Any new anxiolytics on the horizon?

[birchswing]

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I asked once before about a compound called XBD-173, which is now called emapunil and I see has gone into various clinical trials. Looks like it's not gone far, though.

Are there anxiolytics on the horizon that might actually go into clinical trials? What causes these things to go in waves? It seems like there hasn't been anything new in the world of treating anxiety since, well, I guess SSRIs.

 

[MacDonaldTriad]

Tiagabine / Gabatril has a panic study or two.

 

[st2205]

Norax. It's an alprazolam/hydrocodone combo. Early studies are showing promise.

 

[Ceke2002]

What about advances in, or evidence based studies showing efficacy of non pharmacological treatments for anxiety? I must admit I don't pay much attention to medication trials (unless I'm the one who's going to be taking the medication) but a Psychiatric research group here in Adelaide had some interesting findings on the use of MBI's (Mindfulness Based Interventions) in the treatment of a number of conditions, including anxiety. I don't have access to the results at its completion, but here's an overview of the study at the time it was being run. If I find/can get hold of some more detailed information/study outcomes I'll see if I can link you to them, the Coordinator of this study (who is not my Psychiatrist) also happens to be the Coordinator of the MBCT (Mindfulness Based Cognitive Therapy ) programs at the clinic I'm currently attending :

Mindfulness Research Group

1. Overview and General Aims

Due to new research findings in the field of treatment and relapse prevention of depression, anxiety, stress and emotional dysregulation, attention has turned to working with meta-cognitive psychological processes rather than working with the content of thinking. This has led to the development of therapies such as Mindfulness-based Stress Reduction (MBSR), Mindfulness-based Cognitive Therapy (MBCT), Acceptance and Commitment Therapy (ACT) and Dialectical Behaviour Therapy (DBT). These are also known as Mindfulness-based Interventions (MBIs) and all share an emphasis on mindfulness meditation practice to varying degrees.

Long waiting lists for individual therapy have led to exploring cost-effective programs to increase accessibility so most of these therapies above can be or are usually offered in a group setting. MBIs are part of a range of services offered by the Centre for Treatment of Anxiety and Depression, a clinic that is part of Adelaide Metro Mental Health Directorate and affiliated with the University of Adelaide.
Mindfulness practices are designed to bring awareness to meta-cognitive processes such as rumination and experiential avoidance, and then teach the use of skilful alternatives. Research findings show promising results from a range of RCTS in this area.

2. Current Projects and Research Themes

1. MBIs in workplace stress, depression, anxiety, chronic psychosis and chronic pain

2. Mediators of Mindfulness-based Interventions (MBIs) effects

3. MBI's Effects on Biomarkers (eg heart rate variability, PNS tone)

4. MBIs in Educational Settings

3. Methods and Outcomes

1. Investigate effects of mindfulness-based interventions that benefit cognitive, emotional and behavioural function in a range of psychiatric and physical disorders, and in non-clinical populations in educational and workplace settings

2. Apply a variety of biological and psychological assessment tools to assess biomarkers, mediators of outcome, and clinical & educational outcomes.

4. Recent Key Findings and Achievements

1. MBCT pilot study showing promising efficacy for its use in active treatment resistant depression

2. MBCT shown to have lasting effects on depression scores up to 3-4 years later

3. MBCT shown to have positive effects on reducing comorbid anxiety symptoms in depressive conditions

4. MBCT shown to have positive effects on reducing work place stress

5. ACT and CBT RCT where both treatments were shown to reduce methamphetamine use and related harm.

6. Development of the Valuing Questionnaire for evaluating Acceptance and Commitment Therapy

5. Key Publications

Kenny MA, Williams JMG. (2007). Treatment-resistant depressed patients show a good response to Mindfulness-based Cognitive Therapy. Behaviour Research & Therapy 45: 617-625.

Mathew KL, Whitford HS, Kenny MA & Denson LA (2010). The Long-Term Effects of Mindfulness-Based Cognitive Therapy as a Relapse Prevention Treatment for Major Depressive Disorder. Behavioural and Cognitive Psychotherapy, 38 (5): 561-576.

