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Dr. Bob is Robert Hsiung, MD,
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Posted by anxiety_free on November 23, 2004, at 4:32:37
In reply to What is best for anxiety? Benzos or APs?, posted by AlexSamuel on November 23, 2004, at 3:23:34
Hey! OK, here's my take on this debate: anti-psychotics should be reserved primarily for those who are...psychotic, prone to psychosis, etc. So those with schizophrenia and people with bipolar disorder, people with anxiety with psychotic features, etc. can greatly benefit from these drugs and the risk is usually worth it, especially with newer anti-psychotics. Now, in your case, a benzo works almost as well as an old-school AP. My advice would be to take a benzo, but something longer-lasting than xanax (xanax xr, klonopin) and ditch the stelazine. That way you get long-lasting relief, few side effects, and the longer-acting drugs are (supposedly) easier to taper, so you'll be able to stop the drug if you want to. Good luck!
Posted by Paul Smith on November 23, 2004, at 5:28:49
In reply to benzos vs APs, posted by anxiety_free on November 23, 2004, at 4:32:37
I`ll add that benzos can be very painful for some people to taper or stop. And withdrawal effects can be long term. Also, doctors can be fickle with them, not wanting to cooperate with needed dose increases, or wanting to push you off of them. The more promising solutions seem to be meds like Paxil. But it is all in the individuals needs, what works, risks and rewards. But pays to be educated in all that may be involved.
Posted by ed_uk on November 23, 2004, at 6:01:23
In reply to What is best for anxiety? Benzos or APs?, posted by AlexSamuel on November 23, 2004, at 3:23:34
Hi AlexSamual,
What dose of trifluoperazine do you use?
Ed
Posted by smokeymadison on November 23, 2004, at 12:41:14
In reply to Re: What is best for anxiety? Benzos or APs?, posted by ed_uk on November 23, 2004, at 6:01:23
hey,
i have dealt with anxiety for quite a few years. paxil does work all right but the sexual side effects were intolerable for me. I have tried Xanx and Klonopin but they aren't as effective for constant anxiety as Gabitril. It is an anticonvulsant that works great for anxiety and also helps stabilize mood. I have nothing but praise for it although if you have ever had seizures you should be careful with it b/c since it is an anticonvulsant it can mess with those instaed of prevent them in some rare cases. good luck!
Posted by ed_uk on November 23, 2004, at 12:49:16
In reply to Re: What is best for anxiety? Benzos or APs?, posted by ed_uk on November 23, 2004, at 6:01:23
Hi!
If you do decide to use the trifluoperazine on a long term basis you need to make sure that you're taking the minimum effective dose.
Regards,
Ed.
Posted by CareBear04 on November 23, 2004, at 23:00:40
In reply to What is best for anxiety? Benzos or APs?, posted by AlexSamuel on November 23, 2004, at 3:23:34
having taken all the new antipsychotics, many of the old, and almost all the benzos, i would say go with the benzos. the only effective antipsychotic for me has been haldol which, like stelazine, is one of the old ones. both can cause irreversible problems like tardive dyskenesia. haldol and other old APs have a lot of side effects and interactions that are hard to predict and control. that said, xanax and benzos cause dependence, but at least you can better predict and treat their effects. you can control how much you take and learn not to mix them with substances that will make them stronger. the downside is that you never know whether your next doctor will support your benzo use and keep prescribing whereas no one who doesn't need something like haldol or stelazine is likely to ask for a script. that's just my view. good luck, cb
Posted by AlexSamuel on November 24, 2004, at 2:22:40
In reply to Re: What is best for anxiety? Benzos or APs?, posted by ed_uk on November 23, 2004, at 6:01:23
Hi Ed, others
I am on 2mg which I think is a small dose. Meanwhile, I have got some samples of Dolmatil(Sulpiride) from my doc. Should I try it instead of Stelazine? Xanax gives me a drugged feeling while stelazine is so subtle. I am afraid to continue xanax, most probably I will end up in abusing it to experience that drugged high feeling. So, either Stelazine or Sulpiride. I have to make choice in between these two big S's. What may be your choice?
