Posted by cache-monkey on January 16, 2006, at 21:23:08
In reply to Re: Keppra for benzo taper and/or mood stabilizer... ? » cache-monkey, posted by SLS on January 16, 2006, at 20:48:14
Hey Scott,
Good to hear your input. I remember that you had tried Keppra for a while, but then it looked like it started being a bad experience. I didn't realize that you were still on it. So, I assume that you think it's helping to some degree after all. What sort of benefits are you getting from it?
Also, I haven't seen you posting that much on babble lately. How are things going for you in general? Have you had some reprieve from your depression?
I'm currently on:
* 2.5 mg selegiline -- positive effect on mood, but makes me sleepy so I'm moving the dose to the evening
* 112.5 mg Lithium; in the process of tapering because it made me more anxious; I seem to do alright a couple days after each dose reduction; in between I get really tired and depressed
* 0.75 Klonopin; in the process of a smalll dose reduction because it makes me slow and contributes to my depressionSo there's a lot going on right now, with the double taper. But for me this makes sense: based on independent variation of each, the Lithium and Klonopin seem to have been working at odds with eachother. I'm going to get off the Lithium and see whether I can reduce the Klonopin in the process.
When that settles down, my pdoc and I are talking about either Neurontin or Keppra for mood stabilization and to help with the rest of the benzo taper. I will definitely keep you and anyone else interested posted.
Best,
cache-monkey> 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.
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> If you decide to use an anticonvulsant to mitigate the benzodiazepine withdrawal syndrome, please post your results. Thanks.
>
>
> - Scott
>
>
poster:cache-monkey
thread:599782
URL: http://www.dr-bob.org/babble/20060115/msgs/599824.html