Things I'm learning about Bac

[Ne/Neva Eva]

Hey, MJM. Congratulations on the sober time. Spreading the doses out is what has always worked for me, especially when titrating up or new to a level. Glad it's working for you.



I read in the book, A Prescription for Alcoholics that



"Scientists have found that bothe the SSRI fluoxetine (brand name Prozac) and the popular SNRI venlafaxine (brand name Effexor) enhanced the alcohol deprivation effect (ADE) and led to an increase in drinking lasting at least 5 weeks in research animals."

(A Prescription for Alcoholics, Linda Burlison, p. 499. http://amazon.com/Prescription-Alcoh...linda+burlison)



I haven't read the research where she found the information, but based on what I've read and verified from the rest of her book, I trust that her information is legitimate. KEEP THIS IN MIND: It was one study. It was done on rats. It is definitely not conclusive. But it was enough for me, and I talked to my doctor about getting off of it. (I actually take desvenlafaxine, AKA Pristiq, which is the newer version.) I take an extended release formula and she suggested I take it every other day for three weeks. It definitely isn't something you want to stop abruptly, so make sure you talk to your doc about titrating off of it. (How you titrate off will depend on how much and what kind you are taking.) Today was my last dose, and I haven't really noticed any difference. I'll give it another 5 days before I change anything else (like titrating back up on baclofen again) just to make sure that I'm not (in my doctor's words) destabilized.



I will add this anecdote: I started drinking alcoholically again, after almost 4 years of contented sobriety, in December 2014.



In that month, I saw a doctor at a walk-in-clinic type place because I was having chest pain. I went back three times about my chest pain. On the third visit, he (very gently) assured me that my heart and my general health were fine, but that he thought I should take an antidepressant for anxiety. (I had to laugh at myself, since anxiety was clearly the problem to begin with and I knew it.) He prescribed a low dose of venlafaxine/Effexor.



I can't remember which came first, the antidepressant or the drinking...



For me, being depressed is almost as scary as continuing to drink. It is also a reason to drink. So in a way it's a difficult decision. On the other hand, if there is any evidence, anywhere, that I may be contributing to my addiction to alcohol, it's got to go. Lots of other ADs on the market. (If you're interested in which ones are contraindicated and which ones seem to be beneficial, it's worth it to buy the book. The book is AH-MAZING.)

[lex]

Ne-

1) I am reading "The Natural History of Alcoholism, Revisited" by George E. Valliant. Very important book. Based on longitudinal studies, he believes the usual course is for alcohol abuse/dependence to lead to depression, rather than vice versa. He notes that sober alcoholics typically believe "alcohol is the antithesis of a tranquilizer," whereas drinking alcoholics typically believe "alcohol makes me feel less anxious and depressed." Id. at 220.

2) My experience has been that SSRIs and SNRIs led to an increase in my drinking. My experience is that the MAOI drug Nardil led to a pronounced decrease in my drinking- it made me indifferent to alcohol. Saved my marriage and career- and I was taking it for depression, not alcoholism! I had no idea it would create indifference to alcohol. Frankly I did not expect or want it to. YMMV of course, but if you are seeking an effective antidepressant I strongly suggest your doctor considers Nardil for you. Incidentally, the risk of hypertensive crisis from eating tyramine-rich food is completely overblown. In my view, a person stands a much greater risk of having any crisis due to alcohol abuse, than he or she stands to have due to eating tyramine-rich food while on Nardil.

[Spiritfree]

Ne-

1) I am reading "The Natural History of Alcoholism, Revisited" by George E. Valliant. Very important book. Based on longitudinal studies, he believes the usual course is for alcohol abuse/dependence to lead to depression, rather than vice versa. He notes that sober alcoholics typically believe "alcohol is the antithesis of a tranquilizer," whereas drinking alcoholics typically believe "alcohol makes me feel less anxious and depressed." Id. at 220.

2) My experience has been that SSRIs and SNRIs led to an increase in my drinking. My experience is that the MAOI drug Nardil led to a pronounced decrease in my drinking- it made me indifferent to alcohol. Saved my marriage and career- and I was taking it for depression, not alcoholism! I had no idea it would create indifference to alcohol. Frankly I did not expect or want it to. YMMV of course, but if you are seeking an effective antidepressant I strongly suggest your doctor considers Nardil for you. Incidentally, the risk of hypertensive crisis from eating tyramine-rich food is completely overblown. In my view, a person stands a much greater risk of having any crisis due to alcohol abuse, than he or she stands to have due to eating tyramine-rich food while on Nardil.

