Shown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by utopizen on February 17, 2004, at 22:13:48
I've got extreme sleepiness, or narcolepsy w/o sleep attacks.
My doc suggested Strattera, since I also have ADD. I'm not optimistic it would help either. He also said, since it was developed as an antidepressant, it may help my anxiety.
Sounds like another Wellbutrin to me. And I was tired and had headaches on that at 300mg plus 20mg of Adderall 2x/day.
I'm afraid if I mention it to the new pdoc I'll be seeing soon, he'll say, "Grrrrrrr-eat!" and use it to substitute my Desoxyn or any stim for the next two months. So should I even bother to bring it up, or just go, "look, dude, I've got big issues. I don't even stay up on Dexedrine, and don't even try to mention Provigil, because 400mg had no effect." ?
Posted by Viridis on February 18, 2004, at 0:40:46
In reply to Straterra makes anyone more energetic/alert?, posted by utopizen on February 17, 2004, at 22:13:48
I really liked Strattera for a while, but overall it was too weird for me. Initially it made me a bit ill, but I titrated gradually and this side effect was fairly minimal. One major side effect that took months to subside was extreme dry mouth (this too eventually went away).
It improved my mood at first, and I found it quite relaxing -- definitely no stimulation. If anything, it improved my sleep. The worst thing, though, was that it exaggerated any effects of tiredness, sleep deprivation, etc. It didn't make me tired, but any side effect associated with exhaustion seemed to be magnified. I also found it to be an extreme appetite suppressant -- good or bad, depending on your situation. I could easily forget to eat for a day while taking it.
Finally, at 80 mg/day, it just stopped having any benefits (although it continued to suppress my appetite and make any symptoms of tiredness worse, plus my blood pressure increased pretty dramatically). So I stopped, without any problems, and the side effects quickly subsided..
My pdoc, who was initially enthusiastic, simply agreed that it's an odd drug and that I was right to go off it. I find Adderall vastly more effective, and now I'm liking Lamictal too. And oh yeah -- Klonopin is great, as always.
Posted by Chairman_MAO on February 18, 2004, at 7:30:02
In reply to Straterra makes anyone more energetic/alert?, posted by utopizen on February 17, 2004, at 22:13:48
Please man, do NOT mention Strattera. If you replace your Desoxyn with this, your narcolepsy will be essentially untreated. The only NE reuptake inhibitor that works for sleepiness is protryptiline (Vivactil), and, although it has perhaps the coolest trade name of any drug (sounds like a dinosaur and a patent medicine at the same time), has too strong a side-effect profile for most people.
If Provigil had no effect, Strattera will have less than no effect. Do you think you could augment your Desoxyn with high doses of Cylert? It might have no effect, but it might help; the army uses it to force pilots to stay up. When I took 75mg 2x/day, I had to use Seroquel or I did not sleep at all. If you took like 225mg/day (this is perfectly safe with liver function tests), you could get some good results IF YOU DO NOT DUMP THE DESOXYN. I mean, you could try to dump it, but I doubt you'd like the result.
Posted by utopizen on February 18, 2004, at 17:50:34
In reply to Re: Straterra makes anyone more energetic/alert? » utopizen, posted by Chairman_MAO on February 18, 2004, at 7:30:02
Chairman,
thanks for reitterating that rational voice in my head, "don't mention it, don't babble, keep cool." It would be nice to think if I brought it up I could just as easily ask not to try it, or that I could ask to augment it with Desoxyn, but it's too much of a risk, and too few docs bother augmenting meds with it.
I haven't tried mixing extended release stims with Desoxyn (which USE to be sold by Abbott as an extended release, 12-hr., the only true all-day stim ever made until 2000). The Journal of Sleep Medicine in 1994 issued guidelines for the use of stimulants in narcolepsy.
It said Vivactil had no established basis for helping anyone's viligance during the day. It's typically used for narcolepsy patients with cataplexy, because cataplexy requires the use of an antidepressant and Vivactil apparently isn't sedating.
I need to find a journal abstract making it clear to my p-doc before the 22nd when I see him that narcolepsy patients typically require a non-benzo hypnotic like Ambien or Sonata, for sleep archiecture reasons (versus, say, Trazodone or other trycyllics which will mess with my sleep and make me feel groggy as a result).
If you could help me or come across such an abstract, I'd greatly appreciate it. I've already found one that came out a week ago, titled like, "Patients presenting with insomnia not drug-seeking."