Thanks for all
Posted by AlexSamuel on November 24, 2004, at 2:36:18
In reply to Re: What is best for anxiety? Benzos or APs? » AlexSamuel, posted by CareBear04 on November 23, 2004, at 23:00:40
Hi Care,
Thanks for your reply. I too wish if I could have stayed indefinitely on Xanax without ever increasing the dose or abusing it. (BTW I never increased the dose, there was no need of it) As you stated, it is easy to get a script for Stelazine from any doc, but most of the docs are highly treatment resistant benzophobics. I don't know when my current doc is going to retire and substitute with a new one with the phobia. I don't like to take chances, so am on a very small dose of Stelazine which I hope will never induce TD. Xanax is very hard to come off, while I can stop Stelazine at short notice. These are the advantages I see on going with a particular AP. Once again your opinions please.
Posted by darkhorse on November 24, 2004, at 5:59:16
In reply to Re: What is best for anxiety? Benzos or APs? » ed_uk, posted by AlexSamuel on November 24, 2004, at 2:22:40
> Hi Ed, others
>
> I am on 2mg which I think is a small dose. Meanwhile, I have got some samples of Dolmatil(Sulpiride) from my doc. Should I try it instead of Stelazine? Xanax gives me a drugged feeling while stelazine is so subtle. I am afraid to continue xanax, most probably I will end up in abusing it to experience that drugged high feeling. So, either Stelazine or Sulpiride. I have to make choice in between these two big S's. What may be your choice?
> Thanks for allHi,
I have tried both and I think that Sulpiride at 50mg a day is a much better choice : I had Akathisia with stelazine at 2mg,and sulpiride is one of the APs that are known to very ralrley cause the famous AP's side effects.....However, personally, I wouldn't trade AP for a benzo to treat anxiety-related issues..AP's are powerful drugs on the mind and can have very serious effects, while benzos have no serious side effects and all that you need is to choose the one that suits you and to take it as needed- the risk of "addiction" is way overexaggerated.
Posted by ed_uk on November 24, 2004, at 8:20:27
In reply to Re: What is best for anxiety? Benzos or APs?, posted by darkhorse on November 24, 2004, at 5:59:16
Hi AlexSamuel,
Are you having any side effects from the Stelazine at the moment? How long have you been taking the Stelazine?
Do you take 1mg twice daily or a 2mg spansule once daily. If you decide to continue the Stelazine you should find the lowest dose which helps you. You can do this using the Steazine syrup. It contains 1mg/5ml. The pharmacy can give you a 2.5ml spoon to measure out doses as low as 0.5mg. Alternatively, you could buy an 'oral syringe' to measure out very low doses accurately.
Ed
Posted by pseudonym on November 24, 2004, at 12:51:49
In reply to Re: What is best for anxiety? Benzos or APs? » AlexSamuel, posted by CareBear04 on November 23, 2004, at 23:00:40
Finally, after a year of hand-wringing, Dov's ocinaplon (a non-sedative, non-addictive anxiolytic) will enter the phase III trial. This qualifies as good news to GAD and possible Social Anxiety sufferers. Ocinaplon is not a "me-too" compound either, its mechanism of action is unique in that it targets the anxiolytic subset of GABA-A receptors. I'm happy because ocinaplon is another possibility to rid myself of this non-sensical anxiety.
Posted by KaraS on November 24, 2004, at 15:49:29
In reply to Good news: Dov's ocinaplon in phase III, posted by pseudonym on November 24, 2004, at 12:51:49
> Finally, after a year of hand-wringing, Dov's ocinaplon (a non-sedative, non-addictive anxiolytic) will enter the phase III trial. This qualifies as good news to GAD and possible Social Anxiety sufferers. Ocinaplon is not a "me-too" compound either, its mechanism of action is unique in that it targets the anxiolytic subset of GABA-A receptors. I'm happy because ocinaplon is another possibility to rid myself of this non-sensical anxiety.
