dose increase?

[shiznit76]

Hi, for the last couple weeks i have titrated up from 25mg/day to 75mg twice a day. Things have been great,but i have been struck with anxiety again, do you think i need a dose increase? My psych wanted me on this dose,but i seen folk here on higher doses. Do higher doses work?

[SmilingAlbert]

Hey Shiznit,

Higher doses are often useful; Preg like all meds is tricky as everyone reacts differently. Some people get a useful effect from only 50mg/day, while others need more. The max dose is 600mg/day, so you have a lot of room to go up.

However, remember that no drug can entirely kill anxiety. It just depends on the reasons for it. GAD I think is defined as ill-defined and has no specific cause. If you are in a stressful situation for whatever reason, you will feel anxious. But this should subside as the reasons for the stress goes away.

If your stress is perpetual - work/life situation etc. - then things like Preg can help deal with that certainly, and that's probably where a higher dose can come in useful. FWIW I'm on 225mg, have been for 2 years, and it works well. But I do still get stressed out on occasion; some days when stress is lower I miss a dose, with no ill effects as far as I can tell.

Bottom line: if Preg has been useful at lower doses, it will probably be more useful at higher ones, but you should consult with your doctor here.

Albert

[shiznit76]

Thanks Albert, you are an expert as always.
It is GAD, no reason for the sudden anxiety. I can understand that situational anxiety will still occur, and this is normal, but feeling anxious for no real reason is no fun.
I will try and see if i can get a higher dose, not sure how he keen he will be though, had to get a private psych to prescribe it to me in first place as it wasn't something he was willing to do

[shiznit76]

Saw my GP this morning, he is going phone my private psych for advice as taking 20mg escitalopram also , but think this does nothing for me like the other SSRI's ive tried. I've suggested dose increase of pregabalin and change anti depressant. Hope hear back from him soon

[shiznit76]

Had dose increased to 100mg twice day and to go back see pysch in two weeks, hopefully she will address the escitalopram then

[hanshan]

Hi Shiznit,

Good luck with the new dose, but I do worry that doctors only make small increases at a time.

[pinnor]

I find that I gradually get tolerant to any increase in dosage, and it no longer helps me. It works very well for a week, better than nothing for another week or two, then it's a sugar pill. Maybe longer if it's a big increase. Excellent drug in the short term, useless in the long-term.

That's probably not want you want to hear. But it does seem to be the case for the majority of people, at least anecdotally. There are some people on here who have different experiences, who find it has helped them long-term, but I'm not sure if they have had pregabalin monotherapy; if not it may be the other drug, e.g. an antidepressant, which is having the therapeutic effect. I wouldn't be that surprised if not everyone gains tolerance, as some people also claim therapeutic effectiveness for benzos after many years. You might be one of the lucky ones.

Gaining tolerance is not only a problem with pregabalin though, "pooping out" is a fairly common occurrence with other drugs too, though anecdotally it seems more people claim long term success with anti depressants. I've yet to find a real solution to my anxiety.

[hanshan]

Probably the combination of pregabalin plus and AD works best for a number of people. There has been a small number of long-term studies (well, I can only find two) of pregabalin and GAD.

One study (Feltner et al 2008) found that for people who had initially shown a response to pregabalin, after a further 24 weeks at 450 mg pregabalin per day 42% had relapsed back into GAD, whereas 65% of those switched to placebo had relapsed. So pregabalin is better than placebo, but not "the answer". The results of the other study (Montgomery et al 2013) are confusingly presented in the abstract, but the authors conclude that it is useful long-term. (And studies can give quite contradictory results, so a number need to be conducted).

[pinnor]

Probably the combination of pregabalin plus and AD works best for a number of people. There has been a small number of long-term studies (well, I can only find two) of pregabalin and GAD.

One study (Feltner et al 2008) found that for people who had initially shown a response to pregabalin, after a further 24 weeks at 450 mg pregabalin per day 42% had relapsed back into GAD, whereas 65% of those switched to placebo had relapsed. So pregabalin is better than placebo, but not "the answer". The results of the other study (Montgomery et al 2013) are confusingly presented in the abstract, but the authors conclude that it is useful long-term. (And studies can give quite contradictory results, so a number need to be conducted).

That's interesting. However I would still question, from that first study, if pregabalin does not stop working in the long term. (I haven't looked at the second study).

I think that in the period when preg is working, it can give you your confidence back and allow you to make changes to your life which reduce anxiety. Then those changes themselves can be long-term. So that after 24 weeks, the lack of relapse into GAD may be due to the changes, rather than the fact that preg is still providing an anxiolytic effect (maybe it did for the first 15 weeks, for instance). Which is fine, of course. That is how I think drugs like preg and benzos CAN work for most people...they work for a short while allowing you to make changes, have therapy, gain your confidence back, etc. However, I think for some people it takes a lot longer to do the requisite work, than preg will allow.

Also I would say that 24 weeks is medium term. It could be that in that time tolerance has not yet built to 450mg, but after 50 weeks it has.

[hanshan]

You have to allow that different people will respond differently. I've been taking pregabalin since 2010 and haven't relapsed (and I was a several-decades-long GAD sufferer before that). But I can't generalise from myself to everyone, unfortunately.

Of the people in the first study who initially responded to pregabalin and continued on for almost six months at 450 mg per day, 42% relapsed. So it's like saying that even if pregabalin works at first, there's a two in five chance it will stop working in the following six months. Not the greatest odds. (But this is just one study, however).

Interestingly, scientists are starting to use gene maps to see what genes are common among people who respond to therapies when others don't - particularly the lucky few who go into apparently permanent remission, even in the face of aggressive cancers.