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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by AndrewB on May 19, 2000, at 12:49:39
I have just finished a two week trial with the D2/D3 agonist Mirapex, the last week of the trial I did not take any other medications besides reboxetine. As an antidepressant and anxiolytic, Mirapex seemed to have little or no effectiveness for me. Taking only the Mirapex, I became quite depressed and socially anxious. My energy was good, but this was probably maintained by the reboxetine. For my condition at least, Mirapex appears to be very much inferior to the D2/D3 presynaptic antagonist amisulpride. I have dysthymia with social anxiety. It is possible that this trial was too short to give Mirapex a chance to work, though it is normally effective within a week. Also it is possible that my dosage was too small. I was taking what limited studies indicate is the normal amount.
Posted by Brandon on May 24, 2000, at 23:11:51
In reply to My Mirapex Trial, posted by AndrewB on May 19, 2000, at 12:49:39
Hi andrew,
Sorry to hear that the mirapex didnt turn out. Have you gone back to amisulpride? I also thought that I read you were going to begin taking St. Johns Wort. How has that been going? I find it to be very effective but it tends to make me a little high strung so I am currently looking for ways to deal with that. What is your current dose? Wishing you well.
Brandon
Posted by JohnL on May 25, 2000, at 3:17:32
In reply to My Mirapex Trial, posted by AndrewB on May 19, 2000, at 12:49:39
> I have just finished a two week trial with the D2/D3 agonist Mirapex, the last week of the trial I did not take any other medications besides reboxetine. As an antidepressant and anxiolytic, Mirapex seemed to have little or no effectiveness for me. Taking only the Mirapex, I became quite depressed and socially anxious. My energy was good, but this was probably maintained by the reboxetine. For my condition at least, Mirapex appears to be very much inferior to the D2/D3 presynaptic antagonist amisulpride. I have dysthymia with social anxiety. It is possible that this trial was too short to give Mirapex a chance to work, though it is normally effective within a week. Also it is possible that my dosage was too small. I was taking what limited studies indicate is the normal amount.
Hi Andrew,
Thanks for the update. Sorry Mirapex didn't pan out. As you know, I am in the camp that believes 2 weeks was plenty long enough for a fair trial. I mean, sure, perhaps it could have worked better in time through a trickle down process. But I don't think that's what you or I are interested in. We want something that nails it directly, don't we? The fact that you became depressed and anxious is a pretty strong clue, in my opinion at least, that this drug was off-base. I would bet a higher dose and/or more time would not have been a good experience. Though it looked good on paper and in theory, it was a completely different story at a molecular level in your own unique chemistry. But hey, another clue for the puzzle. We never know till we try, right?I just hope you're feeling a little better now. I know how rough it is coming back from the adverse state of mind that a wrong drug creates. No fun. It makes for some very tough long days in survival mode.
So what's next? Any plans or ideas? Any possible thoughts on optimizing Amisulpride?
JohnL
Posted by Ed on May 25, 2000, at 5:02:37
In reply to My Mirapex Trial, posted by AndrewB on May 19, 2000, at 12:49:39
Andrew- I take it you are back on Amisulpride? How are you doing?
Posted by AndrewB on May 25, 2000, at 8:56:09
In reply to Re: My Mirapex Trial, posted by Ed on May 25, 2000, at 5:02:37
Thanks for the kind words.
2 weeks in all likelihood should had been enough for the trial given the normal time of onset for Mirapex and dopamine agonists in general.
I'm back on amisulpride now.
The Mirapex trial (or is the timing just a coincidence) seems to have diminished the effectiveness of the reboxetine I'm taking. Anyway, have bumped the reboxetine up to 10mgs. from 8.
I've added on St. John's Wort. Too early to say anything about it yet. Taking 1500mgs. Hoping for a bit of JohnL's luck with it though. Probably wouldn't hurt to have a little more serotenergic activity anyway.
After St. Johns will be trying entacapone, a CAMP inhibitor, to augment the dopaminergic activity of the amisulpride. Dr. Jay Goldstein has had some luck with COMTs.
