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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 21 of 21. This is the beginning of the thread.
Posted by Stryker88 on December 5, 2004, at 4:39:28
Everytime I drink a cup of good coffee my mood gets so much better I have so much more energy and alertness that it helps me get things done, and keep track of my life. My concern is that coffee is not really a medicine. I wish I could feel as good as I do after a good cup all the time, but the Coffee Perk as we all know goes away after about one hour then you have to drink more and more just to keep up that pace. I am going to ask my doctor about what he says about my energy problem. Can Someone Give Me there 2 Cents About What I should think about and what medications help with energy??????
Posted by jclint on December 5, 2004, at 9:36:11
In reply to Coffee Helps!! My Mood!!! But What RX's Could?????, posted by Stryker88 on December 5, 2004, at 4:39:28
I'm not an expert on this by any means, but I think there are a number of things that are effective for your situation.
Stimulants, like Adderall or Ritalin, seem to to have a caffeine like effect and are good for ADD. These might be a bit too much for you though, and I doubt your doctor would prescribe them if your condition is not too serious.
I think I speak for the most people here when I recommend something called Provigil. Its quite the drug du jour at the moment. Its approved for conditions like narcolepsy but is being prescribed for all sorts of conditions, as it seems to be effective for many different things. I haven't tried it but I've read countless anecdotes about its long lasting caffeine-like effect. It really seems to help a lot of people. On remedyfind.com, it has the highest recommendation for depression - very significant seeing as it isn't even approved for that condition. I know many people swear by it, and to me it looks like it could be just what you're looking for.
The only problem is the cost - I know in the US, daily use can get very expensive (in the UK we have fixed price prescriptions). However the generic version is coming out soon I believe which will inevitably bring the price down. You may also want to look at something called Adrafinil, which is related to Provigil but isn't available on presription in the US or UK. You can order it without an RX from Europe though at prices a lot cheaper than Provigil. Some people on here have had good results with it, although it must be pointed out that it is perhaps more demanding on the liver than provigil - its recommended that you have liver enzyme tests now and then just to make sure.
These are just a couple of things. There are, fortunately, several things available that will most likely help you a lot.
Here is a link to the remedyfind page on provigil for depression:
http://www.remedyfind.com/rm-3061-Provigil.aspJohn
Posted by Racer on December 5, 2004, at 10:51:16
In reply to There's several things you could try... » Stryker88, posted by jclint on December 5, 2004, at 9:36:11
Posted by linkadge on December 5, 2004, at 10:58:59
In reply to Second the recommendation for Provigil (nm), posted by Racer on December 5, 2004, at 10:51:16
It really helps my mood too. I explained this to my doctor but he didn't care.
Coffee alters a lot of things. Opiates, noradrenaline, dopamine, acetylcholine. I tell ya, mother nature is playing games with us.
If only coffee had a half life of 36 hours, I'd be a lot happier.
Linkadge
Posted by zeugma on December 5, 2004, at 12:17:04
In reply to Re: Second the recommendation for Provigil, posted by linkadge on December 5, 2004, at 10:58:59
> It really helps my mood too. I explained this to my doctor but he didn't care.
>
> Coffee alters a lot of things. Opiates, noradrenaline, dopamine, acetylcholine. I tell ya, mother nature is playing games with us.
>
> If only coffee had a half life of 36 hours, I'd be a lot happier.
>
>
> Linkadge
>
>
> The psychotropic effects of caffeine have not escaped the attention of pharmacologists. In particular, the AD effects (documented lowering of suicide rates) and anti-Parkinson's effects, have attracted research. This derivative of caffeine looks particularly promising:http://www.jbc.org/cgi/content/full/277/39/36040
ABSTRACT
Caffeine and more specific antagonists of the adenosine A2A receptor recently have been found to be neuroprotective in the MPTP (1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine) model of Parkinson's disease. Here we show that 8-(3-chlorostyryl)caffeine (CSC), a specific A2A antagonist closely related to caffeine, also attenuates MPTP-induced neurotoxicity. Because the neurotoxicity of MPTP relies on its oxidative metabolism to the mitochondrial toxin MPP+, we investigated the actions of CSC on striatal MPTP metabolism in vivo. CSC elevated striatal levels of MPTP but lowered levels of the oxidative intermediate MPDP+ and of MPP+, suggesting that CSC blocks the conversion of MPTP to MPDP+ in vivo. In assessing the direct effects of CSC and A2A receptors on monoamine oxidase (MAO) activity, we found that CSC potently and specifically inhibited mouse brain mitochondrial MAO-B activity in vitro with a Ki value of 100 nM, whereas caffeine and another relatively specific A2A antagonist produced little or no inhibition. The A2A receptor independence of MAO-B inhibition by CSC was further supported by the similarity of brain MAO activities derived from A2A receptor knockout and wild-type mice and was confirmed by demonstrating potent inhibition of A2A receptor knockout-derived MAO-B by CSC. Together, these data indicate that CSC possesses dual actions of MAO-B inhibition and A2A receptor antagonism, a unique combination suggesting a new class of compounds with the potential for enhanced neuroprotective properties.
