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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by HopeNotLost on November 22, 2002, at 20:18:56
Every time I visit my psychiatrist, I jokingly ask, "Anything else out there comparable to Nardil that will give the same results without all the dietary restrictions and side effects?" (I have horrible insomnia this time around on Nardil and feel like my motor is running constantly.) To my surprise, this time he said, "Maybe."
Of course, he gave me the bad news about Nardil's availability (or lack thereof). But then he went on to tell me of another patient who has an extraordinarily similar case of panic disorder. She has a PhD in pharmacology and, after not getting any relief on the medication merry-go-round, she did some medical research of her own. She brought to his attention a drug that is seeing good success in studies. Funny thing is that the FDA-approved indication for this drug is for the treatment of epilepsy and seizures . . . panic disorder is not mentioned. After researching it and educating himself further, the doctor prescribed it for her. She is currently living free of panic attacks and enjoying life like she hasn't in many years. The drug is Gabitril. Information about it is available at http://www.gabitril.com/patients/home/default.asp.
He and I weighed the pros and cons and, finally, I decided to try it. I have a phobia, of sorts, about taking new pills (loss of control once it's in the body - - I'm sure you know what I mean), so he started me at the lowest prescribable dosage, 2 mgs daily. The sweet spot for treatment of panic disorder seems to be in the 8-12 mgs range. Putting that in perspective, for epilepsy/seizure control, it's around 36-52 mgs daily.
I can't say my initial experience has been great. I take it at night since it's also supposed to help one sleep better (and it does!). But I wake every morning shaky, watery-headed, feeling as if nothing is real. It's almost like a low blood sugar episode mixed with a bad hangover. I stayed with it for a little more than a week (during the first week I stopped taking the Nardil) and finally called him. He told me to stop taking it, wait until I felt somewhat normal again, then try halving it to l mg daily. If I feel like I just can't even try that, I have to go back in and we'll start back at square one. I'll probably give it the ol' college try (especially since I'll be vacationing off/on throughout December), but I am fairly nervous about it. I'm afraid I'm losing some of the progress I made with Nardil.
It's so disappointing. Have any of you tried Gabitril or had it suggested to you? What's your experience with it? I've read another thread suggesting Parnate - - anyone tried that in place of Nardil and had success?
I still have hope, but I'm so tired of this sh*t. I can't even remember what it's like to feel relaxed and normal - - again, something I'm sure all of you can relate to without difficulty.
Have a pleasant evening (and sorry for the length of the post).
*Hope*
Posted by utopizen on November 22, 2002, at 21:16:44
In reply to Nardil gone; surprising new med to try, posted by HopeNotLost on November 22, 2002, at 20:18:56
Yeah, I tried Neurontin several months ago for my anxiety (although I don't get panic attacks-- it's social anxiety).
I just started taking it two days ago. Strangely not similar feel like Neurontin, less "blatant" effect... sort of like Benadryl, minus the mild psychosis Benadryl puts me into. Drowsy effect. But then again, I need lots of sleep. I don't know, I'll have to give it more time to feel it out.
Pretty mild drug, though. Not something I would worry about. It's a type of drug used if a doc can "get away" with it (if it ends up working) because it is an alternative to the habit-forming benzos. That and I'm 19. Taking new prescriptions is one of the few thrills I have in my life right now. Yeah, it's pretty dull, but hey. As long as I never fear new meds, at least my life still has some excitement in it...
As for fearing meds, that's like, for me that would be like missing out on the only fun thing I do in life, once every several months when my doc finally gives up on a certain script and writes a new one.
Imagine my smile when I convinced him to script Desoxyn one day. Just knowing you have a drug that so few have three pharmacists at the busiest pharmacy in the city never heard of it and go crazy when they find out what it is.
Wow. I found a drug the pharmacists were impressed over. Wow.
