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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by TheOutsider on November 7, 2004, at 7:52:40
I'm going to see a new doc at the end of this month for my social anxiety.
I'm going to suggest that he prescribe me Pregabalin, despite the fact that its not aproved for anxiety in the UK.Doctors in the UK are reluctant to prescribe Benzos especially for social anxiety because of the risk of withdrawals and supposed deppendence issues.
One of the major advarntages of pregabalin over benzos is that it supposedly does not cause withdrawals, is there any clear evidence for this which a doctor would accept?
Posted by SLS on November 7, 2004, at 8:05:11
In reply to Withdrawals from Pregabalin/Lyrica?, posted by TheOutsider on November 7, 2004, at 7:52:40
Am J Psychiatry. 2003 Mar;160(3):533-40.
Pregabalin in generalized anxiety disorder: a placebo-controlled trial.
Pande AC, Crockatt JG, Feltner DE, Janney CA, Smith WT, Weisler R, Londborg PD,
Bielski RJ, Zimbroff DL, Davidson JR, Liu-Dumaw M.Pfizer Global Research and Development, Ann Arbor Laboratories, MI, USA.
OBJECTIVE: Current drug therapies for generalized anxiety disorder have
limitations. In a controlled trial, the novel agent pregabalin was studied for
the treatment of patients with generalized anxiety disorder. METHOD: In this
double-blind study, patients with DSM-IV generalized anxiety disorder were
randomly assigned to receive pregabalin (150 mg/day or 600 mg/day), lorazepam (6
mg/day), or placebo. A 1-week placebo lead-in was followed by 4 weeks of
treatment and then a 1-week dose taper. The primary efficacy measure was the
Hamilton Anxiety Rating Scale score at endpoint. RESULTS: A total of 276
patients were randomly assigned to a treatment group and received at least one
dose of their assigned medication. Fewer patients given lorazepam (59%, N=40 of
68) completed the trial than did those given placebo (73%, N=50 of 69), 600
mg/day of pregabalin (71%, N=50 of 70), or 150 mg/day or pregabalin (90%, N=62
of 69). The mean baseline-to-endpoint decreases in total Hamilton anxiety scale
score in the patients given 150 mg/day of pregabalin (-9.2), 600 mg/day of
pregabalin (-10.3), and lorazepam (-12.0) were significantly greater than the
decrease in those given placebo (-6.8). As early as the week 1 observation,
pregabalin significantly reduced the total Hamilton anxiety scale score compared
with placebo. The most frequent adverse events reported for pregabalin and
lorazepam were somnolence and dizziness. There were no serious adverse events
reported by patients given pregabalin, and no withdrawal syndrome was associated
with pregabalin treatment. CONCLUSIONS: These results indicate that pregabalin
is an effective, rapidly acting, and safe treatment for generalized anxiety
disorder. In short-term treatment, pregabalin does not appear to have the
withdrawal symptoms associated with the benzodiazepines.Publication Types:
Clinical Trial
Randomized Controlled TrialPMID: 12611835 [PubMed - indexed for MEDLINE]
Posted by jclint on November 7, 2004, at 9:01:44
In reply to Withdrawals from Pregabalin/Lyrica?, posted by TheOutsider on November 7, 2004, at 7:52:40
I'm in a similar position, my thread a little up from here might be useful for you.
To be honest I'm finding it hard to believe that this drug is going to have zero withdrawal/addiction etc. Seems to good to be true. My guess is that we wont really know until at least a few months time when people have had time to report their experiences. Fingers crossed though dude, here's to an effective new treatment!
Posted by ed_uk on November 7, 2004, at 9:52:29
In reply to Re: Withdrawals from Pregabalin/Lyrica?, posted by jclint on November 7, 2004, at 9:01:44
Jclint makes a good point. EVERY time a new treatment for anxiety/depression comes on to the market we're told it doesn't cause dependence and that withdrawal won't be a problem. We have to learn from the experiences of people who have had difficulty withdrawing from drugs like barbiturates, benzos, SSRIs, effexor etc. Personally I was very lucky in getting only mild withdrawal symptoms when I stopped Effexor 'cold turkey'.
After all, withdrawal symptoms have been reported with gabapentin(Neurontin)- pregabalin's close relative....Gabapentin withdrawal presenting as status epilepticus (prolonged episode of convulsions).
Barrueto F Jr, Green J, Howland MA, Hoffman RS, Nelson LS.
