View Full Version : Cognitive effects?
Hey all, I've had an anxiety relapse for the first time in years and I'm considering Lyrica. I've tried a lot if SSRIs and they've never worked for me. Trouble is I work in science and its sometimes hard enough to think straight with anxiety let alone added effects from meds. Has anyone noticed if Lyrica 'dumbs' you down a bit? X
What caused the relapse, anything in particular?
It's just been a really stressy few months - thesis deadline approaching, money worries, family health problems, moving house. I should have been smart enough to predict the effects and start going back to therapy or taken other steps to prevent it getting this bad but I've just been so busy. And before I knew it I was having panic attacks over ridiculous things like choosing what bananas to buy in the supermarket! :)
Personally, I have never noticed any negative effect on cognitive skills. In fact, since I can deal with previously stressful situations in a calmer frame of mind, I feel that my thinking is clearer under pressure.
Hi there,
I think I possibly had some minor short-term memory stuff going on when at my highest point of Lyrica usage - but these were nothing compared to the effects of not being able to think straight from the anxiety! I was able to go from not getting up all day to teaching a full courseload without problems, so that for me, the positives far outweighed any (potential, unproven) negatives.
I wouldn't let the possibility of cognitive effects stop you from trying something that might really help. IMO it's more important to get a handle on the anxiety and go from there.
Good luck!
Thanks Beatroon, thats v reassuring. Unfortunately my GP is refusing to prescribe it to me until I've exhausted every other option. God knows how long it would take to get through all SSRI's and SNRI's (already tried three and refuse to try any more as I don't see the point).
i'm starting it tomorrow. i've been watching a girl who started it and you can really see her life improve really well on it (with only a slight side effect)
https://www.youtube.com/user/lilywight/videos
I had to get a psychiatrist to prescribe it though.
Lissa, Pregabalin is on the NHS website. It you look under treatments for anxiety you will see it there so it is a recognised drug to use. Perhaps pointing this out to the doctor may help.
Hi Lissa101,
Ask your GP what the other options are, if you have tried SSRIs and SNRIs.
Hopefully the doctor will realise that you are an intelligent person who has done their homework, and needs to be recognized as such.
Thanks guys. I went to see a different GP and he told me that the surgery won't prescribe Lyrica at all for anxiety. This is apparently because its still on patent and they feel its being pushed on GPs to prescribe for conditions that its not fully been tested on (basically anything that's not specifically related to pain relief).
Seems a bit daft to me but there you go. I'm not going to change surgery as I might end up at one with the same policy. I can't afford to go private and have no chance of seeing an NHS psychiatrist for 'just' anxiety (docs words). Guess I'll just have to accept it at the moment. I'm going through CBT and that's having a positive impact on its own so fingers crossed x
Hi Lissa,
What the doctor said was just plain wrong on both counts. Pregabalin is (1) now no longer under patent for anxiety, and (2) has been thoroughly researched with well-designed studies for around a decade now for its effect on anxiety.
Is there somewhere in the UK that you can complain to about this kind of misinformation?
It's actually written on the NHS site that it's used to treat anxiety.
Despite that one of the gps at my surgery would give me my next prescription over the phone because "its only for pain". So I have to see a specific gp even though the surgery have a letter to say what I should be on from my psychiatrist. Ridiculous
MyNameIsTerry
05-10-16, 11:44
Lissa,
It's as hanshan & skymaid have said. On top of this I can tell you it's licenced by the MHRA, who licence all drugs in the UK, for treatment of GAD and has been recommended by NICE in their GAD guidance since 2011 for when other meds fail.
I can provide you with links to all of this.
Your GP is deliberately lying. Sadly there have been many posts just like yours on this board. Why are GP's saying this? Because it's a much more expensive drug than others, even as a generic.
The only relevance to pain reduction here is the pain of the cost to the GP. They are trying to steer you away from it by lying, or deliberately misleading you if we were talking about a politician. :winks:
---------- Post added at 11:44 ---------- Previous post was at 11:41 ----------
Is there somewhere in the UK that you can complain to about this kind of misinformation?
There is the NHS complaints policy. This means either complaining to the surgery or an NHS body. The former may be pointless if they are unscrupulous.
There is also PALS who well help the patient access what they are entitled to but they can't get involved in clinical decisions.
I've given up trying to find a GP with a good understanding of anxiety. I know its not their job to specialise in mental health but its such a common affliction you'd think that they'd develop some knowledge over the course of their career.
Next time I go I'll make sure I'm armed with some better information in case I get a similar response. I would have thought I'd be the ideal person to request this medication, being that I spent 12 months trying three different SSRI's and that my condition is chronic and, so far, resistant to all of the meds I've tried (Prozac, Zoloft, Citalopram, Propanolol).
Thanks for the info, its appreciated :) x
Hi Lissa,
From what I can gather, you ARE the ideal person to try pregabalin, if you have ongoing anxiety and have tried several antidepressants.
