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 Post subject: Anxiety
PostPosted: Thu May 12, 2016 8:59 am 
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I have been on suboxone for the past 2 years and it has been working very well for me. But for the past week, I have been experiencing significant anxiety. There are definitely things in my life that could contribute -- finishing up my thesis, my job, etc, but still... I did take some Tagamet one morning and the anxiety was worse for the next couple days. I was wondering if that would decrease first pass metabolism of naloxone as well as buprenorphine and contribute to the anxiety. I do have an appointment with my doctor next week to discuss options. I really hate feeling this way!


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 Post subject: Re: Anxiety
PostPosted: Thu May 12, 2016 2:59 pm 
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Hey Cmr,

I'm sorry to hear about ur anxiety. I've been going through major anxiety lately but it's not because of suboxone. I think I must be in perimenopause or having hormonal problems (I know u probably don't wanna hear about my female issues lol). But I understand the misery of anxiety that u can't control. I feel bad for my family because I become hateful at times. And it isn't all the time, I can go weeks without anxiety so it's unpredictable too. It's a crappy feeling and I absolutely hate it. Anyway lol enough about my anxiety.

Tagament, is that a stomach medicine or am I thinking of something else? I just started taking omeprazole (prilosec) last 6 months. I've not noticed it giving me any anxiety that I know of. Sorry I don't have any better answers for ya, I just wanted to tell ya I understand anxiety that u aren't totally understanding of. Hopefully ur Dr will be able to shed more light on it for ya.

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Jennifer


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 Post subject: Re: Anxiety
PostPosted: Fri May 13, 2016 12:57 am 
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I think tagamet is a CYP 3A inhibitor; Wikipedia has a list of inhibitors and inducers of those enzymes-- so theoretically it would reduce the metabolism of buprenorphine and make it last longer. Naloxone may be affected too, but naloxone 1. is not absorbed significantly through the oral mucosa, and 2. the part absorbed in the gut is so effectlvely metabolized that it would be hard to imagine tagamet having a significant effect. Understand that those cytochrome enzymes metabolize many things besides medications-- and if tagamet could shut down a cytochrome enzyme more than a very small amount, then tagamet would really cause the body to go haywire by messing up a bunch of other metabolic pathways.

Beyond that, if naloxone was causing the anxiety, you would also be sitting on the toilet with bad diarrhea, yawning like crazy, and sweating up a storm.

Anxiety is very, very common-- and it usually comes from something causing fear that you don't want to think about. Finishing a thesis, for example, comes with many fears-- fears of the upcoming defense of the thesis, fears of moving on and finding something to do with all that knowledge, fears of leaving behind important relationships... usually when I ask a patient what's coming up and I see something obvious, and the patient insists 'no- THAT'S not bothering me AT ALL!', I have found the issue causing the anxiety.


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 Post subject: Re: Anxiety
PostPosted: Sun May 15, 2016 1:03 pm 
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Thank you very much for your replies. I am thinking about asking my gp about starting propranolol or gabapentin. I get migraines regularly, maybe there will be an added benefit of migraine prophylaxis. I was on sertrailine for a while for post partum depression & I really didn't love the side fx. I just want to not go back into the trap of self-prescribing.

I have a wonderful, supportive husband, three beautiful children and I guess I am a little frustrated with myself for not being stronger.


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Fond Du Lac Psychiatry
Dr. Jeffrey Junig, M.D., Ph.D.

  • Board Certified Psychiatrist
  • Asst Clinical Professor, Medical College of Wisconsin

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