![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 23 of 23. This is the beginning of the thread.
Posted by ronaldo on December 16, 2006, at 12:44:15
I suffer from the negative symptoms of schizophrenia namely:
affective flattening, alogia, apathy, AVOLITION and social withdrawal. Am I right in saying that these symptoms are caused by a dopamine deficit in certain areas of the brain? "Reduced dopamine concentrations in the prefrontal cortex are thought to contribute to attention deficit disorder and negative schizophrenia." [Wikipedia] Am I also right in saying that Zyprexa is a dopamine antagonist? IOW is Zyprexa helping to maintain my negative schizophrenia symptoms by starving my brain of dopamine?My dx is bipolar disorder in remission but most pdocs thought I was question mark schizoaffective disorder. One doctor was unconvinced that I was bipolar and unconvinced that I was schizoaffective. I just wish I could clear my brain of the Zyprexa and make a new start.
I ask all you educated people, with tears in my eyes, please lend me your attention. I need to find out what is wrong with me. I only see the pdoc once in every three or four months and then only for fifteen minutes. I have to take control of my illness myself. I have only my gratitude and good will to offer in return.
....ronaldo
Posted by dessbee on December 16, 2006, at 13:39:59
In reply to Dopamine deprivation - starvation?, posted by ronaldo on December 16, 2006, at 12:44:15
Your diagnosis seems uncertain.
Have you experienced any positive symptoms of schizophrenia (delusions, auditory hallucinations, thought disorder)?
In my opinion negative symptoms of schizophrenia could also be symptoms of depression.
There is also the possibility that you are suffering from psychotic depression. Patients with psychotic depression also show schizophrenic's positive symptoms. The difference is that patients with psychotic depression usually are aware that these thoughts are not true.
Posted by laima on December 16, 2006, at 15:33:30
In reply to Dopamine deprivation - starvation?, posted by ronaldo on December 16, 2006, at 12:44:15
I'm not savvy enough about bio-chem to know much about zyprexa or ADD meds are thought to work, but I do read zyprexa's supposed to help the negative symptoms you mention for many people, and know that it is also prescribed for depression as well as for schizophrenic symptoms. But I've used both zyprexa and stimulants, and they don't seem to cover the same issues, and they sure don't produce the same effects. I'm guessing they work quite differently.
Stimulants such as ritalin and adderall have helped me considerably with issues such as apathy, avolition, and social withdrawal, among others. My first short trail of zyprexa was quite helpful in terms of mood and sociability, but second trial a few years later mostly made be groggy and gave a voracious appetite. Not sure why. I personally didn't do well with its side effects either time.
I hope you experience some relief soon.
Best wishes,
Laima
> I suffer from the negative symptoms of schizophrenia namely:
> affective flattening, alogia, apathy, AVOLITION and social withdrawal. Am I right in saying that these symptoms are caused by a dopamine deficit in certain areas of the brain? "Reduced dopamine concentrations in the prefrontal cortex are thought to contribute to attention deficit disorder and negative schizophrenia." [Wikipedia] Am I also right in saying that Zyprexa is a dopamine antagonist? IOW is Zyprexa helping to maintain my negative schizophrenia symptoms by starving my brain of dopamine?
>
> My dx is bipolar disorder in remission but most pdocs thought I was question mark schizoaffective disorder. One doctor was unconvinced that I was bipolar and unconvinced that I was schizoaffective. I just wish I could clear my brain of the Zyprexa and make a new start.
>
> I ask all you educated people, with tears in my eyes, please lend me your attention. I need to find out what is wrong with me. I only see the pdoc once in every three or four months and then only for fifteen minutes. I have to take control of my illness myself. I have only my gratitude and good will to offer in return.
>
>
> ....ronaldo
Posted by laima on December 16, 2006, at 15:53:30
In reply to Re: Dopamine deprivation - starvation? » ronaldo, posted by dessbee on December 16, 2006, at 13:39:59
There was something in the news a while ago about some experts now debating whether or not "schiozophrenia" was useful as a diagnostic term. I think their point was that the term was being used for too wide of an array of symptoms, or something like that.
Just thought that was interesting, possibly relevant here for you. I tried to look it up just now, but not much luck.
