![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 25 of 183. This is the beginning of the thread.
Posted by sukarno on March 23, 2005, at 5:50:47
I have panic disorder with agoraphobia and have tried several tricyclic antidepressants, SSRIs and am now on Xanax (alprazolam) 1mg q.i.d. (4x/day) and famotidine 20mg q.i.d. for GERD (acid reflux). I'm 33 years old, white male, diagnosed with panic disorder in 1988 at the age of 16.
Imipramine worked well for the panic, but unfortunately that and other tricyclics gave me terrible cardiovascular side effects (racing heart, irregular heartbeat) even in very low doses.
SSRIs such as Prozac and Paxil gave me terrible, horrific panic attacks (especially Paxil) and I developed an allergy to Prozac (rashes on arms and legs along with fever and upper GI/stomach bleeding), even at low doses of 0.5mg - 1mg/day (Prozac elixir). A single dose of Paxil 10mg (1/2 tablet) gave me severe panic attacks and depersonalization an hour later, landing me in the ER. I experienced electric shock-like sensations for the next few days after that single Paxil dose.
I have read about and just bought Stablon from the pharmacy here in Jakarta, Indonesia. From what I've read it has promise in panic disorder since it was shown in one study to block panic attacks when patient was administered 35% CO2 (carbon dioxide) gas.
I also have mild asthma and have read that tianeptine is good for asthma.
I have read the previous posts about tianeptine and am wondering if anyone else here has tried it for panic disorder and associated depression?
I also have SAD (seasonal affective disorder), but am becoming lazy when it comes to using my lightbox, even though the lightbox is effective.
I think medication would be easier to treat the SAD and hopefully will help with the asthma and panic attacks.
Sorry for the long post! I would like to take antidepressants, but cannot tolerate them and hope this one is the one that will work.
Thanks,
Paul
Posted by The_Resistance on March 23, 2005, at 10:38:11
In reply to Tianeptine good for panic disorder?, posted by sukarno on March 23, 2005, at 5:50:47
Good luck with tianeptine Sukarno
Please keep us posted about how the trial goesThe fact that SSRIs made you worse does seem to suggest that Tianeptine might work.
I'm personaly very interested in this drug, I wonder if it is effective for social anxiety.
Its certainly an interesting antidepressant
Posted by sukarno on March 24, 2005, at 10:20:52
In reply to Re: Tianeptine good for panic disorder?, posted by The_Resistance on March 23, 2005, at 10:38:11
I took the tianeptine 7 hours ago and within one hour I could feel some effects, notably a warm sensation in my face and a feeling like I wanted to laugh..not a "high" really, but a mild uplifting feeling and "glow". This warm feeling wore off after a while, but I do feel a bit more relaxed and my mood, while still depressed, isn't as severe as before. I realise though that this could be a placebo effect and hope it works.
No other side effects to speak of, which says a lot, because I am horribly sensitive to antidepressants and drugs in general.
Posted by sukarno on March 25, 2005, at 5:30:58
In reply to Re: Tianeptine good for panic disorder?, posted by The_Resistance on March 23, 2005, at 10:38:11
I took the Stablon 6 hours ago and about an hour after taking it I started to develop a mild headache (vascular headache in the temples, similar to caffeine withdrawal) and mild nausea.
I was supposed to take another dose now (6 hours after the first one), but have decided to have a snack for now and wait a few more hours.
It's nothing like the SSRIs though. I think I can tolerate these side effects. I am using the recommended dose of 12.5mg t.i.d. and usually those of us with panic disorder cannot tolerate full doses like this I would guess.
It has not aggravated my anxiety though. Just the headache and lowered appetite/mild nausea.
I bet this one doesn't cause weight gain. In fact, I was reading that tianeptine doesn't cause weight gain in the studies.
Posted by sukarno on March 27, 2005, at 6:54:05
In reply to Developing side effects to tianeptine (Stablon), posted by sukarno on March 25, 2005, at 5:30:58
The side-effects went away about 24 hours ago, but I'm not feeling much antidepressant effect yet. I guess I just have to be more patient as it has only been 3 or 4 days and can take up to two weeks to feel the full effects.
I'm taking the recommended dose of 12.5mg three times a day.
