Monday, October 19, 2009

Thoughts on psych drugs for Lyme patients

These are my opinions based on my reading and clinical experiences.

Most of the patients I treat with significant chronic Lyme disease suffer with a variety of neuro-psychiatric symptoms. Patients have recently commented to me about the post on Klonopin.

Patients with Lyme-Brain seem to have poor tolerance for SSRIs: drugs which increase serotonin levels in brain synapses. Perhaps the injured brain is sensitive to these drugs. Many patients come to me already taking drugs with a strong affinity for serotonin receptors in the brain such as Lexapro or Cymbalta. These drugs may cause increased brain fog, irritability and a paradoxical increase in depression.

Other anti-depressants act primarily on the brain chemical norepinephrine. Patients seem to tolerate these drugs better. These includes the anti-depressant Wellbutrin and ADD medicines which also effect dopamine. Charts in pharma books show the relative affinity of anti-depressants for serotonin and norepinephrine. If the ratio favors norepinephrine the patients may tolerate this drug better. This includes drugs such as Desipramine, an old TCA antidepressant. These meds are best tolerated in low doses.

Drugs used for ADD can be quite helpful. These drugs target the neuro-transmitter dopamine as
well as norepinephrine. These drugs increase wakefulness and energy and may correct some frontal lobe dysfunction seen in many Lyme patients. My favorite drug here is Ritalin which comes in a variety of doses and can be carefully titrated.

Mood stabilizers can be very helpful as well. These drugs are anti-convulsants which stabilize abnormal chemical/electrical imbalances in the brain. I like Lamictal because it has antidepressant effects and mild glutamate inhibition. This drug has significant toxicity and should only be prescribed by physicians familiar with its side effects. Glutamate toxicity is thought to be a major problem in the injured brain. The best drug for glutamate toxicity may be the anti-Alzheimer's drug Namenda, which frequently improves cognitive dysfunction.(Rocephin also works by this mechanism).

Klonopin binds to the neuro-transmitter GABA, which is a major inhibitory neuro-transmitter.
Lyme patients can suffer with excessive expression of excitatory neurochemical in the brain. Most of this is mediated by serotonin, the "work horse of the brain." This dovetails with my comments about the potential harmful effects of serotonergic drugs.

Other commonly used GABA drugs are Neurontin and Lyrica which may be well tolerated. In my experience, benzodizapines like Klonopin work better. This may be due their increased anti-anxiety effects.

Anti-psychotic medicines, like Seroqel, are certainly helpful for patients experiencing psychotic symptoms such as hallucinations. They may help in other ways. Although they inhibit dopamine, they bind to different receptors, deep in the brain, unlike ADD medications which stimulate dopamine pathways in the cortex of the brain.

Many Lyme patients have sleep disorders. The activating neuro-chemicals, serotonin and norepinephrine are prominent during waking hours. This is counteracted by a predominance of acetlycholine effects which occur during sleep. Restful sleep is important. When a "sleeper" is needed I prefer Restoril which produces a good night's sleep and promotes normal sleep architecture. Lunesta may be a good alternative.

16 comments:

bobcat said...

The "adult" ADD drug Strattera was helpful to me at one point with brain functioning. (for those not aware, it is not a stimulant, and takes a few days of use to even work)

Now however, I am doing much better cognitively thanks to the antibiotics. Particularly, Bactrim DS for the bartonella.

bobcat said...

I should add that with Strattera, 18 mg was enough. Which is considered a small dose.

Quinn Comendant said...

Yes but what is your opinion on using these drugs for treating symptoms of lyme disease? It seems these drugs are normally used to treat syndromes which have an unknown cause; lyme's cause is known though it is not always effectively treated. Are these valid solutions to the issues of chronic lyme or are they Band-Aids with unknown long-term outcomes? Not easy to know I guess.

Lyme report: Montgomery County, MD said...

Stattera is a norepinephrine drug.
This is consistent with my recommendations.

These drugs are not curative, but feeling better facilitates the healing process.

Certainly one wants to avoid drugs which can excerbate symptoms.

grzegorz brzeczyszczykiewicz said...

is neuropsychiatric-Lyme even treatable? or the treatment progress will stop in some point?

bitten said...

Maybe this explains why, after taking Zoloft for 2 months, I feel a lot worse.

girl mark said...

I had horrible, horrible insomnia while on Biaxin- it may have been a side effect of the Biaxin itself in my case- but I got great symptom relief from the insomnia by taking tiny doses of Klonopin- 1/4 of a pill (can't remember dosage) was enough to make me sleepy when needed but left no side effects the next morning.

