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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by krybrahaha on July 1, 2003, at 0:49:10
I have extreme anxiety along with OCD and TS. I have been on every med except for Luvox and the tricyclics(prone to side effects) and maoi's(cant handle the food restrictions.) The meds I have been on so far include: Paxil, zoloft, celexa, prozac, serzone, effexor xr, buspar, remeron, ativan, valium, klonopin(awesome for social phobia but made me irritable), and now Tranxene. ( this med doesnt seem strong enough though, i feel i keep getting tolerant to the dose, Im at the max of 60 mg daily now.
I have read a few articles recently (one in particular) that state that Gabatril might work wonders for people with treatment resistant anxiety. Gabatril is non addictive and the first gaba inhibitor. Anyone tried this med for anxiety?
Here's one article:
James L. Schaller, MD, MAR, PA, DABPN, DABFM
Clinical and Research Psychiatry and Medicine
Adult Psychiatry and Psychotherapy Services
Subspecialty Child & Adolescent Psychiatry
Hormonal & Nutraceutical Consultation
Anti-Aging & Obesity Consultation
www.personalconsult.comA Non-Addicting Option for Multiple Types of Anxiety: Considering Gabatril Effectiveness in Adult Anxiety Disorders
Some current problems with medication or other therapeutic anxiety treatment is that some options undermine sexual functioning, sedate, cost a good deal of money or require a significant time commitment.For example, all serotonin medications made by drug companies, e.g., Zoloft, Prozac, Paxil (SSRIs), can limit sexual functioning. And while a massage is the greatest thing since sliced bread, it requires time and money. It is not covered by insurance. Further, individuals in addiction recovery sometimes prefer to use a medication that is less seductive than the benzodiazapines - Xanax, Ativan and Valium. At times, such medications make some addiction prone people vulnerable to relapse.
Therefore, I would like to discuss an entirely different class of medication, which has been used for other things in the past, has only recently been appreciated as an option to treat different significant anxiety disorders.
Gamma-aminobutyric acid (GABA) is the major inhibitory neurotransmitter of the brain. Alterations in the GABA system are known to be involved in the pathophysiology of anxiety.1-4 Agents that enhance GABA neurotransmission have been used in the treatment of anxiety.5-7 Tiagabine (GABATRILTM) is a selective GABA reuptake inhibitor (SGRI) that has shown promise in the treatment of panic disorder,8 posttraumatic stress disorder,9 and treatment-resistant anxiety.10
This case series reports on the use of low dose tiagabine in three individuals with generalized anxiety disorder (GAD) and one with significant anxiety comorbid with major depressive disorder (MDD). All patients were private patients who consented to a trial of treatment with tiagabine.
Case 1. A 32-year old male with a lifetime history of "shyness" and performance anxiety met the Diagnostic Statistical Manual IV-Text Revision (DSM-IV-TR) criteria for anxiety and had a Beck Anxiety Inventory (BAI) score of 21, indicating mild to moderate anxiety.11 Patient was initially treated with buspirone (Buspar) 10 mg three times daily; however, he had a 'bad anxiety experience' and requested a "non-addictive" anti-anxiety agent that was not associated with anorgasmia or other sexual side effects. Tiagabine was initiated at 2 mg/day (1 mg AM and at night), which resulted in a 3-point drop in the BAI score to 18 within 1 day. The tiagabine dose was increased to 4 mg/day (2 mg AM and at night), resulting in a 12-point drop in BAI score to 6. At tiagabine 5 mg/day (3 mg AM and 2 mg at night), the patient reported no symptoms of anxiety and had a normal BAI score of 5. The anxiety decreasing effect of tiagabine has been sustained for over four months.
Case 2. A 57-year-old, post-menopausal female with onset of symptoms of anxiety and Attention-Deficit/Hyperactivity Disorder (ADHD) occurring in early elementary school years, met the DSM-IV-TR criteria for both disorders. A score of 24 on the BAI and 44 on the Utah Wender Rating (UWR) scale12 were consistent with the diagnosis of GAD and ADHD, respectively. To address the anxiety, tiagabine was initiated at 4 mg/day (2 mg AM and at night). After 7 days, the dose of tiagabine was increased to 8 mg/day (4 mg AM and at night), and the patient's BAI score decreased to 3. With her anxiety effectively controlled with tiagabine, methylphenidate 15 mg/day (7.5 mg AM and at lunch) was added to manage her ADHD, with no complaints of increased anxiety. Following methylphenidate treatment, her UWR score decreased to 19. At a 3-month follow up, the patient reported that she has not experienced any anxiety symptoms while continuing treatment with tiagabine 8 mg/day.