Department of Emergency Medicine, New York University School of Medicine and the New York City Poison Control Center, New York, New York 10016, USA. fbarrueto@hotmail.com
A 34-year-old male with lumbar disc disease and surgery was placed on gabapentin daily for chronic back pain. He remained on a steady dose of 8000 mg/day for 9 months, almost doubled what is considered therapeutic. He ran out of medication, was unable to refill his prescription for 2 days and presented to the emergency department in status epilepticus. There was no previous history of seizure disorder and he was on no other medications. A medical evaluation for an alternative etiology of his seizures was negative. Although gabapentin withdrawal has been previously reported and usually consists of anxiety, diaphoresis, and palpitations, this is the first reported patient with generalized seizures and status epilepticus secondary to gabapentin withdrawal.
Ed
Posted by jlbl2l on November 7, 2004, at 10:13:40
In reply to Withdrawals from Pregabalin/Lyrica?, posted by TheOutsider on November 7, 2004, at 7:52:40
I have been on it with very much success for months now and i stopped taking it a few times and had no symptoms except my social phobia and neuropathic pain. For comparison, i was on klonopin for a year and slowly withdrew and had a seizure after i got off it and terrible symptoms from that...
So lyrica seems very safe so far.. When i got off, my pain levels go up and its difficult to sleep though, so i guess those would be withdraw side effects.
Posted by ed_uk on November 7, 2004, at 10:32:17
In reply to Re: Withdrawals from Pregabalin/Lyrica?, posted by jlbl2l on November 7, 2004, at 10:13:40
Hello...
Compared with drugs like effexor, klonopin and xanax, I think(hope!) the withdrawal symptoms from lyrica won't usually be too bad. I've only seen a few reports of withdrawal symptoms from Neurontin, I suppose that's a good sign!
Ed
Posted by SLS on November 7, 2004, at 10:57:29
In reply to Re: Withdrawals from Pregabalin/Lyrica?, posted by ed_uk on November 7, 2004, at 9:52:29
Discontinuing any anticonvulsant abruptly has the potential to precipitate seizures. However, this is not the same as the withdrawal syndrome associated with benzodiazepines.
- Scott
Posted by ed_uk on November 7, 2004, at 11:14:12
In reply to Re: Withdrawals from Pregabalin/Lyrica?, posted by SLS on November 7, 2004, at 10:57:29
Hello...
I didn't say that gabapentin causes a withdrawal syndrome comparable to that associated with the benzodiazepines. To be fair, withdrawal from gabapentin seems to have been very poorly studied, making it impossible to make any comparisons. As was reported, anxiety, palpitations and diaphoresis are some of the symptoms that have occured after gabapentin withdrawal. Similar symptoms are commonly seen after the withdrawal of benzos. I strongly believe that it's much too early to say that pregabalin is not associated with a withdrawal syndrome. The information that you provided may provide some reassurance but more evidence is still needed. After all, look what's become of all those other anxiolytics which were alleged to be easy to come off!!
All the best...
Ed
Posted by SLS on November 7, 2004, at 12:21:17
In reply to Re: Withdrawals from Pregabalin/Lyrica?, posted by ed_uk on November 7, 2004, at 11:14:12
Hi Ed.
> Hello...
> I didn't say that gabapentin causes a withdrawal syndrome comparable to that associated with the benzodiazepines. To be fair, withdrawal from gabapentin seems to have been very poorly studied, making it impossible to make any comparisons. As was reported, anxiety, palpitations and diaphoresis are some of the symptoms that have occured after gabapentin withdrawal. Similar symptoms are commonly seen after the withdrawal of benzos. I strongly believe that it's much too early to say that pregabalin is not associated with a withdrawal syndrome. The information that you provided may provide some reassurance but more evidence is still needed. After all, look what's become of all those other anxiolytics which were alleged to be easy to come off!!
> All the best...
> Ed
Buspar is supposed to be very forgiving upon discontinuation. It does not act upon GABA circuits directly. My guess is that any drug that acts upon the BZD GABA receptor is going to produce a robust withdrawal syndrome.Unlike benzodiazepines and the other anticonvulsants, Neurontin and Lyrica do not act to enhance GABAergic neurotransmission. They seem to reduce excitatory events by acting as ligands upon voltage gated calcium channels (N and Q/P subtypes) to block calcium influx and inhibit neurotransmitter release. I would not expect them to produce a withdrawal syndrome similar to the BZDs in intensity.
