Posted by ed_uk2010 on December 13, 2014, at 5:55:50
In reply to Re: Caution » ed_uk2010, posted by linkadge on December 12, 2014, at 20:21:08
>ketamine, nicotine and scopolamine....
Ketamine - early days. Not exactly an ideal first line treatment ready to use on a widespread basis :) I have to say, despite its potential benefits, I can't see ketamine replacing the likes of sertraline or citalopram for general use. I can see it being used as an alternative to ECT in some situations.
Scopolamine - high doses are deliriant as much as euphoric, and can be intensely unpleasant. Same applies to various other central anticholinergics. The anticholinergic effects of TCAs may be relevant to producing a response in some people. Amitriptyline, for example, is exceptionally anticholinergic. I find all strong anticholinergics intolerable, including scopolamine, but I do believe some may respond. Of course, central anticholinergics can produce a high incidence of cognitive and memory impairment at anything above the smallest doses. In the elderly, even tiny doses can cause acute confusional states and are contra-indicated in dementia. Drugs which elevate acetylcholine, eg. the acetylcholinesterase inhibitors (donepezil, Aricept and so on) are the main pharmacological treatment for dementia, with limited success. Their side effects are the opposite of anticholinergics, and on combination cancel each other out. Peripherally acting anticholingergics, eg. Buscopan, the lipid-insoluble form of scopolamine, may be of some use in treating the GI side effects of donepezil due to poor absorption and poor CNS penetration. Combining standard scopolamine (eg. Scopoderm) or amitriptyline with donepezil would cancel out the benefits. Donepezil can be 'depressing', but some dementia pts experience an improvement in mood associated with a reduction in confusion. Confusion is no fun, certainly not on a long-term basis....
Nicotine - I've heard of the nicotine patch being used with some success on occasion. Again, I wouldn't say it's first line, or that it will replace anything. Nicotine products tend to cause a high incidence of side effects in non-smokers, and can actually be dysphoric in anything more than tiny amounts eg. 1mg gum. Only very low doses of nicotine temporarily enhance calmness and concentration. Higher doses frequently cause nausea, dizziness, some degree of agitation and worsened cognitive performance.
>the nonsense they prescribe now...
Well, none of the treatment we have are anywhere near ideal, including those discussed above :)
poster:ed_uk2010
thread:1074099
URL: http://www.dr-bob.org/babble/20141120/msgs/1074191.html