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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by Tiss on January 27, 2004, at 1:19:14
I am following alot of threads about the fear of addiction to benzos even in a very controlled setting. I take klonopin as prescribed, do not go above the dose and have not felt a need to. But cigs are (to me) are the MOST addictive drug of all. I'm down to 3 a day but it kills me that I seem so weakwilled that I have a tremendous fear of giving them up! I cannot give them up where as I can give up klonopin without feeling like I'm totally lost! I think that nicotine has to be the worst addiction. How many people do you hear about that die in the THOUSANDS from accurately prescribed benzos-never! (not from what I've read). Anyway, is anyone else suffering from the withdrawals of cigs and if so I'd like to know what worked for you! THanks,Tiss
Posted by ann72 on January 27, 2004, at 7:18:44
In reply to Cigaretts-the worst addiction of all!, posted by Tiss on January 27, 2004, at 1:19:14
I just wanted to say I know exactly how you feel. I tried quitting smoking a few wks before xmas and ended up spiralling into a major depressive episode. I was greiving everyday for the loss of my cigs. I ended up smoking regulary again, but I hope to quit again. It is the worst addiction of all i think..Just try to stick with it and maybe try a support group.
Good luck to you..
Posted by Chairman_MAO on January 27, 2004, at 8:55:39
In reply to Re: Cigaretts-the worst addiction of all!, posted by ann72 on January 27, 2004, at 7:18:44
I quit smoking with the aid of cannabis; simply substitute a cigarette with a joint and in three days--that you'll barely remember--the withdrawl is over!
For many on this board, this is not feasible because of laws nor prudent due to possible worsening of psychiatric disorders. A more legal and cognition-sparing option is galantamine (Nivalin, Reminyl (US)), a reversible acetylcholinesterase inhibitor and nicotinic agonist (www.nivalin.com). While I've yet to see any kind of trial in the literature, I found that taking 5-10mg of galantamine completely abolished all nicotine withdrawl symptoms. It doesn't take any advanced knowledge to see why this might be: it potently stimulates nicotinic receptors!
I'd be interested to know if anyone's used this or related compounds in smoking cessation. Note: cholinergic drugs may worsen depression or other mood disorders. Consult with your doctor.
-cm
Posted by Tiss on January 27, 2004, at 9:01:36
In reply to Re: Cigaretts-the worst addiction of all!, posted by Chairman_MAO on January 27, 2004, at 8:55:39
I cannot even imagine where I would buy pot as I am 47 and haven't smoked pot since college! ALso, it made me paranoid-not a good thing for me. I am very curious about this other stuff you mentioned for withdrawal pangs of smoking. I live in the US, is it available here? What exactly is it? Thanks, Tiss
Posted by Chairman_MAO on January 27, 2004, at 9:58:22
In reply to Re: Cigaretts-the worst addiction of all!, posted by Tiss on January 27, 2004, at 9:01:36
Reminyl is $$$ in the US, unless you have insurance to pay for it. If you cannot afford it here, I suggest ordering it from overseas @ www.nivalin.com (they're the people that first produced it as a pharmaceutical in Bulgaria). Check out www.nivalin.com and www.us.reminyl.com for some basic information.
Ever noticed how nicotine enhances your thought processes? That's because it stimulates receptors appropriately named nicotonic acetylcholine receptors; they're intimiately implicated in learning and memory (such as the acquisition of the smoking habit, heh). Galantamine--approved for Alzheimer's disease in the US--inhibits the breakdown of acetylcholine, thereby allowing more of it to be available to stimulate cholinergic receptors. It also directly stimulates nicotinic receptors as nicotine does. It was first used to reverse the actions of curare, which is the poison used on the ends of arrows by some South African tribes to paralyze prey and in modern medicine to control convulsions during surgery.
I must emphasize that my suggestion to use this drug only comes from my personal experience as well as my substantial--but not professional--knowledge of central nervous system drugs. In general, though, galantamine is a very safe drug with little toxicity, and you may very well have success using it as a nicotine replacement. It also is WAY more potent at enhancing cognition than nicotine (one would imagine that if it improves the symptoms of Alzheimer's disease, it helps one think, heh); some people refer to it as a "smart drug".
Quitting smoking is important, and I'd imagine your doctor would allow you to try just about anything he/she'd consider safe to that end.
I'd imagine galantamine combined with a dopaminergic agent such as Wellbutrin/Zyban or selegiline would be even more powerful in eliminating nicotine cravings. Just remember that addiction itself is not medical (despite what many will tell you); it is behavioral. There is no drug that will eliminate the habit, only symptoms.
Any other questions, let me know.
Best of luck!
