![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 29 to 53 of 53. Go back in thread:
Posted by Ritch on January 27, 2003, at 12:27:16
In reply to Re: The Neurontin Scandal » Ritch, posted by dreamerz on January 27, 2003, at 11:39:56
> Hello Mitch_babe
>
> The combo Depakote/Neurontin/Effexor makes me a nicer person around people...although I still prefer isolation. I'm somewhat spaced out slow , sedated but not the tired yawning kind...although I do sleep a lot . Neurontin also fixes my back/neck pains..I'm kind of trying to deal with the fact that I had should of had anti-convulsants/anti-depressants years ago especially at university..Oh well..
> Think I'm the first patient to be prescribed Neurontin in my area of London.
> Also you are correct about it not stopping hypo/manic episodes..that's why I got the Depakote added.
>
>This is really weird, but back when I was on lithium instead of AED's, and I was first given Effexor I found it super activating. Now, it just seems to grogg me out major (as does Celexa and the other sedative SSRI's). I wish I could tolerate Zoloft or Prozac. I was a lot more "zippy" on those.
mitchiebabe
Posted by Luka62 on January 27, 2003, at 13:41:13
In reply to Re: The Neurontin Scandal , posted by missliz on January 25, 2003, at 13:26:17
My doc kept me on Neurontin much longer than I wanted to be on it. It did nothing to help my mood swings, and I was put on Lamictal 1 1/2 yrs ago, which works well.
I finally made a decision to go off the Neurontin, against my doc's advice, (I now have a new doc, happily.) I've been off of it since last July, and never in 25 years have I been this stable. I'd swear up and down that Neurontin made me Worse!!
When my teen son's doc took him off Neurontin and switched his med, his mood stability also improved dramatically.
Anyone else out there who had worsening symptoms on Neurontin??
Posted by dreamerz on January 27, 2003, at 18:26:32
In reply to Re: The Neurontin Scandal » dreamerz, posted by Ritch on January 27, 2003, at 12:27:16
> This is really weird, but back when I was on lithium instead of AED's, and I was first given Effexor I found it super activating. Now, it just seems to grogg me out major (as does Celexa and the other sedative SSRI's). I wish I could tolerate Zoloft or Prozac. I was a lot more "zippy" on those.Mitch~babes...
Effexor has never activated me , it's a kind of an anti -agressive sedative , all other ssri's activated bigtime and so I drank heavily on them.
For me it's a very thin line between too much energy and non at all..I'm also starting to put weight on so I'm exercising-sort of.
I still get paranoia/panicky and other stuff but when it happens I don't care so much , I ride it--that's the Neurontin helping mostly.
Posted by hildi on January 27, 2003, at 22:51:31
In reply to Re: The Neurontin Scandal » missliz, posted by Luka62 on January 27, 2003, at 13:41:13
> My doc kept me on Neurontin much longer than I wanted to be on it. It did nothing to help my mood swings, and I was put on Lamictal 1 1/2 yrs ago, which works well.
> I finally made a decision to go off the Neurontin, against my doc's advice, (I now have a new doc, happily.) I've been off of it since last July, and never in 25 years have I been this stable. I'd swear up and down that Neurontin made me Worse!!
> When my teen son's doc took him off Neurontin and switched his med, his mood stability also improved dramatically.
> Anyone else out there who had worsening symptoms on Neurontin??Hi. I Cannot answer you on that one, since I'm still trying to figure out whether to try either one of these meds and am trying to obtain as much information as possible, first.
But can you tell me if you are bipolar? Did you ever try other AD's and if so, how did you do on them? And your son, what is his diagosis? Similar to yours?
I don't mean to be nosey, I'm wondering because of the different variables and the different effects/responses so many have had on these meds, and if I want to chance trying either one of these.
Hildi
Posted by not exactly on January 28, 2003, at 5:27:34
In reply to Re: gabitril neurontin? » hildi, posted by Ame Sans Vie on January 19, 2003, at 13:34:43
Michael,
> Actually, just several days ago I was placed on a regimen of 20mg Valium 2xday, 2mg Xanax 3xday, 4mg Ativan as needed, and 4mg Klonopin 2xday + 30mg twice every other Sunday.