Smout, M.F., Longo, M., Harrison, S., Minniti, R., Wickes, W., & White, J.M. (2010).
Psychosocial treatment for methamphetamine use disorders: A preliminary randomized controlled trial of cognitive behaviour therapy and acceptance and commitment therapy. Substance Abuse, 31:98-107.

 

[Ceke2002]

Norax. It's an alprazolam/hydrocodone combo. Early studies are showing promise.

Oh well played.

 

[birchswing]

What about advances in, or evidence based studies showing efficacy of non pharmacological treatments for anxiety? I must admit I don't pay much attention to medication trials (unless I'm the one who's going to be taking the medication) but a Psychiatric research group here in Adelaide had some interesting findings on the use of MBI's (Mindfulness Based Interventions) in the treatment of a number of conditions, including anxiety. I don't have access to the results at its completion, but here's an overview of the study at the time it was being run. If I find/can get hold of some more detailed information/study outcomes I'll see if I can link you to them, the Coordinator of this study (who is not my Psychiatrist) also happens to be the Coordinator of the MBCT (Mindfulness Based Cognitive Therapy ) programs at the clinic I'm currently attending :

Mindfulness Research Group

1. Overview and General Aims

Due to new research findings in the field of treatment and relapse prevention of depression, anxiety, stress and emotional dysregulation, attention has turned to working with meta-cognitive psychological processes rather than working with the content of thinking. This has led to the development of therapies such as Mindfulness-based Stress Reduction (MBSR), Mindfulness-based Cognitive Therapy (MBCT), Acceptance and Commitment Therapy (ACT) and Dialectical Behaviour Therapy (DBT). These are also known as Mindfulness-based Interventions (MBIs) and all share an emphasis on mindfulness meditation practice to varying degrees.

Long waiting lists for individual therapy have led to exploring cost-effective programs to increase accessibility so most of these therapies above can be or are usually offered in a group setting. MBIs are part of a range of services offered by the Centre for Treatment of Anxiety and Depression, a clinic that is part of Adelaide Metro Mental Health Directorate and affiliated with the University of Adelaide.
Mindfulness practices are designed to bring awareness to meta-cognitive processes such as rumination and experiential avoidance, and then teach the use of skilful alternatives. Research findings show promising results from a range of RCTS in this area.

2. Current Projects and Research Themes

1. MBIs in workplace stress, depression, anxiety, chronic psychosis and chronic pain

2. Mediators of Mindfulness-based Interventions (MBIs) effects

3. MBI's Effects on Biomarkers (eg heart rate variability, PNS tone)

4. MBIs in Educational Settings

3. Methods and Outcomes

1. Investigate effects of mindfulness-based interventions that benefit cognitive, emotional and behavioural function in a range of psychiatric and physical disorders, and in non-clinical populations in educational and workplace settings

2. Apply a variety of biological and psychological assessment tools to assess biomarkers, mediators of outcome, and clinical & educational outcomes.

4. Recent Key Findings and Achievements

1. MBCT pilot study showing promising efficacy for its use in active treatment resistant depression

2. MBCT shown to have lasting effects on depression scores up to 3-4 years later

3. MBCT shown to have positive effects on reducing comorbid anxiety symptoms in depressive conditions

4. MBCT shown to have positive effects on reducing work place stress

5. ACT and CBT RCT where both treatments were shown to reduce methamphetamine use and related harm.

6. Development of the Valuing Questionnaire for evaluating Acceptance and Commitment Therapy

5. Key Publications

Kenny MA, Williams JMG. (2007). Treatment-resistant depressed patients show a good response to Mindfulness-based Cognitive Therapy. Behaviour Research & Therapy 45: 617-625.

Mathew KL, Whitford HS, Kenny MA & Denson LA (2010). The Long-Term Effects of Mindfulness-Based Cognitive Therapy as a Relapse Prevention Treatment for Major Depressive Disorder. Behavioural and Cognitive Psychotherapy, 38 (5): 561-576.