-cm
Posted by scott-d-o on January 27, 2004, at 15:30:49
In reply to Re: Cigaretts-the worst addiction of all!, posted by Chairman_MAO on January 27, 2004, at 8:55:39
> I quit smoking with the aid of cannabis; simply substitute a cigarette with a joint and in three days--that you'll barely remember--the withdrawl is over!
>Yeah, I quit smoking with the aid of cocaine (it was so easy)!. However, looking back on it, trading those two addictions wasn't the best of ideas, and, of course, as soon as I kicked coke (not easy), I was back to the cigs. Addiction is an endless cycle.....
Posted by Dr. Bob on January 27, 2004, at 21:30:38
In reply to Cigaretts-the worst addiction of all!, posted by Tiss on January 27, 2004, at 1:19:14
> is anyone else suffering from the withdrawals of cigs and if so I'd like to know what worked for you!
Sorry to interrupt, but I'd like to redirect this thread to Psycho-Babble Substance Use. Here's a link:
http://www.dr-bob.org/babble/subs/20031208/msgs/306244.html
Thanks,
Bob
Posted by Tiss on January 28, 2004, at 9:52:29
In reply to Redirect: Cigaretts-the worst addiction of all!, posted by Dr. Bob on January 27, 2004, at 21:30:38
Sorry Bob! (nm)
Posted by Dr. Bob on January 28, 2004, at 18:33:33
In reply to Re: Redirect: Cigaretts-the worst addiction of all!, posted by Tiss on January 28, 2004, at 9:52:29
Posted by Questionmark on January 29, 2004, at 20:48:20
In reply to Re: Cigaretts-the worst addiction of all! » Tiss, posted by Chairman_MAO on January 27, 2004, at 9:58:22
Thanks for that info on galantamine. i looked up some stuff on it, and i am highly interested in it. Not only would the nicotinic effects seem to be helpful, but i have some pretty bad cognitive and anticholinergic effects from the med i'm on now (Nardil)-- which is helping a great deal, but the side effects are a royal pain. .. So i was wondering if you think that galantamine would be a beneficial drug in terms of alleviating anticholinergic side effects.? i'm almost sure it would with the cognitive aspects, which would be wonderful in itself, but the other ones would be nice to alleviate too.
Also, you said it is available in the States, but it is very expensive? Correct? That's disappointing.
What would be the best way to ask a pdoc for this do you think? i'd mostly want it to improve my cognitive abilities and alleviate my anticholinergic symptoms from Nardil, but that might not be enough. Plus i don't really smoke. So, i duno. Anyway, thanks.
> Reminyl is $$$ in the US, unless you have insurance to pay for it. If you cannot afford it here, I suggest ordering it from overseas @ www.nivalin.com (they're the people that first produced it as a pharmaceutical in Bulgaria). Check out www.nivalin.com and www.us.reminyl.com for some basic information.
>
> Ever noticed how nicotine enhances your thought processes? That's because it stimulates receptors appropriately named nicotonic acetylcholine receptors; they're intimiately implicated in learning and memory (such as the acquisition of the smoking habit, heh). Galantamine--approved for Alzheimer's disease in the US--inhibits the breakdown of acetylcholine, thereby allowing more of it to be available to stimulate cholinergic receptors. It also directly stimulates nicotinic receptors as nicotine does. It was first used to reverse the actions of curare, which is the poison used on the ends of arrows by some South African tribes to paralyze prey and in modern medicine to control convulsions during surgery.
>
> I must emphasize that my suggestion to use this drug only comes from my personal experience as well as my substantial--but not professional--knowledge of central nervous system drugs. In general, though, galantamine is a very safe drug with little toxicity, and you may very well have success using it as a nicotine replacement. It also is WAY more potent at enhancing cognition than nicotine (one would imagine that if it improves the symptoms of Alzheimer's disease, it helps one think, heh); some people refer to it as a "smart drug".
>
> Quitting smoking is important, and I'd imagine your doctor would allow you to try just about anything he/she'd consider safe to that end.
>
> I'd imagine galantamine combined with a dopaminergic agent such as Wellbutrin/Zyban or selegiline would be even more powerful in eliminating nicotine cravings. Just remember that addiction itself is not medical (despite what many will tell you); it is behavioral. There is no drug that will eliminate the habit, only symptoms.
>
> Any other questions, let me know.
>
> Best of luck!
