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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by utopizen on May 25, 2006, at 16:21:57
Yeah, just wanted to report my year now with a low dose (5mg) of Aricept.
For one thing, why did I start it?
I had social anxiety disorder really bad, along with ADD-inattentive subtype.I began reading journal articles in 2002 with doctors finding unique findings in patients with the combination of social anxiety disorder and ADD.
Around the same time, the big Asperger's Syndrome push came around, trying to explain that you don't need to see Rain Man before diagnosing someone with Asperger's.
Anyhow, I am on the following regimen:
Klonopin Wafers (now generic!) 1mg 3x/day
Desoxyn 5mg 2x/day
Aricept 5mg/day
Celexa 30mg/day
Evoxac 30mg 3x/day (for dry mouth)
Nexium 1x/day for GI side-effects of Aricept
Side-effects:Well, I did attempt after a few months to go up to the regular dosing of 10mg (5mg is starting dose for geriatric patients).
Long story short, I went manic for a few hours, it wasn't pleasant, but taking a Klonopin like with anything subdued the matter immediately.
So I returned and stayed at 5mg.
I was able to lower my dose to 5mg of Desoxyn 2x/day, while the average daily dose is 20-25mg/day.
One thing I noticed when it began kicking in after a couple of months of being on it (2-3 months) was this incredibly refreshing sleep. The moment I awoke, whether it was a nap or during normal bedtime, I would find myself very restored.
I also needed just 7 hours of sleep, and nothing more, to go all day long.
I also had this sort of "automatic thinking" - I noticed it first when I awoke from a nap to a call, answered it, and the person on the other line said, "oh, I didn't mean to wake you" and I said "oh, no problem" all of a sudden energetically, and then he said something for a bit, and I spun off clearly and articulately (yet faster than I've ever talked) a few smoothly constructed sentences as though someone else had just written my response and orated it on my behalf.
Well, I also managed to give presentations like this too-- concise, to-the-point, measured, quick-witted, and very cohesive. I just sort of would come in and out of topics with such ease.
I even could exit gracefully (for the first time in my life) -- I would end the conversation I had to end by saying something very relevant to what had just been said by another person, and quickly cap it off with a "well, I have to go, but good to meet you, and we'll talk later" (an example) with no hesitation and total ease.
Sounds oddly simple, but you have to understand the subtle nature of how smooth and effortless things like this became to me that were once incredibly difficult or frustrating.
I felt like that kid in the movie Thumbsucker (2005) -- and I have tried every ADD stimulant, and nothing came close to what happened when I combined Aricept with a stimulant.
Anyhow, hope everyone is well.
By the way, my mood, and energy, and everything, has been rock solidly awesome for a year now.
My doc over last summer, after a couple of months into regimen, said "This is the best I've ever seen you!"
(I came to him a year earlier, despondent and so depressed I couldn't hide it at all to anyone).
Take care!
Posted by Paulbwell on May 26, 2006, at 14:12:29
In reply to One year on Aricept- ADD augmenter, sleep booster, posted by utopizen on May 25, 2006, at 16:21:57
> Yeah, just wanted to report my year now with a low dose (5mg) of Aricept.
>
> For one thing, why did I start it?
>
>
> I had social anxiety disorder really bad, along with ADD-inattentive subtype.
>
> I began reading journal articles in 2002 with doctors finding unique findings in patients with the combination of social anxiety disorder and ADD.
>
> Around the same time, the big Asperger's Syndrome push came around, trying to explain that you don't need to see Rain Man before diagnosing someone with Asperger's.
>
> Anyhow, I am on the following regimen:
>
>
> Klonopin Wafers (now generic!) 1mg 3x/day
> Desoxyn 5mg 2x/day
> Aricept 5mg/day
> Celexa 30mg/day
> Evoxac 30mg 3x/day (for dry mouth)
> Nexium 1x/day for GI side-effects of Aricept
>
>
> Side-effects:
>
> Well, I did attempt after a few months to go up to the regular dosing of 10mg (5mg is starting dose for geriatric patients).
>
> Long story short, I went manic for a few hours, it wasn't pleasant, but taking a Klonopin like with anything subdued the matter immediately.
>
> So I returned and stayed at 5mg.
>
> I was able to lower my dose to 5mg of Desoxyn 2x/day, while the average daily dose is 20-25mg/day.
