![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 13 to 37 of 42. Go back in thread:
Posted by SLS on May 23, 2008, at 21:20:51
In reply to Re: Suggestions for non-benzo anxiolytics PLEASE.. » torachan, posted by Quintal on May 23, 2008, at 20:21:43
I've seen people use Phenergan (promethazine) as an anxiolytic when nothing else worked. I really don't know much about the drug except that it is a phenothiazine derivative. There is some chance of developing EPS with Phenergan. It seems minimal compared to Thorazine. I'm not sure what the statistics are on that. It might be worth looking into if you are resistent to the anxiolytic effects of the benzodiazepines.
- Scott
Posted by Molybdenum on May 24, 2008, at 0:37:52
In reply to Re: Suggestions for non-benzo anxiolytics PLEASE.., posted by SLS on May 23, 2008, at 21:20:51
> I've seen people use Phenergan (promethazine) as an anxiolytic when nothing else worked. I really don't know much about the drug except that it is a phenothiazine derivative. There is some chance of developing EPS with Phenergan. It seems minimal compared to Thorazine. I'm not sure what the statistics are on that. It might be worth looking into if you are resistent to the anxiolytic effects of the benzodiazepines.
>
>
> - Scott
>Thanks Scott,
I know promethazine gets used as a sedative for children, so I imagine it's relatively safe.
Thing is, with all my other meds on board, I'm trying not to get anything that includes sedation.
I'm not resistant to the benzos - not psychologically or physically. I mean, I know Xanax really kills my anxiety perfectly. I'm just very wary about building up a tolerance. For instance, I used to take .5mg Xanax every few days. Last few weeks it's been 3 times a day - and I can feel the anxiety come creeping back in the moment the .5mg wears off.
"That" is what worries me about the benzos. Plus from experience I know that getting off them is not so easy and can involve a degree of rebound anxiety. Put those ideas together & that's why I am wanting an "anything but benzo" drug.
Funny about Efexor (venlafaxine). I'm on a huge dose of it & every time my dosage got increased I'd get anxiety for a week or so until I got used to it. And yet for many, it relieves their anxiety.
We really need those scientists to hurry up with those pre-med tests - the ones that can determine if a given drug will work on you. That will be a great day for Babblers the world over....
Posted by SLS on May 24, 2008, at 4:39:15
In reply to Re: Suggestions for non-benzo anxiolytics PLEASE.., posted by Molybdenum on May 24, 2008, at 0:37:52
I know this one guy who was taking Phenergan for many months. I saw him after he had been on it for awhile. He had no sedation at that point. Unfortunately, I see him only rarely. I don't know how he felt upon startup of the drug.
What about the extended release Xanax?
- Scott
Posted by Molybdenum on May 24, 2008, at 4:54:03
In reply to Re: Suggestions for non-benzo anxiolytics PLEASE.. » Molybdenum, posted by SLS on May 24, 2008, at 4:39:15
> I know this one guy who was taking Phenergan for many months. I saw him after he had been on it for awhile. He had no sedation at that point. Unfortunately, I see him only rarely. I don't know how he felt upon startup of the drug.
>
> What about the extended release Xanax?
>
>
> - ScottHmm....well I'll keep the Phenergan in mind - thanks.
As for Xanax XR, I can't see why it would be any different than simply popping a lesser dose 3 times a day. I think the XR factor is just a convenience issue. So I'd be just as worried about taking it as I would the standard Xanax.
...and unfortunately I think I'll need to rely on an anxiolytic medium to long term too. Without writing another chapter of my life here, basically I am in the middle of a messy divorce. Kids involved, lots of stress & lawyers.
Every time I get a bit of bad news it hits me really hard. I just get devastated for the next week. Physically it triggers / causes pretty severe anxiety 24x7 plus my confidence in dealing with other little problems (like unemployment) gets eroded too. Did I say eroded? I mean wiped out. So is this GAD? I don't know. I'm just writing it in case someone thinks this type of anxiety lends itself to a certain type of drug.
