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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 11 to 35 of 35. Go back in thread:
Posted by SLS on February 21, 2005, at 13:43:20
In reply to Re: Kindling?, posted by ed_uk on February 21, 2005, at 13:06:44
> Scott, I think you may find this interesting............
Yes. Another major consequence of a kindling model is that the withdrawal syndrome becomes more severe with repeated exposures. I decided not to mention it previously because I didn't want to introduce too many concepts at once.
- Scott
Posted by Minnie-Haha on February 21, 2005, at 15:24:30
In reply to Re: Kindling?, posted by SLS on February 20, 2005, at 8:15:31
> Has anyone discontinued Paxil, Effexor, or a benzodiazepine while taking an anticonvulsant / mood stabilizer? Which one(s)? How would you describe your withdrawal experience?
I got off of Effexor while I was on a mood stabilizer. I can't remember now whether it was Depakote (my first MS) or Trileptal (my second/current MS), but I just don't remember having severe problems. I gradually decreased my Effexor dose and slowly started up on Wellbutrin.
Posted by Minnie-Haha on February 21, 2005, at 15:26:14
In reply to Re: Kindling?, posted by SLS on February 20, 2005, at 8:43:18
> It might not be a bad idea to look at glutamatergic activity as being involved in the development and persistence of a withdrawal syndrome...
You completely lose me when you talk like this, but I like that there are people here who understand this stuff enough to ask what appear to be really good questions.
Posted by SLS on February 21, 2005, at 16:32:34
In reply to Re: Kindling?, posted by Minnie-Haha on February 21, 2005, at 15:24:30
Hi Minnie
Your contribution was EXTREMELY helpful. Thank you.
> > Has anyone discontinued Paxil, Effexor, or a benzodiazepine while taking an anticonvulsant / mood stabilizer? Which one(s)? How would you describe your withdrawal experience?
> I got off of Effexor while I was on a mood stabilizer. I can't remember now whether it was Depakote (my first MS) or Trileptal (my second/current MS), but I just don't remember having severe problems. I gradually decreased my Effexor dose and slowly started up on Wellbutrin.Have you ever needed to discontinue an SSRI (Prozac, Zoloft, Paxil, Luvox, Celexa, Luvox)? Were you on a mood stabilizer at the time? What was your experience?
> > It might not be a bad idea to look at glutamatergic activity as being involved in the development and persistence of a withdrawal syndrome...
> You completely lose me when you talk like this,That's OK. I get lost often when I try to make heads or tails of what the neuroscientists are talking about. Out of necessity, I have been learning this stuff - VERY SLOWLY - over the course of many years. I think that applies to a great many people here who would just as soon not know anything about medicine at all should there never have been a need to.
Thanks again.
- Scott
Posted by Minnie-Haha on February 22, 2005, at 13:57:38
In reply to Re: Kindling? » Minnie-Haha, posted by SLS on February 21, 2005, at 16:32:34
> Have you ever needed to discontinue an SSRI (Prozac, Zoloft, Paxil, Luvox, Celexa, Luvox)? Were you on a mood stabilizer at the time? What was your experience?
Actually, the first AD I ever had to get off of was Zoloft. I had taken it once for 4-6 months for depression, so when I had depression again a couple of years later it was RXd again. However, this second time, after I'd been on it for some months, I started to feel really weird... agitated. As I look back on it now, I think it may have been largely anxiety, but as I'd never experienced anxiety like that before, I didn't recognize it. (Oh, for those long-gone, innocent days.) Anyway, I was immediately put on Depakote and phased off of Zoloft and onto Effexor. Once again, I don't recall this being particularly problematic.
Are you hypothesizing that being on a mood stabilizer may make starting/stopping an AD easier? (I know some use benzos to help with withdrawals, maybe MSs could be helpful, too? I don't know.)
Posted by SLS on February 22, 2005, at 16:07:47
In reply to Re: Kindling?, posted by Minnie-Haha on February 22, 2005, at 13:57:38
Hi.
> Are you hypothesizing that being on a mood stabilizer may make starting/stopping an AD easier?:-)
We'll see...
Thanks for responding.
- Scott
Posted by SLS on March 6, 2005, at 8:05:21
In reply to Re: Kindling?, posted by SLS on February 22, 2005, at 16:07:47
Hi.