I think I notice less anxiety in between Xanax doses, but not sure if that is the Stablon working or just placebo effect.
Posted by sukarno on March 29, 2005, at 15:16:56
In reply to Developing side effects to tianeptine (Stablon), posted by sukarno on March 25, 2005, at 5:30:58
It is day 6 or 7 of being on Stablon (12.5mg t.i.d.) and no more side effects, but also no significant antidepressant effect yet. The manufacturer says it can take two weeks to lift the depression, so I should be more patient.
I have heard of folks taking SSRIs and having to wait several weeks to get any noticeable effect.
I haven't read many stories of people on Stablon, so I am not sure what to expect from it. I have Seasonal Affective Disorder so it is possible this is a different type of depression, but then again, maybe it will respond to Stablon.
I guess what I can say is that I am not as severely depressed as I was the day I started taking this new drug. I'd say that maybe my mood has improved by 10%.
The only definite effect I can feel is a reduction in anxiety.. moreso a reduction in anxiety rather than depression.
I hope others on this drug can post their stories here.
Posted by ed_uk on March 29, 2005, at 15:57:00
In reply to No more side effects to Stablon (tianeptine), posted by sukarno on March 29, 2005, at 15:16:56
Hello,
It's always interesting to hear from people taking unusual meds (ie one's we don't have here).
It's good that you've had a reduction in anxiety. Most antidepressants take longer than 2 weeks to have a good effect and I expect that tianeptine is no exception. Don't give up too early!
Keep posting :-)
Ed.
Posted by sukarno on April 2, 2005, at 12:53:03
In reply to Developing side effects to tianeptine (Stablon), posted by sukarno on March 25, 2005, at 5:30:58
Last night I started to feel the antidepressant effect starting and feel a bit better today. No side effects, which is great. :) I'll keep you posted. :)
Posted by ed_uk on April 2, 2005, at 13:16:31
In reply to Feeling the antidepressant effect, posted by sukarno on April 2, 2005, at 12:53:03
Hi!
>Last night I started to feel the antidepressant effect starting and feel a bit better today.
Hey, that's great :-)
How long have you been taking the tianeptine for now???
>I'll keep you posted...
Please do!
Kind regards,
Ed.
Posted by sukarno on April 2, 2005, at 16:40:29
In reply to Re: Tianeptine » sukarno, posted by ed_uk on April 2, 2005, at 13:16:31
Hi there! :) This is day 11 of being on it. Which country do you live in? I was told that it is available in parts of Europe and also in the UK, but not 100% sure about the UK.
Paul
Posted by ed_uk on April 2, 2005, at 17:58:04
In reply to Re: Tianeptine, posted by sukarno on April 2, 2005, at 16:40:29
Hi Paul!
>Which country do you live in?
England. It's available in certain parts of Europe, I know it's available in France. It's never been available in England though.
Keep posting! It's nice to hear how you're doing,
Ed.
Posted by BradD on April 5, 2005, at 11:40:07
In reply to Feeling the antidepressant effect, posted by sukarno on April 2, 2005, at 12:53:03
Unfortunately Tianeptine did nothing for my depression/social-phobia. And I've used different doses to see if it kicks in.
Posted by sukarno on April 5, 2005, at 20:48:40
In reply to Re: Feeling the antidepressant effect, posted by BradD on April 5, 2005, at 11:40:07
On Day 12 or 13 I experienced a sudden effect from the tianeptine 30 minutes after taking my third dose of the day. It was somewhat indistinguishable from a hypoglycemic attack in the beginning (I have reactive hypoglycemia), in that there was a lot of adrenaline activity. Other that that it was best described as a "speedy" effect with unusual ease in breathing as if my lungs had opened right up, which would be consistent with adrenaline release.
I have no idea if adrenaline played any part in it though. It was definitely a pronounced psychostimulant effect and at one point I thought I was going to have a panic attack, perhaps because I misinterpretted the symptoms as being dangerous when they were only benign.
It was like drinking a few strong cups of coffee..definite bronchodilator effect along with an ability to concentrate much more than usual.
I decided to cut back on it to only 2 tablets today because even this 2nd dose today that I took just an hour ago is giving me a rush..not really euphoric...well, mildly.