Wow - I've never heard of anyone being prescribed 4 different benzo's concurrently! Is there something about this combo that makes it significanly more effective than a single well-chosen benzo?
- Bob
Posted by not exactly on January 28, 2003, at 6:42:51
In reply to Re: The Neurontin Scandal » missliz, posted by Luka62 on January 27, 2003, at 13:41:13
My pdoc put me on Neurontin a couple of years ago, and I've continued it since then (despite changes in my "primary" meds - AD's & stimulants - on top of it). He originally prescribed it to take some of the "rough edges" off my other meds (anxiety & over-stimulation side effects), as well as addressing my pre-existing low-level anxiety (GAD).
It made me drowsy at first, and I slept a lot. But within a few days, I got used to it, and the drowsiness went away. Didn't notice any other side effects.
It did seem to help with the anxiety. But there were other benefits, which I guess were related to the reduction in anxiety. It helped dramatically with my social phobia, which had previously been a serious problem. I was now able to carry on normal, relaxed conversations. I could even make "small talk" with people I had just met, something that had been nearly impossible before. I think the improvement was that I was no longer afraid that I would say/do something "stupid". I wasn't excessively concerned that others would misjudge me. I became much less self-conscious and more confident.
This improvement would have felt miraculous if I hadn't already experienced it before - it helped in the same way that alcohol had. But using alcohol as a chronic solution seemed like a bad idea and I had successfully avoid that trap.
Neurontin also seemed to simplify my life, and my view of the whole world. Everything was less complex and easier to deal with. No more getting bogged down in minute details. The world even looked more simple (in a pleasing, non-threatening way) - kind of cartoon-like with more saturated colors and less texture.
This improvement would have felt miraculous if I hadn't already experienced it before - it helped in the same way that marijuana had. But using marijuana as a chronic solution seemed like a bad idea and I had successfully avoid that trap.
Eventually, I started noticing some long-term negative effects that I also attribute to the Neurontin (although it may be early senility). Not surprisingly, these negative effects also remind me of the negative effects of alcohol and marijuana. I have become more forgetful. I repeat myself because I can't remember who I've told what. I lose things. I can't keep as many details in my head at once as I used to - for example, mental arithmetic has become almost impossible.
The biggest problem is that I don't care about things that I really should. I lost my job over a year ago, but I've been living off my life savings rather than bothering to find a new job. My aging parents are getting too infirm to care for themselves, but I haven't been motivated to help them. I manage to ignore or procrastinate everyday problems that "normal" folks deal with in their stride, such as bill paying and home maintenance.
Several times, I have tried to discontinue or reduce the dose of Neurontin. When I did, mental clarity and concern for important details returned quickly, but so did the anxiety. Each time, it got so bad that I resumed the Neurontin. I felt like a junky.
You will laugh when I tell you my standard dosage. I saved this detail 'til the end because I figured I would get ZERO sympathy. I take 100 mg T.I.D. Yes, friends, that's not a typo - a mere 300 mg per day! If I take more, I get too sedated, apathetic, and just plain "drunk". If I take less, the anxiety drives me up the wall.
Has anyone experienced or heard of anything like this? Or am I just another deluded placebo victim? I really need some help here...
- Bob
Posted by Ritch on January 28, 2003, at 11:29:45
In reply to Neurontin: solution or problem?, posted by not exactly on January 28, 2003, at 6:42:51
> You will laugh when I tell you my standard dosage. I saved this detail 'til the end because I figured I would get ZERO sympathy. I take 100 mg T.I.D. Yes, friends, that's not a typo - a mere 300 mg per day! If I take more, I get too sedated, apathetic, and just plain "drunk". If I take less, the anxiety drives me up the wall.
>
> Has anyone experienced or heard of anything like this? Or am I just another deluded placebo victim? I really need some help here...
