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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 8 to 32 of 32. Go back in thread:
Posted by SLS on August 13, 2012, at 6:25:30
In reply to Re: lyrica - how does it work, posted by rjlockhart37 on August 12, 2012, at 21:15:19
> similar to nuerontin.....well its its sister drug...anyways, it reduces firing by using the GABA receptors but it doesnt do the benzo thing...its unique how it works because of pain relief and mood aspects, it has been known to improve mood, but mainly its used for anxiety when benzos are not considered.
Never again say that you are somehow below average in intelligence!
I don't think it is yet clear how Neurontin works. I think it depends on which circuits are being examined. It hurts my brain whenever I attempt to figure it out.
I doubt Neurontin modulates GABA receptors directly. However, it does binds to the alpha2delta subunit of voltage-gated calcium channels found on catecholaminergic neurons. It does not block calcium entry through the channel when administered acutely (although it might do so if applied chronically). Acute Neurontin application does reduce the amount of neurotransmitter released through vesicular fusion with the presynaptic membrane. Neurontin also interacts with the opioid system.
- Scott
Posted by brynb on August 13, 2012, at 9:06:43
In reply to Re: lyrica - how does it work » rjlockhart37, posted by SLS on August 13, 2012, at 6:25:30
> > similar to nuerontin.....well its its sister drug...anyways, it reduces firing by using the GABA receptors but it doesnt do the benzo thing...its unique how it works because of pain relief and mood aspects, it has been known to improve mood, but mainly its used for anxiety when benzos are not considered.
>
Rj, the above is true to an extent. It doesn't really work directly on GABA, otherwise its effects would be very similar to benzos, barbiturates and alcohol.
> I don't think it is yet clear how Neurontin works. I think it depends on which circuits are being examined. It hurts my brain whenever I attempt to figure it out.
>
> I doubt Neurontin modulates GABA receptors directly.Scott, this is true. It seems "they" aren't too clear on how it works in general. The stuff was initially marketed by Pfizer as snake oil, touted as helping practically every condition under the sun. And they did find themselves in hot water over it.
The idea that the drug's mechanism isn't clear seems supported by those who have taken it; it helps mood/it doesn't help mood; it helps anxiety/it causes anxiety and so on. And although it's used as a mood stabilizer, I became manic on it.
-b
Posted by SLS on August 13, 2012, at 9:44:40
In reply to RJ + Scott Re: lyrica - how does it work, posted by brynb on August 13, 2012, at 9:06:43
> The idea that the drug's mechanism isn't clear seems supported by those who have taken it; it helps mood/it doesn't help mood; it helps anxiety/it causes anxiety and so on.
I see. That would jibe with what I read about the behavior of Neurontin. It seemingly contradicts itself, depending on the locus of the circuits affected. For example, it can reduce catecholamine activity in one brain structure and increase it in another. My guess is that each person has a unique set of checks and balances of circuitry; with varying ratios of activation and inhibition between circuits.
> And although it's used as a mood stabilizer, I became manic on it.
My doctor has seen the same thing occur with Topamax. Are you currently experiencing depression? Why was Neurontin chosen as a treatment?
- Scott
Posted by brynb on August 13, 2012, at 12:02:46
In reply to Re: RJ + Scott Re: lyrica - how does it work » brynb, posted by SLS on August 13, 2012, at 9:44:40
>
> > And although it's used as a mood stabilizer, I became manic on it.
>
> My doctor has seen the same thing occur with Topamax. Are you currently experiencing depression? Why was Neurontin chosen as a treatment?
>
>
> - ScottScott,
Right now my depression is seemingly in remission (I'm on Lithium, Lexapro and Tramadol). I'm currently diagnosed w/ having MDD w/ GAD, though it's not definitive (meaning my pdoc has yet to rule out Bipolar). This is consistent with all of my previous pdocs, too (the MDD vs. Bipolar dx not being "clear"). Frustrating, but I'm going on what works (med-wise) as opposed to what's supposed to work for specific conditions.
I was given Neurontin several times in the past to help me while withdrawing from benzos. It didn't help my anxiety, but it elevated my mood. A little too much. At first, I liked it; I guess you could describe it as a euphoric hypomania feeling. But, I would get speedy, too talkative, hyper-sexual, etc. Eventually, the last few times I took it, I became really manic, like over the top with crying fits, spending and just feeling completely out of control. Here's the kicker: when I've explained this to any pdoc (including my current guy) the response is ALWAYS "hmm, strange" or "curious" or "I've never heard that before." I've read about others who had similar experiences, so it doesn't seem all that uncommon.
Topamax didn't make me manic, but it made my anxiety go through the roof.
I always thought that any kind of mania defaults you to the Bipolar spectrum. Or, if it's med-induced, does that technically not "count" as mania??
