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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?

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
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www.personalconsult.com

A 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.


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poster:krybrahaha thread:238362
URL: http://www.dr-bob.org/babble/20030624/msgs/238362.html