..bump..

(and yes NE, you know very well that anti depressants lead to more drinking if you are already an alcoholic -unless of course you just happen to find the right anti-depressant like Lex did.)

[Ne/Neva Eva]

Ne-



1) I am reading "The Natural History of Alcoholism, Revisited" by George E. Valliant. Very important book.

...

2) My experience has been that SSRIs and SNRIs led to an increase in my drinking. My experience is that the MAOI drug Nardil led to a pronounced decrease in my drinking- it made me indifferent to alcohol.

...

Somehow I missed this post, Lex. Thanks for the information. I'll check out the book. I'm still slogging through A Prescription for Alcoholics - Medications for Alcoholism which is not only long, but helping me create the information for the new forum. It's chock full of info about meds and other important things.



I have always been very reluctant to take SSRIs, having read just a bit of info about how they lead to increases in drinking. But the aforementioned book makes the link very clear, for SOME (but not all) people who have alcoholism. Interesting, isn't it?



When I agreed to the SNRI, I was hoping it was different and had many reports of people on here who were taking Effexor and finding it beneficial. Ironic that the book indicates it's one of the ones with a clear link (in rats) to increased drinking and, perhaps more importantly, withdrawal symptoms. Far from conclusive evidence, but enough for me. Nice to hear more anecdotal evidence about other people having a similar reaction. It's been very disheartening to still be drinking against my will after all this time and a whole lot of baclofen. I just stopped the desvenlafaxine (Pristiq, another SNRI) last week, after tapering off for 3 weeks. We shall see how it goes...



If depression returns I will certainly mention your experience with Nardil to my pDoc. MAOIs have so many contraindications that she may be reluctant (as am I) but depression sucks almost as much as drinking alcoholically, so I appreciate your input. Thank you.

[Ne/Neva Eva]

Lex, I just looked up the book you are reading. It was written in 1983! There have been a lot of dramatic changes since then. Do you still find it relevant after all the more recent developments in neuroscience and brain chemistry? If so, I'll definitely order it and put it on the list of things to read.

EDIT: Oops. I see it was updated in 1995. Still, that was a long time ago. I'll order it anyway, but would still like your input, Lex.

[neophyte]

Theres a lot of anecdotal evidence online that SSRIs increase cravings or consumption of alcohol, i myself became an alcoholic when I was on zoloft. Depending on your anti depresant of choice, most of them work on increasing monoamines (serotonin, dopamine and or noradrenaline), most work by increasing serotonin, in the case of MAOIs vs SSRIs they both increase serotonin just by a different mechanism, SSRIs do it via a safer mechanism which is why they are preferred over MAOIs.
I believe that at least some of the MAOIs work on increasing all monoamines, so that said. If increased serotonin is the culprit MAOIs may not help. That said, the way these drugs work in practice is a lot more complicated than simply just increasing a particular monoamine. So the link between alcoholism and anti depressants is potentially more complicated.

I've gone through all sorts of anti depressants, now im on Escitalopram 5mg, which is quite small.

[Otter]

Neo, you should look into the pharmacology of Mirtazapine. My wife only really got fully better once she got off SSRI's and onto Mirtazpine in combination with baclofen and she continues to use both. Mirtazapine has a different mechanism and has good reports in relation to use in alcoholic patients.



Here's an NIH study: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3516621/



"This report provides data from what we believe is the first open-label study evaluating the efficacy of the second generation antidepressant medication mirtazapine for the treatment of both the depressive symptoms and the level of alcohol use of persons with comorbid major depressive disorder and alcohol dependence. The two previous studies involving mirtazapine in this comorbid population did not evaluate the level of drinking of subjects in their studies (Yoon et al., 2006; Altintoprack et al., 2008). Mirtazapine was well tolerated our subjects with comorbid major depressive disorder and alcohol dependence. During the course of the medication trial, study participants demonstrated significant within-group improvement in both depressive symptoms and in level of alcohol consumption. The magnitude of those clinical improvements was large, especially for the clinical improvement in depressive symptoms. These preliminary findings suggest efficacy for mirtazapine for treating both the depressive symptoms and the alcohol use of comorbid major depressive disorder and alcohol dependence. The increase in number of employed subjects noted during this treatment trial suggests an increase in level of functioning associated with the decreases in depressive symptoms and level of drinking. These clinical improvements occurred relatively quickly after starting mirtazapine, which is consistent with the rapid onset of response noted by previous authors (Watanbe et al., 2008).



