Posted by SLS on June 1, 2008, at 16:34:56
In reply to Re: The best Tricyclic for anxiety.... » SLS, posted by torachan on June 1, 2008, at 14:25:30
> Scott, I still don't understand how SSRI/NRI's can be effective for anxiety as some are indicated for anxiety use when, as you say, serotonergic tracts can be anxiogenic.
> As I understand these particular drugs, the increase the action of serotonin by blocking reuptake. Why is there this inconsistency between claims made that increased serotonin activity aggravates anxiety and the claim that serotonin activating drugs improve anxiety?
Remember that part of what is going on here is the downregulation of postsynaptic receptors. Sometimes more equals less. During the first 1-2 weeks, these receptors are flooded with neurotransmitter. One might anticipate things getting worse before getting better when it comes to anxiety, especially with serotonin reuptake inhibitors. It isn't until 2-4 weeks that this downregulation takes place and reregulates synaptic dynamics.
It is perhaps no surprise that Lexapro makes anxiety worse (at 2 weeks) before it makes it better.
> And do the trycyclics work in any significantly different way in this respect to the SSRI/NRI's?
This is where things get tricky. There is still no complete understanding of how these drugs work for the various illnesses they have shown efficacy in. To assume that we can predict how a drug will affect any one person requires that we know all the properties these drugs possess. We don't.
> Honestly, in my opinion as I mentioned somewhere else on this board, the medical community has yet to develop drugs effective for anxiety that rival the benzodiazepines,
What type of anxiety do you have?
It would have been interesting to be able to combine an SSRI with gepirone or ritanserin. Unfortunately, gepirone (a 5-HT1a partial agonist) is deemed not-approvable by the FDA, and the patent on ritanserin (5-HT2 antagonist) has run out. I don't know the percentages, but a minority of people have a robust anti-anxiety response to buspirone (DA antagonist / 5-HT1a partial agonist). The one problem with gepirone and buspirone is that their major metabolite, 1-PP, is a potent NE alpha-2 antagonist. Some people can't handle the activation of certain NE pathways. It can make depression worse. I don't know about anxiety, though.
> Also, do you know of any promising new drugs on the horizon which focuses on anxiety. I looked at Valdoxan, which should help with sleep, but it's still focused on depression.
Drugs don't "focus". Only people focus. The drug is what it is. One of the properties of agomelatine is that it selectively antagonizes 5-HT2c receptors. This might decrease anxiety more than it does depression.
- Scott
poster:SLS
thread:831465
URL: http://www.dr-bob.org/babble/20080528/msgs/832388.html