your experiences to me.
Many people have totally different responses to the same med, so my decision of what to take will not be based solely on one other's personal experience. It's just good to have the information and know some of the reactions, experiences, etc, of others.I am glad you have found a med regimen that works for you. I hope the best for you, and I really appreciate your taking the time to answer my posts. Thanks!
Hildi
Posted by Ritch on January 19, 2003, at 22:19:53
In reply to Re: gabitril neurontin etc » Ritch, posted by hildi on January 19, 2003, at 20:41:22
> Hi Ritch. Thanks for your response. I thought the benzos would be the magic bullet I was looking for, but here I am again!
> Did you try klon and neurontin together? Can they mix?
> I have read posts about being careful with what you take when taking lamictal- but I guess that's really similar to many medications. One med can affect the others. It is hard to tell how things work until you try them, then often cannot tell if something is the med alone, or a synergistic reaction with another med also being taken.
> The Gabitril scares me silly after one of the posts I just read on it- and I thought it was the Lamictal that could be dangerous!
> I tried depakote once-then went into a crying frenzy the next day. It may have been due to not taking my AD, though- I have been 'experimenting' again and cannot remember if that had been a time I was trying other meds w/o AD's. Cannot remember, but it was scary and I am not in a hurry to try depakote again.
> My boyfriend is on dep alone-and it has changed him tremendously for the better. I cannot believe the transformation. So I do believe it is a good med.
> Are you still on depakote and klon? How about neurontin? Also, how much neurontin did you have to take to notice an effect? And finally, how would you compare the effects (for anxiety) of neurontin compared to the benzos, or klon?
> Oh, one last thing- a stimulant for anxiety/depression was mentioned in some posts. What are your thoughts on that? (neurontin and a stimulant, for example) Kind of scares me- but I'm willing to try almost anything at this point.
> Hildi
Hildi, the best (thus far) that I have felt on various combos was Depakote+Neurontin+Klonopin with a small dose of a serotonin reuptake inhibitor. I am almost full circle with experimentation getting back to just that. Depakote, Klon, and Neurontin all mix quite well, IMO. I've never tried Lamictal-but the more I hear about it and the more I understand about the mechanism of action, the more I am inclined to give it a try (pdoc willing of course-and that is not likely at this point), mainly becaue of the effect with glutamine being somewhat similar to lithium (which I have had a good response to previously, but can't take anymore due to medical reasons-thyroid). Depakote and Lamictal is the combo to watch exceptionally carefully and needs close medical supervision, and unfortunately would likely be the most beneficial to me. I would stay away from the stimulants until you get your dx worked out VERY clearly (to ascertain whether they would be beneficial or not), otherwise they *can* make everything go to hell in a hand-basket, if you have occult or hidden problems which they can bring to the surface (a great diagnostic tool in some ways-but you might not want to go there).
Posted by viridis on January 20, 2003, at 1:24:45
In reply to Re: gabitril neurontin etc » Ritch, posted by hildi on January 19, 2003, at 20:41:22
Hi Hildi,
I do well with Klonopin (1 mg/day), Neurontin (1200 mg/day), occasional Xanax, and Adderall -- a stimulant -- 10 mg/day. But I agree with Ritch that you should be careful with stimulants until you're really stabilized and have a clear diagnosis. I didn't have any problem, but I have ADD and find Adderall calming -- others might not. It also has a strong antidepressant effect for me, while SSRIs etc. were terrible.
In terms of anxiety relief, for me Klonopin is definitely much more effective than Neurontin. The Neurontin is just sort of there in the background; I'm not sure if I even need it, but it doesn't cause any problems and may be helping with stability. Klonopin is my "keystone" med and for me, is very effective for anxiety and major depression. Adderall increases my focus and seems to augment the antidepressant effects of Klonopin.
Posted by missliz on January 20, 2003, at 2:19:02
In reply to Re: gabitril neurontin etc » hildi, posted by viridis on January 20, 2003, at 1:24:45
Neurontin is one of the biggest scancals of contemporary psychopharmacology- there was a big trial in Boston, the records were just recently unsealed, the company knew perfectly well it doesn't work but paid off docs to put their names on papers written by the company marketing department and submit them to journals. Neurontin was finally properly tested in double blind placebp cotrolled studies for all the off label uses the company was pushing it hard for (anxiety and BP) and guess what? It either doesn't work or makes people worse. I've noticed that Neurontin is never used alone- it needs the other drugs to do the work. This info comes from the New York Times, by the way.
