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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by dbc on January 29, 2007, at 12:13:13
What is going on neurologically with alprazolam compared to other BZPs? This has been a question posed many times in different forms and i've never seen a real explanation of the mechanics. Is it just hitting more of the GABAa receptor subunits? Is it the fact that the triazolo-ring helps its pass through the blood brain barrier easier?
I ask this because currently im treating a panic disorder and i was getting to around 6mg - 8mg for a maintenance dose of ativan and then decided to switch to xanax and 3mg seems to easily keep things under control and im even considering lowering the dose a little. I have experiance with both drugs in smaller doses but this has confirmed my feelings that theres much more going on with the alprazolam than with most BZPs.
We generally tend to think that all benzos are created equal aside from their half life and dosing but im starting to think differently.
Posted by Phillipa on January 29, 2007, at 14:38:44
In reply to (technical) What makes alprazolam seem so potent?, posted by dbc on January 29, 2007, at 12:13:13
May I follow your thread. I think it pertains to me but don't have the answer. Thanks Love Phillipa
Posted by bassman on January 29, 2007, at 17:33:59
In reply to (technical) What makes alprazolam seem so potent?, posted by dbc on January 29, 2007, at 12:13:13
While the phrase that all benzos are the same in terms of GABA and that they just differ in serum half-life is really common, that doesn't seem to be the experience of many of the members that write for this board. I have PD and find that Ativan does nothing, Klonopin makes me depressed, and Xanax works very well. I think the truth of the matter is that no one really knows the answer to your question, although scientific rationalizations abound. I find it interesting that many people that have PD find something "special" about Xanax in terms of effectiveness and that non-PD folks often don't like the way they feel with Xanax. It often makes them feel very sleepy, spacey, or just plain confused. Could it be that panic has quite a different mechanism than other forms of anxiety and that's why Xanax is so effective on that population? You've got me. :>}
Posted by dbc on January 30, 2007, at 20:24:28
In reply to Re: (technical) What makes alprazolam seem so potent?, posted by bassman on January 29, 2007, at 17:33:59
Answering my own question...
Xanax has been show to have anti-depressant effects.
"These data provide further support for the hypothesis that the GABA/benzodiazepine/Cl complex is directly implicated in the action of antidepressants and that systems other than the GABA system are involved in the antidepressant and anxiolytic effects of alprazolam."
reference:http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1355436&dopt=Abstract
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=2833319&dopt=Abstract
Posted by yxibow on January 31, 2007, at 2:05:34
In reply to (technical) What makes alprazolam seem so potent?, posted by dbc on January 29, 2007, at 12:13:13
Besides the possible antidepressant effect, Xanax has an immediacy effect (the time between ingestion and anxiolytic relief) similar to Ativan that other benzodiazepines do not possess as much.
That's why Xanax is a good medication more for PRN usage than for continuous round the clock dosing because of interdosal withdrawals.But some people respond better to Xanax regardless and for that small population I would suggest Xanax XR, patent renewal comments set aside, than a multi pill dosal regime of regular Xanax.
-- tidings
Posted by bassman on January 31, 2007, at 6:39:51
In reply to Re: (technical) What makes alprazolam seem so pot, posted by dbc on January 30, 2007, at 20:24:28
I find that Xanax has an antidepressant effect on me and has for years-but these articles are pretty old and I wonder how much of what they propose is still considered reasonable. I find Xanax is good for panic precisely because it stimulates me as opposed to calming me.
Posted by blueberry1 on January 31, 2007, at 15:15:51
In reply to Re: (technical) What makes alprazolam seem so pot, posted by bassman on January 31, 2007, at 6:39:51
What dose do you take?
> I find that Xanax has an antidepressant effect on me and has for years-but these articles are pretty old and I wonder how much of what they propose is still considered reasonable. I find Xanax is good for panic precisely because it stimulates me as opposed to calming me.
Posted by bassman on January 31, 2007, at 17:50:27
In reply to Re: (technical) What makes alprazolam seem so pot » bassman, posted by blueberry1 on January 31, 2007, at 15:15:51
0.75 to 1.25 mg/day. I find that the combination of alprazolam and an SSRI works well, and just an SSRI doesn't. I don't know why.
