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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by Angela5 on June 17, 2000, at 15:05:37
You mentioned overseas Adrafinil as something I might consider. I've found many things posted here about where to find it, dosage, etc., and I've gathered that it's in the same category/family as Ritalin or Adderall? What makes it different from these two/how does it work/what is ist used for as opposed to those?
Thanks,
Angela
Posted by JohnL on June 17, 2000, at 18:47:11
In reply to Adrafinil - to JohnL or anyone, posted by Angela5 on June 17, 2000, at 15:05:37
> You mentioned overseas Adrafinil as something I might consider. I've found many things posted here about where to find it, dosage, etc., and I've gathered that it's in the same category/family as Ritalin or Adderall? What makes it different from these two/how does it work/what is ist used for as opposed to those?
>
> Thanks,
>
> AngelaYou know, you ask some pretty tough questions! :-) I'm not a technical expert at all. I'm more of a hands on real life experience kind of guy. Hopefully Andrew will show up because he knows the technicals with astonishing detail.
As he explained in another post, I think Ritalin and Adderall basically cause the release of more NE and/or dopamine, among other things. I don't think Adrafinil does that. Adrafinil instead, I think, helps the existing NE work better than it does on its own. I kind of think of it like this. What if there was some molecule we could attach to a copper molecule that would allow the copper wire to transmit electricity better than copper alone? Or maybe, what if there was a molecule we could attach to the corroded section of a damaged wire that would restore the wire to its original conductivity? Adrafinil is the molecule that does that. It helps norepinephrine along where, for whatever reason, it is weak. That's how I look at it in layman's terms.
Adrafinil is indicated primarily for narcolepsy. It is supposed to promote wafefulness. But in some parts of Europe it is viewed as a highly superior antidepressant over Prozac and such. I think it has its little niches and locals of popularity in the world, though no widespread popularity anywhere. Most people I think have never heard of it. It is also a common drug at the antiaging websites, because it is touted as being a memory enhancer. It is claimed to work on the parts of the brain that deteriorate with age, restoring vigilance and activity. Based on my own trial of n=1, I have to agree strongly with all those claims. And it's only $30 without a prescription? Weird.
Posted by Jonathan on June 17, 2000, at 21:36:39
In reply to Re: Adrafinil - Angela, Andrew, posted by JohnL on June 17, 2000, at 18:47:11
> > You mentioned overseas Adrafinil as something I might consider. I've found many things posted here about where to find it, dosage, etc., and I've gathered that it's in the same category/family as Ritalin or Adderall? What makes it different from these two/how does it work/what is ist used for as opposed to those?
> >
> > Thanks,
> >
> > Angela
>
> You know, you ask some pretty tough questions! :-) I'm not a technical expert at all. I'm more of a hands on real life experience kind of guy. Hopefully Andrew will show up because he knows the technicals with astonishing detail.
>
> As he explained in another post, I think Ritalin and Adderall basically cause the release of more NE and/or dopamine, among other things. I don't think Adrafinil does that. Adrafinil instead, I think, helps the existing NE work better than it does on its own. I kind of think of it like this. What if there was some molecule we could attach to a copper molecule that would allow the copper wire to transmit electricity better than copper alone? Or maybe, what if there was a molecule we could attach to the corroded section of a damaged wire that would restore the wire to its original conductivity? Adrafinil is the molecule that does that. It helps norepinephrine along where, for whatever reason, it is weak. That's how I look at it in layman's terms.
>
> Adrafinil is indicated primarily for narcolepsy. It is supposed to promote wafefulness. But in some parts of Europe it is viewed as a highly superior antidepressant over Prozac and such. I think it has its little niches and locals of popularity in the world, though no widespread popularity anywhere. Most people I think have never heard of it. It is also a common drug at the antiaging websites, because it is touted as being a memory enhancer. It is claimed to work on the parts of the brain that deteriorate with age, restoring vigilance and activity. Based on my own trial of n=1, I have to agree strongly with all those claims. And it's only $30 without a prescription? Weird.JohnL,
I think that adrafinil is a noradrenergic alpha(1) agonist.
