Posted by Quintal on May 26, 2008, at 8:38:22
In reply to Re: Suggestions for non-benzo anxiolytics PLEASE.., posted by undopaminergic on May 25, 2008, at 18:08:48
>Benzos bind to GABA-A receptors, and I think gabapentin (Neurontin) and pregabalin (Lyrica) also work on the GABAergic system, so cross-tolerance may be an issue.
It could be, but since they work at a different site, they could support the GABA system (preventing or attenuating withdrawal symptoms) and allow the benzodiazepine receptors to upregulate, so that when a person starts taking them again tolerence is back to pre-drug levels. Dopamine agonists can do a similar job with opiates by supporting the dopamine system during withdrawal while the opiate recetors recover [personal experience].
>Perhaps alternating between GABAergic drugs (such as benzos) and opiates would be a better idea, as opiates work on their own set of receptors rather than GABA.
Being realistsic, where would people get these opiates from? They're even more tightly controlled (and addictive) than benzos. The original concern was addiction with benzos.
>I consider opioids advantageous also because NDMA-antagonists (including at least memantine and dextromethorphan) are highly effective for preventing or reversing tolerance to them, whereas I don't know of anything that prevents or reverses benzodiazepine-tolerance.
I don't think either of those drugs are highly effective at reversing opiate tolerence. I once read an study where lamotrigine was used to delay tolerence to buprenorphine for six months or so, but ultimately it only delayed tolerence, it didn't reverse or prevent it. I've tried lots of these supposed tolerence reversal stratergies and none of them have worked. The only reliable way of reversing tolerence I know of is to slowly withdraw from the drug and stay off it for a few months.
> Furthermore, opioid-withdrawals are less severe,
I wouldn't say opioid withdrawal is less severe than benzo withdrawal, but it depends on the dose. They're both in the same ballpark, and both are fairly hellish if you're coming abruptly off a high dose.
>and can be further diminished by alpha2-agonists - such as clondidine and guanfacine, whereas I don't know of anything - other than possibly barbiturates and alcohol - that can control benzo-withdrawals.
Clonidine and guanfacine only reduce certain symptoms of opiate withdrawal. They're not a magic cure and carry significant side effects of their own. Many drugs can attenuate some of the symptoms of benzo withdrawal, including Neurontin and Lyrica, but in both cases the best remedy for withdrawal is to slowly decrese the dose of the original drug.
Q
poster:Quintal
thread:830647
URL: http://www.dr-bob.org/babble/20080519/msgs/831190.html