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Thread: Gabapentin

  1. #131
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    Gabapentin

    :new:Hey, I really appreciate reading all of your posts. I'm taking 300mg gabapentin 3X's a day, naltrexone and 10mg abilify. I've been on the gaba and the naltrex now for 6 days and find that this combo is working. I was on Campral w/ the gaba but didn't like the SE's from the Campral. The Campral does work though. I went from drinking 12-14 vodkas and or a combo of vodka and wine a night to having only 2. I feel as if I could take it or leave it, don't have that squirmy feeling any more that the naltrexone alone didn't address. My Doc wants to titrate me up to 1800mg of the gabapentin per day, he is going for complete abstinence, hopefully one day I'll get there, but for right now this is a huge change for me. Tried rehab and AA didn't work for me, just wasn't my thing.

  2. #132
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    Gabapentin

    squeezed;1617431 wrote: It's easy to over-focus on brain receptors and what not, but alcohol hits lots and lots of neural pathways. It seems unlikely that addressing one specific receptor would be a magic bullet.

    It is also simplistic to say that alcoholism is a problem with brain chemistry, since everything we do affects brain chemistry. As humans, we have vastly more extrinsic input into our behavior than ,say, rats; it is difficult to extrapolate rat behavioral experiments to humans.

    Bottom line about bac, or gabapentin, or anything else works for alcoholism or not: large clinical studies are needed. In the meantime, we are all free to try them for ourselves (after due diligence). I have used several myself.

    Even the best results for alcoholism meds aren't that great. People enthuse about the headline 60%, or 75%, or whatever success rate of a study or claim. Underneath the hood the results are less spectacular.

    One example: As-needed nalmefene (basically TSM) was approved in Europe last year on the basis of its 60-65% success rate in large trials. But the success on placebo was 50%. So the Number-Needed-to- Treat (NNT) was close to the 9 for Antabuse, naltrexone (non-TSM), Campral, and even the latest gabapentin study from Scripps. That is: the vast majority will not benefit more than placebo.

    Also, the typical follow-up for these studies is mere months. Would the results be better or worse after a year? Who knows? When I was doing TSM, there were posters on their forum insisting that people should keep going even after 9 months without much difference.

    People should try meds for alcoholism, because they do work. But they shouldn't expect miracles in all - or most - cases. And don't blame yourself if a particular med doesn't work for you.
    squeezed;1618026 wrote: I don't have an agenda. I've tried many of the meds advocated here, and none of them worked for me. (Well, Bac dropped my drinking, if I was willing to stay in bed all day and not work.) Also, no AA for me. So, basically I am pretty cynical about all these miracle cures (having read the studies).

    After reading the newer posts (in other threads), I think I will just step back. It is exciting though to see the unbridled enthusiasm of the newbies.

    Good luck.
    squeezed;1618688 wrote: I did tried to cut down on alcohol during my bac phase. Did I try for abstinence? No. Is there a difference? I don't know.

    When I read papers on alcoholism studies, what really strikes me is how many subjects on *placebo* get better: 25-50% ! Granted, the follow-up periods are short, but we don't know what happens to the med groups 2-5 years either.

    Actually, I do drink much less now. No meds. No AA. Nothing. Something to do with getting older : ) .
    squeezed;1618719 wrote:
    I am very happy that baclofen is working for you, and others.

    I am going to give it a rest. TSM, or gabapentin, or AA work for many people too. So does doing nothing but just deciding not to drink anymore. Is HDB better? By pointing out that *no* med regiment - yes, including HDB - has been shown to be much good, I get vitriol directed my way.

