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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 42. This is the beginning of the thread.
Posted by Molybdenum on May 23, 2008, at 6:10:24
Hi Campers,
I've been on 600mg venlafaxine + 225mg mirtazapine for depression for nearly 2 years now (one year on this dose). It seems to be working.
Plus 200-300mg modafinil to make me happy :)
However, my life's very stressful at the moment and I find I've been taking .5mg alprazolam (Xanax) 3 times a day for weeks now. I was taking .5mg only once every couple of days. Now I notice the minute it's worn off. So maybe some of my angst is rebound from this "mini" addiction.
I've learned years ago to be careful with benzo addiction. I recall clearly feeling horrible for weeks when I was a teenager having decided to go cold turkey. Oh to know what I know now.... Anyway, so I am now very wary of being dependant on benzos again, even though I know it's not a huge dose (1.5mg / day) "at the moment".
So I asked my doc for a non-benzo, non-sedating, non-addictive, non-badthings anxiolytic and he prescribed me 150mg Moclobemide (Aurorix, Manerix).
I know I have to watch out for serotonin syndrome but has anyone here had any success with this drug for purely anxiety?
The web seems full of anecdotal reports of it being a mediocre antidepressant. Other reports say it drastically improves memory (in rats anyway ;)).
I can't find much in the way of recent Babble posts on it either.
So has anyone had it work for them for anxiety?
Thanks
Molybdenum.
Posted by Quintal on May 23, 2008, at 9:27:21
In reply to Anyone had success with Moclobemide for anxiety???, posted by Molybdenum on May 23, 2008, at 6:10:24
No, it's not a very effective drug at all. It doesn't seem very wise to combine it with 600mg venlafaxine either, but let's hope your pdoc knows what he's doing. It tends to cause quite a bit of anxiety and agitation at first, so watch out for that. I can think of much better non-benzo anxiolytics than moclobemide.
I took 900mg for six months, and it was an absolute waste of time. Beyond the inital startup agitation/insomnia it didn't seem to do anything at all. I was taking it for social phobia.
Q
Posted by SLS on May 23, 2008, at 12:41:24
In reply to Re: Anyone had success with Moclobemide for anxiet, posted by Quintal on May 23, 2008, at 9:27:21
> No, it's not a very effective drug at all. It doesn't seem very wise to combine it with 600mg venlafaxine either, but let's hope your pdoc knows what he's doing. It tends to cause quite a bit of anxiety and agitation at first, so watch out for that. I can think of much better non-benzo anxiolytics than moclobemide.
I agree.
> I took 900mg for six months, and it was an absolute waste of time. Beyond the inital startup agitation/insomnia it didn't seem to do anything at all. I was taking it for social phobia.Some people go up to 1200mg, but that is usually after they had some sort of positive response at lower dosages. It seems that you can get a good response at as low as 300mg, but then you have to keep increasing the dosage to chase down the improvement as it is constantly fading.
Roche started a program in the US over ten years ago to try to get moclobemide approved for social anxiety / phobia. They dropped the project once clinical trials failed to show efficacy.
- Scott
Posted by torachan on May 23, 2008, at 17:53:28
In reply to Re: Anyone had success with Moclobemide for anxiet, posted by Quintal on May 23, 2008, at 9:27:21
> No, it's not a very effective drug at all. It doesn't seem very wise to combine it with 600mg venlafaxine either, but let's hope your pdoc knows what he's doing. It tends to cause quite a bit of anxiety and agitation at first, so watch out for that. I can think of much better non-benzo anxiolytics than moclobemide.
>
> I took 900mg for six months, and it was an absolute waste of time. Beyond the inital startup agitation/insomnia it didn't seem to do anything at all. I was taking it for social phobia.
>
> QIf you wouldn't mind, could you give me an idea on what are the good non-benzo anxiolytics. I've yet to find one, but my use has been restricted to the SSRI/NRI camp. I've had some success with Effexor, and I stress the word some, but I don't find it capable of replacing my benzo, even though my benzo seems to be wearing thin after 15+ years of use.
My PDoc wants to try one of the AP's, specifically Seroquel, but I'm not jumping on board that train at the present time. Perhaps you could convince me otherwise.
I've heard Stablon is good for anxiety, but I'm in Canada, and I don't believe it's available.
Posted by Molybdenum on May 23, 2008, at 18:25:18
In reply to Re: Anyone had success with Moclobemide for anxiet, posted by torachan on May 23, 2008, at 17:53:28
What you're saying certainly backs up what I've been reading on the web. Damn it.