>
> -cm
Posted by Chairman_MAO on January 29, 2004, at 22:03:00
In reply to galantamine » Chairman_MAO, posted by Questionmark on January 29, 2004, at 20:48:20
Before adding ANYTHING to an MAOI, I'd consult a knowledgeable pharmacist, psychopharmacologist, or psychiatrist. I doubt galantamine would cause any harm, but it's always good to check. If you cannot afford galantamine, order it from Sopharma AD, Bulgaria @ www.nivalin.com. It's affordable, especially considering you can use a pill cutter to cut the 10mg tabs into 5mg or 2.5mg (takes dexterity!) pieces. If you use it, start at 2.5mg once a day, going to 2.5mg bid and up from there--SLOWLY. Going overboard with acetylcholine could wreck the antidepressant effect of the Nardil.
I never even thought about galantamine with Nardil, but it seems like it could be quite a winning combination: galantamine is indirectly cholinergic, and I'm 99% sure it would mitigate just about any anticholinergic side effect you might have. It also is an extremely potent cognitive enhancer: if you go to the US patent database, look up "benzodiazepine AND galantamine". You will find US patents ripped off from Eastern Bloc research projects involving the treatment of various mental illnesses, including schizophrenia, with _HIGH_ doses of benzodiazepines (15mg of clonazepam) + galantamine. The galantamine PREVENTED SEDATION from _15mg_ of Klonopin in one case! I verified this when I was taking Klonopin. As such, I suspect it could mitigate your Nardil side effects. Check this out (btw, Ketalar is ketamine, which, along with 10mg of diazepam, causes FAR more cognitive impairment than you'll ever get from nardil):
Akush Ginekol (Sofiia). 1987;26(3):28-31.
[Attempt to eliminate residual somnolence and disorientation with nivaline after anesthesia with ketalar and diazepam for minor obstetrical and gynecologic surgery][Article in Bulgarian]
Chakalova E, Marinova M, Srebreva M, Anastasov D, Ploskov K.
PIP: Effectiveness of the anticholinergic agent nivaline to prevent side-effects of anesthetics ketalar and diazepam was studied in 40 pregnant women (15- 40 years old) undergoing induced abortion during the 1st trimester. The patients were divided into two groups. Group 1 included 20 patients who received anesthesia with diazepam (10 mg) and ketalar (50-70 mg) alone. Group 2 included 20 patients undergoing anesthesia under diazepam-ketalar in combination with nivaline (10 mg, iv) during an early postoperative period. The degree of somnolence and disorientation was assessed immediately after anesthesia, and 5, 10, 15, 30 and 60 min after surgery using a scale of 1 to 4 (from response to verbal commands and pain stimulus to complete absence of response). The patients in group 2 were more alert than the patients in group 1 only 5, 10 and 15 min after surgery.
JAMA. 1977 Nov 21;238(21):2293-4.
Reversal of central anticholinergic syndrome by galanthamine.Baraka A, Harik S.
Ten volunteers were given 2 mg scopolamine intravenously (IV) to produce substantial drowsiness and sleepiness. Galanthamine, 0.5 mg/kg IV, effectively reversed the central anticholinergic syndrome produced by scopolamine. Electroencephalographic monitoring of two subjects matched the observed changes of consciousness: scopolamine replaced the dominant awake alpha rhythm with a disorganized, slow, 4- to 6-Hz activity. Galanthamine promptly returned to EEG pattern to the control, awake state. Galanthamine produces effective, safe, and long-lasting reversal of the central anticholinergic syndrome in man.
Posted by Questionmark on January 30, 2004, at 14:34:41
In reply to Re: galantamine » Questionmark, posted by Chairman_MAO on January 29, 2004, at 22:03:00
Hey, thanks so much for the info. That's amazing-- some of that stuff about how galantamine is so good at reversing the cognitive impairment and sedation of benzos and what not. That last abstract isn't too surprising, since any cholinergic is good at reversing anticholinergic syndrome in sufficient doses. But even that's cool in supporting how it works and stuff. And the fact that it's nicotinic is great too (just hope it's not TOO much so-- don't wanna have an addiction to galantamine like a pack-a-day smoker). Man i would LOVE to get my hands on this though-- esp. with Nardil.
And i appreciate what you said about talking to my doc first. But i am so sick of talking to him/them about .. well, anything, but especially about taking anything with Nardil (in fact i asked him if i could try a cholinergic recently, and he said he wasn't comfortable enough). i understand you have to be careful, but come on, people add things to MAOIs carefully and are fine. So if i can get this myself (which is almost surely the only way i could get it), i'm just gonna try it on my own-- but starting out with very low doses (as you basically suggested). i mean i wouldn't likely do such a thing with a serotonergic or adrenergic, but .. yeah. Oh and yeah, i have a good pill cutter and i've become quite adept at using it :?) . Thanks again.