-B
Posted by phidippus on August 13, 2012, at 12:42:41
In reply to lyrica - how does it work, posted by cee on August 12, 2012, at 17:45:24
I never used it for depression, however I have used it to treat anxiety and OCD with fair results.
pregabalin binds to the α2δ (alpha2delta) subunit of the voltage-dependent calcium channel in the central nervous system. Pregabalin decreases the release of neurotransmitters including glutamate, noradrenaline, substance P and calcitonin gene-related peptide. However, unlike anxiolytic compounds (eg, benzodiazepines) which exert their therapeutic effects through binding to GABAA, GABAB, and benzodiazepine receptors, pregabalin neither binds directly to these receptors nor augments GABAA currents or affects GABA metabolism.
Eric
Posted by King of Nothing on August 17, 2012, at 13:15:33
In reply to Re: lyrica - how does it work » cee, posted by phidippus on August 13, 2012, at 12:42:41
> I never used it for depression, however I have used it to treat anxiety and OCD with fair results.
>
> pregabalin binds to the α2δ (alpha2delta) subunit of the voltage-dependent calcium channel in the central nervous system. Pregabalin decreases the release of neurotransmitters including glutamate, noradrenaline, substance P and calcitonin gene-related peptide. However, unlike anxiolytic compounds (eg, benzodiazepines) which exert their therapeutic effects through binding to GABAA, GABAB, and benzodiazepine receptors, pregabalin neither binds directly to these receptors nor augments GABAA currents or affects GABA metabolism.
>
> EricI don't know how it works, but it does wonder for my anxiety disorder.
Posted by SLS on August 17, 2012, at 14:23:49
In reply to Re: RJ + Scott Re: lyrica - how does it work, posted by brynb on August 13, 2012, at 12:02:46
> I always thought that any kind of mania defaults you to the Bipolar spectrum. Or, if it's med-induced, does that technically not "count" as mania??
In the DSM V, the proposed diagnoses for bipolar disorder will include a subtype for which mania occurs only in association with drug exposure.
There has been some debate on Psycho-Babble regarding this issue. I didn't learn that I was bipolar until I experienced my first manic reaction to antidepressants. Previously, I had been chronically and severely depressed for 15 years. Howevever, I was also a "unipolar" ultra-rapid cycler for a few years before I was treated with lithium, after which, the cycle ceased. It was William Z. Potter at the NIH who attached the bipolar diagnosis to my case. It is my belief that I am indeed bipolar because:
1. Depression emerged by age 10.
2. I displayed ultra-rapid cyclicity for three years. My cycle had a period of exactly 11 days - 8 days depression followed by 3 days of euthymia. Mania never emerged during this time. The cycle ceased as a result of my first exposure to lithium, after which the course of illness was that of unremitting chronic depression.
3. I had several severe manic reactions to antidepressant treatment.
4. My symptom cluster resembles a pattern of atypical depression, but without mood reactivity.
5. The presence of psychomotor retardation.
- Scott
Posted by phidippus on August 17, 2012, at 16:13:41
In reply to Re: RJ + Scott Re: lyrica - how does it work » brynb, posted by SLS on August 17, 2012, at 14:23:49
I would consider you bipolar 2.
Eric
Posted by brynb on August 17, 2012, at 16:19:44
In reply to Re: RJ + Scott Re: lyrica - how does it work » SLS, posted by phidippus on August 17, 2012, at 16:13:41
> I would consider you bipolar 2.
>
> EricHi Eric-
Do you mean me?
-b
Posted by phidippus on August 17, 2012, at 16:22:24
In reply to Re: RJ + Scott Re: lyrica - how does it work, posted by brynb on August 17, 2012, at 16:19:44
no, I meant Scott...erg.
Eric
Posted by brynb on August 17, 2012, at 16:39:29
In reply to Re: RJ + Scott Re: lyrica - how does it work » brynb, posted by SLS on August 17, 2012, at 14:23:49
> > I always thought that any kind of mania defaults you to the Bipolar spectrum. Or, if it's med-induced, does that technically not "count" as mania??
>
> In the DSM V, the proposed diagnoses for bipolar disorder will include a subtype for which mania occurs only in association with drug exposure.Thanks, Scott.
In your opinion, do you think I'm in the bipolar category?
My depression started at 14, I was very irritable during my teens, started having severe depressive episodes/breakdowns from age 18 on, and the severity of my episodes have gotten much worse with age. I also had a rough time with substance abuse from my late 20s to mid 30s.I always had some hypomania, be it irritability, anxiety, snapping at people, mood swings, etc., but with Neurontin I get full-blown mania (spending, hypersexuality, rapid speech, crying fits, euphoria).