Interestingly, Provigil is also neuroprotective in the same animal model of Parkinson's-like neurotoxicity.
I read yesterday in a sleep disorders textbook that approx. six cups of coffee produces a psychostimulant effect roughly equal to 5 mg amphetamine.
Posted by jujube on December 5, 2004, at 13:59:26
In reply to Re: Second the recommendation for Provigil, posted by zeugma on December 5, 2004, at 12:17:04
So why not try that No-Dooz stuff (caffeine pills)?
Posted by ed_uk on December 5, 2004, at 15:19:41
In reply to Re: Second the recommendation for Provigil, posted by jujube on December 5, 2004, at 13:59:26
I like the idea of a modified-release caffeine tablet. I don't think you can buy these in England. Are they available where you live?
Ed.
Posted by ed_uk on December 5, 2004, at 15:52:20
In reply to Re: Second the recommendation for Provigil, posted by ed_uk on December 5, 2004, at 15:19:41
Anyone seen this?
Heavy coffee drinking and the risk of suicide.
Tanskanen A, Tuomilehto J, Viinamaki H, Vartiainen E, Lehtonen J, Puska P.
Department of Psychiatry, University of Kuopio, Finland. antti.tanskanen@kuh.fi
Earlier research has implicated coffee drinking as a possible protective factor for suicide. We followed-up 43,166 subjects for the mean 14.6 years, and 213 suicides were committed. Daily coffee drinking had a J-shaped association with the risk of suicide. Using the Cox model we controlled for potential covariates, and found that among heavy coffee drinkers (> or = 8 cups/day) the risk of suicide was 58% higher compared with more moderate drinkers.
Ed.
Posted by zeugma on December 5, 2004, at 16:49:50
In reply to Re: Second the recommendation for Provigil, posted by ed_uk on December 5, 2004, at 15:52:20
> Anyone seen this?
>
> Heavy coffee drinking and the risk of suicide.
>
> Tanskanen A, Tuomilehto J, Viinamaki H, Vartiainen E, Lehtonen J, Puska P.
>
> Department of Psychiatry, University of Kuopio, Finland. antti.tanskanen@kuh.fi
>
> Earlier research has implicated coffee drinking as a possible protective factor for suicide. We followed-up 43,166 subjects for the mean 14.6 years, and 213 suicides were committed. Daily coffee drinking had a J-shaped association with the risk of suicide. Using the Cox model we controlled for potential covariates, and found that among heavy coffee drinkers (> or = 8 cups/day) the risk of suicide was 58% higher compared with more moderate drinkers.
>
> Ed.A J-shaped curve implies that although >8 cups/day isn't as good as more moderate amounts, it is still better than not drinking coffee at all?
if that's the case, then Ritalin may be an AD for me after all- by getting me to moderate my coffee consumption. I typically make 3 cups of coffee at a time, and this morning, after taking my morning dose, found that my craving for caffeine was so mild that I only drank a cup and a half. I may have a little more lite coffee (half the caffeine) to keep myself going through the early evening, but it would be great if I was able to avoid the 'hook' of that J-shaped curve through Ritalin.
If I relied on NoDoz, I'd be popping them all day long. My tolerance to caffeine is very high (been drinking huge quantities for many years in frantic attempts at self-medication).
-z
Posted by Sebastian on December 5, 2004, at 19:52:57
In reply to Coffee Helps!! My Mood!!! But What RX's Could?????, posted by Stryker88 on December 5, 2004, at 4:39:28
I take wellbutrin for energy.