>
> - Bob
>
I'm bipolar and I was on Neurontin at that dosage you mention for over a year (with no other mood stabilizer) with .5mg of Klonopin and a little Celexa (about 1.25-2.5mg), and it had a stabilizing effect for me and I slept better than I do now with Depakote. In my case, anxiety (esp. GAD) seems to fuel the bipolar as much as the reverse. Neurontin didn't help much with temper spells (dysphoric hypomania) that Depakote works well for, however. I want to add back 100mg at bedtime or 100mg bid of Neurontin for improved sleep cycles and the benefits that you mention, but leave in the Depakote for the hypomania. As far as Neurontin dosages go, I think for psych probs. it will work at lower dosages (if it is going to), and as you ramp up the dose the returns diminish rapidly. In my case I didn't notice any added benefits whatsoever above 900mg/day, just more adverse effects.
Posted by Luka62 on January 28, 2003, at 19:16:02
In reply to Re: The Neurontin Scandal » Luka62, posted by hildi on January 27, 2003, at 22:51:31
> > My doc kept me on Neurontin much longer than I wanted to be on it. It did nothing to help my mood swings, and I was put on Lamictal 1 1/2 yrs ago, which works well.
> > I finally made a decision to go off the Neurontin, against my doc's advice, (I now have a new doc, happily.) I've been off of it since last July, and never in 25 years have I been this stable. I'd swear up and down that Neurontin made me Worse!!
> > When my teen son's doc took him off Neurontin and switched his med, his mood stability also improved dramatically.
> > Anyone else out there who had worsening symptoms on Neurontin??
>
> Hi. I Cannot answer you on that one, since I'm still trying to figure out whether to try either one of these meds and am trying to obtain as much information as possible, first.
> But can you tell me if you are bipolar? Did you ever try other AD's and if so, how did you do on them? And your son, what is his diagosis? Similar to yours?
> I don't mean to be nosey, I'm wondering because of the different variables and the different effects/responses so many have had on these meds, and if I want to chance trying either one of these.
> Hildi<<<<<<<<<<Yes, I am bipolar. My son is also bipolar as well as ADHD. Over the years I've tried Prozac, lithium, depakote, Wellbrutin,Elavil Tegretol, Buspar,not to mention the benzo's. I had bad side effects from several,none of which had any therapeutic value for me. I hate that it's trial and error, but it is. What works for one, may causes problems in another. I can't believe I had to go through so many years of wild mood swings, severe depression, anxiety and panic, to finally find a combo that works for me. (Nardil and Lamictal).
If I had to do it all over again, I would assert myself more with the doctors and trust my own judgement and sense of whether I am doing better on a particular medication.
I'm grateful I now have a pdoc that really listens to me.
Posted by sydney on January 29, 2003, at 15:31:33
In reply to Neurontin: solution or problem?, posted by not exactly on January 28, 2003, at 6:42:51
While Neurontin may not be miracle drug, It is a gross overgeneralization to claim it has no place in psychopharmacology. For example:
Neurontin has been shown to be more effective than placebo in double-blind studies for the treatment of social anxiety order. See J Clin Psychiatry 2001;62 Suppl 1:50-3 Jefferson, JW; Madison Institute of Medicine, Inc., and the University of Wisconsin Medical School, USA.
The therapeutic efficacy of Neurontin has been shown in relieving pain from Guillain-Barre syndrome in a randomized, double-blinded, placebo-controlled, crossover study of 18 patients. Anesth Analg 2002 Dec;95(6):1719-23
Its been shown to help people with restless leg syndrome in placebo controlled studies. Neurology 2002 Nov 26;59(10):1573-9.
And last but not least, Neurontin is certainly an effective anti-epileptic.
The point is this: Neurontin was oversold by the manufacturer. Now the pendulum has swung too far the other way and it is being overlooked by people who could genuinely benefit from it.
Posted by luka62 on January 29, 2003, at 17:44:36
In reply to Re: Neurontin: solution or problem?, posted by sydney on January 29, 2003, at 15:31:33
Certainly Neurontin has a place in psychopharmacology. However, the drug company was indeed taken to court (in the state of New York I believe. Many of the studies, inc. double-blind studies, were done by the manufacturer itself. They grossly misrepresented themselves, the studies, and the results to the public. I do know many people benefit from Neurontin for things other than epilepsy, as well as other non-labeled problems. It was ineffective and even harmful to me. But not disclosing that they sponsored the studies, and reported on them favorably is still a question of ethics, in my opinion, or lack therof.
