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Dr. Bob is Robert Hsiung, MD,
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Posted by Christ_empowered on May 1, 2011, at 4:24:57
In reply to Re: PLEASE READ.Pro/con:Gabapentin-agitated depression » jmb2012, posted by mtdewcmu on May 1, 2011, at 1:05:28
If you like gabapentin, get that Lyrica script ASAP. Maybe you'll be able to get better results w/ less sedation? One thing I noticed about gabapentin...over time, it made me stupid. Since Lyrica is stronger, maybe you'll be able to get even better results w/o cognitive impairment (?).
Personally, I'd just take a low-dose, high-potency BZD...cheaper, proven effective, etc. etc. But that's just me.
I wouldn't worry too much about addiction. Some people find gabapentin pleasant; that's really not a big deal. I mean, who said psychiatric treatment HAS to be an unpleasant experience? As long as you're keeping up with your program and able to function, keep poppin' the Neurontin (or Lyrica).
Good luck.
Posted by SLS on May 1, 2011, at 5:11:14
In reply to Re: PLEASE READ.Pro/con:Gabapentin-agitated depression, posted by Christ_empowered on May 1, 2011, at 4:24:57
> If you like gabapentin, get that Lyrica script ASAP. Maybe you'll be able to get better results w/ less sedation? One thing I noticed about gabapentin...over time, it made me stupid. Since Lyrica is stronger, maybe you'll be able to get even better results w/o cognitive impairment
I agree. There is no guarantee, of course, but Lyrica also inhibits alpha2delta calcium channels in the same way as Neurontin.
> I wouldn't worry too much about addiction. Some people find gabapentin pleasant; that's really not a big deal. I mean, who said psychiatric treatment HAS to be an unpleasant experience? As long as you're keeping up with your program and able to function, keep poppin' the Neurontin (or Lyrica).
I agree - again. Judge the result and not the theory. Cognitive impairment is a possible side effect of both Neurontin and Lyrica. Since there are no long-term irreversible side effects reported for either drug, I would consider a trial with Lyrica if Neurontin has plateaued for you. The pharmacokinetics of the two drugs are very different. Lyrica gets into the brain to a greater extent.
http://www.ncbi.nlm.nih.gov/pubmed/20818832
Good luck.
- Scott
Posted by SLS on May 1, 2011, at 5:36:38
In reply to PLEASE READ.Pro/con:Gabapentin-agitated depression, posted by jmb2012 on April 30, 2011, at 20:21:15
Hi.
> Briefly*: the mechanism of GP is still somewhat in question right? Recent studies however have identified it's activity on voltage gated ion channels- exerting a membrane potential and anti-"kindling" stabilizing effect. They also discovered it acts on a number of enzymes, the net result of which supposedly reduce GLUTAMATE synthesis and release while increasing GABA production and slowing or inhibiting its breakdown. GP's activity on glutamate metabolism strikes the strongest note with me. IT FEELS, no proof, that when the GP wears off the brain compensates for it's reduced glutamate load. That or like benzos the brain becomes unable to properly regulate the GABA/GLUTAMATE inhib/excitatory balance. AGAIN THIS IS ALL SPECULATION. PLEASE SOUND OFF ON THIS IF ANY ONE CARES.
Your speculation is very logical. Do you think you could find any literature describing the enzymatic activity? I don't think Neurontin inhibitsl sodium channels, so I am interested in what other ways it reduces glutamate and increases GABA.
Do you feel a brief lifting of mood immediately upon dosage reduction?
I experienced a significant improvement in depression and anxiety any time I would start Neurontin that would fade within a few hours to a few days.
Someone raised some concerns regarding your psychological component to returning to Neurontin repeatedly. Although there is some physiological accommodation to the effects of Neurontin, withdrawal is usually uneventful if tapered gradually. In other words, dependence is generally not an issue. However, you very well could be attached to Neurontin emotionally in a rollercoaster fashion (approach-avoidence). I imagine you are somewhat impulsive and impatient when self-medicating. It will difficult to change your approach toward treatment. I believe you must be methodical in choice of drug and choice of trial period.
Are you a perfectionist or somewhat obsessive?
- Scott
Posted by linkadge on May 1, 2011, at 19:25:48
In reply to Re: PLEASE READ.Pro/con:Gabapentin-agitated depression » jmb2012, posted by mtdewcmu on April 30, 2011, at 23:49:44
>Are you planning to go to med school? I would >not attempt that with my preexisting psych >issues. I read that a lot of previously healthy >people become suicidal in response to all the >pressure and competition.