Posted by linkadge on December 5, 2004, at 22:45:46
In reply to Re: Coffee Helps!! My Mood!!! But What RX's Could?????, posted by Sebastian on December 5, 2004, at 19:52:57
Posted by Stryker88 on December 6, 2004, at 3:21:37
In reply to Hey coffee is an AD lets modify it and patent it!! (nm), posted by linkadge on December 5, 2004, at 22:45:46
It must have taken some time to come up with your guy's informative replies, I greatly appreciate them. This website is turning out to be wonderful resource and informative place. Thanx Bob.
Posted by ed_uk on December 6, 2004, at 5:27:43
In reply to J-shaped curve » ed_uk, posted by zeugma on December 5, 2004, at 16:49:50
Hi,
It sounds like a small amount of caffeine can be beneficial, but too much is worse than none at all.
Regards,
Ed.
Posted by Dr. Bob on December 6, 2004, at 7:57:37
In reply to I appreciate help, and effort lets keep this going, posted by Stryker88 on December 6, 2004, at 3:21:37
Posted by Stryker88 on December 6, 2004, at 18:28:56
In reply to Re: thanks, and you're welcome (nm) » Stryker88, posted by Dr. Bob on December 6, 2004, at 7:57:37
Hi thanx all for you informative posts. I forgot to mention that I am also on Effexor Xr 150mg and that might be an explaination for my daytime drowsiness, since I turn to over the counter stimulants to help. What about the possibility of using Provigil to eraticate the Effexor drowsinesss. It sounds like a good idea, but I was wondering what everyone thinks.
Posted by HappinessPie on December 7, 2004, at 14:49:44
In reply to There's several things you could try... » Stryker88, posted by jclint on December 5, 2004, at 9:36:11
> I'm not an expert on this by any means, but I think there are a number of things that are effective for your situation.
>
> Stimulants, like Adderall or Ritalin, seem to to have a caffeine like effect and are good for ADD. These might be a bit too much for you though, and I doubt your doctor would prescribe them if your condition is not too serious.
>
> I think I speak for the most people here when I recommend something called Provigil.> The only problem is the cost - I know in the US, daily use can get very expensive (in the UK we have fixed price prescriptions). However the generic version is coming out soon I believe which will inevitably bring the price down. You may also want to look at something called Adrafinil...<snip> although it must be pointed out that it is perhaps more demanding on the liver than provigil - its recommended that you have liver enzyme tests now and then just to make sure.
~~ Start of Message / Reply ~~
I am very interested in trying Provigil for my mild ADD & moderate depression. I have tried Adrafinil and found it to be effective in keepig me alert without the crash of caffeine, but I was scared away by the liver warnings and also by the cost (still a lot more than a scrip for stimulants in the US). The other reason I didn't want to take it is because I was "self-medicating" with it and didn't feel comfortable sharing this with my regular doctor (this was before I had a p-doc), so if there was a liver issue I would have been at a loss for explaining it.
I am currently in withdrawal from EffexorXR, which I am very happy about (getting free of it :) ) apart from the side effects. I know my p-doc wants me on an AD because I have had a Major Depressive Episode, but I want to go off and either try St John's Wort again or perhaps something else milder (no more SSRIs though, and unfortunately I am allergic to Wellbutrin, which worked quite well). I was on 150 mg of EffXR for about two months but it makes me confused, apathetic, and chubby. :(
I am also in the process of moving to Europe (Spain - within the next couple of weeks), so while that sounds like a bad time to be changing meds, it's actually good for me since I am not working much while I make the move and I will have some down-time with the holidays. I am thinking that I may be in luck because doctors have more experience with Modafinil (Provigil) in Europe and also with prescribing St John's Wort for depression. Both drugs are likely to be cheaper than in the US and the St John's Wort may be more standardized since I understand it is prescribed nearly as often as SSRIs.
I am currently on 10 mg AdderallXR for relatively mild combined-type ADD and also because my depression is the lethargy/low-energy type. It is helping me a lot but I would not be opposed to trying Provigil instead. I am also taking a break from it while I withdraw from Effexor because stimulants seem to make some of the side effects (anxiety, hot flashes, brain zaps/shivers) worse. I have been completely off Effexor for 3 days and it has been about a week since I came down from 37.5 to 18 mg, so I am hoping the SE go away soon...!