The real effect of Neurontin is to make obscene amounts of money. 1.2 billion dollars in 2001. If you read the Rx info you'll notice that it doesn't metabolize into anything else, binds to a "novel" receptor (they don't have a clue what this stuff does in your brain) and has only been approved as add on therapy for certain types of epilepsy. It is expensive, and hell to get off of. Psychiatrists have actively spoken out against Neurontin, refusing to use it in their practices. I'll have to dig out the links and post later, but these are reputable enough guys.
I took it, and kept asking my pdoc why? It didn't do anything and I'm better since I got off it. Neurontin is bogus, and a perfect example of how the mentally ill are exploited. Think Big Tobacco when you think Neurontin. Don't waste your time or money. Buying the stuff just eggs those bastards on.
I had a bad reaction to gabitril and lamotrigine, but at least they work for other people.
Trileptal has been really good for me, just titrate the dose up VERY slowly if you try it. Soothes the anxiety a lot, great mood stabilizer, doesn't make you fat. Easy to live with.missliz
Posted by utopizen on January 20, 2003, at 7:34:08
In reply to Re: gabitril neurontin etc, posted by missliz on January 20, 2003, at 2:19:02
you possible misread the New York Times.
They never said the indications didn't work. And controlled studies do prove its efficacy in many off-label uses, contradicting your statements.
The article simply said the company knew the drug wasn't FDA approved for the indications marketed. An FDA approval for an indication is a marketing approval in nature, meaning it simply means the FDA will allow the company to market it for a specific indication. It does NOT mean simply because the FDA didn't approve a drug for a certain indication that the drug is useless for the unapproved indication.
And I do not know of a single doctor who considers Neurontin unsafe. The is actually one of the more tolerated drugs out there, with a very favorable toxicity rating.
Posted by viridis on January 20, 2003, at 15:46:57
In reply to Re: gabitril neurontin etc, posted by missliz on January 20, 2003, at 2:19:02
I'm not sure what to think about Neurontin. It's hard for me to believe that it does nothing, because initially it was extremely relaxing for me (definitely not placebo effect). This wore off very quickly, but I could certainly see it being useful as an anxiolytic for others if this effect lasts.
I started it early on when my pdoc recommended addition of a mood stabilizer, and I refused to take his preferred med (low-dose Depakote). I suggested Neurontin, and he said OK, it's not a "first line" mood stabilizer, but it is extremely safe and (in his experience) is sometimes helpful. He characterized it as the mildest mood stabilizer, and said its effects are generally very subtle.
When things started to come together (mainly, I think, because of the stabilization with benzos and then the addition of Adderall), Neurontin was still there in the background. I've mentioned to my pdoc a couple of times that I might discontinue it, and he doesn't seem too concerned either way. He prefers that I stay with it because it may add "background stability"; I think it's really a case of "if it ain't broke don't fix it" -- i.e., since this combo is working, why mess with it?
I was surprised by your comment that it's "hell to get off of"; I've skipped doses for varying lengths of time and never noticed anything. I've also (accidentally) taken a double dose a couple of times and not noticed anything either. But it sure was great at the beginning, so if that effect is sustained for some people, I could see it being very useful.
A couple of other comments: Neurontin is considered safe in part because it bypasses the liver, so there are almost no concerns with med interactions. It's essentially impossible to overdose, because there's a limit to the amount that can be absorbed in a given length of time; the rest is simply lost in the urine. And, my understanding is that although it's expensive, it will be off-patent soon (it's already generic in Canada, and here generics are apparently being stalled by the manufacturer via lawsuits until the "new and improved" version, Pregabalin, can be marketed).
Posted by lostsailor on January 22, 2003, at 10:56:24
In reply to Neurontin » missliz, posted by viridis on January 20, 2003, at 15:46:57
As for a mood med I agree that neurontin might as well be made of the same ingreg a pez candy. for anxiety, though, I "think" it work for a while but when it was time for a new mood stabilizer I wanted lamictal. Of note was when I asked him about it less then a year ago, he was against it for the possible rash.