I remember hearing the same kind of things about Buspar. Do you know how this one compares to that?
Posted by pseudonym on November 24, 2004, at 16:25:20
In reply to Re: Good news: Dov's ocinaplon in phase III, posted by KaraS on November 24, 2004, at 15:49:29
You are cetainly correct regarding the promotion of Buspar. Yet never, in any test I have heard or read, was Buspar shown it be as effective an anxiolytic as Valium. The same goes for the SSRIs, now that I think of it. Ocinaplon is consistently shown to be more effective an anxiolytic than Valium at doses which do not induce sedation, muscle incoordination, and amnesia. Also, there is a completely different mechanism of action between buspar and ocinaplon. Ocinaplon targets the GABA-A receptor subtypes which are anxiolytic, and does not target those which are responsible for sedation and amnesia. You can think of ocinaplon as benzo- (benzo minus), in that it targets the GABA-A "anxiety receptors", not each and every GABA-A receptor, like all current benzos.
Posted by jclint on November 24, 2004, at 17:26:53
In reply to Re: Good news: Dov's ocinaplon in phase III, posted by pseudonym on November 24, 2004, at 16:25:20
Sorry for my ignorance, but how long do drugs normally take to get to market once they reach stage III? Its the last stage prior to approval right?
Posted by KaraS on November 25, 2004, at 1:58:17
In reply to Re: Good news: Dov's ocinaplon in phase III, posted by pseudonym on November 24, 2004, at 16:25:20
> You are cetainly correct regarding the promotion of Buspar. Yet never, in any test I have heard or read, was Buspar shown it be as effective an anxiolytic as Valium. The same goes for the SSRIs, now that I think of it. Ocinaplon is consistently shown to be more effective an anxiolytic than Valium at doses which do not induce sedation, muscle incoordination, and amnesia. Also, there is a completely different mechanism of action between buspar and ocinaplon. Ocinaplon targets the GABA-A receptor subtypes which are anxiolytic, and does not target those which are responsible for sedation and amnesia. You can think of ocinaplon as benzo- (benzo minus), in that it targets the GABA-A "anxiety receptors", not each and every GABA-A receptor, like all current benzos.
Thanks for explaining that. This certainly does sound like an exciting new drug. I sure hope it's as good as its sounds.
Posted by rvanson on November 25, 2004, at 5:16:49
In reply to What is best for anxiety? Benzos or APs?, posted by AlexSamuel on November 23, 2004, at 3:23:34
> Hi
>
> When both Xanax and Stelazine(Trifluoperazine-an antipsychotic) are effective for my anxiety, what should I prefer? In terms of effectiveness, trifluoperazine is slightly better over Xanax, because it controls worries better than xanax. But in terms of side effects Xanax is more tolerable without any side effects.
> Using your rationality, what do you advise me? Xanax is addictive, Stelazine is not. But Stelazine has more side effects and long-term effects? (who knows?)
> Can you please answer dear reader
Xanax.Stelazine can bring on TD for one thing.
Xanax will not.
It;s also not nearly as "addictive" as you may think it is.
Posted by rvanson on November 25, 2004, at 5:22:40
In reply to Good news: Dov's ocinaplon in phase III, posted by pseudonym on November 24, 2004, at 12:51:49
> Finally, after a year of hand-wringing, Dov's ocinaplon (a non-sedative, non-addictive anxiolytic) will enter the phase III trial. This qualifies as good news to GAD and possible Social Anxiety sufferers. Ocinaplon is not a "me-too" compound either, its mechanism of action is unique in that it targets the anxiolytic subset of GABA-A receptors. I'm happy because ocinaplon is another possibility to rid myself of this non-sensical anxiety.
Watch out for the elevated liver enzyme levels associated with this drug, if it ever makes it to market.
My best guess is that it will be no miracle drug.
