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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 thomas on June 25, 2000, at 15:38:04
hi! i have tried zoloft,remeron,paxil,effexor xr and nothing helps,just fatigue and more depressed!i have tried them all over 6 weeks each one.what to do,hoping for some help!currently take nothing besides xanax when it gets too hard.
Posted by Cindy W on June 25, 2000, at 20:37:31
In reply to nothing helps, posted by thomas on June 25, 2000, at 15:38:04
> hi! i have tried zoloft,remeron,paxil,effexor xr and nothing helps,just fatigue and more depressed!i have tried them all over 6 weeks each one.what to do,hoping for some help!currently take nothing besides xanax when it gets too hard.
Thomas, what specific symptoms are you trying to remedy? That will help people make suggestions. Hang in there!
Posted by JohnL on June 26, 2000, at 4:37:51
In reply to nothing helps, posted by thomas on June 25, 2000, at 15:38:04
> hi! i have tried zoloft,remeron,paxil,effexor xr and nothing helps,just fatigue and more depressed!i have tried them all over 6 weeks each one.what to do,hoping for some help!currently take nothing besides xanax when it gets too hard.
Thomas,
You might consider Adrafinil.
I suggest this because it doesn't appear the serotonin approach is the right one for you. If it was, I would think there would have at least been a hint of something good in one of the meds you've tried. And of course the most obvious reason I suggest it is because it has worked wonders with me, after failing a huge laundry list of other more common medications.
Your complaint of fatigue I think is an important clue. That's the tippoff. That also tends to point me in the direction of norepinephrine instead of serotonin. Anything's possible, but I get the feeling you'll do a lot better with a non-serotonin med. Of them all, my personal favorite is Adrafinil. Because it is cheap, easy to get, generally very safe, and generally very few if any side effects, and it will work on brain chemistries that you thus far haven't looked at, its as good a place as any to try next.
But whatever you do, don't let the doctor prescribe you yet one more medication in the serotonin class. That's kind of like beating a dead horse. I mean, I could be wrong. You might for example have a miraculous response to Prozac. I just don't think the odds are in your favor for that to happen though.
Think about trying Adrafinil.
JohnL
ADRAFINIL (Olmifon)
Rapidly restores vigilance and alertness in older people and the physically and mentally tired. Has a powerful
antidepressant action far superior to that of fluoxetine (Prozac) and clomipramine (Anafranil) and is without any serious
side effects. Adrafinil restores your powers of concentration, memory and intellectual function. When administered to
older people who have lost interest in life, adrafinil makes them want to take part in life again and they find that they
have renewed energy and vigor. Adrafinil may be correctly described as an anti-aging drug because it directly combats
degeneration in the part of the brain that allows you to take pleasure in life. Elderly people very often have disturbed
sleep patterns and take many naps during the day. Adrafinil restores a youthful sleep/wake cycle of full alertness in the
daytime and deep restorative sleep at night. After several weeks of treatment with Adrafinil daytime sleepiness
disappears, interest in intellectual activity is restored and depression lifts. It is very important to note that this improved
quality of alertness is NOT accompanied with mental excitation and insomnia as occurs with amphetamine or caffeine.
The correct dosage is 300 to 600 mg per day. The dosage can be adjusted according to response. Remember it takes
three weeks for all the effects of Adrafinil to become apparent. Do not use Adrafinil if you have any type of kidney or liver
problem or if you suffer from epilepsy.