    Thanks for being a reasoned poster here. I wish you the best of luck.
    Because this thread was bumped.... My response to this on another thread:

    squeezed;1618848 wrote:
    Neophyte:

    What is the claimed efficacy for HDB anyways? Give it to us in easy terms: NNT
    Everyone knows that the RCTs for HDB haven't concluded yet (even this guy - he's just being antagonistic). This article says that some results will be published in the 2nd half of 2014. Maybe these trials will confirm an efficacy that will encourage more doctors to prescribe baclofen, maybe not. Either way, here's some food for thought regarding why finding the answer might not be that simple (sort of the same drug, but a different malady-for which baclofen is proven effacacious):

    From Multiple Sclerosis Research: XenoPort to drop Arbaclofen for MS spasticity:

    "This study shows that even in late stage development (phase 3), with a drug that has more than a fighting chance, things can go wrong and you get a negative result. The Home - ClinicalTrials.gov trial entry (NCT01359566) suggest they did not use an enrichment design. Why? GW Pharma have shown so elegantly in their Sativex trials that this is the only way to do spasticity trials. In addition, the study used a co-primary outcome; i.e. (1) change from Baseline in maximum Ashworth scale score (6 hour post-dose time point) and (2) a Patient Global Impression of Change (PGIC) score. We now know that the Ashworth is not a good outcome measure; it is not responsive to change and unreliable. At first glance 228 MSers seems to be massively underpowered for these outcomes; there appears to have been 4 arms (placebo vs. 15mg vs. 30mg vs. 45mg) or 57 MSers per arm. For the Ashworth scale you need several hundred per group. I would be very keen to do a post-mortem of this study to see if we can learn something useful from this failure. I sincerely hope that this drug did not fail because of poor trial design."

    "Is this another story of a baby being thrown out with the bathwater?"

    But getting back to Number Needed to Treat....

    squeezed;1614676 wrote: Antabuse, naltrexone, Campral, TSM, bac, gabapentin - they all work. At the level of NNT of 9 or so.
    Turns out many commonly prescribed anti-depressants have similar (or worse) nnts and yet the conclusion in this article is that they are indeed efficacious:

    Antidepressants versus placebo fo... [Cochrane Database Syst Rev. 2009] - PubMed - NCBI

    Antidepressants versus placebo for depression in primary care.
    Arroll B, Elley CR, Fishman T, Goodyear-Smith FA, Kenealy T, Blashki G, Kerse N, Macgillivray S.
    Author information
    Abstract
    BACKGROUND:

    Concern has been expressed about the relevance of secondary care studies to primary care patients specifically about the effectiveness of antidepressant medication. There is a need to review the evidence of only those studies that have been conducted comparing antidepressant efficacy with placebo in primary care-based samples.
    OBJECTIVES:

    To determine the efficacy and tolerability of antidepressants in patients (under the age of 65 years) with depression in primary care.
    SEARCH STRATEGY:

    All searches were conducted in September 2007.The Cochrane Depression, Anxiety and Neurosis Group (CCDAN) Controlled Trials Register was searched, together with a supplementary search of MEDLINE, PsycINFO, EMBASE, LILACS, CINAHL and PSYNDEX. Abstracts of all possible studies for inclusion were assessed independently by two reviewers. Further trials were sought through searching the reference lists of studies initially identified and by scrutinising other relevant review papers. Selected authors and experts were also contacted.
    SELECTION CRITERIA:

    Studies were selected if they were randomised controlled trials of tricyclic antidepressants (TCAs) or selective serotonin reuptake inhibitors (SSRIs) versus placebo in adults. Older patients (over 65 years) were excluded. Patients had to be recruited from a primary care setting. For continuous outcomes the Hamilton Depression scale of the Montgomery Asberg Scale was requred.
    DATA COLLECTION AND ANALYSIS:

    Data were extracted using data extraction forms by two reviewers independently, with disagreements resolved by discussion. A similar process was used for the validity assessment. Pooling of results was done using Review Manager 5. The primary outcome was depression reduction, based on a dichotomous measure of clinical response, using relative risk (RR), and on a continuous measure of depression symptoms, using the mean difference (MD), with 95% confidence intervals (CI).
    MAIN RESULTS:

    There were fourteen studies (16 comparisons) with extractable data included in the review, of which ten studies examined TCAs, two examined SSRIs and two included both classes, all compared with placebo. The number of participants in the intervention groups was 1364 and in the placebo groups 919. Nearly all studies were of short duration, typically 6-8 weeks. Pooled estimates of efficacy data showed an RR of 1.24, 95% CI 1.11-1.38 in favour of TCAs against placebo. For SSRIs this was 1.28, 95% CI 1.15 to 1.43.. The numbers needed to treat (NNT) for TCAs ranged from 7 to 16 {median NNT 9} patient expected event rate ranged from 63% to 26% respectively) and for SSRIs from 7 to 8 {median NNT 7} (patient expected event rate ranged from 48% to 42% respectively) . The numbers needed to harm (NNH for withdrawal due to side effects) ranged from 4 to 30 for TCAs (excluding three studies with no harmful events leading to withdrawal) and 20 to 90 for SSRIs.
    AUTHORS' CONCLUSIONS:

    Both TCAs and SSRIs are effective for depression treated in primary care
    .

    For the context see: http://www.mywayout.org/community/f2...ml#post1618362

    -tk

  3. #133
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    Gabapentin

    bear100;1620907 wrote: :new:Hey, I really appreciate reading all of your posts. I'm taking 300mg gabapentin 3X's a day, naltrexone and 10mg abilify. I've been on the gaba and the naltrex now for 6 days and find that this combo is working. I was on Campral w/ the gaba but didn't like the SE's from the Campral. The Campral does work though. I went from drinking 12-14 vodkas and or a combo of vodka and wine a night to having only 2. I feel as if I could take it or leave it, don't have that squirmy feeling any more that the naltrexone alone didn't address. My Doc wants to titrate me up to 1800mg of the gabapentin per day, he is going for complete abstinence, hopefully one day I'll get there, but for right now this is a huge change for me. Tried rehab and AA didn't work for me, just wasn't my thing.
    Really looking forward to hearing future reports. Thanks

  4. #134
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    Gabapentin

    Funny, I just started a thread on pregabalin the other day. I am starting on pregabalin tomorrow, which from what I have read is some kind of stronger (but nicer in terms of side effects) cousin of gabapentin. Not sure of the differences beyond that but they seem to be very similar. I was prescribed baclofen for the last year, but the doc wants to move onto pregabalin, using it as a kind of transitioning drug in the meantime (I will be taking both for a while, gradually reducing the bac).
    I seem to read great things about it (when prescribed for a specific reason). I'd love to know how it works out for you, I'll try and update too!

  5. #135
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    Gabapentin

    Great thread JDizzle! thanks!
    Few days ago i found the Scripps Institute Study "Gabapentin treatment for alcohol dependence: a randomized clinical trial" already linked here... and get really interested about it.

    I'm actually on Baclofen from over a year with really great results.
    I drink just few beers occasionally but, as many others said, i can feel that i don't have anymore interest on alcohol 'cause it does not have the same effect as before, or maybe (together) i'm not interested anymore on being stoned by a substance...
    Great results for an alcoholic mind drinking over 10 beers a day just a year ago! no? ;-)

    But... even if satisfied w Baclofen there are few things that keeps me searching for some others alternatives "anti-alcohol-drugs":
    - the relative difficulty to manage Baclofen (dose/hours/ - how long on that dose, how fast titrate up and/or down etc etc) that every Baclofen user knows.
    - the also well known SE
    - the obvious "fear of relapse" (that i know happens if you stop take the pills or if you titrate down too fast or whatelse?... and this is the unknown point...).

    In the beginning and for quite all treatment i was not searching for complete abstinence but from few months is just happening... i often (quite always) really don't feel like drinking at all (even annoying sometimes... ;-) but i'm not planning to stop my therapy..no no no!!! ;-)
    The only SE i still have (i'm titrating down on 70mg/day) is the disturbed sleep that is f*****g really annoying.
    Little better now than on higher dose but anyway i'm dreaming of a full night of 8 hours!!!

    So few questions to Gabapentin users:
    - does it works the same way on you? Or does it work for you just as a "limiter" of quantity of alcohol?
    - from how long you're on it?
    - really no SE? this would be great!
    - can you make a brief resume of your previous Baclofen therapy (if you tried)?