Posted by ronaldo on December 16, 2006, at 17:24:37
In reply to Re: Dopamine deprivation - starvation? » ronaldo, posted by dessbee on December 16, 2006, at 13:39:59
Hello dessbee,Thank you for your response. No I do not have any of the positive symptoms of schizophrenia. No hallucinations, no delusions, no thought disorder. Social isolation makes it hard to assess myself but I think I am self-aware enough and possessed of sufficient insight to make a true report.
I feel considerable frustration because it seems to me that the Zyprexa which is supposed to relieve my negative symptoms depletes the dopamine which causes a dopamine deficit which is RESPONSIBLE for the negative symptoms of schizophrenia (in the first place). There seems to be a vicious circle here.
"Moreover, a dopamine deficit has been also hypothesized as the central mechanism explaining the negative symptoms of schizophrenia. These symptoms are the consequence of a deficit of normal behaviours and include affective flattening, alogia, apathy, avolition and social withdrawal. There is thus a great overlap between symptoms of depression and negative symptoms of schizophrenia."
and
"The mechanism of action of olanzapine is unknown, however it is theorized that olanzapine's antipsychotic activity is mediated primarily by antagonism at dopamine receptors(does not allow dopamine to activate the dopamine receptors), specifically D2. Serotonin antagonism may also play a role in the effectiveness of olanzapine, but the significance of 5-HT2A antagonism is debated among researchers."
Why am I taking a medicine - Zyprexa - which theoretically seems to be reinforcing my negative symptoms? Am I mad or is my doctor mad?
....ronaldo
> Your diagnosis seems uncertain.
>
> Have you experienced any positive symptoms of schizophrenia (delusions, auditory hallucinations, thought disorder)?
>
> In my opinion negative symptoms of schizophrenia could also be symptoms of depression.
>
> There is also the possibility that you are suffering from psychotic depression. Patients with psychotic depression also show schizophrenic's positive symptoms. The difference is that patients with psychotic depression usually are aware that these thoughts are not true.
Posted by ronaldo on December 16, 2006, at 17:31:12
In reply to Re: Dopamine deprivation - starvation? » ronaldo, posted by laima on December 16, 2006, at 15:33:30
Hello laima,
Thanks for your response. I think I must try a stimulant. I bought some Adrafinil which if I recall correctly is a mild stimulant. I plan to try it once I have successfully withdrawn from my Zyprexa which is good in the short term but presents withdrawal difficulties in the longer term.
....ronaldo
Posted by laima on December 16, 2006, at 17:48:39
In reply to Re: Dopamine deprivation - starvation?, posted by ronaldo on December 16, 2006, at 17:31:12
Good luck with withdrawing from zyprexa- part of what didn't work for me was in fact that I too suspected it of bringing on in myself precisely much of what it was supposedly treating. (I don't think my doctor ever quite believed that, but that's another story.) I've had very good response to stimulants for exactly these sorts of symptoms, especially the adderall. I think there is good reason to hope you'd get considerable relief from a stimulant yourself.
> Hello laima,
>
> Thanks for your response. I think I must try a stimulant. I bought some Adrafinil which if I recall correctly is a mild stimulant. I plan to try it once I have successfully withdrawn from my Zyprexa which is good in the short term but presents withdrawal difficulties in the longer term.
>
> ....ronaldo
Posted by Phillipa on December 16, 2006, at 17:52:53
In reply to Re: Dopamine deprivation - starvation? » dessbee, posted by ronaldo on December 16, 2006, at 17:24:37
Ronaldo if you are bipolar wouldn't a stinulant be bad for you? I'm not into the chemicals either. Love Phillipa
Posted by Tomatheus on December 16, 2006, at 18:58:15
In reply to Dopamine deprivation - starvation?, posted by ronaldo on December 16, 2006, at 12:44:15
> IOW is Zyprexa helping to maintain my negative schizophrenia symptoms by starving my brain of dopamine?
Ronaldo,
Have you noticed any benefits from Zyprexa? If not, I'm curious as to what your pdoc's rationale is for keeping you on it.
Tomatheus
P.S. What does IOW mean? Just wondering.
