for those taking proton pump inhibitors for reflux

Postby skyboy23 » Wed Feb 02, 2011 2:11 pm

Could proton pump inhibitors cause increased anxiety and panic attacks? found this article on the internet

Rabeprazole-Induced Panic Attacks

Rabeprazole is an anti-ulcer drug in the class of proton pump inhibitors (PPIs). Psychiatric adverse effects reported for rabeprazole during controlled trials and postmarketing experience are rare and include insomnia, anxiety, depression, somnolence, abnormal dreams, decreased libido, agitation, amnesia, and confusion.1 The following is a published report in which a patient developed marked anxiety and panic attacks in association with use of rabeprazole.2


A 55-year-old white woman was prescribed rabeprazole 20 mg/day administered in the morning for persistent symptoms of dyspepsia. Her history was notable for a depressive episode 8 years earlier, which resolved and did not recur after 4 months of treatment with an (unspecified) antidepressant. She was not taking any other medications, including over-the-counter drugs or herbal remedies. She had no known allergies or history of alcohol abuse or illicit drug use. She smoked 15 cigarettes a day. She denied any stressful or traumatic change in her lifestyle during the prior 6 months.


Ten days after initiation of rabeprazole, she presented with a 7-day history of marked anxiety associated with panic attacks, night terror (pavor nocturnus), episodic mental confusion, and attention deficit. The panic attacks lasted from a few minutes to approximately 1 hour and consisted of intense apprehension, dyspnea, palpitations, fear, and a feeling of impending disaster. Within 2 days of discontinuing rabeprazole, all of her symptoms completely resolved. Later work-up revealed the presence of gastroesophageal reflux disease with erosive gastro-duodenitis positive for Heliobacter pylori. Subsequent treatment with esomeprazole for a period of 4 weeks did not result in any psychiatric adverse effects.


It appears that rabeprazole induced this patient’s anxiety and panic symptoms. Among PPI, rabeprazole has the highest capacity to induce increased secretion of gastrin.3,4 PPI-induced secretion of gastrin is mediated by the release of gastrin-releasing peptide (GRP).5 GRP and its receptor are found in the dorsal hippocampus and amygdala, where they are involved in regulating synaptic plasticity and aspects of behavior that might be altered in disorders such as anxiety, depression, and dementia.6 It is known that pentagastrin, a synthetic pentapeptide derived from gastrin, when administered to healthy volunteers, leads to increases in anxiety, heart rate, and physical symptoms of panic in a dose-related manner.7,8 Furthermore, the highly selective gastrin receptor antagonist PD-136,450 has anxiolytic activity in rats and rabbits.9


Regardless of mechanism of action, rabeprazole may be anxiogenic in certain vulnerable patient populations. Further studies are needed to confirm these preliminary observations. PP


References

1. Aciphex [package insert]. Tokyo: Eisai Co., Ltd; 2003.
2. Polimeni G, Cutroneo P, Gallo A, Gallo S, Spina E, Caputi AP. Rabeprazole and psychiatric symptoms. Ann Pharmacother. 2007;41(7):1315-1317.
3. Williams MP, Sercombe J, Hamilton MI, Pounder RE. A placebo-controlled trial to assess the effects of 8 days of dosing with rabeprazole versus omeprazole on 24-h intragastric acidity and serum gastrin concentrations in young healthy male subjects. Aliment Pharmacol Ther. 1998;12(11):1079-1089.
4. Warrington S, Baisley K, Boyce M, Tejura B, Morocutti A, Miller N. Effects of rabeprazole, 20 mg, or esomeprazole, 20 mg, on 24-h intragastric pH and serum gastrin in healthy subjects. Aliment Pharmacol Ther. 2002;16(7):1301-1307.
5. Takehara Y, Sumii K, Tari A, et al. Evidence that endogenous GRP in rat stomach mediates omeprazole-induced hypergastrinemia. Am J Physiol. 1996;271(5 Pt 1):G799-804.
6. Roesler R, Henriques JA, Schwartsmann G. Gastrin-releasing peptide receptor as a molecular target for psychiatric and neurologic disorders. CNS Neurol Disord Drug Targets. 2006;5(2):197-204.
7. McCann UD, Slate SO, Geraci M, Uhde TW. Peptides and anxiety: a dose-response evaluation of pentagastrin in healthy volunteers. Anxiety. 1994-1995;1(6):258-267.
8. Geraci M, Anderson TS, Slate-Cothren S, Post RM, McCann UD. Pentagastrin-induced sleep panic attacks: panic in the absence of elevated baseline arousal. Biol Psychiatry. 2002;52(12):1183-1189.
9. Bastaki SM, Hasan MY, Chandranath SI, Schmassmann A, Garner A. PD-136,450: a CCK2 (gastrin) receptor antagonist with antisecretory, anxiolytic and antiulcer activity. Mol Cell Biochem. 2003;252(1-2):83-90.
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#1

