![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by mike99 on December 23, 2005, at 20:05:08
Can anyone give a subjective comparison of Provigil vs. Aricept or Namenda for inattention in terms of effectiveness and cardiovascular stimulation?Although it is a "non-stimulant", I am hesitant to try Provigil as it works through adrenergic activation and I'm super-sensitive to anything even mildly adrenergic (in terms of peripheral stimulation--even SSRI's).
Posted by Tom Twilight on December 24, 2005, at 15:22:14
In reply to ADHD: Aricept/Namenda vs. Provigil, posted by mike99 on December 23, 2005, at 20:05:08
I don't think I really ADD, although I certainly do have some characteristics.
I didn't like Provigil, I found it made me very anxious.
More so than DexedrineI'm really interested in Namenda/Mementine
I remember one poster described it a being quite energising.
Posted by Emme on December 24, 2005, at 17:14:42
In reply to ADHD: Aricept/Namenda vs. Provigil, posted by mike99 on December 23, 2005, at 20:05:08
I don't have ADHD per se, but I have had some distractability associated with my anxiety and depression.
I found provigil stimulating. I liked the mood brightening, but it tired me out after a while. It promoted things like chatting and closet cleaning. If you decide to try it, at least it won't be in your system for too long.
Aricept seemed to promote focus and clarity of thought for me as well as acting as an AD. It was neither activating nor sedating. The cardiovascular effect was lowered heart rate.
I take memantine now. At my current dose it's neither particularly activating nor sedating and doesn't seem to have cardiovascular effects. I was tired and loopy on it at higher doses.
YMMV.
emme
Posted by Tom Twilight on December 24, 2005, at 18:12:40
In reply to Re: ADHD: Aricept/Namenda vs. Provigil » mike99, posted by Emme on December 24, 2005, at 17:14:42
> I take memantine now. At my current dose it's neither particularly activating nor sedating and doesn't seem to have cardiovascular effects. I was tired and loopy on it at higher doses.
Hey Emme
What benefits are you getting from Memantine?
Does it help with depression?
Posted by mike99 on December 24, 2005, at 18:56:57
In reply to Re: ADHD: Memantine-Emme, posted by Tom Twilight on December 24, 2005, at 18:12:40
Emme,You mentioned Aricept helped some with focus and clarity of thought--- do you see any of these benefits with memantine?
Posted by Emme on December 24, 2005, at 19:34:17
In reply to Re: ADHD: Memantine-Emme, posted by Tom Twilight on December 24, 2005, at 18:12:40
Hi Tom,
> What benefits are you getting from Memantine?
> Does it help with depression?Yes. That is the main benefit for me.
emme
Posted by Emme on December 24, 2005, at 19:53:55
In reply to Re: ADHD: Memantine-Emme, posted by mike99 on December 24, 2005, at 18:56:57
Hi.
> You mentioned Aricept helped some with focus and clarity of thought--- do you see any of these benefits with memantine?
No. Not specifically. Actually, my brain had a foggy feeling at a higher dose (it's okay at my current dose). But YMMV, especially depending on what else you're taking with it. It's been a good drug for for me for depression.
I would still like to be better focused, but my cognitive issues have improved. I think it's because:
1) I take less medicine overall than I used to. I take several drugs, but mostly small doses. Having found good drugs to augment Lamictal, I was able to lower my dose of Lamictal.
2) Less depression = brain works better.
3) Less anxiety = brain works better. At the moment, I mostly use xanax to combat anxiety, and it doesn't seem to zone me out.
4) Less fatigue and better motivation due to Abilify = brain works better.
I would have continued with Aricept, but my liver enzymes were raised and my GP recommended we d/c it. However, they weren't raised that much and we've since decided that if my regimen goes south, we'll think about retrying Aricept and monitor liver enzymes.
At this point, I also suspect that my focus may improve with practice. During the time that I had a lot of brain fog, I got discouraged and got out of the habit of even trying. Now that things are better, I think I need to just start making myself be disciplined.
emme
Posted by mike99 on December 24, 2005, at 20:09:41
In reply to Re: ADHD: Memantine-Emme » mike99, posted by Emme on December 24, 2005, at 19:53:55
Thanks for the info, Emme. It is much appreciated.
Hope things continue to get better for you.
Posted by theo on December 26, 2005, at 22:40:23
In reply to Re: ADHD: Memantine-Emme » mike99, posted by Emme on December 24, 2005, at 19:53:55
> 4) Less fatigue and better motivation due to Abilify = brain works better.
>What dose of Abilify do you take? Do you take it in the morning or at night?
Posted by Emme on December 28, 2005, at 6:42:12
In reply to Re: ADHD: Memantine-Emme » Emme, posted by theo on December 26, 2005, at 22:40:23
Hi Theo,
> What dose of Abilify do you take? Do you take it in the morning or at night?2.5 mg in the morning every 2-3 days.
emme
Posted by utopizen on December 30, 2005, at 7:00:13
In reply to ADHD: Aricept/Namenda vs. Provigil, posted by mike99 on December 23, 2005, at 20:05:08
>
> Can anyone give a subjective comparison of Provigil vs. Aricept or Namenda for inattention in terms of effectiveness and cardiovascular stimulation?
