Posted by cache-monkey on January 17, 2006, at 13:45:26
In reply to Re: Keppra for benzo taper and/or mood stabilizer... ? » cache-monkey, posted by SLS on January 17, 2006, at 8:41:41
< I find that it [Keppra] helps with mental energy and motivation. >
This is good to hear. Depakote and Trileptal definitely had the opposite effect for me, and I was worried that Keppra would end up being more of the same.
<< Also, I haven't seen you posting that much on babble lately. How are things going for you in general? >>< Not so well, but not horrendous. >
I think this is probably the most positive assessment of your state you've given in a while. I'm glad that there's at least a small uptick for you and hope that the trend continues.
< My lack of posting recently is probably due mostly to PB burnout. >
Understood, and it makes your responses to my posts that much more appreciated. :)
< However, some is due also to a preoccupation with the holidays and a new digital camera I've been playing with. >
New toys are always nice!
<< 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 >>
< Interesting that it should make you sleepy. Does it act to reduce the amount of dreaming you experience? >I'm not sure, but this seems to be clearly a direct effect of the selegiline. I take it and then boom I'm tired an hour later. I've tried moving the dose around in the day to establish cause-and-effect. It's still kind of weird, though, since I thought selegiline's increase in dopamine would be energizing if anything.
<< * 112.5 mg Lithium; in the process of tapering because it made me more anxious; >>
< I've heard of this. It might be an indication that you are adversely affected by serotonergic drugs. Did it cause you to clench your teeth? >No bruxism for me, but I had a pretty bad experience on Lexapro last fall. Somewhat similar increased anxiety and tension. With Lex, though, I also had RLS something aweful. My hypothesis with the Li had to do with it increasing NE release and desensitizing the alpha-2 receptor:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=1645513&query_hl=8&itool=pubmed_docsum
<< I seem to do alright a couple days after each dose reduction; in between I get really tired and depressed. >>
< Similarly, I experienced a rebound antidepressant effect the first time I discontinued lithium. >Actually, I wrote that poorly. I actually get rebound depression for a few days after lowering Li, and then eventually a return to a place slightly less anxious than before the dose reduction, but perhaps a little more melancholy.
<< * 0.75 Klonopin; in the process of a smalll dose reduction because it makes me slow and contributes to my depression >>
< It occurs that some people experience a mild to moderate depressogenic reaction to Klonopin. Personally, I attribute this to its serotonergic effects, although they are not yet well defined. This phenomenon sometimes dissipates over time at a stable dosage and consistent dosing schedule. It might be that the pro-serotonergic effects of both lithium and Klonopin are acting together to create more depression, not less. >
Unfortunately the depressiogenic aspect of Klonopin has been more or less consistent over my time on the drug. The lithium might have actually offset it, to an extent, but at the cost of substantially increased anxiety. Hence the experiment of the double-taper.
<< 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. >>< Generally speaking, Neurontin does not make for an effective mood stabilizer unless it is combined with another one like Lamictal. It is used more as an anxiolytic now. Keppra has yet to prove itself. Lamictal is reported to be particularly effective for rapid-cycling. >
I've tried Lamictal, but that's what ended up putting me on the Klonopin in the first place. I had a full-on panic attack for the first time in my life. :( It also was making my muscles horribly tight, indicated a generalized increase in somatic anxiety. This was at 50 mg/day. Perhaps I need to stick it out longer. Or try it combination with Neurontin. At this point, though, I'm inclined to give Keppra (+selegiline) a go first...
I did find the Kaufman paper, as well as another small open on-off study. I'm also intrigued by the anti-kindling aspect of Keppra, although I don't understand quite what that means. I realize you're taking a babble vacation right now, so I can do some poking around the web and/or look for your old posts.
Finally, and you may have already seen this, but FYI it looks like Keppra may have some back-door pro-GABA effects:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8911659&dopt=Abstract
with (if I'm reading this right) particularly strong effects at the GABA-A complex:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12086975&dopt=AbstractAll the best,
cache-monkey
poster:cache-monkey
thread:599782
URL: http://www.dr-bob.org/babble/20060115/msgs/599976.html