One thing you can do is ask the doctor for a written referral to another doctor for a second opinion. I've done that once long ago (not for medication, but for a treatment option), and found it was suddenly no problem with the second doctor (and the treatment option worked and improved my life no end).
MyNameIsTerry
06-10-16, 11:14
According to NICE in their GAD guidance (CG113), they state the following in the Drug Treatment section:
1.2.24 If the person cannot tolerate SSRIs or SNRIs, consider offering pregabalin. [new 2011]
You've tried 3 SSRI's, which tend to be the first line. Then they tend to move onto things like Mirtazapine, Venlafaxine, etc as 2nd line and Preg tends to be 3rd (I think).
A doctor could decide to try Preg if they feel it more appropriate but they could try the 2nd line first. A psychiatrist would be able to make the best call since they will look more at what is best than use a standard prescribing process since it's for GP's who largely have bugger all knowledge of these meds!
There are usually local trust guidelines for these stages that can be found on line. I've read a few different ones. So, it may be possible to locate one for you if you don't mind saying who your trust are?
One thing I can say about England is, Buckinghamshire have banned Preg for everything, not just anxiety but for epilepsy too. It's nothing to do with patient need, it's all about saving them money since most others can be seen prescribing it. That's the NHS for you, cost before patient need when meds are expensive.
This is what the British National Formulary (BNF) state:
Anxiety disorders and obsessive-compulsive disorder
Management of acute anxiety generally involves the use of a benzodiazepine or buspirone (section 4.1.2). For chronic anxiety (of longer than 4 weeks' duration) it may be appropriate to use an antidepressant. Combined therapy with a benzodiazepine may be required until the antidepressant takes effect. Patients with generalised anxiety disorder, a form of chronic anxiety, should be offered psychological treatment before initiating an antidepressant. If drug treatment is needed, an SSRI such as escitalopram, paroxetine, or sertraline [unlicensed], can be used. Duloxetine and venlafaxine (serotonin and noradrenaline reuptake inhibitors) are also recommended for the treatment of generalised anxiety disorder; if the patient cannot tolerate SSRIs or serotonin and noradrenaline reuptake inhibitors (or if treatment has failed to control symptoms), pregabalin can be considered.
Panic disorder, obsessive-compulsive disorder, post-traumatic stress disorder, and phobic states such as social anxiety disorder are treated with SSRIs. Clomipramine or imipramine can be used second-line in panic disorder [unlicensed]; clomipramine can also be used second-line for obsessive-compulsive disorder. Moclobemide is licensed for the treatment of social anxiety disorder.
That's where advice on prescribing is kept and is accessible via the NICE website.
Hello Terry,
Is there any way of making both doctors and patients mutually aware of the above (your post), so they are all on the same playing field?
At the moment, doctors seem to assume that they are the only ones on the playing field, regardless of the state of their knowledge (or lack thereof).
SmilingAlbert
07-10-16, 15:35
hi guys,
The medical business has still not realised that the information playing field is about a thousand times more level than in the past. The level of ignorance as mentioned above is just unacceptable.
And as Lissa says, given how sadly common mental health problems are, you would have thought that the NHS would make mental health expertise at GP level much more common to offset this. I would suggest that 50% of GPs should be trained-up in this area to reduce the burden on psychiatrists - I gather the current figure is around 15%.
It's really rubbish the way so many patients have to figure their own way around the system and treatment options.
Albert
Really sorry to hear of yet another person in this situation having trouble with their GP not being up to date (or willing to stick to?!) the NICE guidelines and good evidence base for prescribing pregabalin. For people who have tried several SSRI/SNRI's it is very definitely an approved treatment and should be offered, as Terry's great post says.
For me, despite having been prescribed it by an NHS psychiatrist, my old GP was extremely reluctant to continue the prescription - and their attitude was so upsetting that I changed practice rather than try and push my case.
The new GPs I registered with have been absolutely fine: no problems at all - the only thing they wanted to know was if it had been helping (which it has).
So it does vary vastly, and I am just angry that the situation many of us here have experienced is still happening.
For me it has been the only medication that has helped with my GAD (have been on 5 SSRI/SNRI's, propranonol, and a tricyclic in the past). I've been on it about 3 or 4 months now and am still on the lowest therapeutic dose (150mg daily) and it's had a significant impact on my life - I've coped with holidays, returning to my nursing training, and can now actually feel relaxed at home in the evenings! I still have anxiety when I'm in lectures (and when thinking about going on placement in the new year) but it's more manageable, and the thought there is room to go up on the dose a bit if needed is reassuring (not that I want to unless I can't cope). I've also cut down from taking zopiclone nearly every night (weirdly, my old GP was more okay about prescribing that! - which totally contradicts the evidence base for the two medications) to just on average once or twice a week.
Good luck and don't give up.