I'm not entirely sure that kindling can account for the length of time withdrawal symptoms can persist for weeks and months after drug discontinuation. I would love for there to be a study on this. Will a taper schedule that prevents a withdrawal syndrome from appearing also prevent it from persisting? This is a question that is crucial to have answered.
An alternative explanation is that the changes in gene expression that occur during treatment persist as the altered dynamics between second messengers and nuclear events remain chronic. This would really suck. However, I would not give up on the idea that this situation could not be remedied pharmacologically. I would be interested to know how lithium might affect withdrawal. It might help reduce the excitability of the neuron by reducing the expression of G-protein coupled serotonin receptors.
Any takers?
- Scott
Posted by SLS on April 30, 2005, at 10:41:26
In reply to Re: Kindling?, posted by SLS on February 22, 2005, at 16:07:47
Has anyone tried to discontinue an antidepressant or benzodiazepine while taking an anticonvulsant mood-stabilizer? Which one(s)? How would you describe your withdrawal experience?
Depakote
Tegretol
Trileptal
Neurontin
Zonegren
Gabitril
Dilantin
Topamax
Lamictal
Keppra
Lyrica
- Scott
Posted by Declan on April 30, 2005, at 21:13:24
In reply to Re: Kindling?, posted by SLS on March 6, 2005, at 8:05:21
When tapering off methadone I took low dose Dilantin at night, 30-60mg. The idea was to minimise those convulsion-like spasms that came during sleep onset. Didn't notice anything really, but I did manage to reduce methadone to 1.25mg/d. Which is really difficult.
Declan
Posted by River1924 on May 1, 2005, at 12:40:56
In reply to Re: Kindling?, posted by SLS on April 30, 2005, at 10:41:26
I haven't time to read thru all these posts but, if you mind, what withdrawal symptoms would anti-convulsants prevent when stopping anti-depressants? I always take stimulants (or extra stimulants or provigal) to avoid this extraordinary dopiness I feel when I stop zoloft or effexor (Ordinarily, I just hop full dose from one anti-depressant to another and hope for the best.) The four anti-convulsants I've tried have been sedating and depressing. Just curious. Peace, River.
Posted by SLS on May 2, 2005, at 7:04:51
In reply to Re: Kindling? » SLS, posted by River1924 on May 1, 2005, at 12:40:56
> I haven't time to read thru all these posts but, if you mind, what withdrawal symptoms would anti-convulsants prevent when stopping anti-depressants?
I am not sure. I am just beginning to explore what role an anti-kindling medication might play in the course of withdrawal from antidepressants or benzodiazepines. My hope is that it would help prevent most of the withdrawal symptoms reported, including anxiety and "brain zaps".
- Scott
Posted by Slinky on May 5, 2005, at 23:08:23
In reply to Re: Kindling?, posted by SLS on May 2, 2005, at 7:04:51
After my dose of 200mg of Tegretol the brain zaps are reduced..not entirely but more bearable.
I've just ceased Paxil.Slinky
Posted by Chairman_MAO on May 8, 2005, at 13:48:50
In reply to Re: Kindling?, posted by SLS on May 2, 2005, at 7:04:51
For what it's worth, years ago I took Effexor with Dexedrine. When I started withdrawing from Effexor, I found that taking the Dexedrine (30-40mg at a time) eliminated all withdrawal symptoms from the Effexor.
I think kindling is relevant to withdrawal from benzodiazepines but not antidepressants. I had a pdoc tell me once that withdrawal from benzos was WORSE than barbiturates because seizures can occur up to 14 days after detoxification, which is unheard of with barbiturates. Antidepressants lower the seizure threshold (while benzos obviously raise it), so I would think that kindling upon withdrawal would be a nonissue, no? If you want I can ask a pharmacologist.
Posted by SLS on May 9, 2005, at 7:38:17
In reply to Re: Kindling? » SLS, posted by Chairman_MAO on May 8, 2005, at 13:48:50
> For what it's worth, years ago I took Effexor with Dexedrine. When I started withdrawing from Effexor, I found that taking the Dexedrine (30-40mg at a time) eliminated all withdrawal symptoms from the Effexor.
>
> I think kindling is relevant to withdrawal from benzodiazepines but not antidepressants. I had a pdoc tell me once that withdrawal from benzos was WORSE than barbiturates because seizures can occur up to 14 days after detoxification, which is unheard of with barbiturates. Antidepressants lower the seizure threshold (while benzos obviously raise it), so I would think that kindling upon withdrawal would be a nonissue, no? If you want I can ask a pharmacologist.