Posted by valene on January 31, 2007, at 18:32:19
In reply to Re: (technical) What makes alprazolam seem so pot, posted by bassman on January 31, 2007, at 17:50:27
Bassman, do you mind saying which SSRI you take with xanax? I am considering adding an SSRI to my alprazolam, but not sure I want to try Lexapro.......which is what the pdoc I consulted recommended.
Thanks, Val
Posted by bassman on January 31, 2007, at 19:45:47
In reply to Re: (technical) What makes alprazolam seem so pot » bassman, posted by valene on January 31, 2007, at 18:32:19
Don't mind at all (remember I have PD): Initially, I tried Paxil, which gave me the best three years of my life, then Lexapro, which was alright but oddly had profound sexual side effects, and now I'm taking Prozac at a low (10 mg) dose. The Paxil + alprazolam combo energized me so much that I couldn't wait to get out of bed in the morning-and yet didn't interfere with sleeping in the least. Good days.
Posted by psychobot5000 on February 2, 2007, at 17:27:20
In reply to Re: (technical) What makes alprazolam seem so pot, posted by bassman on January 31, 2007, at 17:50:27
> 0.75 to 1.25 mg/day. I find that the combination of alprazolam and an SSRI works well, and just an SSRI doesn't. I don't know why.
>I just yesterday read a study, wherein researchers checked whether lorazepam (ativan) would block the antidepressant effect of paroxetine. I believe they had placebo, paroxetine (paxil), and paroxetine + lorazepam groups of depressed patients.
Contrary to expectations, they found a higher likelihood of remission in the lorazepam + paxil group, than with paxil alone. (Something like 80% to 57% in remission). The data indicate lorazepam (and possibly alprazolam too?) is an effective adjunct to SSRIs. It's a very statistically significant result.
Posted by bassman on February 2, 2007, at 18:11:41
In reply to Re: alprazolam, lorazepam and SSRIs, posted by psychobot5000 on February 2, 2007, at 17:27:20
Wow, thanks! That's really interesting.
Posted by psychobot5000 on February 2, 2007, at 21:29:02
In reply to Re: alprazolam, lorazepam and SSRIs, posted by psychobot5000 on February 2, 2007, at 17:27:20
I've done a little more reading, and I thought I'd note that, apparently, the conventional medical view of this is that benzodiazepines can all produce "symptomatic" results on the HAM-D and MADRS tests, thus seeming to show remission, when they're actually not dealing with the depression. Just relieving the 'distress' type symptoms--which those rely heavily on. ...So, that said, the lorazepam + paxil results may not be significant.
However, I've also read various research that seems to suggest that several benzodiazepines--alprazolam mostly, possibly lorazepam--are different, and seem to have an independent antidepressant action.
Posted by bassman on February 3, 2007, at 8:55:22
In reply to Re: alprazolam, lorazepam and SSRIs, posted by psychobot5000 on February 2, 2007, at 21:29:02
Thanks! I think the common view of depression is that it is exactly "symptoms", that is, the "symptoms" are the disease. If one takes that view, then removing the "symptoms" is significant-it is exactly my experience that alprazolam takes away the pain of depression, to some extent. Hard not to think of that as good. :>}
Posted by rina on February 9, 2007, at 11:00:38
In reply to Re: alprazolam, lorazepam and SSRIs, posted by psychobot5000 on February 2, 2007, at 17:27:20
> > 0.75 to 1.25 mg/day. I find that the combination of alprazolam and an SSRI works well, and just an SSRI doesn't. I don't know why.
> >
>
> I just yesterday read a study, wherein researchers checked whether lorazepam (ativan) would block the antidepressant effect of paroxetine. I believe they had placebo, paroxetine (paxil), and paroxetine + lorazepam groups of depressed patients.
>
> Contrary to expectations, they found a higher likelihood of remission in the lorazepam + paxil group, than with paxil alone. (Something like 80% to 57% in remission). The data indicate lorazepam (and possibly alprazolam too?) is an effective adjunct to SSRIs. It's a very statistically significant result.I stopped lorazepam because it keep me dizzy and nutty as a fruit cake.
>
Posted by bassman on February 9, 2007, at 11:22:03
In reply to Re: alprazolam, lorazepam and SSRIs, posted by rina on February 9, 2007, at 11:00:38
Yipes! I hope you don't have panic disorder-the last thing us PD guys like is being dizzy-probably because it means the Panic Monster is about to strike.
This is the end of the thread.
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