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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by DC on April 26, 2000, at 7:20:16
How come we're not hearing anymore about these drugs? Let's have some more reports. If you take one of these drugs--or one their cousins--can you let me know how it's working for you? --Dwight
Posted by JohnL on April 27, 2000, at 5:05:30
In reply to Adrafinil, amisulpride, reboxetine?, posted by DC on April 26, 2000, at 7:20:16
> How come we're not hearing anymore about these drugs? Let's have some more reports. If you take one of these drugs--or one their cousins--can you let me know how it's working for you? --Dwight
I'm still doing well. My core symptom of anhedonia--inability to experience pleasure in normal everyday activities--has been reduced to a very low level. Not completely gone, but almost.
Current cocktail:
300mg Adrafinil
100mg Amisulpride
1200-1500mg St Johnswort
7.5mg RemeronI tried reducing the Amisulpride to 50mg and noticed deterioration within two days. I would like to increase the Adrafinil, though I have to admit it's working fine at the lowest dose of 300mg. With me there may be no justified reason to raise it, and might be counterproductive. Not sure. But for now, these meds are working better for me than any of at least a couple dozen different meds in five years.
On a 1 to 10 scale I would rate myself a 9 to 9 1/2. 1=wish I would die. 2=living nightmare, extreme depression, how the hell will I make it through the next hour (not to mention the entire day!) 4=able to function, but not enjoying living. For the past five years I have been fluctuating in the 1 to 5 range.
JohnL
Posted by AndrewB on April 27, 2000, at 10:47:20
In reply to Re: Adrafinil, amisulpride, reboxetine?, posted by JohnL on April 27, 2000, at 5:05:30
John,
Again it is pleasing to hear of your good state of mind.
I'm curious, since your current cocktail covers a lot of bases so to speak as far as neurotransmitters goes, does it compare at all to an MAOI. A Parnate without side effects perhaps?
AndrewB
Posted by Scott L. Schofield on April 28, 2000, at 9:44:05
In reply to Re: Adrafinil, amisulpride, reboxetine?, posted by JohnL on April 27, 2000, at 5:05:30
> On a 1 to 10 scale I would rate myself a 9 to 9 1/2.
> JohnL
Holy crap!Yay! Don't stop!
(If you have any neurotransmitter left over, I'll give you my mailing address).
- Scott
Posted by JohnB on April 28, 2000, at 13:32:37
In reply to Re: Adrafinil, amisulpride, reboxetine?, posted by JohnL on April 27, 2000, at 5:05:30
John- Congratulations on your breakthrough. I think like you put in the time and research to deserve it, too. Also, thanks for all the sharing of info on this board.
Your "scale of 1-10" that you mention seems to indicate unipolar depression, but you always mention "anhedonia". I know what the dictionary definition of the term is, but how does it fit into the depressive scale. Is that a more specific form of clinical depression or is it something similar to dysthymia or . . . . ?
Posted by JohnL on April 29, 2000, at 3:05:22
In reply to Re: JohnL, posted by AndrewB on April 27, 2000, at 10:47:20
> John,
>
> Again it is pleasing to hear of your good state of mind.
>
> I'm curious, since your current cocktail covers a lot of bases so to speak as far as neurotransmitters goes, does it compare at all to an MAOI. A Parnate without side effects perhaps?
>
> AndrewBGood question Andrew. But I don't know the answer. The only MAOI experience I have is with Moclobemide, which made me feel much worse. I have also noticed my depression worsens when serotonin is raised too much (like on 30+ mg Prozac, or any dose of a serotonin med slightly higher than the usual dose). Increasing serotonin levels does not work for me very well, and increasing NE levels generally causes worsening. With that in mind, I suspect a real MAOI would not be good for me.