Case 3. A 46-year-old male with a lifetime history of "fairly constant anxiety" met DSM-IV-TR criteria for GAD. He had been previously treated with paroxetine (maximum dose 20 mg/day), which caused sedation and moderate anorgasmia. Clonazepam was initiated at 1 mg every 8 hours and the patient reported an improvement in anxiety and had a BAI score of 2. However, the patient wanted to discontinue Clonazepam treatment due to a fear of addiction from her other family members‹she had many substance abusing relatives. While being tapered off clonazepam (at a rate of 0.25 mg every week), the patient reported a relapse in anxiety (chief complaint of 'nerves') at clonazepam 0.5 mg every 8 hours; his BAI score increased to18. Tiagabine 4 mg/day (2 mg AM and at night) was initiated. After 14 days, the dose of tiagabine was increased to 10 mg/day (4 mg AM and 6 mg at night); the patient no longer complained of anxiety at this dose and his BAI score had decreased to 4. Currently, the patient has been in remission for 11 weeks while receiving tiagabine monotherapy at 10 mg/day and reports feelings of being rested and calm, similar to those experienced with clonazepam.
Case 4. A 58-year-old female, who had a 15-year history of MDD, and moderate remission on paroxetine 40 mg/day. However, she would regularly miss one to two doses per week and experience intermittent classic withdrawal symptoms associated with SSRI treatment (i.e., myalgia, nausea, headache, crying, diarrhea and anxiety). To improve her daily residual anxiety, which she only had when having depression, tiagabine was initiated at 6 mg/day (3 mg AM and at night) and her BAI decreased from a baseline score of 13 to 1. Curiously, she also reported 75% to 85% improvement of SSRI withdrawal symptoms with tiagabine treatment. We offer no explanation for this observation, but propose tiagabine as an option to reduce antidepressant withdrawal, such as in the case of rare sudden allergic responses after long-term use, which require complete cessation.
In conclusion, these four cases demonstrate how the SGRI tiagabine improves anxiety and may be a therapeutic option in the treatment of anxiety. In contrast to other antidepressant classes, the benefits of tiagabine treatment were reported to occur as early as the first day of treatment. Furthermore, tiagabine may be useful in the reduction of withdrawal symptoms associated with SSRI treatment. The only side effect reported with tiagabine was in a fifth patient, a fifteen-year old youth with neurological impairment, who experienced increased anxiety on 1 mg am and bed, and was not retried. We suspect our low side effect incidence was partly due to low starting doses. These positive results of low dose tiagabine deserve further study in the treatment of anxiety disorders.
References
Tiihonen J, Kuikka J, Rasanen P, et al. Cerebral benzodiazepine receptor binding and distribution in generalized anxiety disorder: a fractal analysis. Mol Psychiatry 1997;2:463-71.
Smith TA. Type A gamma-aminobutyric acid (GABAA) receptor subunits and benzodiazepine binding: significance to clinical syndromes and their treatment. Br J Biomed Sci 2001;58:111-21
Goddard AW, Mason GF, Almai A, et al. Reductions in occipital cortex GABA levels in panic disorder detected with 1h-magnetic resonance spectroscopy. Arch Gen Psychiatry 2001;58:556-61.
Bremner JD, Innis RB, White T, et al. SPECT [I-123]iomazenil measurement of the benzodiazepine receptor in panic disorder. Biol Psychiatry 2000;47:96-106.
Davis LL, Ryan W, Adinoff B, et al. Comprehensive review of the psychiatric uses of valproate. J Clin Psychopharmacol 2000;20:1S-17S.
Pande AC, Pollack MH, Crockatt J, et al. Placebo-controlled study of gabapentin treatment of panic disorder. J Clin Psychopharmacol 2000;20:467-71.
Uhlenhuth EH, Balter MB, Ban TA, et al. International study of expert judgment on therapeutic use of benzodiazepines and other psychotherapeutic medications: VI. Trends in recommendations for the pharmacotherapy of anxiety disorders, 1992-1997. Depress Anxiety 1999;9:107-16
Zwanzger P, Baghai TC, Schule C, et al. Tiagabine improves panic and agoraphobia in panic disorder patients. J Clin Psychiatry 2001;62:656-7.