Just another Cybalta that everyone here waited for so long, only to find out that it isnt all that great a drug :(
Posted by pseudonym on November 25, 2004, at 13:18:56
In reply to Re: Good news: Dov's ocinaplon in phase III, posted by rvanson on November 25, 2004, at 5:22:40
rvanson, I hear you on the elevated liver enzyme issue. As I recall, that issue came from one patient in the phase II trial, it was not widespread. But anyway, that's part of the point of the phase III trial, to test liver enzymes, along with efficacy. If liver enzymes are a problem, then the drug will be rejected period. If not, then we have something to look forward too.
The reason this is exciting to me is the mechanism of action - Ocinaplon is not a "me-too" compound like Cymbalta. Closely associated with with Ocinaplon is Indiplon, which is licensed via Pfizer/Neurocrine. Indiplon compound targets the GABA-A receptors responsible for sedation. If you want muscle-incoordination, they can probably build you a drug for that too:) It depends on which subtype you target.
Posted by pseudonym on November 25, 2004, at 13:40:34
In reply to Re: Good news: Dov's ocinaplon in phase III, posted by jclint on November 24, 2004, at 17:26:53
Yes, phase III is the last phase, but ... compounds can be in phase III for a long time. Duloxetine (Cymbalta) had a successful phase III test somewhere in 2001 I believe. Cymbalta then arrived on the market 3+ years later. Pregabalin was in phase III in 2000, and it was approved in Europe in 2004. So, best case scenario is late 2006. Don't lose sleep over this one.
Posted by jclint on November 25, 2004, at 15:57:24
In reply to Good news: Dov's ocinaplon in phase III, posted by pseudonym on November 24, 2004, at 12:51:49
Just found this in a news article, thought it might interest some people.
"Ocinaplon is DOV's product candidate for the treatment of anxiety disorders, including GAD, the first indication for which the Company intends to seek FDA approval. Anxiety can be defined in broad terms as a state of unwarranted or inappropriate worry, often accompanied by restlessness, tension, distraction, irritability and sleep disturbances and is made up of various disorders, including GAD, panic disorder and phobias. GAD is the most common of the anxiety disorders, with a lifetime prevalence of approximately 5%. Every year, it is estimated that approximately 15 million people in the U.S. suffer solely from an anxiety disorder.
The Company believes ocinaplon, a non-benzodiazepine, can address significant unmet needs for the treatment of anxiety disorders. Ocinaplon appears to selectively modulate a specific subset of GABAA receptors that DOV believes are involved in the mediation of anxiety. Preclinical studies have demonstrated that ocinaplon produces an anti-anxiety effect at doses 20 to 40 times lower than doses that produce sedation and muscle relaxation and 10 times lower than doses that produce amnesia. In preclinical studies, ocinaplon was also shown to be 15 times less likely than Valium to potentiate the sedating effects of alcohol. By contrast, benzodiazepines often produce these side effects at doses approximating those that produce an anti-anxiety effect.
To date, 11 clinical trials on ocinaplon have been conducted, including nine Phase I trials. In these clinical trials, ocinaplon was shown to be safe and well-tolerated at the maximum doses used, with no evidence of sedation or any other side effects typically associated with benzodiazepines. To date, 477 subjects have been treated with ocinaplon.
In DOV's two Phase II double-blind, placebo-controlled clinical trials, ocinaplon exhibited the following characteristics:
-- efficacy at least comparable to what has been reported for
benzodiazepines;-- rapid onset of action;
-- a favorable side effect profile not significantly different from
placebo; and-- no "rebound" anxiety following treatment cessation."
Posted by krybrahaha78 on April 21, 2006, at 0:41:18
In reply to Ocinaplon details, posted by jclint on November 25, 2004, at 15:57:24
Is this drug still coming out?
> Just found this in a news article, thought it might interest some people.