Posted by xbunny on December 16, 2006, at 20:40:15
In reply to Dopamine deprivation - starvation?, posted by ronaldo on December 16, 2006, at 12:44:15
> I suffer from the negative symptoms of schizophrenia namely:
> affective flattening, alogia, apathy, AVOLITION and social withdrawal. Am I right in saying that these symptoms are caused by a dopamine deficit in certain areas of the brain? "Reduced dopamine concentrations in the prefrontal cortex are thought to contribute to attention deficit disorder and negative schizophrenia." [Wikipedia] Am I also right in saying that Zyprexa is a dopamine antagonist? IOW is Zyprexa helping to maintain my negative schizophrenia symptoms by starving my brain of dopamine?I think its too easy to miss the qualifiers when it comes to psychiatric medications and statements about brain chemisty. Examine:
"Reduced dopamine concentrations in the prefrontal cortex are thought to contribute to attention deficit disorder and negative schizophrenia." [Wikipedia]
The qualifer is 'thought to contribute' - they dont know, its a guess.
"How Does ZYPREXA Work?
Illnesses that affect the brain, such as schizophrenia and bipolar disorder, are thought to be caused by certain chemicals in the brain being out of balance. Although it is not entirely clear how antipsychotic medications work in the body, it is believed that ZYPREXA works by adjusting the imbalance of chemicals in the brain that may cause psychotic symptoms."
[from http://www.zyprexa.com/patient/faqs.jsp]That is fairly clear that the action of zyprexa is unclear again the action is an informed guess.
To me even this is bunk. How is anyone to know whether what your problems are the negative symptoms of schizophrenia or depression or bipolar disorder or something else we dont know about yet?
Not yet can anyone say whether you have a dopamine imbalance or a serotonin sensitivity or some thing else entirely.My opinion is that if you think the medication is not helping you and you feel you have given it an adequate trial then drop it and move onto something else.
>
> My dx is bipolar disorder in remission but most pdocs thought I was question mark schizoaffective disorder. One doctor was unconvinced that I was bipolar and unconvinced that I was schizoaffective. I just wish I could clear my brain of the Zyprexa and make a new start.To me that sounds like a great idea. If I were you if zyprexa wasnt working and I had given it a fair trial then I wouldnt take it. Doubly so if I felt that it was infact being detrimental.
>
> I ask all you educated people, with tears in my eyes, please lend me your attention. I need to find out what is wrong with me. I only see the pdoc once in every three or four months and then only for fifteen minutes. I have to take control of my illness myself. I have only my gratitude and good will to offer in return.My advice would be to take control of the mental health services. If your not happy seeing the psychiatrist every 3-4 months try to get more frequent appointments, perhaps you can ask to be shortlisted for cancellation appointments or maybe just nagging will work. See if you can get other services; a psychiatric nurse, a therapist of some kind, group services, a support worker - anything is worth a try if you havent already tried it.
From a personal point of view I found that I was much more able to take a rational viewpoint of my illness when I stopped trying to work out what exactly it was or precisely why the things that 'should' work didnt do the expected things. It relates back to the qualifiers statement, if you miss the qualifiers you might well beleive that the science is rather more there than it actually is.
Bunny
Posted by ronaldo on December 17, 2006, at 4:01:43
In reply to Re: Dopamine deprivation - starvation? » ronaldo, posted by Tomatheus on December 16, 2006, at 18:58:15
Posted by ronaldo on December 17, 2006, at 4:07:48
In reply to Re: Dopamine deprivation - starvation? » ronaldo, posted by xbunny on December 16, 2006, at 20:40:15
Thanks for your opinion bunny. I think I will take your advice. Not trying to rationalize the uncertain is good advice. Have you got any tips on how to withdraw from Zyprexa?
......ronaldo
Posted by hgi698 on December 17, 2006, at 11:55:24
In reply to Re: Dopamine deprivation - starvation? » xbunny, posted by ronaldo on December 17, 2006, at 4:07:48
There are several medicines that may improve negative symptoms. These include selegiline (Mao-b selective dose around 5 mg), mirtazapine, amisulpride. Do a search for these and "negative schizophrenia" on this website:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi
you should be able to find a few papers published.
There is also an article titled "Negative symptoms: A review of schizophrenia, melancholic depression and Parkinson's disease." Basically it says that negative symptoms are found in several different disorders.
Other things that might help negative symptoms include adderall, ritalin, wellbutrin, buspirone, glycine (a supplement you can buy at iherb.com takes 30 to 60 grams per day to work, I tried it and it made me feel worse though), transcranial magnetic stimulation on the dorsolateral prefrontal cortex (not FDA approved), Gaba-A alpha 2 modulators (not out yet) that's about it.