>
> One thing I noticed when it began kicking in after a couple of months of being on it (2-3 months) was this incredibly refreshing sleep. The moment I awoke, whether it was a nap or during normal bedtime, I would find myself very restored.
>
> I also needed just 7 hours of sleep, and nothing more, to go all day long.
>
> I also had this sort of "automatic thinking" - I noticed it first when I awoke from a nap to a call, answered it, and the person on the other line said, "oh, I didn't mean to wake you" and I said "oh, no problem" all of a sudden energetically, and then he said something for a bit, and I spun off clearly and articulately (yet faster than I've ever talked) a few smoothly constructed sentences as though someone else had just written my response and orated it on my behalf.
>
> Well, I also managed to give presentations like this too-- concise, to-the-point, measured, quick-witted, and very cohesive. I just sort of would come in and out of topics with such ease.
>
> I even could exit gracefully (for the first time in my life) -- I would end the conversation I had to end by saying something very relevant to what had just been said by another person, and quickly cap it off with a "well, I have to go, but good to meet you, and we'll talk later" (an example) with no hesitation and total ease.
>
> Sounds oddly simple, but you have to understand the subtle nature of how smooth and effortless things like this became to me that were once incredibly difficult or frustrating.
>
> I felt like that kid in the movie Thumbsucker (2005) -- and I have tried every ADD stimulant, and nothing came close to what happened when I combined Aricept with a stimulant.
>
> Anyhow, hope everyone is well.
>
> By the way, my mood, and energy, and everything, has been rock solidly awesome for a year now.
>
> My doc over last summer, after a couple of months into regimen, said "This is the best I've ever seen you!"
>
> (I came to him a year earlier, despondent and so depressed I couldn't hide it at all to anyone).
>
> Take care!Hi Ya!
How do you find the dsoxyn helps?-what dose are you scripted, i guess if you have lowered yr dose then you have spare?
Feedback-coolness?
Cheers
Posted by blueberry on May 26, 2006, at 15:33:19
In reply to One year on Aricept- ADD augmenter, sleep booster, posted by utopizen on May 25, 2006, at 16:21:57
What exactly was it that prompted you to think a cholinergic mechanism was involved? It is great it has helped you so much. I am curious what led you in that direction. While it seems the entire world is looking at serotonin, dopamine, norepinephrine, and gaba, what was it that made you look at cholinergic mechanisms?
Posted by utopizen on May 31, 2006, at 5:53:14
In reply to Re: One year on Aricept- ADD augmenter, sleep boos » utopizen, posted by blueberry on May 26, 2006, at 15:33:19
> What exactly was it that prompted you to think a cholinergic mechanism was involved? It is great it has helped you so much. I am curious what led you in that direction. While it seems the entire world is looking at serotonin, dopamine, norepinephrine, and gaba, what was it that made you look at cholinergic mechanisms?
>Well... the thing to remember is, the "cholinergic mechanism" is at hand with basically everything.
It's also well-studied. And drugs that dry you up, like amphetamines, etc., are acting at the same parts of brain as Aricept, with certain variations.
Hence, why I needed to _REDUCE_ my use of Desoxyn. 10mg 2x/day became unpleasant, too much with the introduction of Aricept. I would hyperfocus, get agitation, all of the signs of overdose, at the normally prescribed dose all of a sudden.
So it potentiates existing effects a stimulant causes. This is because it's working on similiar mechanisms, increasing dopamine, etc.
So, not sure what you mean by that... um, Aricept is used for Altzhiemer's patients.
My mind tends to think in creative processes that seem as intuitive/instrinsic to me, and then when forced to explain how I arrived at what seemed "elementary, my Dear Watson" I notice the burden Sherlock Holmes has in having to explain how I came about something by connecting so many dots so rapidly and effortlessly.
I don't mean to suggest everyone who takes Aricept to add-on to their ADD regimen will become this creative, quick-witted, socially adept genius smooth talker with incredible charm (fortunately, pharmaceutical companies have failed in their efforts to emulate my essence).
Yet like Thomas DeQuincey makes clear in Confessions of an Opium Eater, a dull person who takes something like opium will have yet still dull dreams. He doesn't let people think someone unlike him who takes the same drug will be able to write a great literary work.
A drug that potentiates may only potentiate a potential.