According to Arnsten, AFT [Catecholamine regulation of the prefrontal cortex (PFC),
J. Psychopharmacol. 11(2): 151-162 ('97)] noradrenaline exerts its beneficial effects
on PFC function through alpha(2A) receptors, but actually impairs PFC action through
alpha(1) receptors. He suggests that high levels of noradrenaline release due to
stress cause the alpha(1) effect to predominate and take the PFC 'off-line',
allowing faster, more instinctive responses arising in lower parts of the brain
to take over. I can confirm that stress makes my inattention problems, which
probably result from impaired PFC function, much worse, and more so since I've
been taking reboxetine. Mightn't adrafinil, being an alpha(1) agonist, have the
same effect?On the other hand, an alpha(2) agonist like guanfacine might improve PFC function.
Guanfacine is used to treat ADD, as is clonidine, an agonist at both types of
alpha receptor. I've never heard of adrafinil having a beneficial effect on
attention deficit symptoms, and fear the opposite.In the absence of stress, noradrenaline at levels boosted by the right dose of a
reuptake inhibitor may affect alpha(2) receptors in the PFC more than alpha(1),
hence the interest in tomoxetine for ADD. The same applies to noradrenaline
released by Ritalin or Adderall.My instinct is to favour reuptake inhibitors over agonists because the pattern of
which noradrenergic neurons are firing and which are not may encode important
information. Reuptake inhibitors amplify this signal, like your nice example
of a molecule that restores the conductivity of corroded sections of copper
wire, but presumably has no effect where there never was a wire: agonists swamp
the signal with noise, as if someone has poured mercury everywhere so that the
current can flow regardless of whether the wire was ever there or not.However, this is all theory. Theory in psychopharmacology is always too simple
and often wrong.Jonathan.
Posted by Angela5 on June 18, 2000, at 2:16:19
In reply to Re: Adrafinil - Angela, Andrew, posted by Jonathan on June 17, 2000, at 21:36:39
>I've never heard of adrafinil having a >beneficial effect on
> attention deficit symptoms, and fear the >opposite.Okay, this is really interesting (and somewhat confusing), since I had the impression that adrafinil could be a substitute (in a sense, of course) for Ritalin or Adderall, in that it was definitely supposed to help concentration, etc.
Does anyone have any more insight/personal experiences?
Thanks,
Angela
Posted by Angela5 on June 18, 2000, at 2:19:52
In reply to Re: Adrafinil - Angela, Andrew, posted by Jonathan on June 17, 2000, at 21:36:39
One more thing - I think it was Andrew that mentioned in a previous post that you need to get your liver functions checked if you plan on being on this more than a couple of months. Is this a known side effect, and is this drug not recommended for maintenance use? John, how long do you plan to take it?
Thanks,
Angela
Posted by JohnL on June 18, 2000, at 5:27:17
In reply to Re: Adrafinil - Angela, Andrew, John - IMPORTANT, posted by Angela5 on June 18, 2000, at 2:19:52
Angela,
I did get a liver blood test at about 3 weeks into Adrafinil. I'm sure that was too soon, and everything tested fine. But I voluntarily get a blood test once every six months anyway, so that issue didn't bother me. The elevated liver enzymes that occur with Adrafinil in longterm use doesn't happen frequently. But it does happen sometimes, and thus the responsible warning to monitor it. If it is a concern, dose reduction or temporary withdrawal is the remedy. That's another reason why I reduced my dosage to 300mg after responding to 900mg. I wanted to see if I could maintain the response at a lower dose and simultaneously lower any infrequent risks to near zero.I wouldn't worry about that. And I wouldn't spend too much effort basing your decisions on theories or how I or anyone else respond to different meds. Psychiatry really does seem like more an art than a science, and you are a unique piece of canvas on which a unique masterpiece is in the process of being painted. Nobody else has your chemistry, your genes, your strengths, your flaws, your personality, or your brain. They are all unique to you.