Thanks ;)
Mr Be Damned.
Posted by SLS on May 24, 2008, at 5:08:58
In reply to Re: Suggestions for non-benzo anxiolytics PLEASE.., posted by Molybdenum on May 24, 2008, at 4:54:03
I'm sorry about the stressors you have to deal with. They can definitely present themselves as an increase of both depression and anxiety. What's more, both of these conditions are going to magnify and make overwhelming any bad news that comes by.
You might have mentioned this before, but Effexor and Paxil are particularly good for GAD. I am nervous about mentioning Lyrica because a minority of people have reacted to it by making their depression worse - myself included. Buspar works well for some people, but this is probably the exception rather than the rule. Don't discount it, though. Nardil would probably work. This drug is a work-horse and treats a variety of psychiatric conditions, including unipolar depression, bipolar depression, OCD, GAD, and social anxiety/phobia.
- Scott
Posted by Molybdenum on May 24, 2008, at 6:32:36
In reply to Re: Suggestions for non-benzo anxiolytics PLEASE.. » Molybdenum, posted by SLS on May 24, 2008, at 5:08:58
Hi,
As I'm already on a high dose of Efexor, increasing it isn't an option for me. I find it interesting though, that it is commonly prescribed for GAD because I had much increased anxiety when I started on it & whenever I increased the dose. I remember having to increase in 37.5mg increments because the angst was too much on a 75mg bump.
Funny how we all react differently....
Another thing too SLS - you have Babblemail turned off. So nobody can send you a message. Just checking that this is intentional.
Regards
Mr Be Damned.
Posted by SLS on May 24, 2008, at 7:11:32
In reply to Re: Suggestions for non-benzo anxiolytics PLEASE.. » SLS, posted by Molybdenum on May 24, 2008, at 6:32:36
> Funny how we all react differently....
Yes. It can be a real pain in the derrière.
> Another thing too SLS - you have Babblemail turned off. So nobody can send you a message. Just checking that this is intentional.
Yes, it is. It was a difficult decision to make to turn my babblemail off because it makes me less accessible. However, I need to protect my boundaries. Thanks for checking me out on that.
I think I would drop the Effexor now if I were you. You could cross-over to Paxil for a little while to see if it treats you any differently.
- Scott
Posted by Quintal on May 24, 2008, at 9:34:34
In reply to Re: Suggestions for non-benzo anxiolytics PLEASE.., posted by SLS on May 23, 2008, at 21:20:51
I've taken quite a few packets of Phenergan over the years. I mostly used it as a sleep-aid, and as an anxiolytic when I was withdrawing from clonazepam. I'd say it was moderately effective for anxiety, but it did cause very significant sedation. Unlike benzos, I thought the anxiolytic effect was closely related to the sedative effect, much like Atarax etc.
My drug book recommends promethazine be used only as a short-term measure because "this drug may cause involuntary movements of the tongue and face if taken for more than three months. In practice however, this is not usually a problem since promethazine is used only for short periods of time." If you go to the same pharmacist every time, they probably wouldn't dispense it for more than two or three times in a row, unless you lied to them how and why you were using it. I've found pharmacists quite reluctant to give me it because "it's very strong". They usually recommend Kwells (for motion sickness) instead. Every pharmacist I've gone to has refused to dispense it as a sleep aid, even though it is indicated for this purpose.
Q
Posted by SLS on May 24, 2008, at 9:37:51
In reply to Re: Suggestions for non-benzo anxiolytics PLEASE.., posted by Quintal on May 24, 2008, at 9:34:34
Best to keep away from it, then.
- Scott> I've taken quite a few packets of Phenergan over the years. I mostly used it as a sleep-aid, and as an anxiolytic when I was withdrawing from clonazepam. I'd say it was moderately effective for anxiety, but it did cause very significant sedation. Unlike benzos, I thought the anxiolytic effect was closely related to the sedative effect, much like Atarax etc.
