14 replies to this topic

[Jgfergie]

I'm working with a new psychiatrist who has me tapering off the Diazepam (per my wishes) by using and increasing a new drug, Gabapentin (Neurontin).  I was taking 9 mg of Diazepam per day.  He has had me reduce that dose by 1 mg every 5 days, and increasing Gaba by a corresponding 100 mg, from a starting dose of 500 mg to 800 mg so far.

This past weekend, I had a serious depressive episode.  Not sure if it was related.  

For further background, I was on Klonopin for almost 12 months, when my old psych switched me from 2 mg Klonopin to 18 mg Valium.  I then reduced from 18 mg of Valium at 2 mg per week.  When I hit 12 mg, I had a bad depressive and panic episode.  I then slowed the taper significantly to 9 mg over the next 3 months.  

I did feel better when the Gaba was introduced.  But I'm wondering now about my taper speed of the Valium.  

My first question for anyone who has tried this substitution (or any expert opinions on this) is: what do you think about this pace of taper/substitution?

My second question is: has anyone had luck switching from Valium to Gabapentin (Neurontin) for anxiety?

For full disclosure, it should also be noted that I take 60 mg of Cymbalta and 200 mg of Wellbutrin per day, which has remained at this level for several months.

Thank you,
Jfergie

[fishinghat]

Gabapentin has been around since 1993. It is FDA approved for seizures and neuropathic pain. However, drs love using it on many off label usages. In my opinion, its effectiveness in applications such as yours is a very unique attempt to control benzo withdrawal. Most of these types of usages are either wonderful successes or dismal failures with the gabapentin. I must admit that I have used gabapentin but not in this manner. Just one mans opinion.

I will check and see if there is anything in the medical journals on this type of application. Be back with you soon.

[fishinghat]

I did manage to find two articles on this type of application. Apparently this is a new approach. The first article gives some good info but the second article lacked an abstract so I did not include it.

https://www.ncbi.nlm...pubmed/22545971

Basic Clin Pharmacol Toxicol. 2010 Nov;107(5):883-6. doi: 10.1111/j.1742-7843.2010.00590.x.

Does Pregabalin (Lyrica(®) ) help patients reduce their use of benzodiazepines? A comparison with gabapentin using the Norwegian Prescription Database.

Bramness JG1, Sandvik P, Engeland A, Skurtveit S.
Author information

Abstract
Pregabalin (Lyrica(®) ) may have an anxiolytic effect. It has also been reported that the use of this drug helps prevent excessive use of benzodiazepines. The aim of the present study was to examine if pregabalin reduced the intake of benzodiazepines. In a pharmacoepidemiological study, we compared pregabalin to the older drug gabapentin (Neurontin(®) ) in the Norwegian Prescription Database. The database has total capture of all prescribed drugs outside institutions. We identified all prescriptions for the two drugs for patients aged 18-69 years between 2004 and 2007. Patients were grouped as psychiatric patients, patients with epilepsy, patients with neuropathic pain or non-specified users. We measured the use of benzodiazepines 182 days before and after the initiation of treatment with pregabalin and gabapentin. Between 15% and 29% of the patients were able to stop using benzodiazepines after starting pregabalin or gabapentin treatment. Psychiatric patients who started pregabalin were able to reduce the amount of benzodiazepines used by 48%, compared to only 14% among starters of gabapentin. This study shows that some patients reduced their use of benzodiazepines substantially after starting pregabalin.

[Jgfergie]

Thanks, Fishinghat.

 

What do you think about the pace of the taper of Valium (approx 1 mg/5 days, when taking under 10 mg of Valium)?

[fishinghat]

I would say a little fast. About 10% every 10 days would be what I expect.

 

I am not sure why he is using gabapentin to treat the withdrawal. Water titration has proven very successful without any withdrawal symptoms although it can take a long time. That technique has been around a long time but can take a couple years to withdraw from a dose like yours.

 

Oh, by the way, I assume your dr told you that there was a withdrawal from gabapentin?

[Jgfergie]

He told me that Gabapentin was not addictive in the same way that benzo's are.  He didn't mention withdrawal.  

 

I told him I wanted to get off Valium because I didn't want to on benzo's (since it's been 13 months), and that I wanted a healthier substitute for Valium to treat my anxiety and panic, which is still high given a particular long-term situation I am dealing with.

[fishinghat]

Why gabapentin? It is not considered an anxiety medicine although it has proved helpful to some. I would consider it as a last resort. Clonidine  and/or hydroxyzine is the typical treatments for benzo withdrawal. I guess he has his reasons.

[Jgfergie]

I'll raise these questions with him.  I do still need something effective for anxiety.  It's not just about getting off the Valium.

 

Can Clonodine be used in conjunction with Gabapentin?  I'm thinking of suggesting a switch over to Clonodine if it's better at treating anxiety, but I'm concerned about doing it all at once.

 

I'm going through a bad depression today that might be a built-up result of coming off the Valium too fast.  This has happened before when I've decreased it too fast.

 

Is it true that going back up on the Valium (like 1 mg) would not be effective at combating this depression effect?

[Jgfergie]

Fishinghat -- another question for you: what do you consider to be good non-Benzo medications for treating anxiety?  

[fishinghat]

First is, of course, antidepressants, second is benzodiazepines (Valium, Xanax, Ativan, etc). third is chlonidine and fourth is hydroxyzine. I always recommend the last two first as they are very effective for most and have no withdrawal and are not addictive. In the event they do noit work for an individual then they still have the option of trying a benzo. Any of these medications can be used with gabapentin. By the way hydroxyzine is a common treatment for benzo withdrawal.

 

The statistics I have seen show that around 55% of those who go back up on a benzo have no success and 25% have very little success in correcting the withdrawal symptoms.

[Jgfergie]

Thank you, Fishinghat!  

[gail]

Hello JG,

I was given Gabapentin for neuropathic pain after surgery last June. Gabapentin "cured" the anxiety and let me tell you that I have been suffering from anxiety for the past 10 years and more.

It's been a blessing. Just my experience, it does nothing much for the depression.

I am also tapering Valium, real slow, like 1 mg a month or so. And at times, I skip a month.
4 mg to go.

I also have been lowering Gabapentin, but I will always be on it for the pain. Like 100 mg every 10 days without any withdrawal. I'm at the desired point now.

On that, don't be afraid of the Gabapentin. I do believe that it helps with Valium tapering.

[Chaos]

I would say a little fast. About 10% every 10 days would be what I expect.

 

I am not sure why he is using gabapentin to treat the withdrawal. Water titration has proven very successful without any withdrawal symptoms although it can take a long time. That technique has been around a long time but can take a couple years to withdraw from a dose like yours.

 

Oh, by the way, I assume your dr told you that there was a withdrawal from gabapentin?

Oh my.. I slowly withdrew from 3600mg of gabapentin trying to control motor neuron issues and I will tell you from one person it was and has been the most horrific challenge I have ever experienced!!!

[fishinghat]

Wow!! That was a high dose. No wonder you had so much problems. Most take 100 to 200 mg a day for the withdrawal.

[invalidusername]

Holy crap!!! Are you sure that's not a typo?!