ADRAFINIL: What is; (a.k.a. Olmifon) (Description & information below)
NOTE:not to be confused with "Anafranil (a.k.a. clomipramine)" the Antidepressant.Adrafinil provides alertness in most without the feeling often felt with stimulants that usually are prescribed for a person with
narcolepsy. Such as amphetamines etc. Also the possibility of tolerance is low with its continued use. There is however a
need for certain Liver function tests
on a regular basis with its continued use. Normally the same types of required testing as with the medication " cylert " which is
commonly prescribed in the USA. It is also used in certain parts europe as a "antidepressant". It is the combination of
Adrafinil's releasing stimulantive arousal effect(s), and its antidepressant effects that some doctors in europe recommend
Adrafinil over its newer form of Modafinil. There have been studies done in the United States "measuring depression in
individuals with sleep disorders",. In one study it was suggested that the
"rate of narcolepsy and depression is estimated to be between 30-52%".ADRAFINIL
Adrafinil: Alertness Without StimulationAdrafinil is the prototype of a new class of smart drug - the eugeroics (ie, "good arousal") - designed to promote vigilance
and alertness. Developed by the French pharmaceutical company Lafon Laboratories, adrafinil (brand name, Olmifon) has
been approved in many European countries for treating narcolepsy, a condition characterized by excessive daytime sleepiness
and other unusual symptoms.Non-narcoleptic users generally find that adrafinil gives them increased energy and reduces fatigue, while improving cognitive
function, mental focus, concentration, and memory. It has been reported that quiet people who take adrafinil become more
talkative, reserved people become more open, and passive people become more active.Of course, many stimulant drugs, ranging from caffeine to methamphetamine, are known to produce similar alerting/energizing
effects. Adrafinil has been described by some users as a "kinder, gentler" stimulant, because it provides these benefits but
usually with much less of the anxiety, agitation, insomnia, associated with conventional stimulants.Adrafinil's effects are more subtle than those of the stimulants you may be used to, building over a period of days to months.
They appear to be based on its ability to selectively stimulate 1-adrenergic receptors in the brain.2 These receptors normally
respond to norepinephrine (noradrenaline), a neurotransmitter linked to alertness, learning, and memory. This is in contrast to
conventional stimulants, which stimulate a broader spectrum of brain receptors, including those involving dopamine. Its more
focused activity profile may account for adrafinil's relative lack of adverse side effects.Dosing
The standard dose is 2 to 4 300-mg tablets per day for improving cognitive function, although some people may find lower
doses produce a desirable degree of improvement. Higher doses have been used to treat narcolepsy.ADRAFINIL (OLMIFON)
A unique substance which improves daytime alertness and vigilance
without altering the phases of sleep. Take 2 to 4 tablets per day. After
8 to 10 days of treatment feelings of fatigue disappear, after 15 days
there is a powerful effect on activity and after 1 to 3 months cognitive
effects are experienced. Intellectual function is improved particularly,
the ability to formulate new ideas and recall information. Avoid if you
suffer from epilepsy, kidney or liver impairment.
Posted by dj on June 26, 2000, at 7:27:50
In reply to Re: nothing helps, posted by JohnL on June 26, 2000, at 4:37:51
So John L. are you using solely ADRAFINIL (OLMIFON)now and are you experiencing any side effects?
Posted by Angela5 on June 26, 2000, at 12:09:44
In reply to Re: nothing helps, posted by JohnL on June 26, 2000, at 4:37:51
How long has this been on the market in Europe? Is much known about long-term side effects?
Thanks,
Angela
Posted by Andre Allard on June 27, 2000, at 0:52:34
In reply to nothing helps, posted by thomas on June 25, 2000, at 15:38:04
Whoa there Johny Boy! Don't get the guy so excited about something that might not work. I am not very familiar with Adrafinil although I do know that it is not yet available in North America. Adrafinil is not an antidepressant because it generally does not give antidepresant effects. If it did, it would be referred to as an antidepressant. Any stimulant will cause euphoria or a high. Smoke crack, snort eight balls of cocaine and I am sure you will feel a little better. I am not saying that Adrafinil will not work so give it a try if you like.
It is rare that you did not respond at all to any of the ADs you listed above. What were your dosages - I would like to know.
