![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by ronaldo on November 25, 2006, at 6:12:47
This is what I am suffering from:
Avolition, Anhedonia, Flat Affect, Cognitive Blunting.
This is the culprit imho: Olanzapine at 7.5 mg previously 10 mg. I am tapering off the Olanzapine. I am that sure it is to blame.
My dx is 'bipolar disorder currently in remission'.
The only other med I take is Lithium controlled release (Priadel) at 900 mg nocte. I take all my meds at 9:30 pm.
My dx is by no means definite. The pdoc who says 'BD currently in remission' has never made a dx of BD currently active so it is hard to understand how he arrives at his 'currently in remission' dx.
Most other pdocs have said '?? schizo-affective disorder'. Anyway my dx in South Africa was Bipolar Disorder. That was 30 years ago, and I have been taking lithium for close to 30 years. I live in the UK now.
I know that it could be the lithium to blame but the avolition series of symptoms only seemed to appear when I started taking the Olanzapine regularly. Hang on a minute. I increased my Lithium from 800 mg to 900 mg round about the same time that I started taking the Olanzapine regularly. I first used Olanzapine occasionally to help me sleep about four years ago and it worked very well to start with but it faded later. Today I get by on about 5 hours of sleep at night. I would like more but this is all I get...
Could the increase in my lithium be responsible for my avolition etc symptoms? 100 mg is not a big increase but might have been enough to tip me over. My lithium blood levels are steady around the 0.8 mMol/litre mark.
Can anyone express an opinion? Is the Olanzapine to blame or is it the Lithium? One thing I won't do is taper off the lithium at the same time I am decreasing the Olanzapine. Lithium is a much cleaner drug than Olanzapine and I would much rather ditch the latter.
Is there any medication specifically aimed at reducing the avolition series of symptoms? I suppose an AD might work. Maybe I am depressed?
What do you think? I will be grateful for all opinions expressed.
Posted by blueberry on November 25, 2006, at 7:25:45
In reply to Avolition, Anhedonia, Flat Affect, Cognitive Bl..., posted by ronaldo on November 25, 2006, at 6:12:47
I had the same symptoms of avolition and anhedonia when on prozac. Zyprexa added to it didn't help. There was not joy, no motivation, no pleasure, no zest. But I wasn't depressed.
I experimented with probably thousands of dollars of meds and supplements to counteract the symptoms (what I eventually decided were very close to what are called the negative symptoms of schizophrenia).
I found one that worked fairly good...amisulpride. But it had two major problems...I had to mailorder it from overseas and was afraid of losing an order; the sexual side effects were really bad.
I stumbled on to one that worked fantastic. Adrafinil. Its purpose in Europe is to increase vigilance. Its major metabolite is modafinil, so modafinil might have the same effect. I had to mailorder adrafinil from overseas but never had any problems. It is dirt cheap and easy to order. The US Customs intercepted one of my shipments, they put a green Customs label on it that said "supplements" and sent it on its way to my mailbox no problem. It is not a controlled substance or anything like that. It is actually pretty popular in Europe as a nootropic, antidepressant, and vigilance promoter. It is called a kinder gentler stimulant. Side effects at first were agitation and inner tension. Those went away in a few days.
I got immediate benefits the very first day. Then they faded away. I kept taking it. At about 3 weeks it really kicked in and I was alive with zest for life. Anhedonia and all that stuff was gone. I had no side effects. The dose is 3 pills a day, but I never took more than 2 a day, and I spent a few years on just 1 a day. It was an excellent antidepressant and vigilance promoter, targeting all of the symptoms you described.
I screwed up though and started smoking pot. The two didn't mix...explosive diarrhea. I wanted pot so I stopped adrafinil. And I'm sorry. I don't smoke anymore and am looking at a box of adrafinil right now saying, "Hmmmm".
Posted by ronaldo on November 25, 2006, at 8:22:58
In reply to Re: Avolition, Anhedonia, Flat Affect, Cognitive Bl... » ronaldo, posted by blueberry on November 25, 2006, at 7:25:45
Thanks for your advice blueberry. Can you tell me what the strength is of your Adrafinil; ie is it 300mg? or is it 100mg? If you take 3 pills a day I would guess that it is 100mg but that is only a guess...
...ronaldo
Posted by ronaldo on November 25, 2006, at 10:27:39
In reply to Re: Avolition, Anhedonia, Flat Affect, Cognitive Bl... » ronaldo, posted by blueberry on November 25, 2006, at 7:25:45
One side effect of Olanzapine is *somnolence*.
I am hoping that getting off the Olanzapine will reduce my somnolence and also get rid of the avolition series of symptoms/side effects.