Posted by zeugma on February 18, 2004, at 19:12:27
In reply to Re: Straterra makes anyone more energetic/alert? » utopizen, posted by Chairman_MAO on February 18, 2004, at 7:30:02
I wouldn't recommend replacing a stimulant with strattera. But for the subsidiary symptoms of narcolepsy (cataplexy and hypnagogic hallucinations) there is no reason why Strattera should be any less effective than Vivactil, which apparently has almost as steep an adverse=effect profile as amitriptyline. in fact, after I added Strattera, I had NO hypnagogic hallucinations until I added Klonopin. So in that sense, i consider Strat an excellent drug for narcolepsy, while i would find a replacement for klonopin if I could. Unfortunately, my social anxiety would soon make me unemployable again, so i try to ration out my sleep so i don't accumulate too big a debt, because that brings back the hypnagogics in a nasty new form (feels like I've stuck my tongue in an electrical socket as I struggle to open my eyes).
By the way: William Dement, after discovering REM, turned his attention to investigating narcoleptic dogs, and he found that NE reuptake inhibitors are the best drugs for blocking cataplexy. I think that's a historical point of some interest.
Posted by Chairman_MAO on February 18, 2004, at 20:31:30
In reply to Re: Straterra makes anyone more energetic/alert?, posted by utopizen on February 18, 2004, at 17:50:34
Isn't it lovely how the only way to get the drugs you need out of most physicians is by arguing like an attorney? Gee, I'm sure the founding fathers of this country wanted us to be virtually held hostage by the medical profession when we're trying to be healed--something which, contrary to popular belief, is primarily OUR responsibility and not the doctors. Maybe healthcare costs would go down if only those for whom a consultation with a PHARMACIST wasn't enough would have to see doctors ... all prescription laws should be repealed.
Off my soapbox, you might be able to get Cylert this way: perhaps you should tell him that the Desoxyn is working OK your narcolepsy, but that you're not noticing the same "ADD symptom control" that you used to, and would like to augment it with Cylert. Say that you want an agent free of adrenergic activity (Cylert is only dopaminergic) because you do not want any more sympathetic nervous system stimulation. You may also mention that Cylert has proven effectiveness in narcolepsy, and since it is not as robust as Desoxyn, it would help it but not replace it for this application as well. This logic jives, while still retaining the integral nature of the Desoxyn. Under the above two constraints, we have restricted the choice of medication to only Cylert. See what I mean about arguing like an attorney? If I weren't a philosophy major, I doubt I could have even come up with this. And doing this IMPROMPTU is REALLY hard, as you must know.
Insofar as studies for your sleep, here's one that you could use to get an "emergency supply" of Ambien (we'll ignore other studies that say it's ineffective if used intermittently, heh):
Eur Psychiatry. 2003 Aug;18(5):201-8.
The challenge of chronic insomnia: is non-nightly hypnotic treatment a feasible alternative?
Hajak G, Cluydts R, Allain H, Estivill E, Parrino L, Terzano MG, Walsh JK.
Department of Psychiatry and Psychotherapy, University of Regensburg, Universitatsstrasse 84, 93053 Regensburg, Germany. Goeran.Hajak@bkr- regensburg.de
The adverse effects of insomnia on health and quality of life are matters receiving increasing attention. Yet, surveys have consistently shown that most people suffering from insomnia do not seek medical help, perhaps, in part, because of a concern of becoming dependent on hypnotic medication. The treatment of chronic insomnia poses a particular dilemma in that continuous hypnotic treatment is restricted in many countries to a maximum of 4 weeks, and behavioural treatment is not readily available. Non-nightly hypnotic treatment of chronic insomnia offers a promising alternative option for the many patients whose symptoms do not necessitate nightly drug intake, allaying fears of psychological dependence on medication and respecting regulatory constraints on hypnotic use while providing patients with adequate symptom relief. The practical feasibility and efficacy of this approach has been demonstrated with zolpidem using various treatment regimens and study designs. So far, six clinical trials have been completed on over 4000 patients. Published results show effective treatment of insomnia without any evidence of either adverse event associated with a discontinuous regimen or increased hypnotic use over the treatment period.
I'm sorry, but a medline search on "zolpidem" and "narcolepsy" turned up nothing, and I am not expert enough to be able to boostrap an argument based upon other studies to show that you require it. Any physician with a brain, however, would know that Ambien has no hangover and the antihistaminic drugs do. A holistic nurse-practitioner that I saw years ago once told me in response to my asking if she ever prescribes Ambien long-term, "Well, not usually, but if someone comes to me and says Ambien is the only way they get a good night's sleep, it's pretty hard to say no ..."