Thanks for the encouraging words! I wouldn't call it a right off just because of existing mental issues. I was told the same thing with the math degree I took. There are many other factors involved. That being said, klonazepam made me a real idiot.
Linkadge
Posted by mtdewcmu on May 1, 2011, at 20:15:11
In reply to Re: PLEASE READ.Pro/con:Gabapentin-agitated depression, posted by linkadge on May 1, 2011, at 19:25:48
> >Are you planning to go to med school? I would >not attempt that with my preexisting psych >issues. I read that a lot of previously healthy >people become suicidal in response to all the >pressure and competition.
>
> Thanks for the encouraging words! I wouldn't call it a right off just because of existing mental issues. I was told the same thing with the math degree I took. There are many other factors involved. That being said, klonazepam made me a real idiot.
>I didn't mean to be discouraging to all people with a psych diagnosis, but that's how I feel about me. I worked at a teaching hospital, and the new physicians I met all seemed to be functioning at a higher level of mental health than I was. If my ADD issues had been treated, then maybe. I don't think of math as being all that high pressure. Assuming you are talking about undergraduate. I made it through undergraduate computer science, although not without experiencing florid MH problems and being somewhat scarred by the experience.
Posted by B2Chica on May 2, 2011, at 12:39:27
In reply to PLEASE READ.Pro/con:Gabapentin-agitated depression, posted by jmb2012 on April 30, 2011, at 20:21:15
Hi.jmb2012
have aggitated depression/BP mixed whatever they feel like calling it. sometimes its psychotic depression...
ANYWAY.
am on gabapentin now.
like you between 600mg -1500/day.
depending on anxiety.i feel in about 20min a slight effect. i dont get the relaxed feeling till i swear 2 hours later. then it lasts for about 2 hours and i need to take again.
i normally take 600 in morning, and 300 thereafter.every 4 hours till late afternoon/evening.i dont know if its a tolerance so much as my anxiety getting better and worse. so i adjust meds to compensate.
and i think i only notice (addictive qualities) at night trying to sleep. my body is used to either gaba or xanax (or both) for sleep. and if i take less or none i have real difficulties.
i do get "addicted" to that high i feel about 2 hours after taking. but i dont like the lethargy it leaves me with. when my anxiety is high i like it because it FORCES my body to relax. but when anxiety is lower i dont like to take as much or any if i can avoid it cuz then i get too tired.
i dont know if i relate or not, but there's my experience with it.
Thanks for posting!
b2c.
Posted by Jmb2012 on May 2, 2011, at 13:07:59
In reply to Re: PLEASE READ.Pro/con:Gabapentin-agitated depression » jmb2012, posted by B2Chica on May 2, 2011, at 12:39:27
Thank u b2c. Just came back from dr. After explaining situation he wrote me an rx for 1000mg Depakote er. I'll search the site for experiences and advice. One thing that sprung to my obsessive mind is that Depakote and many other anticonvulsants are known to raise insulin levels causing hyperinsulinemia. This is thought to b a possible cause of weight gain and, potentially, hair loss-- seeing that excess Insulin raises testosterone which downstream can cause hairloss. Any one want to sound off on that? Also thinking neurotically abou medicine as I do, was wondering if metformin or even cinnamon, the first being s treatment for hyperinsulinemia , would help ameliorate the anticonvulsant Induced high insulin.
Hopefully some of the really smart people I have seen on this site will put their .02$ in.
Posted by mtdewcmu on May 2, 2011, at 14:18:26
In reply to Re: PLEASE READ.Pro/con:Gabapentin-agitated depression, posted by Jmb2012 on May 2, 2011, at 13:07:59
> One thing that sprung to my obsessive mind is that Depakote and many other anticonvulsants are known to raise insulin levels causing hyperinsulinemia. This is thought to b a possible cause of weight gain and, potentially, hair loss-- seeing that excess Insulin raises testosterone which downstream can cause hairloss. Any one want to sound off on that? Also thinking neurotically abou medicine as I do, was wondering if metformin or even cinnamon, the first being s treatment for hyperinsulinemia , would help ameliorate the anticonvulsant Induced high insulin.
Interestingly enough, Depakote does seem to be capable of causing hair loss (alopecia). A quick way to check side effects is rxlist.com. Did you already know that, or were you predicting it from its effects on hormones? It seems a tad speculative to recommend an add-on, especially for a side effect that you have not yet demonstrated trouble with.
Thinking a little more about your situation -- if this latest trial does not do the trick, maybe you have been barking up the wrong tree with anticonvulsants. Gabapentin sounds like it is giving you an alcohol-like buzz. Anything that causes euphoria will tend to make your problems go away. However, I don't think that can be taken as evidence that you will respond to a non-euphoric anticonvulsant. Maybe you should go back to trying more standard psychiatric meds. I don't recall your exact symptoms, but it sounded like an anxiety disorder. There are other med classes that have better established records in anxiety disorders.