>
> My drug book recommends promethazine be used only as a short-term measure because "this drug may cause involuntary movements of the tongue and face if taken for more than three months. In practice however, this is not usually a problem since promethazine is used only for short periods of time." If you go to the same pharmacist every time, they probably wouldn't dispense it for more than two or three times in a row, unless you lied to them how and why you were using it. I've found pharmacists quite reluctant to give me it because "it's very strong". They usually recommend Kwells (for motion sickness) instead. Every pharmacist I've gone to has refused to dispense it as a sleep aid, even though it is indicated for this purpose.
>
> Q
Posted by undopaminergic on May 24, 2008, at 17:06:28
In reply to Suggestions for non-benzo anxiolytics PLEASE..??? » torachan, posted by Molybdenum on May 23, 2008, at 18:25:18
>
> Anyway, so any non-benzo anti-anxiety meds you can suggest would be greatly appreciated...!
>I've never been as relaxed and free from anxiety as when I took codeine cough syrup some time ago, along with a little bit of dextromethorphan-based cought syrup that also contained tiny amounts of salbutamol. It is notable that I was also taking stimulants, memantine and guanfacine at the time.
Memantine helps prevent tolerance to opiates. So perhaps memantine + an opioid would be a workable solution?
Posted by Sigismund on May 24, 2008, at 21:52:28
In reply to Re: Suggestions for non-benzo anxiolytics PLEASE.., posted by Quintal on May 23, 2008, at 19:09:20
When I took even small amounts of moclobemide (75mg/d) I felt like having a stiff drink.
Posted by Molybdenum on May 25, 2008, at 2:21:54
In reply to Re: Suggestions for non-benzo anxiolytics PLEASE.., posted by Sigismund on May 24, 2008, at 21:52:28
Thanks to everyone for your thoughts & suggestions. The more I read about Moclobemide (the relatively little info there is out there compared to other drugs), the more I wonder why its on the market at all. Seems to be "the boss's son" of the drug world ;)
I'll keep at it for a couple of weeks & see how I go. The two doses so far don't seem to be producing any new side effects.
Thanks....
M.
Posted by Phillipa on May 25, 2008, at 12:02:00
In reply to Re: Suggestions for non-benzo anxiolytics PLEASE.. » Molybdenum, posted by SLS on May 24, 2008, at 7:11:32
Scott just added small dose of generic paxil to luvox 50mg. paxil is only 5mg but so far lots of watery diarrhea sorry to be graphic. Used to need magnesium and colace should I continue on paxil? Also still on the valium thanks Phillipa
Posted by undopaminergic on May 25, 2008, at 17:29:29
In reply to Re: Suggestions for non-benzo anxiolytics PLEASE.. » SLS, posted by Phillipa on May 25, 2008, at 12:02:00
> Scott just added small dose of generic paxil to luvox 50mg. paxil is only 5mg but so far lots of watery diarrhea sorry to be graphic.
>Try adding some loperamide or codeine. I did that with Lexapro and managed to avoid the loose stools.
Posted by undopaminergic on May 25, 2008, at 17:36:01
In reply to Re: Suggestions for non-benzo anxiolytics PLEASE.., posted by Molybdenum on May 25, 2008, at 2:21:54
>
> I'll keep at it for a couple of weeks & see how I go. The two doses so far don't seem to be producing any new side effects.
>Be *very* careful about using moclobemide with venlafaxine. The combination has the potential to precipitate hyperserotonergia (serotonin syndrome), and deaths have been reported. Make sure you have cyproheptadine at hand as an antidote, and take a tablet if you find your temperature on the rise, as the condition can sometimes progress rapidly to the point where consciousness is lost.
Posted by undopaminergic on May 25, 2008, at 18:08:48
In reply to Re: Suggestions for non-benzo anxiolytics PLEASE.., posted by Quintal on May 23, 2008, at 19:09:20
> The older non-selective MAOIs are better for anxiety than moclobemide, particularly Nardil. Other options include Lyrica, Neurontin, Anafranil and even BuSpar. I don't mean to cast a shadow over your trial, but moclobemide really is a pretty poor anxiolytic.