Posted by xbunny on December 17, 2006, at 13:29:59
In reply to Re: Dopamine deprivation - starvation? » xbunny, posted by ronaldo on December 17, 2006, at 4:07:48
[This should be redirected to withdrawal probably - the content doesnt in general just apply to withdrawal though]
> Thanks for your opinion bunny. I think I will take your advice. Not trying to rationalize the uncertain is good advice. Have you got any tips on how to withdraw from Zyprexa?
Well probably the most useful advice I can offer is to discuss the withdrawal in as great detail as you can with your psychiatrist. Together you should try to cover the situations you expect to encounter, here are some ideas of mine:
what is the likely hood additional temporary agents such as sleeping pills or antianxiety agents will be required? how will you get access to them? If they might be required what will you take? at what point should you consider using them? For how long? what is thier part in the plan?
Do you have a number of the mental health services your psychiatrist is attached to that you can call in (a) an emergency, (b) should you require advice and wish to talk to a professional, Who can you talk to? what is the lag time to get to talk to someone? what situations require which people? and at what timescale?
What is the overall plan? are you planning to get off zyprexa and onto another medication? would a cross taper be less stressful (likely if the next agent is also an antipsychotic), similarly if the next agent is not an antipsychotic or if you feel the side effects might be manageable it might be better to start the other med and then taper off the zyprexa after you are successfully on the new medication. What other options are there? maybe a reduction of zyprexa and a reassessment, maybe a reduction and the addition of a new agent? something else entirely? Are you ready to stop zyprexa? where is your treatment going? what is the goal?
Try to set milestones, get the psychiatrist to agree that if the situation at time period X is not what is expected then the two of you will review the plan.
You should also discuss the plan with someone close to you, a family member, partner, friend whatever. If you know that someone can offer you support and also perhaps keep a little eye on you it can help you feel more secure should things start to get unmanageable and maybe help you persist throught those experiences. Finally be sure to know what you are expecting, how are you expecting to feel, what will you do when you feel like X, are your expectations realistic? what is the psychiatrists view of this? do you think his expectations are realistic?So anyways discuss it with your psychiatrist, again my opinion is that failure to do so or failure to make an adequately complete treatment plan is probably going to result in a mess! I dont think this applies to just withdrawal, I think to acheive some kind of reasonable chance of decent treatment you need to plan as skillfully as you can.
Bunny
Posted by ronaldo on December 17, 2006, at 15:05:34
In reply to Re: Dopamine deprivation - starvation?, posted by hgi698 on December 17, 2006, at 11:55:24
Posted by ronaldo on December 17, 2006, at 15:34:37
In reply to Re: Dopamine deprivation - starvation? » ronaldo, posted by xbunny on December 17, 2006, at 13:29:59
Wow thanks Bunny,
You sure believe in covering all the bases :-)
I'm more of a haphazard guy myself which is why I always get into trouble. I only see my pdoc second week of January. I might phone him before then but during my first w/d he was not a lot of use. He prescribed Seroquel which just would not work no matter how I tried it. I have got some Trazodone 50mg and 100mg and I plan to take 50mg tonight for sleep just to see how it works. I predict major insomnia in the weeks to come, especially when I get down to 2.5mg. I am hoping the Trazodone will alleviate this. I only have 3 x 50mg capsules and 13 x 100mg but if it works I can get some more from my GP who is very good to me.
Last w/d I did suffer some anxiety but I put that down to the Seroquel but it could easily have been the Zyprexa. Will Trazodone at such a low dose have any effect on anxiety? Insomnia when it gets really bad tends to send me manic not hyper but just the other side of hypo.
I don't have a very good working relationship with my pdoc. He has only just taken over from another pdoc and we don't really know each other yet. But he is good at returning my calls so that is a plus.
After I have got off the Zyprexa I am going to start a course of Adrafinil, a poor relation of Provigil, which is billed as a psycotonic - there were quite a few posts on it a few weeks ago. But that is way in the future. I will just be glad to be free of the Zyprexa which does exactly nothing for me. Adrafinil will have to wait until Feb. or March.
Thanks for your detailed post. I will come back to it often to plan my strategy. I am sure it will be very useful. I wish I could email my pdoc - that would make things so convenient. I think I will phone up his secretary and see if he has an email address.
....ronaldo
Posted by linkadge on December 17, 2006, at 20:41:00
In reply to Re: Dopamine deprivation - starvation? » xbunny, posted by ronaldo on December 17, 2006, at 15:34:37
For starters, why was the zyprexa prescribed?
