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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 mikialzed on December 7, 2004, at 10:43:02
Does anyone know if there are any new medications for alcoholism besides naltrexone / ReVia®).
I have heard about Zofran® (generic name: ondansetron) and Topamax® (generic name: topiramate), but i know little about them.I am ADD & Bipolar taking Wellbutrin SR, Trazadone to sleep, Pemoline, Abilify & was on Strattera, but couldn't handle the medicine taste it left + felt no effect.
I recently lost my job and am extremely anxious, and i started to drink again, which is not helping.
Could someone give me some guidance here?
Posted by owenus32 on December 10, 2004, at 0:51:12
In reply to Other new meds for alcohol cravings, posted by mikialzed on December 7, 2004, at 10:43:02
I take lexapro and klonopin and I think any drug that reduces your symptoms will help decrease aclocol cravings but you also need something like outpatients alcolol abuse group or aa or something on top of it.
Posted by barbaracat on December 11, 2004, at 2:11:07
In reply to Other new meds for alcohol cravings, posted by mikialzed on December 7, 2004, at 10:43:02
I'm doing a serious research on alcohol right now because I have had my last embarassing humliating binge and am committed to stopping. What I've been finding out is that alcohol primarily affects the D2 receptors which do not so much account for the lovely calm feelings (hitting the GABA and opiate receptors take care of that within the first 20 minutes). It's the D2 receptors, or pleasure seeking stimulus, which account for the subsequent craving and which make it so hard to stick with it. Some people are simply genetically deficient in these receptors which revisits the alcoholism as a disease theory. Others burn them out with abuse. Takes about 90 days to regenerate, so if you can hold on that long and you're not genetically deficient...
Some interesting studies where they've bred mice without D2 receptors were poor little mouse boozers, then genetically introduced D2 and they quit on their own - until it wore off.
This doesn't answer your specific question, and I wish I could recall some of the drugs I skimmed past, but in my searching I came across some new promising drugs in the pipeline and some older ones that work on dopamine. You've already tried Wellbutrin. They found it doesn't affect D2 receptors specifically. Unfortunately, the ADHD meds and other stimulants, although they try for dopamine pathways, target D4 and not D2 and that seems to be important. Selegeline (deprenyl) showed promise, so did moclobemide.
Be wary of meds that are dopamine antagonists. Abilify is one. It's an antipsychotic and reduces dopamine. Dopamine is implicated in schizophrenia and psychotic disorders and it seems that if this theory is correct, any dopamine antagonist antipsychotic is not going to be helpful in stopping alcohol craving.
Do a search on alcohol+dopamine and see if anything crops up for further exploration. One word of advice - antabuse will cause many problems, especially if you're taking meds already. It affects an enzyme P-450 that can cause unpredictable med effects and does no good for your liver. I have never taken this nasty sledgehammer approach and truly believe there are better ways. Also, most in-patient facilities generally don't believe in any medications at all and have you rely solely on attending AA and other meetings. Pretty shocking relapse rate.
Some facilities look good for their emphasis on nutritional aspect. I feel any residential facility HAS to address the nutritionally deprived state any alcoholic is in, but it's not enough, unless there's a specific nutrient that targets these pleasure satiation/reward pathways. If I come up with something specific I'll post back. - Barbara
> Does anyone know if there are any new medications for alcoholism besides naltrexone / ReVia®).
> I have heard about Zofran® (generic name: ondansetron) and Topamax® (generic name: topiramate), but i know little about them.
>
> I am ADD & Bipolar taking Wellbutrin SR, Trazadone to sleep, Pemoline, Abilify & was on Strattera, but couldn't handle the medicine taste it left + felt no effect.
>
> I recently lost my job and am extremely anxious, and i started to drink again, which is not helping.
>
> Could someone give me some guidance here?
>
Posted by jujube on December 11, 2004, at 10:11:39
In reply to Re: Other new meds for alcohol cravings, posted by owenus32 on December 10, 2004, at 0:51:12
I posted this on the Substance Abuse board the other day. May be of interest to you.