Posted by thomas on June 27, 2000, at 3:58:39
In reply to Re: JohnL and Thomas, posted by Andre Allard on June 27, 2000, at 0:52:34
Thanks john for the long reply!i quess you right about that the serotonin function is not the problem.Maybe i will order adrafinil and give it a try.To andre my dosages was zoloft 100mg,remeron up to 60 mg,paxil 40 mg,effexor xr up to 225 mg.To cam ? Im diagnosed 1.GAD 2.Moderate to severe depression 3.and my psyc-doc.described me After the meds didnt work as borderline also?I have heard its quite common anyway here in sweden were i come from,that people whit anxiety and depression who dont respond to meds as above gets in the trash can?
Posted by JohnL on June 27, 2000, at 4:36:29
In reply to Re: JohnL and Thomas, posted by Andre Allard on June 27, 2000, at 0:52:34
> Whoa there Johny Boy! Don't get the guy so excited about something that might not work.
......Why not? Hope is crucial. I've been in Thomas's shoes way too often. Hope was the only stepping stone to get through the next hour. With nearly all drugs, eventual despair followed. But with the anticipation of yet another choice, hope was restored. You're right, it might not work. But neither might anything else. I think Thomas should get excited. Adrafinil in my experience stands a greater chance of working than nearly anything else I can think of. I don't say this haphazardly. I don't say it lightly. Believe me, I've been around the block more times than I care to remember.
>I am not very familiar with Adrafinil although I do know that it is not yet available in North America.
.....I know. That's why I've provided info on it. You might want to read it. I can provide the package insert also if you are interested. It is very inexpensive. Because of that, the low profit motive does not support the expensive FDA process. We aren't likely to ever see it in US pharmacies. That's too bad. There are some wonderful European medications out there that will never be available in US due to political or economic constraints. Just because something isn't FDA approved doesn't mean it isn't safe or effective. There's a lot more to it than that.
>Adrafinil is not an antidepressant because it generally does not give antidepresant effects.
.....Sorry, this statement is totally false. Where did you get this idea? I know when all we see is what goes on within our own borders it seems like what goes on in the rest of world is somehow devalued. Adrafinil is an antidepressant in countries that are familiar with it.
>If it did, it would be referred to as an antidepressant.
.....I know people who have had their depression respond to Naltrexone, Ritalin, Adderall, Zyprexa, Amisulpride, Deprenyl, Lithium, Lamictal, Neurontin...on and on. None of these are antidepressants either. That doesn't mean they don't have antidepressant qualities. It is not at all uncommon to see various medications used for off-label purposes.
>Any stimulant will cause euphoria or a high.
.....Sorry, this is totally false. Adderall for example sent me into crying fits of despair. The exact opposite of euphoria. If one reviews posts here going back months, one will find dozens of example of other real life people who experienced increased depression instead of euphoria with stimulants.
>Smoke crack, snort eight balls of cocaine and I am sure you will feel a little better.
.....My intention was to stay on topic with valid therapies, not illegal drugs of abuse. I discovered a French website that listed drugs of abuse and dependence. Cocaine was obviously on it. So was amphetamine. It also listed drugs that were not abused and did not have dependence. Adrafinil is in the NON dependent list. Decades ago I was a serious abuser of cocaine for a short while. Believe me, I know addiction. Ritalin to me is a lot like Cocaine. Adrafinil isn't anything similar at all.
>I am not saying that Adrafinil will not work so give it a try if you like.
.....Good idea. :-)
> It is rare that you did not respond at all to any of the ADs you listed above......I never said I didn't respond at all. In reality I responded about 50% to most of the popular antidepressants you can think of. Though that is the most common clinical measurement of 'success', I wasn't exactly prepared to plan a party over it. I'm not satisfied with partial recovery. I always believed total recovery was a real goal. As my psychiatrist recently told me, 80% of patients who try at least two different antidepressants will improve, but very few of them recover to 'normal baseline' as he called it. So my case isn't so rare after all. In my opinion, the extent of partial response is bogus. Especially in this day and age of a vast array of medications available, and expert doctors, there's no excuse for less than 99% recover. I don't buy it.
>What were your dosages - I would like to know.
