Posted by Cam W. on May 7, 2000, at 21:59:08
In reply to Re: help me please-panic: More - Cam?, posted by SLS on May 7, 2000, at 20:28:53
Scott - Every study I have seen or heard about has said that while pindolol can augment the onset of SSRIs in panic disorder, by itself it has had no effect, especially when compared to the benzos. I still think that the theory behind pindolol augmentation looks good; in actuality I have not seen much luck in using it. Again remember, I am in a small city at the outskirts of the frontier. We have many very competent docs and researchers out here.But being a "community pharmacist" and not a "clnical" pharmacist, I am looked down on by many of my hospital pharmacy colleagues as not knowing the latest of techniques. I do not get to hear about many of the clinical trials that are going on in the hospitals. Some of my colleagues are beginning to talk to me, but only because I have "fixed" several of their mistakes.
For example, taking a cocaine addict off of Tegretol and putting him on divalproex, then sending him out into the community. The guy happened to come to my store and I was able to tell him to lower his coke dose because of the potential loss of CYP-3A4 enzyme induction, by stopping the Tegretol. Phone the clinical boys and ask what they were thinking and they said, "I never thought of that". I guess some of us live in the real world.
Example 2 - The hospital boys (and these are guys, not ladies) swear by Seroquel in the hospital. They discharge a person on it and by 6 weeks the guy is back in hospital. Seroquel works in a number of people with psychoses, but seems to lack the anti-anxiety effects of the other atypical antipsychotics. In a hospital setting there is reduced anxiety. Place the same person back on the streets and bang, the stress induces relapse.
...But I digress (sorry, just another rant)...
At one time (way back in the 1970s and 80s) it was hypothesized that panic was associated with problems in noradrenergic activity (if memory serves me correctly - and many times lately it hasn't). They thought that ß-blockers could reverse panic. In head-to-head trials the benzos (like diazepam and xanax) and the SSRIs work much better than the ß-blockers. Also, I have never heard heard of increasing propranolol during a panic episode. It might work, but it might cause too much hypotension as well (I don't know for sure, though). I always see extra clonazepam, alprazolam or lorazepam or, more recently, Zyprexa given for a breakthrough panic episode.
About using other ß-blockers than propranolol for anxiety (like stage fright), I have never seen it. Even for mood stabilization, propranolol is all I have seen used. Whether this is just a local thing in my area or others ß-blockers have been found not to work, again, I don't know. Interesting question, though. I will drop it in conversations this week and see what comes up.
Thanks for the intriguing questions Scott - Cam
poster:Cam W.
thread:32230
URL: http://www.dr-bob.org/babble/20000429/msgs/32700.html