I guess my questions would be: (1) does anyone know about the use of Provigil in Spain (or elsewhere in the EU) for depression, and/or its cost (to buy there, not to ship to US)? (2) has anyone heard of or made a good comparison between Adderall and Provigil for ADD?
Any information would be greatly appreciated!
Posted by HappinessPie on December 7, 2004, at 14:55:30
In reply to Re: Effexor/Provigil combo idea regarding this.., posted by Stryker88 on December 6, 2004, at 18:28:56
> What about the possibility of using Provigil to eraticate the Effexor drowsinesss. It sounds like a good idea, but I was wondering what everyone thinks.
Adderall certainly helped reduce my EffexorXR drowsiness, so it seems plausible that Provigil might do the same. Although my drowsiness also mostly went away once I got up to 150 mg - it was the worst at 37.5 and 75 mg, and I took it at night then. When I got up to 112.5 I switched to taking it in the AM because it started waking me up in the middle of the night.
Even at 75 mg though, I did notice an improvement when taking a stimulant (at the time it was Concerta) along with it.
Posted by lorilu on December 8, 2004, at 2:02:05
In reply to Re: Effexor/Provigil combo idea regarding this.. » Stryker88, posted by HappinessPie on December 7, 2004, at 14:55:30
> > What about the possibility of using Provigil to eraticate the Effexor drowsinesss. It sounds like a good idea, but I was wondering what everyone thinks.
>
> Adderall certainly helped reduce my EffexorXR drowsiness, so it seems plausible that Provigil might do the same. Although my drowsiness also mostly went away once I got up to 150 mg - it was the worst at 37.5 and 75 mg, and I took it at night then. When I got up to 112.5 I switched to taking it in the AM because it started waking me up in the middle of the night.
>
> Even at 75 mg though, I did notice an improvement when taking a stimulant (at the time it was Concerta) along with it.
Hi,
That's funny... Adderall does the complete opposite for me. It seems to calm me down and help me concentrate. For example, I always take 125 mg of Effexor and 200 of Provigil. On the first day I added Adderall I was driving for an hour to one of my doctors. Even though I was going over 70 mph on the freeway it felt like I was going much slower and that I was going in slow motion. I also felt like I could take a nap and it was only lunch time. I take the Provigil to stay awake so this was a funny feeling. When I got the the therapist I didn't know this was from the meds until this happened to come up and he said that this med can work in one day and I must really have a case of ADD. Unfortunately I probably wouldn't need the Provigil but I had sleep apnea (had a surgery for it but haven't retested to see if it worked yet) plus I take 400 mg of Topamax and that wipes me out. I'd like to get off some meds so we are thinking of dropping Effexor first (AND YES I KNOW ABOUT HOW HARD IT IS TO STOP) ;). PS I really live Provigil, although my therapist loves Adderall and would love to see off Provigil (my pdoc prescribed the Provigil)How many labels can a person have??????OCD, Anxiety, Depression, and now ADD! Wait at one time PTSD....The list goes on.............
Posted by Stryker88 on December 8, 2004, at 5:28:11
In reply to Re: Effexor/Provigil combo idea regarding this.. » Stryker88, posted by HappinessPie on December 7, 2004, at 14:55:30
i forgot to mention that I take Ginseng Daily and I have heard that it can react with Effexor, however I cannot find the official source of herb/Effexor interaction data, each place I look says a different thing, and my doc says a different thing then the sources I find.
Posted by Larry Hoover on December 8, 2004, at 22:28:58
In reply to J-shaped curve » ed_uk, posted by zeugma on December 5, 2004, at 16:49:50
> > Anyone seen this?
> >
> > Heavy coffee drinking and the risk of suicide.
> >
> > Tanskanen A, Tuomilehto J, Viinamaki H, Vartiainen E, Lehtonen J, Puska P.
> >
> > Department of Psychiatry, University of Kuopio, Finland. antti.tanskanen@kuh.fi
> >
> > Earlier research has implicated coffee drinking as a possible protective factor for suicide. We followed-up 43,166 subjects for the mean 14.6 years, and 213 suicides were committed. Daily coffee drinking had a J-shaped association with the risk of suicide. Using the Cox model we controlled for potential covariates, and found that among heavy coffee drinkers (> or = 8 cups/day) the risk of suicide was 58% higher compared with more moderate drinkers.