Posted by not exactly on January 29, 2003, at 18:01:11
In reply to Re: Neurontin: solution or problem?, posted by sydney on January 29, 2003, at 15:31:33
> While Neurontin may not be miracle drug, It is a gross overgeneralization to claim it has no place in psychopharmacology.
> it is being overlooked by people who could genuinely benefit from it.I never claimed that it was ineffective, even (especially) for its "off-label" uses. I am quite sure that it has helped my social anxiety and improved my self-esteem. My mother takes it to relieve her severe chronic back pain, and it has enabled her to walk and sleep without using narcotics. It is clearly a useful drug.
My concern is about some of the side effects which I have experienced. Specifically, I feel that it has had a negative impact on my memory, intellectual ability, and the capacity to truly care about things that matter. While these side effects may not be common, I find hard to believe that I'm the only one experiencing them.
These negative effects are subtle, and some may not notice them. The Catch-22 is that such effects can reduce one's ability to notice or care about the problems!
In my case, the solution may be to switch to another med, such as a benzo or perhaps Buspar. I hope I can find something else that works as well but doesn't have these side effects. If I discover a successful substitute, will I conclude that Neurontin was a mistake and a "bad drug"? No.
Neurontin has its place (which IMO extends beyond its approved uses). But it's not a panacea, nor is it devoid of side effects. All drugs entail a tradeoff between potential benefit and risk of harm. Let's use them wisely. Openly & honestly discussing the pros & cons here (on Psycho-Babble) contributes to that wisdom.
- Bob
Posted by Alan on January 29, 2003, at 19:03:40
In reply to Re: Neurontin, etc., posted by Alan on January 29, 2003, at 18:52:25
The best way to receive the least comercially driven information would be to take oversight of clinical trials away from the FDA and give it to the NIH. That is, accept as evidence only trials designed and supervised by the NIH.
Failing that, ban cross-employment between the FDA and any company that it regulates for 10 or 15 years in either direction. Right now, there is a revolving door between the fox's house and the henhouse. It's bad enough that regulators are hired directly from the regulated companies. It's even worse that the FDA's "internal advocate" for a drug can and often does leave the FDA after approval of the drug to earn hundreds of thousands of dollars a year working for the maker of the drug.
Actually, we probably need both of the steps above.
And of course we need a law placing all directly or indirectly maker-funded research about a drug into the public domain when that drug receives FDA approval.
To review:
National Public Radio Reportage on Neurontin...
http://www.npr.org/display_pages/features/feature_920362.html
It turns out there are a number of stories on the illegal mis-marketing of Neurontin at this page, both print and audio.
I think it's important to understand the ramifications of the mis-marketing of Neurontin. Many, many millions were spent to get out the news that it works magically for all these unapproved conditions (for which it doesn't work in reality). But who is going to spend comparable amounts to reverse that message now that it has been show to be illegal and usually false?
These stories also give you some insight into how pharmaceutical research works here in the US, where many of the articles published in medical journals are not written by the doctors whose names appear on them. Instead they're written by professional advertising writers and doctors are paid to put their name at the top.
There's no evidence Neurontin is systematically effective against anxiety. Of course there's always SOMEBODY who'll get a beneficial response from anything, including pickled herring. But the makers of Neurontin have faced FDA sanctions here in the United States, plus massive civil lawsuits, because they pushed Neurontin for ALL kinds of conditions for which there is either no evidence it's effective or for which there IS evidence that it's NOT effective.
Maybe one's doctor is unaware of these developments, or maybe he has had one or two of those patients with an exceptional response. Or maybe one's anxiety or panic is biologically related to seizures. There's good evidence for a connection like that, though it still doesn't prove Neurontin would help the anxiety.
I post this because I was on the receiving end of this kind of thing and as aresult, my anxiety went untreated in the mean time...the "side effects" of that untreated anxiety being much worse than the side effects of those medications that were actually theraputic such as, in my case, benzodiazepines.
