![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 21 of 21. This is the beginning of the thread.
Posted by Lynne on July 3, 2000, at 14:30:00
I have been taking 300-600 mgs of Adrafinil for two weeks now. I haven't felt any difference yet. I am also coming off of Prozac that I only took for a month. Prozac made my mind too slow and I felt so in the (twilight zone) so enough of that. I will give the Adrafinil a few more weeks. It does cause a little nausea is my only side effect. Anyone else trying this med? What doesages?
thanks,
Lynne
Posted by KarenB on July 3, 2000, at 16:06:29
In reply to Anyone having success with Adrafinil?, posted by Lynne on July 3, 2000, at 14:30:00
> I have been taking 300-600 mgs of Adrafinil for two weeks now. I haven't felt any difference yet. I am also coming off of Prozac that I only took for a month. Prozac made my mind too slow and I felt so in the (twilight zone) so enough of that. I will give the Adrafinil a few more weeks. It does cause a little nausea is my only side effect. Anyone else trying this med? What doesages?
>
> thanks,
> LynneHey there, Lynne.
I started a trial of Adrafinil, 300 to 600mg, just a few days ago.
Reportedly, the results are more subtle than most stimulants and it takes up to a month to build in the system, until cognitive benefits are seen, as well as energy and motivation. I am hopeful. At this point, it feels better - and different - than the Provigil which I tried over a week ago. I admittedly did not give that a fair trial, as my initial days taking it coincided with PMS from hell and a sinus infection treated by antibiotics. It was NOT a good week. I may give Provigil another try later but maybe not if the Adrafinil is a roaring success.
BTW, Amisulpride may be a good choice to augment this drug - it has been for JohnL and I have firsthand experience with Sulpiride augmentation of a psychostimulant, which gave me the best relief I have ever had from my depression symptoms (apathy, fatigue, excessive daytime sleepiness, irritability, irrational and suicidal ideology, some social anxiety plus ADD). Sulpiride is very close to amisulpride, chemically and has some antidepressant action, as well. While the psychostimulant provided energy, the Sulpiride relieved my physical symptoms of fatigue, heaviness and social anxiety. I was as well as I have ever been while on these meds. I have been attempting for the past several months to find a combo, stateside, to give similar results but have always come up short. I am almost ready to order overseas and be my sane self once again. I don't know how much longer I can take the depression and mood swings when I know of something that actually works.
I don't know your symptoms but just thought you may be interested if you were taking Adrafinil for any of these difficulties.
Good luck. Give it some more time. Hope it works for you.
Karen
Posted by Lynne on July 3, 2000, at 17:02:34
In reply to Re: Adrafinil? » Lynne, posted by KarenB on July 3, 2000, at 16:06:29
KarenB,
You must be my twin!! I am experiencing everything that you are. I also tried Provigil at two different times and I hated it. So far Adrafinil is alot better. What is the difference between Amisulpride and Sulpride? Where can I order some and do I need a prescription? If you would like e-mail me privately at Har1667@aol.com or post on the board. Thank you so much.
Lynne
>
>
Posted by Joy on July 3, 2000, at 18:12:58
In reply to Re: Adrafinil? » KarenB, posted by Lynne on July 3, 2000, at 17:02:34
> Hi. I am taking Adrafinil [300 mg] about 6 days. I am taking 10 mg Celexa also, but don't know if I should go to 20 Celexa with the Adrafinil or just stay with 10 mg so it doesn't interfere with Adrafinil. I just want to be less irritable and happy and upbeat. Hang in there, and anyone who has any tips I'd really appreciate it. I guess I don't know what to expect. Thanks.
Joy
Posted by SadSuzie on July 3, 2000, at 19:36:06
In reply to Re: Adrafinil? » Lynne, posted by KarenB on July 3, 2000, at 16:06:29
Karen B,
Glad to hear Adrafinil seems to be having a positive effect. Please keep me posted as our symptoms sound very much alike. I'm considering ordering Amisulpride or sulipride as well.
> > I have been taking 300-600 mgs of Adrafinil for two weeks now. I haven't felt any difference yet. I am also coming off of Prozac that I only took for a month. Prozac made my mind too slow and I felt so in the (twilight zone) so enough of that. I will give the Adrafinil a few more weeks. It does cause a little nausea is my only side effect. Anyone else trying this med? What doesages?
> >
> > thanks,
> > Lynne
>
> Hey there, Lynne.
>
> I started a trial of Adrafinil, 300 to 600mg, just a few days ago.