Now though, he says he is using it often. He titrated my dose very slowly from 25 mg a day for a week, to 50 for a week to 100 to 150 and finally stopping at 200 for now. I have found this med amazing.
~Tony
Posted by judy1 on January 23, 2003, at 17:38:54
In reply to Re: Neurontin~~hil, posted by lostsailor on January 22, 2003, at 10:56:24
http://www.npr.org/display_pages/features/feature_920362.html
Posted by lostsailor on January 23, 2003, at 18:43:56
In reply to The Neurontin Scandal, posted by judy1 on January 23, 2003, at 17:38:54
well, this is one prob, but....not in deffence of ethics, often meds are use in "off-label" uses that eventually are FDA appoved and of great help to many until final "result" I don't side with the drug comp, I find neurotin a poor med for BPD but I am happy that this practice is used. I think...lol
~Tony
Posted by hildi on January 23, 2003, at 22:42:14
In reply to Re: Neurontin~~hil, posted by lostsailor on January 22, 2003, at 10:56:24
Posted by judy1 on January 24, 2003, at 11:05:28
In reply to Re: The Neurontin Scandal-off-label marketing., posted by lostsailor on January 23, 2003, at 18:43:56
Tony,
I was up to 3g/day of neurontin for bipolar disorder and it had absolutely no effect, and I know I'm not the only one so I find the pharm co.'s tactics disturbing. Re: lamictal, I'm glad you had such great success. I was part of a study (STEP-BD) where it was used with great success, unfortunately I've gotten hypomanic on 2 trials. take care, judy
Posted by Maximus on January 24, 2003, at 12:32:18
In reply to Lamictal amazing?For anxiety,or just mood? (nm) » lostsailor, posted by hildi on January 23, 2003, at 22:42:14
Posted by Alan on January 24, 2003, at 14:28:05
In reply to The Neurontin Scandal, posted by judy1 on January 23, 2003, at 17:38:54
National Public Radio Reportage on Neurontin:
http://www.npr.org/display_pages/features/feature_920362.html
It turns out there are a number of stories on the illegal mis-marketing of Neurontin at this page, both print and audio.
I think it's important to understand the ramifications of the mis-marketing of Neurontin. Many, many millions were spent to get out the news that it works magically for all these unapproved conditions (for which it doesn't work in reality). But who is going to spend comparable amounts to reverse that message now that it has been show to be illegal and usually false?
These stories also give you some insight into how pharmaceutical research works here in the US, where many of the articles published in medical journals are not written by the doctors whose names appear on them. Instead they're written by professional advertising writers and doctors are paid to put their name at the top.
There's no evidence Neurontin is systematically effective against anxiety. Of course there's always SOMEBODY who'll get a beneficial response from anything, including pickled herring. But the makers of Neurontin have faced FDA sanctions here in the United States, plus massive civil lawsuits, because they pushed Neurontin for ALL kinds of conditions for which there is either no evidence it's effective or for which there IS evidence that it's NOT effective.
Maybe one's doctor is unaware of these developments, or maybe he has had one or two of those patients with an exceptional response. Or maybe one's anxiety or panic is biologically related to seizures. There's good evidence for a connection like that, though it still doesn't prove Neurontin would help the anxiety.
I post this because I was on the receiving end of this kind of thing and as aresult, my anxiety went untreated in the mean time...the "side effects" of that untreated anxiety being much worse than the side effects of those medications that were actually theraputic such as, in my case, benzodiazepines.
Posted by viridis on January 25, 2003, at 1:33:26
In reply to Re: The Neurontin Scandal - NPR, posted by Alan on January 24, 2003, at 14:28:05
The Neurontin marketing story is disturbing, and it does sound like the pharmaceutical company was out of line. However, I'll repeat what I said earlier -- Neurontin was a great anxiolytic for me the first few times I took it, so it must do something. Unfortunately, the effect didn't last (benzos have been much more reliable), but given my initial reaction to Neurontin, I could see it being helpful for those in whom the effect does last. And, my psychiatrist seems convinced that it works (subtly) for a minority of patients, although he isn't a big advocate. He does consider it very safe. I'll probably discontinue it soon, but if I could consistently get the results I did the first few times I took it, I'd recommend it more enthusiastically. Maybe Pregabalin (the "improved" version) will work better, if it makes it to market?