The significant decrease in depressive symptoms during the course of the current treatment trial is consistent with the finding of Yoon and colleagues (2006) and of Altintoprak and colleagues (2008), both of whom reported significant decreases in depressive symptoms in their studies of comorbid subjects involving mirtazpine. However, those two previous studies did not evaluate the level of alcohol use during the course of their studies, though they both reported a significant decrease in level of alcohol craving during the course of their studies. Consequently, we cannot compare the results of the current study to the results from those other two studies on the important outcome variable of level of alcohol use. Therefore, we believe that our current study is the first study to report a significant decrease in level of drinking in a comorbid major depressive disorder/alcohol dependence population treated with mirtazapine. The reason for the effect of mirtazapine on alcohol consumption in the current trial is not clear, though mirtazapine is known to affect both the serotonergic system and the noradrenergic system, as opposed to selective serotonin reuptake inhibitors which affect only the serotonergic system. The norepinepherine system may be involved in the modulation of brain reward circuit, which can be related to level of drinking.



The results of this study should be interpreted in light of some limitations. First, the sample size in this pilot study was limited, as was the number of assessment instruments. Also, no placebo control group was used, so we cannot rule out the possibility that some (or all) of the therapeutic effect that was noted in this clinical trial may have resulted from the brief motivation enhancement therapy used in study, or from the extra attention and monitoring afforded by the study. In addition, it is unclear to what extent the results of this study generalize to inpatient populations or populations using cocaine, opiates, etc., in addition to their depression and their alcohol use disorder. Therefore, the exclusion criteria used in the current study may have contributed to a selection bias, and thus may limit the generalizability of the findings to other populations. Double-blind placebo-controlled trials of mirtazapine appear to be warranted in to clarify the role of mirtazapine vs. therapy in the treatment of persons with comorbid disorders."

[Chrysalis1]

This is such a lovely thread and so helpful to me. I am English and live in France and so my my doctor (lovely guy) is cued up. And he told me it is for me to find my dosage. I have jst got my prescription today and am excited about starting, and there has been so much encouragement here.

I would be interested though to hear from people about how it has helped their anxiety. I know this is why I drink - how about you folks?

[Otter]

There was a lot of interest in baclofen for anxiety and PTSD a few years ago and I found a link to an old thread: https://www.mywayout.org/community/ar...p/t-62674.html

I think the Carrots of Hope organization is no longer around though.

I took it for anxiety and it was great at a very low dose of 10 mg in the morning and that was all. When I went higher than that it became a problem because if you take a high dose, a few hours later it wears off and you get withdrawal.

I got up to doses of 150 mg a day and took that for maybe a year or so during the worst of our situation. In the end it was a serious problem for me because as it wore off my body would actually seize up and I would start walking with a stiff left leg. That went away as soon as I took more baclofen but at that high dose I was pretty heavily drugged and felt lousy about things. In the end I stopped taking it by going through a withdrawal program I devised for myself. It took just over a day to come off baclofen completely with no problems.

I would recommend baclofen for anxiety but you have to be aware that it is not like valium where you take a pill every few hours or twice a day. It's a very potent, strong drug and works at very low doses, even if you don't feel it. And the reason you don't feel it is that it mimics a naturally occurring brain chemical which makes you feel normal so at low levels you shouldn't feel anything at all but it should take the edge off anxiety. I seriously recommend that anyone who has massive stress...gets rid of the stress. I overdosed on baclofen for a long time because I got myself into massive problems which took a long time to get out of and it was the only thing I could do to keep my sanity.