>
> Reportedly, the results are more subtle than most stimulants and it takes up to a month to build in the system, until cognitive benefits are seen, as well as energy and motivation. I am hopeful. At this point, it feels better - and different - than the Provigil which I tried over a week ago. I admittedly did not give that a fair trial, as my initial days taking it coincided with PMS from hell and a sinus infection treated by antibiotics. It was NOT a good week. I may give Provigil another try later but maybe not if the Adrafinil is a roaring success.
>
> BTW, Amisulpride may be a good choice to augment this drug - it has been for JohnL and I have firsthand experience with Sulpiride augmentation of a psychostimulant, which gave me the best relief I have ever had from my depression symptoms (apathy, fatigue, excessive daytime sleepiness, irritability, irrational and suicidal ideology, some social anxiety plus ADD). Sulpiride is very close to amisulpride, chemically and has some antidepressant action, as well. While the psychostimulant provided energy, the Sulpiride relieved my physical symptoms of fatigue, heaviness and social anxiety. I was as well as I have ever been while on these meds. I have been attempting for the past several months to find a combo, stateside, to give similar results but have always come up short. I am almost ready to order overseas and be my sane self once again. I don't know how much longer I can take the depression and mood swings when I know of something that actually works.
>
> I don't know your symptoms but just thought you may be interested if you were taking Adrafinil for any of these difficulties.
>
> Good luck. Give it some more time. Hope it works for you.
>
> Karen
>
>
Posted by SLS on July 3, 2000, at 21:02:07
In reply to Re: Adrafinil? » Lynne, posted by KarenB on July 3, 2000, at 16:06:29
> BTW, Amisulpride may be a good choice to augment this drug - it has been for JohnL and I have firsthand experience with Sulpiride augmentation of a psychostimulant, which gave me the best relief I have ever had from my depression symptoms (apathy, fatigue, excessive daytime sleepiness, irritability, irrational and suicidal ideology, some social anxiety plus ADD). Sulpiride is very close to amisulpride, chemically and has some antidepressant action, as well. While the psychostimulant provided energy, the Sulpiride relieved my physical symptoms of fatigue, heaviness and social anxiety. I was as well as I have ever been while on these meds. I have been attempting for the past several months to find a combo, stateside, to give similar results but have always come up short. I am almost ready to order overseas and be my sane self once again. I don't know how much longer I can take the depression and mood swings when I know of something that actually works.
Dear Karen,I have been taking sulpiride 50mg a day, first thing in the morning, for about 12 days. I thought I felt a little something in the morning after taking it for the first few days. It is not helping right now, but neither is it producing any sedation. I take this to be a good sign. I can't help but to be hopeful. I could use a little help before seeing my doctor on Wednesday. I hope it's not too much trouble for you to answer a few questions. More than a few questions. Sorry.
When you had such great success with sulpiride:1. What dosage of sulpiride were you taking, and how did you divide your doses during the day?
2. What brand-name did you use, and what was the dosage of each pill?
3. Where did you get it?
4. How much did it cost?
5. What other drugs were you taking at the time? Stimulant?
6. How long did it take to work?
7. Were there any side effects?
8. Why did you stop taking sulpiride?
9. Why are you no longer taking a stimulant?
If sulpiride is partially effective, I will need to choose other drugs to add to it. I was thinking about using Provigil, but both you and JohnL describe adrafinil as being better. The other route involves going back to an MAO inhibitor, probably Parnate. Do you have any thoughts? I am also taking Lamictal 300mg. I suffer from an anergic bipolar depression that shares many of the features you describe for your condition.THANKS.
-Scott
Posted by KarenB on July 4, 2000, at 0:19:37
In reply to Re: Adrafinil? Sulpiride? » KarenB, posted by SLS on July 3, 2000, at 21:02:07
Scott,
Your questions:
> When you had such great success with sulpiride:
> 1. What dosage of sulpiride were you taking, and how did you divide your doses during the day?50mg 3x a day. 1st dose 1/2 hr before getting out of bed in the am, at lunch and at about 4 pm.
> 2. What brand-name did you use, and what was the dosage of each pill?Dogmatil - 50mg
> 3. Where did you get it?From my doctora in the Philippines. She'd ship it to me, via DHL, with a script and copy of her license.
> 4. How much did it cost?
20 pesos, or 50 cents(USDollar) per capsule.
> 5. What other drugs were you taking at the time? Stimulant?Just Amineptine, 100mg 2x a day, before arising and at about 1-2:00pm
> 6. How long did it take to work?
As I remember, immediately - which is a good thing. Waiting is not my forte.
> 7. Were there any side effects?Complete cessation of menses (no worries, Scott:)and slight (5-10lb) weight gain. After a few weeks of feeling better, I dropped the lbs. because I kept a consistent exercise program. REALLY helped with the physical symptoms of my illness.
