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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by Ed on August 28, 2001, at 9:32:15
I am starting gabatril today, and am wondering if anyone has found it helpful. There were a few posts on it several months ago, but no follow-ups. Thanks.
Posted by Anna P. on August 28, 2001, at 16:29:39
In reply to Gabitril (tiababine) successes? , posted by Ed on August 28, 2001, at 9:32:15
> I am starting gabatril today, and am wondering if anyone has found it helpful. There were a few posts on it several months ago, but no follow-ups. Thanks.
Hi,
I had a short time success with Gabitril to augment Zyprexa this summer. I was taking 5 mg Gabitril, and 2.5 Zyprexa at night.
Anna P.
Posted by Ed on August 28, 2001, at 16:59:19
In reply to Re: Gabitril (tiababine) successes? , posted by Anna P. on August 28, 2001, at 16:29:39
Did it curb anxiety? At least for a while?
> > I am starting gabatril today, and am wondering if anyone has found it helpful. There were a few posts on it several months ago, but no follow-ups. Thanks.
>
> Hi,
>
> I had a short time success with Gabitril to augment Zyprexa this summer. I was taking 5 mg Gabitril, and 2.5 Zyprexa at night.
>
> Anna P.
Posted by Mitch on August 28, 2001, at 18:14:10
In reply to Gabitril (tiababine) successes? , posted by Ed on August 28, 2001, at 9:32:15
> I am starting gabatril today, and am wondering if anyone has found it helpful. There were a few posts on it several months ago, but no follow-ups. Thanks.
Ed,
I was taking it about two years ago as a switch from Depakote. I started at 4mg/day (one pill) and increased it in 4mg/day increments every week. The neuro I was seeing wanted the titration upwards even faster. The first thing I noticed was some mood elevation and activation with some mild cognitive problems. By the time I got to 16mg/day I definitely noticed an anxiolytic effect, but my memory was not very good. It appeared to work quite well as a mood stabilizer, though. I continued on upwards and when I reached 24mg/day (12mg bid), my face, and forehead got all numb and had quite severe cognitive problems at work and I felt detached from my body which made me feel panicky in my head, but I had no physical signs of panic-very weird. Well, uh it got discontinued after that episode. Who knows maybe if I would have stayed at a lower dosage I could have gotten better benefit from it. It really felt kind of like Topamax but speedier more of an antidepressant effect.
Mitch
Posted by SalArmy4me on August 28, 2001, at 21:03:40
In reply to Gabitril (tiababine) successes? , posted by Ed on August 28, 2001, at 9:32:15
SCHAFFER, LINDA C. M.D. Tiagabine and the Treatment of Refractory Bipolar Disorder. American J of Psychiatry. 156(12), Dec 99.
"To the Editor: Gabapentin and lamotrigine have been recently introduced as add-on medications for the treatment of partial seizures. Several case reports and open studies in the psychiatric literature indicate that these two newer anticonvulsant drugs show promise in the treatment of bipolar disorder (1). Another anticonvulsant used for the treatment of partial seizures, tiagabine, was recently approved by the U.S. Food and Drug Administration (2). We report a positive response to tiagabine as an add-on agent in two patients with refractory bipolar disorder. Both patients gave written informed consent to take tiagabine for a non-FDA-approved indication.
Ms. A was a 46-year-old woman with a 23-year history of bipolar disorder type I with rapid cycling. Her illness had been difficult to manage. She had used the following medications in varying combinations and doses: lithium carbonate, imipramine, fluoxetine, divalproex, sertraline, gabapentin, clonazepam, alprazolam, thioridazine, risperidone, olanzapine, thiothixene, lamotrigine, and quetiapine.
Ms. A was taking a combination of quetiapine, lamotrigine, and alprazolam. This combination was initially effective; however, about 6 months later, she began to experience an increasing recurrence of mixed and manic symptoms. We elected to begin a trial of tiagabine. Her quetiapine therapy was discontinued and replaced with tiagabine, beginning at 1 mg/day (one-fourth of a 4-mg tablet) because she had a history of marked sensitivity to psychiatric medications. Lamotrigine and alprazolam treatment was continued. In response to the tiagabine, Ms. A commented that her mood was better than it had been in years. Her sleep was consistent, she was cognitively sharp, her energy and motivation were markedly improved, her dysphoria and anhedonia were resolved, and she could experience happiness. After 2 months of taking an average of 3 mg/day of tiagabine, she began to experience a manic episode. Restabilization was finally accomplished by increasing the tiagabine to 4 mg/day. She continued to experience benefit from tiagabine after 5 months. Her other psychiatric medications were lamotrigine (6.25 mg/day) and alprazolam (0.75 mg at bedtime) for insomnia.