> I just came across a book called "Dr. Isadore Rosenfeld's Breakthrough Health", in which he states that researchers at the University of Texax Health Science Centre have discovered that Topamax (topiramate), an approved antiseizure medication, appears to be much more effective in helping alcoholics quit drinking than any other drug available. According to their paper, published in the journal The Lancet, Topamax works by washing away excess dopamine, a chemical in the brain that enhances the craving for alcohol.
>
> The researchers studied 103 heavy drinkers (men who regularly consumed more than five drinks a day and women who took more than four), all of whom had already tried and failed Alcohol Anonymous, drug therapy, psychotherapy, and rehabilitation clinics. 55 subjects were given oral Topamax; the remaining 48, a placebo. At the end of the study, 24 percent of those taking the topamax had abstained completely for 1 month, compared with only 4 percent of the placebo group. Another plus for topamax was that it improved abnormal liver function caused by alcohol excess in some patients. It also lifted mood and relieved anxiety symptoms.
>
> Patients on topamax do not have to abstain completely. However, if they do continue to drink, they do so less than before.
>
> Tamara> I take lexapro and klonopin and I think any drug that reduces your symptoms will help decrease aclocol cravings but you also need something like outpatients alcolol abuse group or aa or something on top of it.
Posted by jujube on December 11, 2004, at 10:13:55
In reply to Re: Other new meds for alcohol cravings, posted by owenus32 on December 10, 2004, at 0:51:12
Posted by mikialzed on December 11, 2004, at 11:37:26
In reply to Re: Other new meds for alcohol cravings, posted by owenus32 on December 10, 2004, at 0:51:12
My Doctor has given me a prescription for Topamax and after three days I can realy feel a difference. I am going to ask him about refraining from the Abilify. Thank you all for responding, especially all the details from Barbaracat. I appreciate your time and concern.
Posted by jujube on December 11, 2004, at 11:53:49
In reply to Re: Other new meds for alcohol cravings » mikialzed, posted by barbaracat on December 11, 2004, at 2:11:07
Barbara,
You might want to have a look at a book called "Seven Weeks to Sobriety" by Dr. Joan Mathews Larson. Dr. Mathews Larson is (was) director of a nutritionally oriented alcoholism-treatment centre in Minneapolis. She developed and used a technique that quickly eliminated her alcoholic clients' cravings. The technique involved the use of specific amino acids that could rapidly feed the addicted brain exactly the type of protein that it needed to naturally fill up its empty mood-chemical sites.
Tamara
Posted by barbaracat on December 11, 2004, at 14:55:38
In reply to Re: Other new meds for alcohol cravings » owenus32, posted by jujube on December 11, 2004, at 10:11:39
Thanks for the post. I'll check this book out - it looks interesting. I have some definite questions about the theory of 'washing away excess dopamine', however, since it's actually a disconnect in the dopamaminergic system that's implicated in cravings. Generally too little, or receptors that are not functional, rather than 'excess dopamine'. However, there is a 'spiking' and 'phasic' mechanism, one of which just may hang around too long and need a mop up. The whole subject is so complex and fascinating that I'd appreciate learning anything I can about it.
The reason Topamax has been suggested in alcohol rehab is that it is a weak dopamine agonist, so washing excess away would go against it's intended effect. The extra dopamine is also why Topamax, of all the mood stabilizers, has weight loss as a side effect and rest are porky meds.
I tried Topamax at the beginning of my hunt for bipolar meds and it made me feel absolutely horrible. Anxious, squirmy. It wasn't a good med for me.
> I posted this on the Substance Abuse board the other day. May be of interest to you.
>
> > I just came across a book called "Dr. Isadore Rosenfeld's Breakthrough Health", in which he states that researchers at the University of Texax Health Science Centre have discovered that Topamax (topiramate), an approved antiseizure medication, appears to be much more effective in helping alcoholics quit drinking than any other drug available. According to their paper, published in the journal The Lancet, Topamax works by washing away excess dopamine, a chemical in the brain that enhances the craving for alcohol.
