Psycho-Babble Medication Thread 14073

Shown: posts 1 to 15 of 15. This is the beginning of the thread.

 

Mood Stabilizers

Posted by Susan on October 28, 1999, at 5:43:55

Has anyone heard of any documentation that Neurontin or Lamictal are being used as the first line of treatment for cyclothymia? Are these newer meds "safer" than Lithium or Depakote since they do not require blood level checks? Are they supposed to be more or as effective? If Lamictal causes a bad reaction (hypomania/nightmares/pain/etc.) would it be safe to try Neurontin?

 

Re: Mood Stabilizers

Posted by Elizabeth on October 28, 1999, at 10:32:07

In reply to Mood Stabilizers, posted by Susan on October 28, 1999, at 5:43:55

> Has anyone heard of any documentation that Neurontin or Lamictal are being used as the first line of treatment for cyclothymia? Are these newer meds "safer" than Lithium or Depakote since they do not require blood level checks? Are they supposed to be more or as effective? If Lamictal causes a bad reaction (hypomania/nightmares/pain/etc.) would it be safe to try Neurontin?

For their use as first-line agents, or in cyclothymia specifically? No. However, as far as I know, treatments for cyclothymia are pretty much the same as for bipolar II, and Lamictal and Neurontin both have been studied for that.

As for the first-line-ness, I think Neurontin is probably the "safest" of them all in that it doesn't have any of those "rare-but-potentially-dangerous" side effects (none that I can think of, anyway), whereas I'm sure you were cautioned to tell your doctor immediately if you develop a rash on Lamictal.

They are definitely better tolerated than lithium or Depakote (i.e., fewer side effects). I had no side effects from Lamictal (up to 500mg), and the only SE's I had from Neurontin were drowsiness (mild) and the munchies (the reason I didn't stay on it - I gather this is not a common problem, BTW).

 

Re: Mood Stabilizers

Posted by Sean on October 28, 1999, at 11:20:33

In reply to Re: Mood Stabilizers, posted by Elizabeth on October 28, 1999, at 10:32:07

> > Has anyone heard of any documentation that Neurontin or Lamictal are being used as the first line of treatment for cyclothymia? Are these newer meds "safer" than Lithium or Depakote since they do not require blood level checks? Are they supposed to be more or as effective? If Lamictal causes a bad reaction (hypomania/nightmares/pain/etc.) would it be safe to try Neurontin?
>
> For their use as first-line agents, or in cyclothymia specifically? No. However, as far as I know, treatments for cyclothymia are pretty much the same as for bipolar II, and Lamictal and Neurontin both have been studied for that.
>
> As for the first-line-ness, I think Neurontin is probably the "safest" of them all in that it doesn't have any of those "rare-but-potentially-dangerous" side effects (none that I can think of, anyway), whereas I'm sure you were cautioned to tell your doctor immediately if you develop a rash on Lamictal.
>
> They are definitely better tolerated than lithium or Depakote (i.e., fewer side effects). I had no side effects from Lamictal (up to 500mg), and the only SE's I had from Neurontin were drowsiness (mild) and the munchies (the reason I didn't stay on it - I gather this is not a common problem, BTW).

Hi-

Neurontin is very safe although I've found that
it is quite sedating. Safer than lithium for sure,
as people have injested mass quantities of Neurontin
and lived to tell the tale.

At this point, the use of Neurontin for mood
stabilization is still in the off-label phase.
There are a handful good studies, but nothing yet
that suggests "first-line" treatment status.
However, some p-docs on the cutting edge may
use it in this manner based on their personal
experience. As with all this stuff, you need to
try it personally.

Sean.

 

Re: Mood Stabilizers

Posted by Annie on October 28, 1999, at 12:24:06

In reply to Mood Stabilizers, posted by Susan on October 28, 1999, at 5:43:55

Susan,
If you do a search on PubMed, you will find quite a few articles on Neorontin(Gababentin)being used for bipolar, although cyclothymia is not mentioned specifically.
I am currently on 2800mg of Neurontin as a monotherapy for mixed state bipolar.
I have experienced both the "munchies" Elizabeth mentioned and the sedation Sean mentioned. Both of these, along with blurry vision, occur about a day after raising the dose and seem (for me) to go away after a few days. I have also noticed I am clumsier lately, dropping and spilling things frequently. This may just be some residual sedation or an adjustment to the medication.
I have not noticed any horrible side effects I experienced with Lithium and other mood stabilizers and think it would be safe to give it a try if your doctor thinks this could help you.
Annie

 

Re: Mood Stabilizers

Posted by Sean on October 28, 1999, at 13:13:02

In reply to Re: Mood Stabilizers, posted by Annie on October 28, 1999, at 12:24:06

> Susan,
> If you do a search on PubMed, you will find quite a few articles on Neorontin(Gababentin)being used for bipolar, although cyclothymia is not mentioned specifically.
> I am currently on 2800mg of Neurontin as a monotherapy for mixed state bipolar.
> I have experienced both the "munchies" Elizabeth mentioned and the sedation Sean mentioned. Both of these, along with blurry vision, occur about a day after raising the dose and seem (for me) to go away after a few days. I have also noticed I am clumsier lately, dropping and spilling things frequently. This may just be some residual sedation or an adjustment to the medication.
> I have not noticed any horrible side effects I experienced with Lithium and other mood stabilizers and think it would be safe to give it a try if your doctor thinks this could help you.
> Annie

Annie -
I can't take near the amount you are on - 600mg seems
to be the limit so far as my vision and balance are really
affected, so I'm climbing up slowly. No munchies
for me though, in fact, it seems to supress my
appetite.