Somewhat overstimulating. Maybe I don't need this much tianeptine. That "12.5mg t.i.d from the start!" that the drug company Servier promotes seems like it isn't appropriate for everyone.
No one size fits all I think. I hope I can obtain some anti-panic effect from it in the lower doses.
Posted by sukarno on April 6, 2005, at 12:12:22
In reply to Developing side effects to tianeptine (Stablon), posted by sukarno on March 25, 2005, at 5:30:58
Hi again. Is this a stimulant? The manufacturer, Servier, claims there are no sedative or stimulant effects, but this is just overstimulating. I took 2 tablets yesterday and today I took only 1/2 tablet and then I felt really jittery and my heart jumped around a few times.
Of course, the good thing is I don't feel depressed like I did prior to treatment two weeks ago..maybe just slightly depressed. I'd say about a 50% improvement in depression and the anxiety that goes with it.
This stimulant effect though is too much for me. It is like I drank 2 or 3 cups of tea. Uncomfortable and anorectic also.
Whoever here has taken tianeptine before, did you experience these negative side effects?
I really can't see how this can be good for panic disorder if it is making me so nervous and full of adrenaline.
If it is so short-acting (half-life of 3 hours), how can it "accumulate" like this?I'll try to lower the dose. I have heard of good results from just 1/2 tablet twice a day (from this website).
The best way to describe what I'm feeling is that feeling you get when you are almost hit by a car, but instead that "fight or flight" feeling just persists.
If I could compare this to any drug I've ever taken before, I would say it is similar to Effexor.
Posted by sukarno on April 6, 2005, at 12:20:56
In reply to Re: Feeling the antidepressant effect, posted by BradD on April 5, 2005, at 11:40:07
> Unfortunately Tianeptine did nothing for my depression/social-phobia. And I've used different doses to see if it kicks in.
Hi Brad, how long did you take this drug and which dose? Did it make you nervous? I feel quite nervous...I had to take an extra 0.5mg Xanax to counter this effect somewhat.
Posted by ed_uk on April 6, 2005, at 13:36:28
In reply to Is tianeptine a stimulant?, posted by sukarno on April 6, 2005, at 12:12:22
Hi!
Tianeptine does seem to act as a stimulant in some people- it has been used 'recreationally' for this reason!
'The authors report a case of tianeptine abuse in a 30 year-old woman. After a medical prescription of the recommended dosage of 12.5 mg 3 times daily of oral tianeptine for a depressive illness, the patient spontaneously increased the dosage which after two months reached 150 tablets per day. No severe toxic effects were observed. As adverse effects, the patient, in the beginning of this high treatment period suffered from nausea, vomiting, abdominal pain, anorexia with weight loss, constipation. These side effects progressively disappeared. The biological tolerance was excellent, and hepatic parameters were not affected. The patient experienced and seek a *psychostimulant* effect. After seven months of such a therapy, she was hospitalized to undergo a withdrawal. The discontinuation of the tianeptine treatment occurs in four days.'
Posted by sukarno on April 11, 2005, at 20:50:28
In reply to Developing side effects to tianeptine (Stablon), posted by sukarno on March 25, 2005, at 5:30:58
I'm still on tianeptine, but I lowered the dose for a while. Today is day 20 of being on it and I feel ok. At least I don't feel as depressed as before. I'd say it's a 75% improvement in my mood. When I am happy, I really feel happy, whereas when I was on Prozac I remember it blunting my emotions so I felt "artificially happy". Hard to describe and I guess that is a bit subjective.
I'm taking about 12.5mg a day in divided doses (instead of the 12.5mg t.i.d.)
Paul
Posted by ed_uk on April 12, 2005, at 10:46:37
In reply to Doing ok now, posted by sukarno on April 11, 2005, at 20:50:28
Hi Paul!
>I'd say it's a 75% improvement in my mood. When I am happy, I really feel happy.........
Excellent :-)
RE the Xanax, have you tried reducing the dose?
Regards,
Ed.
Posted by sukarno on April 12, 2005, at 19:23:21
In reply to Re: Doing ok now » sukarno, posted by ed_uk on April 12, 2005, at 10:46:37
Hi Ed! :) Unfortunately, I don't think I'm able to reduce the Xanax at this time. I did attempt a taper in 2003 and only reduced the dose by 0.125mg, but woke up sweating and breathless with tachycardia and anxiety. Definitely Xanax is very hard to taper, whereas I had little trouble tapering Valium or Tranxene.
