Polypharmacy anyone?

[Yogamom]

OK, well I finally was able to get on the new site. Here is my dilemma/story. I need to cut back on my drinking. I feel so much better when I do. DH is happier. Everything is better. I was on Topamax for migraines awhile back and it really helped me with the drinking. I had some side effects of depression and low sex drive. I am now wondering if I should go back on it, try baclofen, try naltrexone, or maybe try naltrexone and topamax. Anyone here try more than one med to cut down on side effects? Thanks in advance for any advice!

[Alky]

I am on quite a cocktail that includes gabapentin, clonidine and baclofen, supplemented with naltrexone, hydroxyzine and Ativan as needed. They were all prescribed by a doctor after extensive consultation. Although self-medication is frequently promoted on this forum, I had disastrous consequences with it. Your best bet: go see a doctor with a background in addiction medicine. I could not think and pill-pop my own way out of alcoholism. Your doctor will know what medication is best for you. Let them decide.

[neophyte]

Alky can you expand on your negative experience self medicating? It might help others here to not make the same mistake.

You are on quite a cocktail of medications there, how does the gabapentin and clonidine help you stop drinking? I take it that hydroxyzine and ativan are as needed for sleep?

I go to a psychiatrist who specialises in addiction, I should have done that first instead of visiting general practitioners who didn't know anything about baclofen.

[Yogamom]

I agree with not self medicating. That is quite an array of meds you are on.

[Alky]

Hi Neo and Yogamom, gabapentin is gaining acceptance after a placebo-controlled trial here in the USA as an anti-craving medication. Spiritwolf has posted a link to the study somewhere around here, but I don't have the time right now to try and find it. I also have severe anxiety and am prone to panic attacks, so it seems to have a mood-stabilizing effect as well. Clonidine is also used to control anxiety and helps with my ADD. In fact, even though clonidine for ADD is off-label here, it isn't down in your part of the world. The hyrdroxyzine is for acute panic attacks. 50mg restores me to baseline without being sedating. And the ativan is the doomsday weapon - reserved for only the most debilitating of panic attacks. I do not take it for sleep or on anything resembling a regular basis. And my doctor is extremely careful - I get very few tablets at a time.

As far as the self-medicating goes, I, along with many other people, stumbled across this forum in a truly desperate state. The prevailing zeitgeist here seems to be, "get yourself some baclofen," self-medicate, and soon you won't be an alcoholic anymore and can even drink moderately if you want. And who needs doctors anyway? They're just idiots. "I know more than doctors," was a verbatim quote from one former member of this forum. Well, I got my under-the-table baclofen, managed actually to hit the switch, at least I think I did, but without medical and psychological guidance, quickly became an alcoholic on HDB. And it might seem undiplomatic to point out, there are a lot (at least in the past - I don't come around here much anymore) of people on HDB who are in active addiction. I was one of them. Since hitting my switch, I've been involuntarily committed to a psych ward and a detox facility, and nearly lost my driver license over a possible detox seizure. So pardon me for calling BS on those parties still here who think the answer to drinking is to take more and more and more baclofen and nothing else. Only after seeking psychological and group support therapy (yes - including the reviled AA) do I finally have a sense that I might be able to beat this thing.

[neophyte]

Alky, is there a problem with tollerance or poop out with gabapentin? This drug interests me as its marked as being good for social anxiety, which im currently on effexor for but doesnt seem to be working that well, i think its made me into a bit of a zombie.

As far as self medication is concerned. I did like most on here and self medicated with baclofen, I prefer not to do this on my own so i've gone to a psychiatrist after the fact. I did find that regular doctors refused to even listen to me. They would simply say no, baclofen isn't used for that purpose, go get some therapy instead. End of conversation. Medical science is a huge field so its not like you can expect a doctor to give a learned opinion on every aspect. However they tend not to admit that they don't know or that you might be correct on something they have no idea about, which i think is where the frustration comes from. The medication is approved in France, there is a prescribing guide and studies proving it works. If thats not enough to have a serious conversation with my doctor that can get me on this treatment without a good reason then I'm going to go ahead on my own.

True you can't just rely on baclofen, I've learned that the hard way. Baclofen helps but its still a day by day battle and perhaps it always will be. Baclofen does help immensely. If I can't drink it's not a big deal. before baclofen, i would plan well ahead to ensure I always had alcohol and the thought of going without was a horrible one. I think there are still some psychological reasons I want to drink. I work in an open plan office and it really messes with my head anxiety wise so I need ways to cope with that.

[guapo]

Maybe this is the wrong place to post something about naltrexone but I'm going to anyway.

I've used it as prescribed by the Sinclair method for over a year, and my drinking is now next to nothing. Occasionally with dinner, at a wedding, at a sporting event, but never to excess, never alone.