Is Lamictal less sedating? I also don't seem to be
getting an AD effect from Neurontin. Are you?

 

Re: Mood Stabilizers

Posted by Annie on October 28, 1999, at 18:18:15

In reply to Re: Mood Stabilizers, posted by Sean on October 28, 1999, at 13:13:02

Sean,
I think my appetite is also somewhat depressed after the initial cravings. I am getting no AD affects that I notice yet. I have only been on Neurontin for 3 weeks so it's early in the game. I was only on Lamictal (as augmentation to Zoloft) for a short time a few years ago, so I have no info about it.
Annie

 

Neurontin and sedation, etc.

Posted by Elizabeth on October 28, 1999, at 23:37:51

In reply to Re: Mood Stabilizers, posted by Annie on October 28, 1999, at 18:18:15

Actually, Neurontin reminded me a lot of Xanax. Same sort of clumsy sedation, munchies, etc. I think the munchies thing is more a disinhibition effect than an appetite effect.

Anyone else find that Neurontin feels like a benzo? It has been used for panic and social phobia (actually I was taking it for panic disorder - ended up not needing it after I started an antidepressant).

 

Re: Mood Stabilizers

Posted by jamie on October 29, 1999, at 3:46:00

In reply to Mood Stabilizers, posted by Susan on October 28, 1999, at 5:43:55

Both neurontin and lamictal are used as 1st line with some pdocs around the country. They prefer the favorable side effect profiles compared to older choices. And they like the AD potential of lamictal. Lamictal can be activating or neutral whereas neurontin can be sedating. But sometimes it's the other way around. You know how that goes. Both are even used simultaneously I saw somewhre.

 

Re: Neurontin and sedation, etc.

Posted by Susan on October 29, 1999, at 11:40:32

In reply to Neurontin and sedation, etc., posted by Elizabeth on October 28, 1999, at 23:37:51

> Actually, Neurontin reminded me a lot of Xanax. Same sort of clumsy sedation, munchies, etc. I think the munchies thing is more a disinhibition effect than an appetite effect.
When I took Lamictal for 2 weeks I needed more Xanax in order to sleep. Xanax works good for me for panic and social phobia and is inexpensive so perhaps it makes sense to listen to my pdoc who has said that I do not use it enough and should accept that I will probably need it for a lifetime. ?? If Neurontin works like Xanax why would I want to try such an expensive medication? Especially if mood swings are controllable with Xanax which I originally started because of insomnia. I know Xanax is not a good choice for insomnia but the side effects are so minimal compared to Ambien, Tylenol PM, Ativan, Trazodone, Sinequan, etc.
>
> Anyone else find that Neurontin feels like a benzo? It has been used for panic and social phobia (actually I was taking it for panic disorder - ended up not needing it after I started an antidepressant).

My thinking has been that too much Effexor XR has the same effect as too little. Right now 75mg seems to be doing the trick but my pdoc thinks I am just in a good phase and will need Neurontin. Thanks for letting me think "out loud."

 

Re: Neurontin Off Label Usage (T)

Posted by Noa on October 29, 1999, at 14:49:38

In reply to Re: Neurontin and sedation, etc., posted by Susan on October 29, 1999, at 11:40:32

There may never be any big controlled studies of Neurontin as a mood stabilizer, because 1)it is already on the market and has FDA approval, 2)there is anecdotal reporting of its effectiveness for this use, and 3) it sounds like it is relatively safe. So who would be motivated to put up the money for a big time study? (Usually the funds come from the pharmaceutical company, and it is seen as an investment to get the drug on the market in the first place). Problem: Some managed care insurance companies won't cover off label usage. AARRGGHH!!!! (sorry for the appended (E) in this generally (T) post).

 

Re: Mood Stabilizers

Posted by Sean on October 29, 1999, at 14:56:35

In reply to Re: Mood Stabilizers, posted by Annie on October 28, 1999, at 18:18:15

> Sean,
> I think my appetite is also somewhat depressed after the initial cravings. I am getting no AD affects that I notice yet. I have only been on Neurontin for 3 weeks so it's early in the game. I was only on Lamictal (as augmentation to Zoloft) for a short time a few years ago, so I have no info about it.
> Annie

Annie -

I'm early in the game too. It is harder to detect
the effect of mood stabilizers than AD's. With
AD's you feel *good* whereas I can't say Neurontin
is making me feel better than well.