> 8. Why did you stop taking sulpiride?
Futile attempt (at least so far) at finding something comparable stateside that was covered by my insurance and readily available.
> 9. Why are you no longer taking a stimulant?I am. Adderall until a couple weeks ago and I am now trialing Adrafinil.
> If sulpiride is partially effective, I will need to choose other drugs to add to it. I was thinking about using Provigil, but both you and JohnL describe adrafinil as being better. The other route involves going back to an MAO inhibitor, probably Parnate. Do you have any thoughts? I am also taking Lamictal 300mg. I suffer from an anergic bipolar depression that shares many of the features you describe for your condition.
Anergic bipolar? What exactly IS that? As it stands, I am in a state of floating diagnoses. Previously Bipolar...currently ADD with depression...possible PMDD. I don't even know any more. I can't afford a consultation with an expert who can make a definitive statement, either. I AM very clear, though, about how I DO NOT want to feel any more.
As far as stimulants go, I suggest Adderall or Adrafinil. You can give Provigil a try - I couldn't give it a fair trial because I was beside myself last week with PMS and a sinus infection. Hard to tell if it worked or not. If you could get Amineptine, that would be ideal but...oh well...
Let me know if you have any other questions.
Oh, BTW, the Sulpiride had a definite mood stabilizing effect. Mood stabilizers, on the other hand, never have been effective with me. They make me nauseous, sleepy or sloooow.
Please, keep us updated if you give this duo a try. I worked so well for me, I'll be really interested as to how you do with it.
Still hoping for the magic bullet...
Karen
Posted by JohnL on July 4, 2000, at 6:35:15
In reply to Anyone having success with Adrafinil?, posted by Lynne on July 3, 2000, at 14:30:00
> I have been taking 300-600 mgs of Adrafinil for two weeks now. I haven't felt any difference yet. I am also coming off of Prozac that I only took for a month. Prozac made my mind too slow and I felt so in the (twilight zone) so enough of that. I will give the Adrafinil a few more weeks. It does cause a little nausea is my only side effect. Anyone else trying this med? What doesages?
>
> thanks,
> Lynne
I'm doing very well at 600mg.I started taking Adrafinil while discontinuing Prozac, just like you. During the transition zone when Prozac was wearing off, I think it kinda blunted the good effects of Adrafinil. It's just my experience, but all serotonin meds have a way of numbing my emotions. So much so that the good effects of Adrafinil were obscured until the Prozac in my system faded.
To give it a fair trial, you could stay at a steady 600mg for a solid month. Six weeks would be better. I usually don't agree with this standard approach. But Adrafinil is the exception. It really does take time to build up and do its thing. By then the Prozac will be nearly completely eliminated (very long halflife...up to 5 weeks to get rid of most of it) so there won't be any confusion as to what's doing what.
I don't experience the nausea you mentioned, but I have noticed a decrease in snacking appetite. Meals are fine. I just don't have that desire for snacks during the day. Other than that, no side effects. Motivated, interested, active, socially comfortable. It's been a long long time and many meds since I've felt so well. 600mg Adrafinil has been wonderful to me.
JohnL
Posted by SLS on July 4, 2000, at 9:28:43
In reply to Re: Adrafinil? Sulpiride? » SLS, posted by KarenB on July 4, 2000, at 0:19:37
Dear Karen,
Thank you SO, SO much!
Your comments regarding low-dose sulpiride and mood stabilization are fascinating and extremely important.
In what ways has sulpiride acted as a mood stabilizer? How was your mood unstable previously?
"Anergic" means without energy. Bipolar depression is usually very anergic (low-energy), and in many ways appears similar to atypical unipolar depression.
What is it about your case that has led to a diagnosis of bipolar disorder?
ADD / ADHD and bipolar disorder often occur simultaneously. I believe that Provigil is currently being studied for use in ADD. Initial results are encouraging. However, I could not find anything on Medline regarding this. I imagine adrafinil would have the same utility. I can find nothing in the Provigil (modafinil) package insert that would suggest that it cannot be combined with Dexedrine, Adderal, or Ritalin. The only interaction listed is that Ritalin may delay the absorption of Provigil by one hour if they are taken simultaneously. I do not know to what extent this information is applicable to adrafinil. I'm sure your doctor will be able to tell you with certainty. I included relevant information below. Perhaps adrafinil will improve your mood without improving ADD. In this case, adding a stimulant may be desirable.
Did sulpiride produce any improvement in PMS?
I can't tell you how much it means to me that you posted such a detailed reply. Thanks again.
