![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 8 to 32 of 103. Go back in thread:
Posted by 3 Beer Effect on December 15, 2001, at 22:08:20
In reply to GABITRIL (tiagabine) new anti-anxiety drug?????, posted by 3 Beer Effect on December 14, 2001, at 22:42:11
Is Neurontin superior to Gabitril filmtabs for social phobia? What doses would be good of both for an anti-anxiety effect (i don't have epilepsy or siezures). I currently take Klonopin 0.5 mg twice per day (8 am & 8 pm) for social phobia. This dose seems to low to me, but my psychiatrist won't raise this dose but I am getting a new psychiatrist after January 1st.- I've tried almost all of the anti-depressants (SSRIs, effexor, remeron etc.) they all caused me insomnia, nervousness, or in the case of remeron- no anti-anxiety or anti-depression efficacy & sleeping 17 hrs per day, which contributed to me failing out (got medical withdrawl thankfully) of my senior year of college.
I still think alcohol is the hands down best cure for social phobia but you can't drink 24 hours per day so I decided to stop drinking Sept 11th and try to find another way to be socialable & talk to women, go on dates etc, without drinking. Any suggestions would be appreciated- it seems as though most psychiatrists know little about social phobia & are scared of the first line treatment- klonopin because they say it is extremely addictive (which from the research & my experience seems false- Unlike Xanax, Klonopin takes 2 hours to work & causes no euphoria- I have heard of college kids seeking out Xanax & Valium to combine with their drinking & party with but never Klonopin or Ativan ever.
Posted by Mitch on December 16, 2001, at 9:10:24
In reply to Is Neurontin superior to Gabitril for social ph?, posted by 3 Beer Effect on December 15, 2001, at 22:08:20
> Is Neurontin superior to Gabitril filmtabs for social phobia? What doses would be good of both for an anti-anxiety effect (i don't have epilepsy or siezures). I currently take Klonopin 0.5 mg twice per day (8 am & 8 pm) for social phobia. This dose seems to low to me, but my psychiatrist won't raise this dose but I am getting a new psychiatrist after January 1st.
Neurontin is probably the only anticonvulsant that seems to have some tangible effectiveness for sp. I got the best results with 300mg doses either twice or three times a day. Some people do better with more. I was too tired above 900mg/day. The best meds to throw in with it (besides the benzos and SSRi's you listed) I found were a low-dose of Adderall combined with an low-dose atypical AP (Risperdal). Of course the TD issue is important to me and I will not take any AP's unless absolutely necessary. But I found that Neurontin 300mg twice daily+ Adderall 5-10mg/day + Risperdal .5mg at bedtime did wonders.
Mitch
Posted by SLS on December 16, 2001, at 9:49:43
In reply to Re: GABITRIL (tiagabine) new anti-anxiety drug????? » 3 Beer Effect, posted by Mitch on December 15, 2001, at 10:11:40
> I took it for a few weeks for bipolar as a mood stabilizer. It seemed to have more of an antidepressant effect (at lower doses) than an antianxiety effect.
> Mitch
Hi Mitch.It comes as exciting news to me that you experienced an antidepressant effect to Gabitril.
Of course, I've got a bunch of questions for you, but I'll try to limit them.
1. Are you bipolar I or bipolar II?
2. Is your depression chronic, severe, or treatment resistant?
3. How often have you been manic?
3. Which antidepressants have you responded well to in the past?
4. Did the antidepressant effect disappear at higher dosages?
5. Why did you discontinue Gabitril?
I guess I didn't do a very good job at limiting them. Any feedback will be greatly appreciated.
Thanks much.
- Scott
Posted by Emme on December 16, 2001, at 10:28:24
In reply to what do you mean your body didn't tolerate it?, posted by 3 Beer Effect on December 15, 2001, at 21:54:58
I felt sick starting a few days after hitting 12 mg. A little feverish, eyes hurt and felt swollen, I felt like my head was going to explode (no sinus problems) and slept for a night sitting up, shaky, and just plain cruddy. I had a creepy gut feeling that the Gabitril wasn't agreeing with me. My doctor had blood drawn for CBC, which was fine. As soon as I skipped a dose and then resumed at a half dose I felt much better. So, we concluded it was probably a drug reaction. I am sensitive to meds, so don't be scared off by my experience!
I wasn't on gabitril long enough at a high enough dose to really make a good comparison between it and neurontin. I do like Neurontin. It seems to provide some background smoothness. At times when my nerves were totally jangled, neurontin was soothing. Aside from being tired if the dose is too high, it's easy for me to tolerate. I can easily adjust the dosage by a few hundred milligrams to accommodate my fluctuating anxiety/energy levels. It's more subtle for me than Klonopin, which I also like. I'm not sure it's doing much for depression. I think the gabitril might give you some help with both anxiety and depression (if you need help with depression). I can't tell you much about social enhancement as I'm not social phobic. Okay, well, my social life is the pits because I haven't had the energy or decent mood to make many friends since moving to where I live now. But I'm happy enough to talk to people when I am actually around some.
Emme
> What side effects did you encounter from Gabitril?
> Did Neurontin work better as a social enhancer/anxiety reducer? >
>
>
> I found some antianxiety effects with it when I got up around 12 mg. I was also taking Neurontin and a little Klonopin, but I felt some additional anxiety control with Gabitril, as well as some antidepressant effects. Unfortunately, my body didn't tolerate it well at that dose, so that's as far as I can comment. But it seems to me the potential is definitely there.
> >
> > Emme
> >
> >
> > .
Posted by Elizabeth on December 16, 2001, at 13:23:54
In reply to Is Neurontin superior to Gabitril for social ph?, posted by 3 Beer Effect on December 15, 2001, at 22:08:20
I don't know about Gabitril vs. Neurontin. Neurontin has been studied a bit (in SP and other anxiety disorders -- panic, PTSD -- too) and the results so far are positive, while Gabitril hasn't yet. Neurontin is worth a try, maybe to augment the Klonopin if your new doctor is as benzophobic as the present one. Lamictal might also be worth trying. There has been one study of Depakote, with negative results. Pregabalin, an anticonvulsant that is still in the pipeline, is similar to gabapentin and seems to work in anxiety disorders as well.
Benzos work, although your dose is on the low end of the effective range. 1 mg twice a day of Klonopin would not be at all unreasonable, and any doctor who thinks Klonopin is all that addictive is ignorant and needs a good continuing education course on benzos! I don't think that there's evidence that any benzo works better than any other. The ones that have been systematically evaluated are Klonopin, Xanax, and Ativan. Klonopin is slow to kick in, as you say, but it works well if you take it around-the-clock (as you're taking it -- two or maybe three times a day) so you always have some in you. I take benzos as-needed, so Xanax, which works faster, is better suited to my needs.
Exactly what antidepressants have you tried, and what happened? How long did you take them and at what doses?
Have you ever tried a MAOI? RIMAs may work, and if you can get them easily it might be worth trying them before moving on to the irreversible MAOIs. I think Nardil is the best of these, but Parnate works well too and may have fewer annoying side effects (weight gain, sexual dysfunction). You can take MAOIs along with benzos and anticonvulsants, but not with other antidepressants that work for social phobia. (The primarily noradrenergic antidepressants don't work for SP, and most tricyclics are therefore ineffective. Clomipramine, which has the most effect on serotonin of all the TCAs, can work well, but it has some pretty nasty side effects.)
Finally, as I've said before, opioids work the best for me -- Nardil is the only thing that's come close. But I don't know whether what I have is regular social phobia.