Like torachan said, can anyone recommend some non-benzo anxiolytics? I was enthusiastic about Phenelzine (Nardil) until I read about the problems with the new manufacturing process. Still, despite the stories I do find it hard to believe a drug co would stuff up the manufacturing process - and not correct it.
Anyway, so any non-benzo anti-anxiety meds you can suggest would be greatly appreciated...!
Thanks...
Molybdenum.
Posted by torachan on May 23, 2008, at 19:00:19
In reply to Suggestions for non-benzo anxiolytics PLEASE..??? » torachan, posted by Molybdenum on May 23, 2008, at 18:25:18
Like I said Stablon/tianeptine I've heard good things about. Again, I don't believe it's marketed in the US/Canada. It's manufactured in France and available in many European countries, some Asian ones, Australia and UK I believe.
Not that I should be saying this, but there are online sources. I won't go into details. I'm considering giving it a go.
It's a serotonin reuptake enhancer unlike SSRI's. But many reports suggest it as a good anxiolytic. 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.
Posted by Quintal on May 23, 2008, at 19:09:20
In reply to Suggestions for non-benzo anxiolytics PLEASE..??? » torachan, posted by Molybdenum on May 23, 2008, at 18:25:18
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).
I think the UK and Australian versions of Nardil are pretty close to the original formulation (some people have imported the UK version into the US), so aren't affected by the new formulation controversy. The 'new Nardil' formula still works for many people though, just some who had been taking the old formula for years said they found the new one less effective.
Q
Posted by torachan on May 23, 2008, at 19:16:23
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).
>
> I think the UK and Australian versions of Nardil are pretty close to the original formulation (some people have imported the UK version into the US), so aren't affected by the new formulation controversy. The 'new Nardil' formula still works for many people though, just some who had been taking the old formula for years said they found the new one less effective.
>
> QQ, do you know if Lamictal is effective for anxiety?
Posted by Quintal on May 23, 2008, at 19:19:30
In reply to Re: Suggestions for non-benzo anxiolytics PLEASE.., posted by torachan on May 23, 2008, at 19:00:19
Tianeptine worked quite well for my anxiety and depression. I wish I had some now. It isn't available in the UK, US, or Australia. I had to buy it from online pharmacies, but tianeptine isn't a controlled drug and it's not illegal to import a supply for your own use AFAIK. I've never had a shipment seized by customs.
I love cheese, but I didn't find the MAOI diet hard to stick to. When MAOIs work, they *work*. It compensates for the lack of cheese.
Q
Posted by torachan on May 23, 2008, at 19:34:46
In reply to Re: Suggestions for non-benzo anxiolytics PLEASE.. » torachan, posted by Quintal on May 23, 2008, at 19:19:30
One of the doctors I've consulted with recently said they would NEVER prescribe a MAOI. I wondered if it was solely because of the dietary restrictions or perhaps some other reason unbeknownst to me.
I have a source for tianeptine, I'm just mulling it over if I should try it out. Effexor doesn't do it for me, nor do the other SSRI/NRI's.
Posted by Molybdenum on May 23, 2008, at 20:10:39
In reply to Re: Suggestions for non-benzo anxiolytics PLEASE.., posted by torachan on May 23, 2008, at 19:34:46
Thanks Quintal & torachan, (hell - have we all gone Pokemon or what??) ;)
I see my pdoc again in 2 weeks, so I'll see how I go on the Moclobemide for the moment. I've taken my first dose a few hours ago and I do feel a little weird but not anxious, which is a good sign. So maybe it's working - definitely in the "can't possibly tell" phase at the moment of course.
I'll make a note of your other suggestions too if this doesn't work - thanks :)
The Tianeptine (Stablon, Coaxil) does sound appealing. Trouble is it's not available in Australia but I agree we can probably import it with a local doc's script. Trouble is, it's quite expensive. Recommended dose is 3x12.5mg tablets a day. That makes for just ten doses for USD$38 "at one site" plus I know that I get hit another $50 or so from the damn banks when I use this site.
My doc's a bit concerned about serotonin syndrome given my high doses of ADs. So he might not go for anything that he believes increases that risk too much.
Thanks again - I'll let you know how I go :)
Mr Be Damned.
Posted by Quintal on May 23, 2008, at 20:21:43
In reply to Re: Suggestions for non-benzo anxiolytics PLEASE.., posted by torachan on May 23, 2008, at 19:16:23
I don't think Lamictal is particulary effective for anxiety. I've never seen much improvement in anxiety while taking it, and I've seen quite a few people report startup anxiety with this drug. Lyrica and Neurontin are much better.
Q
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
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