Posted by hildi on January 29, 2003, at 23:09:39
In reply to Re: The Neurontin Scandal » hildi, posted by Luka62 on January 28, 2003, at 19:16:02
> > > My doc kept me on Neurontin much longer than I wanted to be on it. It did nothing to help my mood swings, and I was put on Lamictal 1 1/2 yrs ago, which works well.
> > > I finally made a decision to go off the Neurontin, against my doc's advice, (I now have a new doc, happily.) I've been off of it since last July, and never in 25 years have I been this stable. I'd swear up and down that Neurontin made me Worse!!
> > > When my teen son's doc took him off Neurontin and switched his med, his mood stability also improved dramatically.
> > > Anyone else out there who had worsening symptoms on Neurontin??
> >
> > Hi. I Cannot answer you on that one, since I'm still trying to figure out whether to try either one of these meds and am trying to obtain as much information as possible, first.
> > But can you tell me if you are bipolar? Did you ever try other AD's and if so, how did you do on them? And your son, what is his diagosis? Similar to yours?
> > I don't mean to be nosey, I'm wondering because of the different variables and the different effects/responses so many have had on these meds, and if I want to chance trying either one of these.
> > Hildi
>
>
>
> <<<<<<<<<<Yes, I am bipolar. My son is also bipolar as well as ADHD. Over the years I've tried Prozac, lithium, depakote, Wellbrutin,Elavil Tegretol, Buspar,not to mention the benzo's. I had bad side effects from several,none of which had any therapeutic value for me. I hate that it's trial and error, but it is. What works for one, may causes problems in another. I can't believe I had to go through so many years of wild mood swings, severe depression, anxiety and panic, to finally find a combo that works for me. (Nardil and Lamictal).
> If I had to do it all over again, I would assert myself more with the doctors and trust my own judgement and sense of whether I am doing better on a particular medication.
> I'm grateful I now have a pdoc that really listens to me.
>
> I am glad you finally found some relief and I agree it really is frustrating to have to find out things through trial and error- which can take years, especially if you have a dr. who will not listen to you or 'appreciate' a patients' assertiveness. I am in the process of changing dr.'s now, and I hope my new one will actually listen to me and my suggestions, and take me seriously when I say that something is not working for me. My last dr. didn't.
Because you are bipolar the lamictal seemed to work well for you, and your son. While the neurontin doesn't sound like it has mood stabilizing effects. Curious though how one med can work so well while other 'similar' meds will not, such as the depakote. Some people with bipolar do great on dep- such as my fiance, he has felt great on this med alone-while other people do not do as well.
I still don't know what to do. I hope to gain as much info as I can and pray that this new dr. can help me find the right med.
Thanks for you response, and be well.
Hildi
>
Posted by hildi on January 29, 2003, at 23:13:46
In reply to Re: Neurontin: solution or problem?, posted by sydney on January 29, 2003, at 15:31:33
> While Neurontin may not be miracle drug, It is a gross overgeneralization to claim it has no place in psychopharmacology. For example:
>
> Neurontin has been shown to be more effective than placebo in double-blind studies for the treatment of social anxiety order. See J Clin Psychiatry 2001;62 Suppl 1:50-3 Jefferson, JW; Madison Institute of Medicine, Inc., and the University of Wisconsin Medical School, USA.
>
> The therapeutic efficacy of Neurontin has been shown in relieving pain from Guillain-Barre syndrome in a randomized, double-blinded, placebo-controlled, crossover study of 18 patients. Anesth Analg 2002 Dec;95(6):1719-23
>
> Its been shown to help people with restless leg syndrome in placebo controlled studies. Neurology 2002 Nov 26;59(10):1573-9.
>
> And last but not least, Neurontin is certainly an effective anti-epileptic.
>
> The point is this: Neurontin was oversold by the manufacturer. Now the pendulum has swung too far the other way and it is being overlooked by people who could genuinely benefit from it.Sounds much like prozac- the 'oversell', that is.
Some benefit, other's fare much worse, and the theraputic claims for this med range far and wide and name changes are included to profit the drug company as much as possible.