Mitch mentioned he takes Risperdal. I just wanted to let you know that I don't know of any evidence that antipsychotics help in SP, and there is a chance they might make it worse. Of course, everybody's different, but I would put antipsychotics way down at the bottom of the list of things to try.
Another med that Mitch mentioned was Adderall. I think that stimulants can help some people with SP -- they can sort of give you the extra push you need to be able to be social. That's just my opinion though, and I'm sure it doesn't apply to everyone with SP; some people may find that stimulants just make them more nervous.
I hope this helps. Keep in mind, there are lots of options. I especially urge you to get an adequate dose of Klonopin, or add something to it that gives you adequate relief -- any of these drugs is *much* healthier than alcohol!
best,
-elizabeth
Posted by Mitch on December 16, 2001, at 15:54:14
In reply to Re: GABITRIL (tiagabine) new anti-anxiety drug????? » Mitch, posted by SLS on December 16, 2001, at 9:49:43
> > I took it for a few weeks for bipolar as a mood stabilizer. It seemed to have more of an antidepressant effect (at lower doses) than an antianxiety effect.
> > Mitch
>
>
> Hi Mitch.
>
> It comes as exciting news to me that you experienced an antidepressant effect to Gabitril.
>
> Of course, I've got a bunch of questions for you, but I'll try to limit them.
>
> 1. Are you bipolar I or bipolar II?BPII, atypical BP, adult ADHD, seasonal depressive, depending on which doc I see.
>
> 2. Is your depression chronic, severe, or treatment resistant?Seasonal major depression (winter and summer-avg. six weeks each) sometimes a mild mixed-state scene in the summer, with 20-day cycles in between involving a few days of mild depression during the cycling.
Treatment intolerant-lots of different AD's "work"-I just either can't handle G.I. side effects/insomnia or they make me hypomanic or aggravate cycling.>
> 3. How often have you been manic?Never have been "manic"-in the sense of staying up all nite and having people getting concerned and trying to drag you to the doctor. Never have been high enough that I couldn't go to work-however I was off meds for a while and I had to *leave* work a couple of times to go home and take some meds to chill me out because I was having a hard time not laughing!
>
> 3. Which antidepressants have you responded well to in the past?I have done the best with Prozac and other more activating SSri's (Zoloft-Celexa). However, they are the toughest ones for me to tolerate. I am taking 75mg of Wellbutrin with just a pinch of Celexa (2mg/day) for my seasonal depression right now and it is working well. But, the Wellbutrin overall is a little too activating. I found that Celexa+Nortriptyline or Zoloft+Nortiptyline worked about as good as the current Celexa/WB combo. For the seasonal stuff I have to have something a little "buzzy" or I get worse.
>
> 4. Did the antidepressant effect disappear at higher dosages?Usually could never get there! The highest "therapeutic" dose of an AD that I have ever taken was probably 150mg of doxepin a day (TCA), and it never did much for me except help me sleep.
>
> 5. Why did you discontinue Gabitril?Derealization/depersonalization, facial/forehead numbness, and severe cognitive dysfunction at the higher doses. I was just drawing "blanks" at work. I had this "panic" attack where I felt completely unreal, didn't know who I was or where I was. But my body didn't have any adrenaline rushes or anything-one of the weirdest feelings I have ever experienced (this at 24mg/day). GABA affecting meds-Depakote, benzos (at anything above small doses), and Gabitril just blitz my ability to focus and think (hence the ADHD dx).
The antidepressant effect seemed to wear away on the Gabitril after I got above 12mg/day. I just got very flattened and blunted and very stupid!>
> I guess I didn't do a very good job at limiting them. Any feedback will be greatly appreciated.
>
> Thanks much.
>
>
> - Scott
Posted by Mitch on December 16, 2001, at 15:59:58
In reply to Re: Is Neurontin superior to Gabitril for social ph? » 3 Beer Effect, posted by Elizabeth on December 16, 2001, at 13:23:54
> Mitch mentioned he takes Risperdal. I just wanted to let you know that I don't know of any evidence that antipsychotics help in SP, and there is a chance they might make it worse. Of course, everybody's different, but I would put antipsychotics way down at the bottom of the list of things to try.
>Oh, Elizabeth,
That is really past tense. I only was on low-dose Risperdal for a few weeks. It did really help with SP (and so did Seroquel-only 25mg at bedtime), but I get EPS from AP's really easily, and I had cogwheel rigidity with the Risperdal.
Mitch
Posted by JahL on December 16, 2001, at 19:01:11
In reply to Re: Is Neurontin superior to Gabitril for social ph? » 3 Beer Effect, posted by Elizabeth on December 16, 2001, at 13:23:54
> Mitch mentioned he takes Risperdal. I just wanted to let you know that I don't know of any evidence that antipsychotics help in SP, and there is a chance they might make it worse. Of course, everybody's different, but I would put antipsychotics way down at the bottom of the list of things to try.
Except of course Sulpiride & Amisulpride. They're both highly regarded social phobia treatments at Maudsley, England's top psychiatric hospital. Sulpiride is the only med to offer consistent help in this regard for me and I've tried all the conventional options listed.
> Finally, as I've said before, opioids work the best for me -- Nardil is the only thing that's come close. But I don't know whether what I have is regular social phobia.
Interestingly, Methadone seems to make more sociable, though it's early days (did you get my email?).
>I especially urge you to get an adequate dose of Klonopin, or add something to it that gives you adequate relief -- any of these drugs is *much* healthier than alcohol!
..but *much* less fun %^)
J.
Posted by Elizabeth on December 16, 2001, at 23:00:22
In reply to Re: antipsychotics for social p. » Elizabeth, posted by JahL on December 16, 2001, at 19:01:11
> Except of course Sulpiride & Amisulpride.
Oh yes! I always forget those, or think of them more as antidepressants. I'm not surprised to hear that they work for SP.
> Interestingly, Methadone seems to make more sociable, though it's early days (did you get my email?).
I just read it, and I will try to write back tomorrow. All the opioids I've tried (except Ultram and codeine, which don't seem to work for me) help me come out of my shell.
> >I especially urge you to get an adequate dose of Klonopin, or add something to it that gives you adequate relief -- any of these drugs is *much* healthier than alcohol!
>
> ..but *much* less fun %^)I've never been very impressed with alcohol (or benzos, for that matter -- even the supposedly "fun" ones like Xanax and Valium).
-elizabeth
Posted by SLS on December 17, 2001, at 7:09:08
In reply to Re: antipsychotics for social p. » Elizabeth, posted by JahL on December 16, 2001, at 19:01:11
> > Of course, everybody's different, but I would put antipsychotics way down at the bottom of the list of things to try.
> Except of course Sulpiride & Amisulpride. They're both highly regarded social phobia treatments at Maudsley, England's top psychiatric hospital. Sulpiride is the only med to offer consistent help in this regard for me and I've tried all the conventional options listed.
Hi JahL.What dosage of sulpiride did you find optimal? A TRD specialist who uses sulpiride recommended 50mg. He also commented that he preferred sulpiride to amisulpride. In his words, he said that "amisulpride is too much an antipsychotic". Amisulpride has a much higher affinity for the DA2 receptor than does sulpiride. Perhaps this accounts for his sentiments.
I have a batch of the stuff. It is incredibly inexpensive. I experienced a "blip" improvement in depression within an hour of my first dose that lasted for a few hours. I was taking only Lamictal at the time. I felt some vague inkling of an improvement during the first week, but I ended up discontinuing sulpiride because the addition of Provigil screwed things up. I wish I had been more patient and methodical. I am often my own worst enemy.