Smout, M.F., Longo, M., Harrison, S., Minniti, R., Wickes, W., & White, J.M. (2010).
Psychosocial treatment for methamphetamine use disorders: A preliminary randomized controlled trial of cognitive behaviour therapy and acceptance and commitment therapy. Substance Abuse, 31:98-107.

These all sound like they would be good for me. Especially anything that can help with rumination. I try to do some of that on my own but I'm not good at sticking to it. I sort of dabble in a lot of self-help things and they all go back to that idea of neuroplasticity and retraining the brain by focusing on the positive and getting out of the ruts you've been in and also the idea of not attaching to thoughts. I need to be more regular about meditation and practicing these things. My OCD is not well controlled and leads to a lot of negative thinking, which feeds into other areas. I was very interested in DBT after reading a book called the Borderline and the Buddha. It seemed like life skills that would be valuable for anyone. I guess all of this takes some structure that I haven't had. Thank you for the suggestion back to these areas (versus drugs).

 

[birchswing]

Tiagabine / Gabatril has a panic study or two.

Very interesting. That's not one I had heard of before. I had heard of Trileptal, but not this one.

Norax. It's an alprazolam/hydrocodone combo. Early studies are showing promise.

I can't speak to opiates, but if only benzos kept working the way they did the first time without any of the repercussions. I was in 10th grade and the very first time I took it I was sitting in my pre-calculus class and I thought, "Oh my God, this must be how everyone feels all the time." It felt like the most natural way in the world to feel. I could sit and listen and just be. Makes me think of a good TV show I just watched called The Young Doctor's Notebook in which the doctor uses morphine. I could relate to that initial relief they show in the program.

 

[NickNaylor]

If the activities of our IM colleagues at my hosptial are any indication, quetiapine seems to be a perfectly suitable first-line anxiolytic... 😕

 

[birchswing]

If the activities of our IM colleagues at my hosptial are any indication, quetiapine seems to be a perfectly suitable first-line anxiolytic... 😕

Well, it is hard to be anxious when you're sleeping. Though I've managed it on occasion.

 

[Baller MD]

Besides anxiolytics, any new promising psychotropic drugs on the horizon?

 

[Shikima]

Heard the makers of Abilify are going to release a new product.

 

[F0nzie]

Very interesting. That's not one I had heard of before. I had heard of Trileptal, but not this one.


I can't speak to opiates, but if only benzos kept working the way they did the first time without any of the repercussions. I was in 10th grade and the very first time I took it I was sitting in my pre-calculus class and I thought, "Oh my God, this must be how everyone feels all the time." It felt like the most natural way in the world to feel. I could sit and listen and just be. Makes me think of a good TV show I just watched called The Young Doctor's Notebook in which the doctor uses morphine. I could relate to that initial relief they show in the program.

I received Dilaudid in the ER once when I had a kidney stone. My anxiety was 10/10. Within minutes it dropped down to 0/10. I also felt like I was flying with the white dragon from The Never Ending Story.

 

[st2205]

I received Dilaudid in the ER once when I had a kidney stone. My anxiety was 10/10. Within minutes it dropped down to 0/10. I also felt like I was flying with the white dragon from The Never Ending Story.

You should've tried it with the IV Benadryl that everyone keeps asking for.

 

[Shikima]

I received Dilaudid in the ER once when I had a kidney stone. My anxiety was 10/10. Within minutes it dropped down to 0/10. I also felt like I was flying with the white dragon from The Never Ending Story.

Gives new meaning for 'chasing the dragon'....

 

[birchswing]

If the activities of our IM colleagues at my hosptial are any indication, quetiapine seems to be a perfectly suitable first-line anxiolytic... 😕

You should've tried it with the IV Benadryl that everyone keeps asking for.

I know that Seroquel shouldn't be prescribed low-dose for sleep, but in reality it is. I've always wondered why doctors wouldn't just prescribe Benadryl instead, as my understanding is that Seroquel at a low dose is just functioning as an anti-histamine.

 

[hamstergang]

I know that Seroquel shouldn't be prescribed low-dose for sleep, but in reality it is. I've always wondered why doctors wouldn't just prescribe Benadryl instead, as my understanding is that Seroquel at a low dose is just functioning as an anti-histamine.