Postby paulo111 » Wed Feb 02, 2011 2:26 pm

skyboy23 wrote:Could proton pump inhibitors cause increased anxiety and panic attacks? found this article on the internet

Rabeprazole-Induced Panic Attacks

Rabeprazole is an anti-ulcer drug in the class of proton pump inhibitors (PPIs). Psychiatric adverse effects reported for rabeprazole during controlled trials and postmarketing experience are rare and include insomnia, anxiety, depression, somnolence, abnormal dreams, decreased libido, agitation, amnesia, and confusion.1 The following is a published report in which a patient developed marked anxiety and panic attacks in association with use of rabeprazole.2


A 55-year-old white woman was prescribed rabeprazole 20 mg/day administered in the morning for persistent symptoms of dyspepsia. Her history was notable for a depressive episode 8 years earlier, which resolved and did not recur after 4 months of treatment with an (unspecified) antidepressant. She was not taking any other medications, including over-the-counter drugs or herbal remedies. She had no known allergies or history of alcohol abuse or illicit drug use. She smoked 15 cigarettes a day. She denied any stressful or traumatic change in her lifestyle during the prior 6 months.


Ten days after initiation of rabeprazole, she presented with a 7-day history of marked anxiety associated with panic attacks, night terror (pavor nocturnus), episodic mental confusion, and attention deficit. The panic attacks lasted from a few minutes to approximately 1 hour and consisted of intense apprehension, dyspnea, palpitations, fear, and a feeling of impending disaster. Within 2 days of discontinuing rabeprazole, all of her symptoms completely resolved. Later work-up revealed the presence of gastroesophageal reflux disease with erosive gastro-duodenitis positive for Heliobacter pylori. Subsequent treatment with esomeprazole for a period of 4 weeks did not result in any psychiatric adverse effects.


It appears that rabeprazole induced this patient’s anxiety and panic symptoms. Among PPI, rabeprazole has the highest capacity to induce increased secretion of gastrin.3,4 PPI-induced secretion of gastrin is mediated by the release of gastrin-releasing peptide (GRP).5 GRP and its receptor are found in the dorsal hippocampus and amygdala, where they are involved in regulating synaptic plasticity and aspects of behavior that might be altered in disorders such as anxiety, depression, and dementia.6 It is known that pentagastrin, a synthetic pentapeptide derived from gastrin, when administered to healthy volunteers, leads to increases in anxiety, heart rate, and physical symptoms of panic in a dose-related manner.7,8 Furthermore, the highly selective gastrin receptor antagonist PD-136,450 has anxiolytic activity in rats and rabbits.9


Regardless of mechanism of action, rabeprazole may be anxiogenic in certain vulnerable patient populations. Further studies are needed to confirm these preliminary observations. PP