COuld you detect an AD effect with Lamictal? Also
why did you stop taking it? Rash? I've heard it is
pretty well tolerated provided you don't get the
skin reaction thing.

Hope all is well,

Sean.

 

Re: Neurontin Off Label Usage (T)

Posted by Sean on October 29, 1999, at 15:23:46

In reply to Re: Neurontin Off Label Usage (T), posted by Noa on October 29, 1999, at 14:49:38

> There may never be any big controlled studies of Neurontin as a mood stabilizer, because 1)it is already on the market and has FDA approval, 2)there is anecdotal reporting of its effectiveness for this use, and 3) it sounds like it is relatively safe. So who would be motivated to put up the money for a big time study? (Usually the funds come from the pharmaceutical company, and it is seen as an investment to get the drug on the market in the first place). Problem: Some managed care insurance companies won't cover off label usage. AARRGGHH!!!! (sorry for the appended (E) in this generally (T) post).

I think there may be some better studies on this
med actually. When a drug becomes "indicated" the
sales for that med can increase greatly because
the med is now on the formulary for a particular
government or private provider.

Also, I think that bipolar depression is getting
more play in research circles. It is more common
than schizophrenia, costs lots of lives each
year, and we have very few meds to treat it with
any kind of specificity. Good drugs for this
disease are very cost effective in terms of
the impact on society at large...

Then again maybe I'm being too optimistic!

Sean.

 

Re: Neurontin Off Label Usage (G?)

Posted by Noa on October 29, 1999, at 16:22:54

In reply to Re: Neurontin Off Label Usage (T), posted by Sean on October 29, 1999, at 15:23:46

Sean, I think you may be right--there may be profit incentive to get anticonvulsants "labeled" for mood stabilization for the reasons you mentioned.

 

Re: Neurontin and sedation, etc.

Posted by Elizabeth on October 29, 1999, at 16:37:31

In reply to Re: Neurontin and sedation, etc., posted by Susan on October 29, 1999, at 11:40:32

> If Neurontin works like Xanax why would I want to try such an expensive medication?

I didn't mean to imply that Neurontin works just like Xanax, but to me, it *felt* like Xanax. I just found that kind of interesting.

> Especially if mood swings are controllable with Xanax which I originally started because of insomnia. I know Xanax is not a good choice for insomnia but the side effects are so minimal compared to Ambien, Tylenol PM, Ativan, Trazodone, Sinequan, etc.

Actually I think Xanax is fine for insomnia, and I use it myself. Not on a daily basis, but occasionally when I need it. It lasts just the right amount of time. A "good choice" for insomnia (or anything) is whatever works for you.

 

Re: Recent Study of Neurontin

Posted by JohnB on November 6, 1999, at 22:09:08

In reply to Re: Neurontin and sedation, etc., posted by Susan on October 29, 1999, at 11:40:32

Hi. Here's an august '99 published study of neurontin for social phobia, which I copied out of pubmed. sponsor is Parke-Davis, manufacturer of Neurontin. I understand that 3600mg/day was the efficacious dose for social phobia. I also understand that Parke-Davis is planning a follow-up controlled study of all partcipants at 3600mg/day. Apparently, with managed care beginning to only pay for drug prescriptions for FDA approved usage, Parke-Davis has some incentive to get approval of Neurontin for treatment of social phobia. Currently, is only approved use is as an anti-epileptic.

Hope this helps. JohnB. :)


J Clin Psychopharmacol 1999 Aug;19(4):341-8

Treatment of social phobia with gabapentin: a placebo-controlled study.

Pande AC, Davidson JR, Jefferson JW, Janney CA, Katzelnick DJ, Weisler RH, Greist JH, Sutherland SM
Parke-Davis Pharmaceutical Research, Division of Warner-Lambert Company, Ann Arbor, Michigan 48105, USA. atul.pande@wl.com

A randomized, double-blind, placebo-controlled, parallel-group study was conducted to evaluate the efficacy and safety of gabapentin in relieving the symptoms of social phobia. Sixty-nine patients were randomly assigned to receive double-blind treatment with either gabapentin (dosed flexibly between 900 and 3,600 mg daily in three divided doses) or placebo for 14 weeks. A significant reduction (p < 0.05) in the symptoms of social phobia was observed among patients on gabapentin compared with those on placebo as evaluated by clinician- and patient-rated scales. Results were similar for the intent-to-treat and week-2 completer populations. Adverse events were consistent with the known side effect profile of gabapentin. Dizziness (p = 0.05), dry mouth (p = 0.05), somnolence, nausea, flatulence, and decreased libido occurred at a higher frequency among patients receiving gabapentin than among those receiving placebo. No serious adverse events or deaths were reported. On the basis of these limited data, it seems that gabapentin offers a favorable risk-benefit ratio for the treatment of patients with social phobia. Further studies are required to confirm this effect and to determine whether a dose-response relationship exists.

Publication Types:


Clinical trial
Multicenter study
Randomized controlled trial
PMID: 10440462, UI: 99367074



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