Posted by B2chica on May 2, 2011, at 14:31:49
In reply to Re: PLEASE READ.Pro/con:Gabapentin-agitated depression, posted by Jmb2012 on May 2, 2011, at 13:07:59
my pdoc told me about the hairloss with depakote cuz i was experiencing it with pristiq so he told me to take centrum silver. it is shown to work in people taking depakote...
Posted by linkadge on May 2, 2011, at 15:19:21
In reply to Re: PLEASE READ.Pro/con:Gabapentin-agitated depression » linkadge, posted by mtdewcmu on May 1, 2011, at 20:15:11
>I didn't mean to be discouraging to all people >with a psych diagnosis, but that's how I feel >about me. I worked at a teaching hospital, and >the new physicians I met all seemed to be >functioning at a higher level of mental health >than I was.
IQ is an important factor that mitigates the interaction of learning and stress. A friend of mind suffered severe MDD, but it wasn't really stress induced. In addition, his ability to learn highly complex concepts on the first pass ultimately made law school manageable for him in spite of MDD (and epilepsy).
>If my ADD issues had been treated, then maybe. I >don't think of math as being all that high >pressure. Assuming you are talking about >undergraduate.
Well, the school I went to had the highest rate of suicide in the math and computer science programs (apparently) in the provice I'm in. However, I found teachers college more stresfull since my associate teacher had a Ph.D. and there was a long drive to my school (and other factors)
>I made it through undergraduate computer >science, although not without experiencing >florid MH problems and being somewhat scarred by >the experience.
Thats exactly the point. Some people are scarred by even high school experiences. It depends on the how stressful the individual precieves the experience to be, and this depends on individual abilities, mental health issues, and many other factors (financial capacity, family supports).
According to an article on medscape, clinical depression is a big problem in med school. This doesn't mean that many of these people don't get through, however.
Linkadge
Posted by mtdewcmu on May 2, 2011, at 16:30:30
In reply to Re: PLEASE READ.Pro/con:Gabapentin-agitated depression, posted by linkadge on May 2, 2011, at 15:19:21
> >I made it through undergraduate computer >science, although not without experiencing >florid MH problems and being somewhat scarred by >the experience.
>
> Thats exactly the point. Some people are scarred by even high school experiences. It depends on the how stressful the individual precieves the experience to be, and this depends on individual abilities, mental health issues, and many other factors (financial capacity, family supports).
>My ability to accept new concepts is highly dependent on my level of stress/anxiety. There was a class in my major where I just could not get into the subject matter at the time. I went on to learn about the subject on my own years later when I was not feeling the same stress and anxiety.
Posted by linkadge on May 3, 2011, at 17:03:02
In reply to School and psychiatric illness » linkadge, posted by mtdewcmu on May 2, 2011, at 16:30:30
>My ability to accept new concepts is highly >dependent on my level of stress/anxiety. There >was a class in my major where I just could not >get into the subject matter at the time. I went >on to learn about the subject on my own years >later when I was not feeling the same stress and >anxiety.
Of course the issue has a reflexive nature. I.e. stress can affect ability to learn *and* ability to learn could reduce stress (at least in university).
Linkadge
Posted by SLS on May 3, 2011, at 18:17:13
In reply to Re: School and psychiatric illness, posted by linkadge on May 3, 2011, at 17:03:02
High levels of stress compounded by irregular sleep-wake cycles can trigger mental illness in those who are vulnerable to them. Even if an MI is adequately treated, being subject to new stressors can induce treatment-breakthrough (relapse). Attending medical school is a prime example of this.
I was crushed when my doctors at the National Institutes of Health recommended against my going to medical school if I wanted to maximize my chances of getting well and staying well. Their recommendations applied specifically to me. They were not meant to apply globally to all cases of MI.
I decided to take their recommendations. Maintaining my mental health must take precedence over career choice.
- Scott
Posted by Phillipa on May 3, 2011, at 21:57:13
In reply to Re: School and psychiatric illness, posted by SLS on May 3, 2011, at 18:17:13
It was recommended at the time when only on off and on benzos that RN school wasn't a good idea for me by a very good pdoc in Ct. I went anyway and for me the best thing I ever did. Took my mind off any problems and first divorce. Didn't effect me for 15 years which I will never forget. Graduated Magna c*m Laude. So for me it helped. But I didn't have the long hours that being a doc requires. Phillipa
Posted by mtdewcmu on May 3, 2011, at 23:19:01
In reply to Re: School and psychiatric illness, posted by linkadge on May 3, 2011, at 17:03:02
> >My ability to accept new concepts is highly >dependent on my level of stress/anxiety. There >was a class in my major where I just could not >get into the subject matter at the time. I went >on to learn about the subject on my own years >later when I was not feeling the same stress and >anxiety.
