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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by paulb on March 8, 2002, at 14:42:31
Alan,
Can you tell me what causes and the mechanism of the antidepressant effect that people experience when taking Xanax and Valium. Thanks in advance for advice.
Paulb
Posted by Alan on March 8, 2002, at 18:02:21
In reply to Alan-benzodiazepine advice, posted by paulb on March 8, 2002, at 14:42:31
> Alan,
> Can you tell me what causes and the mechanism of the antidepressant effect that people experience when taking Xanax and Valium. Thanks in advance for advice.
> Paulb
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I had only heard of a mild anidepressive effect from xanax. Valium too?You'd have to ask an expert like elizabeth here at PPbabble as to the mechanics of what's involved. There are many studies that show strong evidence that chemically they do have a mild antidepressant effect along with the anxoilytic effect.
I do know that alot of mixed anx/depression is really an anxiety disorder overloading a person, or hyperarousing a person to the point that they're sympathetic nervous system is depleted - hence the depressive effect. Many find after BZD monotherapy that the depression lifts almost completely and the little that might be left can be treated with low dose ssri or Neurontin, change in diet, lifestyle, etc.
Alan
Posted by paulb on March 9, 2002, at 10:33:58
In reply to Re: Alan-benzodiazepine advice » paulb, posted by Alan on March 8, 2002, at 18:02:21
Its interesting that you mentioned Neuontin because Neurontin may work by stimulating the release of Serotonin and GABA. Maybe we can get some input from Elizabeth and explore further the antidepressant mechanism of Xanax and Valium. I would have to agree to diagree that the the AD effect is mild. I have often heard reports of euphoria with these two benzodiazepines, making them popular drugs of abuse, as opposed to other benzodiazepines. I agree that Lizzy would be helpful, this lady knows her stuff. Elizabeth??
paulb
Posted by Alan on March 9, 2002, at 12:37:22
In reply to Thanks Alan, Elizabeth???, posted by paulb on March 9, 2002, at 10:33:58
>"...I would have to agree to disagree that the >AD effect is mild. I have often heard reports of >euphoria with these two benzodiazepines, making >them popular drugs of abuse, as opposed to other >benzodiazepines...."
> paulb
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I think that there needs to be a very important point noted here when talking about BZD's in general - and the two that you mention in particular.For those seeking a high on anything - let alone a BZD - who experience a euphoria (as opposed to simple releif of symptoms) on either of these meds would seem to be ones with a contraindication for use of these drugs as a choice of treatment because of the potentiation of abuse. I'm not sure how many with legitimately diagnosed anxiety disorders actually experience these effects. My understanding is that it is very rare, not predominant....that the risk is very far from unacceptably high.
And I'm not sure that one's predisposition to feel such a high is limited to BZD's, mistakenly viewing the BZD exclusively as the problem - rather than viewing the individual's reaction to them as the source for potential abuse.
It would be interesting to know if the 2 BZD's are shown chemically in some way for those predisposed to abuse or feeling a high to gravitate towards them instead let's say ativan or valium. I know of no studies or chemical rationale to provide evidence of such, only anecdotal evidence...but perhaps elizabeth knows of some.
Of course the use amongst poly-drug abusers that use the BZD's to get from one high to another or to potentiate a "higher" high from the primary drug of abuse such as alcohol or narcotics is well known. They are not a first choice as a drug of abuse except for those that have a predisposition for it...and from all accounts, a chronic anxiety suffer is at near the bottom of that list in that regard.
Alan
Posted by Elizabeth on March 9, 2002, at 15:14:05
In reply to Thanks Alan, Elizabeth???, posted by paulb on March 9, 2002, at 10:33:58
Hi guys.
