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What Causes Keppra To Be Ineffective In Treatment Of OCD?
Question: I was taking until some time ago 1000mg Keppra as mood stabilizer, Klonopin 1mg, Lexapro 2.5 mg and amisulpride (Solian) 100mg. My psychiatrist decided to change Keppra for Gabapentin, but this med didn't worked and suddenly an old OCD/phobia reappeared. It was under control until the change of Keppra for Gabapentin. But the most strange thing is that when my psychiatrist decided to go back to Keppra, the problem was not resolved as before and the symptom of OCD/phobia stayed and it's still here. My question is: why the problem was not there at the beginning, it appeared with the change of antiepileptic (to Gabapentin) BUT it NOT disappeared going back to Keppra, while Keppra was working BEFORE the change and for some four years? Is there any reason that could explain that Keppra was not able to do the same effect because it was retired for two weeks in the replacement by Gabapentin? My psychiatrist told me that what happened is difficult to understand, because we tried again Keppra for one month after Gabapentin and in a higher dosage but the problem remains.
Brief Answer:
Go for Prestique or wait more to late keppra work
Detailed Answer:
Hi,
Thanks for using healthcaremagic.
You can wait for one month of Keprra 2000 mg to work. If still you do not have improvement, likely possibility is that it will not work.Reason behind that is irreversible receptor modulation done when gabapentine is given. Exact mechanism is difficult to find in current medical science.
Another option is you can go for a new molecule Desvenlafexine(Prstique) as lexapro dose increasing is not feasible due to CYP system problem in you. Prestique is metabolized through conjugation in liver, so you can tolerate well.
And yes , please understand below mechanism which I have explained before
The problem is not with keppra's action but brain's reaction to it.
Note some facts.
In diabetes, medical science know that how insulin deficiency occurs and how it can be treated means exact etiology(cause) of the problem is known so exact treatment is also available.
While in neurological-mental health science exact mechanism of either any disorder or any drug is not known.
Our brain has lots of neurotransmitters and they work indifferent parts in different manner and different coordination.
That's why sometime we can not understand about drug's action as in your case.
Even one medicine in OCD can be helpful in x person and not in Y as brain structures and genetic make up differs person to person.
In your case problem is OCD which is one of the difficult disorders in psychiatry from treatment point of view. Etiology of OCD is not exactly established that we can target it.
You were stable on keppra, with gabapentin not improvement and reintroduction of keppra is not yet effective.
Gabapentin interacts with voltage-sensitive calcium channels in cortical neurons
while mechanism of action of keppra is the drug binds to a synaptic vesicle glycoprotein, SV2A and inhibits presynaptic calcium channels reducing neurotransmitter release and acting as a neuromodulator.
So gabapentine had done some neurochemical changes which might preventing keppra to again work effectively.
Hope I have cleared your query,
Regards,
Dr.Chintan Solanki.
Go for Prestique or wait more to late keppra work
Detailed Answer:
Hi,
Thanks for using healthcaremagic.
You can wait for one month of Keprra 2000 mg to work. If still you do not have improvement, likely possibility is that it will not work.Reason behind that is irreversible receptor modulation done when gabapentine is given. Exact mechanism is difficult to find in current medical science.
Another option is you can go for a new molecule Desvenlafexine(Prstique) as lexapro dose increasing is not feasible due to CYP system problem in you. Prestique is metabolized through conjugation in liver, so you can tolerate well.
And yes , please understand below mechanism which I have explained before
The problem is not with keppra's action but brain's reaction to it.
Note some facts.
In diabetes, medical science know that how insulin deficiency occurs and how it can be treated means exact etiology(cause) of the problem is known so exact treatment is also available.
While in neurological-mental health science exact mechanism of either any disorder or any drug is not known.
Our brain has lots of neurotransmitters and they work indifferent parts in different manner and different coordination.
That's why sometime we can not understand about drug's action as in your case.
Even one medicine in OCD can be helpful in x person and not in Y as brain structures and genetic make up differs person to person.
In your case problem is OCD which is one of the difficult disorders in psychiatry from treatment point of view. Etiology of OCD is not exactly established that we can target it.
You were stable on keppra, with gabapentin not improvement and reintroduction of keppra is not yet effective.
Gabapentin interacts with voltage-sensitive calcium channels in cortical neurons
while mechanism of action of keppra is the drug binds to a synaptic vesicle glycoprotein, SV2A and inhibits presynaptic calcium channels reducing neurotransmitter release and acting as a neuromodulator.
So gabapentine had done some neurochemical changes which might preventing keppra to again work effectively.
Hope I have cleared your query,
Regards,
Dr.Chintan Solanki.
Note: For further guidance on mental health, Click here.
Above answer was peer-reviewed by :
Dr. Yogesh D
Answered by
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