Ms. B was a 42-year-old woman with a 6-year history of bipolar disorder type I. Her treatment course was initially turbulent. She was treated with the following medications in varying combinations and doses: lithium, temazepam, trazodone, amitriptyline, diazepam, sertraline, bupropion, paroxetine, fluoxetine, nortriptyline, divalproex, carbamazepine, flurazepam, and gabapentin. She was stabilized with a combination of lithium, venlafaxine, and flurazepam. Although she continued this combination therapy for several years, repeated occurrences of manic symptoms required adjunctive treatment. The following adjunctive medications were used without success: clonazepam, risperidone, haloperidol, lamotrigine, thioridazine, olanzapine, primidone, and quetiapine.
When Ms. B continued to experience marked recurrences of manic symptoms, we began a trial of tiagabine. Like Ms. A, Ms. B was sensitive to psychotropic drugs and was therefore started on the same low initial dose of 1 mg at bedtime. She gradually increased the dose to 4 mg at bedtime. She experienced no side effects and was able to lower her dose of flurazepam. Mood response was quite good; there was a marked reduction of manic symptoms. She took tiagabine for at least 3 months and was satisfied with the improved control of her manic symptoms. In addition to tiagabine, her other psychiatric medicines were venlafaxine (25 mg/day), lithium (300 mg/day), and flurazepam (7.5 mg at bedtime) for treatment of insomnia.
To our knowledge, these are the first case reports of the successful use of tiagabine as an augmenting agent for bipolar disorder. Tiagabine is a [gamma]-aminobutyric acid uptake inhibitor that is metabolized by the liver. Most studies of the use of tiagabine for epileptic patients indicate that it is usually well tolerated (3). One report emphasized that a group of patients with epilepsy and psychiatric disorders (including depression) tolerated tiagabine as well as a group of patients with epilepsy without a history of psychiatric disorders (4).
The therapeutic range for tiagabine plasma concentrations has yet to be established. Our patients responded to a low dose of tiagabine compared to the doses required for seizure control in patients with epilepsy, according to the neurological literature. In our experience, psychiatric patients tend to respond to lower doses of anticonvulsants than patients with epilepsy. It is hoped that this encouraging response to tiagabine in two patients can be duplicated in other patients with refractory bipolar disorder."
Leach, John Paul. Brodie, Martin J. Tiagabine. Lancet. 351(9097):203-207, January 17, 1998:
"675 patients have received tiagabine in add-on placebo-controlled trials compared with 363 on placebo. Dizziness, asthenia, nervousness, tremor, diarrhoea, and depressed mood were reported significantly more frequently with tiagabine. [40] Open studies in 2185 patients showed a similar side-effect profile with additional reports of headache, somnolence, confusion, and ataxia. Dizziness, in particular, may be related to the peak concentration of the drug. The frequency of symptoms suggestive of psychosis in patients taking tiagabine (2%) was not statistically different from that on placebo (1%). Rash is a very unusual occurrence, and an association with tiagabine is not yet proven. Similarly, no idiosyncratic reactions have as yet been linked to this drug. [34]
Withdrawals from trials due to adverse effects are a useful pointer to the tolerability of any new antiepileptic agent, although they may reflect pharmacokinetic or pharmacodynamic interactions with existing treatments. Overall, 13[center dot]6% of patients taking tiagabine dropped out due to adverse events compared with 5[center dot]8% in placebo groups. [34] Specific problems leading to withdrawal were dizziness (3%), asthenia (3%), somnolence (2%), non-specific nervousness (1%), tremor (1%), difficulty in concentration (1%), confusion (1%), and depressed mood (1%). Most of these complaints occurred during the titration period, were usually transient, or disappeared after dose adjustment or on discontinuation of tiagabine. The odds ratio for withdrawal from treatment for any reason across the three placebo-controlled parallel-group studies (TIA-106, TIA-107, and TIA-109) was 1[center dot]81 (95% CI 1[center dot]21-2[center dot]70). [35]
------------------------------------------------
Salvationism Around the World
RUSSIA - After a 65-year ban, the Salvation Army returned to Russia in 1991, and now has centers in Moscow and and St. Petersburg.
PARIS - The Army has a barge on the River Seine to provide food and shelter for the homeless.