Posted by HopeNotLost on November 22, 2002, at 21:39:39
In reply to Re: Nardil gone; surprising new med to try, posted by utopizen on November 22, 2002, at 21:16:44
I certainly don't know all there is to know about meds and treatments for anxiety disorders, but I DO know that if I took desoxyn, I'd be on the ceiling. Or cowering in a corner, depending on the day. :)
As it is, I always feel like the world is too 'sharp', if that makes any sense at all, and I just feel like I'm always on the verge of sensory overload. Too much light, not enough light. Too many people, too 'alone'. But always, always, I feel weak. Humiliating, to say the least. It's a daily struggle to find that happy medium. But I'm a consummate actress. My doc says if he didn't know I had panic disorder, he'd never 'know'. I work hard not to let on what's happening because I don't want people to pity me or think I'm weak or incapable. Anyway, Nardil works for me - I found myself driving places and doing things I hadn't done in a LONG time - without really thinking about it. That, in turn, led to decreased stress and anxiety about life overall.
I'm gearing myself up to start back on the Gabitril at 1 mg on Wednesday evening. I'll have a long weekend to start working it through my system and get an idea of how it's going to go. *sigh* I dread it. Contrary to you and your world, taking a new drug is more excitement than I need or want!
Posted by utopizen on November 22, 2002, at 22:35:51
In reply to Re: Nardil gone; surprising new med to try » utopizen, posted by HopeNotLost on November 22, 2002, at 21:39:39
Contrary to you and your world, taking a new drug is more excitement than I need or want!
>
>
Oh well. I'm young and trying to discover things.
You appear trying to avoid lulling away in the corner... that's quite understandable (even though I haven't felt that way before).Desoxyn does make me quite anxious, however... also quite happy... too bad I switched back to Adderall. Probably for the best, as it does have a distinctively "harder" feel on my heart, and sometimes a fuzzy feel in my head. And the vague sense that at some vague dose it may be neurotoxic, well that's no fun. Still, it's been widely in use since 1945... although not so much since the early 70's, when it ceased its widespread use as a diet drug of choice...
Posted by viridis on November 22, 2002, at 23:57:55
In reply to Re: Nardil gone; surprising new med to try, posted by utopizen on November 22, 2002, at 21:16:44
I've never tried Gabatril (tiagabine), but it isn't Neurontin (which I do take). Neurontin is gabapentin, something quite different. These similar drug names can get pretty confusing.
There have been some posts here in the last few months about Gabatril that might be worth looking up. BTW, I find Neurontin very mild, although it's had no side effects, except a pleasant mild euphoria the first couple of times I took it.
I also take Adderall, but haven't had the opportunity to try Desoxyn (doubt I ever will!).
Posted by HopeNotLost on November 23, 2002, at 0:08:23
In reply to Clarification re: Gabatril, posted by viridis on November 22, 2002, at 23:57:55
Thanks, viridis, I was wondering about that. I looked up Neurontin and saw its 'other name' and realized there may have been a mix-up. Who knows if Gabitril will work for me. I have my doubts, especially after the reaction at such a low dosage (2 mgs), but I'll give it another shot at 1 mg as the doc suggested. I have no choice, really, because I'm out of options.
I've often said that I'd like to go somewhere and detox for about 2 months and see how I'd REALLY feel - - would the panic disorder and agoraphobia be something I could control on my own? Again, I have my doubts.
If anybody else knows something about Gabitril for the treatment of panic disorder, I'd love to hear about it.
*Hope*
Posted by viridis on November 23, 2002, at 1:59:17
In reply to Re: Clarification re: Gabatril » viridis, posted by HopeNotLost on November 23, 2002, at 0:08:23
Hi HNL,
Just a question, but I guess you've tried Klonopin? Based on my experience and that of many here, it can be great for PD.
All the best,
Viridis
Posted by HopeNotLost on November 23, 2002, at 13:09:29
In reply to Re: Clarification re: Gabatril » HopeNotLost, posted by viridis on November 23, 2002, at 1:59:17
Actually, I haven't tried Klonopin. My doc throws out a bunch of names, but he's pretty adamant about what he believes will and won't work for me. He and I are both pleased with the success (twice over) that I've had with Nardil, but slightly disappointed that the Gabitril is giving me such fits.