References

1. Aciphex [package insert]. Tokyo: Eisai Co., Ltd; 2003.
2. Polimeni G, Cutroneo P, Gallo A, Gallo S, Spina E, Caputi AP. Rabeprazole and psychiatric symptoms. Ann Pharmacother. 2007;41(7):1315-1317.
3. Williams MP, Sercombe J, Hamilton MI, Pounder RE. A placebo-controlled trial to assess the effects of 8 days of dosing with rabeprazole versus omeprazole on 24-h intragastric acidity and serum gastrin concentrations in young healthy male subjects. Aliment Pharmacol Ther. 1998;12(11):1079-1089.
4. Warrington S, Baisley K, Boyce M, Tejura B, Morocutti A, Miller N. Effects of rabeprazole, 20 mg, or esomeprazole, 20 mg, on 24-h intragastric pH and serum gastrin in healthy subjects. Aliment Pharmacol Ther. 2002;16(7):1301-1307.
5. Takehara Y, Sumii K, Tari A, et al. Evidence that endogenous GRP in rat stomach mediates omeprazole-induced hypergastrinemia. Am J Physiol. 1996;271(5 Pt 1):G799-804.
6. Roesler R, Henriques JA, Schwartsmann G. Gastrin-releasing peptide receptor as a molecular target for psychiatric and neurologic disorders. CNS Neurol Disord Drug Targets. 2006;5(2):197-204.
7. McCann UD, Slate SO, Geraci M, Uhde TW. Peptides and anxiety: a dose-response evaluation of pentagastrin in healthy volunteers. Anxiety. 1994-1995;1(6):258-267.
8. Geraci M, Anderson TS, Slate-Cothren S, Post RM, McCann UD. Pentagastrin-induced sleep panic attacks: panic in the absence of elevated baseline arousal. Biol Psychiatry. 2002;52(12):1183-1189.
9. Bastaki SM, Hasan MY, Chandranath SI, Schmassmann A, Garner A. PD-136,450: a CCK2 (gastrin) receptor antagonist with antisecretory, anxiolytic and antiulcer activity. Mol Cell Biochem. 2003;252(1-2):83-90.


Has your dr found what's causing the reflux? Have you ever tried orange peel extract? Have you been looked at for ulcers or hiatial hernia?
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#2

Postby skyboy23 » Wed Feb 02, 2011 3:16 pm

duodenitus he says after having a camera shoved down my throat
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#3

Postby paulo111 » Wed Feb 02, 2011 3:18 pm

skyboy23 wrote:duodenitus he says after having a camera shoved down my throat


Endoscopy, not pleasant are they, nor when they go up the other hole either (ouch)...
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#4

Postby Tom60 » Wed Feb 02, 2011 8:13 pm

Anything is possible, of course, but I take omeprazole (generic Prylosec) along with citalopram which preceded the omeprazole by a year and have had no unusual interactions. Different PPIs and SSRIs might interact differently, but my doctors (both the psychiatrist who prescribed the citalopram and the ENT who prescribed the omeprazole) said there shouldn't be any special problem with taking those two and I haven't had any, thankfully.
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#5

Postby daisylou » Thu Feb 03, 2011 9:12 am

you know there may be something in that! after coming off of my Lansoprazole (i was on omeprazole previous to this) i haven't felt any where near as anxious/depressed.

i chose not to have the scope, the Dr didn't see any urgency for me to have it, and im glad!
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#6

Postby skyboy23 » Wed Feb 09, 2011 3:59 pm

what do you take now?
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#7

Postby daisylou » Fri Feb 11, 2011 9:04 am

im currently med free :D i do take a lansoprazole if i feel what im about to eat will cause probs but appart from that and a couple of Gaviscon im goood
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#8

Postby adagioforstrings » Mon Apr 04, 2011 5:51 am

Interesting post!

I'm currently trying to work out what's causing my anxiety and general unhappiness/depression and it's crossed my mind before to check whether Rabeprazole has any side effects that could be related.

The problem is that if I don't take it I start to suffer with acid reflux a few hours later so I would need some kind of effective alternative.

I've had an endoscopy and tried a course of treatment to get rid of heliobacter pylori (twice!) and in the end was fobbed off by being told that I just produce too much acid....? So although I don't have an exact diagnosis I know hat I need to take something daily to prevent the symptoms.
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#9

Postby paulo111 » Tue Apr 05, 2011 11:54 am

adagioforstrings wrote:Interesting post!

