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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 40 to 64 of 64. Go back in thread:
Posted by jane d on May 3, 2009, at 23:12:56
In reply to Re: drug for motivation!, posted by seldomseen on May 3, 2009, at 11:19:29
> Have you told your pdoc that you recently quit smoking?
>
> Man, I have said this before on this board, but I'm saying it again - quitting smoking radically changes your brain chemistry......
> Most docs are "Yipee! you quit smoking - good for you!" I wish pdocs were more enlightened as to the effect of such an act on our brain chemistry.
>
> Seldom.
AMEN!jane
Posted by softheprairie on May 3, 2009, at 23:59:40
In reply to Re: drug for motivation!, posted by Frustratedmama on May 3, 2009, at 11:19:15
> I am taking vyvanse for adhd right now and zyrtec for allergies. I have a diagnosis of adhd and mood disorder (but my daughter has asperger's). I am thinking I will ask for pristiq- your posts seem to mirror my moods frequently. I have been reading a lot of posts lately! let's pray this works- the lexapro left me feeling worse!I haven't read all of the posts on this thread yet, but I wanted to tell you that some of your fatigue is likely from the Zyrtec. I found it quite tiring. Clairitin (available as generic loratadine) is better in that department.
Posted by desolationrower on May 4, 2009, at 0:09:03
In reply to note to Frustratedmama, posted by softheprairie on May 3, 2009, at 23:59:40
hm. i haven't gottne any stimulants but i used nicotinei lozenges and they help with attention/distraction, but not motivation. my raction to nicotine before, was mostly just 'hm what a wierd tingly sensation'. never had any feel of addiction, though i do like the physicla routine of smoking, so i occasionally do socially, or smoke a pipe, but health/aftersmell kept me from smoking with any routine. dunno if lozenges woudl be worth a try, they might just make you wanta to smoke agian...
also, i probably asked before, but have you tried an nri? i'd fix hypothyroidism first though.
-d/r
Posted by Garnet71 on May 4, 2009, at 11:35:32
In reply to motivation/nicotine, posted by desolationrower on May 4, 2009, at 0:09:03
d/r - well I'm thinking distraction would be related to addiction to nicotine rather than it acting as an aid to concentration...
Yeah, I've tried Effexor....so what made you think of that?
Posted by metric on May 4, 2009, at 13:28:08
In reply to Re: drug for motivation!, posted by garnet71 on May 2, 2009, at 16:18:28
> I think I'm going to stop by PDocs ofc Monday and see if I can get some of the Pristiq samples he has.
If you've taken Effexor (venlafaxine), you've already taken Pristiq (desvenlafaxine). Pristiq is the primary active metabolite of Effexor. Wyeth's exclusivity protection on the extended-release formulation of venlafaxine (Effexor XR) will soon expire (hence Pristiq). I would take Effexor XR instead of Pristiq, if I were going to take either.
> I just realized I have only 1 buspirone left for tonight, then I"m out. I do have 1 xanax too. I don't even have $5 right now to get my scripts filled.
Running out of buspirone is not a cause for panic; running out of Xanax is. I'm surprised anyone still manufactures buspirone.
> My new PDoc appt. isn't for almost 2 months. He charges $300 though, so I have no idea how I'm going to pay him.
Is he going to require you to keep coming back to get new scripts/refills when you run out? Or just when you want to try something different?
> I don't think Ill last till then. My current PDoc works mostly out of a hospital, stablizing patients. I don't think he is experienced in these types of treatments. I know he won't give me the Provigil--we discussed it last appt. He referred me to a new Psychopharmacologist.
I don't think you'd like Provigil very much -- at least not on its own. If you can get some free samples, try it and see how it feels. But even if you like it, it's way too expensive without insurance. Importing it from overseas is a bad idea because it's a controlled substance in the U.S. (you could go to prison).
> But why would I need a mood stabilizer if I have no mood problems?
You wouldn't. Shrinks (not all, but many) will put you all sorts of weird drugs if you let them. Sedated mentally-disabled patients are easier to deal with. Be especially wary of the ones who promote the use of atypical neuroleptics for anxiety, insomnia, etc.
> I just don't understand that stuff. even so, I'm scared of lamictal--memory, cognitive problems, WEIGHT gain. yuck...I haven't yet lost the weight from last ADs. Sometimes I think it would be just better to die than live like that.
>
> I can't even call my son's sister back who wants to know if I'm going to her wedding this month, and before that, didn't even check my voicemails for 2 days. I'm probably losing my friends again, because I've been ignoring calls and breaking plans. I hate this.Does Xanax help?