Toothfairy55 said...

Before I had a Lyme diagnosis I was treated for Panic attacks. A variety of drugs were tried. I had adverse reactions to all of them. I guess I'm in that group that can't take antidepressants.
My daughter is on Wellbutrin and Adderal in addition to Abilify

Carey said...

I've had insomnia for 18 years - since the Lyme really kicked in (I think I got it years before). It waxes and wanes in severity. My 2 cents: Ambian works, but I wake up with a headache. Lunesta works great or not at all. Neurontin worked beautifully for a while, then stopped.... although I've started taking it again for Flagyl-induced Peripheral Neuropathy which is also keeping me awake lately. I'm on Lariam + Doxy now for babesia because I can't afford Mepron. For the first time in my 18 months of treatment (and years of illness) I have mental clarity, and noticeable increase in energy. Yay! The downside is severe insomnia.I'm writing this at 5 am and have been up all night. Ugh.
Also, Seroquel turned me into a zombie for a month; I actually walked smack into a door jamb (trying to exit the room) and almost broke my nose. Then it evened out and didn't do anything except make me tired. Strattera was creepy; very dark emotionally. Ritalin just made me jumpy.
I didn't get a clear brain until the Lariam/Doxy combo, and the first 2 months were tough; random, bewildering bursting into tears with no noticeable triggers. I finally decided it was my subconscious crying for all the years I've lost to these diseases. Sigh.

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Serg said...

Lyme report has a valid argument, the drugs may not cure the disease but it will make the person feeling ok. Just like when you buy viagra, you know you are going to feel good, but it is not going to make the problem go away.

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Jay Vd said...

Doc, sertraline has been found to have antibiotic properties. Mainly as a efflux inhibitor. Could this be why pts have a hard time with it? A herx.

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nienner90210 said...

Almost 2018 here & lyme patients are still in desperate need of answers.

Personally, I was an opiate addict for years, unknowingly attracted to them because of the way they made me feel better with lyme.
Once I finally found out I had it, it was a week before going into my 1st treatment center. I was highly unaware of the truths of this disease (both tbh) & quickly started feeling awful again, relapsing only 3months later.

Yet again, after 5months-entered treatment a 2nd time. This time with a bit more knowledge behind me. However, I still could not manage to find a Dr & once again relapsed within 3 months.

After sobering up for a 3rd time..scrounging my way up this hill yet again..I've finally beaten my 3month mark, have found two wonderful doctors, one-a natural Dr who sees me for free 1x/month based on a "15min consultation", & 2-a great psych Dr who not only treats my past traumas, but is VERY open to how she can help me with my symptoms in regards to lyme. (Also talk to a therapist 2-3×/mo). I'm still working things out finding the best combo of meds for me.

However- what I have found over the years:

SSRI/SSRIDs:fuuck no. Not only do the w/d's scare the heck out of me, but theyve ALL made me feel worse, more depressed/manic/tired/cranky


Adderall: saved me. In small doses. Too much built in the body makes my aches much worse and crack like crazy. I also notice I am much more irritable on it, along with more tense and a quicker temper. Use with caution. Also been told it lowers the immune system, though I never was sick on them.

Wellbutrin: not sure how I feel about this. Only been on about 3 wks- but strangely seems to be working. Makes me feel like, whats the catch? I am genuinely HAPPY. It makes me awake and alert enough where I don't even need to take adderall. It evens me out wonderfully. Still skeptical of any antidepressants tho.

Xanax: too great. Taken in low doses ad prescibed for 3x months. Helped in almost every way. Was still always tired tho. After about 3months started to detach emotionally and become neutral to any and everything. Use SPARINGLY. Can also be highly addictive, tho it was never my DOC.

Buspirone/Buspar: a placebo effect. A waterrible drug. Did nothing for me, as I have also heard the same for many people. Don't waste ur time. Or try it and maybe it'll work for u. Didn't do a single thing for me.

Klonopin: helps anxiety..maybe? Kind of? Seems to just make me very tired and zombie and then gives me greater anxiety the next day.

Marijuana: (did this one for fun) works wonders. Helps immaculately with appetite/sleep/body aches. However-I tend to eat nothing but junk food when I smoke, and noticed my brain fog last for a few days after. So use with caution and see how it works for u. At least it isn't an Rx.


Umm..that's all I can think of right now. I'm not a Dr nor claim to be medically educated. Just another being very in tune with her body and trying to play this process of elimination game. Much luck and love to all :)