What's interesting about these two drugs is that neither is an antagonist at the 5-HT2 receptors as are Zyprexa, Risperdal, and Geodon. I have a problem with these latter three drugs. I receive a significant improvement from them early in treatment at low dosages. As the effect wanes, increasing the dosages to 5.0mg., 1.5mg., and 60mg. respectively in an attempt to recapture and secure the improvement results in my experiencing unacceptable mind-numbing cognitive side-effects. I feel like I've been hit over the head with a baseball bat. I am suspicious that this is due to the 5-HT2 blockade. When the time comes to again try adding a neuroleptic, I think I'll give sulpiride a try.
Why did you stop taking sulpiride?
- Scott
Posted by JahL on December 17, 2001, at 10:56:38
In reply to Re: antipsychotics for social p. » JahL, posted by SLS on December 17, 2001, at 7:09:08
> What dosage of sulpiride did you find optimal?Hi Scott.
I currently take about 150mg. Above this there is no further benefit and mild sedation begins to set in. Anything much below and the s. phobia kicks in. I am obviously concerned about TD & so I try and take as little as possible.
>A TRD specialist who uses sulpiride recommended 50mg.
That sounds rather low. I was prescribed 200mg to begin with, which seems fairly standard procedure over here. I'm not sure 50mg would do much for me, tho' the response is definitely linear.
>He also commented that he preferred sulpiride to amisulpride. In his words, he said that "amisulpride is too much an antipsychotic".
That's very interesting. Sulpiride is preferred here too; Amisulpiride (50-100mg) did nothing for me.
Interesting because the Antipsychotic I respond best to is Promazine, a very 'weak' AP primarily used for sedative purposes. Amazingly I would feel mildly euthymic w/in a couple of hours of taking 25mg. I have BPII very similar to yours and this drug addressed all symptoms equally (ie it somehow addressed the BP itself and not just individual symptoms). I can replicate the improvement time and time again. Unfortunately the EPS were unbearable, it has a short half-life and mild paranoia (I remember being stalked by a Swan one night...) set in if I got the dose wrong. We tried Sulpiride instead and I haven't looked back since (1.5 yrs now). Sulpiride doesn't particularly lift my mood but is excellent for s. phobia and ruminations.
I would be interested to see if someone with the same condition could benefit similarly from Promazine. Naturally I'm yet to meet a pdoc who believes an AP can induce mild euthymia w/i hours but having been unremittingly depressed my entire life I think I know what a (partial) remission feels like.
> I have a batch of the stuff. It is incredibly inexpensive. I experienced a "blip" improvement in depression within an hour of my first doseLike Promazine for myself?
>that lasted for a few hours. I was taking only Lamictal at the time. I felt some vague inkling of an improvement during the first week.
From what I remember the transition from Promazine to Sulpiride was fairly smooth and so I can only assume that Sulpiride must've begun working with the first dose. Might be worth trying at a higher dose; I don't get any side-effects.
>. When the time comes to again try adding a neuroleptic, I think I'll give sulpiride a try.
Good luck.
> Why did you stop taking sulpiride?Didn't know I had :-)
J.
Posted by NikkiT2 on December 17, 2001, at 12:53:35
In reply to Re: antipsychotics for social p. » Elizabeth, posted by JahL on December 16, 2001, at 19:01:11
Jah,
Just out of interest, are you getting your methadone prescribed?? (if you don;'t want to mention it on here, feel free to email me!!) I'm interested as I have a friend who is trying to get off heroin, and has met alot fo resistance from doctors... he's currently buying "on the street" and self medicating with it.
I know I have been very anti methadone use in the past as I have seena friend come cold turkey off it, and it was a scary experience... but, sometimes it takes my mind a while to catch up, and I speak now eating humble pie. The idea's of its use in mental health now has me interested. Do you know of its use in helping the symptoms of BPD - not just the depression that comes with it, but the ruminating, psyhcotic thoughts etc.
Thanks
Nikki thinking this should have gone on the methadone post!!
Posted by JahL on December 17, 2001, at 15:43:32
In reply to methadone » JahL, posted by NikkiT2 on December 17, 2001, at 12:53:35
> Jah,
>
> Just out of interest, are you getting your methadone prescribed?? (if you don;'t want to mention it on here, feel free to email me!!) I'm interested as I have a friend who is trying to get off heroin, and has met alot fo resistance from doctors... he's currently buying "on the street" and self medicating with it.I'll mail ya. So what you're saying is pdocs let opiophobia/fear of govt crackdown come before helping someone off H? I mean, isn't that what Methadone's for? I'd be interested to know just what they do prescribe M for.
> I know I have been very anti methadone use in the past as I have seena friend come cold turkey off it, and it was a scary experience... but, sometimes it takes my mind a while to catch up, and I speak now eating humble pie. The idea's of its use in mental health now has me interested.Glad you've come round :-)
I guess if you were naive about Effexor and saw a friend come off it cold turkey, you'd form a similar opinion. Of course this doesn't necessarily detract from its clinical usefulness (as w/ Methadone).Constipation not withstanding ( :-0 ), Methadone is remarkably side-effect free. Far from being a stupefacient, personally speaking it seems to improve mental clarity and enhance energy (tho' I actually feel calmer). An example: the one thing I force myself to do everyday is work out on the punch-bag for half an hour. BPII slows me down generally; I have less strength, stamina & coordination. Since taking low-dose Methadone I've managed to break a knuckle (no 6 & counting) and the rest are covered in blood-blisters (& this when wearing 1" thick gloves). In other words, I'm hitting a lot harder than usual. My body actually functions better. Weird but exciting...
>Do you know of its use in helping the symptoms of BPD - not just the depression that comes with it, but the ruminating, psyhcotic thoughts etc.
I probably don't know much more about Meth. than yourself. Elizabeth's the one to ask probably. Just from where I'm sitting tho', when opioids do work, they seem to help quite a broad spectrum of symptoms...
So far as ruminating thoughts go, I've found Sulpiride+Lamictal to be most useful on that front. As far as Meth goes, I'd have to maintain myself on a higher dose before I could comment. I'll let ya know. Are your thoughts truly psychotic at times?
Best,
J.
Posted by NikkiT2 on December 17, 2001, at 18:38:19
In reply to Re: methadone » NikkiT2, posted by JahL on December 17, 2001, at 15:43:32
Thanks, that was interesting... and also the thought that my opinion has started changing since trying to get off effexor cold turkey (pdoc wouldn't believe me about "rumours" I'd heard that you need to titrate). I guess it the same with M.. You just need to titrate off it slowly.
God knows what the doctors in this country are up to. I just feel so awful for my friend. Addiction is a terribel thing, and by going to M he is seeing the same people who sell H, thus if no M availa ble, he's back to square 1!
I may bring up the opoid point withmy pdoc.. he is quite young and very open to what I think and want to try. Zyprexa has really helped with my ruminating (and yes, the thoughts can get very psychotic at times, I just hide it well!), but I feel so... dull.. I am totally grey and have no enthusiasm or energy to do anything at all, and this in turn is increasing my SP.Thanks to you and Elizabeth for some interesting things to ponder!!!
