Baclofen and Anti-depressants

[Mandiekinz]

Hi guys! I know I've been a lost butterfly fluttering in and out of here randomly the past couple of years...Life has been chaotic to say the least lately.

I finally gave up on the liquid baclofen after almost 3 years and switched to the pills with aid from Dr. Channon. I moved back up in dose (200mg) as I'm no longer worried about running out of medicine or relying on other not-so-reliable persons to supply it. Sobriety has been fairly successful the past 3 months with the exception of a mild week long bender that just got me extremely sick.

I have been extremely depressed lately, whereas baclofen has been my anti-depressant/anti-anxiety medication, I'm considering adding on an anti-depressant. I haven't been on them in YEARS, and when I was, I never took them properly and it was constantly changed to different types. I'm not sure nor remember what the effects where on my psyche. I'm constantly tired, not just from the baclofen side-effects, and almost always batting away suicidal thoughts. It takes so much effort just to shower. I can wake up from a nightmare and be upset that I'm back in reality. Then other times, I almost black out fading into a panic attack. Perhaps this is all just temporary and due to my situation. I don't know.

Anyone taking anti-depressants with baclofen that can give me a little insight on what worked best, what didn't, side-effects, ect...I'd really appreciate it.

[kronkcarr]

Hey, it's good to see you. There's a new meds site and they've been talking about antidepressants and baclofen. Go here and have a look:Checking In/General Chit-Chat - The End of my Addiction

[Ne/Neva Eva]

Hey, Mandi!
As Kronk pointed out, we've moved to a new website.

I think I might start a thread about antidepressants, actually. I've been struggling with depression, too. And was taking an antidepressant that I've since found out has been shown to increase drinking, and increase withdrawal symptoms, in rats. Not conclusive evidence, by any stretch of the imagination. (Effexor/Pristiq) However, when I stopped taking it, I stopped drinking as much. By A LOT.

I can't get on there and start the discussion today, but I'll do it tomorrow, unless you want to start it and see what others have to say.

Glad to hear from you, though sorry about the circumstances.

[aihfl]

I am currently on two antidepressants plus 80mg of baclofen daily, which is nowhere near your dose, but I've had no bad effects from the combination of the three. My highest baclofen dose was 120mg, then I came down to 90, then the pdoc dropped it to 80, but then added 900mg of gabapentin (Neurontin). The two antidepressants I'm on are a morning and a night one. Citalopram 20mg (Celexa) in the morning and mirtazapine 15mg (Remeron) at night. I did not know this at the time, but some studies have shown Celexa to decrease drinking days. I started out at 15, then was increased to 20. I also have a script for doxepin 75mg, a tricyclic antidepressant for sleep, but I rarely take it since 1. I've been AF for long enough that my sleep patterns have pretty much returned to normal, and 2. the cocktail of gabapentin, mirtazapine and my final dose of 20mg baclofen is sufficient to put me to sleep and keep me asleep.

The important thing to keep in mind with antidepressants is that they aren't going to immediately alleviate your depression. My pdoc explained that it takes about 4-6 weeks to see any therapeutic benefit, and that's AFTER finding the optimal dose, which only adds time on to that 4-6 weeks. I have only been on Celexa since the end of March, so I have a follow up scheduled for the 20th.

I certainly don't feel worse combining these two antidepressants with baclofen, but I can't say for sure whether or not I'm feeling better because of them, or in spite of them. Maybe just not drinking, exercising and keeping myself preoccupied has as much, or more to do with it.

[terryk]

Hi Mandiekinz - it's very nice to see you back here, but I'm sorry that it's because you're having a rough time.

Here's a bunch of stuff to look at:

Some new research has linked the use of some SSRI's with increased drinking in some populations:

New onset alcohol dependence linked to treatment with selective serotonin reuptake inhibitors.

Ninety-three cases of alcohol dependence following SSRI treatment.

Could SSRIs Lead To Increased Alcohol Consumption In Some Populations?