Posted by missliz on January 25, 2003, at 13:26:17
In reply to Re: The Neurontin Scandal - NPR, posted by Alan on January 24, 2003, at 14:28:05
A whole lot of you all missed my point SO TOTALLY!
1- there are numerous double blind placebo controlled studies showing that Neurontin doesn't work for the off label studies the company claimed it was so wonderful for. They were done to try to get the stuff aditional FDA approvals. Neurontin either doesn't work, works for a few weeks/ months then quits, or makes people worse. Google it and see for youselves. The search engine is the patients best freind, learn how to use it.
2- Neurontin is a product that happens to be a drug. Do not kid yourselves, the drug co.'s are loyal to the stockholders and see us as cash cows to be exploited. Psych patients are the most easily kicked around group in our society, and a lot of us have federally funded insurance to milk. Our society is full of dangerous automobiles, crummy food, cigarettes, smog, and you're surprised that a bogus psych drug came along to pick your pocket?
3- This isn't about a New York Times article. There was a trial in Boston where all this came out, a whistle blower from whithin the company produced the same kind of incriminating evidence as the stuff that came out at the big tobacco hearings. Don't you people watch the news? Or Google drugs before you eat them?
As long as you are all good little children and tolerate this kind of horrific treatment we will never get better drugs and better lives because a bunch of crooked businessmen will use us as human sacrifices to the bottom line. I think I deserve better, but the mentally ill are the most crapped on group of people in America because most patients won't take responsibility and say no, that isn't acceptable. A lot of us can't, but the people who can write their congressman about things like this can't be bothered. Spare me the self centered whining.
4- One last peice of reality, kiddoes. Drug company reps are the biggest source of your doctors continuing education. A lot of the drugs pushed for psych do work, but there's just too much money to be made for a Neurontin not to happen. Zyprexa was surrounded by apalling scandal in its testing phase too, but I know half of you won't beleive it. Not until you get type II diabetes and a hundred pound wheight gain and all the other grisly fallout from that particular work of the devil. Read the book, "Mad in America" by Robert Whitaker for starters.
I personally spent two years of personal crisis while on Neurontin wondering what the hell had happened to my mind. Then I refused to take it anymore and am returning to myself again. I'm not the only one. And I'm angry about it, I deserve better.missliz
Posted by Alan on January 25, 2003, at 13:36:54
In reply to Re: The Neurontin Scandal , posted by missliz on January 25, 2003, at 13:26:17
> A whole lot of you all missed my point SO TOTALLY!
> 1- there are numerous double blind placebo controlled studies showing that Neurontin doesn't work for the off label studies the company claimed it was so wonderful for. They were done to try to get the stuff aditional FDA approvals.
> 2- the drug co.'s are loyal to the stockholders and see us as cash cows to be exploited.
> 3- This isn't about a New York Times article. There was a trial in Boston where all this came out, a whistle blower from whithin the company produced the same kind of incriminating evidence as the stuff that came out at the big tobacco hearings.
> 4- Drug company reps are the biggest source of your doctors continuing education. A lot of the drugs pushed for psych do work, but there's just too much money to be made for a Neurontin not to happen. > missliz
>
=================================================Seems like my post addressed these very issues and more with the link to the NPR site.
Alan
Posted by Dr. Bob on January 25, 2003, at 18:28:39
In reply to Re: The Neurontin Scandal , posted by missliz on January 25, 2003, at 13:26:17
> A whole lot of you all missed my point SO TOTALLY!
> Don't you people watch the news?
> As long as you are all good little children ... we will never get better drugs... Spare me the self centered whining.I know you're angry, but please don't post anything that could lead others to feel accused or put down, thanks.
Bob
PS: Follow-ups regarding posting policies, and complaints about posts, should be redirected to Psycho-Babble Administration.
Posted by dreamerz on January 26, 2003, at 23:33:22
In reply to Re: The Neurontin Scandal , posted by missliz on January 25, 2003, at 13:26:17
I must be of the minority..works for me .
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