Sincerely and Appreciatively,
Scott
P.S. I haven't menstruated since beginning sulpiride either. I don't know how to feel about that.
------------------------------------------------------------8: J Clin Pharmacol 1998 Oct;38(10):971-8
Comparison of the single-dose pharmacokinetics and tolerability of modafinil and
dextroamphetamine administered alone or in combination in healthy male
volunteers.Wong YN, Wang L, Hartman L, Simcoe D, Chen Y, Laughton W, Eldon R, Markland C,
Grebow PCephalon, Inc., West Chester, Pennsylvania, USA.
An open-label, randomized, crossover study was performed in healthy male
volunteers to evaluate the potential pharmacokinetic and pharmacodynamic
interactions and tolerability of single oral doses of modafinil (200 mg) and
dextroamphetamine (10 mg). Blood samples were collected for determination of
plasma levels of modafinil, the acid and sulfone metabolites of modafinil, and
dextroamphetamine at intervals through 48 hours after administration for each
treatment. Vital signs (blood pressure and pulse rate) were measured through 48
hours, and electrocardiograms were measured through 24 hours after
administration. Pharmacokinetic parameters were determined using
noncompartmental methods. The data collected in this study of 24 healthy
volunteers suggest that concomitant administration of single oral doses of
modafinil and dextroamphetamine has no clinically significant effects on the
pharmacokinetic profile of either agent. Although there was a slightly greater
incidence of adverse events when modafinil and dextroamphetamine were
administered together, the concomitant administration of the two drugs was well
tolerated.Publication Types:
Clinical trial
Clinical trial, phase i
Randomized controlled trialPMID: 9807980, UI: 99023133
----------------------------------------------------------
SOURCE: Cephalon, Inc.Physician Reports First U.S. Study of Modafinil (PROVIGIL(R)) in ADHD
WEST CHESTER, Pa., May 18 /PRNewswire/ -- A study presented today at the annual meeting of the American Psychiatric Association (APA) in Chicago described the effects of modafinil and the drug's potential as a treatment for Attention Deficit Hyperactivity Disorder (ADHD). The study conducted by Fletcher B. Taylor, M.D., of Tacoma, WA, compared modafinil to dextroamphetamine, a commonly used amphetamine, and placebo in adults with ADHD. Results of the study demonstrated that an average daily dose of approximately 200 mg of modafinil produced a statistically and clinically significant reduction (30 percent or more) in the symptoms of ADHD as measured by the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM-IV) ADHD Behavior Checklist for Adults, compared to placebo. Modafinil is marketed as PROVIGIL® (modafinil) Tablets [C-IV] in several countries, including the United States, by Cephalon, Inc. (Nasdaq: CEPH - news) for the treatment of excessive daytime sleepiness associated with narcolepsy.
Posted by Lynne on July 4, 2000, at 10:08:51
In reply to Re: Anyone having success with Adrafinil?, posted by JohnL on July 4, 2000, at 6:35:15
JohnL,
Thank you for the information. Do you take the 600 mgs at the same time or do you take 300mg in am and 300 mgs at noon? I have had a insomnia problem most of my life, I have tried Ambien,Sonata,Xanax,Temazapan and haven't really liked any of them. My doc gave me Seroquel and it does help me sleep, but I worry if it will hinder the effects of the Adrafinil. Do you still take Remeron? I tried it once and slept for 2 days and could'nt stop eating. Any suggestions?
Thanks,
Lynne
Posted by AndrewB on July 4, 2000, at 10:29:35
In reply to Re: Anyone having success with Adrafinil? » JohnL, posted by Lynne on July 4, 2000, at 10:08:51
Scott,
Could you ask your doctor when you see him if he purposely is starting you out at a less than therapuetic dose and why? I find this curious. Maybe this primes the presynaptic receptor and the dose will be increased with your next visit?
Some info on Sulpiride and mood stabilization on the Solian Philippines website. My experience with amisulpride is less moodiness and irritability.
Thanks for keeping us updated on your sulpiride experience.
I have stopped my trial with sinemet (with l-dopa) and entacapone. Causes a lowering of the mood, increased social anxiety and little if any increased arousal. Literature for use of amisulpride for dysthymia says l-dopa interferes with action of amisulpride.
AndrewB
Posted by SLS on July 4, 2000, at 11:14:27
In reply to Re: Sulpirde-SLS, posted by AndrewB on July 4, 2000, at 10:29:35
> Scott,
>
> Could you ask your doctor when you see him if he purposely is starting you out at a less than therapuetic dose and why? I find this curious. Maybe this primes the presynaptic receptor and the dose will be increased with your next visit?