I wish now that I had never taken Olanzapain. :-(
...ronaldo
Posted by blueberry on November 25, 2006, at 10:44:15
In reply to Re: Avolition, Anhedonia, Flat Affect, Cognitive Bl... » blueberry, posted by ronaldo on November 25, 2006, at 8:22:58
> Thanks for your advice blueberry. Can you tell me what the strength is of your Adrafinil; ie is it 300mg? or is it 100mg? If you take 3 pills a day I would guess that it is 100mg but that is only a guess...
>
> ...ronaldoRonaldo, I hope the post was helpful but I didn't really mean for it to be advice. I was just trying to share ideas with you that worked for me in identical circumstances.
Adrafinil is 300mg per pill. It takes several weeks to work, which is strange for a stimulant. I never took more than 2 pills.
Since modafinil is its primary metabolite, you might get the same effects from it. The drawback is that modafinil is extremely expensive while adrafinil is real cheap.
Posted by ronaldo on November 25, 2006, at 12:31:31
In reply to Re: Avolition, Anhedonia, Flat Affect, Cognitive Bl... » ronaldo, posted by blueberry on November 25, 2006, at 10:44:15
> > Thanks for your advice blueberry. Can you tell me what the strength is of your Adrafinil; ie is it 300mg? or is it 100mg? If you take 3 pills a day I would guess that it is 100mg but that is only a guess...
> >
> > ...ronaldo
>
> Ronaldo, I hope the post was helpful but I didn't really mean for it to be advice. I was just trying to share ideas with you that worked for me in identical circumstances.
>
> Adrafinil is 300mg per pill. It takes several weeks to work, which is strange for a stimulant. I never took more than 2 pills.
>
> Since modafinil is its primary metabolite, you might get the same effects from it. The drawback is that modafinil is extremely expensive while adrafinil is real cheap.You say Adrafinil is real cheap. It costs $69.29 for 80 tabs delivered through your door. Less than $1 per tablet. Modafinil costs $126 for 30 x 200 mg delivered. Plus $4 per pill, yes that is expensive!
Trouble is I will have to wait until I am off the Olanzapain before I can try it.
I appreciate that you cannot give me advice, blueberry, and thank you for sharing your experiences with me. If it all goes pear-shaped I will only have myself to blame. If everything turns out great I will have you to thank for sharing your ideas.
...ronaldo
Posted by blueberry on November 25, 2006, at 13:35:44
In reply to Re: Avolition, Anhedonia, Flat Affect, Cognitive Bl... » blueberry, posted by ronaldo on November 25, 2006, at 12:31:31
> You say Adrafinil is real cheap. It costs $69.29 for 80 tabs delivered through your door. Less than $1 per tablet. Modafinil costs $126 for 30 x 200 mg delivered. Plus $4 per pill, yes that is expensive!
>
> Trouble is I will have to wait until I am off the Olanzapain before I can try it.
>Ronaldo,
I was on 5mg zyprexa and 20mg prozac the entire time I was also using 300mg - 600mg adrafinil, which was about 3 years. Adrafinil and zyprexa were fine together. It breaks down mostly to modafinil, which is prescribed with many psychiatric meds including antipsychotics.
If you do go this route, please re-post when you are set to go. I have been through adrafinil start-ups, adrafinil withdrawal (minor) and zyprexa withdrawal (major). So maybe we can share some tricks.
I thought of another anti-anhedonia med that worked well for me and I just restarted this week...Kira brand st johns wort. Currently at just 300mg. I have taken it with 5mg zyprexa too as high as 900mg. I might be on my way to a Kira + adrafinil + 2.5mg zyprexa combo, with the hopes of slowing carefully dropping the zyprexa by crumbs at a time over a couple months. Though I buy Kira at Rite-Aid where I live, the same stuff is a prescription medication in Germany.
In the meantime, I wish some good babble folks would show up with some more ideas to consider.
Posted by ronaldo on November 25, 2006, at 15:20:32
In reply to Re: Avolition, Anhedonia, Flat Affect, Cognitive Bl... » ronaldo, posted by blueberry on November 25, 2006, at 13:35:44
>
> > You say Adrafinil is real cheap. It costs $69.29 for 80 tabs delivered through your door. Less than $1 per tablet. Modafinil costs $126 for 30 x 200 mg delivered. Plus $4 per pill, yes that is expensive!
> >
> > Trouble is I will have to wait until I am off the Olanzapain before I can try it.
> >
>
> Ronaldo,
>
> I was on 5mg zyprexa and 20mg prozac the entire time I was also using 300mg - 600mg adrafinil, which was about 3 years. Adrafinil and zyprexa were fine together. It breaks down mostly to modafinil, which is prescribed with many psychiatric meds including antipsychotics.
>
> If you do go this route, please re-post when you are set to go. I have been through adrafinil start-ups, adrafinil withdrawal (minor) and zyprexa withdrawal (major). So maybe we can share some tricks.