Nikki
Posted by MB on December 19, 2001, at 13:47:27
In reply to GABITRIL (tiagabine) new anti-anxiety drug?????, posted by 3 Beer Effect on December 14, 2001, at 22:42:11
I just started Gabitril five days ago (tonight will be my sixth dose). It was prescribed to me by a doctor at the Amen Clinic where I just had some SPECT scans done. My immediate impression of the doctor was that he really new his stuff. He was looking at the scans and asking "does *this* happen to you, does *that* happen to you?" and he kept hitting the proverbial nail on the head, which was really hope-giving. One of the things he saw was a "hot-spot" in my left-temporal area which he thought explained my anxiety, violent moods and rage attacks...and he also thought it was why SSRIs, while they help me in some areas, make my anxiety and rage worse. Anyway, he put me on Gabitril which is supposed to help with such hot-spots, and, via such cooling, allow me to tolorate an SSRI which I need for OCD. And then a few months down the road I'm supposed to start Adderall for attention problems (when I was concentrating, the scans showed that activity actually decreases instead of increasing in the front of my brain). So that's the general long-range plan (to be adjusted as needed as I proceed).
So, that's that, and here I am starting on the Gabitril, so I wanted to jump in on this thread. I was given a general guideline to increasing my doseage over time. When I first started taking it, I didn't really feel anything, and I thought it was going to be really easy going: I made the first two dose increases as quickly as was allowed by the given parameters (went from 4mg to 8mg on the second day, and went from 8mg to 12mg on the fourth day). I thought I was in the clear, but the second night that I took the 12mg, I got really sick: headache, nausea, shakiness and the general feeling of weirdness one gets after a massive dose of dextromethorphan (that's the only way I can describe it). I've dropped back down to 8mg at bedtime (last night), but I'm still really sick this morning. Will this crap stop? Now I remember why I went almost two years without medication. I had forgotten how BAD BAD BAD psychiatric medication makes me feel physically. I went to the gym and worked out and the ensuing headache damn near killed me. I couldn't bend over and tie my shoes without feeling like I had just busted an aneurysm. Now this worries me because this isn't the first time that weight lifting has caused this kind of nausea and vascular headache. Am I putting too muchg strain on my cerebral vascular system? Am I going to have a stroke? Is the Gabitril making this worse? Is it even the Gabitril, or just some physiological problem with my brain? These are the questions that circulate in my mind, almost paralysingly, and you can see why I need something for OCD. I feel totally crazy, no less anxious, and f*ck f*ck f*ck, I wish I wasn't in AA because I need a damned DRINK to calm down right now. Thanks for listening to my obsessive/panicked rant. I am really not OK, I guess that is why I am a psychiatric patient < g >
MB
Oh yeah, anyway, so is this Gabitril supposed to eventually help with my anxiety. Sometimes I think it is making it worse (or is it just worse because I feel sick?). See, questions questions questions, they're killing me.
Posted by MB on December 19, 2001, at 13:50:04
In reply to Re: GABITRIL (tiagabine) new anti-anxiety drug?????, posted by MB on December 19, 2001, at 13:47:27
Oh yeah, also...is this stuff going to make me fat?
Posted by Mitch on December 19, 2001, at 23:22:55
In reply to Re: GABITRIL (tiagabine) new anti-anxiety drug?????, posted by MB on December 19, 2001, at 13:47:27
> I just started Gabitril five days ago (tonight will be my sixth dose). It was prescribed to me by a doctor at the Amen Clinic where I just had some SPECT scans done. My immediate impression of the doctor was that he really new his stuff. He was looking at the scans and asking "does *this* happen to you, does *that* happen to you?" and he kept hitting the proverbial nail on the head, which was really hope-giving. One of the things he saw was a "hot-spot" in my left-temporal area which he thought explained my anxiety, violent moods and rage attacks...and he also thought it was why SSRIs, while they help me in some areas, make my anxiety and rage worse. Anyway, he put me on Gabitril which is supposed to help with such hot-spots, and, via such cooling, allow me to tolorate an SSRI which I need for OCD. And then a few months down the road I'm supposed to start Adderall for attention problems (when I was concentrating, the scans showed that activity actually decreases instead of increasing in the front of my brain). So that's the general long-range plan (to be adjusted as needed as I proceed).
>
> So, that's that, and here I am starting on the Gabitril, so I wanted to jump in on this thread. I was given a general guideline to increasing my doseage over time. When I first started taking it, I didn't really feel anything, and I thought it was going to be really easy going: I made the first two dose increases as quickly as was allowed by the given parameters (went from 4mg to 8mg on the second day, and went from 8mg to 12mg on the fourth day). I thought I was in the clear, but the second night that I took the 12mg, I got really sick: headache, nausea, shakiness and the general feeling of weirdness one gets after a massive dose of dextromethorphan (that's the only way I can describe it). I've dropped back down to 8mg at bedtime (last night), but I'm still really sick this morning. Will this crap stop? Now I remember why I went almost two years without medication. I had forgotten how BAD BAD BAD psychiatric medication makes me feel physically. I went to the gym and worked out and the ensuing headache damn near killed me. I couldn't bend over and tie my shoes without feeling like I had just busted an aneurysm. Now this worries me because this isn't the first time that weight lifting has caused this kind of nausea and vascular headache. Am I putting too muchg strain on my cerebral vascular system? Am I going to have a stroke? Is the Gabitril making this worse? Is it even the Gabitril, or just some physiological problem with my brain? These are the questions that circulate in my mind, almost paralysingly, and you can see why I need something for OCD. I feel totally crazy, no less anxious, and f*ck f*ck f*ck, I wish I wasn't in AA because I need a damned DRINK to calm down right now. Thanks for listening to my obsessive/panicked rant. I am really not OK, I guess that is why I am a psychiatric patient < g >
>
> MB
>
> Oh yeah, anyway, so is this Gabitril supposed to eventually help with my anxiety. Sometimes I think it is making it worse (or is it just worse because I feel sick?). See, questions questions questions, they're killing me.Wow!,
I had a relatively decent antidepressant response to Gabitril up to a certain level-about 12mg/day. It sure enough does flatten out your mood. Hmmm..this seems to be a certain spot that others have posted about as well (where the benefits start to switch over to unpleasant side-effects). BTW, "cooling" such hot-spots can be successful with Lithium, Depakote, Topamax, Tegretol, Trileptal, Lamictal, etc.-not just Gabitril.
Personally---I would back off to 8mg/day and explain that reaction to this doctor and ask him if something else would work better given your adverse reactions to the med. I couldn't stand the stuff above 12mg/day.So, (IMHO), I believe your doc's assessment of the *fundamentals*-you need a mood stabilizer(s)+SSRI+psychostimulant. I also have done well with that combo (that's the combo I am on NOW-Neurontin+Klonopin+Celexa+Wellbutrin, I am counting the WB as a pstim). You are just getting a bad reaction to the Gabitril. Ask him to switch you to a different MS. Geez- Depakote, Neurontin, Lamictal. I just haven't heard any success stories with Gabitril. I had the worst derealization experience with Gabitril at 24mg/day.
Mitch
Posted by MB on December 20, 2001, at 0:38:02
In reply to Re: GABITRIL (tiagabine) new anti-anxiety drug????? » MB, posted by Mitch on December 19, 2001, at 23:22:55
> Wow!,
>
> I had a relatively decent antidepressant response to Gabitril up to a certain level-about 12mg/day. It sure enough does flatten out your mood. Hmmm..this seems to be a certain spot that others have posted about as well (where the benefits start to switch over to unpleasant side-effects). BTW, "cooling" such hot-spots can be successful with Lithium, Depakote, Topamax, Tegretol, Trileptal, Lamictal, etc.-not just Gabitril.
> Personally---I would back off to 8mg/day and explain that reaction to this doctor and ask him if something else would work better given your adverse reactions to the med. I couldn't stand the stuff above 12mg/day.