....Oh man, what a list. Can we put this in another post? I mean, we're talking L O N G. :-) Just for a rough sketch though, my early days included things like 40mg Paxil for a year, 250mg Zoloft for 3 months, 60mg Prozac for 6 months. You get the picture.
Andre, you bring up some good points. I'm glad you did, because they are important points to address and understand. The most important points I would like to stress are: Adrafinil is not amphetamine-like. It is an antidepressant (depends on what country we're talking about), just as many other drugs that are not called antidepressants. It's just as likely, or more likely, to work than anything else we might choose. Its very low cost, easy availability, few side effects, and different chemistry than either amphetamines or more common serotonin antidepressants make it attractive to someone experiencing difficulty with any of these issues.
Hope this helps.
JohnL
Posted by KarenB on June 27, 2000, at 11:52:02
In reply to Re: JohnL and Thomas, posted by JohnL on June 27, 2000, at 4:36:29
Andre: > > Whoa there Johny Boy! Don't get the guy so excited about something that might not work.
>
Johnny Boy: > ......Why not? Hope is crucial. I've been in Thomas's shoes way too often. Hope was the only stepping stone to get through the next hour. With nearly all drugs, eventual despair followed. But with the anticipation of yet another choice, hope was restored. You're right, it might not work. But neither might anything else. I think Thomas should get excited. Adrafinil in my experience stands a greater chance of working than nearly anything else I can think of. I don't say this haphazardly. I don't say it lightly. Believe me, I've been around the block more times than I care to remember.Me: Hey, I think it's important to get excited about ANY new med that might work. But after a while, despair does follow if you are treatment resistant. I would venture to say that we have more than your average share of this type on the Babble board. SSRIs and tricyclics have not worked for me either and I have given them all a fair trial, except when side effects were unbearable. Now, I am trying stimulants which seem to be closer to what will work. The only meds that have truly worked for me are not available in the US and are also from Europe (Amineptine - a psychostimulant and Sulpiride - a neuroleptic, taken together). I am trying to get something that is available here but if I can't, I can't. At least I am giving it a try. Do you really think that FDA approval means that we have the best that is available in the world, here in the US? We really do have center-of-the-universe-complex in this country, don't we?
Andre:> >I am not very familiar with Adrafinil although I do know that it is not yet available in North America.
Me: So...does not being available in North America make it suspect? Why would you be adamant about a drug you know little about?
> >Adrafinil is not an antidepressant because it generally does not give antidepresant effects.
Me: Huh? Do a search and check it out, Andre. People are using it as an antidepressant all over the world, including the States. Adrafinil is currently in research, as is Provigil, as a new ADD drug and for use in all forms of fatigue, ranging from MS to Chronic Fatigue Syndromes. The great thing about it is that it not only stimulates but brightens mood and increases motivation. It is suggested as an adjunct to many ADs, should there be residual fatigue during treatment.
Andre> >Any stimulant will cause euphoria or a high.
I beg to differ. The wrong stimulant causes agitation, anxiety, annnnnnger and worsens depression in some (like me). The right one can be like a miracle.
Andre: > >Smoke crack, snort eight balls of cocaine and I am sure you will feel a little better.
Me: As a teenager, attempting to self medicate, I tried many things but none of them made me feel "normal." I think that's what we are aiming for here - not to feel "high."
I am with "Johnny Boy" on this one. This girl is not about to settle for minor or even 50% improvement. I want to be well. I may die trying but to lose hope for me is to give up my chance at a life.
I have been where you are, Thomas. It's time to read. Time to become informed. Time to take your mental health into your own hands and use your doc to help you. No one will ever care about what's happening in your mind like you will. Except God...and that's a whole nutha subject.
Karen
Posted by Andre Allard on June 28, 2000, at 0:45:44
In reply to nothing helps, posted by thomas on June 25, 2000, at 15:38:04
I see you like to type.
I was giving a general opinion on Adrafanil. If you were to ask a doc what would most likely work better; 1) an SSRI, SNRI, effexor, remeron, serzone, TCA, MAOI, or 2) adrafanil, he would most likely go for #1. Just a general opinion.