>
> Of course the issue has a reflexive nature. I.e. stress can affect ability to learn *and* ability to learn could reduce stress (at least in university).
>Hence the vicious cycle that I get into.
Posted by mtdewcmu on May 3, 2011, at 23:22:11
In reply to Re: School and psychiatric illness, posted by SLS on May 3, 2011, at 18:17:13
> High levels of stress compounded by irregular sleep-wake cycles can trigger mental illness in those who are vulnerable to them. Even if an MI is adequately treated, being subject to new stressors can induce treatment-breakthrough (relapse). Attending medical school is a prime example of this.
>
> I was crushed when my doctors at the National Institutes of Health recommended against my going to medical school if I wanted to maximize my chances of getting well and staying well. Their recommendations applied specifically to me. They were not meant to apply globally to all cases of MI.
>
> I decided to take their recommendations. Maintaining my mental health must take precedence over career choice.
>Even practicing as a doctor probably doesn't go very well with highly chronic and recurring MI.
Posted by desolationrower on May 3, 2011, at 23:25:41
In reply to Re: School and psychiatric illness, posted by mtdewcmu on May 3, 2011, at 23:22:11
> > High levels of stress compounded by irregular sleep-wake cycles can trigger mental illness in those who are vulnerable to them. Even if an MI is adequately treated, being subject to new stressors can induce treatment-breakthrough (relapse). Attending medical school is a prime example of this.
> >
> > I was crushed when my doctors at the National Institutes of Health recommended against my going to medical school if I wanted to maximize my chances of getting well and staying well. Their recommendations applied specifically to me. They were not meant to apply globally to all cases of MI.
> >
> > I decided to take their recommendations. Maintaining my mental health must take precedence over career choice.
> >
>
> Even practicing as a doctor probably doesn't go very well with highly chronic and recurring MI.otoh, having a high-status job is strongly associated with better handling of stress, through enhanced sense of personal power and efficacy.
-d/r
Posted by SLS on May 3, 2011, at 23:32:00
In reply to Re: School and psychiatric illness, posted by desolationrower on May 3, 2011, at 23:25:41
http://emedicine.medscape.com/article/806779-overview
On average, the United States loses the equivalent of at least one entire medical school class each year to suicide (reliable estimates are as many as 400 physicians).
Sadly, physicians globally have a lower mortality risk from cancer and heart disease relative to the general population, presumably relating to self-care and early diagnosis; however, physicians have a significantly higher risk of dying from suicide, the end stage of an eminently treatable disease process. Depression is a leading risk factor for myocardial infarction in male physicians. Although, as a profession, physicians seem to have heeded their own advice about avoiding smoking and other common risk factors for early mortality, they are decidedly reluctant to address a significant risk of both morbidity and mortality that disproportionately affects them.
In all populations, suicide is usually the result of untreated or inadequately treated depression coupled with knowledge and access to lethal means. Depression is at least as common in the medical profession as in the general population, affecting an estimated 12% of males and 18% of females. Depression is even more common in medical students and residents, with 15-30% screening positive for depressive symptoms. Because of stigma, self-reporting likely underestimates the prevalence of the disease in both populations.
Perhaps due in part to knowledge of and ready access to lethal means, completed suicide is far more prevalent among physicians than the public, with the most reliable estimates ranging from 1.4-2.3 times the rate in the general population. More alarming is that, after accidents, suicide is the most common cause of death among medical students. Although female physicians attempt suicide far less often than their counterparts in the general population, completion rates equal those of male physicians and, thus, far exceed that of the general population (2.5-4 times the rate by some estimates). A reasonable assumption is that underreporting of suicide as the cause of death by sympathetic colleagues might well skew these statistics, so the real incidence of physician suicide is probably somewhat higher.
The most common psychiatric diagnoses among physicians who complete suicide are affective disorders (eg, depression and bipolar disease), alcoholism, and substance abuse. The most common means of suicide by physicians are lethal medication overdoses and firearms.
Posted by mtdewcmu on May 3, 2011, at 23:39:14
In reply to Re: School and psychiatric illness, posted by desolationrower on May 3, 2011, at 23:25:41
> otoh, having a high-status job is strongly associated with better handling of stress, through enhanced sense of personal power and efficacy.