Posted by Abby on May 25, 2000, at 11:03:58
In reply to Re: My Mirapex Trial, posted by AndrewB on May 25, 2000, at 8:56:09
> Thanks for the kind words.
>
> 2 weeks in all likelihood should had been enough for the trial given the normal time of onset for Mirapex and dopamine agonists in general.
>
> I'm back on amisulpride now.
>
> The Mirapex trial (or is the timing just a coincidence) seems to have diminished the effectiveness of the reboxetine I'm taking. Anyway, have bumped the reboxetine up to 10mgs. from 8.
>
> I've added on St. John's Wort. Too early to say anything about it yet. Taking 1500mgs. Hoping for a bit of JohnL's luck with it though. Probably wouldn't hurt to have a little more serotenergic activity anyway.
>
> After St. Johns will be trying entacapone, a CAMP inhibitor, to augment the dopaminergic activity of the amisulpride. Dr. Jay Goldstein has had some luck with COMTs.Have you tried risperidone, though as I write, I remember that this has very limited affinity for dopamine receptors.
Abby
Posted by JohnL on May 26, 2000, at 3:29:47
In reply to My Mirapex Trial, posted by AndrewB on May 19, 2000, at 12:49:39
> I have just finished a two week trial with the D2/D3 agonist Mirapex, the last week of the trial I did not take any other medications besides reboxetine. As an antidepressant and anxiolytic, Mirapex seemed to have little or no effectiveness for me. Taking only the Mirapex, I became quite depressed and socially anxious. My energy was good, but this was probably maintained by the reboxetine. For my condition at least, Mirapex appears to be very much inferior to the D2/D3 presynaptic antagonist amisulpride. I have dysthymia with social anxiety. It is possible that this trial was too short to give Mirapex a chance to work, though it is normally effective within a week. Also it is possible that my dosage was too small. I was taking what limited studies indicate is the normal amount.
Andrew,
You mentioned trying St Johnswort? That's pretty cool. I'm sure you are aware of the brands to stick with.Just a note on dose size, for trivia, for whatever it's worth. That is, I responded best at 600mg a day. I felt improvement during the first week. So I knew SJW was on target. No trickle down effect needed. But of course, I am very aware of the 2700mg doses used in some clinical trials. So I figured if 600mg was good, I might as well head up towards 2700mg. But around 1500mg I realized things weren't as good. Back to 900mg to 1200mg got a little better. But at 600mg to 900mg I get the best response. Weird. I guess it's true, more is not always better. I think with all of us there must be a unique therapeutic window. Mine has proven to be in the 600mg to 900mg range.
I think SJW and Amisulpride is a pretty cool combination. While Amisulpride is stimulating dopamine, SJW is preventing it's reuptake. And simultaneously it's also providing reuptake inhibition of NE and serotonin, all in approximately equal proportions. But of course, with the Amisulpride, the bias of treatment is on dopamine. SJW also lowers prolactin, which helps counter Amisulpride's effect of raising prolactin. Not to mention whatever else there is about SJW that we don't know yet.
Anyway, I guess it's a flip of the coin whether it will be helpful to you or not, but I'm wishing you the best.
Johnl
Posted by SLS on May 26, 2000, at 7:24:42
In reply to Re: My Mirapex Trial, posted by JohnL on May 26, 2000, at 3:29:47
> Andrew,
> You mentioned trying St Johnswort? That's pretty cool. I'm sure you are aware of the brands to stick with.
>
> Just a note on dose size, for trivia, for whatever it's worth. That is, I responded best at 600mg a day. I felt improvement during the first week. So I knew SJW was on target. No trickle down effect needed. But of course, I am very aware of the 2700mg doses used in some clinical trials. So I figured if 600mg was good, I might as well head up towards 2700mg. But around 1500mg I realized things weren't as good. Back to 900mg to 1200mg got a little better. But at 600mg to 900mg I get the best response. Weird. I guess it's true, more is not always better. I think with all of us there must be a unique therapeutic window. Mine has proven to be in the 600mg to 900mg range.