MyNameIsTerry
11-10-16, 07:35
Really sorry to hear of yet another person in this situation having trouble with their GP not being up to date/willing to understand the NICE guidelines and good evidence base for prescribing pregabalin to people who have tried several SSRI/SNRI's with no effect on their anxiety. For me, despite having been prescribed it by an NHS psychiatrist, my old GP was extremely reluctant to continue the prescription - and their attitude was so upsetting that I changed practice rather than try and push my case.
The new GPs have been absolutely fine: no problems at all - the only thing they wanted to know was if it had been helping (yes).
So it does vary vastly, and I am cross that the situation many of us here have experienced is still happening.
I wish you luck with this. For me it has been the only medication that has helped with my GAD: I've been on it about 3 or 4 months now and am still on the lowest therapeutic dose (150mg daily) and it's had a significant impact on my life - I've coped with holidays, returning to my nursing training, and can now actually feel relaxed at home in the evenings! I still have anxiety when I'm in lectures (and when thinking about going on placement in the new year) but it's more manageable, and the thought there is room to go up on the dose a bit if needed is reassuring (not that I want to unless I can't cope). I've also cut down from taking zopiclone nearly every night (weirdly, my old GP was more okay about prescribing that! - which totally contradicts the evidence base for the two medications) to just on average once or twice a week.
Good luck and don't give up xx
It's sad, isn't it.
Zopiclone is considered more habit-forming than even the benzo's. I took it for 30 days nightly and became dependant and from doing some reading that's often the case. Yet GP's are more willing to follow the 2 week rule for Diazepam. :doh:
I'm glad you stuck to your guns and got what you needed. It's still early days at 4 months too in terms of getting your life back and I found in my first recovery that a year later I was significantly better for going back to work as it was a real confidence booster and those slight wobbles went.
Thanks, Terry. Yes - zopiclone was a lifesaver when I was very unwell and not sleeping more than an hour or so at night...but being in hospital for a while meant that I ended up taking it every night for quite a long time, as did most patients on the ward.
I did try not to develop too much tolerance on it by not always taking the full dose, and skipping days, but I think while my anxiety was so bad I was using it more than anything as an anxiolytic (it was the only thing that helped pre-pregabalin).
But I'm very glad to be down to taking it just once a week (if that) as the pregabalin is helping still very much with GAD - for me it was always worse in the evenings.
It's good to hear that you had a good long-term recovery too : )
MyNameIsTerry
31-10-16, 07:55
Hello Terry,
Is there any way of making both doctors and patients mutually aware of the above (your post), so they are all on the same playing field?
At the moment, doctors seem to assume that they are the only ones on the playing field, regardless of the state of their knowledge (or lack thereof).
Hi hanshan,
Sorry, I bookmarked this to come back to and forgot!
For patients, education. Anywhere we can list what they need to understand is better than nothing. So, on here that could be a sticky thread so it's easily seen. Something like a "Preg and your rights" thread?
With doctors, it needs to be something that hammers it into them. So, perhaps something like the Healthwatch groups who will lobby for change direct with the trusts or main NHS. If they can influence them to produce properly guidelines, more than exists now, in places like NHS Choices and in the local prescribing guidelines, it will help. They can tell their trusts what to do and in turn circulars go out to the surgeries.
The trouble will always be that each GP surgery is it's own island. They are "service providers" so they are like private businesses who rely on grants from the NHS. It's the ultimate example of a cottage industry. Everyone looks after number one. Governance of them is poor. It's only in recent years that they have started to survey these practices to ensure they are even up to expected standards.
Then you have issues with Buckinghamshire and their blanket ban. That needs something big to sort that out. Someone needs to take them into a court or some form of hearing, possibly over discrimination.
The same with Scotland to a lesser degree but that's a different NHS. Scotland are also well behind NHS England with mental health.
So, it's a question of how much people want to do. A sticky is easy enough. The rest is a job for those who want to lobby for change. The only other thing could be to set up a website for it to exist to give this advice?
---------- Post added at 07:55 ---------- Previous post was at 07:53 ----------
Thanks, Terry. Yes - zopiclone was a lifesaver when I was very unwell and not sleeping more than an hour or so at night...but being in hospital for a while meant that I ended up taking it every night for quite a long time, as did most patients on the ward.
I did try not to develop too much tolerance on it by not always taking the full dose, and skipping days, but I think while my anxiety was so bad I was using it more than anything as an anxiolytic (it was the only thing that helped pre-pregabalin).
But I'm very glad to be down to taking it just once a week (if that) as the pregabalin is helping still very much with GAD - for me it was always worse in the evenings.
It's good to hear that you had a good long-term recovery too : )
Thanks. I relapsed after this and the new med made me far worse but I've been heading in the right direction for years now so I'm much better than I was.
My GP dished the Zopiclone straight out because of the problems I had before. I resisted taking it though.
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