>
> So, (IMHO), I believe your doc's assessment of the *fundamentals*-you need a mood stabilizer(s)+SSRI+psychostimulant. I also have done well with that combo (that's the combo I am on NOW-Neurontin+Klonopin+Celexa+Wellbutrin, I am counting the WB as a pstim). You are just getting a bad reaction to the Gabitril. Ask him to switch you to a different MS. Geez- Depakote, Neurontin, Lamictal. I just haven't heard any success stories with Gabitril. I had the worst derealization experience with Gabitril at 24mg/day.
>
> MitchHey Mitch,
I think you're right that the Gabitril might not be the best MS for me...but I still want to give it one more try with a much slower upward titration this time. Before I start switching meds, I want to be 100% sure (or at least close to it) that it's not tolorable. This is more for my own weird obsessive reasons than for any good logical reason. I remember during my first ride on the AD merry-go-round some years ago. If I didn't like the side effects of a drug, I'd switch to a new one within a few days. Then, if I didn't like the side effects of the next drug, I would start obsessing (I mean *really* obsessing) about whether or not I had given the previous drug a good chance (maybe a lower dose would have worked? maybe this? maybe that? etc.) and I would want to go back to it for another try and the doc would be like, "Nope, we've already tried that, let's try something new." I would obsess over the "what ifs" until I drove myself crazy. So, I'm going to try a slower titration and then, if I still can't tolorate the Gabitril, I will call it an unequivocal failure and ask to have my MS changed (another reason I want to give the Gabitril another chance is that i just bought 120 pills yesterday--ouch!). The doc said that the next MS he would want to try if Gabitril didn't work would be Trileptal. Have you heard anything one way or another about its efficacy in treating rage/anger problems? Is it bacically a "safer Tegretol"?Out of curiosity, what type of titration schedule did you use to get up to 24 mg?
Take it easy,
MB
Posted by Mitch on December 20, 2001, at 9:44:13
In reply to Re: GABITRIL (tiagabine) new anti-anxiety drug?????, posted by MB on December 20, 2001, at 0:38:02
> Hey Mitch,
> I think you're right that the Gabitril might not be the best MS for me...but I still want to give it one more try with a much slower upward titration this time. Before I start switching meds, I want to be 100% sure (or at least close to it) that it's not tolorable. This is more for my own weird obsessive reasons than for any good logical reason. I remember during my first ride on the AD merry-go-round some years ago. If I didn't like the side effects of a drug, I'd switch to a new one within a few days. Then, if I didn't like the side effects of the next drug, I would start obsessing (I mean *really* obsessing) about whether or not I had given the previous drug a good chance (maybe a lower dose would have worked? maybe this? maybe that? etc.) and I would want to go back to it for another try and the doc would be like, "Nope, we've already tried that, let's try something new." I would obsess over the "what ifs" until I drove myself crazy. So, I'm going to try a slower titration and then, if I still can't tolorate the Gabitril, I will call it an unequivocal failure and ask to have my MS changed (another reason I want to give the Gabitril another chance is that i just bought 120 pills yesterday--ouch!). The doc said that the next MS he would want to try if Gabitril didn't work would be Trileptal. Have you heard anything one way or another about its efficacy in treating rage/anger problems? Is it bacically a "safer Tegretol"?
>
> Out of curiosity, what type of titration schedule did you use to get up to 24 mg?
>
> Take it easy,
> MB
>
MG,I understand what you mean about the *obsessing* about whether you missed out by switching a med too soon. I have crossed paths with several meds with several trials just to *show* myself that something or other doesn't work-sure enough. What seems to work the best for identifying something that is good is noticing a substantial improvement in the symptoms you are treating (relatively early on) without regard to side effects. The one "rule-of-thumb" that hasn't failed me yet is: If something doesn't seem to be helping (something!) after a certain length of time it probably never will.
I was on Trileptal rather briefly. I didn't get the "obviously helping me" reaction to it that I did with Depakote or Neurontin or Lithium. I got nauseated really bad-there were others here that complained of that as well. The *one* thing I did notice-it *did* improve my attentiveness, in other words I didnt' feel all dulled out by it.
As far as MS meds that helped with "rage-anger" problems Lithium and Neurontin helped the most. Depakote helped some, but it made my depression worse-which made me sullen and grouchy. OH yeah-Topamax probably would do a good job (if you can tolerate it). The Gabitril in hindsight helped with grouchiness, too-I just couldn't tolerate the cognitive adverse events. I titrated it at the slowest rate you can 4mg/week. I got to 24mg/day-hey I didn't bail out! But it was a nightmare for me.
Actually, in my honest opinion....MOST of the "anger" and "rage" problems that I have experienced were not the result of a "lack" of or "incorrect" mood stabilizer-it was a freaking antidepressant or an anxiolytic causing the problem. In my personal experience here's a few that made me a real bastard: Remeron, Effexor, Buspar. Prozac could also set me off some. Zoloft to a lesser extent. Celexa and Paxil didn't experience any grouchiness. TCA's would do it rather easily-especially desipramine. The odd-ball one is Wellbutrin. I can "feel" grouchy, but I don't pop off and start adrenalizing and ruminating. It must the impulse control with the ADHD-who knows??
good luck,
Mitch
Posted by MB on December 20, 2001, at 10:47:15
In reply to Re: GABITRIL (tiagabine) new anti-anxiety drug????? » MB, posted by Mitch on December 20, 2001, at 9:44:13
> > Hey Mitch,
> > I think you're right that the Gabitril might not be the best MS for me...but I still want to give it one more try with a much slower upward titration this time. Before I start switching meds, I want to be 100% sure (or at least close to it) that it's not tolorable. This is more for my own weird obsessive reasons than for any good logical reason. I remember during my first ride on the AD merry-go-round some years ago. If I didn't like the side effects of a drug, I'd switch to a new one within a few days. Then, if I didn't like the side effects of the next drug, I would start obsessing (I mean *really* obsessing) about whether or not I had given the previous drug a good chance (maybe a lower dose would have worked? maybe this? maybe that? etc.) and I would want to go back to it for another try and the doc would be like, "Nope, we've already tried that, let's try something new." I would obsess over the "what ifs" until I drove myself crazy. So, I'm going to try a slower titration and then, if I still can't tolorate the Gabitril, I will call it an unequivocal failure and ask to have my MS changed (another reason I want to give the Gabitril another chance is that i just bought 120 pills yesterday--ouch!). The doc said that the next MS he would want to try if Gabitril didn't work would be Trileptal. Have you heard anything one way or another about its efficacy in treating rage/anger problems? Is it bacically a "safer Tegretol"?
> >
> > Out of curiosity, what type of titration schedule did you use to get up to 24 mg?
> >
> > Take it easy,
> > MB
> >
>
>
> MG,
>
> I understand what you mean about the *obsessing* about whether you missed out by switching a med too soon. I have crossed paths with several meds with several trials just to *show* myself that something or other doesn't work-sure enough. What seems to work the best for identifying something that is good is noticing a substantial improvement in the symptoms you are treating (relatively early on) without regard to side effects.
Yeah...saddly, I don't notice any real benifit from the Gabitril (but I'm only on 8mg/day). What I *do* notice is that I'm mildly headachy, nauseated, and I can't remember huge chunks of yesterday...nor can I differeniate the memories I have of yesterday with the memories I have of the day before that. I was having physical symptoms *before* the medication (headache, fatigue, nausea, visual flashes of color/light) and I figured that they were psychosomatic and that they would go away with medication, but this medication is actually making it worse.
> The one "rule-of-thumb" that hasn't failed me yet is: If something doesn't seem to be helping (something!) after a certain length of time it probably never will.