Posted by metric on May 4, 2009, at 16:57:02
In reply to Re: drug for motivation!, posted by linkadge on May 3, 2009, at 20:40:32
> Stimulants don't always improve motivation however. It depends on the ballance of monoamines in the prefrontal cortex. If dopamine concentrations are already high in the prefrontal cortex, you can actually induce depression by elevating them further.
>
> This is why people take their time and sip coffee when performing certain tasks. The right ratio of dopamine to serotonin will increase motivation, but if you increase dopamine too far you can start to induce depressive, antisocial and/or amotivational syndromes.
>Wow. I had no idea that's why people sip their coffee. I thought they just savored the taste. Or preferred the sustained delivery and consequent minimization of crashes.
> This is why some people compain of depression and apathy on stimulans. If you reach this point, the stimulant does not increase motivation but rather decreases it. In this case, you may actually benifit from a lower dose, or even the addition of an SSRI.
Or neurotransmitter depletion and/or receptor desensitization and/or a million other factors.
Unfortunately, neuroscience hasn't reached the stage where such nuanced interpretations of neurochemical phenomena can be regarded as more than wild conjecture. The brain remains a black box, especially as it concerns the more subtle variations that give rise to changes in mood-related areas.
Posted by linkadge on May 4, 2009, at 17:34:38
In reply to Re: drug for motivation!, posted by metric on May 4, 2009, at 16:57:02
>Wow. I had no idea that's why people sip their >coffee. I thought they just savored the taste. >Or preferred the sustained delivery and >consequent minimization of crashes.Not necessarily. There is the same phenomina with smoking. Some studies show that smokers will smoke to reach a certain level of MAO inhibition. In certain animal models of depression there is an increase in prefrontal dopaminergic neurotransmission. The same appears to be true in humans. Depressed patients who responded to ketamine for instance experienced a decrease in prefrontal cortex metabolism. See:
http://www.sciencedaily.com/releases/2008/05/080506112416.htm
Increasing prefrontal cortex function doesn't always result in improved mood. There is a threshold effect beyond which you can worsen mood. For certain depressions, drugs which increase prefrontal metabolism can substantially worsen depression. Wellbutrin for instance, makes some people acutely worse.
>Unfortunately, neuroscience hasn't reached the >stage where such nuanced interpretations of >neurochemical phenomena can be regarded as more >than wild conjecture. The brain remains a black >box, especially as it concerns the more subtle >variations that give rise to changes in mood->related areas.
I like to think I am a step above conjecture.
Linakdge
Posted by garnet71 on May 4, 2009, at 19:14:39
In reply to Re: drug for motivation! » garnet71, posted by metric on May 4, 2009, at 13:28:08
Yeah, Metric, I know about the patent extender Pristiq. I thought I could get loads of it free since the drug reps are now pushing it. but I'm really having trouble getting myself to take it (ask for it)....I think I like my little experiment-alternating dextro with ritalin (for now!); every other day...until I see new doctor...I'd hate to take something that messes me all up whem my mood is good every single day.
Don't be angry at my buspirone...I love the stuff...you must be taking too much xanax (you forget we talked about this). lol
I don't know about new pdoc yet..appt is not for 2 months..but yeah, xanax helps w/anxiety....but not motivation. I still take .25 xanax...actually, more lately so I'll likely run out.
what I really need is treatment for hypothyrodism...been thinking about that since yesterday.
Posted by jane d on May 4, 2009, at 20:57:06
In reply to Re: drug for motivation! » garnet71, posted by metric on May 4, 2009, at 13:28:08
> I don't think you'd like Provigil very much -- at least not on its own. If you can get some free samples, try it and see how it feels. But even if you like it, it's way too expensive without insurance. Importing it from overseas is a bad idea because it's a controlled substance in the U.S. (you could go to prison).
>Since when is it a controlled substance?
I do agree it's way too expensive. And I don't think it's a miracle drug. But it certainly wasn't controlled when I took it. In fact I got the impression that perhaps some docs liked prescribing it instead of cheaper, more effective stimulatants just BECAUSE it wasn't controlled.
jane
Posted by Garnet71 on May 4, 2009, at 21:12:05
In reply to Re: drug for motivation! » metric, posted by jane d on May 4, 2009, at 20:57:06
Provigil: $ cha-ching
lol
http://www.usdrugstoreonline.com/DrugInfo.aspx?id=6010&RefID=Microsoft
Not that I would order it from that pharmacy if I had a script....I'm going to call the grocery store pharmacy that charges about 1/3 of the price with a AAA card....(and they even gave me 2 Buspirones for free yesterday!). Maybe it could be obtained much cheaper if anyone were to look around.