Since the medication takes away the short-lived reward of drinking alcohol, over time the desire to drink fades away. What also comes is a realization that alcohol never solves anything or improves anything.

My perspective changed, so did the urge to drink. Its way more than just taking the naltrexone, which I do about once a week. Spent a lot of time reading, looking at these forums, visited with a counselor, some hypnosis, some mindfulness training etc etc.

So I see the medication as a tool that helps. Now things are never a struggle, It was a horrible struggle to hide my drinking, and to deal with the consequences of drinking on a daily basis. THAT was a nightmare. This is freedom from a horrendously destructive and stupid habit. Maybe the most important tool was to be optimistic, and have faith in getting past this.

That's my take on things.

[Alky]

Maybe this is the wrong place to post something about naltrexone but I'm going to anyway.

I've used it as prescribed by the Sinclair method for over a year, and my drinking is now next to nothing. Occasionally with dinner, at a wedding, at a sporting event, but never to excess, never alone.

Since the medication takes away the short-lived reward of drinking alcohol, over time the desire to drink fades away. What also comes is a realization that alcohol never solves anything or improves anything.

My perspective changed, so did the urge to drink. Its way more than just taking the naltrexone, which I do about once a week. Spent a lot of time reading, looking at these forums, visited with a counselor, some hypnosis, some mindfulness training etc etc.

So I see the medication as a tool that helps. Now things are never a struggle, It was a horrible struggle to hide my drinking, and to deal with the consequences of drinking on a daily basis. THAT was a nightmare. This is freedom from a horrendously destructive and stupid habit. Maybe the most important tool was to be optimistic, and have faith in getting past this.

That's my take on things.

The title of this thread is "Polypharmacy Anyone?" and as such is dedicated to those of us using multiple medications. It would have been more appropriate for you to post on a TSM thread, or for you to have even started a new thread, rather than hijack this one. Please give it some thought before you decide to post something "anyway" in the future.

[Ne/Neva Eva]

Ouch! I think someone woke up on the wrong side of the mattress and had to have cold coffee or something.

Take it easy, there, will ya'? The way I read it, the original post is a person who is looking for solutions, suggestions, and commentary. I didn't read anything about "If you only used one medication, then please don't post here." just sayin'

Let's not go all sideways and start all that stuff up again! Please. Pretty please. I'll buy you a hot coffee.

[Ne/Neva Eva]

...maybe try naltrexone and topamax. Anyone here try more than one med to cut down on side effects? Thanks in advance for any advice!

I'm guessing guapo didn't have to take topamax, which I would also guess is valuable information for the OP.

[guapo]

The title of this thread is "Polypharmacy Anyone?" and as such is dedicated to those of us using multiple medications. It would have been more appropriate for you to post on a TSM thread, or for you to have even started a new thread, rather than hijack this one. Please give it some thought before you decide to post something "anyway" in the future.

WOW. In the spirit of helping, I shared a strategy that was very successful. If I remember correctly, you were the same person that called me a "troll" for some reason.

Nobody's hijacking anything here, but that kind of antagonistic immature response is uncalled for.

I imagine a poly pharmaceutical approach must be a very complicated and thought consuming process. How would you ever know which drug was doing what ?

I wish you the best of luck.

[Alky]

Alky, is there a problem with tollerance or poop out with gabapentin?

Hey Neo - I've not read anything about tolerance to gabapentin, but the max daily dose as mandated by law here in the USA is 3600mg. I can't imagine getting anywhere near that close - I can barely tolerate the 900mg I'm supposed to take, and many days I only take the 600 at night. The gabapentin and the hydroxyzine for acute panic attacks is a huge improvement over benzos, though I mentioned I still have Ativan on hand to take care of those doomsday scenario panic attacks. I haven't taken any recently, but knowing that they're seems to help psychologically, if that makes sense; knowing I can reach for those instead of a bottle. I have a friend from detox who finally found a new doctor to take her off Effexor - she was complaining of the same problems as you.

I'm also curious if you're in talk therapy for your anxiety. As I mentioned earlier, I have generalized anxiety and occasionally experience moderate to crippling panic attacks. Talk therapy and even AA has been beyond valuable in learning psychological coping strategies and hearing others' means of dealing with issues. I tried to medicate my way out of my anxiety, first with alcohol and then with pharmaceuticals thinking therapy was a bunch of "mumbo-jumbo" but as I said, it's helped me immensely.

As far as all the other stuff goes, the point I was trying to make is that baclofen therapy alone may or may not be the answer out of one's alcoholism, and what is the harm of letting a psychiatrist make the determination of what drug, or combination of drugs, works best for any one individual?

[Yogamom]

Polypharmacy might be complicated but it might be worth the try so I just want to learn as much as I can. Lots of people are on two or three drugs for depression or high blood pressure. I dont think there is a one size fits all answer.