Posted by Ritch on April 9, 2003, at 22:59:00
In reply to Re: Anticonvulsants for Anxiety: which are best? » Ritch, posted by Stan on April 9, 2003, at 13:35:59
> >>> Well.. thus far if benzos have had a better response than antidepressants/Buspar, probably Neurontin would be worth a try. There are some that find the positive effects wear off after awhile, it is rather short-acting (so you have to take it two or three times a day), some get a paradoxical reaction to it. The only thing I can say is try it and see what happens. Gabitril is in clinical trials for GAD. Neurontin's refined version (pregabalin) is in clnical trials for GAD as well. Gabitril can cause mental dulling as well. Have you tried any TCA's for your GAD? You might find nortiptyline effective.<<<<
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> thanks for the reply, ritch -- i didn't realize that pregablin is an update of neurontin, so to speak -- i actually have a newspaper article from a about a year ago about pregablin that i have filed away somewhere, but i can't find it now. is the newer medication supposed to have fewer or less prominent side effects than neurontin, or is it intended to have a stronger anti-anxiety effect, or both? in the meantime i will try to get some samples of neurontin to try for a short while to see if it relieves anxiety without bringing on the "blahs" like benzos do for me. how would you compare the nature of the cognitive impairment that occurs with anticonvulsants vs the type that benzos bring on, if you've had any experiences with both? is it a similar "feel"?
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> i will have to research the nortriptyline a bit -- thanks for the suggestions. i'm one who has always eschewed the TCAs in favor of more modern meds, when it's possible that those old drugs work just as well as the new stuff. my limited knowledge of them has led me to believe that in general the TCAs affect too many receptors, causing troublesome side effects that i would object to. for example, meds with a strong antihistamine effect (e.g. remeron) put me to sleep immediately, as do those that block the "alpha-1" adrenalin receptor (e.g. trazodone). i found that remeron and trazodone were ok for mild anxiety relief, probably partly due to the properties just mentioned, but their sedative properties were so overpowering that they made me *more* depressed.
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> i did a couple of google searches to check out nortriptyline but haven't been able to pin down which receptors it interferes with -- if it does anything that causes sedation, dry mouth, blurred vision, etc., then i might have to look elsewhere. thanks again for your help.
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>Pregabalin from what I understand is simply a "refined" version of gabapentin (Neurontin). I understand that in the clinical trials they *are* using a fraction of the dosage that is commonly seen with folks prescribed Neurontin. I think they are using somewhere between 150mg-600mg/day of pregabalin. I have heard of Neurontin doses of up to 2400mg/day or more. I hope it has *fewer* side effects than Neurontin. Neurontin caused excessive throat dryness, esophageal spasm for me, so I can't tolerate it because of that. Otherwise it worked quite well. I took it instead of Depakote for bipolar for almost two years and didn't experience any super-mania or anything.
As far as comparing Neurontin with benzos.... well it depends on what you are used to. There was a time I was taking 900mg/day of N. and got used to the sedation and it didn't interfere with my work that much. I can take small quantities of Klonopin at work (no more than .25mg though), and it doesn't bother me either. But you might have some serious startup cognitive problems until you adapt to either drug, IMO.As far as TCA's go, nortriptyline was the only one that I didn't get orthostatic hypotension from (the kind of dizziness you get from suddently standing up). It does cause some dry mouth and drowsiness, but it also was the only TCA that I could take small doses of during the daytime without being too sedated. I also found low-doses of NT practically stopped anxiousness from taking Wellbutrin (just a side note there).
poster:Ritch
thread:216861
URL: http://www.dr-bob.org/babble/20030407/msgs/218058.html