The hard part for me is determining what that length of time is. There are two waiting periods, it seems...a) the time one waits for start-up side effects to diminish and b) the time one waits for the desired effects to kick in. Paxil was a medicine I tolorated pretty well after I had been on it for six months, but when I first took it I thought the doc was crazy: the stuff felt like poison. It was just a matter of waiting it out. However, in the end, it was pointless for me to "wait it out" because the medicine did absolutely nothing positive for my mood and made me gain thirty pounds. THEN, it was living hell getting off the stuff--a nightmare. So, I want to give the drug some time, but not too much time...especially since I don't notice anything good from it. How long at what dose is enough...how long is too much? It's not like I can just call my doc and ask. He's out of state and booked up for months (my next phone appointmet in in three weeks). He said that if I ran into real trouble with the Gabitril to call his secretary and he would schedule 15 minutes on the phone during his lunch hour. I don't want to put him in that situation until I've firmly decided.
> I was on Trileptal rather briefly. I didn't get the "obviously helping me" reaction to it that I did with Depakote or Neurontin or Lithium. I got nauseated really bad-there were others here that complained of that as well. The *one* thing I did notice-it *did* improve my attentiveness, in other words I didnt' feel all dulled out by it.
Trileptal *helped* your attentiveness??!! That's very cool. This stuff I'm on now is making me feel totally stupid. The pharmacist said that was supposed to be transient, though.
> As far as MS meds that helped with "rage-anger" problems Lithium and Neurontin helped the most. Depakote helped some, but it made my depression worse-which made me sullen and grouchy. OH yeah-Topamax probably would do a good job (if you can tolerate it). The Gabitril in hindsight helped with grouchiness, too-I just couldn't tolerate the cognitive adverse events. I titrated it at the slowest rate you can 4mg/week. I got to 24mg/day-hey I didn't bail out! But it was a nightmare for me.
>
> Actually, in my honest opinion....MOST of the "anger" and "rage" problems that I have experienced were not the result of a "lack" of or "incorrect" mood stabilizer-it was a freaking antidepressant or an anxiolytic causing the problem. In my personal experience here's a few that made me a real bastard: Remeron, Effexor, Buspar. Prozac could also set me off some. Zoloft to a lesser extent. Celexa and Paxil didn't experience any grouchiness. TCA's would do it rather easily-especially desipramine. The odd-ball one is Wellbutrin. I can "feel" grouchy, but I don't pop off and start adrenalizing and ruminating. It must the impulse control with the ADHD-who knows??
Interesting...just goes to show that YMMV: Wellbutrin made me absolutely, out-of-my-mind, violently enraged. I could only tolorate it with Xanax. So anxiolytics gave you anger/rage? What do you think the mechanism of *that* was? That seems almost conterintuitive that that would happen. I remember getting restless leg syndrome from Librium. Now *that* was one reaction i didn't see comming.
> good luck,
>
> Mitch
Good luck to you as well,
MB
Posted by Mitch on December 20, 2001, at 23:23:18
In reply to Re: GABITRIL (tiagabine) new anti-anxiety drug?????, posted by MB on December 20, 2001, at 10:47:15
> > I understand what you mean about the *obsessing* about whether you missed out by switching a med too soon. I have crossed paths with several meds with several trials just to *show* myself that something or other doesn't work-sure enough. What seems to work the best for identifying something that is good is noticing a substantial improvement in the symptoms you are treating (relatively early on) without regard to side effects.
>
>
> Yeah...saddly, I don't notice any real benifit from the Gabitril (but I'm only on 8mg/day). What I *do* notice is that I'm mildly headachy, nauseated, and I can't remember huge chunks of yesterday...nor can I differeniate the memories I have of yesterday with the memories I have of the day before that. I was having physical symptoms *before* the medication (headache, fatigue, nausea, visual flashes of color/light) and I figured that they were psychosomatic and that they would go away with medication, but this medication is actually making it worse.
UH OH, That was the problems I was having with it before it got nasty. Short term memory. It was wiped. I may as well have smoked a bunch of grass and went to work. I could be working on the computer and be typing something and ....just get lost...what was it I was trying to say?..who was I writing this too?...it seemed like I was always getting lost and found-wasting a LOT of time.
>
>
> > The one "rule-of-thumb" that hasn't failed me yet is: If something doesn't seem to be helping (something!) after a certain length of time it probably never will.
>
>
> The hard part for me is determining what that length of time is. There are two waiting periods, it seems...a) the time one waits for start-up side effects to diminish and b) the time one waits for the desired effects to kick in. Paxil was a medicine I tolorated pretty well after I had been on it for six months, but when I first took it I thought the doc was crazy: the stuff felt like poison. It was just a matter of waiting it out. However, in the end, it was pointless for me to "wait it out" because the medicine did absolutely nothing positive for my mood and made me gain thirty pounds. THEN, it was living hell getting off the stuff--a nightmare. So, I want to give the drug some time, but not too much time...especially since I don't notice anything good from it. How long at what dose is enough...how long is too much? It's not like I can just call my doc and ask. He's out of state and booked up for months (my next phone appointmet in in three weeks). He said that if I ran into real trouble with the Gabitril to call his secretary and he would schedule 15 minutes on the phone during his lunch hour. I don't want to put him in that situation until I've firmly decided.Well, it sounds to me that you can trust your feelings on this one. I would give him that call and just lay it out. Hey, you never know-all of this is experimental-he may be wanting to try the Gabitril and is getting *data* from you and others he is treating with it. Not a bad idea-BUT, if it isn't working and it is making things worse-HE needs to get THAT data.
>
>
> > I was on Trileptal rather briefly. I didn't get the "obviously helping me" reaction to it that I did with Depakote or Neurontin or Lithium. I got nauseated really bad-there were others here that complained of that as well. The *one* thing I did notice-it *did* improve my attentiveness, in other words I didnt' feel all dulled out by it.
>
>
> Trileptal *helped* your attentiveness??!! That's very cool. This stuff I'm on now is making me feel totally stupid. The pharmacist said that was supposed to be transient, though.Oh yes. Tegretol didn't bother me much in that department either. Neurontin helps attentiveness too! It doesn't cause any trouble until I get over 900mg/day. For some reason it seems the GABA affecting anticonvulsants cause all of the stupidity. The calcium and sodium channel blockers don't seem to be nearly as bad.
Well, if it is supposed to be transient, then you could make a compromise and tell him that you will stay with 8mg/day UNTIL the cognitive dysfunction lifts-how about that one? Somehow, I don't think it is going to be transient.
>
>
> > As far as MS meds that helped with "rage-anger" problems Lithium and Neurontin helped the most. Depakote helped some, but it made my depression worse-which made me sullen and grouchy. OH yeah-Topamax probably would do a good job (if you can tolerate it). The Gabitril in hindsight helped with grouchiness, too-I just couldn't tolerate the cognitive adverse events. I titrated it at the slowest rate you can 4mg/week. I got to 24mg/day-hey I didn't bail out! But it was a nightmare for me.
> >
> > Actually, in my honest opinion....MOST of the "anger" and "rage" problems that I have experienced were not the result of a "lack" of or "incorrect" mood stabilizer-it was a freaking antidepressant or an anxiolytic causing the problem. In my personal experience here's a few that made me a real bastard: Remeron, Effexor, Buspar. Prozac could also set me off some. Zoloft to a lesser extent. Celexa and Paxil didn't experience any grouchiness. TCA's would do it rather easily-especially desipramine. The odd-ball one is Wellbutrin. I can "feel" grouchy, but I don't pop off and start adrenalizing and ruminating. It must the impulse control with the ADHD-who knows??