What looks good on paper may turn out to be a total flop. That's happened to me so many times. The best layed theories ended up being interesting yet useless ponderings. I wish there was some accurate way to predict which med is correct. But the only way I've found is to actually try them one at a time and see. When you discover the right color for your canvas, there will be no doubt.
According to my pdoc, results of recent conferences indicate that while 80% of patients will improve if they try at least 2 different antidepressants, very few of them actually return to what he called 'normal baseline'. The difference between the 'recovered-to-functionality' patient and the 'completely well' patient is the determination to keep trying new things until the right color is discovered. With me as an example, I could have stayed on Paxil from years ago and been OK the rest of my life. Even though I was OK and relieved to be out of the depression dungeon, I knew I wasn't fully recovered. One trial after another finally allowed me to stumble onto the perfect color I had been looking for. I didn't know what it was until I found it. Reboxetine and other NE enhancing meds made me much worse, so I had no expectation at all that Adrafinil would do any good. In the real world however, it turned out to be magical. Go figure. But again, that's just me and my unique chemistry. What's right for you may or may not be right for someone else, and may or may not make sense on paper.
To complicate the statistics I mentioned above, 50% of those patients who improved were taking sugar pills.
In the absence of finances to enlist a real good pdoc this week (versus an appointment a month from now), the most attractive options for you as I see it at this very point in time with your unique circumstances are SJW, Adrafinil, SAMe, or any combination of two of these. These things are readily available to start today (except Adrafinil), inexpensive (except SAMe), and stand just as good a chance as anything else. SJW overall looks the best, but would be greatly enhanced by starting SAMe at the same time so as to have the potential for quick recovery while waiting for the SJW to do its thing. And if money is available, order some Adrafinil which will arrive in about a month. If at that time you are well, then the money would have been wasted. No need for the Adrafinil. On the other hand, if things aren't that good, then you have a new med on-hand to try.
You know, a lot of doctors and a lot of readers and patients would be upset at me for talking like this, because it sounds like I'm advocating self medication. And it sounds like I think I know what I'm doing. But that's not the case. All I care about is seeing you get well as fast as possible. Under your cirumstances, what are the best options to do that? The FDA is given the green light by default to self medicating with these things by not restricting them. Heck, you can buy them anywhere right alongside the vitamins. I don't know what I'm doing except for one thing...all choices stand an equal chance of working, and we never know for sure till we try.
JohnL
Posted by AndrewB on June 18, 2000, at 14:35:37
In reply to Adrafinil - to JohnL or anyone, posted by Angela5 on June 17, 2000, at 15:05:37
Angela,
There are many significant differences between adrafinil and amphetamines like ritalin and adderall. Indeed, adrafinil is in different classes with a different mode of action. Adrafinil is an alpha 1 andrenergic receptor agonist that is able affect increased upregulation of the alpha 1 receptor over the long term. Amphetamines are dopamine and norepinephrine releasers (put simply).
Adrafinil was designed to take away daytime sleepiness such as is experienced by narcoleptics. Others uses for it have developed since then. For example, those with energy and cognition problems often find relief with adrafinil. What is more adrafinil is unlike amphetamines in that it accomplishes this increased arousal without the : potential for addiction/tolerance/abuse, interference with sleep, loss of effect or ‘poop out’ with repeated dosing, or a roller coaster ride of energy surges and crashes.
Adrafinil isn’t written up as being effective for ADD. Amphetamines are probably effective for ADD through their dopaminergic action, something that adrafinil does not have. Jonathan sounds off an important warning. Alpha 2 agonists like clonidine have been effective for treating ADD symptoms. The alpha 1 and 2 receptors seem to (often) act with mutual antagonism towards one anothers’ actions. If this receptor relationship exists concerning ADD symptoms expression then the alpha 1 agonist adrafinil (or Prodigal) may make ADD symptoms worse.