Posted by luka62 on January 30, 2003, at 7:53:20
In reply to Re: The Neurontin Scandal » Luka62, posted by hildi on January 29, 2003, at 23:09:39
Hildi, I was on Depakote at one time. But I gained 70lbs., and I was at that time doing serious battle with being anorexic. I was dangerously underweight, went on Depakote, gained so much weight..I stopped the drug, and was devastated at this huge amount of weight ---I set out to lose all of it, which I did in 3 1/2 months.
I know several people who gain more than a little on depakote.
Posted by lostsailor on January 30, 2003, at 10:38:58
In reply to Re: The Neurontin Scandal » hildi, posted by luka62 on January 30, 2003, at 7:53:20
~Hi there...
So I'm getting weight gain is an issue?? I gained only about 5 lbs on two years of depakote, but I also run, cycle and eat well. The weight gain fluxed a bit but I cant be certain if that was me or the results of dep. all during treatment.
If we are looking for a new treatment for BPD , I strongly advise you not to initiate neurontin. For anxiety, the results are a bit interesting. For mood swings as a primary med it did < and according to doc> nothing. Anxiety????
Three other meds are great to look at :
1) lamictal, most cited for bpd with depressive symptoms prominent
2) toprimax, I am not sure about indications, but often results in weight loss--according to doc I was not a good candidate b/c I am kinda lean already. He uses it at times with pple with eds or bpd that are above normal weight.
3) triliptal--not really seen as a weight gainer--often used for bp's with co-existing anxiety.
Hope this was a bit of help. ~tony
Posted by Ritch on January 30, 2003, at 11:47:51
In reply to Re: The Neurontin Scandal~~hildi, posted by lostsailor on January 30, 2003, at 10:38:58
>
>
>
>
> ~Hi there...
>
> So I'm getting weight gain is an issue?? I gained only about 5 lbs on two years of depakote, but I also run, cycle and eat well. The weight gain fluxed a bit but I cant be certain if that was me or the results of dep. all during treatment.
>
> If we are looking for a new treatment for BPD , I strongly advise you not to initiate neurontin. For anxiety, the results are a bit interesting. For mood swings as a primary med it did < and according to doc> nothing. Anxiety????
>
> Three other meds are great to look at :
>
> 1) lamictal, most cited for bpd with depressive symptoms prominent
>
> 2) toprimax, I am not sure about indications, but often results in weight loss--according to doc I was not a good candidate b/c I am kinda lean already. He uses it at times with pple with eds or bpd that are above normal weight.
>
> 3) triliptal--not really seen as a weight gainer--often used for bp's with co-existing anxiety.
>
> Hope this was a bit of help. ~tony
>
I was taking low-dose Depakote+Trileptal+Klonopin for bp+anxiety and I had weight gain on the Depakote previously, but only at doses of 500mg or higher/day. I have been having some transient bad cognitive difficulty with Depakote even at 250mg lately, so I reduced it to 125mg and it helped. My pdoc changed it back to Neurontin today, so now I am on Neurontin+Trileptal+Klonopin. We are using Trileptal as the primary antimanic since I did notice some mood flattening with its addition (and some cycle lenghening-which I never noticed before with anything). I am to attempt upward titration on the Trileptal (very slowly) over the next several weeks. I sleep better on the Neurontin than any of the other antimanics (except Topamax).
Posted by sydney on January 30, 2003, at 12:09:21
In reply to Re: Neurontin, etc. P.S., posted by Alan on January 29, 2003, at 19:03:40
Alan, you are flat out wrong when you say that Neurontin has NEVER been shown to be effective for anxiety. Your cite to NPR says nothing of the sort. Your suggestion that we google it ourselves implies but does not actually constitute proof.
As I mentioned previously, Neurontin has been shown to be more effective than placebo in double-blind studies for the treatment of social anxiety order. See J Clin Psychiatry 2001;62 Suppl 1:50-3 Jefferson, JW; Madison Institute of Medicine, Inc., and the University of Wisconsin Medical School, USA.