I'd like to get off Xanax someday as long as there is something else there to stop the panic attacks.
I've noticed a problem with lack of cross-tolerance between Xanax and Valium. One does not substitute well for the other in my experience. I've quit Valium (5mg 4x/day) and substituted it with Xanax (0.5mg 4x/day) and 4 days later experienced significant withdrawal symptoms from Valium (insomnia, nervous wreck, sweating, rebound anxiety, seeing spots, problems with visual accomodation and double vision..even saw an eye doctor for it not knowing it was Valium withdrawal). Xanax didn't seem to "cover" for the Valium.
Conversely, switching from Xanax to Valium is worse. I noticed muscle cramps all over my body and a sense of paralysis along with severe anxiety (and that was from being on Xanax for only one week). I raised the Valium temporarily and then all the withdrawal was gone, except for some muscle cramps that were mild.
I've been on Xanax daily since October 2002 at 1mg 4x/day by prescription from a psychiatrist, and now just see a GP.
I've read Dr. Heather Ashton's website on Valium substitution and am giving that some thought.
Have you heard of her? I think she is popular in the UK.
Apparently most people can taper using Xanax alone, but it doesn't seem to be the case with me. Luckily I don't feel any psychological dependence on it, but the physical dependence is severe.
At least it works as it did from the beginning. Zero panic attacks (or very rarely), whereas prior to medication years ago I had 3 to 5 panic attacks per day. :(
I don't like the cognitive effects and they persist. Feeling like everything you've done is a "dream". I don't forget things, but that sense that nothing is real enough is very bothersome and I'd like to be off all drugs someday if possible.
I hope tianeptine can control the panic disorder. If not, I thought about going back on imipramine even though it really raised havoc with my heart.
I am desperate for something that won't interfere with or dull my mind and at the same time won't cause dependence, so should I want to quit, it will be easy.
Thanks for listening.. I think I've rambled on and on. hehheh.
Posted by ed_uk on April 13, 2005, at 8:50:35
In reply to Re: Doing ok now, posted by sukarno on April 12, 2005, at 19:23:21
Hi!
>I'd like to get off Xanax someday as long as there is something else there to stop the panic attacks.
Apart from Valium, Tranxene and Xanax, which medications have you tried so far? (for the panic) I imagine you've tried many of the common drugs such as the SSRIs.
>Xanax didn't seem to "cover" for the Valium.
That's very interesting, I've heard of people having problems switching from Xanax to Valium but never vice versa.
I once tried Xanax but it didn't seem to help- I think I'll stick to Valium!
>I've been on Xanax daily since October 2002 at 1mg 4x/day by prescription from a psychiatrist, and now just see a GP.
When you were on Valium, what dose did you take?
What dose of Tranxene did you take?
Which benzodiazepine did you find the most effective?
Which drug caused the most side effects? (including cognitive effects)(sorry for all the questions LOL)
>I've read Dr. Heather Ashton's website on Valium substitution and am giving that some thought.
Yes, you could cross-taper onto Valium and then taper the Valium. 1mg Xanax = (approx) 10-20mg Valium.
>Conversely, switching from Xanax to Valium is worse. I noticed muscle cramps all over my body and a sense of paralysis along with severe anxiety (and that was from being on Xanax for only one week). I raised the Valium temporarily and then all the withdrawal was gone, except for some muscle cramps that were mild.
Perhaps you'd need to substitute 20mg of Valium per 1mg of Xanax to prevent withdrawal symptoms.
>Have you heard of her? I think she is popular in the UK.
Yes, I like her withdrawal guide. I do think she tends to be overly negative about benzos though. They can certainly cause very severe withdrawal symptoms but they do have their uses!
>I don't like the cognitive effects and they persist. Feeling like everything you've done is a "dream".
I know what you mean! I can't 'function' if I've taken a benzo. I tend to need quite high doses and I can't concentrate or remember anything. Valium makes me feel quite introverted and I don't pay attention to my surroundings- I'm not quite there! I only take diazepam occasionally though, I don't know what I'd be like if I took it regularly.
