Rupprecht, Rainer

Zwanzger, P.

English

Universität München: Elektronischen Publikationen

Vigabatrin and Tiagabine Might have Antipanic Properties

Open Access LMU ( Ludwig-Maximilians-Univ. München)

 http://jop.sagepub.com/Journal of Psychopharmacology http://jop.sagepub.com/content/18/3/440The online version of this article can be found at: DOI: 10.1177/026988110401800319 2004 18: 440J PsychopharmacolP. Zwanzger and R. RupprechtVigabatrin and Tiagabine Might have Antipanic Properties  Published by: http://www.sagepublications.comOn behalf of:   British Association for Psychopharmacology can be found at:Journal of PsychopharmacologyAdditional services and information for      http://jop.sagepub.com/cgi/alertsEmail Alerts:   http://jop.sagepub.com/subscriptionsSubscriptions:   http://www.sagepub.com/journalsReprints.navReprints:   http://www.sagepub.com/journalsPermissions.navPermissions:   http://jop.sagepub.com/content/18/3/440.refs.htmlCitations:   What is This? - Sep 6, 2004Version of Record >>  at LMU Muenchen on May 16, 2013jop.sagepub.comDownloaded from In their recent perspectives paper, Ashton and Young (2003) dis-cuss the important issue of the therapeutic potential of selectiveGABAergic treatment in affective disorders. The authors reviewdata available on the new antiepileptic drugs gabapentin, vigaba-trin, tiagabine, pregabalin, topiramate, lamotrigene, amongst others. They conclude that this new generation of GABA enhancersmight have a therapeutic potential in some affective disorders andchronic pain. The beneficial effects for anxiety disorders remain tobe seen. Regarding the side-effects of these compounds, the ques-tion of the development of tolerance and dependency would beespecially important (Ashton and Young, 2003).This prompts us to share some of our recent experiences in thetreatment of panic and anxiety using vigabatrin and tiagabine.Initial studies by our group on the effects of vigabatrin andtiagabine on experimentally-induced panic with cholecystokinin-tetrapeptide (CCK-4) in healthy volunteers showed a significantreduction of panic scores after 1 week of treatment with both com-pounds (Zwanzger et al., 2001c; Zwanzger et al., 2003). Based onthese results, which suggested putative antipanic properties inpatients with anxiety disorders, we investigated the effects of viga-batrin and tiagabine in patients suffering from panic disorder, withand without agoraphobia (DSM-IV), in two small open-label trials.Treatment with vigabatrin led to a marked reduction reduction ofanxiety on the HAMA-scale after 2 weeks and a improvement ofagoraphobia measured with the Bandelow Agoraphobia Scale.Remission was obtained after 4 weeks of treatment. A follow-upinvestigation showed that these effects could be maintained in thefollowing 6 months (Zwanzger et al., 2001a). In a similar trial,treatment with tiagabine also led to a marked improvement ofpanic and agoraphobia in panic disorder patients. In two out of fourpatients, remission was obtained after 4 weeks (Zwanzger et al.,2001b).All patients were treated in the anxiety clinic and outpatientclinic of the department of psychiatry. After the trial, follow-uptreatment was provided for all participants. During this period,patients were seen continuously at intervals of 2–4 weeks forapproximately 1 year. Within this period, medication was taperedoff slowly over 4–6 weeks in most subjects. Psychopathology, possible side-effects and the development of tolerance and withdrawal symptoms were monitored by experienced psychia-trists. Apart from mild dizziness or vertigo, no major side-effectswere observed in the acute phase of the study. These symptomsmost commonly were reported during the first few days of treat-ment and after dose increase in the patients treated with tiagabine.After treatment discontinuation, no withdrawal symptoms such assweating, tremor, increased blood pressure or heart rate wereobserved. Similarly, there were no reports of a sudden increase ofanxiety or reoccurrence of panic attacks.In conclusion, these initial clinical experiences in patients withpanic disorder provide further evidence that GABAergic com-pounds might constitute an alternative treatment approach inpatients with anxiety disorders, and support the relevance of selec-tive GABAergic compounds in the treatment of affective disorders,as suggested by Ashton and Young (2003). Furthermore, clinicalobservations after long-term treatment with both compounds donot suggest a risk for the development of tolerance and withdraw-al after treatment discontinuation.ReferencesAshton H, Young A H (2003) GABA-ergic drugs: exit stage left, enter stageright. J Psychopharmacol 17: 174–178Zwanzger P, Baghai T, Boerner R J, Möller H J, Rupprecht R (2001a)Anxiolytic effects of vigabatrin in panic disorder. J ClinPsychopharmacol 21: 539–540Zwanzger P, Baghai T, Schüle C, Minov C, Padberg F, Möller H J,Rupprecht R (2001b) Tiagabine improves panic and agoraphobia inpanic disorder patients. J Clin Psychiatry 62: 656–657Zwanzger P, Baghai T, Schüle C, Ströhle A, Padberg F, Kathmann N,Schwarz M, Möller H J, Rupprecht R (2001c) Vigabatrin decreasescholecystokinin tetrapeptide (CCK-4) induced panic in healthy volun-teers. Neuropsychopharmacology 25: 699–703Zwanzger P, Eser D, Padberg F, Baghai T C, Schule C, Roetzer F, Ella R,Moller H J, Rupprecht R (2003) Effects of tiagabine on cholecystokinin-tetrapeptide (CCK-4) induced anxiety in healthy volunteers. DepressAnxiety 18: 140–143Journal of Psychopharmacology18(3) (2004) 440© 2004 British Associationfor PsychopharmacologyISSN 0269-8811SAGE Publications Ltd,London, Thousand Oaks,CA and New Delhi10.1177/0269881104044590Vigabatrin and tiagabine might haveantipanic propertiesP. Zwanzger Anxiety Research Unit, Department of Psychiatry, Ludwig-Maximilians-University, Munich, Germany.R. Rupprecht Anxiety Research Unit, Department of Psychiatry, Ludwig-Maximilians-University, Munich, Germany.Corresponding author: Peter Zwanzger, Anxiety Research Unit, Department of Psychiatry, Ludwig-Maximilans-University, Nussbaumstrasse 7, 80336 Munich, Germany. Email: zwanzger@psy.med.uni-muenchen.deLetters to the Editors at LMU Muenchen on May 16, 2013jop.sagepub.comDownloaded from 

Vigabatrin and Tiagabine Might have Antipanic Properties

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