I asked this question in another thread and got only one unsatisfying answer.

The problem I have with antipsychotics strictly for sleep is that they are sedating due to their antihistaminergic properties, right? So why use them instead of a cleaner antihistaminic agent with generally fewer side effects?

you would think so, but for whatever reason Vistaril, Doxepin, etc don't put people to sleep in facilities(especially treatment centers when people are detoxing and just through detox) like Seroquel does. At least in my experience. You can explain that to the patients all you want, but seroquel puts them down and the others don't. Maybe it's placebo effect I dunno(they think seroquel is stronger maybe and patients talk to each other and confirm bias), but ive worked at more than one residential recovery center and this same issue came up.

 

[cookymonster]

Where I trained, we avoided using Seroquel for sleep, but where I work now it is part of our order sets and is given like candy as a PRN for insomnia. As a result, patients get it their first night in the hospital, and if they like it, it can be a pain to get them off.

There are a number of less than ideal outcomes from this, including antipsychotic polypharmacy, supplying addicts with an agent with considerable street value, and all the other side effects with Seroquel when there are plenty of safer alternatives available. I HATE this practice.

 

[whopper]

I know that Seroquel shouldn't be prescribed low-dose for sleep, but in reality it is. I've always wondered why doctors wouldn't just prescribe Benadryl instead, as my understanding is that Seroquel at a low dose is just functioning as an anti-histamine.

Cause no hot drug rep in her 20s is pushing it.


Ever wonder why Abilify is now the best selling prescription med despite that there's plenty of other antidepressant augmentation agents for only $4 a month, but Abilify is over $500?

 

[birchswing]

Cause no hot drug rep in her 20s is pushing it.


Ever wonder why Abilify is now the best selling prescription med despite that there's plenty of other antidepressant augmentation agents for only $4 a month, but Abilify is over $500?

Yes, and I'm now supposed to take Deplin based on a genetic test ($3,000). Thanks to Reddit helping me interpret the results, I found that I actually don't have trouble processing folic acid (although my doctor claims I do, and arguing about that doesn't lead anywhere productive—I'm an intermediate metabolizer, which she claims means by body is getting no l-methylfolate—from what I read I'm getting enough—I don't know why she couldn't at least admit I'm getting some). And Deplin is $130 a month, whereas folic acid is pennies and is found in so many sources of food. Plus I don't even have the diagnosis Deplin is indicated for. I found out that only 10% of the population is "normal" when it comes to processing folic acid, which raises the question of what normal is. A lot of questions are also raised by the fact that Deplin is sold by the same company under four different names for four different medical conditions. But sometimes you have to placate your doctor. If I try to dispute anything, she double-downs on her assertions. $130 is a huge percentage of my monthly income, though, so I'm sticking with my multivitamin. I wonder if doctors don't realize that patients suspect there are kickbacks. When you've already been waiting 45 minutes in the waiting room and can see your doctor in plain view talking to a drug rep and the doctor is in no hurry to take patients back, and suggestions for very expensive medical foods that seem completely unrelated to your issues come out of the blue, it doesn't take much paranoia to put 1 and 1 together. Even if the doctor isn't getting a kickback, why wouldn't you care about creating that impression?

This seems like it should be an easy thing to just legislate away (drug reps visiting doctors). I know some doctors say they aren't influenced by them and just like to have the free samples on hand, but there seems to be a lack of insight if you truly believe you aren't influenced by pretty people who flirt with you and bring you food. And I will say, they are very attractive. They seem so put-together and solid. Certainly more functional than I am, as well. Compared to the patients and even the doctors, when one walks into the dumpy offices, they carry this air of authority. That's marketing. They have that fresh, clean international look--sort of like flight attendants. They even carry their materials with them like flight attendants (in those rolling briefcases).They have the image that they're more in control and know more of what's going on than anyone who works in the office. So knowing, and the way they just walk back to see the doctor while everyone else is waiting in steerage. They don't even ask. They just flash a smile to the receptionist and walk on back. It's like they have some express pass that the patients are missing.