>I thought about going back on imipramine even though it really raised havoc with my heart.
What did it do to your heart? Did you have an ECG? Imipramine commonly causes a rapid pulse (sinus tachycardia) but serious arrhythmias are uncommon. It often causes orthostatic hypotension as well, and resulting dizziness on standing up.
I take a tricyclic myself: lofepramine, my heart rate is 100 beats per minute at rest- it has been 100 bpm for the last two years! It's reassuring to remember that the chronically elevated heart rate that tricyclics so commonly cause isn't related to any of their serious cardiac side effects. Have you tried any of the other tricyclic antidepressants?
>I hope tianeptine can control the panic disorder.
Me too :-)
>Thanks for listening.. I think I've rambled on and on. hehheh.
It was a nice post :-)
Kind regards,
Ed.PS. Are you from Indonesia or did I just imagine that?
Posted by sukarno on April 13, 2005, at 21:02:52
In reply to Re: Doing ok now » sukarno, posted by ed_uk on April 13, 2005, at 8:50:35
Thanks for the post. :) I've tried about 15 medications: Imipramine, nortriptyline, desipramine, trazodone, fluoxetine (Prozac), paroxetine (Paxil/Seroxat), sertraline (Zoloft/Lustral), buspirone (BuSpar), clorazepate (Tranxene), diazepam (Valium), lorazepam (Ativan), alprazolam (Xanax), clonazepam (Klonopin/Rivotril), oxazepam (Serax..was given it in ER once), venlafaxine (Effexor) and hydroxyzine (Atarax/Vistaril).
I was diagnosed in 1988 when I was 16 and prescribed imipramine 25mg in November '88. It was quite sedating and made me feel weak the first few days..along with some increased blood pressure and tachycardia (90bpm).
My psychiatrist recommended taking up some exercise, so I did that and my resting heart rate dropped to an average of 60bpm, sometimes lower.
I was in good shape then and my grades went back up to 4.0 in high school and I worked part-time too. The problem with my heart started about 1 month later and felt like "skipped beats" and then I woke up one night with a rapid pulse of 120bpm and palpitations/irregular heart action and my face felt flushed. My father called up the psychiatrist and she told me she wouldn't prescribe imipramine again.
She then prescribed nortriptyline 25mg. I was ok on that for a few months and put up with the "skipped beats" and finally decided to taper off it. When I quit nortriptyline my panic did not return for at least 10 days, but when it did resume it was back to the classic 3 to 5 a day as it was prior to diagosis and medication.
I did notice in the 18 months preceding my first panic attack, that I felt a lack of motivation and ambition, lowered sense of self-esteem but nothing major. My grades did suffer and dropped to below 3.0. I began to drink more caffeinated beverages to help increase my attention and focus on school and resorted to caffeine pills at one point.I certainly hope that caffeine wasn't responsible for my current problems. Perhaps it set it off earlier than it would have, had I not been taking caffeine.
I could tolerate large doses of caffeine without any palpitations or anxiety prior to panic disorder. However, after panic disorder struck me, I no longer had a tolerance to caffeine and even 1/2 cup of coffee would trigger heart palpitations.
I saw another psychiatrist in 1989 who tried Prozac since it was quite new and he thought it might work. I took it for 3 days at 20mg/day and on day 3 I was walking to school and suddenly felt as if my body was on fire along with the worst anxiety I had ever experienced in my life. I immediately went to the school nurse and called my psychiatrist who then asked me if I'd heard of Valium or Xanax, because that was what he was going to try next. I did try Xanax and felt it didn't last long enough to keep the anxiety away at 0.5mg 3x/day and also gave me some vertigo a few times which was unpleasant. Valium worked excellently, but it also made me quite sleepy in class, so I complained to him about it and he took me off it.He then tried BuSpar (buspirone) and it had no effect whatsoever on my anxiety, even after taking it for a while. I tried trazodone (Desyrel) 50mg and it made me very sleepy and the dry mouth I experienced with it along with feeling quite drugged was not something I liked, so I quit taking that.
Later on I tried desipramine (Norpramin) in 1990 but it made me feel faint all of the time. I couldn't tolerate the side effects. It was different than the other tricyclics in that it wasn't sedating and caused more orthostatic hypotension. My psychiatrist wasn't too understanding of the suffering I was experiencing from desipramine and I just decided to stop taking it.
