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Dr. Bob is Robert Hsiung, MD,
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Posted by Stephen32 on May 21, 2011, at 14:15:30
I want to come off of my 4mg Klonopin daily which I have been taking for around six months because of severe anxiety. Tolerance has kicked in and sleep is getting worse.
In the past Depakote ER was pretty useful for a relatively fast and smooth benzodiazepine withdrawal. As I don't want to take benzos again after the W/D I thought maybe the combination of valproate (Depakote ER) & tiagabine (Gabitril) might be a good long-term strategy for treatment resistant social / generalized anxiety. I also had some mood swing problems in the past.
As valproate and tiagabine increase brain GABA levels by different mechanisms of action there should be a synergistic or at least additive effect IMHO. The safety of the combination has been tested in patients with epilepsy receiving up to 30-50 mg/day (much more than necessary for anxiety disorders) - http://www.ncbi.nlm.nih.gov/pubmed/15693805
What do you think about the idea?
Posted by Phidippus on May 21, 2011, at 17:46:31
In reply to Valproate + Tiagabine combination, posted by Stephen32 on May 21, 2011, at 14:15:30
I had touch and go success using Gabitril as an anxiolytic. I did however read a case study about a woman being treated effectively for anxiety with Gabitril. Depakote, however, is a powerful GABA exciter and glutamate antagonist. At 2000 mg it helped me combat the worst kind of OCD: harming thoughts. Have you considered Lyrica? Its gabaergic, glutamatergic and antagonizes substance P which helps with anxiety. Also consider Zonegran, as it too is gabaergic and glutamatergic.
P
Posted by Stephen32 on May 21, 2011, at 18:43:07
In reply to Re: Valproate + Tiagabine combination » Stephen32, posted by Phidippus on May 21, 2011, at 17:46:31
There exist a few promising trials about tiagabine for anxiety (two randomized).
I have tried Lyrica to no avail and Topamax too, so I won't take Zonegran. But thanks for your suggestions!
I'm really interested in the possible synergistic GABAergic / anxiolytic effect of a valproate + tiagabine combination.
This is the end of the thread.
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