I'm currently trying to work out what's causing my anxiety and general unhappiness/depression and it's crossed my mind before to check whether Rabeprazole has any side effects that could be related.

The problem is that if I don't take it I start to suffer with acid reflux a few hours later so I would need some kind of effective alternative.

I've had an endoscopy and tried a course of treatment to get rid of heliobacter pylori (twice!) and in the end was fobbed off by being told that I just produce too much acid....? So although I don't have an exact diagnosis I know hat I need to take something daily to prevent the symptoms.


Did you test positive for h pylori? That bacteria is very stubborn and can protect itself with a biofilm which you have to break up to get rid of the infection, and then zinc/glutamine to heal any ulcers the caused. I always got told it was something to break up the biofilm on an empty stomach, 30 mins later the antibitoic whether prescription of with mastic gum/oregano, then a fibre like charcoal to absorb the toxins 20 mins after the anitbiotics.

Did they rule out hiatial hernia? Stomach acid defiency? Have you ever used antacids? Crohns? Hypothyroidism? Diabetes 2? I think some of the causes of heartburn/GERD are actually to little stomach acid as opposed to to much. Theres a link bewtween stomach acid and whether you under or over methylate, I know folk who over methylate which makes them prone to HCL defiency which in turn makes them very prone to bacterial/yeast infections.

Orangle peel extract can help with reflux:

http://ezinearticles.com/?Acid-Reflux-H ... &id=487827
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#10

Postby paulo111 » Tue Apr 05, 2011 12:02 pm

PS - do you smoke? Drink much coffee/alcohol? Have you been tested for food allergies?
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#11

Postby adagioforstrings » Wed Apr 06, 2011 5:48 am

Hi Paulo

As far as I know they didn't test for H Pylori, just gave me the course of treatment and assured me that it would solve the problem and when it didn't work told me to try it again. I think it was a one week course of tablets.

I think by doing the endoscopy they ruled out hiatial hernia etc. and it was after the endoscopy that I was given the detailed diagnosis of "you just produce too much acid" and told that I'd have to take Rabeprazole on an on going basis. I've also had tests for diabetes (the one where they prick your finger and test the blood sample right?) as for the rest, well I assume that during the times I visited the GP and the hospital these were looked into.

As for caffeine I do have a coffee and 2 - 3 cups of tea but only really in the morning - after lunch I'm generally caffeine free. I smoke perhaps 2 - 3 a day, probably more at a weekend if I go out drinking and I don't touch alcohol during the week but do drink at weekends. No I haven't been tested for food allergies, not even sure how to go about that and I'm slightly sceptical as I'm sure you can be told you're allergic to anything (if you have any info please enlighten me!).

To be honest I'm used to being fobbed off in this manner by the NHS as I'm sure alot of people are.

Today I have a review of my medication with the GP (I've also been taking Citalopram 10mg - been trying to come off it for quite a while now) and I have quite alot I'd like to say to the doctor but as usual I guess I'll be rushed out within my 7 minute window or whatever it is these days :-/
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#12

Postby paulo111 » Wed Apr 06, 2011 8:02 am

adagioforstrings wrote:Hi Paulo

As far as I know they didn't test for H Pylori, just gave me the course of treatment and assured me that it would solve the problem and when it didn't work told me to try it again. I think it was a one week course of tablets.

I think by doing the endoscopy they ruled out hiatial hernia etc. and it was after the endoscopy that I was given the detailed diagnosis of "you just produce too much acid" and told that I'd have to take Rabeprazole on an on going basis. I've also had tests for diabetes (the one where they prick your finger and test the blood sample right?) as for the rest, well I assume that during the times I visited the GP and the hospital these were looked into.

As for caffeine I do have a coffee and 2 - 3 cups of tea but only really in the morning - after lunch I'm generally caffeine free. I smoke perhaps 2 - 3 a day, probably more at a weekend if I go out drinking and I don't touch alcohol during the week but do drink at weekends. No I haven't been tested for food allergies, not even sure how to go about that and I'm slightly sceptical as I'm sure you can be told you're allergic to anything (if you have any info please enlighten me!).