> If you're worried about addiction/dependence with benzos you could try alternating it with Lyrica every few months to allow your benzo receptors to re-grow (I don't know if this actually works, but it's something I'd like to try).
>Benzos bind to GABA-A receptors, and I think gabapentin (Neurontin) and pregabalin (Lyrica) also work on the GABAergic system, so cross-tolerance may be an issue. Perhaps alternating between GABAergic drugs (such as benzos) and opiates would be a better idea, as opiates work on their own set of receptors rather than GABA.
I consider opioids advantageous also because NDMA-antagonists (including at least memantine and dextromethorphan) are highly effective for preventing or reversing tolerance to them, whereas I don't know of anything that prevents or reverses benzodiazepine-tolerance. Furthermore, opioid-withdrawals are less severe, and can be further diminished by alpha2-agonists - such as clondidine and guanfacine, whereas I don't know of anything - other than possibly barbiturates and alcohol - that can control benzo-withdrawals.
Posted by undopaminergic on May 25, 2008, at 18:14:31
In reply to Re: Suggestions for non-benzo anxiolytics PLEASE.., posted by torachan on May 23, 2008, at 19:00:19
>
> I considered Nardil like you Moly, but with dietary restrictions of MAOI's Id never give it a go. I LOVE cheese and the odd alcoholic beverage, along with some other likely prohibited foods.
>Alcohol isn't a problem with MAOIs. Besides, there is a potential chemical solution to tyramine sensitivity, namely noradrenaline reuptake inhibitors, such as reboxetine or even methylphenidate. Unfortunately, this solution remains theoretical as long as people don't dare try it.
Posted by Molybdenum on May 25, 2008, at 19:54:11
In reply to Re: Suggestions for non-benzo anxiolytics PLEASE.., posted by undopaminergic on May 25, 2008, at 18:14:31
Thanks for all the suggestions undopa. I really appreciate it.
>Be *very* careful about using moclobemide with venlafaxine. The combination has the potential to precipitate hyperserotonergia (serotonin syndrome), >and deaths have been reported. Make sure you have cyproheptadine at hand as an antidote, and take a tablet if you find your temperature on the rise, as >the condition can sometimes progress rapidly to the point where consciousness is lost.
Yeah...I am a bit concerned. I've just taken my 3rd 150mg Moclobemide tab (over 3 days). I feel "slightly dizzy" but not enough to stop me driving, etc. Otherwise I have noticed my anxiety has reduced a lot. Time will tell if this is due to the drug or not. I have to remain hopeful, else why take anything? Doc said the anxiolytic effects were best at low doses, which is good. FYI, the data sheet says peak plasma concentration is reached at 7 days, so by then I guess I'll know if I'm going to get serotonin syndrome or not. ;)
I'd never heard of your suggested antidote "cyproheptadine" so I looked it up & found that it also sounds like a good sleeping pill. In fact it says "cyproheptadine enhances sleep quality and quantity whereas benzodiazepines tend to decrease sleep quality". Only downside is that is causes sedation. No good for me because it would be negating the effect of my ADs I suppose. Pity, sounds good otherwise.
>Benzos bind to GABA-A receptors, and I think gabapentin (Neurontin) and pregabalin (Lyrica) also work on the GABAergic system, so cross-tolerance >may be an issue. Perhaps alternating between GABAergic drugs (such as benzos) and opiates would be a better idea, as opiates work on their own set of >receptors rather than GABA.
Opiates are very hard to get here on account of their abuse potential. I've taken 60mg codeine with paracetamol as a pain medication post surgery & found that it really affected me mentally. I know you'd like me to be more precise but the best description I can come up with is that I felt very "out of it". So I think I'll have to pass on the codeine.
