# Benzos are addictive but Neurontin isn't?



## PBNC (Mar 4, 2006)

At my last appointment, my doctor prescribed Neurontin because she is uncomfortable with my taking Xanax daily. I don't understand - if both work on GABA, what is the difference that makes one cause dependency and not the other?


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## Caedmon (Dec 14, 2003)

I don't think anyone really knows, but my guess is that addiction to benzodiazepines is caused by some sort of reward circuitry (in cases of true addiction). I would guess that physical dependence is a result of benzos changing the number of GABA and glutamate receptors. When you stop taking benzos, the change in glutamate receptors means that this excitatory neurotransmitter is bouncing around, wreaking havoc more - and that makes you nervous and wound up and so on, until the receptor numbers change back to where they were before. (Assuming they do. I *think* they do.) Too much glutamate tends to make people feel like crap. 

Neurontin (and the new, improved Neurontin - Lyrica) work on a calcium ion channel. For reasons I don't understand, this probably causes downstream increases in the rate of GABA production and turnover, and it also inhibits glutamate release. Presumably then, there is a change in concentrations of these neurotransmitters but not in the receptor numbers. But I don't know that for sure. Interestingly this is one of the reasons that glutamate inhibitors are used to treat alcohol and benzodiazepine withdrawals. Neurontin can also be used to treat this, because it is indirectly a glutamate inhibitor.


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## PBNC (Mar 4, 2006)

Caedmon, you're so knowledgeable. I always appreciate your responses. 

My doctor only has me on 300 mg. of Neurontin (well, gabapentin, to be precise) a day - isn't the therapeutic dosage 900? I can't help but get frustrated that my doc takes everything so slowly. I took a dose of 600 mg. this morning and I could tell a significant difference. I felt a little "speedy," which I hope would go away, but I also felt relaxed and more talkative, which I hope WOULDN'T go away. 

Now I have to decide what to do with Wellbutrin. I was supposed to start it tomorrow, but it makes me nervous. I don't want to experience added anxiety. I guess the only way to know is to try it.


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## arthur56 (Jul 31, 2005)

theres a lot of doubt about neurontin being any help for anxiety at all, the makers of it were fined for wrongly promoting it for several disorders with no proper trials or proof
docs generally prescribe the meds that are the most highly promoted to them and arent necessarily the best for the patient , maybe complimentary seminars to hawaii or frequent flyer points are on offer :nw 
perhaps neurontin is now promoted as the non addictive alternative to xanax, the way buspar was about 10 years ago
most SA sufferers are much too sensible to become addicted to xanax


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## UltraShy (Nov 8, 2003)

arthur56 said:


> theres a lot of doubt about neurontin being any help for anxiety at all


My personal experience was that Neurontin does nothing at all (not even side effects). Might as well have been a sugar pill. Neurontin went generic back in 2004 in the US, so it's hasn't been promoted by drug reps for a couple years now. But while it was under patent, the maker never got it approved for treatment of SA or any other form of anxiety disorder, which I think should tell you something. Consider that SA is the 3rd most common mental disorder (after depression & alcoholism). In other words, there is a gigantic and potentially very profitable gold mine of anxiety patients out there. Now any company knows the point is to maximize profit and one way of doing that is to get your pill approved to treat more disorders, so you can sell more, and rack in more cash. Yet, they never got Neurontin FDA approved for the treatment of any anxiety disorder in all the years it was under patent and could have made them fortune had then been able to do so. What could explain this? The only logical explanation that I can come up with is that they simply were unable to produce any studies that would show the FDA that it's effective against anxiety. I personally am not aware of any studies that show Neurontin to be effective on anxiety, nor do I know of anyone on SAS who has had success using it to treat SA.

In short, everything I've read on it plus personal experience tells me that it doesn't work.

My brother doesn't get enough benzos either because his doc is afraid of the DEA. ("All hail the mighty DEA" -- do a Nazi-style salute as you chant that.) How does my brother handle this problem: whiskey, rum, and gin. Apparently, doctors aren't familiar with these places called liquor stores -- it's what folks turn to when they can't get prescription meds to calm them adequately. Is there anyone here who seriously thinks Xanax is more dangerous than booze? (other than the DEA)


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## No Limit (Dec 6, 2005)

I wouldn't say that Xanax is addicting. I was taking it on a regular basis for a speech class for about 5-6 weeks. I stopped taking it at the end of my class and I definitely don't depend on it just to function day-to-day. I guess when you're taking it just to function is when it's getting to the addiction point. Benzos like Xanax really should be used for situational cases like making a presentation or going for an interview. At least that's how I use them.


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## UltraShy (Nov 8, 2003)

No Limit said:


> I wouldn't say that Xanax is addicting.


 :agree When somebody, often an MD, says Xanax is addictive it means:

1) They fail to understand the difference between addiction & dependency.

2) They know the difference, but are just using imprecise language because us patients are ignorant and aren't expected to know the difference.

3) They actually have one of the truly rare cases of benzo addiction. I recognize such cases exist -- they're just so rare, despite the frequent use of "addiction" in any sentence that contains "Xanax".



No Limit said:


> I guess when you're taking it just to function is when it's getting to the addiction point. Benzos like Xanax really should be used for situational cases like making a presentation or going for an interview. At least that's how I use them.