In "Hyperhidrosis in social anxiety disorder" found in the DECEMBER 2002, Journal of Progressive
Neuropsychopharmacology and Biological Psychiatry; 26(7-8):1327-31, authors Davidson, Foa, Connor and Churchill report that Neurontin produced a measurable improvement over placebo vis-a-vis social anxiety.I'm not saying Neurontin is the be-all of drugs. I'm not saying that Neurontin should be a drug of first choice.
I especially agree with Not Exactly's call for reasonable skepticism and honest debate as to the costs and benefits of Neurontin and any other drug. But your repeated assertion that "There's no evidence Neurontin is systematically effective against anxiety" is patently false.
Posted by not exactly on January 30, 2003, at 14:15:15
In reply to Re: You're Wrong Alan., posted by sydney on January 30, 2003, at 12:09:21
> your repeated assertion that "There's no evidence Neurontin is systematically effective against anxiety" is patently false.
Based on my own experience w/ Neurontin, I can definitely vouch for its effectiveness in treating anxiety in general and social anxiety disorder in particular (for me, anyway, YMMV). However, I'm not willing to continue paying the s/e cost, especially when there are other viable options.
- Bob
Posted by Alan on January 31, 2003, at 9:48:27
In reply to Re: You're Wrong Alan., posted by sydney on January 30, 2003, at 12:09:21
Perhaps it MAY be effectvive in the limited studies that you mention for social anxiety disorder. I have not seen the studies to look at.
One of the things to look for, particularly with Neurontin, is whether the author(s) actually had any participation in the work or was merely paid to glance over and sign their names to the article.
Not saying that happened here, but it seems to have happened more often than not with "the good news about Neurontin." Therefore one can't always take articles at face value.
I believe it wasn't until late 2002 that the AMA took a position against MDs putting their name on other people's work, and I'm still not sure what teeth there may be in their position.
Posted by lostsailor on February 2, 2003, at 11:58:35
In reply to Re: Neurontin.... » sydney, posted by Alan on January 31, 2003, at 9:48:27
I have not read studies at all. Subjectively, I am unsure of what it did for me in re to anxiety as i use high doses of benzos. As I stated in earlier post, it did nothing for mood stab purposes. Doc and I have joked about the intentional use of spin on GABA in the Gabapentin name and remembers that being part of initial "pitch" given by sales reps.
~tony
Posted by not exactly on February 2, 2003, at 13:15:11
In reply to Re: Neurontin....alan/ all??? --subjective view, posted by lostsailor on February 2, 2003, at 11:58:35
> the intentional use of spin on GABA in the Gabapentin name
The "gabapentin" name is justifiable chemically, since gabapentin [http://biopsychiatry.com/gabapentin] is effectively GABA [http://biopsychiatry.com/gaba] with a 5-carbon chain added (thereby forming a cyclohexane ring). However, its in-vivo functional relationship to GABA is questionable. Pfizer's "prescribing information" monograph [http://www.Pfizer.com/download/uspi_neurontin.pdf] admits:
"Gabapentin is structurally related to the neurotransmitter GABA (gamma-aminobutyric acid) but it does not modify GABA-A or GABA-B radioligand binding, it is not converted metabolically into GABA or a GABA agonist, and it is not an inhibitor of GABA uptake or degradation."
In fact, they go on to say:
"Gabapentin was tested in radioligand binding assays at concentrations up to 100 µM and did not exhibit affinity for a number of other common receptor sites, including benzodiazepine, glutamate, N-methyl-D-aspartate (NMDA), quisqualate, kainate, strychnine- insensitive or strychnine-sensitive glycine, alpha 1, alpha 2, or beta adrenergic, adenosine A1 or A2, cholinergic muscarinic or nicotinic, dopamine D1 or D2, histamine H1, serotonin S1 or S2, opiate mu, delta or kappa, cannabinoid 1, voltage-sensitive calcium channel sites labeled with nitrendipine or diltiazem, or at voltage-sensitive sodium channel sites labeled with batrachotoxinin A 20-alpha-benzoate. Furthermore, gabapentin did not alter the cellular uptake of dopamine, noradrenaline, or serotonin."