>
> Some info on Sulpiride and mood stabilization on the Solian Philippines website. My experience with amisulpride is less moodiness and irritability.
>
> Thanks for keeping us updated on your sulpiride experience.
>
> I have stopped my trial with sinemet (with l-dopa) and entacapone. Causes a lowering of the mood, increased social anxiety and little if any increased arousal. Literature for use of amisulpride for dysthymia says l-dopa interferes with action of amisulpride.
>
> AndrewB
Hey Andrew! You're back!As far as to why my doctor started me out with such a low dose, I'm not sure. I know that his consultant told him to start me at 50mg/day, but I am wondering if he meant to start there to titrate higher rather than recommend remaining at 50mg as a trial dosage. In any event, my doctor wanted to see if I would respond to it. Perhaps they want to find the absolute minimum needed to reduce the risk of developing EPS and TD. I see him tomorrow. I think I'm going to ask him to move me up to 150mg/day, 50mg t.i.d.
Do you think 50mg of amisulpride = 100mg of sulpiride? Had you tried 25mg of amisulpride before raising the dosage to 50mg?
Your thoughts regarding presynaptic receptor priming are pretty cool. I just hope that staying on a low dose of sulpiride for 2 weeks hasn't reduced my chances of responding to it. I don't think it has. I had a thought (can you believe it?). I am wondering if experiencing initial sedation and somnolence with sulpiride or amisulpride is a prognosticator of non-response. Any thoughts?
(I had thought that I should have thought to find a word other than thought to use in place of the last thought, as I thought I had used the word thought too many times - or so I thought. I just hadn't thought of one.)
By the way, the explanation my doctor's consultant gave as to why he chose sulpiride over amisulpride is that he felt amisulpride was "too much of an antipsychotic". Amisulpride binds to D2 and D3 receptors with much greater affinity than sulpiride. I don't know how this might relate to his statement, but perhaps it reduces the "preference" for antagonizing presynaptic versus postsynaptic receptors.
My doctor told me that Sanofi is getting ready to start investigations of amisulpride in the U.S. for the treatment of depression/dysthymia.
I'm sorry to hear about your disappointment with your recent drug trials. I'm sure you'll come up with more of your innovative approaches. I'll be praying that you find what you're looking for.
With the sincerest of appreciation,
Scott
Posted by KarenB on July 4, 2000, at 12:40:20
In reply to Re: Adrafinil? Sulpiride? » KarenB, posted by SLS on July 4, 2000, at 9:28:43
> Dear Karen,
>
> Thank you SO, SO much!No problem!
> Your comments regarding low-dose sulpiride and mood stabilization are fascinating and extremely important.
>
> In what ways has sulpiride acted as a mood stabilizer? How was your mood unstable previously?No more raging irritability, irrational anger about petty things, I was just more steady and able to cope, even in high stress situations.
> "Anergic" means without energy. Bipolar depression is usually very anergic (low-energy), and in many ways appears similar to atypical unipolar depression.
> What is it about your case that has led to a diagnosis of bipolar disorder?
The irritability and irrational anger sound a lot like mania, don't they? That's what two different docs thought. It was my research that revealed the ADD. I probably have both, although I don't really want to face that possibility right now. My doctor wants me to see Dr. Steven Dobovsky, a specialist in both disorders but he is very expensive, doesn't take my insurance and is booked until Winter.
> ADD / ADHD and bipolar disorder often occur simultaneously. I believe that Provigil is currently being studied for use in ADD. Initial results are encouraging. However, I could not find anything on Medline regarding this. I imagine adrafinil would have the same utility. I can find nothing in the Provigil (modafinil) package insert that would suggest that it cannot be combined with Dexedrine, Adderal, or Ritalin. The only interaction listed is that Ritalin may delay the absorption of Provigil by one hour if they are taken simultaneously. I do not know to what extent this information is applicable to adrafinil. I'm sure your doctor will be able to tell you with certainty. I included relevant information below. Perhaps adrafinil will improve your mood without improving ADD. In this case, adding a stimulant may be desirable.
Using another stimulant plus Adrafinil seems like it would be redundant. I am on the Adrafinil alone right now.
> Did sulpiride produce any improvement in PMS?
YES! Without menses, there is no PMS and none of the awful physical and psychological symptoms. This is probably one reason it was so stabilizing for me. I'd be interested to see what the effect is in a male.
> I can't tell you how much it means to me that you posted such a detailed reply. Thanks again.
:)
>
> Sincerely and Appreciatively,
> Scott
>
>
> P.S. I haven't menstruated since beginning sulpiride either. I don't know how to feel about that.Ha ha...
Have a good 4th!