In the fall of 1990 I had seen a GP at my college who gave me BuSpar again and it gave me side effects such as dizziness/mild vertigo, palpitations and diarrhea after about 1 week. I told the GP about this and he handed me some free samples of Tranxene (clorazepate) saying, "I don't like to prescribe this to college students.". He really had no choice though as I didn't respond well to other medications.
Tranxene took effect quickly and I felt so relieved: no more palpitations or anxiety or apprehension. I could sleep well and felt like a huge burden was lifted from me, however, it did cause me to sleep quite deeply and caused a few paradoxical reactions a few times. It certainly wasn't good for my studies.
I remained on Tranxene for the next 10 years and only briefly tried other SSRIs.I had tried 1/2 tablet of Paxil/Seroxat and I ended up going to the ER with severe panic attacks.
I also tried a low dose of Zoloft/Lustral and felt a tingling sensation all over, so I quit that too.
I asked for Effexor and my psychiatrist prescribed 25mg (the lowest dose). I took only 1/4 tablet and a few hours later my pulse was up to 90bpm and I had difficulty sleeping. I also developed a severe headache and pressure in the head, so I went to have my blood pressure checked and it was marginally high (150/95).
I told him I'd never take it again, yet he didn't seem to think it was a big deal...either that, or he didn't want to believe it. So he tried to get me on Klonopin/Rivotril along with another SSRI, but I refused that. I had tried Klonopin once years ago and it was far too sedating for me. For some odd reason he didn't like prescribing Valium, but didn't tell me why.
When it comes to benzos, I have found that Valium and Tranxene were quite similar. Actually Tranxene is one of Valium's active metabolites. :)
However, the advantage of Valium is that, according to the British National Formulary or BNF, it is the fastest acting BZD due to his high lipid solubility. It would take effect within 7 minutes, so it was useful in the event I felt a panic attack coming on.Xanax is slower to take effect..about 20-30 minutes. I found Xanax to produce dysarthria (trouble speaking at times) and more cognitive deficits, but less sedation.
Valium produced more muscle relaxation, no dysarthria and was heavily sedating, but not as bad as Klonopin/Rivotril.
Ativan (lorazepam) produced dysarthria and hypersalivation along with some nasty cognitive effects such as a sense of amnesia. I couldn't tell when I was on Ativan or withdrawing from it. hehheh. It just made my mind so fuzzy that I thought I was going to lose my mind totally... well, it wasn't _that_ bad, but I see it as more of a sleeping pill than a daytime anxiolytic.
Overall, Valium was an excellent medication. The only problem I had with it was elevation of my liver enzymes. Other than that I liked it. Tranxene was similar but took about 15 minutes to take effect, but when it did take effect it felt identical to Valium.
Xanax just seems like a different drug. It lacks the muscle relaxant effects of Valium and muscle relaxation is very useful for me in controlling my GAD (Generalised Anxiety Disorder) which then prevents my panic attacks from occuring. Valium is also, like Tranxene, *very* easy to taper. I could taper 20mg/day (5mg 4x/day) down to 12.5mg/day in 3 weeks without any problems, except an increase in my asthma attacks.
I've also found hydroxyzine (Atarax/Vistaril), a sedating antihistamine, to be useful as needed for anxiety and it is also doesn't produce dependence, although it can produce tolerance when taken regularly.
If I had to label a benzo as being "addictive"..and that is a highly charged word often taking out of context these days, I would say Ativan is the worst offender because it had a lot of cognitive effects (to me that was unpleasant, but perhaps others like that and abuse it for that feeling).
Otherwise I've never escalated the dose of any BZD I've ever taken. I've found myself wanting to lower the dose over time.
I would prefer Valium above all other benzos (or Tranxene..it is similar), but I'm afraid of developing high liver enzymes again.
Have you had your liver enzymes checked? My GGT (Gamma GT) was 205 and ALT was 78 on Valium. Three liver function tests taken over a 2 month period confirmed the same results. That's the only thing keeping me off Valium and why I asked for Xanax. Xanax is very short-acting and much easier on the liver, although I have read in the BNF and other books that Serax (oxazepam) is the easiest on it.
