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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by 3 Beer Effect on February 2, 2002, at 3:31:42
I was recently taking Neurontin 900 mg/day but it hasn't done anything for my social phobia, only seems to make it worse. I stay in the house all the time, somnolent, drowsy & much more irritable when on the neurontin. Some studies said it might help with social phobia but they only got a 32% response rate with a 14% placebo response rate.
Does Gabitril (tiagabine) function as a mood-stabilizer or an anxiolytic/anti-anxiety drug?. On paper, it looks like it would help with Social Phobia since it potentiates GABA like alcohol (which I still think is the best social phobia/anxiolytic drug ever), which the benzos also do but through a different mechanism.
But I don't know much about Gabitril since I've never heard anyone talk much about it on this board. Is Gabatril the non-benzodiazpine, non-tolerance inducing cure for Social Phobia that everyone has been looking for? Does it make you "dumb" & drowsy all of the time so you can't get studying or other work done?- I found Neurontin to have this effect on me.
Posted by Elizabeth on February 2, 2002, at 14:24:28
In reply to GABITRIL- a substitute for benzos like Klonopin?, posted by 3 Beer Effect on February 2, 2002, at 3:31:42
> I was recently taking Neurontin 900 mg/day but it hasn't done anything for my social phobia, only seems to make it worse.
Is it really making your SP worse, or is it just making you so tired that you don't have the energy to go out? My idea would be to decrease the dose to something more tolerable, then increase it again *gradually* as needed.
> Does Gabitril (tiagabine) function as a mood-stabilizer or an anxiolytic/anti-anxiety drug?
I've been wondering that myself, but I haven't gotten any answers. I'm interested in Sabril (vigabatrin) too; it's been looked at a bit for panic disorder as well as in some animal models of anxiety.
> On paper, it looks like it would help with Social Phobia since it potentiates GABA like alcohol (which I still think is the best social phobia/anxiolytic drug ever), which the benzos also do but through a different mechanism.
Gabitril is a GABA reuptake inhibitor. I don't think that it potentiates GABA, but rather increases the amount available.
Anyway, here's a citation for an article that might address the issue:
Ketter TA, Post RM, Theodore WH.
Positive and negative psychiatric effects of antiepileptic drugs in patients with seizure disorders.
Neurology 1999; 53(5 Suppl 2): S53-67.(The abstract didn't go into much detail.)
-elizabeth
Posted by bob on February 2, 2002, at 16:26:07
In reply to GABITRIL- a substitute for benzos like Klonopin?, posted by 3 Beer Effect on February 2, 2002, at 3:31:42
> I was recently taking Neurontin 900 mg/day but it hasn't done anything for my social phobia, only seems to make it worse. I stay in the house all the time, somnolent, drowsy & much more irritable when on the neurontin. Some studies said it might help with social phobia but they only got a 32% response rate with a 14% placebo response rate.
That doesn't sound like too bad a response rate to me. I read articles about AD studies that have led to approval with less spectacular results. It is more than twice the placebo response.I think antiseizure drugs are much more likely to be effective for non-social GAD, and free-floating type anxieties. That, of course, is just an opinion on my part.
Posted by Lorraine on February 2, 2002, at 16:30:21
In reply to Re: anticonvulsants for anxiety » 3 Beer Effect, posted by Elizabeth on February 2, 2002, at 14:24:28
Elizabeth: This link is to an interesting slide re vigabatrin and its effects in the brain. Below is a summary of a rat study re its mode of action. I hope this is helpful. I'll let you know what the cdoc says after I see him and thanks for your other thoughts re my pulse etc. It will be useful when I meet with my pdoc on Tuesday (after my cdoc on Monday.)
Lorraine
U K U N E U R O S C I E N C E P U B L I C A T I O N S Halonen T, Pitkänen A, Riekkinen PJ.Administration of vigabatrin (gamma-vinyl-gamma-aminobutyric acid) affects the levels of both inhibitory and excitatory amino acids in rat cerebrospinal fluid.J Neurochem 1990;55:1870-1874AbstractThe effect of vigabatrin (gamma-vinyl-gamma-aminobutyric acid), a new anticonvulsant drug, on the transmitter amino acids in rat cisternal CSF was studied. CSF was collected through a permanently implanted polyethylene cannula from freely moving rats at 5, 24, 48, and 96 h after administration of 1,000 mg/kg of vigabatrin. The free gamma-aminobutyric acid (GABA) level was elevated maximally (13.5-fold; p less than 0.01) at 24 h after injection. The homocarnosine (GABA-histidine) level also was increased (123%; p less than 0.01) at 24 h after injection, and its concentration remained at the same level for the next 3 days. Glycine and taurine concentrations had increased [31% (p less than 0.05) and 63% (p less than 0.01), respectively] at 5 h after injection. It is interesting that the levels of glutamate and aspartate increased [330% (p less than 0.05) and 421% (p less than 0.01), respectively] at 96 h after injection, the time when the free GABA level had returned to the baseline concentration and the vigabatrin level was 3% of the maximal concentration. The present study indicates that a single dose of vigabatrin in rats elevates levels of both the inhibitory and excitatory amino acids in CSF. However, the temporal profile of observed changes in relation to vigabatrin injection shows that neither the long-lasting elevation of GABA content nor the increase in glutamate and aspartate levels correlates with the level of vigabatrin in CSF. These findings suggest that the excitatory mechanisms are also augmented following acute administration of vigabatrin, especially when the content of GABA had decreased to the baseline level and the level of vigabatrin was low.
Hope this helps.Lorraine
> > I was recently taking Neurontin 900 mg/day but it hasn't done anything for my social phobia, only seems to make it worse.
>
> Is it really making your SP worse, or is it just making you so tired that you don't have the energy to go out? My idea would be to decrease the dose to something more tolerable, then increase it again *gradually* as needed.