[Baclofenman]

Baclofen has helped my anxiety no end - I dont mean that I dont care about anything, it means I dont have the "stupid" thoughts about things and situatuations that:-

Really did not matter - Or at least they should not matter

One day I might admit to the "exchange rate" anxiety that cost me months of sleep

Regards


Bacman

[time2quit]

baclofen makes me a lot less anxious. no clinical studies jus what it is. Never even realized i had anxiety till bac alleviated it..

[MeJustMe]

I went through a period when I was titrating up on Bac where I felt incredibly calm. It was weird but also wonderful. It didn't last. Occasionally now I have moments of happy calmness (if that makes any sense) but I still occasionally feel anxious. Not as bad as before, but I also take Effexor for depression.
I am wondering what to do about the Effexor, given its tendency to make us more thirsty. I will change to another anti-depressant in the longer term. I don't want to upset the applecart by weaning off Effexor now, and tumbling into depression.
It's been a month or so now. I feel pretty good in the main. I have my stressful days and not-so-stressful. I have actually resorted to exercise here and there to relieve the stress!
I noticed how when I am tired, I am doubly so on Bac. So my son woke in the middle of the night with toothache, I then had to get up at 6.00 for work, stop work in the middle of the day to take my son to a dentist etc. I was very tired and stressed. I feel asleep just after 9pm that night -- my wife woke me an hour later to tell me I should go off to bed! Felt great the next morning though...
I still feel that Bac is only part of the answer, albeit a huge part. That's the problem -- I don't feel compelled to do much else (such as regular exercise etc) because life takes off in a wonderful way on Bac

[Ne/Neva Eva]

Forgive, me, MJM, but I'm not going to read back to see just where you are...

I am wondering what to do about the Effexor, given its tendency to make us more thirsty. I will change to another anti-depressant in the longer term. I don't want to upset the applecart by weaning off Effexor now, and tumbling into depression.

I felt the same way. And agree with you totally. I know I mentioned this earlier in the thread, but I'll say it again. I talked to my psychiatrist about it and tapered off of what I was taking (which is the newest version of Effexor--Pristiq) while watching and touching base with her about my feelings relative to being literally, clinically depressed. Depression is not something I want to mess around with again ever. And I felt like I was careful and hope you will be, too. (Besides, the research is not conclusive, though it is pretty persuasive.) When you get to the point when things are pretty stable, that's the time to think about changing it up. Or if, like me, you keep drinking despite everything else, then I'd look closely at Effexor and changing it...

It's been a month or so now. I feel pretty good in the main.
...
I still feel that Bac is only part of the answer, albeit a huge part. That's the problem -- I don't feel compelled to do much else (such as regular exercise etc) because life takes off in a wonderful way on Bac

Look, new sobriety and all the changes you're going through and HDB...Man, I'd just embrace where you are. You know? You're feeling pretty good, you're sleeping pretty well, if feeling too tired occasionally, and things are okay.

Sounds pretty good to me!

Which is not to discourage you from doing all of those other things that we know are good for us and important, both for long term sobriety and long term contentedness...like exercise. But yay! Things are okay! Right?

[lex]

Ne- George Vaillant MD's Natural History of Alcoholism (Revised 1995) is fascinating. It was hard for me to put it down. It is a longitudinal study that followed roughly 500 boys from the Boston area from the age of 18 or so to the age of 60 or so. There were two groups: 300 of the boys were from white blue collar neighborhoods- mostly Irish or Italian; the other 200 boys were selected from Harvard's freshman classes for 1942-44. The study followed their alcohol use. The book taught me a hell of a lot about alcohol abuse and alcoholism. The risk factors. The way it progresses, or not, in folks. Although the book is 20 years old, it is a one-of-the-kind longitudinal 60-year study (as far as I am aware, at least).

I have already ordered his newer book, Triumphs of Experience: The Men of the Harvard Grant Study (May, 2015), his broader perspective obtained from the Harvard leg of the study, in which he concludes among other things, that alcohol abuse was the single most devastating limiting factor in the mens' lives.

[Ne/Neva Eva]

Ne- George Vaillant MD's Natural History of Alcoholism (Revised 1995) is fascinating. It was hard for me to put it down.
...

Thanks, Lex, for the info. I haven't ordered it yet, but I will. I don't know when I'll get around to reading it, given what I have going on, but it'll stay on the list. Thanks again for the recommendation.