>
> Although it is a "non-stimulant", I am hesitant to try Provigil as it works through adrenergic activation and I'm super-sensitive to anything even mildly adrenergic (in terms of peripheral stimulation--even SSRI's).
>
>I found Provigil _not_ to give me the jitters. Caffiene, nicotine does (I tried Nicorette once for AD/HD-- terrible terrible idea. All it did was make me feel like I drank 20 cups of coffee!)
It also didn't seem to do anything else.
However, when combined with Straterra, according to my doctor-- who was a pulmonary specialist specializing in ADHD/sleep apnea comorbidity--
he claimed his patients were experiencing wonderful synergy from the combination.
I wouldn't be too frightful of being frightful, however. There's no basis to believe you would respond in such a certsin way to a drug you haven't taken yet.
As for Aricept, I combine it with a lower(ed) dose of Desoxyn. It increases the efficacy of the Desoxyn (as it would increase the efficacy of any amphetamine, I am certain) so I only now take a couple of Desoxyn at most during the day, say, two 5mg doses divided twice daily.
I find it's really helped me become a genius, but, I'm also smart to begin with... so I don't know how much to attribute things to what.
All I can say is, after a couple of months or so, I noticed a dramatic effect on my sleep seeming to have markedly reduced REM, increased efficiency, and I had these coherent, lucid dreams that seemed to all make sense and follow a cohesive tract for awhile.
Also, I began to respond immediately with like no hesitation whenever anyone asked a question I had any shot of answering with this immediate, razor-sharp precision that baffled others (as well as myself).
I remember one time, I awoke from a call during a nap, a kid I recently met who looked at the apt. was on the line, and he said a few sentences, and I immediately responded with a very quick, coherent, cohesive, razor-sharp response that was very graceful, quick, and said it so concisely I was off the phone like 20 seconds later. It even included a salutation imbedded at the end, and I felt like it was so natural I had no deliberation or thought process involved.
Interesting stuff.
Posted by utopizen on December 30, 2005, at 7:27:34
In reply to Re: ADHD: Memantine-Emme » mike99, posted by Emme on December 24, 2005, at 19:53:55
> At this point, I also suspect that my focus may improve with practice. During the time that I had a lot of brain fog, I got discouraged and got out of the habit of even trying. Now that things are better, I think I need to just start making myself be disciplined.
>
> emme
>
Emme,Thank you SO MUCH for pointing this out-- I can't stress this enough.
As my N.P. says, "Drugs only go half way." (He says this to encourage I go to therapy, which I finally do).
Um, I have to say, learning from Medline searches for Aricept that patients with dementia taking amphetamine or Aricept both improved on either drug when given cognitive behavorial therapy along with the drug.
They were given routine brain exercises in a lab and that apparently sharpened their mental pencils, if I may say such a thing.
I like to compare the brain to a cement truck. It's constantly going around and around, partyly because of nutrition, drugs, and biology, but also by the interaction of all these things by the "driver" (the person) engaging in "rotating" their brain.
By exercising, by walking even, by thinking, by forcing yourself to the habit of locomotion in general-- locomotion of body, but of mind as well- you will become more Socratic.
Socrates encouraged his students to have peripatetic learning-- sorry for the $10 word, but I love it- it simply means, to walk, basically.
The idea is, he'd give lessons and discuss with his students while walking (so I hate when teachers claim they use the Socratic method, because Socrates would hate the idea of teaching still all day).
OKAY, BACK TO PSYCHOPHARMACOLOGY, PLEASE DON'T DIVERT POST ELSEWHERE DR. BOB =)
Anyhow, I used this realization that new CBT methods to help mental acuity in geriatric patients who suffered dementia and took either an amphetamine or Aricept improved markedly better to teach my psychopharmacology class I took as a student about the cognitive enhancers and their application in emerging treatments like AD/HD with Exeucitve Dysfunction, Asperger's Snydrome, etc.
The point is this:
Your brain is mostly cement, constantly requiring locomotion of thought in general.
Exercises, mentally, at least, can and will help optimize how the drugs work.
When I was in speech therapy as a young child, thank god for my speech therapist being as skilled as she was! She helped me articulate with grace, after intially being inarticulate for many years as a child.
I remember doing tongue exercises.
She called them tongue exercises, because it exercised the muscle in my tongue, a big muscle actually in one's anatomy-- and I'd have to force my tongue to stretch itself out to the roof of my mouth like there was peanut butter stuck to it.
Anyhow, I know this is a long post, but, there's lots of stuff to say here, and, I would like to say I somehow pulled off what my psychopharmacology professor said was a "well-polished, impressive" concise and cohesive explanation into all the cognitive enhancers, like Aricept, Memantine, how they work, their neuroscience, their clinical efficacy, how their clinical efficacy relies heavily on therapy, etc. all in 10-15 min. tops, including questions.
And getting back to your mentioning of mood-- I initiated the rather daunting task at first (I had previously relayed concern to my professor I didn't know where to start or how to "interface" all my knowledge in a short time)--Yes, mood-- depression- whatever- is going to play a role in memory, in executive function.