> I think SJW and Amisulpride is a pretty cool combination. While Amisulpride is stimulating dopamine, SJW is preventing it's reuptake. And simultaneously it's also providing reuptake inhibition of NE and serotonin, all in approximately equal proportions. But of course, with the Amisulpride, the bias of treatment is on dopamine. SJW also lowers prolactin, which helps counter Amisulpride's effect of raising prolactin. Not to mention whatever else there is about SJW that we don't know yet.
Hi John.You've sparked my interest about some of the specific pharmacological properties SJW has.
For instance, dopamine reuptake inhibition. Where can I find information about this drug?That SJW demonstrates a therapeutic window for you seems like it would be an important clinical observation that would be critical for its successful use. Have you seen this addressed in anything you have read? Perhaps you ought to submit your observations to a SJW website or newsgroup.
As always, thanks for writing stuff.
- Scott
Posted by AndrewB on May 26, 2000, at 8:27:25
In reply to Re: My Mirapex Trial, posted by SLS on May 26, 2000, at 7:24:42
John,
Thanks for the St. John's feedback. Any specific signs to look for that would indicate overdosage such as headaches or overstimualtion or is it just a matter of a sense of general well being.
AndrewB
Posted by JohnL on May 28, 2000, at 4:09:36
In reply to Re: St. John's- JohnL, posted by AndrewB on May 26, 2000, at 8:27:25
> John,
>
> Thanks for the St. John's feedback. Any specific signs to look for that would indicate overdosage such as headaches or overstimualtion or is it just a matter of a sense of general well being.
>
>
> AndrewBWell, with me, it was just a general overall sense of wellbeing. Dosing changes didn't really do anything drastic one way or the other. I probably could have described it more accurately by calling it fine-tuning. When it's just right, I feel fine. If it's too much, I get a hint of tenseness. That's all. Sometimes I think SJW isn't doing anythihg. But if I stop taking it, in three days I'm back to the anhedonic world again.
John
Posted by KarenB on June 3, 2000, at 11:16:20
In reply to Re: St.John's-Andrew, posted by JohnL on May 28, 2000, at 4:09:36
John,
Now, let me get this straight: You are taking Adrafinil and Amisulpride right? (Can you tell me your doses? I know you posted this before but can't remember when) And SJW too? Were you taking SJW all along? Did you stop the others?
Someone thanked you in another thread for them being able to convince their doc to start them on "Anafranil." This is a different drug, of which I am unfamiliar. Did she misunderstand you and by some awesome twist of fate, it worked out anyway or did you recommend this drug to her? I am just curious as to how confused I really am...
Ok, while I am asking, what is your overseas source for Adrafinil and Amisulpride and is it reliable?
Do you see noticeable weight gain from either of these meds? I consider fat to be a provoker of depression.
I've been away a couple of weeks so I think I missed something. Kind of glad I have, seeing the nasty flame thread that's been going on, which I will not comment on for fear of being perceived as shallow and not understanding of the "big picture." Gee, that was a comment, wasn't it? Guess I couldn't help myself. Must be my ADD;)
BTW, the Adderall along w/ Buspar is working pretty well but I still have some mood swings I don't seem able to control. I am taking Ultram as well, though, for chronic back pain which makes me irritable when it wears off - I am attempting to ease off it altogether to see whether the other meds are working and the Ultram is the problem.
Sorry for rambling.
Hope you're doing well, dude. Missed all you guys!
Karen
Posted by JohnL on June 5, 2000, at 4:04:06
In reply to Re: JohnL - I'm confused..., posted by KarenB on June 3, 2000, at 11:16:20
> John,
>
> Now, let me get this straight: You are taking Adrafinil and Amisulpride right? (Can you tell me your doses? I know you posted this before but can't remember when) And SJW too? Were you taking SJW all along? Did you stop the others?
>
> Someone thanked you in another thread for them being able to convince their doc to start them on "Anafranil." This is a different drug, of which I am unfamiliar. Did she misunderstand you and by some awesome twist of fate, it worked out anyway or did you recommend this drug to her? I am just curious as to how confused I really am...
>
> Ok, while I am asking, what is your overseas source for Adrafinil and Amisulpride and is it reliable?