Berigan T. Treatment of posttraumatic stress disorder with tiagabine. Can J Psychiatry 2002;47:788. 10. Schwartz TL. The use of tiagabine augmentation for treatment-resistant anxiety disorders: a case series. Psychopharmacol Bull 2002;36:53-7.
Beck AT, Epstein N, Brown G, et al. An inventory for measuring clinical anxiety: psychometric properties. J Consult Clin Psychol 1988;56:893-7.
Ward MF, Wender PH, Reimherr FW. The Wender Utah Rating Scale: an aid in the retrospective diagnosis of childhood attention deficit hyperactivity disorder. Am J Psychiatry 1993;150:885-90.
Posted by utopizen on July 1, 2003, at 1:10:30
In reply to Any one ever heard of Gabitril for anxiety, posted by krybrahaha on July 1, 2003, at 0:49:10
Yeah. I tried it while I was under a benzophobe who wouldn't give me Klonopin because of "withdrawl." Got psychotic for the night.
Now I take a different p-doc, with Klonopin 3x/day. No psychosis, no withdrawl. Gee, Klonopin is actually safer, even though there's no pens with its name on it. Whod'athunk?
Posted by Dragonslayer on July 1, 2003, at 7:48:34
In reply to Re: Any one ever heard of Gabitril for anxiety, posted by utopizen on July 1, 2003, at 1:10:30
No, I have no experience with it, but yet another Klonopin success story. I know it seems to be the trend to "blow the horn" of this drug. It is the only thing that worked for me. I also see a trend to use psy and neuro drugs for uses other than orginal development - maybe this is good, maybe not. The brain is still a mystery. There is an argument to be made for money issue, too.
If you haven't gotten adequate relief and it appears from your writing you have not, it's worth a question for your doc. Sorry, I can't help more. That's sometimes the reason people don't post - at any given time, the "looking and answering" population here may have no good input for your question. Good Luck to you.
Posted by Ritch on July 1, 2003, at 10:01:07
In reply to Any one ever heard of Gabitril for anxiety, posted by krybrahaha on July 1, 2003, at 0:49:10
>I have extreme anxiety along with OCD and TS. I have been on every med except for Luvox and the tricyclics(prone to side effects) and maoi's(cant handle the food restrictions.) The meds I have been on so far include: Paxil, zoloft, celexa, prozac, serzone, effexor xr, buspar, remeron, ativan, valium, klonopin(awesome for social phobia but made me irritable), and now Tranxene. ( this med doesnt seem strong enough though, i feel i keep getting tolerant to the dose, Im at the max of 60 mg daily now.
>I have read a few articles recently (one in particular) that state that Gabatril might work wonders for people with treatment resistant anxiety. Gabatril is non addictive and the first gaba inhibitor. Anyone tried this med for anxiety?
You can try it out and see what happens. I was switched to it from Depakote as an experiment for bipolar disorder. Watch out with the dosage, though. I had a pretty intense depersonalization/derealization experience at higher doses (20-24mg/day) which ended the med for me. At the middle dose range (12-20mg/day), I had some pretty significant cognitive problems at work (forgetfulness-word-finding difficulty, etc.) However, on the plus side, lower doses seemed to help sleep, and it had a mild antidpressant effect. If I ever tried it again, a bedtime dose would be all I could stand for sleep (no more than 8mg).
Posted by Viridis on July 1, 2003, at 20:46:38
In reply to Re: Any one ever heard of Gabitril for anxiety » krybrahaha, posted by Ritch on July 1, 2003, at 10:01:07
I'm curious about it too -- my pdoc gave me a box of 2 mg samples to try and said "see what you think". He advised me to dose very conservatively at first. Apparently, he's heard good things about it from colleagues who treat anxiety patients, but hasn't yet prescribed it himself.
For now, I'm sticking with Klonopin, mainly because I'm also in the middle of adjusting to Strattera and don't want to add two meds at once. The Strattera is working out well, so I'll try the Gabitril fairly soon and report back on it.
Posted by Ritch on July 1, 2003, at 23:06:34
In reply to Re: Any one ever heard of Gabitril for anxiety, posted by Viridis on July 1, 2003, at 20:46:38
> I'm curious about it too -- my pdoc gave me a box of 2 mg samples to try and said "see what you think". He advised me to dose very conservatively at first. Apparently, he's heard good things about it from colleagues who treat anxiety patients, but hasn't yet prescribed it himself.
