Psycho-Babble Medication Thread 616686

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Keppra for generalized or social anxiety?

Posted by Rocket Jackson on March 6, 2006, at 14:55:19

Has anyone tried Keppra for GAD and/or social anxiety? I found one fairly recent study (via a medline search) performed at Duke that seemed to show some promise for social anxiety, but of course, more studies are needed for confirmation. I'm thinking about giving it a try for my generalized and social anxiety (in addition to my Klonopin prn which I may switch to daily). Any thoughts?

Thanks!

Rocket

 

Re: Keppra for generalized or social anxiety?

Posted by SLS on March 7, 2006, at 7:43:36

In reply to Keppra for generalized or social anxiety?, posted by Rocket Jackson on March 6, 2006, at 14:55:19

> Has anyone tried Keppra for GAD and/or social anxiety? I found one fairly recent study (via a medline search) performed at Duke that seemed to show some promise for social anxiety, but of course, more studies are needed for confirmation. I'm thinking about giving it a try for my generalized and social anxiety (in addition to my Klonopin prn which I may switch to daily). Any thoughts?
>
> Thanks!
>
> Rocket

I am currently taking Keppra for bipolar depression. It helps only a bit. Every little bit counts, I guess. I can't comment on its utility for social anxiety disorders, however, I will say that it seems to be a "clean" drug with few side effects. It doesn't affect my cognition or memory at all. It does give me dry skin, though.

One thing I found with Keppra and depression is that it can make depression worse at higher dosages. For me, it has a therapeutic window that lies somewhere between 750mg and 1500mg. I would recommend splitting up your dosing to twice a day. Keppra has a rather short half-life.


- Scott

 

Re: Keppra for generalized or social anxiety?

Posted by Rocket Jackson on March 7, 2006, at 8:52:05

In reply to Re: Keppra for generalized or social anxiety?, posted by SLS on March 7, 2006, at 7:43:36

> > Has anyone tried Keppra for GAD and/or social anxiety? I found one fairly recent study (via a medline search) performed at Duke that seemed to show some promise for social anxiety, but of course, more studies are needed for confirmation. I'm thinking about giving it a try for my generalized and social anxiety (in addition to my Klonopin prn which I may switch to daily). Any thoughts?
> >
> > Thanks!
> >
> > Rocket
>
>
>
> I am currently taking Keppra for bipolar depression. It helps only a bit. Every little bit counts, I guess. I can't comment on its utility for social anxiety disorders, however, I will say that it seems to be a "clean" drug with few side effects. It doesn't affect my cognition or memory at all. It does give me dry skin, though.
>
> One thing I found with Keppra and depression is that it can make depression worse at higher dosages. For me, it has a therapeutic window that lies somewhere between 750mg and 1500mg. I would recommend splitting up your dosing to twice a day. Keppra has a rather short half-life.
>
>
> - Scott
>

Hi Scott,

Thanks for the helpful info. Just curious- did you by chance notice any particular side effects upon first starting Keppra that resolved with continued use? I've read about emotional lability... did you notice this or have you noticed it all?

Thanks again,

Rocket

 

Re: Keppra for generalized or social anxiety? » SLS

Posted by CareBear04 on March 7, 2006, at 15:12:09

In reply to Re: Keppra for generalized or social anxiety?, posted by SLS on March 7, 2006, at 7:43:36

Hi Scott,
I just started taking Keppra for bipolar, too. I don't know anyone else who has taken it, so I'm curious to know more about your experience. Have you taken other mood stabilizers? How do you find Keppra compares to them? I'm on such a huge cocktail of meds that I can't tell what the Keppra is doing. You're right, though, that it's a "clean" drug without many side effects. I'd love to hear any thoughts you have about the drug.
Thanks!
CB

 

Re: Keppra for generalized or social anxiety? » CareBear04

Posted by SLS on March 8, 2006, at 7:28:55

In reply to Re: Keppra for generalized or social anxiety? » SLS, posted by CareBear04 on March 7, 2006, at 15:12:09

Hi CB.

How does your bipolar disorder affect you?

There are so many different opinions regarding the utitility of Keppra for bipolar disorder. One doctor I spoke to said that it was better for the depressive phase than for the manic phase. Another told me just the opposite. Another told me that it didn't have much of a mood-stabilizing effect, another published a paper saying that it does. Yet another said that it had the effect to destabilize mood and precipitate depression and mood lability.