> >
> > Ed.
>
> A J-shaped curve implies that although >8 cups/day isn't as good as more moderate amounts, it is still better than not drinking coffee at all?No, you've got the J backwards.
At no coffee intake, there is some moderate risk of suicide. As coffee intake increases from zero, the risk falls to some arbitrary minimum, but then begins to increase again. It rises exponentially to an asymptote, in this case set at 8 cups per day.
It's a U-curve, but with the Y co-ordinates for low X values suppressed, from a symmetry about the minimum perspective.
> if that's the case, then Ritalin may be an AD for me after all- by getting me to moderate my coffee consumption. I typically make 3 cups of coffee at a time, and this morning, after taking my morning dose, found that my craving for caffeine was so mild that I only drank a cup and a half. I may have a little more lite coffee (half the caffeine) to keep myself going through the early evening, but it would be great if I was able to avoid the 'hook' of that J-shaped curve through Ritalin.
>
> If I relied on NoDoz, I'd be popping them all day long. My tolerance to caffeine is very high (been drinking huge quantities for many years in frantic attempts at self-medication).
>
> -zIn that case, Ritalin sounds like an excellent adjunct.
Lar
Posted by zeugma on December 9, 2004, at 15:46:53
In reply to Re: J-shaped curve » zeugma, posted by Larry Hoover on December 8, 2004, at 22:28:58
> > > Anyone seen this?
> > >
> > > Heavy coffee drinking and the risk of suicide.
> > >
> > > Tanskanen A, Tuomilehto J, Viinamaki H, Vartiainen E, Lehtonen J, Puska P.
> > >
> > > Department of Psychiatry, University of Kuopio, Finland. antti.tanskanen@kuh.fi
> > >
> > > Earlier research has implicated coffee drinking as a possible protective factor for suicide. We followed-up 43,166 subjects for the mean 14.6 years, and 213 suicides were committed. Daily coffee drinking had a J-shaped association with the risk of suicide. Using the Cox model we controlled for potential covariates, and found that among heavy coffee drinkers (> or = 8 cups/day) the risk of suicide was 58% higher compared with more moderate drinkers.
> > >
> > > Ed.
> >
> > A J-shaped curve implies that although >8 cups/day isn't as good as more moderate amounts, it is still better than not drinking coffee at all?
>
> No, you've got the J backwards.
>
> At no coffee intake, there is some moderate risk of suicide. As coffee intake increases from zero, the risk falls to some arbitrary minimum, but then begins to increase again. It rises exponentially to an asymptote, in this case set at 8 cups per day.
>
> It's a U-curve, but with the Y co-ordinates for low X values suppressed, from a symmetry about the minimum perspective.Thanks, Lar. it's my dyslexia! I see a lot of things backwards- I read the 'J' from right to left.
>
> > if that's the case, then Ritalin may be an AD for me after all- by getting me to moderate my coffee consumption. I typically make 3 cups of coffee at a time, and this morning, after taking my morning dose, found that my craving for caffeine was so mild that I only drank a cup and a half. I may have a little more lite coffee (half the caffeine) to keep myself going through the early evening, but it would be great if I was able to avoid the 'hook' of that J-shaped curve through Ritalin.
> >
> > If I relied on NoDoz, I'd be popping them all day long. My tolerance to caffeine is very high (been drinking huge quantities for many years in frantic attempts at self-medication).
> >
> > -z
>
> In that case, Ritalin sounds like an excellent adjunct.
>
> Lar
>
I agree, it wakes me up and makes me less reliant on coffee. Unfortunately, it simply doesn't help my emotional state (it intensifies my anxiety) and also worsens impulsivity. In contrast, Provigil improved impulsivity, was somewhat anxiolytic, and would have allowed me to see the J-shaped curve for what it was. I recommended provigil for dyslexia on this board, in fact, although my case is so idiosyncratic that extrapolations may be invalid. I was told by an expert in dyslexia that i do indeed have it, but a 'non-classical' case. I can't take Provigil due to side effects. And the Ritalin, although it doesn't hit me with the kind of somatic problems that the provigil did, is simply not helping my ADD much. I am dealing with a difficult constellation of anxiety, sleep, and learning/attentional disorders that is very hard for me to handle, and I have an appt. with a new pdoc who may be more familiar with this constellation than my present one.thanks again,
z
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