Karen
Posted by AndrewB on July 4, 2000, at 20:12:36
In reply to Re: Adrafinil? Sulpiride? » SLS, posted by KarenB on July 4, 2000, at 12:40:20
Scott,
Thanks for the info. below on Adrafinil. I think it is important to know to try to understand its underlying mechanism(s) of action. There was mention that modafinil might act, at least in part, via increased glutamate levels and decreased GABA in areas of the brain involved with sleep wakefulness. My experience with the amino acid l-glutamate is that it is very arousing. Possibly adrafinil acts on glutaminergic transmission or indirectly on NE....idle speculation.
I have never used less than 50mg. of amisulpride a day. No studies have used less than 50mg/day.
Sulpiride doses, from the literature I’ve read, can range from 100mg to 400mg. per day. The average therapeutic dose may fall between 150 and 200mg per day. Dosing varies possibly due to individual variation in the absorption of Sulpiride. It is not clear whether multiple daily dosing is preferable over once daily dosing.
Yes I’m thinking initial somnolence and sedation is an indicator of non-response with amisulpride. Maybe what is happenning is that postsynaptic receptor (instead of presynaptic receptor) antagonism is occurring even at low doses. Why??? The individual maybe has lessened presynapatic receptor binding affinities? A lower number of presynaptic receptors? All I can say is it is very curious.
Thanks for the info. about the consultant saying greater binding affinities may hobble the effectiveness of amisulpride. Could you ask what the implications of this may be for those who take amisulpride; 1) more non-responders vs. Sulpiride 2) a less robust effect 3) a greater chance of postsynaptic instead of presynaptic antagonism at low doses.
I’m not that disappointed by recent drug trial failures. I am very grateful for how I feel now though I’m still seeking additional improvement. I recently stopped
St. John’s Wort because it seems its serotonin action was making me lethargic, sleepy, groggy and less mentally sharp. No serotonin enhancement for me I guess.I increased my dose of reboxetine to 12mg/day, the maximum dose, due to partial poop out. Good arousal has been restored I believe.
After trying neurontin for about a month, I don’t think I have a use for it. Makes me a little sleepy and relaxed, that is about it.
Am trying seligiline at 5mg/day for social anxiety. Supposedly need 4-6 weeks to take effect.
Happy 4th!!!
AndrewB
Posted by KarenB on July 5, 2000, at 22:42:02
In reply to Re: Sulpiride- Scott, posted by AndrewB on July 4, 2000, at 20:12:36
> Thanks for the info. about the consultant saying greater binding affinities may hobble the effectiveness of amisulpride. Could you ask what the implications of this may be for those who take amisulpride; 1) more non-responders vs. Sulpiride 2) a less robust effect 3) a greater chance of postsynaptic instead of presynaptic antagonism at low doses.
Hey guys,
You know, when you get into that binding, postsynaptics, presynaptics, etc., you kind of lose me. I'm just not that technical. So, please respond accordingly, OK? OR...write a really long one explaining that stuff?
Question: Does the above question indicate that there may be a substantial difference in expected response between amisulpride and sulpiride? If so, why?
As you know, I did best on Amineptine/Sulpiride. Both are Dopamine reuptake inhibitors right? At what receptors? What then would this indicate about possibilities of successful medications for me? Do you think Adrafinil is a good choice...or only good if augmented by another Dopamine blocker? It seems to me it would enhance the energizing effects of the Adrafinil. Is there another psychostimulant that is a Dopamine blocker to replace the Amineptine? Ritalin and Adderall just do not compare to the Amineptine.
What would you do if you had my brain (aside from considering a sex change)?
Sorry for the deluge of questions but I plan to order one or the other soon and want to make the right choice.
BTW, anybody got any amisulpride laying around that you won't be using?
Thanks!!
Karen
Posted by SadSuzie on July 6, 2000, at 7:22:16
In reply to Re: Stim/Sulp. Question-AndrewB,SLS,JohnL,etc, posted by KarenB on July 5, 2000, at 22:42:02
Hey Karen,
Actually, I do think I have a brain very similiar to yours - at least in regard as to how they react to different medications. Please keep posting your med combos and results. Definitely let me know if you find a source for amisulpride.
Thanks,
ss
> > Thanks for the info. about the consultant saying greater binding affinities may hobble the effectiveness of amisulpride. Could you ask what the implications of this may be for those who take amisulpride; 1) more non-responders vs. Sulpiride 2) a less robust effect 3) a greater chance of postsynaptic instead of presynaptic antagonism at low doses.
>
> Hey guys,
>
> You know, when you get into that binding, postsynaptics, presynaptics, etc., you kind of lose me. I'm just not that technical. So, please respond accordingly, OK? OR...write a really long one explaining that stuff?