Interesting that you bring this up. There is actually some evidence that Xanax may act as an antidepressant, at least in mild or moderate depression. (Upjohn seized on this as an excuse to get "anxiety associated with depression" listed as an indication for Xanax.) The dose required may be quite high, though. Xanax and Halcion differ in chemical structure from the other benzos (they have a ring with three nitrogens in it, so they are called triazolobenzodiazepines; trazodone and nefazodone share the triazolo moiety). It's not known for sure what pharmacological properties this chemical characteristic may confer on these drugs, though. Halcion typically causes too much sedation and memory impairment to be suitable for use as an antidepressant, so we don't know if it shares Xanax's antidepressant efficacy. A third triazolobenzodiazepine, adinazolam (brand name Deracyn), is used as an antidepressant in some countries, but not in the U.S. (I've always thought it would be nice if we had adinazolam here.)
These benzos have some endocrine effects which may be significant. Xanax and Valium both decrease cortisol secreation, Xanax quite a bit more than Valium. There have also been findings suggesting that depressed patients who have elevated urinary levels of MHPG (a norepinephrine metabolite) are more likely to respond to alprazolam than are depressed patients without elevated urinary MHPG. There are some other endocrine effects that I can't remember right now. An interpretation of these findings has been that Xanax-responding depressives have hyperactive hypothalamic-pituitary-adrenal (HPA) axis functioning.
As Alan says, there are probably some cases of depression (I'm guessing quite a lot, although I don't know of any statistics regarding this) that are secondary to anxiety disorders; that is, the person was originally anxious and then became depressed as a result of the anxiety. (I like Alan's description of the anxiety "overloading" the person, although it's not known what pharmacological mechanism might be responsible for this.) It's not surprising that in such a case, treating the anxiety might relieve the depression also.
Some people do feel euphoric or high on benzos, and Valium and Xanax are believed to be particularly "good" (or "bad," depending who you talk to). I don't think this is the same as an antidepressant effect, but some depressed people find that a drug that might normally be expected to cause euphoria simply makes them feel normal. So I could see how some people might experience relief of depression (without euphoria) on benzos just as I do on opioids.
> I would have to agree to diagree that the the AD effect is mild. I have often heard reports of euphoria with these two benzodiazepines, making them popular drugs of abuse, as opposed to other benzodiazepines.
This is my impression also. I think that their rapid onset of action might have something to do with it: both Xanax and Valium are relatively fast-acting when taken orally, compared to the other benzos. I've also heard people say that they can feel it when Xanax or Valium kicks in, but they don't notice anything when Klonopin or Librium (for example) starts to work.
> I agree that Lizzy would be helpful, this lady knows her stuff. Elizabeth??
Thanks...but who are you calling a "lady??!!!"
:-)
-e
Posted by gilbert on March 9, 2002, at 20:39:18
In reply to Xanax and depression » paulb, posted by Elizabeth on March 9, 2002, at 15:14:05
Xanax definitely has a lift that other benzos did not have for me. Body builders also like to use xanax after workouts and steroid use becuase it increaes dhea levels. I think this is only effective on short term though not long term but increased dhea would certainly lift ones mood. Xanax also seemed to eleviate some of the sexual side effects of ssri's for me which would further confirm the dhea claims made by muscle heads. I thought klonopin had sertonin antangonsim which would explain why it activated me not sedated, plus I got sexual side effects that I did not get with xanax. High doses of xanax seem to make me almost manic which is also strange because I am an ex drinker and booze used to do the same thing seem like it lit a fire under my ass. Everything in me seems backwards......what works for most does not work for me.
Gil
Posted by paulb on March 10, 2002, at 8:07:11
In reply to Re: Xanax and depression, posted by gilbert on March 9, 2002, at 20:39:18
> Xanax definitely has a lift that other benzos did not have for me. Body builders also like to use xanax after workouts and steroid use becuase it increaes dhea levels. I think this is only effective on short term though not long term but increased dhea would certainly lift ones mood.
>>Interesting I didnt know this.
Xanax also seemed to eleviate some of the sexual side effects of ssri's for me which would further confirm the dhea claims made by muscle heads.Bit confused here gilbert, "alleviate" or "elevate". Would like to know?
I thought klonopin had serotnin antangonsim which would explain why it activated me not sedated, plus I got sexual side effects that I did not get with xanax.
