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Ask Dr Ivan

In the third of his regular column, Dr Ivan Goldberg,MD, Director, N.Y. Psychopharmacologic Institute, New York, NY, answers a few of the many questions that arrive in our mailbox. We are sorry, but Dr Goldberg cannot enter into individual correspondence.


I've heard of a drug called hydroxyzine (Atarax) which relieves anxiety and tension. I tried to get some information about the drug. In the Oxford Medical Dictionary, it's said to be a sedative rather than a tranquilizer. However, When I looked it up in 2 pharmacological guides, it seemed to me that it's not more likely to cause drowsiness than Diazepam. However, none of the guides said it's addictive in any way.

What are the advantages and disadvantages of using hydroxyzine versus using diazepam to relieve anxiety?

Hydroxyzine is an antihistamine that suppressed activity in subcortical regions of the brain. The the results of the reduced activity of these subcortical regions is often reduced anxiety and possibly sleepiness. Hydroxyzine is more likely to fail to relieve anxiety than diazepam (Valium). One advantage of hydroxyzine over diazepam is that hydroxyzine is not habit forming. On the other hand, it is not as reliable antianxiety agent as diazepam. While diazepam has anticonvulsant activity, there are reports of hydroxyzine-induced seizures.


Given that both migraine and depression are serotonin based, I am interested in any studies, especially those available on the Net, of patients that have both migraine and clinical depression. Are there any organizations or individuals that are investigating any correlation? What would be considered appropriate drug therapy?

There has been much recent interest in the role of serotonin in the pathophysiology of many diseases including migraine, depression. Also there is research evidence that there is considerable overlap in the incidence of migraine and depression. I have not been able to locate any articles available on Internet that report of the association of depression and migraine headaches.

Many drugs that affect migraine also impact on depression. Both tricyclic antidepressants and monoamine oxidase inhibitors have been utilized as as treatments for both migraine and depression. There have also been some reports that fluoxetine (Prozac) best known for its antidepressant activity also can be used for migraine prophylaxis.


I am interested in alternatives to Zoloft without male sexual side effects, such as ejaculatory inhibition...

While many antidepressants adversely affect both male and female sexual desire and performance, not all do so. Tricyclic antidepressants such as imipramine and amitriptyline have such sexual effects, as do the SSRIs (the Prozac-like medications, venlafaxine, and the monoamine oxidase inhibitors.

Two antidepressants that do not have detrimental effects on sexuality are nefazodone, and bupropion.


I've read on the Internet about a drug called Piracetam which is said to have various effects on concentration and brain functioning. Are those claims true in any way? Does the drug have any toxic effects whatsoever?

There is some, but not overwhelming, evidence that piracetam is capable of modestly increasing memory function and learning in both animals and humans. It is not at all clear how these effects come about. While modest effects have been demonstrated when the drug has been administered to normal people, attempts to treat people with dementing disorders with piracetam have led to generally disappointing results. Piracetam is well tolerated and appears to be free of side-effects

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