This is the way any physician who is interesting in holding up the hippocratic oath should behave. Your doctor is afraid of overprescribing scheduled drugs: you're already on Desoxyn and Klonopin. Doctors can get their licenses yanked by the DEA if they write too many controlled prescriptions; that is, they can only write so many for all patients combined. Yaaay, police state! Go persecution of drug users! Go!
Order your Ambien from overseas, or get it from another doctor. Your current doctor simply does not want to prescribe you another controlled substance, and will give you an infinite number of arguments and half-truths to cover up that fact. And you may not realize it, but you ARE "drug-seeking". Everyone who goes to a psychiatrist expecting medication is "drug-seeking". This is not a bad thing! Rather, it's what we're all forced into in order to be allowed to purchase drugs! As I said earlier, perhaps what we need is repeal of prescription laws ...
Best of luck
Posted by zeugma on February 19, 2004, at 22:11:10
In reply to Re: Straterra makes anyone more energetic/alert?, posted by utopizen on February 18, 2004, at 17:50:34
I need to find a journal abstract making it clear to my p-doc before the 22nd when I see him that narcolepsy patients typically require a non-benzo hypnotic like Ambien or Sonata, for sleep archiecture reasons (versus, say, Trazodone or other trycyllics which will mess with my sleep and make me feel groggy as a result).
Where did you see that trazodone or tricyclics damage sleep architecture? Trazodone repairs SSRI-damaged sleep architecture and most TCA's improve the sleep of people with narcolepsy, as well as people with fibromyalgia and depressives.
I'm not familiar with Ambien's effect on sleep architecture so I would appreciate any insights you have on this. I know benzos mess with sleep architecture big time.
Posted by Chairman_MAO on February 20, 2004, at 7:41:53
In reply to Re: Straterra makes anyone more energetic/alert? » utopizen, posted by zeugma on February 19, 2004, at 22:11:10
I think what he's saying is that the half-life of all of those drugs is long enough such that there's a hangover from the antihistamine effect. I experience this from trazodone (which I MUST take to sleep normally) with a profound hangover in the morning. I am so out of it my ADD/energy is WRECKED in the morning, and thus I have to drink coffee, which then agitates me and punches holes in my stomach 2-3 hours later.
Someday I am going to dump this Wellbutrin and trazodone and take Parnate with Gabitril at night.
By the way utopizen, you really should consider asking about Gabitril if he refuses you Ambien/Sonata.
Posted by zeugma on February 21, 2004, at 1:00:09
In reply to Re: Straterra makes anyone more energetic/alert? » zeugma, posted by Chairman_MAO on February 20, 2004, at 7:41:53
> I think what he's saying is that the half-life of all of those drugs is long enough such that there's a hangover from the antihistamine effect. I experience this from trazodone (which I MUST take to sleep normally) with a profound hangover in the morning. I am so out of it my ADD/energy is WRECKED in the morning, and thus I have to drink coffee, which then agitates me and punches holes in my stomach 2-3 hours later.
>That makes sense- although I thought trazodone had a relatively short half-life- something on the order of 5-8 hours. Nortriptyline has a half-life of about 31 hours, which sounds like hangover hell- but it is a lot more stimulating than trazodone (because of its NE effects) and its metabolite (10-hydroxy-nortriptyline) is more stimulating still (and has no antihistaminic effect). I feel hung over in the a.m., sure, and need to drink gallons of coffee to stay alert. But I was never able to get by without coffee. And when you consider that prior to this drug regimen I would rarely be awake before 2 p.m.- or asleep before 5 a.m. - and now I have to wake up at 5 a.m. every morning in the week- it has been nothing less than a remarkable improvement in both sleep quality and speed of onset (I have terrible, terrible initial insomnia and wakings at sleep onset).
The TCA's seem to be put together like a set of Chinese boxes- both amitriptyline and imipramine have metabolites that are more activating and less sedating, and this is true of the metabolites themselves, also. Nortriptyline pharmokinetics are interesting in this respect because the peak plasma levels which are reached eight hours after beginning of metabolism are of unchanged nortriptyline which is more antihistaminic (and serotonergetic); after that the hydroxylated metabolite kicks in and the noradrenergic effect intensifies, resulting in a more activating profile that presumably helps with getting out of bed.The catch? TCA's are a lot less CONVENIENT than trazodone. You need to take full AD doses to get a real sedating effect, and it can take a while to titrate up to therapeutic level. And that comes complete with s/e. I have a mouthfullof cavities due to dry mouth. On the other hand, I have something like a life.
> Someday I am going to dump this Wellbutrin and trazodone and take Parnate with Gabitril at night.
>
> By the way utopizen, you really should consider asking about Gabitril if he refuses you Ambien/Sonata.
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