Posted by michael on June 14, 2000, at 10:52:21
In reply to Re: Michael, posted by AndrewB on June 14, 2000, at 9:21:50
Hi Andrew -
Have you ever tried any stimulants to address the fatigue aspect? I think you mentioned recently that you were going to give ritalin a shot?
> Michael,
>
> I have never taken adrafinil. I presume though that its effect for fatigue and arousal are similar to reboxetine’s . Both, I believe, derive there significant effect through alpha 1 andrenergic receptor stimulation. When this receptor is robustly stimulated, the effect is very noticeable. For example, your heart rate increases, you may sweat more, you head feels clearer, without any sense of agitation (if you haven’t taken too much), you feel more aroused. You obviously aren’t getting that response. Maybe all you need to do is take a higher dose. If adrafinil acts like reboxetine, there is a certain threshold of dosage that it must pass over before the alpha 1 receptor is stimulated and you feel much of any effect. You can also quickly determine if your alpha 1 receptor has a normal responsiveness by taking naphazoline eye drops since it is a quick onset alpha 1 agonist.
>
> You asked me what amisulpride does for my dysthymia. It does a lot. My mood is better, I don’t have those feelings of hopelessness, My concentration is better and it takes away my brain fog. I am less moody and irritable. I am less tired. I have the energy to care about life. Amisulpride takes away the vicious, self deprecating talk that would go on in my head. It takes away some anxiety. So, you see, with amisulpride I feel much better. But there are some things it doesn’t completely do. Reboxetine is able to deal with many of these residual complaints. Namely, even with amisulpride, I still get some tiredness, mental fatigue and irritability long after I exercise. This kind of response is common in those with Chronic Fatigue Syndrome (CFS). I believe my dysthymia overlaps into CFS somewhat. I also get spells of daytime sleepiness and tiredness. It is for these residual symptoms for which reboxetine (now along with naphazoline) has proven effective. It arouses me and takes away mental and physical tiredness, sleepiness and irritability. What, remains as residual symptoms that neither reboxetine or amisulpride has taken away is a subtle but pervasive social anxiety. Let’s see if a solution can be found for that.
>
> Obviously you are not getting a robust response to amisulpride if any at all. In my mind this could mean two things. Either you have no D2/D3 hypofunction or your presynaptic D2/D3 receptors aren’t being antagonized by the amisulpride. In the future you may consider a trial with bromocriptine. It is fairly cheap and easy to get overseas without an Rx. It is a D2 agonist, thus it has a different mode of action than amisulpride. If your fatigue is a result of D2/D3 hypofunction, you should get some effect from it, especially with mental fatigue.
>
> There are other strategies to deal with fatigue, but that is another story and another day.
>
> AndrewB
poster:michael
thread:37157
URL: http://www.dr-bob.org/babble/20000610/msgs/37261.html