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Tiagabine trial

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So, I'm starting a trial of tiagabine for potential treatment of HPPD symptoms. I'll give a quick rundown and then I guess use this thread as sort of a log.


Tiagabine is, for those that don't know, an anticonvulsant typically used as an adjunctive treatment for seizures. However, it has been used off-label in the treatment of panic disorder and generalized anxiety disorder. Tiagabine works as a selective GABA reuptake inhibitor, specifically it works by blocking the action of GAT-1. In turn this increases the overall level of GABA in the brain. Since GABA is an inhibitory neurotransmitter, it would make sense that increasing the levels of it would increase the inhibition of interneuron transmission which in turn would reduce a number of things, the most notable of which is seizures. However, because of the effectiveness GABA receptor modulators such as benzodiazepines in treating anxiety disorders, increasing GABA levels would suggest it would be effective at treating anxiety disorders as well.


This is where it starts for me. First my psychiatrist considered the effectiveness of clonazepam in treating HPPD (or at least some of the symptoms of HPPD) with which I believe most of you are familiar. Unfortunately, this wasn't necessarily the case for me. Clonazepam had no effect on visual symptoms but it did have a marked effect on my comorbid panic disorder and the DP/DR associated with HPPD. So next he looked at the inhibitory nature of GABA and hypothesized that increasing overall GABA levels would be beneficial since it seems the main hypothesis is that HPPD is simply neuron disinhibition. So that's what led him to suggesting that I at least give it a try.


So far I've run the gamut in terms of medications, SSRIs, NDRIs, antipsychotics, lamotrigine, and clonazepam. I decided to go ahead with it because why not? According to everything I've read it is relatively benign. At the very worst it does nothing, and at the very best it works wonders for HPPD. Somewhere in the middle it simply helps with my panic disorder. Should it not work, we'll just move on and try carbamazepine, and then the other treatments like clonidine, tolcapone w/ levodopa, and naltrexone. 


I'm only 3 days into this new medication so I don't have anything to report. My psychiatrist says that in his experience and in the literature that the effects of tiagabine should come on fairly quickly, within a few days to a couple of weeks. My dosing target is 8mg/day taken at bedtime and my taper schedule is 2mg for 4 days, 4mg for 4 days, 6mg for 4 days and then finally the full 8mg/day. The only negative side effects I have to report at the moment is a headache (though I'm not sure if this is actually a headache or just a manifestation of dizziness, I'm inclined to think dizziness because it is the number one reported side effect) and some abdominal discomfort (also slightly expected). I'll keep posting in this thread with updates, probably on a weekly basis.

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  • 3 weeks later...

So, bit of an update. About 3 weeks into starting this medication. I'm at the full 8mg/day. No noticeable effect on any HPPD symptoms. However, that being said, 8mg/day is a paltry dose compared to the average dose which is 32mg/day or more. I discussed this with my psychiatrist today and he suggested to up my dose to 16mg/day in split doses, 8mg in the morning and 8mg at night since I'm tolerating it well and I don't feel drowsy when taking it. However, it has improved my quality of sleep quite a bit. I may not be getting more sleep or falling asleep easier, but I am certainly getting much more quality sleep (REM/'deep sleep') which leaves me not feeling so groggy and out of it if I only get say 4 hours of sleep (I average 5-6 hours a night during the week and anywhere from 8-12 hours on the weekends since I don't have to get up so damn early). But overall, with regards to HPPD and mental well being, nothing has really changed.


School is starting up soon (tomorrow in fact) and as such I'm going to be trialing some nootropics to aid with studying. Part of my stack is going to be Alpha GPC and Lion's Mane, so those might help with HPPD. I am also going to try thiamine cocarboxylase. And on an unrelated note, I had my psychiatrist write a letter to my university's disability support services so I can take tests in a quiet room and take as long as I want. Tests have always been tough for me because more often than not I know the answer and the process of arriving at an answer, but the way my brain works doesn't allow me to give complete answers in the time allotted. I mean, I can get the answer it just takes me a little longer than average to get it so I need more time to formulate my answers. Not to mention, but the rushed nature of tests at the university level (you usually only have an hour), my anxiety shoots through the roof and I'll just get stuck, sitting there starting at my test wondering what the fuck I'm gonna do and how the hell I'm going to come up with answers in such a short amount of time.

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