>
> I thought of another anti-anhedonia med that worked well for me and I just restarted this week...Kira brand st johns wort. Currently at just 300mg. I have taken it with 5mg zyprexa too as high as 900mg. I might be on my way to a Kira + adrafinil + 2.5mg zyprexa combo, with the hopes of slowing carefully dropping the zyprexa by crumbs at a time over a couple months. Though I buy Kira at Rite-Aid where I live, the same stuff is a prescription medication in Germany.
>
> In the meantime, I wish some good babble folks would show up with some more ideas to consider.Thanks again for your thoughts blueberry.
To me it seems strange to be mixing Zyprexa, with its side effect of somnolence, with Adrafinil which is designed to keep one awake. The two seem opposed to each other but then you may not have experienced the somnolence. I do. I've worked out that it is going to take me about ten weeks to get off the Olanzapain :-( so I will have to wait 10 weeks before I can try the Adrafinil. I like to keep it simple - one step at a time.
Last time, two months ago, I came off 5 mg Olanzapine in just under 4 weeks which was much too fast. I had terrible insomnia and some anxiety too, plus my Seroquel wouldn't work and neither would my Zopiclone. I was in a bit of a pickle and in the end I had to go back on the Olanzapine at 10 mg. I am coming off this, slowly this time, and at present I am just down to 7.5 mg. I will reduce further to 5 mg once my GP has prescribed me some. At least I have the Adrafinil to look forward to - a light shining at the end of the tunnel. But I reckon I should feel better just for getting off the Olanzapine.
...ronaldo
Posted by ronaldo on November 27, 2006, at 12:22:40
In reply to Re: Avolition, Anhedonia, Flat Affect, Cognitive Bl... » ronaldo, posted by blueberry on November 25, 2006, at 13:35:44
Hi blueberry
How are you getting on with that packet of Olmifon? Are you still looking at it and going hhmmm or have you breached the blister pack? Crazy Horse (Help...Please) pricked his ears up when I mentioned Adrafinil to him but he thinks it is not available in the USA. I have put him straight on that one and also referred him to you as the Adrafinil fundi (compared to me that is).
It would be nice if quite a few babblers started on it together from the point of view of comparing notes. I hear what you say about using Adrafinil with Zyprexa but I still want to get off the Z first. Last time, two months ago, I messed up by starting Seroquel while I was still coming off the Z. This time I want to do it right. I have a modus operandi from Ed_uk which tells me how to tackle it. It should be fairly easy down to 5mg but after that it will become more difficult. At present I have been on 7.5mg for 13 days. I hope to get a new Rx for 5mg and 2.5mg from my GP tomorrow. If so I will drop to 5mg on Wednesday.
It seems a pity that no other Babblers have shown any interest in Adrafinil so far. Actually I think this thread may be dead now. I would have emailed you (if that is OK with you) but your light was out.
I will post again when I start Adrafinil. May also post if I run into difficulty in tapering off the Zyp. I would be interested in any tips/tricks you may have regarding withdrawing from the Zyp.
ciao for now
....ronaldo
Posted by ronaldo on November 27, 2006, at 16:08:38
In reply to Re: Avolition, Anhedonia, Flat Affect, Cognitive Bl... » ronaldo, posted by blueberry on November 25, 2006, at 13:35:44
Hi blueberry
Ordered 2 x 40 x 300mg
Total cost with delivery = $81
I think I have done the right thing
Now I just have to get off the Zyprexa
...ronaldo
Posted by Crazy Horse on November 30, 2006, at 19:38:46
In reply to Have ordered my Adrafinil - awaiting delivery..... » blueberry, posted by ronaldo on November 27, 2006, at 16:08:38
> Hi blueberry
>
> Ordered 2 x 40 x 300mg
>
> Total cost with delivery = $81
>
> I think I have done the right thing
>
> Now I just have to get off the Zyprexa
>
> ...ronaldoMine was shipped out today Allen. You really want to get off zyprexa first before trying Anafrinil, huh? Be cool if we could start together..but i def. need to start mine as soon as it arrives.
-Monte
Posted by blueberry on November 30, 2006, at 20:10:49
In reply to Hello blueberry...., posted by ronaldo on November 27, 2006, at 12:22:40
Hi ronaldo.
Yeah, I started adrafinil 4 days ago. 150mg the 1st day, 300mg 2nd and 3rd, 450mg 4th day. I got a nice mood lift the first day. Since then I have had good energy and good concentration, no good mood, and a headache. Insomnia the first night, but fine after that. It is strange but adrafinil along with its stimulation also seems to be mildly anti-anxiety at the same time. Weird. Anyway, in my past experience it really didn't start to kick in until week 3, so I have quite a ways to go.