>Alcohol isn't a problem with MAOIs. Besides, there is a potential chemical solution to tyramine sensitivity, namely noradrenaline reuptake inhibitors, >such as reboxetine or even methylphenidate. Unfortunately, this solution remains theoretical as long as people don't dare try it.
I read a bit about the MAOI diet in my quest. Even Dr Bob has a page on it: http://www.dr-bob.org/tips/maoi.html#avoid From what I read, it's the tyramine content that is the main issue, and predicting how much tyramine is in the food you're about to eat is not so easy. The older the food is (aged cheese or wines) the more tyramine. I even read that spoiled fish has a lot more tyramine than fresh, but who the hell would intentionally eat spoiled fish??? If you thought it was fresh, you'd eat it. If you thought it was spoiled, you wouldn't. Beats me... So I think the level of dietary restriction you choose depends on how high your MAOI dose is and how cautious you want to be.
Good thing for me while I'm trying out moclobemide is that it doesn't really have any dietary restrictions. From the manufacturer's data sheet: "Thus an interaction with tyramine rich foods is of no clinical importance during moclobemide treatment under normal conditions..". If I choose to leave this world any time soon, I think "death by cheese" will be very low down on my list.... ;) Funny, have you ever seen this film? - have a quick read: http://en.wikipedia.org/wiki/La_Grande_Bouffe
Thanks again to all for the help. I've made a list in case the moclobemide turns out to be a dud...!
:)
M.
Posted by boltsdraggin on May 25, 2008, at 20:39:53
In reply to Re: Suggestions for non-benzo anxiolytics PLEASE.., posted by torachan on May 23, 2008, at 19:16:23
Wow, forget who posted Q is lamictal effective for anxiety - but honest to God, it never worked for me. I was on lamictal at the time I had my breakdown. The anticonvulsants are used more for bipolar disorder or mood stabilization.
Posted by boltsdraggin on May 25, 2008, at 20:54:05
In reply to Re: Suggestions for non-benzo anxiolytics PLEASE.., posted by boltsdraggin on May 25, 2008, at 20:39:53
Interesting stuff here.....
I'm still gaining knowledge in my nursing work with mental health, and it appears that I have so MUCH more to learn. ;-)
Posted by Quintal on May 26, 2008, at 8:38:22
In reply to Re: Suggestions for non-benzo anxiolytics PLEASE.., posted by undopaminergic on May 25, 2008, at 18:08:48
>Benzos bind to GABA-A receptors, and I think gabapentin (Neurontin) and pregabalin (Lyrica) also work on the GABAergic system, so cross-tolerance may be an issue.
It could be, but since they work at a different site, they could support the GABA system (preventing or attenuating withdrawal symptoms) and allow the benzodiazepine receptors to upregulate, so that when a person starts taking them again tolerence is back to pre-drug levels. Dopamine agonists can do a similar job with opiates by supporting the dopamine system during withdrawal while the opiate recetors recover [personal experience].
>Perhaps alternating between GABAergic drugs (such as benzos) and opiates would be a better idea, as opiates work on their own set of receptors rather than GABA.
Being realistsic, where would people get these opiates from? They're even more tightly controlled (and addictive) than benzos. The original concern was addiction with benzos.
>I consider opioids advantageous also because NDMA-antagonists (including at least memantine and dextromethorphan) are highly effective for preventing or reversing tolerance to them, whereas I don't know of anything that prevents or reverses benzodiazepine-tolerance.
I don't think either of those drugs are highly effective at reversing opiate tolerence. I once read an study where lamotrigine was used to delay tolerence to buprenorphine for six months or so, but ultimately it only delayed tolerence, it didn't reverse or prevent it. I've tried lots of these supposed tolerence reversal stratergies and none of them have worked. The only reliable way of reversing tolerence I know of is to slowly withdraw from the drug and stay off it for a few months.