It would appear that withdrawal from SRIs phenomenologically appears like withdrawal from benzodiazepines in that it gets worse the longer it is allowed to continue. If the many reports of extended withdrawal syndrome lasting for months after the last dose of the offending agent can be believed, it looks like those experiencing the worst scenarios are those whom discontinued the SRI abruptly - "cold turkey".I'm too lazy to research it and make a case for a true kindling physiology of these phenomena, but it seems that they can be understood or managed as if they were - a virtual kindling if nothing else. If anything, something might be precipitating a resistance on the part of 5-HT neurons from reregulating themselves due to a lack of change of postsynaptic second messenger and nuclear events despite the loss on reuptake inhibition. The nerves remain hyperexcitable.
Do you happen to know what the physiology is behind the kindling of seizures? I'm not really clear on that.
- Scott
Posted by River1924 on May 10, 2005, at 1:59:19
In reply to Re: Kindling? » Chairman_MAO, posted by SLS on May 9, 2005, at 7:38:17
I think the "brain zap" phenomenon must get a better name. I've never experienced it but I'm willing to say it exists. I doubt if most people outside the psychobabble community would take anyone seriously if he or she said they had withdrawal "brain zaps." Do you think this problem is common?
On another note, would a drug like tianeptine help or a supplement like l-tryptophan? Could these brain zaps be a result of vitamin/amino acid/mineral deficiency?
Peace, River.
Posted by SLS on May 10, 2005, at 7:05:25
In reply to Re: Kindling? brain zaps » SLS, posted by River1924 on May 10, 2005, at 1:59:19
> I think the "brain zap" phenomenon must get a better name. I've never experienced it but I'm willing to say it exists. I doubt if most people outside the psychobabble community would take anyone seriously if he or she said they had withdrawal "brain zaps." Do you think this problem is common?
Even professional literature has failed to find a term for the phenomenon. The best they come up with is "electric shock like sensations". Perhaps we can call it paroxsysmal intracranial paresthesias.
> On another note, would a drug like tianeptine help
That would be a very interesting experiment. I'm not sure if it would make things better or worse.
> or a supplement like l-tryptophan?
That's another good idea that I would like to see tried by someone.
> Could these brain zaps be a result of vitamin/amino acid/mineral deficiency?
I don't think so. I think neurons become hyperexcitable upon a rapid or abrupt discontinuation of a SRI. It might reflect a downregulation of autoreceptors.
- Scott
Posted by Chairman_MAO on May 11, 2005, at 20:54:27
In reply to Re: Kindling? brain zaps » SLS, posted by River1924 on May 10, 2005, at 1:59:19
I noticed amphetamine eliminated the "brain zaps".
Posted by Chairman_MAO on May 11, 2005, at 21:04:07
In reply to Re: Kindling? » Chairman_MAO, posted by SLS on May 9, 2005, at 7:38:17
You bring up a very interesting point that is worthy of investigation. I am absolutely innundated with schoolwork, but I'm going to get around to asking this psychopharmacologist I know what he thinks, as well as my psychiatrist, who seems unusually well-versed in neuropsychopharmacology.
It really is great going to a shrink who knows way more about psych drug action than I do. Of course, it figures that she's barely out of med school; she's still waiting on getting her own Rx blanks, heh. I never asked, but I have a feeling that most of her knowledge was obtained through self-directed learning (which would be awesome because it would mean that she's in it because she loves doing it and not to make money/"be a doctor"), because soooooo many shrinks that I've come in contact with over the years just seem to be utterly clueless about how these drugs work on any more than a basic level. Given that I am an undergraduate whose knowledge is 80% self-taught, it frightens me when I figure out I know more than the MD I am talking to about the action of a drug he/she prescribes.
Posted by Chairman_MAO on May 13, 2005, at 9:21:11
In reply to Re: Kindling? brain zaps » River1924, posted by SLS on May 10, 2005, at 7:05:25
From my former psychopharmacology professor:
"There is no evidence for the kindling phenomenon from SSRIs"
Posted by SLS on May 13, 2005, at 9:37:34
In reply to Re: Kindling? brain zaps » SLS, posted by Chairman_MAO on May 13, 2005, at 9:21:11
> From my former psychopharmacology professor:
>
> "There is no evidence for the kindling phenomenon from SSRIs"Hmm.
Thanks.