I will probably stay at 300mg which is the dose I took for several years. I might increase it but I have other things to consider. For example, I am on day 10 of withdrawing from 10mg prozac. I am on day 3 of reducing zyprexa from 2.5mg to 1.25mg. I am on day 10 of St Johns Wort, starting at 150mg and yesterday hit 450mg. So there is a lot of stuff going on. I'm kind of in a hurry but also trying to be careful and not change any one thing too dramatically all at once.
Overall I feel uneasy, not well, headachey, disconnected, spacey and a bit nervous, on top of the depression. The withdrawals of prozac and zyprexa combined with starting sjw and adrafinil makes for a very weird feeling. I would have liked to completely withdraw from old meds first, but I know from experience that if I did that I would crash and burn badly.
Posted by ronaldo on December 1, 2006, at 8:39:37
In reply to Re: Hello blueberry.... » ronaldo, posted by blueberry on November 30, 2006, at 20:10:49
> Hi ronaldo.
>
> Yeah, I started adrafinil 4 days ago. 150mg the 1st day, 300mg 2nd and 3rd, 450mg 4th day. I got a nice mood lift the first day. Since then I have had good energy and good concentration, no good mood, and a headache. Insomnia the first night, but fine after that. It is strange but adrafinil along with its stimulation also seems to be mildly anti-anxiety at the same time. Weird. Anyway, in my past experience it really didn't start to kick in until week 3, so I have quite a ways to go.
>
> I will probably stay at 300mg which is the dose I took for several years. I might increase it but I have other things to consider. For example, I am on day 10 of withdrawing from 10mg prozac. I am on day 3 of reducing zyprexa from 2.5mg to 1.25mg. I am on day 10 of St Johns Wort, starting at 150mg and yesterday hit 450mg. So there is a lot of stuff going on. I'm kind of in a hurry but also trying to be careful and not change any one thing too dramatically all at once.
>
> Overall I feel uneasy, not well, headachey, disconnected, spacey and a bit nervous, on top of the depression. The withdrawals of prozac and zyprexa combined with starting sjw and adrafinil makes for a very weird feeling. I would have liked to completely withdraw from old meds first, but I know from experience that if I did that I would crash and burn badly.Hi blueberry,
You sure seem to be very busy with all your meds - starting here, decreasing there, etc etc... I think it is impossible to trace any of your side effects to Adrafinil except on the basis of what happened last time. I hope you emerge unscathed from all these changes. I wish you good luck. I hope you don't crash and burn badly or any other way. Take care. I need your advice for when I start on the Adrafinil experiment.
I might just decide to decrease my Zyprexa only as far as the 5mg, I don't know. It has been a long-held ambition of mine to come off the Zyprexa. It is now a question of honour whether I make it to Zero Zyprexa or not. I don't believe I am psychotic and I don't believe I really need the Zyp. It was originally prescribed for me to get some sleep at night. Several changes of pdocs down the line and I got stuck with one pdoc who latched on to the idea that the Zyp was good for maintaining mood stability. I can imagine his satisfaction when I failed to get off the Zyp last time and what is more I had to restart it at 10mg whereas before I was always steady on 5mg. I got a change of pdoc since then. I haven't quite managed to make my new pdoc out. He is a recent immigrant from South Africa. I don't know if he is any good yet. He tried to get me onto Seroquel but it wouldn't work for me, possibly because I came off the Zyp too quickly. I only get to see him once every three or four months.
Anyway I am down to 5mg now. I reduced from 7.5mg to 5mg on Wednesday night so I am not yet stable on 5mg. I've got 4 weeks supply of both 5mg and 2.5mg. I was really surprized to learn that it costs about £2,000 to keep me in Zyp for a year. Lithium by contrast is only about £40 for a year.
I worry a bit about you juggling so many meds at once. Be careful. I wonder how you can tell which side effect belongs to which drug. Experience I guess. Although I have been on psychiatric drugs for thirty odd years I have never bothered to take an interest in how they work and what they do and what the side effects are. That only changed when I joined psychobabble. I can't even remember how I found out about psychobabble. I guess I should delve into the archives and see if I can find out.
I am sorry to hear you have not been feeling well. Take care, don't crash, don't burn, play it safe...
....alan
Posted by elanor roosevelt on December 3, 2006, at 13:35:53
In reply to Re: Hello blueberry.... » blueberry, posted by ronaldo on December 1, 2006, at 8:39:37
Why Adrafinil rather than Modafinil?
Posted by ronaldo on December 5, 2006, at 11:00:53
In reply to Re: Hello blueberry...., posted by elanor roosevelt on December 3, 2006, at 13:35:53
> Why Adrafinil rather than Modafinil?
Economics: Adrafinil is about 5 times cheaper or thereabouts.
...ronaldo
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.