> >
> > The researchers studied 103 heavy drinkers (men who regularly consumed more than five drinks a day and women who took more than four), all of whom had already tried and failed Alcohol Anonymous, drug therapy, psychotherapy, and rehabilitation clinics. 55 subjects were given oral Topamax; the remaining 48, a placebo. At the end of the study, 24 percent of those taking the topamax had abstained completely for 1 month, compared with only 4 percent of the placebo group. Another plus for topamax was that it improved abnormal liver function caused by alcohol excess in some patients. It also lifted mood and relieved anxiety symptoms.
> >
> > Patients on topamax do not have to abstain completely. However, if they do continue to drink, they do so less than before.
> >
> > Tamara
>
>
>
> > I take lexapro and klonopin and I think any drug that reduces your symptoms will help decrease aclocol cravings but you also need something like outpatients alcolol abuse group or aa or something on top of it.
>
>
Posted by lars1 on December 21, 2004, at 5:04:02
In reply to Other new meds for alcohol cravings, posted by mikialzed on December 7, 2004, at 10:43:02
> Does anyone know if there are any new medications for alcoholism besides naltrexone / ReVia®).
Acamprosate (Campral) has been shown to be effective for this. It has been approved in the U.S. and, according to a July 2004 press release, should be available "around the end of the year."
Benzodiazepines are sometimes used for acute withdrawal. They protect against the neurological damage that can otherwise occur when drinking is abruptly stopped. (Basically what happens is this: Alcohol is a CNS depressant. With heavy drinking, the brain compensates by boosting neural activity levels. After drinking is stopped, the boost continues for a while. Neurons get overexcited and fry themselves. Benzodiazepines prevent the overexcitation and are then gradually withdrawn, giving the brain time to adapt.)
Lars
Posted by barbaracat on December 22, 2004, at 17:05:53
In reply to Re: Other new meds for alcohol cravings, posted by lars1 on December 21, 2004, at 5:04:02
Can anyone point me in the direction of just what happens neurologically from drinking? One hears of its CNS dampening properties and then one hears about the buzz created by dopamine? and then there's the affinity for opiod receptors. What's really going on with alcohol? Why does it make us feel so good?
Benzos may be a CNS depressant but they do NOT make me feel like dancing around the room singing sappy songs and then jumping into the sack. Why hasn't anyone figured out a way to duplicate alcohol's enjoyable effects minus the awful day-after ones?
Posted by FredPotter on December 23, 2004, at 14:56:51
In reply to Re: Other new meds for alcohol cravings » lars1, posted by barbaracat on December 22, 2004, at 17:05:53
I dunno Barbaracat. I've always thought that alcohol was a giant clue to the manufacture of an effective anxiolytic. I suffer from a nameless dread that Xanax doesn't touch, but alcohol would make it go away completely, temporarily. But I got into trouble with alcohol and had to give it up. So now I have nothing. Perhaps alcohol's activity is so widespread due to the small molecule size, but I gather it affects just about everything in the brain Fred
Posted by Ron Hill on December 23, 2004, at 19:23:05
In reply to Re: Other new meds for alcohol cravings » lars1, posted by barbaracat on December 22, 2004, at 17:05:53
> Can anyone point me in the direction of just what happens neurologically from drinking? One hears of its CNS dampening properties and then one hears about the buzz created by dopamine? and then there's the affinity for opiod receptors. What's really going on with alcohol? Why does it make us feel so good?
>
> Benzos may be a CNS depressant but they do NOT make me feel like dancing around the room singing sappy songs and then jumping into the sack. Why hasn't anyone figured out a way to duplicate alcohol's enjoyable effects minus the awful day-after ones?http://www.scienceblog.com/community/older/2000/E/200004725.html
Brain steroid a key player in alcohol's effects
CHAPEL HILL -- Scientists at the University of North Carolina School of Medicine may have an answer for one of the biggest questions in the alcohol research field -- how does alcohol exert its effects in the brain?
In a report published in the Journal of Neuroscience March 1, researchers headed by A. Leslie Morrow, PhD, associate professor of psychiatry and pharmacology at UNC-CH discovered that a brain steroid called allopregnanolone is likely an important mediator of alcohol's well-known effects on anxiety and sedation. Morrow's study collaborators include lead-author and graduate student Margaret J. VanDoren, Douglas B. Matthews, PhD, Gregory C. Janis, MA, A. Chistina Grobin, PhD, and Leslie L. Devaud, PhD.