Ironically SJW doesn't worsen me at all, even though it is increasing NE and serotonin levels. Must have something to do with the mechanism by which it inhibits reuptake, which is probably different than the mechanism of prescriptions. I've tried SJW with everything. Usually it seems rather neutral, like a vitamin. But with Adrafinil and Amisulpride, it kicked in nicely the very first day and continues still. Go figure. Our chemistries must be so complicated. That's why I generally frown on diagnosis labels and attempts at predicting success on one med vs another. Even our best explanations of how a drug works and what it affects I think only scratch the surface. I think there's a lot more going on. Probably a lot more than we currently know. All that matters to me is results. And the only way I know of to achieve that is to try and see.
But in theory, on paper, I do not suspect a MAOI would produce good results with me. May likely make me worse. I think the receptor stimulation effect of Adrafinil and Amisulpride is more important to my chemistry than is increasing neurotransmitter levels.
I am not however completely free of side effects. I'm not sure who is at fault here, but my vital parts are rather limp, and having sex has been most frustrating. Either Adrafinil or Amisulpride could be guilty, though I suspect Adrafinil more. I noticed on the Amisulpride label that impotence is stated as a possible side effect. But I took it months ago with Prozac and didn't have any problem then. So I think it's the Adrafinil.
Last night I tried my first 50mg dose of Viagra. I told my pdoc I would like to treat the side effect directly on an as-needed basis, and avoid adding or substracting from the psychiatric mix. I seem to have stumbled onto a delicate balance with my cocktail, and I don't want to rock the boat. Viagra works. :-)
JohnL
Posted by JohnL on April 29, 2000, at 3:23:48
In reply to Re: JohnL, posted by JohnB on April 28, 2000, at 13:32:37
> John- Congratulations on your breakthrough. I think like you put in the time and research to deserve it, too. Also, thanks for all the sharing of info on this board.
> Your "scale of 1-10" that you mention seems to indicate unipolar depression, but you always mention "anhedonia". I know what the dictionary definition of the term is, but how does it fit into the depressive scale. Is that a more specific form of clinical depression or is it something similar to dysthymia or . . . . ?Yikes. Tough questions JohnB.
I think to put it in perspective though it's worth mentioning that my primary core symptom is anhedonia. I have all the other symptoms of depression as well, but they were way down the intensity scale in comparison to anhedonia. I came to view myself as suffering more from a condition of anhedonia rather than a condition of depression. Clearly I fit all the criteria for Major Depression, but the big one is anhedonia.
On my overly simple 1 - 10 scale I usually think in terms of anhedonia. The other symptoms kind of go along with it, but in general I'm rating the anhedonia part of it more than anything else.
Though anhedonia is a core symptom of depression, I've read in some abstracts that it is also viewed as a stand-alone condition--a condition that is both a part of depression, but also sometimes a completely different beast. With some intricate complicated intermingling just to muddy the waters! So I tend to think anhedonia is very different from person to person. It may be just a core symptom of the depression. Or it may be a stand-alone beast with a life all its own. Or it may be a combination of both. But no matter how we look at it, it is a prominent component of both major depression and dysthymia. In general I tend to think of dysthymia as being the same as anhedonia, but that may or may not be accurate. I'm not sure. That's just how I see it.
JohnL
Posted by AndrewB on April 29, 2000, at 10:30:06
In reply to Re: AndrewB, posted by JohnL on April 29, 2000, at 3:05:22
I have also noticed my depression worsens when serotonin is raised too much (like on 30+ mg Prozac, or any dose of a serotonin med slightly higher than the usual dose). Increasing serotonin levels does not work for me very well, and increasing NE levels generally causes worsening. With that in mind, I suspect a real MAOI would not be good for me.
>
******Like you, serotonin enhancers don't seem to help me. Both serzone and 5-htp fail to improve my mood and they give me 'mummifying' side effects. (Have I tried enough serotonergic agents to make this generalization?) Unlike you though, NE enhancers are just fine with me. I really like reboxetine. I think the reason you had a bad expereince with reboxetine is because it stimulates beta adrenergic receptors. Stimulation of beta adrenergic receptors can cause anxiety and other side effects. Reboxtine stimulates both the alpha and beta andrenergic receptors while adrafinil stimulates only the alpha 1 adrenergic receptors. In general, adrafinil should have less side effects than reboxetine. So why take reboxetine? Stimulation of both the alpha and beta receptors have the potential to improve mood. Stimulation of the beta receptor probably explains why Bruce responded to reboxetine but not to adrafinil.