Posted by 10derHeart on May 4, 2009, at 23:38:09
In reply to Re: drug for motivation! » metric, posted by jane d on May 4, 2009, at 20:57:06
hi jane,
Not sure when, but it seems to be listed on Schedule IV of controlled substances, at least it was as of April 2008. (Along with valium, Xanax, ativan and many others far less familiar to me.)
Something like "low potential for abuse, but could cause a chemical or psychological depedence..."
http://www.deadiversion.usdoj.gov/21cfr/cfr/1308/1308_14.htm
I know - I was also surprised. Maybe they added it some time after you were taking it?
Posted by jane d on May 5, 2009, at 1:50:55
In reply to Re: drug for motivation! » jane d, posted by 10derHeart on May 4, 2009, at 23:38:09
> hi jane,
>
> Not sure when, but it seems to be listed on Schedule IV of controlled substances, at least it was as of April 2008. (Along with valium, Xanax, ativan and many others far less familiar to me.)
>
> Something like "low potential for abuse, but could cause a chemical or psychological depedence..."
>
> http://www.deadiversion.usdoj.gov/21cfr/cfr/1308/1308_14.htm
>
> I know - I was also surprised. Maybe they added it some time after you were taking it?Well so it is, 10derheart. Tucked in with all the "pams" as well as Sonata and Ambien. I imagine it always was there but having once jumped through the hoops required for Adderall & Ritalin (sched II) I didn't think of sched IV as being controlled. I wonder what the practical implications are if any?
" could cause a chemical or psychological depedence..." That sounds like a description of my chocolate Haagen Daz as well as most of the meds discussed here.
Thanks for finding and posting that link 10der. I should have tried to check before I posted.
Jane
Posted by jane d on May 5, 2009, at 2:05:50
In reply to Re: drug for motivation!, posted by Garnet71 on May 4, 2009, at 21:12:05
> Provigil: $ cha-ching
>
> lol
>$400 for a months supply? Yikes. Think how much good coffee you could buy for that money! Or even bad coffee. And it might end up working as well.
Seriously though. Have you tried caffeine? There's a reason coffee and college students seem to go together. I remember once realizing that I'd weaned myself mostly off caffeine in one half of my health regimen at the same time that I was raising my stimulant dose in the other. Talk about counterproductive!
jane
Posted by metric on May 5, 2009, at 11:04:31
In reply to Re: drug for motivation!, posted by linkadge on May 4, 2009, at 17:34:38
> Not necessarily. There is the same phenomina with smoking. Some studies show that smokers will smoke to reach a certain level of MAO inhibition. In certain animal models of depression there is an increase in prefrontal dopaminergic neurotransmission. The same appears to be true in humans. Depressed patients who responded to ketamine for instance experienced a decrease in prefrontal cortex metabolism. See:
>
> http://www.sciencedaily.com/releases/2008/05/080506112416.htm
>
> Increasing prefrontal cortex function doesn't always result in improved mood. There is a threshold effect beyond which you can worsen mood. For certain depressions, drugs which increase prefrontal metabolism can substantially worsen depression. Wellbutrin for instance, makes some people acutely worse.Hi Link,
I'm not arguing that "increasing prefrontal cortex function" necessarily improves mood -- just that there's so much other stuff going on that it's impossible to make inferences about subtle human behaviors based on observational correlations of changes in regional brain activity.
Posted by metric on May 5, 2009, at 13:13:44
In reply to Re: drug for motivation! » metric, posted by jane d on May 4, 2009, at 20:57:06
> > I don't think you'd like Provigil very much -- at least not on its own. If you can get some free samples, try it and see how it feels. But even if you like it, it's way too expensive without insurance. Importing it from overseas is a bad idea because it's a controlled substance in the U.S. (you could go to prison).
> >
>
> Since when is it a controlled substance?Its inception (in the United States).
> I do agree it's way too expensive. And I don't think it's a miracle drug. But it certainly wasn't controlled when I took it. In fact I got the impression that perhaps some docs liked prescribing it instead of cheaper, more effective stimulatants just BECAUSE it wasn't controlled.
It's C-IV, which places it in the same federal schedule as the benzodiazepines. The other commonly used stimulants (methylphenidate and amphetamine) are C-II, and the restrictions are much tigher on these drugs. Pemoline (Cylert) is also C-IV but is rarely used anymore because of hepatoxicity (I'm not sure offhand whether it's even still on the market).