It's not that I'm so concerned with the label, I just feel like there's some comfort and justification in knowing that my suffering has a name (and isn't a character flaw!). And my diagnosis from pdocs in the past was never distinct--it was usually considered MDD w/ GAD, but several thought I was bipolar 2.
Thanks.
-b
Posted by phidippus on August 17, 2012, at 18:42:55
In reply to Re: RJ + Scott Re: lyrica - how does it work » SLS, posted by brynb on August 17, 2012, at 16:39:29
If you've experienced hypomania, you would indeed be bipolar 2. If you've experienced straight up mania, you would be a bipolar 1.
Bipolar 2 often presents with a lot of anxiety and is often misdiagnosed as MDD with anxiety.
What are you taking?
Eric
Posted by Phillipa on August 17, 2012, at 21:23:25
In reply to Re: RJ + Scott Re: lyrica - how does it work » brynb, posted by phidippus on August 17, 2012, at 18:42:55
It gets so confusing Phillipa
Posted by SLS on August 18, 2012, at 0:05:56
In reply to Re: RJ + Scott Re: lyrica - how does it work » SLS, posted by phidippus on August 17, 2012, at 16:13:41
> I would consider you bipolar 2.
Nope. My manias were severe and psychotic.
- Scott
Posted by SLS on August 18, 2012, at 0:47:53
In reply to Re: RJ + Scott Re: lyrica - how does it work » SLS, posted by brynb on August 17, 2012, at 16:39:29
The following schema was devised by Young and Klerman in 1992, and was proposed to be used in future editions of the DSM.
Klerman Classification Schema of Bipolar Disorder
Bipolar I - Mania and Major Depression
Bipolar II - Hypomania and Major Depression
Bipolar III - Cyclothymia
Bipolar IV - Antidepressant induced hypo/mania
Bipolar V - Major Depression with a family history of bipolar disorder
Bipolar VI - Unipolar ManiaThe following schema is what is currently proposed for inclusion in the new DSM-5. I think it is inferior to the Klerman proposal. However, with either one, antidepressant-induced bipolar disorder has been added as a new subtype.
C 00 Bipolar I Disorder
C 01 Bipolar II Disorder
C 02 Cyclothymic Disorder
C 03 Substance-Induced Bipolar Disorder
C 04 Bipolar Disorder Associated with Another Medical Condition
C 05 Bipolar Disorder Not Elsewhere Classifiedhttp://www.dsm5.org/proposedrevision/Pages/BipolarandRelatedDisorders.aspx
- Scott
Posted by brynb on August 18, 2012, at 14:13:17
In reply to Re: RJ + Scott Re: lyrica - how does it work » brynb, posted by phidippus on August 17, 2012, at 18:42:55
> If you've experienced hypomania, you would indeed be bipolar 2. If you've experienced straight up mania, you would be a bipolar 1.
>
> Bipolar 2 often presents with a lot of anxiety and is often misdiagnosed as MDD with anxiety.
>
> What are you taking?
>
> EricHi Eric,
I currently take Lithium, Lexapro and Tramadol. On occasion, I'll take a Valium or Xanax if my anxiety is bad.
In the past, I've done okay on Lexapro with Trileptal or Tegretol, though I didn't stay on these combos long enough to properly evaluate. Topamax really exacerbated my anxiety, and Gabapentin made me manic. Lexapro has helped my depression on a daily basis, but used alone, it inevitably poops out and doesn't prevent my depressive episodes.
My symptoms have always been depressive (and, I suppose, hypomanic--anxiety, irritability, mood instability, etc.). On Gabapentin, I experienced (I think) full-blown mania.
-b
Posted by brynb on August 19, 2012, at 8:42:19
In reply to Re: RJ + Scott Re: lyrica - how does it work » brynb, posted by SLS on August 18, 2012, at 0:47:53
> The following schema was devised by Young and Klerman in 1992, and was proposed to be used in future editions of the DSM.
>
> Klerman Classification Schema of Bipolar Disorder
>
> Bipolar I - Mania and Major Depression
> Bipolar II - Hypomania and Major Depression
> Bipolar III - Cyclothymia
> Bipolar IV - Antidepressant induced hypo/mania
> Bipolar V - Major Depression with a family history of bipolar disorder
> Bipolar VI - Unipolar Mania
>
>
>
> The following schema is what is currently proposed for inclusion in the new DSM-5. I think it is inferior to the Klerman proposal. However, with either one, antidepressant-induced bipolar disorder has been added as a new subtype.