 

[Baller MD]

Yes, and I'm now supposed to take Deplin based on a genetic test ($3,000). Thanks to Reddit helping me interpret the results, I found that I actually don't have trouble processing folic acid (although my doctor claims I do, and arguing about that doesn't lead anywhere productive—I'm an intermediate metabolizer, which she claims means by body is getting no l-methylfolate—from what I read I'm getting enough—I don't know why she couldn't at least admit I'm getting some). And Deplin is $130 a month, whereas folic acid is pennies and is found in so many sources of food. Plus I don't even have the diagnosis Deplin is indicated for. I found out that only 10% of the population is "normal" when it comes to processing folic acid, which raises the question of what normal is. A lot of questions are also raised by the fact that Deplin is sold by the same company under four different names for four different medical conditions. But sometimes you have to placate your doctor. If I try to dispute anything, she double-downs on her assertions. $130 is a huge percentage of my monthly income, though, so I'm sticking with my multivitamin. I wonder if doctors don't realize that patients suspect there are kickbacks. When you've already been waiting 45 minutes in the waiting room and can see your doctor in plain view talking to a drug rep and the doctor is in no hurry to take patients back, and suggestions for very expensive medical foods that seem completely unrelated to your issues come out of the blue, it doesn't take much paranoia to put 1 and 1 together. Even if the doctor isn't getting a kickback, why wouldn't you care about creating that impression?

This seems like it should be an easy thing to just legislate away (drug reps visiting doctors). I know some doctors say they aren't influenced by them and just like to have the free samples on hand, but there seems to be a lack of insight if you truly believe you aren't influenced by pretty people who flirt with you and bring you food. And I will say, they are very attractive. They seem so put-together and solid. Certainly more functional than I am, as well. Compared to the patients and even the doctors, when one walks into the dumpy offices, they carry this air of authority. That's marketing. They have that fresh, clean international look--sort of like flight attendants. They even carry their materials with them like flight attendants (in those rolling briefcases).They have the image that they're more in control and know more of what's going on than anyone who works in the office. So knowing, and the way they just walk back to see the doctor while everyone else is waiting in steerage. They don't even ask. They just flash a smile to the receptionist and walk on back. It's like they have some express pass that the patients are missing.

Just to let you know, there are certainly a lot of cons of drug reps visiting doctors. But there are also some pros in some practices as well. Doctors can choose to give away free samples to patients who cannot afford certain medications and have nowhere else to go. Just an fyi.

 

[birchswing]

Just to let you know, there are certainly a lot of cons of drug reps visiting doctors. But there are also some pros in some practices as well. Doctors can choose to give away free samples to patients who cannot afford certain medications and have nowhere else to go. Just an fyi.

Well, I can understand that argument. But wouldn't it be the case that doctors would tend to only get whatever is on-patent? I guess if you were to come up with the example of an atypical antipsychotic for example, the doctor would probably have Abilify samples available. If getting samples of that is unsustainable, the patient would have to go without or start buying it. Whereas, with risperdal you can get it for $10 a month without insurance. (I don't know if this can be right but according to goodrx.com Abilify's cash price is over $1,000 per month where I live and risperdal is as low as $9.)

Seems smarter to get a $10 drug you can reliably get regardless of whether the drug rep comes by that month or not than a $1,000 drug where you're at the mercy of the drug rep. If the patient can't afford a $10 drug for a serious medical condition, then how are they buying food?

 

[Baller MD]

Well, I can understand that argument. But wouldn't it be the case that doctors would tend to only get whatever is on-patent? I guess if you were to come up with the example of an atypical antipsychotic for example, the doctor would probably have Abilify samples available. If getting samples of that is unsustainable, the patient would have to go without or start buying it. Whereas, with risperdal you can get it for $10 a month without insurance. (I don't know if this can be right but according to goodrx.com Abilify's cash price is over $1,000 per month where I live and risperdal is as low as $9.)

Seems smarter to get a $10 drug you can reliably get regardless of whether the drug rep comes by that month or not than a $1,000 drug where you're at the mercy of the drug rep. If the patient can't afford a $10 drug for a serious medical condition, then how are they buying food?