AndrewB
Posted by Lynne on June 18, 2000, at 15:07:03
In reply to Re: Adrafinil - to JohnL or anyone, posted by AndrewB on June 18, 2000, at 14:35:37
I have been taking Adrafinil for a few days now and I think I like it. Does anyone know where I can get more information about this drug. I am concerned about drug interactions.
Thank you,
Lynne
Posted by Angela5 on June 18, 2000, at 15:15:31
In reply to Re: Adrafinil - Angela, Andrew, John - IMPORTANT, posted by JohnL on June 18, 2000, at 5:27:17
John -
Thanks for all the suggestions. However, I think that somewhere along the line there's been some confusion. I am on short-term disability for work, which makes finances almost impossible due to living expenses. However, I do have a pdoc (although he is on vacation all this next week), and I have very good insurance/prescription insurance (as long as I'm still with this job), so I'm not limited in that way.
I am diagnosed with atypical major depression, as well as something that is either bipolar or ADD. My pdoc thinks it is atypical bipolar (no manic episodes) and not ADD, since I did okay except for impulsivity on this weird computer test that they do to diagnose (letters fall down the screen at different rates, and you press the spacebar when there's an X - this lasts about 5 min.). He knows better than I do, I realize, but the symptoms seem more like ADD to me. I am inattentive. I can pay attention in an interactive conversation, but if someone is speaking, ie a lecture, a meeting, a class, even church, even if I find it interesting, I cannot force myself to focus attention no matter how hard I try. I have writer's block on practically everything (especially technical/work documents, even easy ones) to the point that I can't manage to figure out a single sentence, and don't know how to start in more ways than one. When I read, esp. something at all dry, I forget what was on one page the second I turn to the next one. I have to keep going over and over things, and looking back constantly for the same information. It becomes even more awful, as pages and chapters build on each other and I don't have a clue. I comprehend what I'm reading as I read it, I just can't retain it. Reading/Studying and also technical editing/writing are 3/4 of my job - you can imagine how frustrating this is (esp. the reading). It's like you know you have the mental capability to succeed, but your brain won't let you. It got to the point of such frustration that it became frustrating to even think about trying, and to even be in that environment. It began to feel pointless to go to work. I'm sure that's not helped by me not really liking my career, but there was more to this. This was originally why I went to this pdoc in Feb. I was on 60 mg/day of Prozac, which seemed to be working a bit less even though the dosage had been increased earlier in the year. ---See my posts on "Prozac to Serzone/Ritalin to Celexa to Effexor XR" for the drug history recently --- At least I was partially functional then, though - I feel much worse now, I'm completely non functional. Like I said in my second post in the thread I just mentioned, the pdoc thinks there is a drug better than prozac for me, and he's probably right - but what to do? This is so much worse.Thanks,
Angela
Posted by JohnL on June 18, 2000, at 17:09:56
In reply to Re: Adrafinil - Angela, Andrew, John - IMPORTANT » JohnL , posted by Angela5 on June 18, 2000, at 15:15:31
> John -
>
> Thanks for all the suggestions. However, I think that somewhere along the line there's been some confusion. I am on short-term disability for work, which makes finances almost impossible due to living expenses. However, I do have a pdoc (although he is on vacation all this next week), and I have very good insurance/prescription insurance (as long as I'm still with this job), so I'm not limited in that way.Angela,
That's very good news that you have insurance to help out. That opens up a lot more doors. Though there is a lot of potential with the natural alternatives we've already talked about, if you want to go the prescription route you might consider something talked about in another post to Amy. That is, Zyprexa + stimulant. In that post I kind of touched on the reasoning behind it, but in general it's because this combination has a wide therapeutic spectrum for many different symptoms, including all of yours.My doctor wouldn't be happy with me on any particular stimulant if it was working just OK. He would want me to compare it to other stimulant choices through trials to be sure I was on the best one for me, not just a decent one. That's something to consider too. Do you know for sure Ritalin is the best for you?
I know things are real tough right now. Hang in there. It really does get better. :-)
JohnL
This is the end of the thread.
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