Having to use Xanax or other benzos daily just to get by is not in itself addiction. It would be dependency. Self-destructive drug-seeking behavior is the hallmark of addiction. I've been taking benzos daily for 3 years already. I've taken 8 mg of Xanax so far today and I certainly don't consider myself an addict. I'm just an unfortunate guy who's been screwed over by SA, failed to respond to a vast array of meds, and am prescribed 10 mg of Xanax per day.


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## PBNC (Mar 4, 2006)

arthur56 said:


> theres a lot of doubt about neurontin being any help for anxiety at all, the makers of it were fined for wrongly promoting it for several disorders with no proper trials or proof
> docs generally prescribe the meds that are the most highly promoted to them and arent necessarily the best for the patient , maybe complimentary seminars to hawaii or frequent flyer points are on offer :nw
> perhaps neurontin is now promoted as the non addictive alternative to xanax, the way buspar was about 10 years ago
> most SA sufferers are much too sensible to become addicted to xanax


However, as stated in my post, Neurontin IS helping for my anxiety. Individuals respond differently to different medications. I'm in favor of trying a medication out and judging for yourself before making blanket statements about how this or that doesn't work. My doctor actually recommended Lyrica intially, and when I discovered that my insurance company makes filling Lyrica a pain, I suggested Neurontin due to their similiarity. So, in short, the Neurontin was really my idea, and rest assured that my doc won't be relaxing in Hawaii because she prescribed it to me.

I also think that many SA sufferers, due to their high levels of anxiety, their (obvious) attraction to substances that relieve that anxiety, and the chemical imbalances that exist in their brains, are actually prime candidates for addiction.


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## Caedmon (Dec 14, 2003)

PBNC said:


> My doctor only has me on 300 mg. of Neurontin (well, gabapentin, to be precise) a day - isn't the therapeutic dosage 900?


Right. Well, I hear different things, but it seems to be 600-900mg. Some people go much higher, to a few thousand milligrams, although you get the law of diminishing returns at higher doses and the bioavailability decreases. This is the main advantage of Lyrica - it does not do this as much, so people who may not respond to Neurontin might on Lyrica, because they can take more and it's more bioavailable. (People who respond to a lower dose of Neurontin will probably not see an added benefit from Lyrica - or anyway, this would be my guess.) Lyrica was approved in Europe for the treatment of GAD.

I take 900mg. My experience is similar to yours - it does have a distinct antianxiety, antidepressant effect. But, I really think gabapentin goes well with Parnate, I have read several user's reports that it does this.

When I got my Rx for Neurontin I asked my psych about the tarnished reputation of the drug. He explained the "behavior curve" or some such thing, basically a curve that explains human behavior. He drew a sine wave that flattens at the end to a straight horizontal line and explained that drugs go through this procession:

1. Meh, it'll never work
2. Wow, this is a good drug! Let's try it on everything! 
3. It's a miracle!
4. Um, no, it's not
5. It doesn't work!
6. It's a terrible drug! It gives you cancer and vericose veins!
7. This drug is okay, it has a place... -->

Life is like that with a lot of things. Politics, sports, etc. Anyway. If you read reports from 10 years ago there are a lot of optimistic reports on Neurontin being helpful for a lot of conditions - and it was tried on a lot of conditions, because (a) it has a low side effect profile, so why not? and (b) it parallels other anticonvulsants that have multiple uses. [Example: Klonopin may be used for anxiety, muscle tension, epilepsy, seizures, alcohol withdrawal, insomnia, bipolar mania, bipolar maintenance, unipolar depressions w/ comorbid issues of anxiety nightmares etc., restless leg syndrome, multiple sclerosis and other degenerative motor disorders, muscle spasms, opiate withdrawals, and probably some other things I'm forgetting.]

There are a fair number of studies showing anxiolytic effects from gabapentin for different types of anxiety. [example; check out the Intro discussion] I haven't seen a lot of success with it on the SAS forum, but wouldn't rule it out either, especially if you are having good results from it.


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## PBNC (Mar 4, 2006)

Thanks, Caedmon. Did you start at 900, or titrate up? I tried taking a dose of 600, and definitely felt a difference - have you gotten that too? Just an energizing sort of feeling.


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## Caedmon (Dec 14, 2003)

I started at 300mg and went to 900 over a 5-day period. Probably smart since there is some dizziness/ ataxia associated with it, but I think that this side effect is going away very quickly. I don't know if it's quite energizing or not but it is more antidepressant than antianxiety for me, at least at this dosage. But a little of both. 

I would also like to take 600mg doses (x3 = 1800mg); similarly, I can feel it 'better' if I take this much at once. 600mg at once gives me a nice, less inhibited, more sociable feeling.


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## Caedmon (Dec 14, 2003)

Post script. Regarding dose, here is an article (full text) about panic disorder use. In this instance the "mean daily oral dosage [was] 1400 mg". Also, "The gabapentin dosage range in the present study falls between 600 mg and 2400 mg , comparable to the RCT study (15) with dosage range between 600 mg and 3600 mg po." The manufacturer's study on gabapentin and social phobia found that pts on doses of ~2100mg or higher did better as a group... at least, this is what I'm told, I don't have access to the article. So, that gives you a wide range of options to consider. There seems to be a lot of individual variation - as usual.


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