Check This Out Friends

[lieze]

I found this very interesting and wanted to share this with the group. Interesting to see how the benzos can impair learning during exposure therapy. I've always been told to take a benzo if needed while trying to do exposure. What do you thing?

Benzodiazepines versus SSRIs in the Learning Process

At the recent ADAA national conference, I had the opportunity to hear Extinguishing Anxiety co-author Dr. Catherine M. Pittman talk on anxiety and the brain. She spoke about how medications fit into this picture. There are three questions to ask about medications:

* How do they affect the anxiety response?

* How do they affect the exposure process? (Meaning how do they affect the amygdala?s learning?

* How do they affect cognitive interventions? (Meaning how do they affect the cortex?s learning?)

Based on the principle that you need to ?activate to generate? new circuitry, here?s what she said:

The SSRIs, such as Zoloft (sertraline), Lexapro (escitalopram oxalate), & Prozac (fluoxetine)

* While they have little immediate effect on the anxiety response, they eventually stimulate neurons to modify the circuits

* It?s possible that they can facilitate activation and new learning

The Benzodiazepines, such as Valium (diazepam), Xanax (alprazolam), & Klonopin (clonazepam)

* Decrease anxiety immediately

* However, they reduce the amygdala?s ability to respond. If they reduce activation, they will tend to preserve the current state of the circuitry

* Therefore, they will impair new learning during exposure treatment

Essentially, the benzodiazepines put the amygdala to sleep. A sleeping amygdala cannot learn anything.

From: http://www.anxieties.com/newsletters/ anxietyupdate_2010spring.php#U1

Post edited by: jojobear, at: 06/03/2010 07:51 AM

I thought this was interesting because when I had inquired about Paxil my OD Tracy told me interestingly enough it is what she did her thesis on regarding how SSRI's help people with POTS. She said they know it works but don't know how.

[TXPOTS]

I would much rather be taking a SSRI or SSNRI for my POTS anxiety, but unfortunately they give me the "headache from he double hockey sticks". Anyone else react like this? The Klonopin helps with sleep and relaxes my tense muscles, but it really doesn't help with the adrenaline surges. If I could have tolerated the SSRI, this would have been a good choice to try with a prn benzo for 6 weeks, until the SSRI kicked in. Anyone come across any studies on SSRIs and POTS?

[lieze]

Do you think they really stimulate new pathways as this suggests?

[juliegee]

I would much rather be taking a SSRI or SSNRI for my POTS anxiety, but unfortunately they give me the "headache from he double hockey sticks". Anyone else react like this? The Klonopin helps with sleep and relaxes my tense muscles, but it really doesn't help with the adrenaline surges. If I could have tolerated the SSRI, this would have been a good choice to try with a prn benzo for 6 weeks, until the SSRI kicked in. Anyone come across any studies on SSRIs and POTS?

Hey TX-

I've shared this story numerous times ( Forgive me!), but I think it bears repeating. When my son first began taking an SSRI, he also got the headache from ****, nausea, vomiting, lightheadedness, etc within 10-15 mins of taking it. His PT (who specialized in ANS issues) theorized that his body was sooooo low in serotonin that it literally freaked-out with the addition of this very necessary neurotransmitter. Mack's starting dose was very low. The PT encouraged him to stick with it & assured Mack that symptoms would eventually go away. Mack initially took it in the evening because he was so sick that there was nothing he could do, but lie in bed afterwards. The PT was right. Within a week, ten days; he tolerated it very well and slowly worked up to a beneficial dosage. Mack eventually had to switch to taking it in the AM as it gives him extra energy & interfered with his ability to sleep.

With the exception of florinef & salt, I would guess that lexapro has been of his most beneficial meds. I just wanted to encourage you or anyone, who had a hard time with an SSRI initially, not to totally rule it out & deprive yourself of the potential benefits.

Julie

[juliegee]

I found this very interesting and wanted to share this with the group. Interesting to see how the benzos can impair learning during exposure therapy. I've always been told to take a benzo if needed while trying to do exposure. What do you thing?

Benzodiazepines versus SSRIs in the Learning Process

At the recent ADAA national conference, I had the opportunity to hear Extinguishing Anxiety co-author Dr. Catherine M. Pittman talk on anxiety and the brain. She spoke about how medications fit into this picture. There are three questions to ask about medications:

* How do they affect the anxiety response?

* How do they affect the exposure process? (Meaning how do they affect the amygdala?s learning?

* How do they affect cognitive interventions? (Meaning how do they affect the cortex?s learning?)

Based on the principle that you need to ?activate to generate? new circuitry, here?s what she said:

The SSRIs, such as Zoloft (sertraline), Lexapro (escitalopram oxalate), & Prozac (fluoxetine)

* While they have little immediate effect on the anxiety response, they eventually stimulate neurons to modify the circuits

* It?s possible that they can facilitate activation and new learning

The Benzodiazepines, such as Valium (diazepam), Xanax (alprazolam), & Klonopin (clonazepam)

* Decrease anxiety immediately

* However, they reduce the amygdala?s ability to respond. If they reduce activation, they will tend to preserve the current state of the circuitry

* Therefore, they will impair new learning during exposure treatment

Essentially, the benzodiazepines put the amygdala to sleep. A sleeping amygdala cannot learn anything.

From: http://www.anxieties.com/newsletters/ anxietyupdate_2010spring.php#U1

Post edited by: jojobear, at: 06/03/2010 07:51 AM

I thought this was interesting because when I had inquired about Paxil my OD Tracy told me interestingly enough it is what she did her thesis on regarding how SSRI's help people with POTS. She said they know it works but don't know how.

VERY interesting. Maybe some insight into HOW SSRI's help patients' with dysautonomia. Perhaps the SSRI's have an effect beyond treating symptoms, and patients can slowly wean themselves off of them once new neural pathways are formed???? Whereas the benzos appear to just just treat symptoms and must be taken as long as symptoms persist???? Just thinking out loud... Thank you for sharing, Lieze.

Julie

[lieze]

I wonder if this is where the feelings of the brain zaps and zaps other places come in and I remember it continuing for a while after I stopped the Zoloft but don't feel it at all now. I wonder if this is nerve cells being activated. At the time it is scary and eery but maybe if we realized it was doing something positive it would make us feel differently.

Damsel

[TXPOTS]

Mack's Mom,

How long did the initial headache last? Mine lasted for 3 days. The duration as well as the severity concerned me.

[juliegee]

Mack's Mom,

How long did the initial headache last? Mine lasted for 3 days. The duration as well as the severity concerned me.

Sounds awful. The headache, nausea, etc was always gone by morning We medicated him to deal with it- pain stuff, zofran. Yours lasted way longer. But Mack's was VERY severe as well. He basically lie prostrate in a dark room (totally unable to even stand up- he barfed in a bowl.) It was frightening to see.

Out of curiosity- what dosage were you on? Mack started with Paxil and had the lowest dose, which we then cut in half. (in retrospect, we could have cut it in quarters.)

Sorry your experience was so awful. Mack's experience may not apply to you, but I thought it was worth sharing in case.

Julie

[lieze]

I probably took way more of the zoloft than I would have needed to also. I would take it before bed and it would literally make me feel as if I was going to die in my sleep. No headache just very zoned out. And I still jerked awake gasping for breath like the anxiety breaks I would have. When I was supposed to increase my dose I did and then I broke out in a rash all over and got flu like symptoms I stopped it then. Looking back a very tiny dose may have been better than nothing with no increases until I felt as if I could tolerate it.