INDIA - The Army has more than 4,900 centers, inculding the Catherine Booth Hospital--50 buildings providing a variety of services to thousands of patients
AFRICA - The Army operates more than 4,000 centers on the continent, including schools for people who are blind and rehav cwenters for children with physical disabilities.
ASIA - In Hong Kong, many young people learn trades at Army vocational training centeers.
Posted by Mitch on August 28, 2001, at 21:34:01
In reply to Re: Gabitril (tiababine) successes? » Ed, posted by SalArmy4me on August 28, 2001, at 21:03:40
> SCHAFFER, LINDA C. M.D. Tiagabine and the Treatment of Refractory Bipolar Disorder. American J of Psychiatry. 156(12), Dec 99.
>
> "To the Editor: Gabapentin and lamotrigine have been recently introduced as add-on medications for the treatment of partial seizures. Several case reports and open studies in the psychiatric literature indicate that these two newer anticonvulsant drugs show promise in the treatment of bipolar disorder (1). Another anticonvulsant used for the treatment of partial seizures, tiagabine, was recently approved by the U.S. Food and Drug Administration (2). We report a positive response to tiagabine as an add-on agent in two patients with refractory bipolar disorder. Both patients gave written informed consent to take tiagabine for a non-FDA-approved indication.
>
> Ms. A was a 46-year-old woman with a 23-year history of bipolar disorder type I with rapid cycling. Her illness had been difficult to manage. She had used the following medications in varying combinations and doses: lithium carbonate, imipramine, fluoxetine, divalproex, sertraline, gabapentin, clonazepam, alprazolam, thioridazine, risperidone, olanzapine, thiothixene, lamotrigine, and quetiapine.
>
> Ms. A was taking a combination of quetiapine, lamotrigine, and alprazolam. This combination was initially effective; however, about 6 months later, she began to experience an increasing recurrence of mixed and manic symptoms. We elected to begin a trial of tiagabine. Her quetiapine therapy was discontinued and replaced with tiagabine, beginning at 1 mg/day (one-fourth of a 4-mg tablet) because she had a history of marked sensitivity to psychiatric medications. Lamotrigine and alprazolam treatment was continued. In response to the tiagabine, Ms. A commented that her mood was better than it had been in years. Her sleep was consistent, she was cognitively sharp, her energy and motivation were markedly improved, her dysphoria and anhedonia were resolved, and she could experience happiness. After 2 months of taking an average of 3 mg/day of tiagabine, she began to experience a manic episode. Restabilization was finally accomplished by increasing the tiagabine to 4 mg/day. She continued to experience benefit from tiagabine after 5 months. Her other psychiatric medications were lamotrigine (6.25 mg/day) and alprazolam (0.75 mg at bedtime) for insomnia.
>
> Ms. B was a 42-year-old woman with a 6-year history of bipolar disorder type I. Her treatment course was initially turbulent. She was treated with the following medications in varying combinations and doses: lithium, temazepam, trazodone, amitriptyline, diazepam, sertraline, bupropion, paroxetine, fluoxetine, nortriptyline, divalproex, carbamazepine, flurazepam, and gabapentin. She was stabilized with a combination of lithium, venlafaxine, and flurazepam. Although she continued this combination therapy for several years, repeated occurrences of manic symptoms required adjunctive treatment. The following adjunctive medications were used without success: clonazepam, risperidone, haloperidol, lamotrigine, thioridazine, olanzapine, primidone, and quetiapine.
>
> When Ms. B continued to experience marked recurrences of manic symptoms, we began a trial of tiagabine. Like Ms. A, Ms. B was sensitive to psychotropic drugs and was therefore started on the same low initial dose of 1 mg at bedtime. She gradually increased the dose to 4 mg at bedtime. She experienced no side effects and was able to lower her dose of flurazepam. Mood response was quite good; there was a marked reduction of manic symptoms. She took tiagabine for at least 3 months and was satisfied with the improved control of her manic symptoms. In addition to tiagabine, her other psychiatric medicines were venlafaxine (25 mg/day), lithium (300 mg/day), and flurazepam (7.5 mg at bedtime) for treatment of insomnia.
>
> To our knowledge, these are the first case reports of the successful use of tiagabine as an augmenting agent for bipolar disorder. Tiagabine is a [gamma]-aminobutyric acid uptake inhibitor that is metabolized by the liver. Most studies of the use of tiagabine for epileptic patients indicate that it is usually well tolerated (3). One report emphasized that a group of patients with epilepsy and psychiatric disorders (including depression) tolerated tiagabine as well as a group of patients with epilepsy without a history of psychiatric disorders (4).