>
> For now, I'm sticking with Klonopin, mainly because I'm also in the middle of adjusting to Strattera and don't want to add two meds at once. The Strattera is working out well, so I'll try the Gabitril fairly soon and report back on it.It is interesting they reduced the smallest dose size from 4mg to 2mg. I wonder how their clinical trials are going. I just don't like the dumbomax experience of taking the medication. I didn't have that trouble with gabapentin, but I got chest wall muscle spasm from that. If pregabalin doesn't cause that problem, I will be on pregabalin over tiagabine because I can think on that one.
Posted by Viridis on July 2, 2003, at 1:00:46
In reply to Re: Any one ever heard of Gabitril for anxiety » Viridis, posted by Ritch on July 1, 2003, at 23:06:34
Hi Ritch,
There seem to be a lot of negative posts here about Gabitril -- I'll definitely try it carefully. I'm not too worried, because my pdoc will definitely provide Klonopin and Xanax as needed, which work very well for me. I think he's mainly interested to hear about my reaction; he says some other pdocs he knows have had good success with it, but he generally holds back a while before prescribing new meds to his general patient population. He also mentioned he may try it himself, since he has anxiety problems and isn't shy about admitting it -- kind of refreshing to have a pdoc who actually uses these meds.
Posted by Ian M on July 2, 2003, at 14:29:19
In reply to Any one ever heard of Gabitril for anxiety, posted by krybrahaha on July 1, 2003, at 0:49:10
I have been taking Gabitril for anxiety and Bipolar II for about 3 and a half months (10 mg, in conjunction with Lamictal).
It SEEMS to be working somewhat, although only time will tell as my anxiety seems to be cyclical as well.
Given that I really can't handle ADs (induce mania) or benzos (alcoholic), I'm glad that it's out there and pleased with the results so far.
Posted by worrier on July 8, 2003, at 22:00:12
In reply to Re: Any one ever heard of Gabitril for anxiety » Ritch, posted by Viridis on July 2, 2003, at 1:00:46
> Hi Ritch,
>
> There seem to be a lot of negative posts here about Gabitril -- I'll definitely try it carefully. I'm not too worried, because my pdoc will definitely provide Klonopin and Xanax as needed, which work very well for me. I think he's mainly interested to hear about my reaction; he says some other pdocs he knows have had good success with it, but he generally holds back a while before prescribing new meds to his general patient population. He also mentioned he may try it himself, since he has anxiety problems and isn't shy about admitting it -- kind of refreshing to have a pdoc who actually uses these meds.>Hey guys, just took my first dose of gabitril tonight 2mg...I'll be interested to see what happens. Viridis, let me know how it works for you, as from previous posts we seem to react in similar ways to many meds (I've had all the SSRI nightmare experiences you've had). Like you, I'm not really worried about this drug because I've got my xanax in case of emergencies. About a month ago I switched from xanax to xanax XR, which is much smoother and lasts about 12 hours. Anyway, the experiment begins...so far I haven't gone nuts,passed out or freaked myself out. I'll let you know how it goes and please do the same. Oh, the dose my pdoc recommended is 2mg at night for 1 week then 4mg at night for 3 weeks then I see him again. He says most people experience side effects only when they try to take too much too fast. He said the key is to increase the dose really slowly.Luck to all, Worrier.
Posted by scientist on December 14, 2003, at 23:15:30
In reply to Re: Any one ever heard of Gabitril for anxiety, posted by worrier on July 8, 2003, at 22:00:12
I was on paxil a few years pack but it gave me symptoms similar to manic depressive disorder. He tried Wellbutrin which more or less killed the little depression I had but didnt do a thing for the anxiety. We also tried Lorezapam which would take the edge off of a really bad panic attack but did nothing at all for my gad. It really just made me drowsy. So my doctor started me on gabitril.
After 10 days on gabitril 2 mg I noticed no change at all
After 10 days on gabitril 4 mg I noticed no change at all
After raising my dose to 6 mg I think I'm pretty sure it is beginning to make a difference. I finshed 7 days on that. I have just raised the dose to 8 mg per day. I'll let you know if it helps more. I really hope this works. If it does all I need to do is convince my doc to let me cut out the wellbutrin or at least lower the dose. I can't write well while on this stuff.It's hard to say if I am experiencing any side effects since the Wellbutrin is ging me some probems. I have a little twitching and I have a bit of trouble concentrating. I think it made my gad a little worse although it lessened the strength of the panic attacks. No sexual side effects or anything like that...at least I don't think so. My sex drive has been way down lately but I think that's just because I'm so busy and frustrated with my xgirlfriend.
This is the end of the thread.
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Dr. Bob is Robert Hsiung, MD,
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