Creating a medication that affects *none* of the neurochemical receptors is quite a trick in itself. One might conclude gabapentin is just a placebo, albeit a convincing one simply because it happens to have a GABA molecule imbedded within it. At best, we're left with the all-too-familiar disclaimer:
"The mechanism by which gabapentin exerts its anticonvulsant action is unknown..."
- Bob
Posted by Ritch on February 2, 2003, at 14:53:02
In reply to Re: Neurontin spin, posted by not exactly on February 2, 2003, at 13:15:11
> > the intentional use of spin on GABA in the Gabapentin name
>
> The "gabapentin" name is justifiable chemically, since gabapentin [http://biopsychiatry.com/gabapentin] is effectively GABA [http://biopsychiatry.com/gaba] with a 5-carbon chain added (thereby forming a cyclohexane ring). However, its in-vivo functional relationship to GABA is questionable. Pfizer's "prescribing information" monograph [http://www.Pfizer.com/download/uspi_neurontin.pdf] admits:
>
> "Gabapentin is structurally related to the neurotransmitter GABA (gamma-aminobutyric acid) but it does not modify GABA-A or GABA-B radioligand binding, it is not converted metabolically into GABA or a GABA agonist, and it is not an inhibitor of GABA uptake or degradation."
>
> In fact, they go on to say:
>
> "Gabapentin was tested in radioligand binding assays at concentrations up to 100 µM and did not exhibit affinity for a number of other common receptor sites, including benzodiazepine, glutamate, N-methyl-D-aspartate (NMDA), quisqualate, kainate, strychnine- insensitive or strychnine-sensitive glycine, alpha 1, alpha 2, or beta adrenergic, adenosine A1 or A2, cholinergic muscarinic or nicotinic, dopamine D1 or D2, histamine H1, serotonin S1 or S2, opiate mu, delta or kappa, cannabinoid 1, voltage-sensitive calcium channel sites labeled with nitrendipine or diltiazem, or at voltage-sensitive sodium channel sites labeled with batrachotoxinin A 20-alpha-benzoate. Furthermore, gabapentin did not alter the cellular uptake of dopamine, noradrenaline, or serotonin."
>
> Creating a medication that affects *none* of the neurochemical receptors is quite a trick in itself. One might conclude gabapentin is just a placebo, albeit a convincing one simply because it happens to have a GABA molecule imbedded within it. At best, we're left with the all-too-familiar disclaimer:
>
> "The mechanism by which gabapentin exerts its anticonvulsant action is unknown..."
>
> - Bob
>
There is some speculation about calcium channels, and it appears that might be the case:http://www.physoc.org/Proceedings/Abstracts/528P/Aberdeen/Files/S37.html
http://lrc.bcm.tmc.edu/mmd/neuro/syllabus.html
Posted by Simcha on February 2, 2003, at 15:19:55
In reply to Re: The Neurontin Scandal~~hildi » lostsailor, posted by Ritch on January 30, 2003, at 11:47:51
Personally I've experienced amazing benefits from Neurontin for off-label uses.
I have bruxism at night. That is, I grind my teeth so bad that I cannot open my mouth in the mornings. The muscles are spasmed so bad. Also I have restless legs at night.
I'm on 40mg of Celexa and 200mg of WellbutrinSR too. The bruxism was made worse by the Celexa.
Anyway, I'm on 600mg of Neurontin at night. I have ceased grinding my teeth. Restless legs does not happen at all. I've had these conditions my entire life. I took Klonopin for this before and it was effective yet occasionally I'd still grind my teeth. On the Neurontin I don't grind my teeth at all.
Also I've noticed that my mood has improved over all. It is a subtle effect. I've been on Neurontin for four months now and I'd never go back to the Klonopin now. The Neurontin has zero side effects for me so far.
Anyway, I think that we use scandals to trash drugs completely at our peril. Sometimes this stuff works for things that cannot be proven absolutely for everyone. In my case Neurontin has done its job and then some.....
Posted by lostsailor on February 3, 2003, at 9:16:42
In reply to Re: The Neurontin Scandal - Neurontin works for me, posted by Simcha on February 2, 2003, at 15:19:55
That's the biggest thing is that it works for you. I wish it did more for me.
take care, ~Tony
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
[email protected]
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.