Okay, that said, for my psychopharmacology presentation, I did have to go, "Um, utopizen, let's re-map how the heck you understood so much enough to actually be your own successful testbed." So, without having to reveal the fact I'm basically a walking case study and proud consumer of Aricept (lol) I did this the following way (in a very concise presentation that amazed my professor):
--First, what defines "cognitive enhancers"(Aricept, NMDA antagonists, amphetamines, nicotines, to be broad) is this:
they delay or reverse cognitive impairment.
(Antonyms really help to define something, especially when you want to broaden an entire class of drugs) ;)
--Second, what disorder do the existing use of the drugs show success, and how does this disorder parallel the target disorder to justify exploring similiar approaches to treatment?
Well, it's a geriatric drug, so, I found an interesting disorder that features Executive Dysfunction as a symptom.
Executive Dysfunction is also a symptom in about 1/3 of patients with AD/HD (while much of AD/HD may be reducable to varying levels of Executive Dysfunction, keep in mind it is separate and is a disorder of severity, not kind-- just like any mental/neurological disorder).
So, with that said, here's a handout. Quiz is Friday. Glad you asked for my response =)
➲ Understanding Concerns of Apathy:
A Correlate to Other Neuropsychological Deficits==> Primarily characterized by motivational loss–– loss of interest and drive to engage in goal-oriented behavior (Martin, 1990).
==> Features distinctively separate from mood disturbance (e.g., depression). Loss of interest and drive rooted in an emotional indifference, not dysphoria (Martin et al., 1994).➲ Three major subsystems implicated in apathy:
==> Dorsolateral Prefrontal Circuit— Executive Cognitive Dysfunction
==> Lateral Orbital Prefrontal Circuit— Disinhibition
==> Medial (anterior cingulated) Circuit— Motivation Disorders (e.g., apathy)
(Cummings, 1993)➲ Neurobiological Basis of Apathy Hypothesis:
==> Medial Frontal Lobe + Limbic Cholinergic Deficits
==> Dopaminergic pathways involved in frontal-subcortical activation
(Cummings and Black, 1998)➲ Pharmacological Treatments Presenting Statistically Significant Clinical Efficacy (P > .05):
==> Donezepil (Aricept ®),
==> Provigil (Modafinal ®),
==> Amphetamines (Dexedrine ®), Adderall ®),
==> Desoxyephederine / Methamphetamine (Desoxyn ®)
==> Methylphenidate➲ Nicotine as a Working Model for Executive Function Mediation
==> Schizophrenia and ADHD:
==> Nicotine stimulation enhances selective attention
==> Sensory detection, and inhibition processes in attention
Posted by utopizen on May 31, 2006, at 6:03:40
In reply to Utopizen » utopizen, posted by Paulbwell on May 26, 2006, at 14:12:29
>
> Hi Ya!
>
> How do you find the dsoxyn helps?-what dose are you scripted, i guess if you have lowered yr dose then you have spare?
>
> Feedback-coolness?
>
> CheersWell, I've tried all the stimulants, and Desoxyn helps, sure. I find Adderall a bit too stimulating to my heart, and Desoxyn slightly less so, and slightly less anxiety-inducing... also, less um, of that whole making me feel excessively introspective thing, which Ritalin and Adderall seemed to do.
Still, I wouldn't say Desoxyn is in some league of its own. If you're finding good results with Adderall, Ritalin, Dexederine, whatever, it's probably not worth having to see what the deal is with Desoxyn. For one thing, it's brand name, so I have to pay $35 (Tier 3 for my insurance, highest co-pay). For another thing, it's, well, Desoxyn. Although there's no rational basis for believing a patient would abuse methamphetamine over amphetamine (all the studies are conclusive in remarking how addicts and animals can't even tell the difference) -- asking your doc for any controlled drug is a risky thing.
My doc is extremely comfortably with me, because he knows I'm a dork and I mention drug names because I study psychopharmacology for fun. It depends on your relationship with your doc.
But, I don't see the point in trying Desoxyn. Whatever works, and then use CBT to go the rest of the way.
As I remarked at the end of my psychopharmacology lecture on the subject of AD/HD + Executive Dysfunction,:
"Medication only goes half-way; Behavorial Therapy does the rest."Now, that said, I don't see that to claim everyone on meds requires CBT, but I view that to suggest even everyday intervention and habits you develop that are adaptive for you to control your problems are a form of mitigating the effect of drug, rather than dropping a pill and expecting yourself to turn into a robot that is effortlessly productive without other changes in how you cope.