I've tried SJW with everything. Usually it seems rather neutral, like a vitamin. But with Adrafinil and Amisulpride, it kicked in nicely the very first day and continues still. But in theory, on paper, I do not suspect a MAOI would produce good results with me. May likely make me worse. I think the receptor stimulation effect of Adrafinil and Amisulpride is more important to my chemistry than is increasing neurotransmitter levels.
>
******What effects specifically does SJW provide for you?
> I am not however completely free of side effects. I'm not sure who is at fault here, but my vital parts are rather limp, and having sex has been most frustrating. Either Adrafinil or Amisulpride could be guilty, though I suspect Adrafinil more. I noticed on the Amisulpride label that impotence is stated as a possible side effect. But I took it months ago with Prozac and didn't have any problem then. So I think it's the Adrafinil.
>
*****You are right. It is the adrafinil. Adrafinil is an alpha 1 receptor agonist. Any med that stimulates the alphha receptors will increase the tone (contraction) of the vascular and non vascular smooth muscle. Therefore you can expect a rise in BP. Also, since there are a lot of alpha 1 receptors in the prostate, you can expect some tightening of the smooth muscle around the urogenital tract which may cause difficulty in urination. Alpha 1 stimulation also seems to cause reduction of the quality of erection and ejaculation due to tightening of smooth muscle in the groin area. Since reboxetine stimulates the alpha 1 receptors, I have also experienced poorer erections. Alas, I am no longer the rock of Gibralter. I have ordered some prazosin, a short acting alpha 1 antagonist to see if it will counteract this effect. It is inexpensive.
> Last night I tried my first 50mg dose of Viagra. I told my pdoc I would like to treat the side effect directly on an as-needed basis, and avoid adding or substracting from the psychiatric mix. I seem to have stumbled onto a delicate balance with my cocktail, and I don't want to rock the boat. Viagra works. :-)******I have also considered Viagra. I have read that most people don't need the larger doses. You can take a 50mg or 100mg pill, which are cheaper by the mg. than the smaller dosage viagra pills, and split them up. Some people even reduce them down to apporximately 5mg or 10mg. doses with good results, making the med quite affordable. Again, congrat.s on the mix you have. You may want to add mirapex at some time to the amisulpride to bolster amisulpride's effect.
AndrewB
Posted by JohnL on April 30, 2000, at 1:54:22
In reply to Re:JohnL, posted by AndrewB on April 29, 2000, at 10:30:06
Andrew,
Thanks for the very informative post. You sure know your stuff. Very interesting reading. I appreciate it.
Two comments on things you mentioned. First, what does SJW do for me? Well, it's hard to put in words actually. The most obvious things I noticed right away were increased energy in the day, and significantly improved sleep quality. But if I take it later than about 4pm, then sleep is instead worse. Overall, it tends to round out the mix, adding color and filling in any gaps missed by Adrafinil and Amisulpride. Kind of like the right mix of spices in a stew, or something like that.
As for Viagra, 50mg was plenty. I may do fine on 25mg. I'm sure in a few weeks I'll find the optimum dose for me. The pills are not designed for easy splitting. Kind of an oval diamond shape with, and not scored. But 100mg is what I got, since it costs the same as 25mg. A sharp knife does the job.
It does seem to have a narrow window for me. I felt it really kick in at about 1 hour and 15 minutes. And I could feel it start to fade at about 2 hours. When it kicked in, I just had this overall instinctive feeling that the soft erection syndrome was history for a little while. What I didn't like was the wearing off period. There was a sense of agitation and irritation that flowed over me. So I think it's best to plan in such a way as to be asleep during that part of it. But that was just the first time. Maybe it won't be like that after continued use. Hopefully over time the impotent side effect will subside on its own and I won't need any remedy.Anyway, thanks again for all your generous input on Adrafinil and such. I always enjoy your writings.
JohnL
This is the end of the thread.
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