>
> Question: Does the above question indicate that there may be a substantial difference in expected response between amisulpride and sulpiride? If so, why?
>
> As you know, I did best on Amineptine/Sulpiride. Both are Dopamine reuptake inhibitors right? At what receptors? What then would this indicate about possibilities of successful medications for me? Do you think Adrafinil is a good choice...or only good if augmented by another Dopamine blocker? It seems to me it would enhance the energizing effects of the Adrafinil. Is there another psychostimulant that is a Dopamine blocker to replace the Amineptine? Ritalin and Adderall just do not compare to the Amineptine.
>
> What would you do if you had my brain (aside from considering a sex change)?
>
> Sorry for the deluge of questions but I plan to order one or the other soon and want to make the right choice.
>
> BTW, anybody got any amisulpride laying around that you won't be using?
>
> Thanks!!
>
> Karen
Posted by AndrewB on July 6, 2000, at 10:12:13
In reply to Re: Stim/Sulp. Question-AndrewB,SLS,JohnL,etc, posted by SadSuzie on July 6, 2000, at 7:22:16
For a list of sources of amisulpride as well as an information piece on the medicine, email me at andrewb@seanet.com.
Is there much of a difference between amisulpride and sulpiride? I don't know. I have asked a French psych this question and hope for a reply soon. Perhaps Scott can ask his doctor also. From what I have read, people seem to respond in about the same way to sulpiride as amisulpride. However, some people who respond to sulpiride may not respond to amisulpride and visa versa.
Karen, there is no dopamine reuptake blocker substitute for amineptine available. Don't get too stuck on the dopamine though. I think what you probably need is a good arousal agent to combine with amisulpride or sulpiride. Remember that I had good results by augmenting amisulpride with reboxetine. Reboxetine works via NE enhancement and amineptine may, in fact, also work, in part via NE enhancement. For now I think adrafinil would be a good med. to try. If that doesn't work, Wellbutrin may. The dopaminergic combo of amantadine, seligiline (low dose) and hydergine amy also be effective.
AndrewB
Posted by SLS on July 6, 2000, at 10:25:59
In reply to Re: Stim/Sulp. Question-AndrewB,SLS,JohnL,etc, posted by KarenB on July 5, 2000, at 22:42:02
> > Thanks for the info. about the consultant saying greater binding affinities may hobble the effectiveness of amisulpride. Could you ask what the implications of this may be for those who take amisulpride; 1) more non-responders vs. Sulpiride 2) a less robust effect 3) a greater chance of postsynaptic instead of presynaptic antagonism at low doses.
>
> Hey guys,
>
> You know, when you get into that binding, postsynaptics, presynaptics, etc., you kind of lose me. I'm just not that technical. So, please respond accordingly, OK? OR...write a really long one explaining that stuff?
Dear Karen,I will attempt to comply with the former, as I don’t have the mental resources to adhere to the latter.
> Question: Does the above question indicate that there may be a substantial difference in expected response between amisulpride and sulpiride? If so, why?It is my guess that there is not a substantial difference between these two drugs regarding their efficacy for treating depression or dysthymia. I have not come across any *clinical* information that indicates that there are. It is my opinion, however, that it is usually a good idea to treat any two drugs as being different simply because they are. The doctor who my doctor consulted with feels that sulpiride is a better choice for treating depression than is amisulpride.
> As you know, I did best on Amineptine/Sulpiride. Both are Dopamine reuptake
inhibitors right?Actually, Karen, they are not both DA reuptake inhibitors. This is probably why they are so effective in combination. They are complimentary rather than being additive. The guy or gal who thought to do this is brilliant IMHO.
Amineptine blocks the reuptake of dopamine molecules by the presynaptic neuron so that it may use them again when it comes time to release them to transmit its message to the postsynaptic neuron.
> At what receptors?
Sulpiride acts to fool the thermostat that helps to regulate the presynaptic neuron. If one were to consider the release of neurotransmitter as being the turning on of a furnace, the presynaptic “autoreceptors” would represent the thermostat that controls it. Sulpiride attaches to these receptors and prevents them from feeling the heat (neurotransmitter) present in the synaptic gap. It would be as if one were to enclose the thermostat in an insulated box in which the air is never warmed by the released heat to the point where it turns off the furnace. So… Sulpiride induces the presynaptic neuron to continue to manufacture and release “extra” dopamine because the furnace is never turned off by the autoreceptor thermostat.