>
> The therapeutic range for tiagabine plasma concentrations has yet to be established. Our patients responded to a low dose of tiagabine compared to the doses required for seizure control in patients with epilepsy, according to the neurological literature. In our experience, psychiatric patients tend to respond to lower doses of anticonvulsants than patients with epilepsy. It is hoped that this encouraging response to tiagabine in two patients can be duplicated in other patients with refractory bipolar disorder."
>
> Leach, John Paul. Brodie, Martin J. Tiagabine. Lancet. 351(9097):203-207, January 17, 1998:
>
> "675 patients have received tiagabine in add-on placebo-controlled trials compared with 363 on placebo. Dizziness, asthenia, nervousness, tremor, diarrhoea, and depressed mood were reported significantly more frequently with tiagabine. [40] Open studies in 2185 patients showed a similar side-effect profile with additional reports of headache, somnolence, confusion, and ataxia. Dizziness, in particular, may be related to the peak concentration of the drug. The frequency of symptoms suggestive of psychosis in patients taking tiagabine (2%) was not statistically different from that on placebo (1%). Rash is a very unusual occurrence, and an association with tiagabine is not yet proven. Similarly, no idiosyncratic reactions have as yet been linked to this drug. [34]
>
> Withdrawals from trials due to adverse effects are a useful pointer to the tolerability of any new antiepileptic agent, although they may reflect pharmacokinetic or pharmacodynamic interactions with existing treatments. Overall, 13[center dot]6% of patients taking tiagabine dropped out due to adverse events compared with 5[center dot]8% in placebo groups. [34] Specific problems leading to withdrawal were dizziness (3%), asthenia (3%), somnolence (2%), non-specific nervousness (1%), tremor (1%), difficulty in concentration (1%), confusion (1%), and depressed mood (1%). Most of these complaints occurred during the titration period, were usually transient, or disappeared after dose adjustment or on discontinuation of tiagabine. The odds ratio for withdrawal from treatment for any reason across the three placebo-controlled parallel-group studies (TIA-106, TIA-107, and TIA-109) was 1[center dot]81 (95% CI 1[center dot]21-2[center dot]70). [35]
>
> ------------------------------------------------
> Salvationism Around the World
>
> RUSSIA - After a 65-year ban, the Salvation Army returned to Russia in 1991, and now has centers in Moscow and and St. Petersburg.
> PARIS - The Army has a barge on the River Seine to provide food and shelter for the homeless.
> INDIA - The Army has more than 4,900 centers, inculding the Catherine Booth Hospital--50 buildings providing a variety of services to thousands of patients
> AFRICA - The Army operates more than 4,000 centers on the continent, including schools for people who are blind and rehav cwenters for children with physical disabilities.
> ASIA - In Hong Kong, many young people learn trades at Army vocational training centeers.Ed,
I think you should try a shot at Gabitril. I may even revisit it myself at a much lower dosage :)
Wow, Christ, I actually survived a 24mg/day dose and lived to tell about it!Seriously, I did mention once that I thought it could be helpful for Chronic Pain sufferers. The anesthesia I experienced was quite profound (at the higher dosage). That should get checked out-I know there are a lot of folks that are hurting needlessly out there, without knowing *WHY*.
Mitch
Posted by Jane D on August 28, 2001, at 21:35:56
In reply to Re: Gabitril (tiababine) successes? » Ed, posted by SalArmy4me on August 28, 2001, at 21:03:40
Sal,
I don't think it is appropriate to post this kind of advertisement for the Salvation Army here. This is very different from your making a personal statement about your affiliation. I've posted an objection to this on administration at:http://www.dr-bob.org/babble/admin/20010718/msgs/1826.html
I'm posting this here because I don't think you always check that board and I don't want to do this behind your back.
Jane
From your post:
> ------------------------------------------------
> Salvationism Around the World
>
> RUSSIA - After a 65-year ban, the Salvation Army returned to Russia in 1991, and now has centers in Moscow and and St. Petersburg.
> PARIS - The Army has a barge on the River Seine to provide food and shelter for the homeless.
> INDIA - The Army has more than 4,900 centers, inculding the Catherine Booth Hospital--50 buildings providing a variety of services to thousands of patients
> AFRICA - The Army operates more than 4,000 centers on the continent, including schools for people who are blind and rehav cwenters for children with physical disabilities.
> ASIA - In Hong Kong, many young people learn trades at Army vocational training centeers.
This is the end of the thread.
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