> Furthermore, opioid-withdrawals are less severe,
I wouldn't say opioid withdrawal is less severe than benzo withdrawal, but it depends on the dose. They're both in the same ballpark, and both are fairly hellish if you're coming abruptly off a high dose.
>and can be further diminished by alpha2-agonists - such as clondidine and guanfacine, whereas I don't know of anything - other than possibly barbiturates and alcohol - that can control benzo-withdrawals.
Clonidine and guanfacine only reduce certain symptoms of opiate withdrawal. They're not a magic cure and carry significant side effects of their own. Many drugs can attenuate some of the symptoms of benzo withdrawal, including Neurontin and Lyrica, but in both cases the best remedy for withdrawal is to slowly decrese the dose of the original drug.
Q
Posted by undopaminergic on May 26, 2008, at 15:40:47
In reply to Re: Suggestions for non-benzo anxiolytics PLEASE.., posted by Molybdenum on May 25, 2008, at 19:54:11
> Thanks for all the suggestions undopa. I really appreciate it.
>
> >Be *very* careful about using moclobemide with venlafaxine. The combination has the potential to precipitate hyperserotonergia (serotonin syndrome), >and deaths have been reported. Make sure you have cyproheptadine at hand as an antidote, and take a tablet if you find your temperature on the rise, as >the condition can sometimes progress rapidly to the point where consciousness is lost.
>
> Yeah...I am a bit concerned. I've just taken my 3rd 150mg Moclobemide tab (over 3 days). I feel "slightly dizzy" but not enough to stop me driving, etc.
>Have you taken your temperature? And blood pressure?
>
> I'd never heard of your suggested antidote "cyproheptadine" so I looked it up & found that it also sounds like a good sleeping pill. In fact it says "cyproheptadine enhances sleep quality and quantity whereas benzodiazepines tend to decrease sleep quality". Only downside is that is causes sedation.
>Sedation is precisely what you want from a sleeping pill. On the other hand, when cyproheptadine is used as an antihistamine, which was the original intention, sedation would typically be undesirable.
>
> Opiates are very hard to get here on account of their abuse potential. I've taken 60mg codeine with paracetamol as a pain medication post surgery & found that it really affected me mentally. I know you'd like me to be more precise but the best description I can come up with is that I felt very "out of it". So I think I'll have to pass on the codeine.
>The effects - and side-effects - are dose-dependent. 60 mg is pretty much - my impressive anxiolytic experience resulted from less than 15 mg. I imagine that powerful opioids like morphine and oxycodone might be difficult to get, but the "minor" ones might not, unless you mention (or otherwise hint at) your interest in their mind-altering - as opposed to pain-killing - properties.
Posted by undopaminergic on May 26, 2008, at 18:53:40
In reply to Re: Suggestions for non-benzo anxiolytics PLEASE.. » undopaminergic, posted by Quintal on May 26, 2008, at 8:38:22
> >Benzos bind to GABA-A receptors, and I think gabapentin (Neurontin) and pregabalin (Lyrica) also work on the GABAergic system, so cross-tolerance may be an issue.
>
> It could be, but since they work at a different site, they could support the GABA system (preventing or attenuating withdrawal symptoms) and allow the benzodiazepine receptors to upregulate, so that when a person starts taking them again tolerence is back to pre-drug levels.
>It may be well worth trying - assuming, of course, that both types of drugs are suffiently effective and well-tolerated in the individual case.
> Dopamine agonists can do a similar job with opiates by supporting the dopamine system during withdrawal while the opiate recetors recover [personal experience].
>Some combination of dopaminergic drugs is quite likely to effectively replace the dopaminergic effects of opioids, but unfortunately not the analgesic effects. Or did you find the dopamine agonists to be effective pain-killers?
> >Perhaps alternating between GABAergic drugs (such as benzos) and opiates would be a better idea, as opiates work on their own set of receptors rather than GABA.
>
> Being realistsic, where would people get these opiates from? They're even more tightly controlled (and addictive) than benzos. The original concern was addiction with benzos.