Posted by Paulbwell on May 31, 2006, at 19:56:39
In reply to Re: Utopizen » Paulbwell, posted by utopizen on May 31, 2006, at 6:03:40
> Well, I've tried all the stimulants, and Desoxyn helps, sure. I find Adderall a bit too stimulating to my heart, and Desoxyn slightly less so, and slightly less anxiety-inducing... also, less um, of that whole making me feel excessively introspective thing, which Ritalin and Adderall seemed to do.
>
> Still, I wouldn't say Desoxyn is in some league of its own. If you're finding good results with Adderall, Ritalin, Dexederine, whatever, it's probably not worth having to see what the deal is with Desoxyn. For one thing, it's brand name, so I have to pay $35 (Tier 3 for my insurance, highest co-pay). For another thing, it's, well, Desoxyn. Although there's no rational basis for believing a patient would abuse methamphetamine over amphetamine (all the studies are conclusive in remarking how addicts and animals can't even tell the difference) -- asking your doc for any controlled drug is a risky thing.
>
> My doc is extremely comfortably with me, because he knows I'm a dork and I mention drug names because I study psychopharmacology for fun. It depends on your relationship with your doc.
>
> But, I don't see the point in trying Desoxyn. Whatever works, and then use CBT to go the rest of the way.
>
> As I remarked at the end of my psychopharmacology lecture on the subject of AD/HD + Executive Dysfunction,:
>
>
> "Medication only goes half-way; Behavorial Therapy does the rest."
>
> Now, that said, I don't see that to claim everyone on meds requires CBT, but I view that to suggest even everyday intervention and habits you develop that are adaptive for you to control your problems are a form of mitigating the effect of drug, rather than dropping a pill and expecting yourself to turn into a robot that is effortlessly productive without other changes in how you cope.
>
>Thanks,
What kind of CBT-type practices do you suggest?
And on the effect of Nicotine, and it's executive/cognitive function, how do you view this?-
-Perhaps this is why i find chewing Nicotine gum helpfull in some way?
Also Methylphenidate often causes some irritability, causing me to crave a drink to attenuate (where 5mgs Valium doesn't do much for now)-Clonazepam seemed to help this better@1mg.
Thanks for any help:)
Cheers
Posted by stan on June 1, 2006, at 2:14:19
In reply to One year on Aricept- ADD augmenter, sleep booster, posted by utopizen on May 25, 2006, at 16:21:57
have you ever tried exelon or razadyne, and if so, did you experience a similar response? how about namenda (which of course has a different mechanism of action than the pro-cholinergics just mentioned). also, do you think it's possible that your response may be due as much to the evoxac as the aricept? both are pro-cholinergics.....what's the difference supposed to be?
stan
> Yeah, just wanted to report my year now with a low dose (5mg) of Aricept.
>
> For one thing, why did I start it?
>
>
> I had social anxiety disorder really bad, along with ADD-inattentive subtype.
>
> I began reading journal articles in 2002 with doctors finding unique findings in patients with the combination of social anxiety disorder and ADD.
>
> Around the same time, the big Asperger's Syndrome push came around, trying to explain that you don't need to see Rain Man before diagnosing someone with Asperger's.
>
> Anyhow, I am on the following regimen:
>
>
> Klonopin Wafers (now generic!) 1mg 3x/day
> Desoxyn 5mg 2x/day
> Aricept 5mg/day
> Celexa 30mg/day
> Evoxac 30mg 3x/day (for dry mouth)
> Nexium 1x/day for GI side-effects of Aricept
>
>
> Side-effects:
>
> Well, I did attempt after a few months to go up to the regular dosing of 10mg (5mg is starting dose for geriatric patients).
>
> Long story short, I went manic for a few hours, it wasn't pleasant, but taking a Klonopin like with anything subdued the matter immediately.
>
> So I returned and stayed at 5mg.
>
> I was able to lower my dose to 5mg of Desoxyn 2x/day, while the average daily dose is 20-25mg/day.
>
> One thing I noticed when it began kicking in after a couple of months of being on it (2-3 months) was this incredibly refreshing sleep. The moment I awoke, whether it was a nap or during normal bedtime, I would find myself very restored.