"Research demonstrates that SSRI are of use in treating individuals with Alcohol Use Disorder only when there is severe comorbid Major Depressive Disorder and severe Alcohol Dependence Disorder (Cornelius et al, 1997). SSRIs are not useful in treating Alcohol Use Disorders in other populations (Gorelick & Paredes, 1992; Kabel & Petty, 1996; Kranzler et al, 1995). Moreover, data from Kranzler et al (1996) suggest a possibility that SSRIs may actually exacerbate AUDs in early onset alcoholics; data from Naranjo et al (1995) suggest the possibility that SSRIs may exacerbate AUDs in women. It is unfortunate that prescribers and the general public seem generally uninformed or even misinformed about the use of SSRIs for AUDs as is evidenced by this quote from the Alcoholism page of the web site of the University of Maryland Medical Center "Newer antidepressants such as selective serotonin reuptake inhibitors (SSRIs) are proving to be very useful complements to AA or counseling sessions". Obrien and McKay's (2002) rather extensive literature review of pharmacological treatments for SUDs mentions only positive outcomes from use of SSRIs for AUDs and fails to mention negative ones. Johnson's (2004) literature review is more balanced in that it mentions some negative results; however, a number of other literature reviews covering the topic of the use of SSRIs for AUDs also fail to mention negative outcomes."

Early studies describing citalopram's usefulness in treating alcoholism:

Citalopram in the treatment of alcoholism: a double-blind placebo-controlled study (1996).

Effect of citalopram on alcohol intake in heavy drinkers (1994).
"Consequently, citalopram at the present dose appears capable of reducing alcohol intake only in a subgroup of heavy drinkers with a mean daily consumption of between 60 and 100 g pure alcohol."

Citalopram decreases desirability, liking, and consumption of alcohol in alcohol-dependent drinkers (1992).

Study describing citalopram as less effective in women (in treating AUD):

Variations in response to citalopram in men and women with alcohol dependence.
"Men receiving citalopram reduced average drinks per day by 44%, whereas women exhibited a 27% decrease (p < 0.05).[...]
Men may benefit more than women from citalopram in the treatment of alcohol dependence."

Studies mentioning citalopram in combination with other medications:

A randomized trial of combined citalopram and naltrexone for nonabstinent outpatients with co-occurring alcohol dependence and major depression.
"These findings suggest that citalopram is not a clinically useful addition to naltrexone and clinical case management in this treatment population."

A randomized, controlled, pilot study of acamprosate added to escitalopram in adults with major depressive disorder and alcohol use disorder.

Report on MWO that citolopram reversed the efficacy of baclofen in one person:

https://www.mywayout.org/community/medication-research-and-support/39168-baclofen-efficacy-reversal.html

Tricyclic ADs are also worth looking at. They have been eclipsed by SSRI's and SNRI's because of the better side-effect profiles and safer therapeutic range of dosing that they have. Mirtazapine is one that gets mentioned here a lot, including by people who use it with baclofen.

Hope this helps,
-tk

[SKendall]

I was surprised that aihfl was prescribed mirtazapine. They had me on that when I lived in Canada and I understand it was widely used in the UK. When I came back to the US I mentioned I had gained about 20lbs and the doc told me that it is common and the use for it here was usually for anorexics and seniors with appetite issues. I found it to be very effective but I don't carry extra weight easily and for the very 1st time I had elevated BP.

I was switched to Lexapro and Wellbutrim and as soon as I stopped Mirtazapine my weight dropped about 3 lbs/month and BP back to 110/70 with no medication aids.

I wish you luck, b/c it was a very effective drug but the extra weight was harmful to my health. We are all so different in how we process medications.

[aihfl]

SK - I was placed on mirtazapine primarily for sleep and secondarily for depression. I started out at 7.5mg, but the daytime drowsiness was intolerable, so it was increased to 15. Paradoxically, mirtazapine is one of those medications that at lower doses are sedating, but the higher the dose, the better it regulates sleep cycles. I'm already on two BP meds, so that hasn't been an issue, and I have noticed an increased appetite (especially when it comes to sweets) but I was under my normal weight while in the throes of active addiction, so I do my best to burn off what I've consumed by exercise.

Like I said earlier, I am on Celexa as well (SSRI), but neither antidepressant is overtly mind-altering, so again, I'm not sure if I feel better because of them, or in spite of them.