>
>
> Interesting...just goes to show that YMMV: Wellbutrin made me absolutely, out-of-my-mind, violently enraged. I could only tolorate it with Xanax. So anxiolytics gave you anger/rage? What do you think the mechanism of *that* was? That seems almost conterintuitive that that would happen. I remember getting restless leg syndrome from Librium. Now *that* was one reaction i didn't see comming.Oh, I didn't say *which* anxiolytics made me grouchy. Valium was the worst. I sucker punched my Dad on that when he asked me one morning to do a relatively minor thing and I went off. Buspar made my angry ruminations worse (and did Remeron), BUT I had probably zero anxiety. Take away the anxiety and you have got a real pistol? Klonopin-Ativan-Xanax, those were different, nothing remarkable there.
>
>
> > good luck,
> >
> > Mitch
>
>
> Good luck to you as well,
> MB
Posted by MB on December 21, 2001, at 11:32:06
In reply to Re: GABITRIL (tiagabine) new anti-anxiety drug????? » MB, posted by Mitch on December 20, 2001, at 23:23:18
> > Yeah...saddly, I don't notice any real benifit from the Gabitril (but I'm only on 8mg/day). What I *do* notice is that I'm mildly headachy, nauseated, and I can't remember huge chunks of yesterday...nor can I differeniate the memories I have of yesterday with the memories I have of the day before that. I was having physical symptoms *before* the medication (headache, fatigue, nausea, visual flashes of color/light) and I figured that they were psychosomatic and that they would go away with medication, but this medication is actually making it worse.
>
>
> UH OH, That was the problems I was having with it before it got nasty. Short term memory. It was wiped. I may as well have smoked a bunch of grass and went to work. I could be working on the computer and be typing something and ....just get lost...what was it I was trying to say?..who was I writing this too?...it seemed like I was always getting lost and found-wasting a LOT of time.
Yeah, it's totally scary. I was driving home last night, and all of a sudden had this horrible realization that I didn't know where I was or where I was going. I looked around and figured it out after a few seconds, but those few seconds were creepy.
> > > The one "rule-of-thumb" that hasn't failed me yet is: If something doesn't seem to be helping (something!) after a certain length of time it probably never will.
> >
> >
> > The hard part for me is determining what that length of time is. There are two waiting periods, it seems...a) the time one waits for start-up side effects to diminish and b) the time one waits for the desired effects to kick in. Paxil was a medicine I tolorated pretty well after I had been on it for six months, but when I first took it I thought the doc was crazy: the stuff felt like poison. It was just a matter of waiting it out. However, in the end, it was pointless for me to "wait it out" because the medicine did absolutely nothing positive for my mood and made me gain thirty pounds. THEN, it was living hell getting off the stuff--a nightmare. So, I want to give the drug some time, but not too much time...especially since I don't notice anything good from it. How long at what dose is enough...how long is too much? It's not like I can just call my doc and ask. He's out of state and booked up for months (my next phone appointmet in in three weeks). He said that if I ran into real trouble with the Gabitril to call his secretary and he would schedule 15 minutes on the phone during his lunch hour. I don't want to put him in that situation until I've firmly decided.
>
> Well, it sounds to me that you can trust your feelings on this one. I would give him that call and just lay it out. Hey, you never know-all of this is experimental-he may be wanting to try the Gabitril and is getting *data* from you and others he is treating with it. Not a bad idea-BUT, if it isn't working and it is making things worse-HE needs to get THAT data.
I'll give it a couple of days longer, but that's it. I can't go back to school if I can't remember my name. That's just plain ridiculous.
> > > I was on Trileptal rather briefly. I didn't get the "obviously helping me" reaction to it that I did with Depakote or Neurontin or Lithium. I got nauseated really bad-there were others here that complained of that as well. The *one* thing I did notice-it *did* improve my attentiveness, in other words I didnt' feel all dulled out by it.
> >
> >
> > Trileptal *helped* your attentiveness??!! That's very cool. This stuff I'm on now is making me feel totally stupid. The pharmacist said that was supposed to be transient, though.
>
> Oh yes. Tegretol didn't bother me much in that department either. Neurontin helps attentiveness too! It doesn't cause any trouble until I get over 900mg/day. For some reason it seems the GABA affecting anticonvulsants cause all of the stupidity. The calcium and sodium channel blockers don't seem to be nearly as bad.
Depakote is a calcium channel blocker, right? That drug kind of scares me. I hear stories of people blowing their livers out, normally thin people gaining 60 lbs in a matter of months, women pulling wads of hair out of the drain after every shower. YIKES. Was your experience with Depakote like this, or was it less severe?
> Well, if it is supposed to be transient, then you could make a compromise and tell him that you will stay with 8mg/day UNTIL the cognitive dysfunction lifts-how about that one? Somehow, I don't think it is going to be transient.
I've often wondered if side effects are ever really transient, or if the patient just "gets used" to feeling like shit. after a year or so on Paxil, I thought the only side effect was drowsyness, but when I quit taking it, I started realising things like: "Wow, my neck isn't stiff anymore," "Wow, I don't get out of breath from walking to the bathreoom anymore," "Wow, I'm not grinding my teeth anymore." I had forgotten what it was like NOT to do those things. The effects never went away, I just accepted them as part of life after a while. I don't want to "accept" being stupid and not knowing what day of the week it is or what town I live in.
> > > As far as MS meds that helped with "rage-anger" problems Lithium and Neurontin helped the most. Depakote helped some, but it made my depression worse-which made me sullen and grouchy. OH yeah-Topamax probably would do a good job (if you can tolerate it).
Isn't Topomax supposed to be even *worse* in the cognative department? Have you taken it (maybe you've said, but right now I can't remember)? Dr. Phelps (the bipolar doc) refers to it on his web site as "Stupimax".
> > > The Gabitril in hindsight helped with grouchiness, too-I just couldn't tolerate the cognitive adverse events. I titrated it at the slowest rate you can 4mg/week. I got to 24mg/day-hey I didn't bail out! But it was a nightmare for me.
At what dose did you find the Gabitril to help with your grouchiness? Was it immediate, or was it only at the 24mg dose?
> > Interesting...just goes to show that YMMV: Wellbutrin made me absolutely, out-of-my-mind, violently enraged. I could only tolorate it with Xanax. So anxiolytics gave you anger/rage? What do you think the mechanism of *that* was? That seems almost conterintuitive that that would happen. I remember getting restless leg syndrome from Librium. Now *that* was one reaction i didn't see comming.
>
> Oh, I didn't say *which* anxiolytics made me grouchy. Valium was the worst. I sucker punched my Dad on that when he asked me one morning to do a relatively minor thing and I went off. Buspar made my angry ruminations worse (and did Remeron), BUT I had probably zero anxiety. Take away the anxiety and you have got a real pistol? Klonopin-Ativan-Xanax, those were different, nothing remarkable there.Isn't it interesting that different drugs from the same class can cause such different reactions in a person? Ativan makes me completely dissociate from reality, while the other benzos don't. Also, about anxiety...for me there seems to be two components: a) the pounding heart, queasy/cramped stomach, sweaty hand component (i.e., the physical); and b) the ruminating worry, impending doom component (i.e., the psychological). My experience with the BuSpar and (so far) the Gabitril, is that they only take care of the mental component but not the physical.
Posted by Mitch on December 21, 2001, at 13:08:18
In reply to Re: GABITRIL (tiagabine) new anti-anxiety drug????? » Mitch, posted by MB on December 21, 2001, at 11:32:06
> > Oh yes. Tegretol didn't bother me much in that department either. Neurontin helps attentiveness too! It doesn't cause any trouble until I get over 900mg/day. For some reason it seems the GABA affecting anticonvulsants cause all of the stupidity. The calcium and sodium channel blockers don't seem to be nearly as bad.
