Shikima

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What would be the mechanism in using an anticholinesterase inhibitor for treating anxiety?
 

clausewitz2

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Namenda actually has larger effects as a glutamate antagonist at NMDA receptors and as a serotonergic antagonist than its effects on the cholinergic system. The glutamtergic activity is, from what I can tell, the basis for a small but growing body of literature evaluating Namenda for just this indication, e.g.: http://www.ncbi.nlm.nih.gov/pubmed/19142108
 

nitemagi

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What would be the mechanism in using an anticholinesterase inhibitor for treating anxiety?
You're mixing up namenda and aricept.
 

birchswing

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I can tell you anecdotally that the longer I have been on benzodiazepines, the worse my OCD has gotten. And one of the most significant adaptations in benzodiazepine tolerance is increased glutamatergic activity, so that Namenda works by antagonizing glutamatergic activity is interesting.
 
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http://www.ncbi.nlm.nih.gov/pubmed/26983548

Curious what people think.

Was told by a psychiatrist at one of the most well-renowned OCD treatment centers in the country that they are using memantine quite frequently with good success at places like Rogers Memorial and McLean, but this was about 5 years ago.
 

birchswing

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Since you're discussing a glutamate lowering drug, I thought I would add to this by mentioning I have recently become interested in N-acetylcysteine. It has varying affects on glutamate levels depending on the dose, but at lower doses tends to lower them. Has shown good effect in OCD and some other psychiatric disorders:

https://en.wikipedia.org/wiki/Acetylcysteine#Psychiatry
 

hamstergang

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I just worry when something is claimed to treat everything: "A systematic review from 2015, and several earlier medical reviews, indicated that there is favorable evidence for N-acetylcysteine efficacy in the treatment of autism, Alzheimer's disease, bipolar disorder, major depressive disorder, obsessive-compulsive disorder, schizophrenia, specific drug addictions (cocaine and cannabis), and a certain form of epilepsy (progressive myoclonic)."

Definitely worth looking into more, though.
 

NickNaylor

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http://www.ncbi.nlm.nih.gov/pubmed/26983548

Curious what people think.

Was told by a psychiatrist at one of the most well-renowned OCD treatment centers in the country that they are using memantine quite frequently with good success at places like Rogers Memorial and McLean, but this was about 5 years ago.
I have seen a few patients on the inpatient unit with severe OCD treated with memantine. In those cases it was essentially a last-line treatment when all other interventions have failed.
 

vistaril

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Since you're discussing a glutamate lowering drug, I thought I would add to this by mentioning I have recently become interested in N-acetylcysteine. It has varying affects on glutamate levels depending on the dose, but at lower doses tends to lower them. Has shown good effect in OCD and some other psychiatric disorders:

https://en.wikipedia.org/wiki/Acetylcysteine#Psychiatry

lmao.....this, ladies and gentleman, is unfortunately what our field has become. I don't know whether to laugh or cry as I see you guys discussing stuff like this and the 6-7 posts above it. By 'other' psychiatric disorders, I'm assuming you mean pretty much every ****ing one? Since that seems to be the direction we are heading.....some drug comes out that maybe helps a little bit with a disorder that may or may not even exist(and if it does the arbitrary way we've decided to characterize it pretty much makes dx meaningless anyways). So various practitioners throw that against the wall for a bit(again at patients who may or may not have this disorder that may or may not be real and even if it is probably doesn't respond to pharmacotherapy of any sort anyways) and eventually some people decide to try it for another couple 'diseases' of questionable validity and dx criteria. And some people(lets call them 'thought leaders') accept some graft to throw together a presentation or two on it and contort themselves in the most hilarious ways to explain why this questionable drug might work off label for this questionable dx. And then people in the community start using it because by golly nothing else is working(jesus perhaps because to them 'nothing else' means none of the other questionable drugs they've tossed at them haphazardly) oh and it doesn't hurt that the 23 yo drug rep who smokes weed every evening keeps bringing the free samples and chipotle boxed lunches by(she said it's good too for this questionable dx...thats gotta count for something right?) and on and on with this merry go round we go.
 

birchswing

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lmao.....this, ladies and gentleman, is unfortunately what our field has become. I don't know whether to laugh or cry as I see you guys discussing stuff like this and the 6-7 posts above it. By 'other' psychiatric disorders, I'm assuming you mean pretty much every ****ing one? Since that seems to be the direction we are heading.....some drug comes out that maybe helps a little bit with a disorder that may or may not even exist(and if it does the arbitrary way we've decided to characterize it pretty much makes dx meaningless anyways). So various practitioners throw that against the wall for a bit(again at patients who may or may not have this disorder that may or may not be real and even if it is probably doesn't respond to pharmacotherapy of any sort anyways) and eventually some people decide to try it for another couple 'diseases' of questionable validity and dx criteria. And some people(lets call them 'thought leaders') accept some graft to throw together a presentation or two on it and contort themselves in the most hilarious ways to explain why this questionable drug might work off label for this questionable dx. And then people in the community start using it because by golly nothing else is working(jesus perhaps because to them 'nothing else' means none of the other questionable drugs they've tossed at them haphazardly) oh and it doesn't hurt that the 23 yo drug rep who smokes weed every evening keeps bringing the free samples and chipotle boxed lunches by(she said it's good too for this questionable dx...thats gotta count for something right?) and on and on with this merry go round we go.
It's a super cheap supplement you can buy at pretty much any drugstore. I don't think there are drug reps pushing it. It's a variation on the amino acid cysteine. L-acetylcysteine is a form that has been used to treat Tylenol overdose for many years. I don't know the ins and outs of how you turn cysteine into L-acetylcysteine or why the FDA doesn't consider it a drug but instead considers it basically a foodstuff (anything in supplements is basically regarded as food). But that's how it is. Who would the drug reps be for this? It's already dirt cheap and there are so many no-name brands that sell it. Doesn't seem like a hot market. If anything, it makes it seem like it would be more likely to be overlooked.
 

clausewitz2

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lmao.....this, ladies and gentleman, is unfortunately what our field has become. I don't know whether to laugh or cry as I see you guys discussing stuff like this and the 6-7 posts above it. By 'other' psychiatric disorders, I'm assuming you mean pretty much every ****ing one? Since that seems to be the direction we are heading.....some drug comes out that maybe helps a little bit with a disorder that may or may not even exist(and if it does the arbitrary way we've decided to characterize it pretty much makes dx meaningless anyways). So various practitioners throw that against the wall for a bit(again at patients who may or may not have this disorder that may or may not be real and even if it is probably doesn't respond to pharmacotherapy of any sort anyways) and eventually some people decide to try it for another couple 'diseases' of questionable validity and dx criteria. And some people(lets call them 'thought leaders') accept some graft to throw together a presentation or two on it and contort themselves in the most hilarious ways to explain why this questionable drug might work off label for this questionable dx. And then people in the community start using it because by golly nothing else is working(jesus perhaps because to them 'nothing else' means none of the other questionable drugs they've tossed at them haphazardly) oh and it doesn't hurt that the 23 yo drug rep who smokes weed every evening keeps bringing the free samples and chipotle boxed lunches by(she said it's good too for this questionable dx...thats gotta count for something right?) and on and on with this merry go round we go.
Vistaril, if you wanted discrete disease entities that were clearly defined and 100% ontologically defensible, why the h*ll did you go into psychiatry?