Sorry I should have clarified that what I mentioned is probably more applicable to a primary care setting where you're dealing with multiple issues and thus drugs.

 

[PikminOC]

Heard the makers of Abilify are going to release a new product.

The people who made Zenzedi are coming out with another stimulant.

 

[PikminOC]

Just to let you know, there are certainly a lot of cons of drug reps visiting doctors. But there are also some pros in some practices as well. Doctors can choose to give away free samples to patients who cannot afford certain medications and have nowhere else to go. Just an fyi.

The drug reps are the only people I get to see other than patients. Sometimes that is nice.
I opted out of them being to find out my prescribing habits. So if they want to come, fine. Doesn't mean I'm going to prescribe their med.
Birch, Im glad you are a smart patient and found out cheaper ways of paying for meds.
I keep track of those things too and tell patients.

 

[Ceke2002]

I received Dilaudid in the ER once when I had a kidney stone. My anxiety was 10/10. Within minutes it dropped down to 0/10. I also felt like I was flying with the white dragon from The Never Ending Story.

I remember the first time I overdosed on heroin, I managed to take about three steps out of the toilet I'd just shot up in, felt myself starting to fall, and then suddenly I was in a car, driving down a picturesque country highway with the breeze blowing in my face, feeling this sense of complete peace and contentment. That was my last clear memory until I was awoken with a start, courtesy of a shot of Naloxone, and surrounded by Ambulance officers. The girl I'd shot up with had very helpfully just bolted and left me unconscious in the alleyway I'd collapsed in, until some time later a good Samaritan found me and dialed triple zero (911 equivalent in Australia).

 

[Ceke2002]

These all sound like they would be good for me. Especially anything that can help with rumination. I try to do some of that on my own but I'm not good at sticking to it. I sort of dabble in a lot of self-help things and they all go back to that idea of neuroplasticity and retraining the brain by focusing on the positive and getting out of the ruts you've been in and also the idea of not attaching to thoughts. I need to be more regular about meditation and practicing these things. My OCD is not well controlled and leads to a lot of negative thinking, which feeds into other areas. I was very interested in DBT after reading a book called the Borderline and the Buddha. It seemed like life skills that would be valuable for anyone. I guess all of this takes some structure that I haven't had. Thank you for the suggestion back to these areas (versus drugs).

Being careful not to look as if I'm offering any actual medical advice, my Psychiatrist attended a conference with His Holiness the Dalai Lama as a keynote speaker and one of the questions that came up was (paraphrased) "What about those patients who have a diagnosis like ADHD who might not have the ability to meditate due to concentration difficulties' and the His Holiness the Dalai Lama's response was basically (again, paraphrased) "If they can only manage 5 seconds a day, then they can do 5 seconds a day, maybe next week they can manage 10 seconds - even 5 seconds of mindfulness is better than not practicing mindfulness at all." Bear in mind as well that 'Mindfulness Based Interventions' doesn't just refer to the meditation aspects of mindfulness, and even with the meditation side of things it's not necessarily the stereotypical practice of 'now clear your mind' that a lot of people think of when they think meditation. A good mindfulness based therapist will tailor the therapy for the individual patient's needs as well.

 

[Indodo]

I would imagine a marijuana based medication could work. CB1, cox-2 based medications etc.

 

[Shikima]

I would imagine a marijuana based medication could work. CB1, cox-2 based medications etc.

A lot more research and refinement of the product is needed. Took a while to find out how to extract ASA into a marketable drug from boiling willow bark.

 

[F0nzie]

I remember the first time I overdosed on heroin, I managed to take about three steps out of the toilet I'd just shot up in, felt myself starting to fall, and then suddenly I was in a car, driving down a picturesque country highway with the breeze blowing in my face, feeling this sense of complete peace and contentment. That was my last clear memory until I was awoken with a start, courtesy of a shot of Naloxone, and surrounded by Ambulance officers. The girl I'd shot up with had very helpfully just bolted and left me unconscious in the alleyway I'd collapsed in, until some time later a good Samaritan found me and dialed triple zero (911 equivalent in Australia).

Scary! Glad someone found you.

