Riluzole and anxiety

[Clearwater AL]

Tillie, just to add why Riluzole may be prescribed before someone has been diagnosed
with MND or a confirmed diagnosis of ALS.

A number of Neurologists have indicated that Riluzole also has a clinical use in mood and anxiety disorder.

It’s been shown to be an antidepressant in the treatment of depression. Also acts as an anxiolytic in general anxiety within diagnostic processes of MND/ALS.

Not saying that is the case here... maybe.

 

[affected]

Re: Bulbar Onset MND

Interestingly I've not heard of that being done in Australia Al, thanks

 

[Clearwater AL]

Re: Bulbar Onset MND

I'd guess that (my reply) took a few by surprise.

Riluzole is within the the lorazepam family of drugs for treating anxiety.

Often posters who have been prescribed Riluzole before getting a confirmed
diagnosis mistakenly consider it as a confirmation because it is so often
written about by PALS and CALS on this Forum who do take it for ALS.

Again, going back to the emotion thing... most people in the process of
diagnosis, possibly being diagnosed with an MND and worse a diagnosis
of ALS, are going to have anxiety.

**Well, except for the ones for some weird reason are hoping for one.

The Neurologist may see one needs some help with anxiety and like you
wrote if it's not an MND or ALS... no harm done and they can go off it.

 

[MarieLaure]

Re: Bulbar Onset MND

Her on our side of the Atlantic when the neurologist prescribed Riluzole to my dad right after diagnosis, he said it could also help him some with the anxiety.

 

[lgelb]

Re: Bulbar Onset MND

Just to be clear for those who might be concerned about starting a benzodiazepine such as lorazepam (Ativan), also commonly called a "downer" or "tranquilizer," riluzole/Rilutek is not in the same class. As a glutamate release inhibitor, it has some anxiolytic properties but does not create tolerance/dependence such as benzos can.

 

[Clearwater AL]

Re: Bulbar Onset MND

Laurie, don't know where you got your info from but on more then one drug web
site... Riluzole is in the Lorazepam family of drugs to treat anxiety. Riluzole was
around long before it was approved for as a treatment for ALS patients about to
go with a trach.

Maybe you can find the info you are referring to and post it here.

I have a Neuro (no surprise) and I am fortunate (compared to others who seem
to have to come here to get answers) that we communicate often. I can ask
questions, share a thought or concern through my Clinic web site messaging
directly to him and get a response within 24 hours.

I was hoping Karen might chime in on this but... I got a sense of what is
going on here. I sit back and smile.

Any anti anxiety drug is a downer. The last thing someone suffering from
anxiety needs is an upper.

Have at it.

 

[lgelb]

Re: Bulbar Onset MND

Here's just one abstract clearly differentiating the mechanism.

 

[Clearwater AL]

Re: Bulbar Onset MND

Laurie... that was a RAT study!

Many rat studies have not given the same results with humans. All the rat studies
that might have given hope to ALS research... zero. So far.

Yes, rat studies are a hopeful research beginning but... they often fail to produce
a break through.

Spend some time on some drug/med web sites.

Don't mean for this Thread to go off the rails... I posted something factual and
hopefully helpful to others believing because they have been given a prescription
for Riluzole it's a confirmation they have an MND or worse... ALS.

That's not true.

Anywhooo...

PS. Tillie, I'm ok with that too. But... I'm not the one who took this Thread off the rails.
I merely posted an add on to what you wrote. Move it if it makes you happy.

 

[lgelb]

Re: Bulbar Onset MND

Al, it was a rat study confirming that the mechanisms do make a difference, and speaks to my statement about tolerance. But rat studies are not used to classify the drug.

You will not find any sites stating that riluzole is a benzo, nor any that state that lorazepam is not a benzo. So I don't know what else to say.

As for riluzole being prescribed as a general anxiolytic, it's way too expensive and esoteric for that, even as a generic. So if someone is rx'd it, there's a pretty high index of suspicion for MND.

 

[KarenNWendyn]

Al, if Riluzole is an anxiolytic (anti anxiety med), then that is a secondary benefit. Lots of meds are found to have effects separate from their intended use. For example, many antidepressants have found a place in chronic pain relief. Minoxidil, originally marketed and studied as an anti-hypertensive, was found to promote hair growth and is now primarily used for that purpose.

Benzodiazepines have been studied and marketed as anxiolytics. They bind to specific receptors in the brain. Riluzole may benefit anxiety but that would be a secondary effect and by a mechanism completely separate from the Benzos. Riluzole is much more expensive than Benzos. Head to head studies of Riluzole vs Benzos for anxiety probably haven’t been done and probably never will be.

 

[Clearwater AL]

Karen, ok, I'll go along with you and Laurie to a degree. Riluzole a common
prescribed ALS drug. And... often prescribed "before" a confirmed diagnosis
of a MND or ALS. ??

Any normal person in the later process of diagnosis in the avenue of an
ALS diagnosis is going to have some level of anxiety and stress.

BZDs (Benzodiazepines) are supposedly (suppose to be) short term drug
treatment for anxiety, depression and others. Anxiety and depression are
curable disorders.

Very seldom are BZDs intended for indefinite treatment.

Riluzole is covered by Medicare and the VA. Neurologists know that. With the
right supplement plan it can be as little as $20 dollars a month. With the right
insurance coverage maybe a little more. Again, Neuros know that and they
know if a patient is financially capable (insurance - no insurance) before
they walk in the exam room for the first time.

If the person is a veteran it might not cost a dime.

Anyway, Riluzole for the most part, was originally directed for PALS headed
for Peg or Trach. Now there is anxiety. But, now it has taken a wider roll.

Karen, you wrote... "They bind to specific receptors in the brain."

Riluzole doesn't?

Then... " Riluzole may benefit anxiety but that would be a secondary effect and by a
mechanism completely separate from the Benzos."

What is the intended primary effect?

 

[KarenNWendyn]

The intended primary effect of Riluzole is to improve survival of motor neurons by reducing Glutamate levels. Presumably Glutamate causes some sort of injury to the motor neurons and is one factor accelerating their decay.

If you want to get more specific about it, here’s what was in my online medical textbook:

“Three separate mechanisms of riluzole are thought to reduce glutamate-induced excitotoxicity: inhibition of glutamic acid release, noncompetitive block of N-methyl-D-aspartate (NMDA) receptor mediated responses, and direct action on the voltage-dependent sodium channel [5]. However, its precise mechanism of action in ALS is unclear [6].”

Al, Benzos are dirt cheap compared to Riluzole and are indicated for both long and short term treatment of anxiety.

I’m not sure I see the point you’re trying to make, but you obviously have strong opinions. I’ve learned not to argue with people’s opinions, only to present data.

 

[Clearwater AL]

Thanks for the info.

The point I originally tried to make is Riluzole has taken a wider roll than it's
early intent of... "Riluzole delays the onset of ventilator-dependence or tracheostomy
in selected patients and may increase survival by approximately two to three months."

And next paragraph.

The original point was posters believing they have a diagnosis of MND/ALS just
because they have been prescribed Riluzole. Maybe Neuros have become more
liberal prescribing Riluzole before a confirmed diagnosis.

Data is often challenged and new data occurs.

Whatever...