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Dr. Bob is Robert Hsiung, MD,
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Posted by Astounder on November 15, 2007, at 17:56:59
My psych said the problem here is with association of sensation/thought/setting/memory with things inherently aversive (sadness, pain, psychic anxiety, somatic/autonomic symptoms). Obsessive rumination and dysphoria on recall continually reconsolidates these fear.
If one could directly interfere with the formation of the aversive conditioning, even without blocking the acute symptoms, one should be able to prevent the development of avoidance behavior.
The idea here would to be to use short-acting amnestics during acute panic, while not using amnestics while anxiety is low (so that the fear will eventually extinguish itself on its own). Among drugs that would prevent acquisition of memory would be very short-acting benzos like midazolam and Halcion. Propranolol to block the consolidation of memory. These drugs affect fear condition at doses that are not universally amnestic (do not interfere with spatial memory). The sedative and sympatholytic (tremor, palpitations) actions of this cocktail would also palliate the attack.
There's anticholinergics like scopolamine that block fear acquisition, but at unselectively amnestic doses. I also don't understand the dynamics of scopolamine, so maybe a better choice would be Benadryl (6 hr half-life)? Dissociatives also have amnestic effects and block fear acquisition, and the co-treatment with an anticholinergic and/or GABAergic would prevent NDMAR-blockade neurotoxicity.
Might have advantages to chronic, prophylactic use of anxiolytics, in that you may eventually be able to extinguish already conditioned fear.Has anyone tried anything like this?
Posted by linkadge on November 15, 2007, at 23:35:11
In reply to Amnestics and panic, posted by Astounder on November 15, 2007, at 17:56:59
I think there are supposedly some natural chemicals released during extreme stress that produce dissociative effects.
I remember reading about some chemical that is released during stress shares similar bindings sites to PCP.
There is the issue that you could prevent the formation of a memory which might help in the extinction process to reduce future panic reactions. I think some research showed that giving mice a beta blocker after a forced swim test prevented post stress induced behavioral consequences, but they also failed to learn the location of the secret platform as well as mice who didn't get the beta blocker post stress.
Somtimes the post stress hypercholinergic function is adaptive. In some situations, introducing a drug during this process might hamper a complete recovery.
For instance, if you took scopolamine after just witnessing a car accident, you'd likely still remember the car accident, but not remember consequent associated events which might ultimately help to bring resolution to the situation. So your brain might just get stuck at the car accident and not be able to move through the event for loss of memory.
(Eh, now I'm just blithering)
Its hard to know in which situations a drug intervtenton might be benificial.
Linkadge
Posted by Jimmyboy on November 16, 2007, at 9:46:16
In reply to Re: Amnestics and panic, posted by linkadge on November 15, 2007, at 23:35:11
I would seriously not mess with scoplamine at all, in small or large doses. I had some bad experiences with it, that seem to keep lingering months after the usage of it. Just a warning.
JB
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