Posted by Cam W. on May 26, 2001, at 12:42:37
In reply to Re: Cam, I would really appreciate insight ..Gil, posted by gilbert on May 26, 2001, at 12:10:07
Gil - I am the wrong guy to ask about cortisol and prolactin, as I am a community pharmacist and have never really been a hospital (clinical) pharamacist, except out of necessity. Perhaps Sunnely could help you here. I have never heard of long-term problems with prolactin nor cortisol levels with benzodiazepines.
That being said, Xanax™ (alprazolam) is slightly different from other benzodiazepines in that it has weak (possibly transient) antidepressant activity due to it's strong binding to a subtype of GABA receptor. This could lead to a lowering of the elevated cortisol levels seen in depression.
As for using SJW, you may run into similar problems that you are with the SSRIs. Then again, a trial of a month or two couldn't really hurt at this point (except to your wallet). If you do try SJW, do use a standardized, recognized brand like Kira™ or Perikya (sp?). Have you considered non-SSRI antidepressants? It may be something to talk to your doctor about, but a word of caution, drugs like Wellbutrin™ (bupropion), Norpramin (desipramine) or reboxetine (which probably won't get approved anyway) could theoretically may the OCD symptoms worse. You may be in a similar situation as I mentioned to GrapeBG, where a subset of serotonin receptor genes is faulty (perhaps a different subset than GBG), rather than having a deficiency of serotonin.
Another option would be to fine tune the Xanax dose slightly downward to see if the blunting stops. That happy medium is sometimes hard to attain.
The last option would be to try a different benzodiazepine like Klonopin™ (clonazepam), Serax™ (oxazepam) or even Valium™ (diazepam), although Xanax is the benzodiazepine of choice for acute panic attacks. Still, I find Xanax to be too short acting for many people for a maintenance drug for panic disorder. I like Xanax more for breakthrough episodes of panic and use a longer acting benzo (like Klonopin) for maintenance.
I hope that you get something out of this wishy-washy answer. - Cam
poster:Cam W.
thread:64311
URL: http://www.dr-bob.org/babble/20010522/msgs/64335.html