Farmapram (alprazolam) drug study
One of the main indications for the use of farmapram (alprazolam) is generalized anxiety disorder (GAD), but the criteria for diagnosing GAD are still controversial, and anxiety is often present in other forms of neurosis and depression. In our study, there were few patients with this diagnosis, and all of them were taking farmapram in combination with antidepressants from the SSRI group, mainly paroxetine. The anti-anxiety effect of these antidepressants is comparable to that of alprazolam, but it occurs a few weeks after the start of therapy. In the first weeks of treatment, anxiety may increase and sleep may be disturbed. It is during this period that the prescription of tranquilizers, and alprazolam in particular, has no alternative. The duration of treatment in patients with GTP is from two weeks to two months at an average dose of 0.75 mg per day (0.25 mg three times a day).
When treating patients with panic disorder, doses of up to 1 mg per day were used, in 3-4 doses. The duration of therapy ranged from 3 to 8 months. Observation of patients in dynamics shows, that at first panic attacks disappear rather quickly, then the anxious expectation of an attack is gradually reduced, fears decrease and, accordingly, avoidance behavior disappears. In some cases, in the presence of depressive symptoms and in order to prevent panic attacks, antidepressants from the SSRI group, in particular Cipralex, were additionally prescribed.
For obsessive-compulsive disorder, alprazolam (0.5 mg per day) was used in combination with fluoxetine for 1 month, and then therapy was changed due to insufficient effectiveness. In another case, in a patient with a variety of obsessions (fears, perceptions, compulsions) combined with panic attacks and avoidant behavior, alprazolam at a dose of up to 1.5 mg daily in combination with etaperazine up to 8 mg daily was successfully used for an extended period (over 4 years) with almost complete reduction of symptoms and restoration of social functioning, with no dependence symptoms.
Patients with depressive disorders, including endogenous and neurotic depression, in our study accounted for more than half of all observations – 58.2%. In most cases, the structure of the depressive syndrome included anxiety symptoms, which was the indication for prescribing alprazolam, especially in the first weeks of therapy, before the anxiolytic effect of antidepressants. For primary depressive episode and recurrent depression, alprazolam was mainly used as part of complex therapy along with antidepressants of different generations (maprotiline, azafen, paroxetine, mirtazapine, symbalta, valdoxan, etc.), small doses of some neuroleptics (sulpiride). In some cases, hypnotics (zopiclone) were additionally prescribed for sleep disorders. Treatment of depression in bipolar disorder (BAD) had its own features, taking into account the possibility of transition to a manic phase, especially in BAD-1. Antidepressants that did not cause inversion of affect (Azafen, Valdoxan, Phevarine) were used. Anticonvulsants (naproates, carbamazepine), antipsychotics (quetiapine, olanzapine) were prescribed during the course of the control therapy, and patients continued to take them during remission as supportive therapy. In BAR-11, depressive symptoms were managed with SSRIs, venlafaxine, Valdoxan in combination with alprazolam, which had an anxiolytic effect, especially during the first weeks of therapy, before development of the antidepressant’s own effects, and potentiated their antidepressant activity. Among anticonvulsants, lamotrigine and valproic acid preparations were preferred; among antipsychotics, quetiapine was preferred. In almost half of the cases of neurotic depression (12 patients), alprazolam was used as monotherapy, in a dose of 0.75-1 mg for 4-7 weeks, with a good effect, i.e., almost complete recovery. This once again shows that alprazolam has an antidepressant effect.