The findings add important new knowledge to the previous work showing that alcohol works on brain cell receptors for the neurotransmitters known as GABA and glutamate.
"It's been known for some time that in addition to having direct effects in the brain on these receptors, alcohol activates the hypothalamic-pituitary-adrenal axis in which nerve signals are converted to hormone signals. And this results in the release of a number of compounds in the brain that could contribute to alcohol's actions," Morrow said.
At the UNC Bowles Center for Alcohol Studies, Morrow's team set their sites on the neuroactive steroid allopreganolone. This is the most potent modulator of GABA-A receptors, which are believed to play a role in many of alcohol's effects.
"And we asked a very simple question: Does ethanol (alcohol) alter levels of this steroid in the brain? And in our studies of laboratory rats, we found that indeed ethanol elevates allopreganolone levels in the brain to pharmacologically active concentrations that have previously been shown to have anti-anxiety and anti-convulsant effects," said Morrow.
The UNC scientist also noted that alcohol's effects on brain concentrations of allopregnanolone are time-dependent. "It takes about 20 minutes for this effect to be observed. And what was interesting is we showed this correlates with the anticonvulsant effects of ethanol, which also take about 20 minutes to be observed."
In addition, Morrow's study team discovered that these temporal findings correlate with the physiological effects of alcohol in the brain. "Ethanol reduces spontaneous neural activity in a number of brain regions but it takes about 15 to 20 minutes for that effect to be observed."
And when the UNC researchers looked at alcohol-induced sleep duration, they found it correlated well with increased brain concentrations of allopregnanolone.
But what would happen if ethanol's ability to increase the steroid's level in the brain was blocked? Would alcohol's electrophysiological and anticonvulsant actions be inhibited as well?
The answer appears to be yes.
In a series of experiments, Morrow and her colleagues turned to a compound called finasteride. This compound blocks an enzyme called 5-alpha-reductase. Finasteride inhibits the formation of allopregnanolone from its precursor progesterone.
"And when we pretreated the animals with finasteride, we inhibited ethanol-induced formation of allopregnanolone by a maximum of 50%," Morrow said.
Following pre-treatment with finasteride, no decrease in spontaneous neural activity due to alcohol was observed in the area of the brain associated with alcohol's sedative-hypnotic effects. Nor were ethanol's anticonvulsant effects observed.
"These findings suggest that allopreganolone plays an important role in the actions of alcohol, at least in the rat," Morrow said.
However, the implications for people are tantalizing.
"This also might be very relevant to our understanding of alcoholism because females have much higher endogenous levels of the compound than males," Morrow said. "And those levels vary across the menstrual cycle and are increased dramatically during pregnancy."
She added: "Females are much less likely to become alcoholics than males statistically. So it's possible that this compound - allopregnanolone - mediates some other effects of alcohol, such as the rewarding effect [in the brain] of ethanol, or it mediates the control mechanism that tells you, 'I've had enough to drink, thank you very much; I feel good.' And since females have much higher levels of this compound in the first place, they might be less likely to drink and less likely to drink as much."
Morrow said research on the role of brain steroids in human subjects is underway.
Funding for the new research came from the National Institute on Alcohol Abuse and Alcoholism.
Note to media: Contact Dr. Morrow at 919-966-7682; email: morrow@med.unc.edu
UNC-CH School of Medicine contacts: Karen Stinneford, 919-966-6047; email: kstinnef@unch.unc.edu
Leslie H. Lang can be contacted at 919-843-9687; email: llang@med.unc.edu
Posted by barbaracat on December 23, 2004, at 23:47:21
In reply to Re: Other new meds for alcohol cravings » barbaracat, posted by Ron Hill on December 23, 2004, at 19:23:05
Posted by mike99 on January 9, 2006, at 21:56:44
In reply to Fascinating - thanks! (nm) » Ron Hill, posted by barbaracat on December 23, 2004, at 23:47:21
Might be a consideration...
This is the end of the thread.
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