I do currently take Ativan - small dosage - which seems to help with general depression (a depression that is brought on by what PD has done to me and my life). But it definitely doesn't have a huge effect on the PD itself. Basically keeps me on an even keel, but doesn't help tamp down on the anxious feelings before they cycle up into full-blown panic attacks.
Any side effects with Klonopin?
Posted by viridis on November 23, 2002, at 15:35:58
In reply to Re: Clarification re: Gabatril » viridis, posted by HopeNotLost on November 23, 2002, at 13:09:29
Hi HNL,
For me, Klonopin has been excellent for anxiety, depression, and panic. I don't have constant panic attacks, but they come in clusters, and when I'm in one of those phases it makes life extremely difficult. I have to interact with people a lot, speak to large groups frequently, and so on, and having a panic attack (or just worrying about having one!) is extremely stressful. I'm sure you can relate.
Antidepressants I've tried (SSRIs, Wellbutrin) either made me more anxious or I experienced bizarre mood swings. These and other side effects didn't go away over time and were intolerable even at very low doses.
When I first saw my current pdoc I was in the midst of one of these panic clusters. He immediately prescribed Klonopin and Xanax -- K daily, X as-needed. The panic attacks stopped immediately and I felt much calmer. That was about a year and a half ago, and I still take the same dose of K daily, with very occasional Xanax. I get the same benefits as I did initially, and haven't had a panic attack or major episode of anxiety since.
For the first couple of weeks that I took K, I was a bit drowsy, forgetful, and clumsy -- nothing too serious, but I did notice it. I tried various dosing schedules (always sticking to 1 mg/day); first 1 mg before bed, then 0.25 mg 4X/day, then 0.5 mg 2X/day. The side effects went away pretty quickly, and I settled on 1 mg all at once in the morning. I haven't experienced any side effects at all since the first couple of weeks. However, if I don't take it for a day, I feel very anxious -- whether this is dependence or just a return to my pre-K state, I'm not sure, but my pdoc emphasized that if I choose to discontinue it, I should do so very gradually, with his supervision.
There's been a ton of discussion on the pros and cons of Klonopin here recently. There are dependency issues (which don't worry me too much any more), and some people say it causes them depression. For me, it actually stopped the cycle of severe anxiety followed by a massive crash into depression, which has been a regular pattern for me since childhood. So, in that sense, K acts as an antidepressant for me, but has the opposite effect in others.
I did have some low-level depression after starting K, but nothing like before. My pdoc made one last try with SSRIs (very low-dose Zoloft) and that was a disaster. Luckily (?) I'd also been diagnosed with ADD previously, and my pdoc agreed, so he suggested adding stimulants. We settled on low-dose Adderall, and that's helped greatly with both concentration and the remaining depression.
I also take Neurontin; I'm not sure it does much, but my pdoc suspects that it adds "background stability". It has no side effects for me so I'm staying with it for now.
Obviously, your doctor knows you much better than I do, but you might discuss Klonopin with him/her. If he/she is willing to prescribe Ativan, that suggests a willingness to use benzodiazepines when appropriate. Klonopin is a benzo, and is generally considered one of the safest and least subject to abuse.
All the best,
Viridis
Posted by ZeeZee on November 24, 2002, at 22:17:24
In reply to Nardil gone; surprising new med to try, posted by HopeNotLost on November 22, 2002, at 20:18:56
I highly recommend Parnate. I used Nardil with much success for my panic disorder and agoraphobia. I was able to do things without thinking much of it, like you've described. However due to the side effects I switched to Parnate and enjoyed 4 years of feeling fairly free of my symptoms. I have not been able to resume the use due to side effects that I never had before (I felt energized with increased libido and decreased weight on the Parnate the first go around). I would definitley recommend you ask your doc about this. Be sure you wait the two weeks before starting it though. I had a hypertensive crisis by being switched too soon.