>
> I also needed just 7 hours of sleep, and nothing more, to go all day long.
>
> I also had this sort of "automatic thinking" - I noticed it first when I awoke from a nap to a call, answered it, and the person on the other line said, "oh, I didn't mean to wake you" and I said "oh, no problem" all of a sudden energetically, and then he said something for a bit, and I spun off clearly and articulately (yet faster than I've ever talked) a few smoothly constructed sentences as though someone else had just written my response and orated it on my behalf.
>
> Well, I also managed to give presentations like this too-- concise, to-the-point, measured, quick-witted, and very cohesive. I just sort of would come in and out of topics with such ease.
>
> I even could exit gracefully (for the first time in my life) -- I would end the conversation I had to end by saying something very relevant to what had just been said by another person, and quickly cap it off with a "well, I have to go, but good to meet you, and we'll talk later" (an example) with no hesitation and total ease.
>
> Sounds oddly simple, but you have to understand the subtle nature of how smooth and effortless things like this became to me that were once incredibly difficult or frustrating.
>
> I felt like that kid in the movie Thumbsucker (2005) -- and I have tried every ADD stimulant, and nothing came close to what happened when I combined Aricept with a stimulant.
>
> Anyhow, hope everyone is well.
>
> By the way, my mood, and energy, and everything, has been rock solidly awesome for a year now.
>
> My doc over last summer, after a couple of months into regimen, said "This is the best I've ever seen you!"
>
> (I came to him a year earlier, despondent and so depressed I couldn't hide it at all to anyone).
>
> Take care!
Posted by utopizen on June 4, 2006, at 17:05:24
In reply to Re: One year on Aricept- ADD augmenter, sleep booster » utopizen, posted by stan on June 1, 2006, at 2:14:19
> have you ever tried exelon or razadyne, and if so, did you experience a similar response? how about namenda (which of course has a different mechanism of action than the pro-cholinergics just mentioned). also, do you think it's possible that your response may be due as much to the evoxac as the aricept? both are pro-cholinergics.....what's the difference supposed to be?
>
> stan
stan,thank you for your thoughtful comments =)
yes, you're right-- Evoxac is certainly a drug that is a cholinergic. However, Aricept works in a completely different mechanism of action. Pretty much all drugs are either cholinergic or anti-cholinergic, so, the only real interest anyone would have on focusing on this attribute of the drug is really an urologist, if you happen to find a drug causing you urinary problems. If so, they'd give you a drug that is on the opposite end of something like Evoxac (which increases saliva, etc.) by prescribing you something that would dry you up (and certainly, likely discontinue your Evoxac first)
As for Aricept, it's so selective on the brain, and complicated, I wouldn't suggest coorelations between it and Evoxac.
I am aware, in rats, one researcher claims in an abstract (available on MedLine) Evoxac is a neuroprotective.
This probably has to do with very unique properties for Evoxac... I would be careful not to make too many loose connections here.
That hypothesis I believe came from the connection that it's basically similiar in effect to pilocarpine, a drug that's been known for about 100 years to increase saliva and tears in Sjorgen's Syndrome.
The likelihood Evoxac has, even in augmentation with another drug, any psychotropic properties that effect behavior in any way is relatively unrealistic. It's been around for a few years now, and its sister drug, Pilocarpine, really isn't much different (Salagen).
I'm aware, as you point out, and I pointed out in making the distinction in my presentation of how an NMDA antagonist is not the same as an anticholinterase inhibitor...But, my days of switching to similiar drugs for the heck of it are over. Aricept works, and, the reality is, I'm probably not going to notice much of a noticable difference with any other similiar drug, or even an NMDA antagonist.
"If it ain't broke, don't fix it" was even said to me by a doc once. With every med change, there should be a very clear basis and rationale.
If I'm doing fine on Aricept, no need to switch, just like no need to switch to different stimulants, since really the belief that different stimulants will radically change how you work is unrealistic.
As for cognitive behaviorial therapy:43folders.com is a good place to get some common sense Podcasts and advice on how to do time management, etc.
and, try to follow this:
"Don't duck the most difficult problems.That just insures that the hardest part will be left when you're most tired.
Get the big one done--
It's downhill from then on.
---Norman Vincent Pearle
utopizen
This is the end of the thread.
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Dr. Bob is Robert Hsiung, MD,
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