I felt like my brain was getting stupid, permamently, when I was depressed-- a common feeling among us all.
Aricept, althought certainly tsken after much success with Lexapro and therapy and great loving friends who never ceased to tell me when I was not acting they way I ought to and not staying on task with my work, or social skills, etc.--
I pick friends who are never hesitant to tell me the truth with bitter honesty- and am a better perosn for it-
helped my mood ever after my Nurse Practioner and I agreed I was in "remission" from depression.
I went beyond being in "remission," and lacking a disorder. I felt positively progressing in general in life, exceeding beyond my peers, beyond my dreams, in everyday functioning.
It helped.
But drugs, they need your help as much as you need theirs. Combining them with good friends, therapy, lifestyle changes, inspiration, exercise, things that matter, and constantly rotating into different directions from within--
that's what makes the dose-response curve really fly off the charts.
Posted by utopizen on December 30, 2005, at 7:42:22
In reply to Re: ADHD: Memantine-Emme » theo, posted by Emme on December 28, 2005, at 6:42:12
> Hi Theo,
>
> > What dose of Abilify do you take? Do you take it in the morning or at night?
>
> 2.5 mg in the morning every 2-3 days.
>
> emmeMy stsrting dose of Abilify, while I was taking it, was 7.5mg/day for two weeks, then 15 mg.
I had akathasia, which is a common and treatable side effect of the atypicals. I simply took benzotropine and the restlessness stopped, the pacing stopped.
I took it for a few months. It may have helped me get a bit more energy, enough anyway to ride my bike like crazy (I would roll out of bed and grab my bike at 5 AM each morning, ride it for 2 hours, go back to bed, ride again a few hours later, and then maybe another ride later at night, out of complete defiance of the deep deep depression I was in, for 3 solid months in the summer)
I switched to a doc my doc referred me to, actually, a Nurse Practioner, to get a different angle we agreed might help my cause...
This dude killed the Abilify and Cogentin I took for the Abilify, and the Lamictal I was beginning to take b/c my doc had a conviction all "hard" cases are likely some vague form of bipolar (not a silly one, just his professional bias).
After slashing off these three drugs, he put me on Lexapro, raising it to 45mg eventually.
Besides adding Klonopin a bit later at 1mg 3x/day, this was all I took, and, a few months later, the Lexapro (combined with a 10mg dose of Seligiline I took) entered me into remission.
But Aricept... boy, it gave me energy. Not, "activativing/sedating" kind of energy, just, energy. Thirst for life kind of feeling-- not a clean my kitchen in a manic fit kind of energy.I began writing poetry, made life changes, and, my psychology major undergrads whisper, "that kid is _really_ smart, he's in my psychopharmacology course" and things like that I overheard when I mentioned something pertinent to a lecture now and then in a psychology course.
"The difference between a tranquillizer and a barbituate is that a tranquillizer is defined by the fact it doesn't sedate," I said once first day in abnormal psych when a kid was puzzled over a 1960's case study mentioning a woman on barbituates.
My psych professor was like, "um, yeah, what he said."
(Keep in mind, it's the reason why Meprobromate is not technically a tranquillizer, due to its sedative properties).
Posted by utopizen on December 30, 2005, at 7:53:26
In reply to Re: ADHD: Aricept/Namenda vs. Provigil, posted by utopizen on December 30, 2005, at 7:00:13
A lot of these newer drugs, for novel approaches to treating Executive Dysfunction in ADHD, or sleepiness with AD/HD (sleep apnea-associated, etc., when combined with a CPAP/BiPAP) often work well when the drugs are combined.
In the case of Namenda, it is already generally used as an adjunct med for Aricept and Reminyl and other drugs of that class.
In the case of Provigil, especially if you have Excessive Daytime Sleepiness, as often occurs in melancholia (a sleepy form of depression with hypersensitivity to rejection, sometimes also called Atypical Depression for God knows why) Provigil, Straterra and a CPAP/BiPAP machine often work well according to my pulmnologist I once saw back when I was depressed.
I never took up his advice to consider Provigil + Straterra combined, fearing it meant forsaking the only last hope to do immediate work in school i had--- amphetamine treatment using Desoxyn.
I also never took up his advice to take the semester off from school, and take a 5th year. I was too depressed to make sense. So I failed most of my classes that year, despite weeping in his office with his Nurse Practioner for no reason other than being depressed and looking like death from it.
End result? I'm taking my 5th year now, and likely could have missed out on a chance to reduce my stress at a terrible point of my life due to depression.
I felt like I had to take on the world, but, I geuss that's a different post.
Anyhow, point is, Namenda, is often combined with Aricept and other drugs of its class.
Provigil is often combined with Straterra. My pulmnologist, a world leader in research for AD/HD comorbid with Sleep Apnea, was remarking he found remarkable results with the combination unseen in either drug used alone in his patients.
So there is always synergy.
Either/or thinking... it rarely works in any event.
That said, reducing the total number of drugs was his priority as well, as that was kind of his basis for suggesting my psychiatrist do it. It would have meant possibly killing need for Klonopin, Desoxyn, Inderal, etc.
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.