Tiagabine in anxiety disorders

Schwartz, Thomas L.; Nihalani, Nikhil

doi:10.1517/14656566.7.14.1977

Cited by 39 publications

(24 citation statements)

References 40 publications

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“…In addition, specifically in the case of TPM, its side effects, especially those related to paresthesias, anorexia and difficulty with memory and concentration may limit its widespread use [32]. The same happens with OXC and TGB, agents that although they have demonstrated their efficacy in treating different anxiety disorders and SUD [72,85,86], have not enough evidence for the treatment of BD and BWS [58,59,74].…”

Section: Discussionmentioning

confidence: 99%

“…Tiagabine: Tiagabine (TGB) is a selective GABA Transporter 1 (GAT1) reuptake inhibitor, which has anxiolytic properties through the facilitation of GABAergic neurotransmission [71,72] and also acts through an indirect GABAergic inhibition on the DA-driven reward system of the brain [73], mechanisms which could contribute to its efficacy in the treatment of BD.…”

Section: Pregabalin: Pregabalin (Pgn) (S)-3-(aminomethyl)-5-methyl-mentioning

confidence: 99%

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Anticonvulsant Agents for the Management of Benzodiazepine Dependence

Marín-Mayor¹,

López‐Muñoz²,

Rubio³

2014

AAD

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IntroductionChronic use of Benzodiazepines (BZDs) can lead to tolerance and dependence, as indicated by a BZD Withdrawal Syndrome (BWS). In general, it is preferred a gradual than an abrupt tapering of BZDs as a first step in the treatment of BZD Dependence (BD). In addition, a great variety of agents have been used as adjuvant medication for BD. Recently, research has focused in the use of Anticonvulsant (AC) drugs. The aim of this article is to review the use of AC in the management of BWS and BD. MethodsMEDLINE and the Cochrane were searched, selecting studies from 1980 until 2014, in which a pharmacological intervention with classic and new AC was made for discontinuing long-term BZD use. ResultsIn regard to classic AC, there were identified 10 studies related to carbamazepine and 4 studies related to valproate. On one hand, whereas there is a great body of research involving carbamazepine and there is a consensus about its efficacy for discontinuing long-term BZD use, especially in terms of improving drug-free outcomes, there have been brought inconclusive results in regard to valproate. On the other hand, studies identified of the new AC are as follows: 2 for gabapentin, 2 for oxcarbazepine, 2 for pregabalin, 1 for tigabine and 2 for topiramate. With the exception of pregabalin, only small studies and cases report have been conducted for most of the new AC. Pregabalin has demonstrated to be effective in the treatment of BD and BWS, exerting its beneficial action by reducing the severity of withdrawal and anxiety symptoms. ConclusionTo date, among AC agents, only carbamazepine and pregabalin can be considered as augmentation alternatives for the treatment of long-term BZD use. Further randomized, double-blind, placebo-controlled studies are necessary to increase the knowledge to support the use of AC for the treatment of BD and BWS.

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Section: Discussionmentioning

confidence: 99%

Section: Pregabalin: Pregabalin (Pgn) (S)-3-(aminomethyl)-5-methyl-mentioning

confidence: 99%

Anticonvulsant Agents for the Management of Benzodiazepine Dependence

Marín-Mayor¹,

López‐Muñoz²,

Rubio³

2014

AAD

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“…Tiagabine has exhibited antikindling and antianxiety effects in preclinical studies [82,83], and its anxiolytic effects have been shown across anxiety disorders [84,85•]. Tiagabine is well tolerated and may hold promise in treating PTSD via its facilitation of GABA neurotransmission [23,86,87]. In fact, tiagabine has shown potential as augmentation or monotherapy for PTSD in preliminary human studies [87,88] and has been shown to improve sleep quality in people with generalized anxiety disorder [89], as well as insomnia and nightmares in PTSD [23].…”