How do you feel about Robert Post's idea for extending the concept of kindling to explain the worsening course of recurrent major depression?
- Scott
Posted by Chairman_MAO on May 13, 2005, at 11:08:52
In reply to Re: Kindling? brain zaps » Chairman_MAO, posted by SLS on May 13, 2005, at 9:37:34
I will have to investigate this. Re: kindling, you may find it interesting that, not on medication, I have consistent and pervasive mild LSD-like pseudohallucinations (patterns, trails, etc) (I used LSD many, many times between ages 19 and 21). One of the reasons I loved being on clonazepam so much is that it completely eliminated them (and perhaps some cognitive/emotional/behavioral problems that may have been concomitant with them). Unfortunately, they were worsened by multiple BZD withdrawals, including one that was purposefully induced in a HOSPITAL. Rather than taper me off 40mg/day diazepam, they gave me a THREE DAY librium taper! I was hallucinating like crazy, and could not move my bowels properly for weeks due to the muscle tension (had to use milk of magnesia to "go" for the first week). That was outright abuse and cruelty to me, as far as I'm concerned.
Interestingly enough, buprenorphine attenuated them a lot. When I switched to phenelzine from tranylcypromine, they all but vanished completely, probably due to the GABAnergic and serotonergic (SSRIs attenuated them to some degree as well) effects of phenelzine.
I'm going to ask to be sure, but I think kindling is relevant in this case. I know this is somewhat off topic, but given our discussion of kindling, I thought it would be good food for your thoughts.
Posted by ed_uk on May 13, 2005, at 11:48:04
In reply to Re: Kindling? brain zaps » SLS, posted by Chairman_MAO on May 13, 2005, at 11:08:52
>Rather than taper me off 40mg/day diazepam, they gave me a THREE DAY librium taper!
Three days! Were they trying to kill you???
Ed.
Posted by floatingbridge on July 16, 2009, at 3:31:16
In reply to Kindling?, posted by SLS on February 20, 2005, at 7:11:30
Hi Scott, I am trying to take in what I think you might be saying (with half flying over my head) to figure out if there are palltive measures to take in order to ease my withdrawal off pristiq. I also take klopopin, which, I hope to keep taking, and Dexedrine MAYBE in small does....as quickly as possible, Lets say the strong shock over the usually over atteuanted i experienced before.What do you think? Thanks!
FB
> I am becoming suspicious that the discontinuation syndrome (withdrawal) is self-reinforcing in a manner similar to the kindling model of epilepsy. If this is true, then one becomes increasingly sensitive to dosage reductions and the severity of the withdrawal symptoms increases over the taper period. The degree to which this occurs would be proportional to the amount of time one spends in the "withdrawal state". Among other things, this might explain why some people describe the persistence of withdrawal symptoms long after the drug has been discontinued. If kindling is operating, it makes it that much more critical to prevent the withdrawal state from emerging in the first place or discontinue the drug as rapidly as possible and endure the syndrome for a shorter period of time while intervening with palliative measures. Strategies might best be designed by taking into account the kindling process.
>
>
> - Scott
Posted by SLS on July 16, 2009, at 6:30:29
In reply to Re: Kindling? » SLS, posted by floatingbridge on July 16, 2009, at 3:31:16
>
> Hi Scott, I am trying to take in what I think you might be saying (with half flying over my head) to figure out if there are palltive measures to take in order to ease my withdrawal off pristiq. I also take klopopin, which, I hope to keep taking, and Dexedrine MAYBE in small does....as quickly as possible, Lets say the strong shock over the usually over atteuanted i experienced before.
>
> What do you think? Thanks!
>
> FBYour way of thinking is accurate in my opinion.
Using an anticovulsant might help. Trileptal was mentioned on the Withdrawal board as being effective. It is low on side effects. Someone else mentioned Depakote. Of the two, I can't guess which one would work best. My first reaction was to say Depakote, but the account given of Trileptal was compelling. Both drugs reduce glutamate excitability by inhibiting sodium channels and promoting GABA activity, although I would guess Depakote would be better at accomplishing the latter.
Morganpmiller has just posted that Depakote helped him with SRI withdwawal. Your taking Klonopin is not a problem given that it might mitigate withdawal somewhat.
- Scott
Posted by floatingbridge on July 16, 2009, at 12:17:03
In reply to Re: Kindling?, posted by SLS on July 16, 2009, at 6:30:29
This is the end of the thread.
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