To be honest I'm used to being fobbed off in this manner by the NHS as I'm sure alot of people are.

Today I have a review of my medication with the GP (I've also been taking Citalopram 10mg - been trying to come off it for quite a while now) and I have quite alot I'd like to say to the doctor but as usual I guess I'll be rushed out within my 7 minute window or whatever it is these days :-/


Did you have the IBS before you had the course of anti-biotics or after? There are some tests you can use with baking soda to identify if you have to little stomach acid, normally it can be to little as opposed to to much, the NHS get it completely backwards. It annoys me how they dish out anti-biotics as though they were sweets, they can wipe out both good colonies of bacteria and bad, so unless used with caution can do more harm than good. You should mayb look to get a stool analysis done but you'd likely need to go private and they can cost £200 or so, may help figure out whats causing the digestive issues though.

With regards to:

To be honest I'm used to being fobbed off in this manner by the NHS as I'm sure alot of people are.


I feel your pain, had the exact same experience and to be honest was ultimately convinced my GP had no clue whatsoever was causing my symptoms and kepy saying you just need to relax its a figment of your imagination (black streaks in my stool which indicates a bleed - he was telling me I was imagining this). When it comes to MH problems and complex digestive disorders they are not far off clueless.
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#13

Postby paulo111 » Wed Apr 06, 2011 8:21 am

This gives some info on smoking and GERD:


http://digestive.niddk.nih.gov/ddisease ... g/#effects

Smoking and Your Digestive System
Cigarette smoking causes many life-threatening diseases, including lung cancer, colon cancer, emphysema, and heart disease. Each year more than 400,000 Americans die from cigarette smoking. One in every five deaths in the United States is smoking related. Estimates show that about one-third of all adults smoke. Adult men seem to be smoking less, but women and teenagers of both sexes seem to be smoking more. Smoking affects the entire body, including the digestive system.

[Top]
What are the harmful effects of smoking on my digestive system?
Smoking can harm all parts of the digestive system, contributing to such common disorders as heartburn and peptic ulcers. Smoking increases the risk of Crohn's disease, and possibly gallstones, which form when liquid stored in the gallbladder hardens into pieces of stone-like material. Smoking also damages the liver.

[Top]
Heartburn
Heartburn is common with more than 50 million Americans having it at least once a month and about 15 million having it daily.

Heartburn is a symptom of a syndrome called gastroesophageal reflux (GER). GER is when the natural acidic juices in the stomach flow backwards into the esophagus—the tube that connects the mouth to the stomach. Acidic juices are made by the stomach to help break down food. The stomach is naturally protected from acidic juices, but the esophagus does not have the same protection. Normally, a muscular valve at the lower end of the esophagus, called the lower esophageal sphincter (LES), keeps the acids in the stomach and out of the esophagus. Smoking, however, weakens the LES, which allows stomach acid to flow into the esophagus. When stomach acid comes in contact with the esophagus, the inner lining can become injured or damaged.


And some stuff on caffeine and GERD:

http://www.acidrefluxatoz.com/caffeine-gerd.html


You may not wish to give up smoking or coffee however, but it would be something to rule out I guess.
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#14

Postby adagioforstrings » Tue Apr 12, 2011 6:02 am

Thanks for the info Paulo

I've never had IBS - why do you ask?

Also do you have any more info on the baking soda tests? Might be interesting. Also the stool analysis sounds like a good idea so I might have to research that one.

As for me mentioning that I had quite alot to say to my GP during the medication review well guess what - it was a complete waste of time as the review was with a nurse and not my GP. When I mentioned that I'd like to talk about a few things she simply told me that I'd have to book another appointment with my GP.

I also have a back injury which I spent the best part of a year trying to have sorted and after waiting months to see a consultant I was told "you'll just have to live with it". In fact I waited months on two seperate occasions to see two different consultants only to have roughly the same response from both. I managed to get a private MRI scan which showed a bulging disc and a benign cyst in my lower spine area but still ended up being told by the NHS that it's something I just have to live with. There's a bit of a pattern here don't you think..........?
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