>The point of alernating between benzos and opioids is to avoid addiction to either of them. Availability can certainly be an issue, but some of the less potent opiates are available without prescription, unlike any benzodiazepine. The ease of getting a prescription for opiate preparations of higher potency is highly variable - as with benzos, some doctors are totally against them, except possibly for terminal cancer, whereas other doctors are more pragmatic and don't have a problem with their usage in moderation.
> >I consider opioids advantageous also because NDMA-antagonists (including at least memantine and dextromethorphan) are highly effective for preventing or reversing tolerance to them, whereas I don't know of anything that prevents or reverses benzodiazepine-tolerance.
>
> I don't think either of those drugs are highly effective at reversing opiate tolerence. I once read an study where lamotrigine was used to delay tolerence to buprenorphine for six months or so, but ultimately it only delayed tolerence, it didn't reverse or prevent it. I've tried lots of these supposed tolerence reversal stratergies and none of them have worked. The only reliable way of reversing tolerence I know of is to slowly withdraw from the drug and stay off it for a few months.
>My personal experience is limited, but my impression from what I've read is that the evidence for the efficacy of NMDA-antagonists in attenuating and preventing the development of tolerance is almost overwhelming, and there are reasonably strong indications that reversal of existing tolerance by NMDA-antagonists is quite feasible under many conditions. I'm not suggesting that it's a workable solution in every case - some people are more prone to devlop tolerance, and some may not tolerate sufficient doses to NDMA-antagonists. Besides, even if tolerance were preventable without exception, there may simply be better solutions than opioids depending on the details of the individual case.
> > Furthermore, opioid-withdrawals are less severe,
>
> I wouldn't say opioid withdrawal is less severe than benzo withdrawal, but it depends on the dose. They're both in the same ballpark, and both are fairly hellish if you're coming abruptly off a high dose.
>Yes, it depends on dose, the degree of dependence, rate of cessation, as well as factors that vary between individuals. However, it's generally accepted that opioid withdrawal is very rarely a serious threat to health physiologically, which is in contrast to benzodiazepines and many other GABAergic drugs.
>
> >and can be further diminished by alpha2-agonists - such as clondidine and guanfacine, whereas I don't know of anything - other than possibly barbiturates and alcohol - that can control benzo-withdrawals.
>
> Clonidine and guanfacine only reduce certain symptoms of opiate withdrawal. They're not a magic cure and carry significant side effects of their own.
>The sympathetic (adrenergic) hyperactivation resulting from the rapid cessation of opiates is the main physiological hazard of the withdrawal syndrome, and these symptoms respond well to the alpha2-agonists. Clonidine is more likely than guanfacine to be troublesome in terms of its side effects; the latter has few adverse effects in my experience, except dryness of the mouth at high doses. A variety of other drugs, including benzos, may be useful for other aspects of the withdrawal syndrome if slow discontinuation or substitution of another opioid is not a suitable alternative.
> Many drugs can attenuate some of the symptoms of benzo withdrawal, including Neurontin and Lyrica, but in both cases the best remedy for withdrawal is to slowly decrese the dose of the original drug.
>A suitably slow rate of discontinuation of any drug that has significant withdrawal effects is generally a sensible way to handle it, but in the case of short-acting drugs, it's often a better idea to switch to a longer acting agent of the same class, such as diazepam in the case of benzos, and methadone or buprenorphine in the case of opiates.