> What then would this indicate about possibilities of successful medications for me?Andrew and I have devoted some thought to try to answer this question, so as to heal ourselves and anyone else would like to go along for the ride. The technical stuff has some relevance in trying to brainstorm a replacement for amineptine.
> Do you think Adrafinil is a good choice
Yes, but not because it does the same thing as amineptine. It doesn’t do it at all at relevant concentrations. It just seems to be a good drug that may potentiate dopamine activity in areas of the brain thought to be involved with depression – motivation, reward, vigilance, and mental energy. It might not work. It’s just that I can think of no reason why it wouldn’t be worth a try.
> ...or only good if augmented by another Dopamine blocker?
A group of 7 people whose depressions were resistant to treatment with various antidepressants were given modafinil (Provigil), a relative of adrafinil to augment them. It helped people for whom it was combined with SSRIs as well as Wellbutrin. From the posts currently appearing on Psycho-Babble, it appears that adrafinil may be more effective than Provigil.
> It seems to me it would enhance the energizing effects of the adrafinil. Is there another psychostimulant that is a Dopamine blocker to replace the Amineptine? Ritalin and Adderall just do not compare to the Amineptine.If you were willing to be a pioneer and a guinea pig, I would be interested to see how you would respond to mazindol (Mazinor, Sanorex). This drug has been used to treat obesity and has been looked at from time to time for treating depression. It has psychostimulating properties and is often used to evaluate dopamine reuptake, as it acts to inhibit it. Mazindol is also a potent reuptake inhibitor of norepinephrine (NE).
> What would you do if you had my brain (aside from considering a sex change)?Do you want to trade? :-) Actually, it is quite possible that we will both respond to similar drug regimens. Let’s stay in touch.
> Sorry for the deluge of questions but I plan to order one or the other soon and want to make the right choice.
Sulpiride vs adrafinil or sulpriride vs amisulpride?I am currently taking sulpiride. I just moved up to 100mg. I don’t know whether to be encouraged or discouraged by my lack of response to 50mg for two weeks. What do you think? How did you go about titrating the dosage? I would like to add either modafinil or adrafinil to sulpiride if it doesn’t work. If this strategy doesn’t work, I am considering combining Parnate (an MAOI) with sulpiride.
I hope I’ve helped in some way. Please post your decision. Good luck.
- Scott
Posted by SLS on July 6, 2000, at 15:42:28
In reply to Re: Stim/Sulp. Question-AndrewB,SLS,JohnL,etc » KarenB, posted by SLS on July 6, 2000, at 10:25:59
Re amineptine: I apologize for delivering such a crappy explanation.
Amineptine blocks the reuptake of dopamine molecules by the presynaptic neuron. In an unmedicated state, the presynaptic neuron recycles the neurotransmitter it releases by absorbing it back from the synaptic cleft into which it had been released. This process is known as neurotransmitter reuptake. When this process is inhibited by amineptine, the released dopamine remains in the synaptic cleft, thereby allowing the concentration of dopamine within the cleft to rise.
- Scott
Posted by SLS on July 7, 2000, at 10:37:48
In reply to Re: Adrafinil? Sulpiride? » SLS, posted by KarenB on July 4, 2000, at 12:40:20
Dear Karen,
I raised my dosage of sulpiride a few days ago to 100mg. I am beginning to feel pretty cruddy. I am experiencing some dulling and slowing of thought, a sedation-type thing, and a bit of apathy. Cruddy. Did any of this happen to you when you first started taking it?
Thanks again.
- Scott
Posted by KarenB on July 9, 2000, at 1:54:42
In reply to Sulpiride side-effects; feeling cruddy » KarenB, posted by SLS on July 7, 2000, at 10:37:48
> Dear Karen,
>
> I raised my dosage of sulpiride a few days ago to 100mg. I am beginning to feel pretty cruddy. I am experiencing some dulling and slowing of thought, a sedation-type thing, and a bit of apathy. Cruddy. Did any of this happen to you when you first started taking it?
>
> Thanks again.
>
>
> - ScottScott,
No, I don't remember any of that but I started on 50mg 3x a day and never changed the dosage. And...I was taking Amineptine, a psychostimulant with it too. Are you taking a stim. along with it? I don't remember what you are taking now. Maybe you'd want to try a higher dosage for a few days and see how that works?
Is the brand name Dogmatil?
Have you made any other changes in meds lately?
A little over a week ago I started feeling terrible and it turned out I had a sinus infection in the works. Antibiotics took care of that but I am hypersensitive to what's going on in my body and will feel crummy the day before an illness actually manifests. I notice that if one of my children is getting sick, even they are in a nasty mood the couple of days prior to symptoms.
How are you feeling today?
Wish you the best...
Karen
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