Good Luck
Posted by Franz on November 25, 2002, at 10:06:18
In reply to Re: Clarification re: Gabatril, posted by viridis on November 23, 2002, at 15:35:58
> For the first couple of weeks that I took K, I was a bit drowsy, forgetful, and clumsy -- nothing too serious, but I did notice it. I tried various dosing schedules (always sticking to 1 mg/day); first 1 mg before bed, then 0.25 mg 4X/day, then 0.5 mg 2X/day. The side effects went away pretty quickly, and I settled on 1 mg all at once in the morning. I haven't experienced any side effects at all since the first couple of weeks.
Hi viridisI am finding it a bit difficult to set the right dose of klonopin.
What is the difference from taking a complete dose once a day (say morning) and half that dose twice a day?. Will taking the split dose give a more stable amount of the drug during the day?.
I am trying to take 2 1/4 .5mg dose/day. Sometimes I feel it is too much (maybe I am still not accustomed to it), but cutting a .5mg pill in eight parts is impossible. So maybe taking 1/4 .5 mg in the morning is enough and if I really need it I could add another 1/4.
>However, if I don't take it for a day, I feel very anxious --
that is bad, so it is better to take some pills with you...
thanks
Posted by viridis on November 27, 2002, at 1:02:32
In reply to klono dose Re: Clarification re: Gabatril » viridis, posted by Franz on November 25, 2002, at 10:06:18
Hi Franz,
Klonopin is supposed to have a very long half-life (the time it takes for half of the drug to be fully metabolized), which is why once-a-day dosing is effective for many people. I found that if I took it before bed, though, its effects wore off by the middle of the next day. Taking divided doses seemed alright for the first while and minimized side effects, but once these disappeared (pretty quickly) it just seemed more effective and convenient to take it all at once in the morning. My pdoc was quite comfortable with whatever dosing schedule worked best -- he commented that doctors on the east coast (of the US) prefer once-a-day dosing and those in the west prefer several smaller doses throughout the day.
It sounds like you're especially sensitive to Klonopin. It should be possible to compound it if cutting up the pills into such tiny pieces is too difficult. This means powdering or dissolving it in something so that you can get the dose you want more easily (for example, if you dissolved a pill in a glass of orange juice, you could drink 1/8 glass at intervals to get the dose you want). For many medications this is possible, but I'd ask an expert for advice. You might ask your pharmacist -- a few pharmacies specialize in this approach, and even if yours doesn't, a good pharmacist could probably give you some tips on how to do this most effectively.
I suspect that the side effects will wear off, but everyone is different in their sensitivity to various medications. I hope that it's helping, despite the side effects.
Posted by DynaUnity333 on December 2, 2004, at 9:40:03
In reply to Re: klono dose Re: Clarification re: Gabatril » Franz, posted by viridis on November 27, 2002, at 1:02:32
I wonder sometimes if people dont take the side effects of the medications they start seriously enough.
If someone is having such memory problems and/or stupor/zoned out etc, it would seem to me that maybe the med is not the right one.
Maybe Gaba is just not the problem for that person.
If someone has enough gaba available in the brain and suddenly its increased its quite easy to conclude that Gaba raising is not necassarily what is needed.
I started Klonopin six weeks ago immediately on 3mgs a day (1mg, three times a day), and apart from the occasional balance problem (which imo is mor to do with me bouncing around without the anxiety, but could well be to do with the Klono aswell), i have had absolutely no side effects except an occasional rise in mood and a little paranoia.
The paranoia has been iliminated with an intake of l-histidine (amino acid to raise histamine), and by adding gabapentin for stability.
I truly believe people should listen to thir bodies when starting taking medications because they will quickly tell you whther or not its something it needs.
Then again YMMV as the old saying goes, maybe you are so deficient in Gaba the body dosn't know what to do with it just yet and its accostoming.
Who knows, but i would suggest tht if the symptoms weren't to calm down over the next couple of weeks to think bout tapering off and trying something else.
Maybe Buspar. It gets a bad rep but it CAN be a really good medication taken at the right dose which is often quite higher than the literature suggests.
A friend of mine used it to withdraw from alcohol and she said it was like a beacon of light??? Not sure what that means, but it was definitely positive.
Listen to yourself, and think about it.
This is the end of the thread.
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