Posted by DSCH on September 21, 2003, at 14:12:03
In reply to Francesco ! » DSCH, posted by Francesco on September 20, 2003, at 20:12:58
> Thanks for your explainations : ) You would deserve an ad-honorem degree in psychiatry (and kindness) ;-) By the way, why do they use HALF-life ? If half-life is x the time for being free of the med is 2x ? (it seems a school-problem ;-)
Thanks for the compliment.
Re:Half life... I think it's an exponential decay in concentration though metabolism rather than linear, much like the decay of radioisotopes.
> In these days my mood is quite good. Anafranil is helping somehow, I'm thinking about future and my mind isn't SO overwhelmed about inessential thoughts ... Of course the "meds-induced SP" occurred again ... in the last week I didn't see any friend and I feel very shy if I have to buy a newspaper or make a phone-call (misteries of brain ...) I'm experiencing some anhedonia but it's nothing compared to the SSRI's one... My brain is impaired and I think that paradoxically is what helps my adhd. My mind is slower so I can control a bit better my impulses. I don't think this is a sharp solution to my problem but so far it has been the best.
I have the thought the "SP-like" effect is due to a conscious wish on your part to dodge potential conflicts arising from your "ODD-like" symptoms that arise when you deal with people. Sound close to the mark?
There was a time when I was still taking pemoline along with DLPA and B-complex that I noticed the speed of my cognition was outpacing my ability to regulate it and my short term memory. I become very physically active and with a feeling of great well-being but really scatterbrained... ADHD? I think that was from having the pemoline exciting too much dopaminergic activity relative to noradrenergic (focus) and acetylcholnergic (memory).
Everything comes down to how you can nudge your system into a proper operating balance. There's a Nobel out there for whoever comes up with the broader, non-linear model that takes into account ALL the neurotransmitters and brain factors and their localized functioning and interconnections. Definately a problem worth the human and computational effort.
> Apart from Reboxetine are there other selective NE-RI ? I'm curious about Reboxetine but I've red many posts talking about impotence (not just sexual dysfunctions ...). Anyway my problem is not only find a med that could work but also find a psychiatrist that would prescribe it. My understanding of the US situation is that you can get what you want if you just ask : ) Consider yourselves lucky !
That's not really the case here. Ask about something by name (especially the stimulants) and you run the risk of being seen as the "seeker"-type here too.
> My alternatives for the future are:
> 1. Try Parmodalin (Parnate + a low dose of an antipsychotic). I've read somewhere that MAOIs can be useful for ADHD & they're also useful for social phobia so this would address all my problems. I know Amen didn't mention MAOIs but ... my simplicistic understanding of the issue is that MAOIs are useful for everything because they affect serotonin, NE and dopamine too. Another simplicistic way of considering my problem is:
>
> I have low dopamine (since I have ADHD)
> Serotoninergic meds makes me Social Phobic
> Serotoninergic meds can cause dopamine depletion
> Low dopamine is related to Social Phobia
> Maybe dopamine depletion cause my induced SP
> Maybe a dopaminergic can help ! : )Then again, maybe you have TOO MUCH dopamine (off meds) like I did. All activity with not enough focus and short term memory to reign it in. :-)
The best ADHD meds all effect norepinepherine. I don't believe the seperate effects have been well separated out yet.
There is atomoxetine as well as reboxetine for selective NE-RI. Atomoxetine only recently got accepted here in the US and is sold under the name Strattera. It's being marketed towards ADHD, which I think strengthens the case that even the hyperactive-side of ADD is quite wrapped up with noradrenergic activity moreso than dopaminergic.
I am skeptical about hyperactivity being related to too little dopamine. I think I had too little dopamine going, but it resulted in lethargy and anhedonia. Anyway, that's just my own subjective experience without nanobot monitors relying hard chemical data from the other side of my BBB. ;-)
I remember posting a while back that a RIMA might help you out. Humoryl should still be available in France at least. MAO-B, IIRC, would retard dopamine and norepinpherine break down more than it would serotonin. There is also low dose selegiline.
Amino acid supplements would be worth a shot too. I would try both L-phenylalanine and L-tyrosine (the precursors to dopamine and norepinepherine) plus vitmains and minerals as long as you aren't on a RIMA or MAOI. With a RIMA or MAOI, I would have a professional advise on amino supplementation (tyramine crisis!).
> 2. (sorry for this very long post but I don't see people so I need talking ;-)
>
> Ask for a less serotoninergic TCA like Desipramine. Anafranil is the worst for what concerns side-effects so I can't see the reason why I'm on it. (I said I get a bit aggressive when I'm on IT ... could it mean TOO MUCH serotonin ? ... I know, introverted and aggressive at the same time is an awful combination : )That you are able to write longer and more coherent and spelling/grammitically correct posts is a good sign! ;-)
If you can get a TC which targets norepinepherine more and serotonin less than does Anafranil then switching to it would probably help you. I'm not so well versed on how the TCs differ from each other. There is a good reference work in a library just a block from my house, so I will post again soon once I check on it.
> 3. I have an appointment with the only italian psychiatrist who knows something about adult ADHD. I asked him by e-mail about Ritalin and he was very very vague ... I must be stupid because I insisted (it sounded like: "gimme ritalin !!!"). I don't know if he will allow me to try it (I doubt it after the paranoid mails I sent him) but if he allows me I think I'll try ... I know about addiction, tolerance and so on but I want to know how what kind of effects it has on me. I don't want to miss the (remote) chance of feeling normal for the first time in my life : ) Anyway I must be very cautios because he cannot *prescribe* Ritalin since it's not on the market. The only stimulant on the italian market is Provigil. I would ask about it to this doc.
>
> 4. Searching the web and begin purchasing Dexedrine and so on in Hawaii Islands at unbelievable prices. This is the last (and least) option.
>
> I wrote a LOT !
> Bye bye and let me know about you : )My own idea would be to contact this ADHD-expert pdoc again, apologize, and mention to him that while you are on Anafranil your ability to communicate open-mindedly in a two-way fashion gets clouded (don't mention ODD by name). I would NOT mention specific "candidate" drugs by name with him for a while (unless you are talking about your history on/off meds). FIRST give him some space to organize your symptom profiles and then prescribe what HE thinks is the first, best choice for you. I doubt any pdoc likes the idea of being second-guessed by their own patient and all the sources the patient has access too. Let him do his job for a while with as little interference as possible, but remember you still have the right (and the responsibility as well!) to determine whether his advice is being helpful or not. Leave the psychopharmocological disscussions on the board for the time being. ;-)
I need to attend to business now. I'll post more soon.
poster:DSCH
thread:260422
URL: http://www.dr-bob.org/babble/20030917/msgs/262196.html