 

[Indodo]

A lot more research and refinement of the product is needed. Took a while to find out how to extract ASA into a marketable drug from boiling willow bark.

True but I don't think that is directly applicable here. Extraction methods are vastly superior now and something like that can be done in weeks, days and sometimes a matter of hours.
Regulations are the more difficult part. You have to do the appropriate trials and then submit it to the FDA, make the corrections etc etc. All of which I think is a good idea.

 

[Ceke2002]

Scary! Glad someone found you.

Yeah, it was so nice of the 'friend' that was with me to stick around and make sure I was okay </sarcasm>. Never did find out who that good Samaritan was, I would have liked to have thanked them. And I'm glad to be here too. To be honest I've been extremely fortunate, the number of times I actually seriously overdosed by all counts I probably should have died 10 times over by now. The only reason my last overdose didn't kill me was the fact that I was lucky enough to have my husband (then fiancee) with me (long story short, I hadn't actually used Heroin in well over a year, but the night I od'd I'd been stupid enough to forget to pick up my dose of methadone for the day, started completely freaking out about going into withdrawals, ended up scoring and almost killed myself in the process); he was able to start mouth to mouth while waiting for the Ambulance, after I'd stopped breathing and begun to turn cyanotic - then 5 shots of Narcan later, combined with emergency airway management and bag ventilation, and the Paramedics were just getting ready to haul me onto a stretcher and rush me off to the nearest hospital when I finally came round. If I'd been by myself that night I would have died with a needle still sticking out of my arm, you know, real classy like. 🙄

There'll be a snowball flying through hell on a pig's back before I ever put that rubbish anywhere near my body again. Now if every other idiot that tries hitting Doctors up for prescription narcotics could get a clue and realise overdoses happen far easier than they might think, whether the stuff your using is street level or pharmaceutical, I'm sure there'd be a lot less grieving families out there, and quite a few less Doctors wanting to bang their heads against the nearest wall every time one of these bozos turns up for an appointment.

 

[Shikima]

True but I don't think that is directly applicable here. Extraction methods are vastly superior now and something like that can be done in weeks, days and sometimes a matter of hours.
Regulations are the more difficult part. You have to do the appropriate trials and then submit it to the FDA, make the corrections etc etc. All of which I think is a good idea.

Not so much the extraction methods rather the R&D into neuroscience, receptors and which of the 30-50,000 chemicals are doing what to which receptors and in what combination. The permutations are enormous!

 

[Indodo]

Absolutely.
I am looking forward to the medications that use these receptors in anxiety, psychosis, depression etc. Not to mention epilepsy and who knows what else.
It seems like the possibilities are enormous.

 

[vistaril]

Where I trained, we avoided using Seroquel for sleep, but where I work now it is part of our order sets and is given like candy as a PRN for insomnia. As a result, patients get it their first night in the hospital, and if they like it, it can be a pain to get them off.

There are a number of less than ideal outcomes from this, including antipsychotic polypharmacy, supplying addicts with an agent with considerable street value, and all the other side effects with Seroquel when there are plenty of safer alternatives available. I HATE this practice.

the street value of Seroquel is pretty negligible.....this is greatly overplayed. it's certainly not 'considerable'.

The reality is that people in residential facilities are going to use what they've seen work(and avoid what they see don't work) to put people to sleep. Regardless of what the pharmacology should say. And if people are finding Seroquel at low doses helps their patients sleep better than low dose tricyclics or trazodone or melatonin or remeron or on and on, they are going to use that.

 

[cookymonster]

I can only tell you that almost every non-bipolar patient who has told me that Seroquel >200 mg was the only thing that worked for their insomnia and for whom no dose seems to be high enough turns out to be a crack user.

I guess I'd hate to see where our field would be if we just threw pharmacology, literature, and safety to the wind and just gave the patient what they say works for all of the other conditions we treat.

 

[vistaril]

I can only tell you that almost every non-bipolar patient who has told me that Seroquel >200 mg was the only thing that worked for their insomnia and for whom no dose seems to be high enough turns out to be a crack user.