>
> > Does Gabitril (tiagabine) function as a mood-stabilizer or an anxiolytic/anti-anxiety drug?
>
> I've been wondering that myself, but I haven't gotten any answers. I'm interested in Sabril (vigabatrin) too; it's been looked at a bit for panic disorder as well as in some animal models of anxiety.
>
> > On paper, it looks like it would help with Social Phobia since it potentiates GABA like alcohol (which I still think is the best social phobia/anxiolytic drug ever), which the benzos also do but through a different mechanism.
>
> Gabitril is a GABA reuptake inhibitor. I don't think that it potentiates GABA, but rather increases the amount available.
>
> Anyway, here's a citation for an article that might address the issue:
>
> Ketter TA, Post RM, Theodore WH.
> Positive and negative psychiatric effects of antiepileptic drugs in patients with seizure disorders.
> Neurology 1999; 53(5 Suppl 2): S53-67.
>
> (The abstract didn't go into much detail.)
>
> -elizabeth
Posted by 3 Beer Effect on February 2, 2002, at 16:56:08
In reply to Re: anticonvulsants for anxiety » 3 Beer Effect, posted by Elizabeth on February 2, 2002, at 14:24:28
I was looking at the gabitril.com website and it appears that the proven anxiolytic/social phobia drugs like alcohol, benzodiazepines, & the barbituates only affect GABA-A.
http://www.gabitril.com/physicians/gaba/default.aspThe Role of GABA in CNS:
GABA binds to 3 principal receptors, each of which is involved in different physiologic functions:GABA-A receptors-- mediate fast inhibitory synaptic transmissions; they regulate neuronal excitability (eg, seizure threshold) and rapid changes in mood (eg, anxiety, panic, and response to stress); they are targets of benzodiazepines, barbiturates, and ethanol.
GABA-B receptors mediate slow inhibitory potentials; they appear to be important in memory, mood (depression), and pain.
GABA-C receptors –– their physiologic role has not yet been described.
Since Gabitril is not selective for GABA-A, then would Gabitril cause "dumb drug" effects on memory?Is there a selective GABA-A agonist besides alcohol, benzos, or barbituatues?
Also, I can't find the "MAOI of GABA" - Sabril (vigabatrine) in the 2002 Nurses Drug Guide or PDR. Is Sabril available in the United States yet? Is Sabril selective for GABA-A?
Posted by JohnX2 on February 2, 2002, at 20:31:32
In reply to Only alcohol, benzos, selective for GABA-A???, posted by 3 Beer Effect on February 2, 2002, at 16:56:08
Mr. 3 Beer,The anti-convulsant Topamax increases Gaba-A conductance.
Btw, what is your favorite beer? ;).
-John
> I was looking at the gabitril.com website and it appears that the proven anxiolytic/social phobia drugs like alcohol, benzodiazepines, & the barbituates only affect GABA-A.
> http://www.gabitril.com/physicians/gaba/default.asp
>
> The Role of GABA in CNS:
> GABA binds to 3 principal receptors, each of which is involved in different physiologic functions:
>
> GABA-A receptors-- mediate fast inhibitory synaptic transmissions; they regulate neuronal excitability (eg, seizure threshold) and rapid changes in mood (eg, anxiety, panic, and response to stress); they are targets of benzodiazepines, barbiturates, and ethanol.
>
> GABA-B receptors mediate slow inhibitory potentials; they appear to be important in memory, mood (depression), and pain.
>
> GABA-C receptors –– their physiologic role has not yet been described.
>
>
> Since Gabitril is not selective for GABA-A, then would Gabitril cause "dumb drug" effects on memory?
>
> Is there a selective GABA-A agonist besides alcohol, benzos, or barbituatues?
>
> Also, I can't find the "MAOI of GABA" - Sabril (vigabatrine) in the 2002 Nurses Drug Guide or PDR. Is Sabril available in the United States yet? Is Sabril selective for GABA-A?
Posted by JohnX2 on February 2, 2002, at 20:36:59
In reply to Re: Only alcohol, benzos, selective for GABA-A??? » 3 Beer Effect, posted by JohnX2 on February 2, 2002, at 20:31:32
whoops, But Topamax is not GabaA selective which is what
you were pointing out with the others.-John
>
> Mr. 3 Beer,
>
> The anti-convulsant Topamax increases Gaba-A conductance.
>
> Btw, what is your favorite beer? ;).
>
> -John
>
> > I was looking at the gabitril.com website and it appears that the proven anxiolytic/social phobia drugs like alcohol, benzodiazepines, & the barbituates only affect GABA-A.
> > http://www.gabitril.com/physicians/gaba/default.asp
> >
> > The Role of GABA in CNS:
> > GABA binds to 3 principal receptors, each of which is involved in different physiologic functions:
> >
> > GABA-A receptors-- mediate fast inhibitory synaptic transmissions; they regulate neuronal excitability (eg, seizure threshold) and rapid changes in mood (eg, anxiety, panic, and response to stress); they are targets of benzodiazepines, barbiturates, and ethanol.
> >
> > GABA-B receptors mediate slow inhibitory potentials; they appear to be important in memory, mood (depression), and pain.
> >
> > GABA-C receptors –– their physiologic role has not yet been described.
> >
> >
> > Since Gabitril is not selective for GABA-A, then would Gabitril cause "dumb drug" effects on memory?
> >
> > Is there a selective GABA-A agonist besides alcohol, benzos, or barbituatues?
> >
> > Also, I can't find the "MAOI of GABA" - Sabril (vigabatrine) in the 2002 Nurses Drug Guide or PDR. Is Sabril available in the United States yet? Is Sabril selective for GABA-A?
This is the end of the thread.
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