>I would believe that they are correlated, but it would be difficult to determine which way causation points. People who handle stress better would be more likely to desire high status.
Posted by mtdewcmu on May 3, 2011, at 23:53:07
In reply to Re: School and psychiatric illness, posted by SLS on May 3, 2011, at 23:32:00
> More alarming is that, after accidents, suicide is the most common cause of death among medical students.
That statistic is not that alarming, because accidents and suicide are the leading killers of everyone at that age (http://www.cdc.gov/injury/wisqars/pdf/Death_by_Age_2007-a.pdf). I don't mean to rip on your article, Scott, but I hate dumb statistics.
Posted by SLS on May 4, 2011, at 6:09:38
In reply to Re: School and psychiatric illness, posted by mtdewcmu on May 3, 2011, at 23:53:07
> > More alarming is that, after accidents, suicide is the most common cause of death among medical students.
>
> That statistic is not that alarming, because accidents and suicide are the leading killers of everyone at that age (http://www.cdc.gov/injury/wisqars/pdf/Death_by_Age_2007-a.pdf). I don't mean to rip on your article, Scott, but I hate dumb statistics.I understand. I guess the statistic that I found pursuasive was:
"Depression is even more common in medical students and residents, with 15-30% screening positive for depressive symptoms"
This is in comparison to 10% of the general population. What we don't know is if the statistic described by the article is either:
1. Lifetime prevalence.
2. 12 month prevalence.http://www.nimh.nih.gov/statistics/1MDD_ADULT.shtml
Despite debatable statistics, I really believe (at least for now) that the chronic stress of medical school and residency precipitates MDD at a greater rate than what is seen in the general population.
- Scott
Posted by SLS on May 4, 2011, at 6:14:06
In reply to Re: School and psychiatric illness » mtdewcmu, posted by SLS on May 4, 2011, at 6:09:38
> > > More alarming is that, after accidents, suicide is the most common cause of death among medical students.
> >
> > That statistic is not that alarming, because accidents and suicide are the leading killers of everyone at that age (http://www.cdc.gov/injury/wisqars/pdf/Death_by_Age_2007-a.pdf). I don't mean to rip on your article, Scott, but I hate dumb statistics.
>
> I understand. I guess the statistic that I found pursuasive was:
>
> "Depression is even more common in medical students and residents, with 15-30% screening positive for depressive symptoms"
>
> This is in comparison to 10% of the general population. What we don't know is if the statistic described by the article is either:
> 1. Lifetime prevalence.
> 2. 12 month prevalence.
>
> http://www.nimh.nih.gov/statistics/1MDD_ADULT.shtml
>
> Despite debatable statistics, I really believe (at least for now) that the chronic stress of medical school and residency precipitates MDD at a greater rate than what is seen in the general population.It occurs to me that the statistic cited by the article is latitudinal, not longitudinal. I believe this is a valid criteria for comparing populations.
- Scott
Posted by mtdewcmu on May 4, 2011, at 11:03:28
In reply to Re: School and psychiatric illness » mtdewcmu, posted by SLS on May 4, 2011, at 6:09:38
> "Depression is even more common in medical students and residents, with 15-30% screening positive for depressive symptoms"
>
> This is in comparison to 10% of the general population. What we don't know is if the statistic described by the article is either:
> 1. Lifetime prevalence.
> 2. 12 month prevalence.
>That one is surprising and significant. They probably administered a questionnaire to med students as a screen, asking about current symptoms. So it's probably closer to 12 month prevalence.
> http://www.nimh.nih.gov/statistics/1MDD_ADULT.shtml
>
> Despite debatable statistics, I really believe (at least for now) that the chronic stress of medical school and residency precipitates MDD at a greater rate than what is seen in the general population.
>No, I agree. You can sort of reverse-engineer these articles and figure out what went into them. It was probably written by a writer who is not an epidemiologist and was using mostly canned statistics. It doesn't mean that all of them are useless, or that the main thrust of the story is off-base. But, of course, I would double-check the statistics.
Posted by mtdewcmu on May 4, 2011, at 11:17:21
In reply to Re: School and psychiatric illness » mtdewcmu, posted by SLS on May 4, 2011, at 6:09:38
Thinking about it some more, the writer of that article must have been looking at a statistic for the prevalence of suicide among medical students. So the statistic itself may have been meaningful, but the writer missed the significance of it.
Posted by linkadge on May 4, 2011, at 16:38:37
In reply to Re: School and psychiatric illness, posted by mtdewcmu on May 3, 2011, at 23:39:14
Higher status jobs are often associated with higher pay. Perhaps the high pay acts as a buffer against stress.
Linkadge
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