It may not be that the zyprexa is such a bad idea. It may just be that you need an additional medication to help negative symptoms.
Some hypothesize that in schizophrenia dopamine is excessive in certain arease (limbic), and hypofunctional in other areas (frontal cortex etc)
If you were experiencing positive symptoms then it may be a good idea to keep a low dose of zyprexa onboard.
Zyprexa may not be *starving* your brain of dopamine. As mentioned before, zyprexa also antagonizes certain serotonin receptors which will acutally release dopamine in certain areas of the fronal cortex.
Go to the qwick-e-mart and pick up some Red Bull.The combination of caffiene and taurine has a synergistic activity on dopamine in the frontal cortex. It also contains some vitamins which may benifit.
You might also look at omega-3, which increases frontal cortex dopamine content, and possably prescription stimulants.
Linkadge
Posted by laima on December 17, 2006, at 21:53:29
In reply to Re: Dopamine deprivation - *get some red bull!*, posted by linkadge on December 17, 2006, at 20:41:00
So I've been wondering, drinks like Red Bull really do something more than a really strong cup of coffee? Does the taurine (and/or other ingredients) really make a difference? And most importantly, does Red Bull taste ok, or weird?Thanks,
Laima> Go to the qwick-e-mart and pick up some Red Bull.
>
> The combination of caffiene and taurine has a synergistic activity on dopamine in the frontal cortex. It also contains some vitamins which may benifit.
Posted by linkadge on December 18, 2006, at 7:45:32
In reply to Re: Dopamine deprivation - *get some red bull!* » linkadge, posted by laima on December 17, 2006, at 21:53:29
Red bull tastes just fine to me. Its not a crazy herbal taste like other energy drinks.
Theres like 1000mg of taurine in it, so that will *definately* have more of an effect than just caffine.
I've had a few people with "schizohprenai" say it helps them a lot more than the stimulants they've been prescribed.
Caffiene does not increase limbic dopamine nearly as much as amphetamine or ritaline. IT seems to be selective to the frontal cortex.
Tarine works like an anticonvulsant. Anticonvulsants like depakote, or tegretol will further decrease limbic dopamine, and increase dopamine release in the frontal cortex.
(infact some authors speculate that shizohprenia is purely due to the hypofunctioning frontal cortex, and its failure to controll overactive limbic cicutry. That is why in some cases amphetamines can be powerfull anti-manic agents!)
Turn on the frontal cortex, turn off the limbic system.Linkadge
Posted by laima on December 18, 2006, at 9:14:09
In reply to Re: Dopamine deprivation - *get some red bull!*, posted by linkadge on December 18, 2006, at 7:45:32
Posted by kelv on December 18, 2006, at 19:14:50
In reply to Re: Dopamine deprivation - *get some red bull!*, posted by linkadge on December 18, 2006, at 7:45:32
> Theres like 1000mg of taurine in it, so that will *definately* have more of an effect than just caffine.
How so? Caffeine is a stimulant, while Taurines a depressant
>
> I've had a few people with "schizohprenai" say it helps them a lot more than the stimulants they've been prescribed.In what way?-REALLY a $1 bottle of fizzy drink helps more than a Sch II drug?
>
> Caffiene does not increase limbic dopamine nearly as much as amphetamine or ritaline. IT seems to be selective to the frontal cortex.
>
> Tarine works like an anticonvulsant. Anticonvulsants like depakote, or tegretol will further decrease limbic dopamine, and increase dopamine release in the frontal cortex.Tegretol sure didn't make me feel like increased frontal cortex dopamine was going on, (stims do) it killed my spirit, and dimmed my brain down to a 35 watt light bulb from a 75 watt bulb
If Depakote and Teg increase frontal cortex-then why arn't they used for ADD/HD?
>
> (infact some authors speculate that shizohprenia is purely due to the hypofunctioning frontal cortex, and its failure to controll overactive limbic cicutry. That is why in some cases amphetamines can be powerfull anti-manic agents!)
> Turn on the frontal cortex, turn off the limbic system.
>
>
>
>
>
> Linkadge
Posted by linkadge on December 19, 2006, at 12:24:08
In reply to Re: Dopamine deprivation - *get some red bull!* » linkadge, posted by kelv on December 18, 2006, at 19:14:50
>How so? Caffeine is a stimulant, while Taurines >a depressant
I am speaking in terms of dopamine release in the frontal cortex.