I think all of these things are true. I think it depends on the person and the dosage used. For me, higher dosages were depressogenic and produced mood lability. For me, 1000mg is OK, but 2000mg is not. It does help me with depression, but not much. However, I keep it because it works with the other drugs I take to allow me to function.

Keppra is unique. Unlike the other mood stabilizers, it neither blocks sodium or calcium channels nor potentiates GABA neurotransmission. It seems to bind selectively to a receptor on the synaptic vessicle - the storage and release structure of the presynaptic neuronal terminal. My guess is that it has a reserpine-type effect for some people. It might produce a short periods of both improvement and worsening of depression by producing increases and decreases in neurotransmitter release respectively.

The one side effect that I am finding problematic is that it is producing a very dry skin condition on the palms of my hands. It took a month or so to develop. Using a moisturizer has helped, but I find that I must apply it continuously throughout the day.

Check this out:

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15582854&query_hl=1&itool=pubmed_docsum

I saw this doctor for a consultation. He genuinely believes that Keppra helped his patient recover from a treatment-resistant rapid-cycling bipolar disorder that presented as a mixed state. I don't know how he came to choose 2000mg as a maintenance dosage, but he apparantly tailored it for this patient through trial and error.

Here, the authors describes some patients as experiencing periodic worsenings of their condition during treatment:

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15766304&query_hl=3&itool=pubmed_docsum

My guess is that the dosages used were too high for these people. Ultimately, it will probably be discovered that Keppra displays a therapeutic window for bipolar disorder.

I think I would first target 1000mg for a month or so. If there is no improvement, then continue to 2000-3000mg.

I hope Keppra works out for you.


- Scott


> Hi Scott,
> I just started taking Keppra for bipolar, too. I don't know anyone else who has taken it, so I'm curious to know more about your experience. Have you taken other mood stabilizers? How do you find Keppra compares to them? I'm on such a huge cocktail of meds that I can't tell what the Keppra is doing. You're right, though, that it's a "clean" drug without many side effects. I'd love to hear any thoughts you have about the drug.
> Thanks!
> CB

 

Re: Keppra for generalized or social anxiety? » Rocket Jackson

Posted by SLS on March 8, 2006, at 7:33:09

In reply to Re: Keppra for generalized or social anxiety?, posted by Rocket Jackson on March 7, 2006, at 8:52:05

> Thanks for the helpful info. Just curious- did you by chance notice any particular side effects upon first starting Keppra that resolved with continued use? I've read about emotional lability... did you notice this or have you noticed it all?

From what I can see, mood lability does occur with Keppra at higher dosages. For me, 2000mg produced periodic worsenings. At 1000mg, I remain much more stable.

Here, periodic exacerbations in some people are reported:

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15766304&query_hl=3&itool=pubmed_docsum

My guess is that most of their patients were titrated to 2000-3000mg.


- Scott

 

Re: Keppra for generalized or social anxiety? » SLS

Posted by CareBear04 on March 8, 2006, at 7:47:21

In reply to Re: Keppra for generalized or social anxiety? » CareBear04, posted by SLS on March 8, 2006, at 7:28:55

Thanks, Scott! You are so knowledgable about these drugs.

I'm currently on 1000mg of Keppra-- 500 in the morning and 500 at night. I've been diagnosed as having Bipolar I most recently, but I don't usually have serious manic episodes. I have very black depressions and hypomanias that are generally enjoyable. I'm not a rapid cycler; I tend to stay in one mood state for weeks if not months. In the past, I haven't done very well on anticonvulsant mood stabilizers-- Depakote and Trileptal tended to depress me, Neurontin didn't do anything, and Lamictal caused hypomania when used on its own. Lithium has been the only mood stabilizer I can count on, but I've gotten really toxic on it a lot of times, and no doctor will rx it for me.

THese are the other psych drugs I'm on right now: Abilify 30mg, Prozac 40mg, Dexedrine 15mg tid, Klonopin 2mg, and Seroquel 25mg. I've been in a really dark depression since the start of the new year. I was in the hospital for about a month during Jan and Feb and again for a few days last week. I don't know what's going on or what I can change or try to break out of this funk. ANy suggestions?

Thanks again for all your help, Scott!
CB


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