> Depakote is a calcium channel blocker, right? That drug kind of scares me. I hear stories of people blowing their livers out, normally thin people gaining 60 lbs in a matter of months, women pulling wads of hair out of the drain after every shower. YIKES. Was your experience with Depakote like this, or was it less severe?How all of the anticonvulsants *work* isn't entirely known for all of them. Depakote tends to increase whole brain GABA, so you could say that it is a GABA-ergic medication. I had some mild weight gain (about 10-15 lbs), no hair loss, and it didn't effect my cognitive functioning too adversely. The ones that definitely wrecked my attentiveness/memory were Gabitril and Topamax.
The liver thing with Depakote is overblown. That is mainly a problem with children. It's a good idea to get a liver function test done, however, and check it every six months or so-especially at higher doses. Neurontin is supposed to be a selective calcium-ion channel blocker in the hippocampus, it does't appear to affect GABA like many think (even though the gabapentin molecule "looks" like GABA). BTW, a lot of folks with partial complex seizures worsen on some anti-epileptic drugs (AED's), and experience *increased* seizure activity. Some folks with CPS, do in fact experience *improved* cognitive functioning IF they find the right AED. How strong the relationship between seizures/epilepsy and bipolar?? Who knows.
> > > > As far as MS meds that helped with "rage-anger" problems Lithium and Neurontin helped the most. Depakote helped some, but it made my depression worse-which made me sullen and grouchy. OH yeah-Topamax probably would do a good job (if you can tolerate it).
>
>
> Isn't Topomax supposed to be even *worse* in the cognative department? Have you taken it (maybe you've said, but right now I can't remember)? Dr. Phelps (the bipolar doc) refers to it on his web site as "Stupimax".Yes, I have, and yes it did! However, I didn't get a problem with it as I did with Gabitril. However, I only took 50mg/day of Topamax. I found if I only took 25mg/day at bedtime it worked fairly OK, but it took several hours after I got up to get to functioning again. Probably not a good pick if you are reacting this badly to the Gabitril as I did.
>
> > > > The Gabitril in hindsight helped with grouchiness, too-I just couldn't tolerate the cognitive adverse events. I titrated it at the slowest rate you can 4mg/week. I got to 24mg/day-hey I didn't bail out! But it was a nightmare for me.
>
>
> At what dose did you find the Gabitril to help with your grouchiness? Was it immediate, or was it only at the 24mg dose?I noticed an antidepresant effect as soon as I got up to 8mg/day. When I reached 12mg/day that was when I began to notice the mood stabilization. However I couldn't THINK. What good is an MS if it impairs nearly everything, just so you are not a little grouchy. There are superior alternatives, combinations.
>
>
> > > Interesting...just goes to show that YMMV: Wellbutrin made me absolutely, out-of-my-mind, violently enraged. I could only tolorate it with Xanax. So anxiolytics gave you anger/rage? What do you think the mechanism of *that* was? That seems almost conterintuitive that that would happen. I remember getting restless leg syndrome from Librium. Now *that* was one reaction i didn't see comming.
> >
> > Oh, I didn't say *which* anxiolytics made me grouchy. Valium was the worst. I sucker punched my Dad on that when he asked me one morning to do a relatively minor thing and I went off. Buspar made my angry ruminations worse (and did Remeron), BUT I had probably zero anxiety. Take away the anxiety and you have got a real pistol? Klonopin-Ativan-Xanax, those were different, nothing remarkable there.
>
> Isn't it interesting that different drugs from the same class can cause such different reactions in a person? Ativan makes me completely dissociate from reality, while the other benzos don't. Also, about anxiety...for me there seems to be two components: a) the pounding heart, queasy/cramped stomach, sweaty hand component (i.e., the physical); and b) the ruminating worry, impending doom component (i.e., the psychological). My experience with the BuSpar and (so far) the Gabitril, is that they only take care of the mental component but not the physical.Interesting, I noticed more improvement with the physical manifestations of panic anxiety, rather than the mental-probably because I suffer from derealization/depersonalization problems and any meds that can cause DR/DP can really aggravate my psychic symptoms.
Mitch
Posted by MB on December 21, 2001, at 18:46:04
In reply to Re: GABITRIL (tiagabine) new anti-anxiety drug????? » MB, posted by Mitch on December 21, 2001, at 13:08:18
OK, I finally called the clinic and left a message for the doctor that I'm worried about the Gabitril...that the side effects at 8mg are lame and that they get worse at 12mg. He's on vacation, but the pdoc filling in is going to give me instructions...I'm just waiting for the call. I've had illusions before where things look different than they're supposed to, but today...today, I've been looking at things, and they look they way they are supposed to, but the stimulous is registering in my mind as something else. I read a word on the TV today, it looked the way it was suppsed to, but my mind told me I had just seen the image of a troll. That's too weird. Yesterday, I screamed and had a panic attack because I thought my coat was a person. It feels like a low dose of PCP (which I smoked by accident when I was a kid). I really want to get to a therapeutic dose of *something* (because the depression and anxiety are literally driving me crazy) but all that the Gabitril is doing is causing me to feel like I'm in a dream and that nothing's real. I probably speak for eveyone when I say that I just wish they could come up with something that works, works fast, and doesn't give side effects worse than the original problem. Sorry about the negativity, but terminal negativity is one of my problems...heh heh heh(sad nervous laughter).
I'll let you know what instructions the doc calls back with. By the way, I really appreciate being able to discuss my Gabitril experience with you...I'd really be worried if I didn't have acces to someone who had taken the stuff before. So, Thanks.
MB
Posted by Mitch on December 21, 2001, at 21:26:40
In reply to Re: GABITRIL (tiagabine) new anti-anxiety drug????? » Mitch, posted by MB on December 21, 2001, at 18:46:04
> OK, I finally called the clinic and left a message for the doctor that I'm worried about the Gabitril...that the side effects at 8mg are lame and that they get worse at 12mg. He's on vacation, but the pdoc filling in is going to give me instructions...I'm just waiting for the call. I've had illusions before where things look different than they're supposed to, but today...today, I've been looking at things, and they look they way they are supposed to, but the stimulous is registering in my mind as something else. I read a word on the TV today, it looked the way it was suppsed to, but my mind told me I had just seen the image of a troll. That's too weird. Yesterday, I screamed and had a panic attack because I thought my coat was a person. It feels like a low dose of PCP (which I smoked by accident when I was a kid). I really want to get to a therapeutic dose of *something* (because the depression and anxiety are literally driving me crazy) but all that the Gabitril is doing is causing me to feel like I'm in a dream and that nothing's real. I probably speak for eveyone when I say that I just wish they could come up with something that works, works fast, and doesn't give side effects worse than the original problem. Sorry about the negativity, but terminal negativity is one of my problems...heh heh heh(sad nervous laughter).
>
> I'll let you know what instructions the doc calls back with. By the way, I really appreciate being able to discuss my Gabitril experience with you...I'd really be worried if I didn't have acces to someone who had taken the stuff before. So, Thanks.
>
> MB
OMG!,You are getting that derealization side-effect from that med. I would back off to 4mg at bedtime and coast through this until you get some communication with your pdoc. I tried PCP once when I was a teenager (about 25 years ago) and come to think of it-is very similar to the worse sfx of this med. When I get cognitive side-effects from anticonvulsants that is what they are like. I would distinctively mention "derealization" and "depersonalization" reactions-may he can get the banana!-let's hope.
Hang in there,Mitch
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