I once thought mCPP, a serotonin agonist was a metabolite of Klonopin. I have been assured by an expert that I am incorrect. Exactly how klonopin elevates serotonin is not fully understood. It may up-regulate serotonin receptors. But its not a serotonin antagonist. Its a potent anticonvulsant due to its enhancement of GABA and potent blockade of high-voltage gated sodium channels.
High doses of xanax seem to make me almost manic which is also strange because I am an ex drinker and booze used to do the same thing seem like it lit a fire under my ass. Everything in me seems backwards......what works for most does not work for me.
I found that too. We are all different. Thats why its such a hard trial and error process.
>
>
Thanks Gil Paulb
Posted by paulb on March 10, 2002, at 8:08:27
In reply to Xanax and depression » paulb, posted by Elizabeth on March 9, 2002, at 15:14:05
NM
Posted by gilbert on March 10, 2002, at 9:30:06
In reply to Re: Xanax and depression, posted by paulb on March 10, 2002, at 8:07:11
> Bit confused here gilbert, "alleviate" or "elevate". Would like to know?
Paul it seemed xanax combined with an ssri would not effect me sexually as much as ssri monotherapy.....strange.......also xanax monotherapy in doses larger than 3mg per day gave me delayed orgasm not as bad as an ssri but still had to chopp the wood a little longer before starting the fire.Gil
Posted by paulb on March 11, 2002, at 16:03:41
In reply to Xanax and depression » paulb, posted by Elizabeth on March 9, 2002, at 15:14:05
>The dose required may be quite high, though.
Xanax and Halcion differ in chemical structure from the other benzos (they have a ring with three nitrogens in it, so they are called triazolobenzodiazepines; trazodone and nefazodone share the triazolo moiety). It's not known for sure what pharmacological properties this chemical characteristic may confer on these drugs, though.>>Im really reaching here, but not optimistically, Im just curious. An expert on mCPP told me that it was definetely not a metaboite of Clonazepam. In fact he thought if would be chemically impossible. However I have read that it is what causes the increase in serotonin when Clonazepam is used and is actually a metabolite of quite a few psychotropic drugs. Xanax and Clonazepam are similar in chemical structure so do you think it might be a possibility also bearing in mind what you wrote about Nefazadone and Trazadone being triazolobenzodiazepines, and knowing for sure they both have the metabollite mCPP.
>
>These benzos have some endocrine effects which may be significant. Xanax and Valium both decrease cortisol secreation, Xanax quite a bit more than Valium.>>Now that is interesting. Links to evidence of this would be appreciated. You are suggesting that Xanax may decrease cortisal levels and during times of stress prevent over-zealous cortisal activity.
An interpretation of these findings has been that Xanax-responding depressives have hyperactive hypothalamic-pituitary-adrenal (HPA) axis functioning.
>> I would add the hypothalamic-pituitary-adrenal (HPA) axis functioning is realted to responses to corticotropin releasing factor(CRF). A lot of research is going on into developing CRF antagonists. Well have we got one already? As I wrote links to evidence of this would be appreciated.
>
> As Alan says, there are probably some cases of depression (I'm guessing quite a lot, although I don't know of any statistics regarding this) that are secondary to anxiety disorders; that is, the person was originally anxious and then became depressed as a result of the anxiety. (I like Alan's description of the anxiety "overloading" the person, although it's not known what pharmacological mechanism might be responsible for this.) It's not surprising that in such a case, treating the anxiety might relieve the depression also.>>Yeah I agree with you both.
> Some people do feel euphoric or high on benzos, and Valium and Xanax are believed to be particularly "good" (or "bad," depending who you talk to). I don't think this is the same as an antidepressant effect, but some depressed people find that a drug that might normally be expected to cause euphoria simply makes them feel normal. So I could see how some people might experience relief of depression (without euphoria) on benzos just as I do on opioids.
>>How is the buprenorphine going for you btw
>
>>I agree that Lizzy would be helpful, this lady knows her stuff. Elizabeth??
>
> Thanks...but who are you calling a "lady??!!!">>ooops sorry.
PaulB
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