> Before adding ANYTHING to an MAOI, I'd consult a knowledgeable pharmacist, psychopharmacologist, or psychiatrist. I doubt galantamine would cause any harm, but it's always good to check. If you cannot afford galantamine, order it from Sopharma AD, Bulgaria @ www.nivalin.com. It's affordable, especially considering you can use a pill cutter to cut the 10mg tabs into 5mg or 2.5mg (takes dexterity!) pieces. If you use it, start at 2.5mg once a day, going to 2.5mg bid and up from there--SLOWLY. Going overboard with acetylcholine could wreck the antidepressant effect of the Nardil.
>
> I never even thought about galantamine with Nardil, but it seems like it could be quite a winning combination: galantamine is indirectly cholinergic, and I'm 99% sure it would mitigate just about any anticholinergic side effect you might have. It also is an extremely potent cognitive enhancer: if you go to the US patent database, look up "benzodiazepine AND galantamine". You will find US patents ripped off from Eastern Bloc research projects involving the treatment of various mental illnesses, including schizophrenia, with _HIGH_ doses of benzodiazepines (15mg of clonazepam) + galantamine. The galantamine PREVENTED SEDATION from _15mg_ of Klonopin in one case! I verified this when I was taking Klonopin. As such, I suspect it could mitigate your Nardil side effects. Check this out (btw, Ketalar is ketamine, which, along with 10mg of diazepam, causes FAR more cognitive impairment than you'll ever get from nardil):
>
> Akush Ginekol (Sofiia). 1987;26(3):28-31.
>
>
> [Attempt to eliminate residual somnolence and disorientation with nivaline after anesthesia with ketalar and diazepam for minor obstetrical and gynecologic surgery]
>
> [Article in Bulgarian]
>
> Chakalova E, Marinova M, Srebreva M, Anastasov D, Ploskov K.
>
> PIP: Effectiveness of the anticholinergic agent nivaline to prevent side-effects of anesthetics ketalar and diazepam was studied in 40 pregnant women (15- 40 years old) undergoing induced abortion during the 1st trimester. The patients were divided into two groups. Group 1 included 20 patients who received anesthesia with diazepam (10 mg) and ketalar (50-70 mg) alone. Group 2 included 20 patients undergoing anesthesia under diazepam-ketalar in combination with nivaline (10 mg, iv) during an early postoperative period. The degree of somnolence and disorientation was assessed immediately after anesthesia, and 5, 10, 15, 30 and 60 min after surgery using a scale of 1 to 4 (from response to verbal commands and pain stimulus to complete absence of response). The patients in group 2 were more alert than the patients in group 1 only 5, 10 and 15 min after surgery.
>
>
> JAMA. 1977 Nov 21;238(21):2293-4.
>
>
> Reversal of central anticholinergic syndrome by galanthamine.
>
> Baraka A, Harik S.
>
> Ten volunteers were given 2 mg scopolamine intravenously (IV) to produce substantial drowsiness and sleepiness. Galanthamine, 0.5 mg/kg IV, effectively reversed the central anticholinergic syndrome produced by scopolamine. Electroencephalographic monitoring of two subjects matched the observed changes of consciousness: scopolamine replaced the dominant awake alpha rhythm with a disorganized, slow, 4- to 6-Hz activity. Galanthamine promptly returned to EEG pattern to the control, awake state. Galanthamine produces effective, safe, and long-lasting reversal of the central anticholinergic syndrome in man.
>
Posted by SLS on January 30, 2004, at 16:00:48
In reply to Re: galantamine » Questionmark, posted by Chairman_MAO on January 29, 2004, at 22:03:00
Pro-cholinergic drugs can actually worsen depression. I had a bad experience recently with Aricept.
- Scott
Posted by Chairman_MAO on January 30, 2004, at 21:59:22
In reply to Re: galantamine, posted by SLS on January 30, 2004, at 16:00:48
Choinergics can worsen depression because, on a neurological level, dopamine and acetylcholine (and I think norepinepherine and acetylcholine, too) counterbalance each other (the real picture is way more complex than I will ever understand). On a psychological level, which often makes more sense when talking about drugs that affect the MIND, "if you think too much, you're gonna be depressed", hehe.
I'd imagine this might not be as bad on Nardil because it increases DA activity to some extent. I used galantamine for months, and found that there was quite a discernable line between enhanced cognitive function and outright thought-frenzied depression. The difference was night and day, and seemed to occur if I exceeded 15mg/day.
I doubt there would be an interaction with an MAO inhibitor; I recommend consulting a doctor because of the risk of worsening depression or other disorders (I believe people with BPD, for instance, have a severe drop in mood if challenged with acetylcholinesterase inhibitors)
This is the end of the thread.
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