See for yourself:
http://www.deadiversion.usdoj.gov/schedules/alpha/alphabetical.htmThat's essentially an alphabetical listing of the drugs Americans find desirable, along with a ranking system in which individual drugs are rated on a scale of 1-5, with 1 being the most and 5 the least sought after, respectively. It's an inverted 5-star system. It reels the mind that not one single "antidepressant" (a category of supposedly mood-elevating chemicals) has managed to secure a place in the top five. Just what are antidepressants supposed to *do*?
Posted by metric on May 5, 2009, at 13:15:52
In reply to Re: drug for motivation! » metric, posted by garnet71 on May 4, 2009, at 19:14:39
> Yeah, Metric, I know about the patent extender Pristiq. I thought I could get loads of it free since the drug reps are now pushing it. but I'm really having trouble getting myself to take it (ask for it)....I think I like my little experiment-alternating dextro with ritalin (for now!); every other day...until I see new doctor...I'd hate to take something that messes me all up whem my mood is good every single day.
Yeah, why ruin a good thing?
> Don't be angry at my buspirone...I love the stuff...you must be taking too much xanax (you forget we talked about this). lol
Nah, I didn't forget about your buspirone.. How could I? You must be the only one on the planet taking it. <g> (I don't take Xanax BTW -- just a single dose of clonazepam h.s., which I'm slowly tapering, as always.)
Posted by metric on May 5, 2009, at 13:30:03
In reply to Re: drug for motivation! » Garnet71, posted by jane d on May 5, 2009, at 2:05:50
BTW, inexpensive generic modafinil would be available if it weren't for Cephalon's antitrust violations. I mentioned this a while back here:
FTC lawsuit against Cephalon
http://www.dr-bob.org/babble/20090313/msgs/886268.html
Posted by linkadge on May 5, 2009, at 18:19:55
In reply to Re: drug for motivation! » linkadge, posted by metric on May 5, 2009, at 11:04:31
>just that there's so much other stuff going on >that it's impossible to make inferences about >subtle human behaviors based on observational >correlations of changes in regional brain >activity.
Its never impossible to make inferences.
Linkadge
Posted by Garnet71 on May 5, 2009, at 21:18:30
In reply to Re: drug for motivation! » garnet71, posted by metric on May 5, 2009, at 13:15:52
"Nah, I didn't forget about your buspirone.. How could I? You must be the only one on the planet taking it."
So they manufacture Buspirone just for me? Or- are there people on other planets who take it?
lol
Seriously-where is this unkown knowledge that Buspirone does not work "at all"?
Show me how it is any different than any of the SSRIs in terms of effectiveness.
I'm also guessing you've tried it and it didn't work for you.....
I happen to really LIKE it....
So how about sharing this knowledge-and clearing this up once and for all...
Or are you concerned they will quit producing buspirone if I--the sole user of the drug-decided to quit taking it?
Posted by metric on May 6, 2009, at 18:14:27
In reply to Re: drug for motivation!, posted by linkadge on May 5, 2009, at 18:19:55
> >just that there's so much other stuff going on >that it's impossible to make inferences about >subtle human behaviors based on observational >correlations of changes in regional brain >activity.
>
> Its never impossible to make inferences.Geez, I had actually used the qualifier "reasonable" in my original wording, but removed it because it seemed superfluous in consideration of the meaning of the word "impossible", which doesn't only mean "not possible" according to actual usage or any English dictionary I've consulted. I didn't want say "conclusion", because it implies too much certainty.
Posted by desolationrower on May 14, 2009, at 3:13:33
In reply to Re: drug for motivation! » metric, posted by garnet71 on May 4, 2009, at 19:14:39
people sip cofffee for the same reason they sip from water bottles. need a little flavor or even just texture every little while. really i can't imagine feeling much from coffee. it just tastes nice.
and nri? effexor isn't a real nri silly. but one might help with anxiety more consistantly than stimulants.
-d/r
Posted by Amelia_in_StPaul on May 18, 2009, at 22:44:15
In reply to Re: drug for motivation! » metric, posted by Garnet71 on May 5, 2009, at 21:18:30
I get sick of hearing this, too. I realize that there isn't as great a response as the drug manufacturers wanted but golly, can't I try this instead of benzos, which I am now dependent on? I mean, to just try? But no, I always get the response that Buspirone doesn't work. Sure, sure. And Prozac is a wonder drug.
