Posted by Ame Sans Vie on January 13, 2004, at 6:21:26
In reply to Re: Can you all give me some feedback? » Ame Sans Vie, posted by Emme on January 12, 2004, at 9:57:56
Hi Emme,
> Good lord! I didn't know there were so many options!
Yeah, doctors don't generally like to let people know about the "old-fashioned" anxiolytics. But the fact of the matter is, some people respond well to Zoloft -- in some it causes hostile psychotic episodes. Those same people may respond to an old-fashioned antidepressant (i.e. Nardil or Parnate) and achieve great success with it. So benzodiazepines just may not be completely for you; a barbiturate, carbamate (meprobamate/carisoprodol), or other (chloral hydrate, hydroxyzine pamoate) anxiolytic may just mesh better with your unique brain chemistry.
Side note: Does anyone know if ethchlorvynol (Placidyl) is still on the U.S. market? I've heard conflicting reports...
> Hmmm...maybe some of these might be options in the case of that extra breakthrough or situational anxiety.
That's definitely the idea. Barbs, carbamates, and the other assorted tranquilizers usually don't function very well as tolerance builds over a week or two of daily use. But prn use, even up to five times weekly, will assure that you have that safety blanket when you need it.
Getting a doctor to prescribe one of these "dangerous" drugs is another issue entirely, though. The vast majority of psychiatrists shy away from barb/carbamate anxiolytics entirely, which makes no sense. They'll readily hand out amphetamines and methylphenidate (in my experience, anyway) which are Schedule II controlled substances, along with most narcotics, cocaine, and various others. Short-acting barbiturates are also Schedule II (i.e. Seconal, Amytal, Tuinal, Nembutal, Butisol -- Pentothal [aka "truth serum"] is Schedule III, while Brevital, a general anaesthetic, is Schedule IV due to the fact that it is only available as a powder for injection). Phenobarbital, Equanil, and chloral hydrate are Schedule IV -- the same risk-class as benzodiazepines. Mebaral (mephobarbital, aka methylphenobarbital) is also Schedule IV and may be an even better alternative that I failed to mention in my last post. And carisoprodol is not even federally classified as a controlled substance! Some states have placed it in Schedule IV or V, though.
> My pulse isn't running *dangerously* high, and I don't have palpitations, but I'd certainly like to get it a bit lower. I may try a higher dose of atenolol. I tolerate it well except that I think it makes me feel cold.
Yep, always better safe than sorry. No reason to allow any amount of stress on your cardiovascular system if it can be avoided.
I'd be very careful about raising the atenolol dose -- beta-adrenergic blockers such as atenolol, propranol, pindolol, et al. are notorious for causing extreme depression. And the cold feeling is very common, especially in the hands. Over time, this can actually become permanent -- a disorder known as Raynaud's phenomenon. I had the cold hands on propranolol, and I developed *horrid* depression after two or three days at 60mg/day. Very unpleasant. Even still, slowly increasing the atenolol dosage is probably the way to go, as you're already taking it. Should you run into problems, I very highly recommend using one of the alpha-adrenergic agonists.
> Is propanolol cardio-selective? I don't know about the other two. I'll look them up.As far as I know, none of the antihypertensives are cardio-selective. All beta-blockers antagonize beta-adrenergic receptors in the CNS. Reduced heart rate and blood pressure are *some* effects of beta-adrenergic antagonism, but it's much more widespread than that (as you can tell from the cold feeling, altered mental status, fatigue, etc.).
Clonidine is sold under the brand name Catapres, and guanfacine under the name Tenex. Both are alpha-adrenergic agonists and, like the beta-blockers, have body-wide effects. Another occasionally useful (though rather outdated) antihypertensive is reserpine, which can also provide useful tranquilizing effects.
> > Of course you have to exercise extreme caution when administering stimulants to bipolars, but how about trading in the selegiline for a very low dose of methylphenidate (2.5mg prn), magnesium pemoline (56.25mg), or an amphetamine (5mg prn) to see how that fares you?
>
> I'll look those up too. It may be that whatever energizing drug I use, it'll have to be on an as-needed basis. I hate symptom-chasing, but...Well, the symptoms are the issue, if you ask me. Nothing wrong with taking this pill for this, and that pill for that. :-)
> > That's true -- though, as I mentioned above, Depakote may also be a good MS to reduce stimulation caused by lamotrigine.
>
> She's held off pushing for it, but I suppose it's possible that my pdoc might bring it up. I feel nervous about it because I've read about the side effects: weight gain, hair loss... Am I being overly nervous? Maybe most people don't have these problems?Most people don't experience alopecia due to Depakote, but unfortunately weight gain is an extremely common side effect (it's about on par with Zyprexa in that area). Depakote also causes "brain fog" in many people. I never experienced a single side effect during the six months I took high-dose Depakote, however, and it worked beautifully at keeping my anger and impulsivity in check. So I guess it's a matter of weighing the risks and benefits, but I wouldn't cross it off the list due to concerns which may be unfounded. If we all did that, none of us would be taking any of these meds at all. :-)
> Thanks for putting so much thought in to replying.
No problem whatsoever -- I hope you get something useful out of this. Take care!
Michael
poster:Ame Sans Vie
thread:299547
URL: http://www.dr-bob.org/babble/20040109/msgs/300090.html