But on Valium I could still think. You'll develop a tolerance for it when you take it 3 or 4 times a day, but it was still effective at preventing the panic attacks. The cognitive effects I did feel from Valium only occurred during the beginning of treatment.
Everyone is different though and might react differently. :)
I think more doctors should use Valium whenever possible since it is tried and true and also easy to discontinue relative to other BZDs. In my opinion, the high-potency BZDs should only be used as a last resort when conventional BZDs fail.
I'm originally from the USA, but lived in Malaysia from 2001-2003 and Indonesia since then. Psychiatrists were very professional in Malaysia.
Here in Indonesia they are ok too, but Malaysia was much more organised about everything and all prescriptions were accounted for by the government. Indonesia is a bit lax on controlled substances. :)
Have you tried Ativan? What benzos have you tried so far?
Thanks for taking the time to read this post! :)
Paul
Posted by sukarno on April 13, 2005, at 21:42:40
In reply to Re: Doing ok now » sukarno, posted by ed_uk on April 13, 2005, at 8:50:35
"When you were on Valium, what dose did you take?"
5mg 4x/day
"What dose of Tranxene did you take?"
7.5mg 4x/day, although sometimes I tapered it down to 3.75mg 4x/day if I was feeling better.
"Which benzodiazepine did you find the most effective?"
Xanax, for panic attacks.
Valium for Generalised Anxiety Disorder. (Maybe I wasn't on enough Valium though, since 5mg 4x/day is the equivalent of 0.25-0.5mg Xanax 4x/day and I'm currently on 1mg 4x/day.)"Which drug caused the most side effects? (including cognitive effects)"
Ativan (lorazepam) :-)
I would rank them like this for mental side effects, with the first one causing the most:
Ativan
Xanax
Valium
Tranxene
For physical side effects, I would rank it like this:
Valium
Tranxene
Ativan
Xanax
Posted by sukarno on April 14, 2005, at 7:09:39
In reply to Developing side effects to tianeptine (Stablon), posted by sukarno on March 25, 2005, at 5:30:58
I'm going to lower the dose again. I was increasing it to 1/2 tablet twice a day and today I started feeling the "adrenaline" again.
I am not depressed at all though. LOL. I was in a great mood today and laughing at jokes I was reading online. :)
This stuff just gives me the jitters. I guess it won't be too hard to titrate the dose since it has a 3 hour half-life. :)
Hey, Ed, you should move to Indonesia.
Posted by sukarno on April 14, 2005, at 7:16:44
In reply to Nervous again on tianeptine, posted by sukarno on April 14, 2005, at 7:09:39
I know I can't list sources, but I asked my doctor about Survector (amineptine) and there is some here in Jakarta, Indonesia. It is expensive for me though..about $4 for 6 tablets.
Should I try Survector, or will that make me more nervous than tianeptine?
I think both of them are related, but Survector is more of a dopamine reuptake inhibitor and doesn't claim to be of use in anxiety disorders.
Survector is also toxic to the liver in some people so I'd need to have frequent liver function tests (LFTs) done to be safe.
The reason I am interested in Survector is because of low libido and lack of motivation/ambition/drive. Despite not feeling depressed one bit, I just don't have any motivation or libido. Is Xanax doing this to me perhaps? I had read that Xanax can also cause hyperprolactinaemia.
Soon I'll be getting a liver function test done and also test for prolactin and thyroid hormone levels. If that all turns out to be normal then I can try to move on in a new direction.
I guess I'm in a dilemma because:
1. Stablon is good for asthma and that's been proven in a few studies. I know I can breathe a *lot* better now.
2. Survector doesn't do anything for asthma, but it can increase libido *and* also increase motivation and ambition.
3. Stablon might have use in treating panic attacks, but Survector doesn't.
What should I do? Take both? My doctor is willing to give me Survector but I forgot to ask her if I can take Stablon and Survector at the same time.
What do you think Ed?
Thanks,
Paul
Posted by ed_uk on April 14, 2005, at 10:00:54
In reply to Survector (amineptine), tianeptine's cousin, posted by sukarno on April 14, 2005, at 7:16:44
Hi Paul!