> Seriously-where is this unkown knowledge that Buspirone does not work "at all"?
>
Posted by Amelia_in_StPaul on May 18, 2009, at 22:57:48
In reply to Re: drug for motivation!, posted by garnet71 on May 2, 2009, at 18:50:44
This may help. I have atypical depression: it's not that I can't get out of bed, it's that I have some days where I am "in the tank" so to speak, and others where I seem to function okay. Typical of atypical depression, harharhar, is that my mood depends on what's happening around me--very situational, in a micro way.
At the same time, I have ADD, subtype inattentive. I had a bunch of tests, including the neurolex test (http://www.addforums.com/forums/showthread.php?t=22136)--have you had tests yet, a confirmation?
Like you, it is hard for me to get motivated. That's obviously part of depression, but it happens when depression lifts, too. Unlike you, I get distracted easily, unless I am really "into" what I am doing. I can also get very overfocused, spending hours more time on something than I should. Hard to pull myself away.
Still, because anxiety has become such a huge part of the picture lately, my therapist questions whether a mood stabilizer would help. But I am totally resistant. I have read that Lamictal, for instance, can impact word recall--not something a writer/editor needs!!
It's all really confusing. One thing I know--I too need something for motivation. I have also asked my pdoc for Provigil and have not gotten it. I don't understand why they are so resistant. Is it an insurance thing? My sleep study doc said that insurance's algorithm is first the doc tries you on Ritalin and Adderall, then Provigil. But I have just about the best insurance ever, and a diagnosis of ADD (and have not tolerated Adderall). So wtf? I'm ditching my pdoc anyway. He doesn't seem to think the ADD is worth working on. Baaaahhhh.
> see - that's the thing! I am interested/motivated in some activities/people but not others......it seems like ADD amplified...symptoms have progressed real bad at this point...which is a reason I had previously asked if ADD could be progressive......so if I was in a depressive state-not just based soley on your ancedotal experience--but taking everything else into account--it would be 'all or nothing'. I remember being depressed years ago too. Well, a little bit. See what I mean, jellybean?
>
> Well I'm going to try a little experiment-I don't think it's harmful at all...I'm going to take dextro one day, Ritalin the next. I just remembered I have a bunch of Ritalin left. I need some nicotine gum though...i wonder if you can get that free anywhere? I don't want to start up w/cigarettes again - when I almost had a breakdown in January, i started cigarettes again, but recently quit again.
>
> I don't want to get caught up in mood stablizers/anti-convulsant trials unless necessary. I'll probably try the Pristiq next week. Just worried it will make me too tired to function for a while. But I could see how the dextro/ritalin experiment works first...only 2 more weeks till I graduate from UG school, can't screw it up now. and gotta sell my home. what to do - ? -
>
> Thanks for all your help and advice Scott! Have a nice evening! :-)
Posted by Amelia_in_StPaul on May 18, 2009, at 23:06:27
In reply to Re: drug for motivation! » Garnet71, posted by Amelia_in_StPaul on May 18, 2009, at 22:44:15
I didn't read the whole thread. So I'm not aiming my rant at any particular person here.
> I get sick of hearing this, too. I realize that there isn't as great a response as the drug manufacturers wanted but golly, can't I try this instead of benzos, which I am now dependent on? I mean, to just try? But no, I always get the response that Buspirone doesn't work. Sure, sure. And Prozac is a wonder drug.
>
>
>
>
> > Seriously-where is this unkown knowledge that Buspirone does not work "at all"?
> >
Posted by Vincent_QC on May 22, 2009, at 8:33:17
In reply to apologies to whomever said that about Buspirone, posted by Amelia_in_StPaul on May 18, 2009, at 23:06:27
> I didn't read the whole thread. So I'm not aiming my rant at any particular person here.
>
> > I get sick of hearing this, too. I realize that there isn't as great a response as the drug manufacturers wanted but golly, can't I try this instead of benzos, which I am now dependent on? I mean, to just try? But no, I always get the response that Buspirone doesn't work. Sure, sure. And Prozac is a wonder drug.
> >
> >
> >
> >
> > > Seriously-where is this unkown knowledge that Buspirone does not work "at all"?
> > >
>
>Hummm... peoples don't realize that a med can work on them, and another one don't... That's different for everyone... That's easy to say that a med worth nothing when it's not working on us, but when it's working, that's also easy to say it's a wonderfull med, the more good in the world!!! lol
For me Buspirone never work, but that doesn't mean it worth nothing...
This is the end of the thread.
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