>
> Do you see noticeable weight gain from either of these meds? I consider fat to be a provoker of depression.
>
> I've been away a couple of weeks so I think I missed something. Kind of glad I have, seeing the nasty flame thread that's been going on, which I will not comment on for fear of being perceived as shallow and not understanding of the "big picture." Gee, that was a comment, wasn't it? Guess I couldn't help myself. Must be my ADD;)
>
> BTW, the Adderall along w/ Buspar is working pretty well but I still have some mood swings I don't seem able to control. I am taking Ultram as well, though, for chronic back pain which makes me irritable when it wears off - I am attempting to ease off it altogether to see whether the other meds are working and the Ultram is the problem.
>
> Sorry for rambling.
>
> Hope you're doing well, dude. Missed all you guys!
>
> KarenHi Karen,
Nice to hear from you. I'll try to answer your questions.My cocktail was 300mg Adrafinil, 100mg Amisulpride, and 600mg to 900mg SJW, and 7.5mg Remeron for sleep (been on it for over a year). Adrafinil provided noradrenaline stimulation; amisulpride provided dopamine stimulation; and SJW provided reuptake inhibition of serotonin, norepinephrine, dopamine, and GABA; Remeron at its very low dose I think was only good for sleep and much else; all together provided a wide spectrum mode of action. My gut instinct at first was that Adrafinil was the major player, and I still feel that way.
The cocktail is in transition though. I had a side effect that really became intolerable. Sex...no interest and zero ability. I tried Viagra. I tried Yohimbe. Both worked, but both came with very uncomfortable side effects of their own. Viagra was good only for ability, and did nothing for pleasure or interest. Yohimbe was powerful, enhancing interest, pleasure, and ability to a surprising degree. But neither Viagra or Yohimbe fully worked unless I took a two day drug holiday as well. The whole process of having sex became a cumbersome nightmare. Very frustrating.
I have since stopped Amisulpride and SJW. I still take Adrafinil, and have replaced the others with 2.5mg Zyprexa. So at this time, my cocktail is 300mg Adrafinil and 2.5mg Zyprexa. It's been four days. It could be my imagination, but I sense my sex life is on the comeback somewhat. I know it doesn't make sense, but I think Amisulpride and/or SJW were the guilty culprits. In any case, I'm still doing very well. I'm undepressed, interested, motivated, and active. I still think Adrafinil is the heavy hitter responsible for my recovery. On paper, Amisulpride looks better. But in reality, I think Adrafinil is.
If someone mistakenly tried Anafranil instead of Adrafinil, I guess that's an easy mistake. Anafranil is a tricyclic antidepressant far different than Adrafinil. But hey, if it worked out, I guess it was a happy accident. Whatever works, right?
Weight gain was not a problem with Amisulpride, and isn't with Adrafinil. They actually caused me to lose weight. I've lost all the weight that I previously gained on an earlier trial of Zyprexa. Even now that I'm back on Zyprexa, I think Adrafinil will neutralize any weight gain tendency.
I will be meeting with my psychiatrist this week and I want to try substituting Adrafinil with Modafinil. Hopefully Modafinil will work the same and improve my sex life more. Not only that, but my insurance will cover it and I won't have to bother with paying cash or waiting for overseas deliveries. I'm really hoping Modafinil is similar enough to Adrafinil that it works as well. If not, well, I know what does work and I can always return to it.
I got Amisulpride from an obscure German pharmacy. Probably the most popular source though is Victoria Apotheke in Switzerland. In either case, a prescription is required. Victoria Apotheke requires the hard copy original prescription be mailed. The German pharmacy was satisfied with a simple faxed prescription. The most popular source of Adrafinil is International Antiaging Systems. All of these overseas deliveries take from 2 weeks to 4.
I wish I could comment more on your Adderall and Buspar. But I didn't respond well at all to either one. I was moody and at times much more depressed with either of those. If you are pondering Adrafinil, I think it would be a very good choice for both ADD and depression. Some of these novel French antidepressants not well-known in the USA--like Adrafinil, Modafinil, and Amisulpride--are far superior to the choices the FDA has given us.(Modafinil is FDA approved for narcolepsy, but in Europe it's an antidepressant). But as you know, we're all different.