Anticonvulsant mood stabilizers seem to have the ability to release dopamine in the frontal cortex.
See:
http://neurotransmitter.net/bipolardopamine.html
"We have recently reported that the anticonvulsant mood stabilizers (AMS), valproic acid, carbamazepine, and zonisamide, but not lithium, also preferentially increase DA efflux in the rat mPFC, and that, at subthreshold doses,"
Wheather or no this extends to taurine is speculation on my part, but if so, then caffine and taurine would potentiate eachother. I will try and find the exact study I am looking for.
>In what way?-REALLY a $1 bottle of fizzy drink >helps more than a Sch II drug?Well for starters, amphetamines can cause psychosis or at least exaserbate it in a psychotic patient, while caffine is a lot less likely to do that. In addition, taurine itself has proven to be a usefull treatment for bipolar disorder. It is an anticonvulsant. Caffine increases limbic dopamine a lot less than do amphetamines, and taurine decreases limbic dopamine. So the decrease in limbic dopamine and increase in frontal cortex dopamine might be the reason.
But, theory aside, I have a few friends with schizophrenia who said they were prescribed amphetamine for negative syptoms, but that red bull seemed to overall help them better.
>Tegretol sure didn't make me feel like increased >frontal cortex dopamine was going on, (stims do) >it killed my spirit, and dimmed my brain down to >a 35 watt light bulb from a 75 watt bulbThese are hard drugs. It is necessary however, to separate limbic dopamine increase from frontal cortex dopamine increase. Limbic dopamine increase is what gives the "subjective" well being. Frontal cortex dopamine increase can improve attention and executive function, but its not going to make you feel great.
>If Depakote and Teg increase frontal cortex-then >why arn't they used for ADD/HD?
Actually they are. They are not, of course, first line treatments, but for a number of patients, (who may have bipolarity) low doses of anticonvulsants are often much better at improving concentration and reducing distractability than are stimulants.
(Don't get me wrong, tegretol made me feel like crap too, so it can depend on the person)
(Taurine alone however really helps my concentration)Linkadge
Posted by hugo on December 20, 2006, at 11:06:34
In reply to Re: Dopamine deprivation - starvation? » xbunny, posted by ronaldo on December 17, 2006, at 15:34:37
Ronaldo
Lyrica has taken the edge off withdrawal (SSRI/benzo) for me. Effects, benficial or otherwise, and dosage seem to vary greatly from individual to individual. For me 150mg as needed for insomnia or daytime distress works well.
I'm also going to give Adrafinil a trial (if my pdoc agrees). I will be interested how it goes for you when you start.
Hugo
> Wow thanks Bunny,
>
> You sure believe in covering all the bases :-)
>
> I'm more of a haphazard guy myself which is why I always get into trouble. I only see my pdoc second week of January. I might phone him before then but during my first w/d he was not a lot of use. He prescribed Seroquel which just would not work no matter how I tried it. I have got some Trazodone 50mg and 100mg and I plan to take 50mg tonight for sleep just to see how it works. I predict major insomnia in the weeks to come, especially when I get down to 2.5mg. I am hoping the Trazodone will alleviate this. I only have 3 x 50mg capsules and 13 x 100mg but if it works I can get some more from my GP who is very good to me.
>
> Last w/d I did suffer some anxiety but I put that down to the Seroquel but it could easily have been the Zyprexa. Will Trazodone at such a low dose have any effect on anxiety? Insomnia when it gets really bad tends to send me manic not hyper but just the other side of hypo.
>
> I don't have a very good working relationship with my pdoc. He has only just taken over from another pdoc and we don't really know each other yet. But he is good at returning my calls so that is a plus.
>
> After I have got off the Zyprexa I am going to start a course of Adrafinil, a poor relation of Provigil, which is billed as a psycotonic - there were quite a few posts on it a few weeks ago. But that is way in the future. I will just be glad to be free of the Zyprexa which does exactly nothing for me. Adrafinil will have to wait until Feb. or March.
>
> Thanks for your detailed post. I will come back to it often to plan my strategy. I am sure it will be very useful. I wish I could email my pdoc - that would make things so convenient. I think I will phone up his secretary and see if he has an email address.
>
> ....ronaldo
This is the end of the thread.
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