    It seems undoubt that the GabaB deficiency its on the base of different kind of addictions - Baclofen works well too on food addiction and on cocaine because they all "affect" the same receptors... really simplified but kind of...
    There is no other med until now that have the same % of good results as Baclofen has but i think is lacking a bit of longer term confirmations (a know lot of cases, yes, but even a lot of relapses...)
    Ok, alcohol addiction is a complex subject, we all knows, and the "physical" side is just one of this.

    Maybe Gabapentin is the next one, maybe better than Baclofen???
    Maybe used together they can give a better results than used alone?
    I really would like to see a clinical trial not with placebo but a "face to face" with this 2 medicaments (or Baclofen vs something else)...
    Would be great.

    Wait to read more (i'm going to Pubmed to read a bit about results of this query "Gabapentin and alcohol" ;-)

  6. #136
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    Gabapentin

    Hi, EMC. Heartening to hear you've had such success with baclofen.

    emc;1625567 wrote:
    Maybe Gabapentin is the next one, maybe better than Baclofen???No.
    emc;1625567 wrote:
    Maybe used together they can give a better results than used alone?
    *maybe*

    They do two completely different things.

    If you're having a problem with scheduling, then you could change it.
    If you can't sleep, you could find something that helps with that.

    I did both of those things and they really helped. I also briefly tried Gabapentin. It had a very sedative effect on me. I felt...drugged. Obviously, not everyone has this experience.

    Hope this helps you.

  7. #137
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    Gabapentin

    Hey NE,
    about scheduling i'm ok, but you cannot say that Baclo is easy easy to manage... i just meant this ;-)
    About sleeping... still didn't find nothing that really helps or that can help but interact with Baclofen in a not well known way. So ok, keep searching or just wait to my maintneance dose hoping to have my full nights back.

    Back to Gabapentin subject... hmmmm i just found something that really don't like!
    Histories of patents, obviously! :-(
    Pregablin then Gabapentin, then law cases for Lyrica... no me gusta at all.

    Making a lot of research on Baclofen i can say that i became little expert and developed some kind of "sensitivity" on the subject of the "economical interest behind a drug", so will continue this research on Gabapentin but for some quick reading... the background does not convince me at all.
    In the beginning i thought that even Gabapentin patent was expired long time ago as Baclofen.

    Maybe does not mean nothing... but anyway i will post some link if i'll find smth interesting.

  8. #138
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    Gabapentin

    The company that makes Gabapentin/Neurontin (for those new to the discussion, not to be confused with little-g over-the-counter supplement) lost a HUGE lawsuit because they were marketing it directly to health care providers as an antidepressant and other-good-things without any proof. The company has many nefarious practices but they're pretty unrelated to this discussion. (For instance, they came out with a vaccine that...blah, blah, blah. Anyway. They suck.)

    It looks like Gabapentin/Neurontin is really good in weird, novel ways. Like, it helps people with neuropathy for both their pain and mental health/well being. And that coupled with an antidepressant, usually an SSRI, really helps people with their pain a lot than either drug alone. That's how the misinformation started, actually. But it, like most drugs, is generic. And there ain't no one making kick-backs off of generic drugs, despite what you read all over this forum.

    That said, there is some really interesting research, some of which is posted here, about Gabapentin/Neurontin and addiction. It's not just Gabapentin/Neurontin, though. It's the class of drugs. Topamax, the entire reason for this forum, is one of them.

    The take away? This isn't new. Certain kinds of anti-seizure medications have an impact on addiction in ways no-one understands yet.

    Oops. Gotta go.

  9. #139
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    Gabapentin

    Sorry about that. I think my point was that it is all really interesting and exciting, even if it's not new-new.

    But Gabapentin and baclofen do two different things entirely.

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    Gabapentin

    Ne/Neva Eva;1625817 wrote: Sorry about that. I think my point was that it is all really interesting and exciting, even if it's not new-new.

    But Gabapentin and baclofen do two different things entirely.
    And Ne -what are the two different things? I am just not so sure that this statement is accurate.

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