You made it sound like adrafanil is the best thing since sliced bread. Maybe for you but you might not want to get the poor guy's hopes up so much and then adrafanil does nothing for him. That is what I was trying to get at. I was discussing this with my grandfather the other week, how although these kind of chat rooms are a good idea they can also be not so good. Someone might ask a question, get a response like you gave and think to themselves, wow, I am really going to get better know because this guy said so and vise-versa.
The question concerning ADs was for Thomas but I enjoy reading of someones history of meds.
Posted by Andre Allard on June 28, 2000, at 0:50:34
In reply to nothing helps, posted by thomas on June 25, 2000, at 15:38:04
I was not being adamant about adrafanil nor was I suspect just because it is from another country. I was just giving a general opinion.
Posted by Andre Allard on June 28, 2000, at 1:52:57
In reply to nothing helps, posted by thomas on June 25, 2000, at 15:38:04
I simple, "I would have to disagree with your reply" would have done just fine but ahh..............
Posted by thomas on June 28, 2000, at 2:50:33
In reply to John and Karen, posted by Andre Allard on June 28, 2000, at 1:52:57
Did adrafinil make you feel agitated,anxious? cause i had enough with that anyway.
Posted by JohnL on June 28, 2000, at 4:04:51
In reply to Re: TO JOHN, posted by thomas on June 28, 2000, at 2:50:33
> Did adrafinil make you feel agitated,anxious? cause i had enough with that anyway.
Thomas,
No agitation for me with Adrafinil. I think my previous posts could have been just a tad bit misleading, so I would like to clarify one thing. That is, Adrafinil is not my only medication. I also take 7.5mg Remeron at bedtime. Even though that is only half of the lowest dose, I know it is doing something because I feel worse when I don't take it. Adrafinil and Remeron are working in harmony. I know for a fact Remeron alone doesn't work that well on my depression. But when combined with Adrafinil it's wonderful. But like I said, the dose is real small.
I didn't mean to make it sound like Adrafinil is the only wonder drug out there. It's hard for me not to get excited about something that has worked so well when so many other things didn't. Sorry if I got a little over-enthusiastic. Nevertheless, I still feel it is a very attractive choice in light of your symptoms and your history. Two excellent combinations with it--in my personal trials only--are either Remeron (half dose) or St Johnswort. A combination that was not good was Adrafinil+Prozac. That combo definitely caused the agitation you were wondering about.
Since you live in Sweden, another good alternative for your symptoms could be the French medication Amisulpride (Solian). I know it's available in Germany and Switzerland, but I don't know about Sweden. You might want to check. Its only drawback is that it's a lot more expensive than Adrafinil.
Hope you're having a smooth day Thomas.
JohnL
Posted by JohnL on June 28, 2000, at 4:26:41
In reply to nothing helps, posted by thomas on June 25, 2000, at 15:38:04
My apologies Andre. I didn't mean any harm. I am excited about Adrafinil because it has worked so well and so many other things didn't. Perhaps I could have used a little more discretion in containing my enthusiasm. I would just like to see Thomas feel better.
Part of the situation I think is that I do have a problem with general comments in psychiatry. It's just my opinion and just my experience only, but I feel all the general comments floating around that are taken for granted or taken as fact are actually major contributors to patients' continued suffering. We seem to assume too many general comments as fact. What we generally accept as truth in psychiatry has failed me time and again and again. So now I tend to dissect sweeping generalities in detail. It's the details that are important to me, because that's where the fastest healing occurs. And that's my goal...complete recovery as fast as possible. Generally accepted opinions in psychiatry often get in the way of that happening.
And no I don't like to type. :-) My long posts make it seem like I do. But I do like to propose different angles of looking at things. I find that difficult to do in short generalized sentences. If someone had done that with me, I would have reached recovery a long time ago. It really is all those generally accepted principles of psychiatry that slowed down my whole recovery process and sent me off in the wrong direction for so long.
This is the end of the thread.
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