Posted by SLS on January 16, 2006, at 20:48:14
In reply to Keppra for benzo taper and/or mood stabilizer... ?, posted by cache-monkey on January 16, 2006, at 20:22:47
Hi CM.
I postulated quite some time ago that anticonvulsants might act to mitigate the withdrawal syndromes that accompany the reduction in dosage or discontinuation of SRI antidepressants and benzodiazepines. I posted my thoughts on the "Withdrawal" board quite awhile ago when I first offered a kindling model to explain the worsening course of withdrawal syndromes through time. No one was able to offer an anecdote to corroborate these ideas unequivocally, as they were being treated with other drugs simultaneously. However, there seemed to be a trend towards a less severe withdrawal syndrome for those people already taking anticonvulsants. I haven't yet formed an opinion as to whether or not pro-GABAergic properties are essential to this reduction effect. My initial impression is that it is not. Anti-kindling properties might be sufficient, regardless of mechanism.
Keppra (levetiracetam) is a prototypic drug. It is the only anticonvulsant that acts to modulate the funtion of presynaptic vesicles. The synaptic vesicle protein SVA2 was singled out as a candidate binding site, and acts to regulate the vesicle fusion process with the neuronal terminal membrane.
In my experience, Keppra can be both antidepressant and depressogenic, depending on the dosage used. It is likely that there is a window of efficacy (upside-down U-shaped dosage-effect curve) when treating mood disorders. I find that 750-1000mg is ideal for me. At 2000mg, I felt worse than I did before starting it. Kenneth Kaufman, MD, wrote up a paper on a treatment-resistant rapid-cycling female who was stabilized on Keppra monotherapy. You should be able to find the abstract on Medline.
If you decide to use an anticonvulsant to mitigate the benzodiazepine withdrawal syndrome, please post your results. Thanks.
- Scott
poster:SLS
thread:599782
URL: http://www.dr-bob.org/babble/20060115/msgs/599798.html