>
> "Ocinaplon is DOV's product candidate for the treatment of anxiety disorders, including GAD, the first indication for which the Company intends to seek FDA approval. Anxiety can be defined in broad terms as a state of unwarranted or inappropriate worry, often accompanied by restlessness, tension, distraction, irritability and sleep disturbances and is made up of various disorders, including GAD, panic disorder and phobias. GAD is the most common of the anxiety disorders, with a lifetime prevalence of approximately 5%. Every year, it is estimated that approximately 15 million people in the U.S. suffer solely from an anxiety disorder.
>
> The Company believes ocinaplon, a non-benzodiazepine, can address significant unmet needs for the treatment of anxiety disorders. Ocinaplon appears to selectively modulate a specific subset of GABAA receptors that DOV believes are involved in the mediation of anxiety. Preclinical studies have demonstrated that ocinaplon produces an anti-anxiety effect at doses 20 to 40 times lower than doses that produce sedation and muscle relaxation and 10 times lower than doses that produce amnesia. In preclinical studies, ocinaplon was also shown to be 15 times less likely than Valium to potentiate the sedating effects of alcohol. By contrast, benzodiazepines often produce these side effects at doses approximating those that produce an anti-anxiety effect.
>
> To date, 11 clinical trials on ocinaplon have been conducted, including nine Phase I trials. In these clinical trials, ocinaplon was shown to be safe and well-tolerated at the maximum doses used, with no evidence of sedation or any other side effects typically associated with benzodiazepines. To date, 477 subjects have been treated with ocinaplon.
>
> In DOV's two Phase II double-blind, placebo-controlled clinical trials, ocinaplon exhibited the following characteristics:
>
> -- efficacy at least comparable to what has been reported for
> benzodiazepines;
>
> -- rapid onset of action;
>
> -- a favorable side effect profile not significantly different from
> placebo; and
>
> -- no "rebound" anxiety following treatment cessation."
>
>
Posted by Tom Twilight on April 21, 2006, at 16:23:01
In reply to what is the current status of Ocinaplon?, posted by krybrahaha78 on April 21, 2006, at 0:42:46
This looks a great drug, on paper at least
The last I heard was bad news though :(
Apparently a patient in a trial experienced elivated liver enzymes or somesuch
Athough this was probably not due to the drug it caused problems for aproval.
Posted by yxibow on April 22, 2006, at 6:05:26
In reply to Re: what is the current status of Ocinaplon?, posted by Tom Twilight on April 21, 2006, at 16:23:01
> This looks a great drug, on paper at least
>
> The last I heard was bad news though :(
>
> Apparently a patient in a trial experienced elivated liver enzymes or somesuch
>
> Athough this was probably not due to the drug it caused problems for aproval.I believe it is shelved at the moment or for good, but in 2004:
http://panicdisorder.about.com/b/a/095407.htm
They're bringing indiplon to the insomnia market though soon, theoretically.
You can look up any NDA/ANDAs for drugs already streamlined through the FDA at
http://www.accessdata.fda.gov/scripts/cder/drugsatfda/index.cfm
Posted by yxibow on April 22, 2006, at 6:24:39
In reply to Re: what is the current status of Ocinaplon? » Tom Twilight, posted by yxibow on April 22, 2006, at 6:05:26
The advanced method of searching allows you to search any 3 month period without entering an drug name starting from 1950 -- a curious history of medications in the United States, not that it answered your question.
Posted by aabag on April 22, 2006, at 14:49:09
In reply to Re: what is the current status of Ocinaplon?, posted by Tom Twilight on April 21, 2006, at 16:23:01
The drug was pulled in phase III trials. This was the compound which showed the most efficacy as an anxioytic, without inducing dependency, sleep, amnestic effects blah blah blah...doesn't matter now. But it was pulled due to liver enzyme elevations in a couple patients. I wonder if McDonald's cheeseburgers would ever pass FDA scrutiny without liver enzyme elevation? Clinical trial would run as follows (1 cheeseburger T.I.D) -- tongue in cheek.
This is the end of the thread.
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