>imipramine 25mg
Imipramine was very effective at only 25mg/day??? I wonder whether you are a slow metaboliser of tricyclic antidepressants ie. low activity of the enzyme CYP2D6. Most ADs are metabolised by CYP2D6, not just TCAs. Slow metabolisers may need very low doses of most ADs, 'standard' doses may cause severe side effects.
>She then prescribed nortriptyline 25mg. I was ok on that for a few months and put up with the "skipped beats" and finally decided to taper off it.
In terms of effectiveness and side effects, did you prefer nortriptryline or imipramine?
>When I quit nortriptyline my panic did not return for at least 10 days.........
It seems that you only need very low doses of TCAs. Perhaps you would do well on an extremely low dose of nortriptyline eg. 10mg/day. Even after you discontinued nortriptyline, it was still effective for several days, perhaps you had a high serum level on 25mg and it took several days to drop below the therapeutic range. If you decided to try nort, your doctor could monitor your nortriptyline serum concentration and also your ECG.
>Later on I tried desipramine (Norpramin) in 1990 but it made me feel faint all of the time.
What dose did you try?
If you are a slow metaboliser of TCAs, you are also likely to be a slow metaboliser of certain SSRIs such as paroxetine. Many people are slow metabolisers of TCAs, people who are slow metabolisers will have high drug serum levels at low doses. Slow metabolisers can often be effectively treated with unusally low doses, 'standard' doses may cause severe side effects. You might actually do well on a micro-dose of Paxil, you could use the oral solution.
>Ativan..........
Yes, I've tried Ativan. I found it less sedating than Valium but it did seem to cause a lot of amnesia.
>The only problem I had with it was elevation of my liver enzymes.
Were your LFTs elevated on Tranxene as well? Perhaps you could try Tranxene again.
I'm not sure whether your elevation of liver enzymes on diazepam was important. With many drugs, mild elevation of LFTs occurs in the absense of any evidence of liver disease. Did you see a liver specialist?
>Xanax is very short-acting and much easier on the liver, although I have read in the BNF and other books that Serax (oxazepam) is the easiest on it.
AFAIK, it's not really a case of oxazepam being easier on the liver, it's more a case of oxazepam being safer than diazepam in patients with established liver disease because it is more rapidly eliminated. Serious liver damage is very rare with benzodiazepines, including diazepam.
>The cognitive effects I did feel from Valium only occurred during the beginning of treatment.
Did the sedation wear off? You said you found it very sedating at first.
>What benzos have you tried so far?
I've mainly used diazepam 10-15mg when required. I've also tried lorazepam and alprazolam. Alprazolam isn't available on the National Health Service in the UK, a friend gave me a few Xanax tablets that he bought on the internet! I didn't like Xanax at all- it made me feel extremely dumb and it didn't seem to treat my anxiety very well! I prefer Valium to be honest. Lorazepam was effective but only at high doses, 3mg 'when required' seemed to work ok. I also once tried clobazam (Frisium) which was rubbish, it didn't make me drowsy but it made me feel confused and my anxiety got worse! I like diazepam's muscle relaxant, it relieves the tension.
>For physical side effects, I would rank it like this:
Valium
Tranxene
Ativan
XanaxWhat physical side effects did Valium cause? It sometimes makes me feel weak due to the muscle relaxation.
>I was in a great mood today and laughing at jokes I was reading online.......
:-)
>Should I try Survector, or will that make me more nervous than tianeptine?
It's hard to predict. Have you ever taken a stimulant such as Ritalin or an amphetamine? Survector is often said to be quite stimulant-like. I not sure how long the supply of amineptine will last, I don't think it's being manufactured anymore.
>The reason I am interested in Survector is because of low libido and lack of motivation/ambition/drive. Despite not feeling depressed one bit, I just don't have any motivation or libido. Is Xanax doing this to me perhaps?
Possibly :-(
>I had read that Xanax can also cause hyperprolactinaemia.
Various benozos have rarely been implicated in causing hyperprolactinemia. Diazepam can cause mild hyperprolactinemia at very high doses, I don't think it's generally significant.
>My doctor is willing to give me Survector but I forgot to ask her if I can take Stablon and Survector at the same time.
I don't know whether they interact, I've never heard of anyone taking them together.
Kind regards,
Ed.
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