- Scott
Posted by TheOutsider on November 7, 2004, at 12:45:42
In reply to Re: Withdrawals from Pregabalin/Lyrica? » ed_uk, posted by SLS on November 7, 2004, at 12:21:17
Thanks to everyone who posted in response especialy jclint and SLS, your experience gives me some hope.
I personaly don't think that I will have that much of a problem getting off Pregabalin, I've gone on and of GHB in the past without much trouble (except for one occasion!).
The problem is I need information to convince doctors to prescribe it.While I've got your attention I will have the impertinence to ask another question!
I'm wondering what is the best aproach to treating my social anxiety and ADD?The alternatives are either to pay to see a private doc, which would be expensive. Alternativly I could try to buy Pregabalin over the internet, which would be cheaper in the short term, but would have its own disadvantages!
Posted by ed_uk on November 7, 2004, at 12:56:56
In reply to Re: Withdrawals from Pregabalin/Lyrica? » ed_uk, posted by SLS on November 7, 2004, at 12:21:17
Hello Scott...
It's certainly true than buspirone doesn't seem to cause many problems on withdrawal, then again not many people seem to find it effective for anxiety!! In fact, buspirone seems to be one of the few psych drugs for which withdrawal problems haven't been reported. This reminds me of my own experience with moclobemide, it didn't have any effect on my anxiety or depression but at least I didn't get any side effects or withdrawal symptoms :-)I expect you are right when you say that Lyrica won't cause withdrawal symptoms comparable to those associated with the BZDs. I have always thought the same thing. Even so, it's too early to be sure. I think we'll probably have to wait for many months or even years before we know for certain. The medical establishment tends to be very slow to accept the possibility that the drugs they prescribe cause withdrawal symptoms. Many doctors in the UK are still unaware of the fact that SSRIs can be difficult to stop.
Anyway, I doubt I'll be trying Lyrica myself. I've tried gabapentin previously with no success. My anxiety is mild at the moment on citalopram.
Hope the Cymbalta is helping you now...
All the best...
Ed
Posted by jclint on November 7, 2004, at 14:23:59
In reply to Re: Withdrawals from Pregabalin/Lyrica?, posted by TheOutsider on November 7, 2004, at 12:45:42
> The problem is I need information to convince doctors to prescribe it.
I know how you feel. Its very annoying, especially with drugs as new as this. Hopefully they will give us the benefit of the doubt, as there is no evidence *yet* to suggest addictive properties. The good thing is, it has been designed to address the tolerance issues of neurontin - if there really are no tolerance issues then its certainly got one up on the benzos there.
> I'm wondering what is the best aproach to treating my social anxiety and ADD?I really don't know much about this stuff, but I've been interested in some people's reports about dopamine deficiency causing these symptoms. I've said this before today, but I'm interested in drugs like Amisulpride which seem to do great things for dopamine.
> The alternatives are either to pay to see a private doc, which would be expensive. Alternativly I could try to buy Pregabalin over the internet, which would be cheaper in the short term, but would have its own disadvantages!
Hmm is it legal to do that? Would be interested about that one. To be perfectly honest with you I wouldn't recommend a private doc even if you have the money. I have been private for a couple of years, but have had no success so far, as far as I'm concerned the only advantage is more convenient waiting lists/appointment times. I'm transferring to the NHS after this appointment, its costing too much and I'm not getting anything back.John :)
Posted by Rhapsody on November 7, 2004, at 16:32:51
In reply to Re: Withdrawals from Pregabalin/Lyrica?, posted by jlbl2l on November 7, 2004, at 10:13:40
Hi jlbl2l,
Are you on any other medications other than Lyrica? I’m interested in what best helps your neuropathic pain level. What was your typical pain level (1-10) before Lyrica compared to when you are using Lyrica?
Does anyone know if Lyrica is available in the USA?
Thanks!
Rhapsody
> I have been on it with very much success for months now and i stopped taking it a few times and had no symptoms except my social phobia and neuropathic pain. For comparison, i was on klonopin for a year and slowly withdrew and had a seizure after i got off it and terrible symptoms from that...
>
> So lyrica seems very safe so far.. When i got off, my pain levels go up and its difficult to sleep though, so i guess those would be withdraw side effects.
This is the end of the thread.
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