>
> C 00 Bipolar I Disorder
> C 01 Bipolar II Disorder
> C 02 Cyclothymic Disorder
> C 03 Substance-Induced Bipolar Disorder
> C 04 Bipolar Disorder Associated with Another Medical Condition
> C 05 Bipolar Disorder Not Elsewhere Classified
>
> http://www.dsm5.org/proposedrevision/Pages/BipolarandRelatedDisorders.aspx
>
>
> - ScottThanks for the above info, Scott. I'm still confused, though (as my pdocs were too, lol!). My depression is and has always been characterized by severe depressive episodes, irritability, anxiety, poor impulse control and lethargy. While ADs never made me manic, Gabapentin did (and it made me more than hypomanic--pure mania as I understand it).
While the DSM can be a helpful tool (probably in the most elementary sense), it seems a bit archaic and too static in trying to define and categorize illnesses that are so dynamic and individual-dependent. If that makes sense ;).
-b
Posted by phidippus on August 19, 2012, at 17:16:38
In reply to Re: RJ + Scott Re: lyrica - how does it work » SLS, posted by brynb on August 19, 2012, at 8:42:19
>severe depressive episodes, irritability, anxiety, >poor impulse control and lethargy.
This sounds like a mixed mood episode.
Eric
Posted by brynb on August 20, 2012, at 14:35:47
In reply to Re: RJ + Scott Re: lyrica - how does it work » brynb, posted by phidippus on August 19, 2012, at 17:16:38
> >severe depressive episodes, irritability, anxiety, >poor impulse control and lethargy.
>
> This sounds like a mixed mood episode.
>
> Eric
Hi Eric,Like a mixed state? Isn't that typical of Bipolar 2? I've experienced chronic depression since I was a teenager, and the severe depressive episodes started around 18. The anxiety, irritability and lethargy co-existed with my depression and worsened with age. The mania from Neurontin emerged over the past several years, and was unlike anything I'd experienced before. (If my understanding of a mixed state is correct, that's how I was on Neurontin--in a depressive episode, but really speedy, crying, impulsive, etc.). Ugh.
-b
Posted by phidippus on August 20, 2012, at 19:12:59
In reply to Re: RJ + Scott Re: lyrica - how does it work » phidippus, posted by brynb on August 20, 2012, at 14:35:47
>Like a mixed state? Isn't that typical of Bipolar >2?
Both BP2+1 can present with mixed states.
You said your mania progressed over the course of treatment with Neurontin. It is more likely you ujust became more manic/mixed and Neurontin wasn't adequate to treating your mania. It is not unusual for bipolar symptoms to worsen with age, especially if inadequately treated.
Have you ever been on a mood stabilizer (besides Neurontin)?
Eric
Posted by brynb on August 20, 2012, at 21:02:55
In reply to Re: RJ + Scott Re: lyrica - how does it work » brynb, posted by phidippus on August 20, 2012, at 19:12:59
>
> Have you ever been on a mood stabilizer (besides Neurontin)?
>
> Eric
>I took Neurontin for help withdrawing from benzos and as an anxiolytic. It didn't help my anxiety, but it boosted my mood (within hours). But it did so too much and made me manic.
I tried a lot of the stabilizers (and some APs) but couldn't handle
most of them. I did do well on Trileptal as well as Tegretol, but for some reason (I actually don't remember why, I think I was in between docs) I didn't continue on them.I'm currently on a low dose of Lithium and so far so good.
-b
Posted by Brainbeard on August 26, 2012, at 10:54:05
In reply to Re: RJ + Scott Re: lyrica - how does it work » phidippus, posted by brynb on August 18, 2012, at 14:13:17
>
> I currently take Lithium, Lexapro and Tramadol.Mixing tramadol with (S)SRI's can lead to full-blown seizures - be careful. How much do you take of both?
Posted by brynb on August 26, 2012, at 12:40:35
In reply to Re: RJ + Scott Re: lyrica - how does it work, posted by Brainbeard on August 26, 2012, at 10:54:05
>
> >
> > I currently take Lithium, Lexapro and Tramadol.
>
> Mixing tramadol with (S)SRI's can lead to full-blown seizures - be careful. How much do you take of both?
>
>I'm aware of this. I usually take 50mg of Tramadol a day (sometimes only 25mg), along with 20mg of Lexapro at night.
So far, I haven't had any problems. It's also a low dose of Tramadol.
thanks,
b
Posted by Brainbeard on August 26, 2012, at 16:19:40
In reply to Re: RJ + Scott Re: lyrica - how does it work » Brainbeard, posted by brynb on August 26, 2012, at 12:40:35
Good to hear that your dose is low indeed.
Posted by phidippus on August 26, 2012, at 18:40:31
In reply to Re: RJ + Scott Re: lyrica - how does it work » Brainbeard, posted by brynb on August 26, 2012, at 12:40:35
I took 100 mg of Tramadol alonside 200 mg of Clomipramine with no SS.
I think your safe.
Eric
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