Some references concerning the use of NMDA-antagonists to reduce opiate tolerance -
NMDA receptor antagonists inhibit opiate antinociceptive tolerance and locomotor sensitization in rats.
http://www.ncbi.nlm.nih.gov/pubmed/17994223Inhibitory effects of MPEP, an mGluR5 antagonist, and memantine, an N-methyl-D-aspartate receptor antagonist, on morphine antinociceptive tolerance in mice.
http://www.ncbi.nlm.nih.gov/pubmed/12442203Clinically available NMDA receptor antagonists memantine and dextromethorphan reverse existing tolerance to the antinociceptive effects of morphine in mice.
http://www.ncbi.nlm.nih.gov/pubmed/10763858Clinically available NMDA antagonist, memantine, attenuates tolerance to analgesic effects of morphine in a mouse tail flick test.
http://www.ncbi.nlm.nih.gov/pubmed/10600036Effects of NMDA receptor channel blockers, dizocilpine and memantine, on the development of opiate analgesic tolerance induced by repeated morphine exposures or social defeats in mice.
http://www.ncbi.nlm.nih.gov/pubmed/9750014Morphine with dextromethorphan: conversion from other opioid analgesics.
http://www.ncbi.nlm.nih.gov/pubmed/10687339Oral administration of dextromethorphan prevents the development of morphine tolerance and dependence in rats.
http://www.ncbi.nlm.nih.gov/pubmed/8951930Effects of perioperative oral amantadine on postoperative pain and morphine consumption in patients after radical prostatectomy: results of a preliminary study.
http://www.ncbi.nlm.nih.gov/pubmed/14695734NMDA BLOCKERS & Memantine
http://www.drgeorgedavidson.com/ebixa_memantine_experience.htmGetting off Methadone with Memantine
http://www.drgeorgedavidson.com/ebixa_getting_off_methadone.htm
Posted by Molybdenum on May 26, 2008, at 20:42:19
In reply to Re: Suggestions for non-benzo anxiolytics PLEASE.., posted by undopaminergic on May 26, 2008, at 18:53:40
Hiya,
I did a little research on opioids and there does seem to be potential for a promising new class of combo anti-depressant + anxiolytics to be explored.
I admit this site is a bit flaky sometimes but here goes anyway: http://opioids.com/jdtic/antidepressant-anxiolytic.html
I couldn't find JDTic for sale anywhere, so I guess I'm a few years to early for that. ;)
Strange thing is that I haven't felt nearly as anxious since I've been taking the moclobemide. I'm only on 150mg, but it might actually be working(!).
My BP is 135/92. That's not bad for me. I have been 150/110 in the past. I've been taking Candesartan Cilexetil for about a year as an antihypertensive. My GP blamed the venlafaxine for the rise in blood pressure. So day 4 of moclobemide seems to be going OK. :)
No idea what my temp is - but I really feel OK. In 3 more days my plasma level of moclobemide with be stabilised (they say it takes a week). If I don't have serotonin syndrome by then, I guess I never will.
I take your point about sedation & cyproheptadine. *doh* :) I just assumed it might produce sedation into the next day - which I really don't need. The real problem with cyproheptadine for me was reading at Wiki that "Cyproheptadine is an antihistaminic and antiserotonergic agent. It acts as a 5-HT2 receptor antagonist and also blocks calcium channels."
I'd be worried that this might mean it's antihistaminic properties may work to undo the mechanism of modafinil. That would be a tragic waste..!
Also, the antiserotonergic aspect so necessary as an antidote to serotonin syndrome would I am sure, negate the "S" aspect of my SNRI venlafaxine. Plus my mirtazapine works by blocking presynaptic alpha-2 adrenergic receptors that inhibit the release of NE and serotonin. So it would work against the serotonin increase I get from that too. And I need every bit of antidepressant activity I can get..! As I said, it's a pity.... because it sounds great otherwise. ;)
Thanks again for all the suggestions. Like the Terminator said "I have detailed files" :)
Take Care
Mr Be Damned.
Posted by Sigismund on May 26, 2008, at 23:34:57
In reply to Re: Suggestions for non-benzo anxiolytics PLEASE.., posted by undopaminergic on May 26, 2008, at 18:53:40
> The ease of getting a prescription for opiate preparations of higher potency is highly variable - as with benzos, some doctors are totally against them, except possibly for terminal cancer
This made me laugh. But thank you for the methadone/memantine reference. That might have been useful for me. Those results sound very impressive.
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