I guess I'd hate to see where our field would be if we just threw pharmacology, literature, and safety to the wind and just gave the patient what they say works for all of the other conditions we treat.

i was referring to facilities, not outpt....the 'street theory'(for those that believe seroquel is so commonly abused) is that cokeheads use seroquel and cocaine together, or at least in close proximity to each other. But if they are already in a facility/residential setting it's very unlikely they are going to have access to cocaine, so that's a non-starter....

but sure, for something like short term insomnia for what is expected to be a very short stay, of course I believe it's prudent to listen to what the patient tells us. If a patient is going to be in my facility for 7 days and he says 50mg seroquel is the only thing that puts him to sleep in such a situation(and yes that includes detoxing situations), then I'll go with that rather than force feed him some combination of vistaril, doxepin, remeron, melatonin, trazodone he already tells me doesn't work in those situations. It's not worth fighting about and building negative rapport over.

 

[cookymonster]

i was referring to facilities, not outpt....the 'street theory'(for those that believe seroquel is so commonly abused) is that cokeheads use seroquel and cocaine together, or at least in close proximity to each other. But if they are already in a facility/residential setting it's very unlikely they are going to have access to cocaine, so that's a non-starter....

but sure, for something like short term insomnia for what is expected to be a very short stay, of course I believe it's prudent to listen to what the patient tells us. If a patient is going to be in my facility for 7 days and he says 50mg seroquel is the only thing that puts him to sleep in such a situation(and yes that includes detoxing situations), then I'll go with that rather than force feed him some combination of vistaril, doxepin, remeron, melatonin, trazodone he already tells me doesn't work in those situations. It's not worth fighting about and building negative rapport over.

See, it's rarely "short-term" in real-life. The problem we encounter is that Seroquel is the only thing that works and they've had this insomnia for years and it's not just exacerbated by their detox... and often only 300mg+ will work for them. And if you plan to take those patients off medications they like prior to discharge, then you risk building up far more "negative rapport" than you would have had if you never would have given them these meds in the first place (shouldn't we only be using treatments that are sustainable?).

If these patients are in residential treatment, why not let them figure out sleep hygiene and utilize relaxation and CBT, or use any number of other treatments before putting them on an antipsychotic? Unfortunately it's part of the PRN order sets where I work, which is something I'd like to change.

We also give out Restoril and Ambien for insomnia quite a bit, but that's a separate discussion.

 

[vistaril]

See, it's rarely "short-term" in real-life. The problem we encounter is that Seroquel is the only thing that works and they've had this insomnia for years and it's not just exacerbated by their detox... and often only 300mg+ will work for them. And if you plan to take those patients off medications they like prior to discharge, then you risk building up far more "negative rapport" than you would have had if you never would have given them these meds in the first place (shouldn't we only be using treatments that are sustainable?).

If these patients are in residential treatment, why not let them figure out sleep hygiene and utilize relaxation and CBT, or use any number of other treatments before putting them on an antipsychotic? Unfortunately it's part of the PRN order sets where I work, which is something I'd like to change.

We also give out Restoril and Ambien for insomnia quite a bit, but that's a separate discussion.

your first paragraph describes a different set of rules and structure than what I'm doing...at least on my unit. I tell the patients ahead of time that I'm not giving them a discharge rx for seroquel because it's probably not best for them longterm. the setting Im talking about is a detox/residential treatment center. The patients in this case are in a new setting(for them) and they are coming off drugs. Both factors that are different for them and likely to mess up their sleep. Neither of these factors would be duplicated some night say...3 months later. I also never use more than 100mg. For whatever reason, my patients at these facilities find that 50mg seroquel puts them to sleep a lot more effectively than large doses of trazodone or antihistamines or whatever. I don't know why that is-maybe the other patients at the facility plant that in their head and it's placebo effect. Maybe they just have a hunch going in seroquel will be 'stronger' than benadryl or whatever. Whatever it is, I'm not going to worry about it. Going to your second paragraph- unfortunately with insurance now we only get some of the patients 15 days or so. Maybe in a 90 day residential center I would take that approach, but with such a short window to treat I'd prefer that 60% of the stay is not spent battling over sleep meds/sleep therapy/sleep period.