See ya. Hope all goes well. Hope something here is some help to you,
JohnL
Posted by CarolAnn on June 5, 2000, at 9:14:52
In reply to Re: Karen, posted by JohnL on June 5, 2000, at 4:04:06
Hey JohnL! Please post the results of your Modafinil trial. I'm going to be looking for something else in a couple months, and I thought about Adrafinil, but if the other is effective and prescribe-able in the U.S., I'll go with it. Good luck! CarolAnn
Posted by KarenB on June 5, 2000, at 10:14:33
In reply to Re: Karen, posted by JohnL on June 5, 2000, at 4:04:06
John,
Thank you so much - your post really answered my questions.
I think I will give the Modafinil a try, as well. I'll let you know how that works out and you do the same, OK? I can't really afford anything my insurance won't cover, right now.
Karen
Posted by AndrewB on June 5, 2000, at 23:27:00
In reply to Re: Karen, posted by JohnL on June 5, 2000, at 4:04:06
John,
Please let me know how taking away the amisulpride affects you (i.e. lessened sexual side effects). I’m trying to track peoples’ responses to amisulpride. Amisulpride washes out of me in about 4 days.
Did you experience anxiety with yohimbine? For your information, yohimbine and Viagra can be combined very effectively using a full dose of yohimbine and a half or a quarter of the usual Viagra dose.
Reboxetine gives me sexual side effects. I think Michael said Adrafinil was giving him sexual side effects. So I certainly wouldn’t be surprised if Adrafinil is giving you sexual side effects. If you observe any ‘puckering’ of the gentalia, that is definately the adrafinil. This is due to alpha 1 adrenergic agonism, the same action that causes urinary hesitancy.
From all I have read, it seems Modafinil lacks these sexual side effects. I am still wondering whether Modafinil is as efficacious though as reboxetine and Adrafinil for arousal and motivation, let alone mood.
As strange as it sounds, many CFIDS patients use naphazoline eye drops, often with very good results, for mental and physical arousal. It is an alpha adrenergic agonist like Adrafinil and may have a similar effect. The eye drops, as do other adrenergic agonists, cause vasoconstriction, thereby getting the red out of the eyes. Onset is rapid, Since the half life is short, they must be applied 3 or 4 times a day. I would think that by skipping a dose a person could avoid any sexual side effects they may cause. I just ordered some from globaldrugs.com of Canada. It is cheap and doesn’t require an Rx, at least in Canada.
AndrewB
Posted by JohnL on June 6, 2000, at 2:46:23
In reply to John L, posted by AndrewB on June 5, 2000, at 23:27:00
Hi Andrew.
Your post was extremely interesting. As usual.It has been 5 days now since stopping Amisulpride. It's too early for me to say anything any accuracy. But if I'm not mistaken, I think my sex drive has returned somewhat, and the genitals don't seem to be as soft and limp as before. This suprises me, because I suspected Amisulpride the least as being the guilty culprit. But it does say on the label one of the possible side effects is impotence. How and why I have no clue. It doesn't make sense to me. I'm just going on realtime observations.
Mood has not deteriorated at all. In fact I think I might be feeling even a touch better. I think Zyprexa could be playing a role in terms of improved sexual side effects and mood. In previous short trials I noticed it helped me by day 3, and that seems to be the case again.
I didn't really plan on quitting Amisulpride. But I forgot my dose one day, and decided what the heck, I've already missed one day, I wonder what would happen if I skipped another day. And then another. And so it went. So far so good.
Like I said, the whole thing doesn't make any sense to me. I mean, the effects I experienced with Amisulpride are not what I would expect with D2 stimulation. But then again, Zoloft has considerable dopamine action, and it too caused a similar dropoff in sexual desire and ability. Now that I think about it, the overall effect of Amisulpride with me was very much like Zoloft.
Anyway, it is too early to tell. But I will keep you updated since you are keeping track of Amisulpride patients.
JohnL
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