Section: Tiagabinementioning

confidence: 99%

Antiepileptic drugs for the treatment of post-traumatic stress disorder

Berlin

2007

Curr Psychiatry Rep

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Post-traumatic stress disorder (PTSD) is a disruptive, chronic, and relatively common disorder that is often difficult to treat. Many patients with PTSD are unresponsive, have only moderate or marginal responses, or have troubling side effects to first-line serotonin reuptake inhibitor treatment. Studies suggest that antiepileptic drugs (AEDs) may be an effective treatment alternative or adjunctive treatment for the symptoms of PTSD. Recent results from case reports and open and controlled studies on the efficacy and tolerability of AEDs in PTSD are reviewed here, and their methodological limitations are discussed when relevant. AEDs shown to be effective in double-blind, placebo-controlled trials of PTSD include lamotrigine, topiramate, and tiagabine. Other AEDs that appear promising in open-label trials of PTSD include carbamazepine, valproate, gabapentin, vigabatrin, phenytoin, and levetiracetam. Stress-activated limbic kindling may be involved in the pathogenesis of PTSD. The possibility that AEDs may be effective in the treatment of PTSD due to their antikindling effect is discussed, and suggestions for future research are made.

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“…Besides its indication in epilepsy, TGB has been found safe and efficacious in various anxiety disorders including GAD, panic disorder, agoraphobia and post-traumatic stress disorder. 2 Moreover, in another recent study TGB has been found efficacious as monotherapy for major depressive disorder with anxiety. 3 However, we should mention the possible temporal delay of TGB -one week -to bring about its anxiolytic effects.…”

mentioning

confidence: 96%

“…1 Only a few follow-up studies, however, regarding suicide attempters are reported, 2,3 and both nationwide and community-based data are lacking in Japan.…”

mentioning

confidence: 99%

For publication: Tiagabine in the discontinuation of long‐term benzodiazepine use

Oulis

Masdrakis

Karapoulios

et al. 2009

Psychiatry Clin Neurosci

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T OLERANCE, DEPENDENCE AND withdrawal symptoms are well-known complications of long-term benzodiazepine (BDZ) use, raising thorny problems in any attempt at their discontinuation. Among the scarce available pharmacological interventions, gradual rather than abrupt discontinuation of BDZ and use of the antiepileptic drug (AED) carbamazepine are the only successfully tested ones for their efficacy.1 Thus, newer innovatory treatments are clearly desirable. The recent marketing of newer AED, especially of the Selective GABA-Reuptake-Inhibitors, such as tiagabine (TGB) might offer new therapeutic options to this end. However, to the best of our knowledge, no such studies or reports are as yet available. In the following, we report precisely on such a case.This is the case of a 68-year-old female patient with a 15-year history of generalized anxiety disorder (GAD) and BDZ-dependence according to Diagnostic and Statistical Manual of Mental Disorders (text revision) criteria without any other psychiatric comorbidity, or medication. For the last five years, she was clearly abusing the BDZ bromazepam at a dosage of 75 mg/day, moreover with a notable tolerance to this drug, as attested by her high levels of anxiety despite its high dosage. This fact along with her resolution to address her BDZ-dependence motivated her hospitalization at our Department. On admission, the patient scored 39 on the Hamilton Anxiety Rating Scale (HARS). Her extensive medical and laboratory workup yielded no pathological findings. After obtaining the patient's written informed consent, we incrementally substituted TGB up to 15 mg/day for bromazepam within one week, each day replacing 10 mg of the latter with 2 mg of the former. Dizziness, headache and sedation were the only transient side-effects of TGB, subsiding within 10 days. On discharge, four weeks later, the patient's scores on the HARS had dropped to 22, a reduction rate by almost 44%.With respect to its mechanism of action, we should note that TGB enhances GABAergic neurotransmission through its blockade of the GABA transporter I (GAT I). Besides its indication in epilepsy, TGB has been found safe and efficacious in various anxiety disorders including GAD, panic disorder, agoraphobia and post-traumatic stress disorder.2 Moreover, in another recent study TGB has been found efficacious as monotherapy for major depressive disorder with anxiety.3 However, we should mention the possible temporal delay of TGB -one week -to bring about its anxiolytic effects.4 Although anecdotic and thus warranting replication in large and wellcontrolled studies, the findings of our case report suggest that TGB might be a promising new pharmacological agent in the treatment of BDZ dependence. REFERENCES

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Tiagabine in anxiety disorders

Cited by 39 publications

References 40 publications

Anticonvulsant Agents for the Management of Benzodiazepine Dependence

Anticonvulsant Agents for the Management of Benzodiazepine Dependence

Antiepileptic drugs for the treatment of post-traumatic stress disorder

For publication: Tiagabine in the discontinuation of long‐term benzodiazepine use

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