Posted by zeugma on March 2, 2006, at 21:59:11
In reply to Re: Yes » zeugma, posted by Chairman_MAO on March 2, 2006, at 21:23:37
> It makes no sense to me to say that it treats mild anxiety after six weeks. Mild anxiety often comes and goes on its own in about that long. More than one psychiatrist I've talked to has told me that buspirone is "the most expensive placebo on the market". My psychopharmacology professor at Syracuse University told me that it was a failed attempt at developing an antipsychotic that was sold for anxiety in order to recover development costs. If you do enough studies on something, by change you will get a difference from placebo. They only have to show the studies that succeed to the FDA, and voila--your treatment for anxiety. What do you use for anxiety? If anything, I'll bet its not buspirone...>>
Far from it. Clonazepam is the only reason I can engage in trivial pleasantries with anyone. My social anxiety is extreme.
> Anxiolytic drugs are those which relieve anxiety upon administration. Benzodiazepines, barbiturates, many antipsychotics, opioids, phenelzine's GABA-T inhibitng metabolite, kavalactones, mirtazapine...even hydroxyzine, diphenhydramine, and trazodone are more anxiolytic than buspirone. >>
Buspirone is certainly not anxiolytic. If anything it is an antidepressant.
Valproate is more of an anxiolytic than buspirone. SSRIs are not anxiolytics, either. They attenuate felt emotion and lessen the number of thoughts coming into consciousness (in most people). Calling them anxiolytics is like calling an anesthetic an analgesic. Sure, if you can't feel ANYTHING, you won't be in pain. The reason many people feel more anxious when starting an SSRI is because they INDUCE ANXIETY. Then, after you adjust to that 4-6 weeks later, you no longer feel the SSRI-induced anxiety, but the emotional anesthetic effect is still maintained. Thus, it seems like something "kicked in". It takes a lot longer to realize what really happened, but I'll bet a lot of people who have taken these medications will agree with me. One may argue that benzos et. al. do this in a way that feels differently. Well, at least that way FEELS CALMER and is directly correlated with the administration of the drug. >>
I think SSRI's are anxiolytic for some. I have seen it. I have seen people who were preoccupied with suicide suddenly end their preoccupation. Of course, a dulling effect (going by what I've seen) sets in that is not very satisfactory. My impression is that SSRI's are better for OCD than depression. I think they are poor drugs long term because they destroy sleep architecture. I have seen sevrely demotivating effects that i do not consider therapeutic. But maybe in OCD this is the therapeutic effect.
> Sure, it has an action: a 5ht1a partial agonist, too-weak-to-matter dopamine blockade, and mCPP's actions. "Placebo" does not mean "devoid of any effects". It does have those effects; if you take too much buspar, they become strong enough to notice (I drank grapefruit juice once by accident with it and had quite a bad time). It feels horrible. It is simply not an anxiolytic drug. Buspirone can help with certain SSRI side effects quite well in some cases and can speed an antidepressant response. And yes, in animal models 5ht1a agonists screen as anxiolytic. However, no one ever asked the rats how they were feeling.
The rats have terrible alexithymia. Shame about that...
I take buspirone because it blocks REM quickly, so I don't get hit with sleep paralysis because nortriptyline kicks in too slowly. My pathology is like that of what used to be called "cholinergic rebound," only not AD-induced (I know, I spent years living in a hole without AD's or anxiolytics and got as many brain zaps at bed time as anyone experiencing Effexor or Paxil withdrawal).
> A benzodiazepine will calm someone in psychosis, as will Seroquel, et. al. 2g of buspirone will do nothing (maybe induce dizziness and vomiting).
Over 30 mg buspirone induces a suspiciously AP-like fatigue (and I have some kind of narcolepsy so any elevation above baseline fatigue quite literally has me sleeping 20 hours at a time). Buspirone is not an anxiolytic, but we have to use the words marketers use; i'll accept that it's a failed antipsychotic with antidepressant effects. I use it to block REM, quickly. I am under constant REM pressure. It does help with this.
> Is there anyone here who had crippling anxiety that was unmanageable, sought pharmacological treatment, and then found relief from buspirone?
Not me. Some of those who have treated me had that hope, but this country does not have wise policies re benzodiazepine guidelines. It seems things are even worse in the UK. The fact of the matter is that psychiatry is a branch of the creative nonfiction that has taken hold of this country, and hopefully people will become interested in more veridical forms of medical pursuit. But I won't hold my breath for that to happen, and in the meantime I have to do soemthing about my cholinergic system.
> The placebo effect is so powerful that it is present even when investigating treatments for very serious disorders that often involve extreme pain, discomfort, etc. That being the case, does it make sense to deem buspirone anxiolytic given that it has virtually no subjective effect at clinical dosages?>>
Well, you can define the illness so the pill will treat it. Generalized Anxiety Disorder is an 'interesting' diagnosis. I have yet to hear of anyone who had that as their sole pathology. Studies involving buspirone do require a certain disregard for the meanings of the words used to write them. There are some abstracts I could quote if I wasn't so f*cking tired. They are actually funny, at least if you aren't breathless from a panic attack.