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Dr. Bob is Robert Hsiung, MD,
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Posted by Joy on July 1, 2000, at 19:10:29
I just started Adrafinil [Olmifon] as an antidepressant. This med is used in Europe for treatment of narcolepsy, but used in smaller doses is reportedly very good for depression. I take 300 a day. Does anybody have any info or experience with this med? I also take Celexa. Thanks.
Posted by SLS on July 2, 2000, at 7:36:51
In reply to Adrafinil [Olmifon] for Depression, posted by Joy on July 1, 2000, at 19:10:29
> I just started Adrafinil [Olmifon] as an antidepressant. This med is used in Europe for treatment of narcolepsy, but used in smaller doses is reportedly very good for depression. I take 300 a day. Does anybody have any info or experience with this med? I also take Celexa. Thanks.
Dear Joy,The following is an abstract describing a study of 7 people for whom modafinil (Provigil), a relative of adrafinil, was used in combination with antidepressants. The dosages used were about half of what is normally used to treat narcolepsy.
----------------------------------------------J Clin Psychiatry 2000 May;61(5):378-81 Related Articles, Books, LinkOut
Modafinil augmentation of antidepressant treatment in depression.Menza MA, Kaufman KR, Castellanos A
Department of Psychiatry, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, Piscataway 08854, USA. menza@umdnj.edu
BACKGROUND: Despite a relative lack of controlled data, stimulants are often used to augment antidepressant treatment in patients who have had only a partial response to first-line therapy. Modafinil is a novel psychostimulant that has shown efficacy in, and was recently marketed for, treating excessive daytime sleepiness associated with narcolepsy. The mechanism of action of modafinil is unknown, but, unlike other stimulants, the drug is highly selective for the central nervous system, has little effect on dopaminergic activity in the striatum, and appears to have a lower abuse potential. METHOD: In this retrospective case series, we describe 7 patients with DSM-IV depression (4 with major depression and 3 with bipolar depression) for whom we used modafinil to augment a partial or nonresponse to an antidepressant. The Hamilton Rating Scale for Depression was administered as part of routine clinical practice prior to treatment and at each subsequent visit. RESULTS: At doses of 100 to 200 mg/day, all 7 patients achieved full or partial remission, generally within 1 to 2 weeks. All patients had some residual tiredness or fatigue prior to starting modafinil, and this symptom was particularly responsive to augmentation. Side effects were minimal and did not lead to discontinuation of the drug in any of the patients. CONCLUSION: Modafinil appears to be a drug with promise as an augmenter of antidepressants, especially in patients with residual tiredness or fatigue. It is a particularly attractive alternative to other stimulants because of its low abuse potential and Schedule IV status.
PMID: 10847314, UI: 20303927
Posted by JohnL on July 4, 2000, at 5:41:29
In reply to Adrafinil [Olmifon] for Depression, posted by Joy on July 1, 2000, at 19:10:29
> I just started Adrafinil [Olmifon] as an antidepressant. This med is used in Europe for treatment of narcolepsy, but used in smaller doses is reportedly very good for depression. I take 300 a day. Does anybody have any info or experience with this med? I also take Celexa. Thanks.
Joy,
I've posted what little info I could find on Adrafinil several times. Since it's much easier than searching old posts, I'll be glad to repost it. In addition, the package insert says it is for narcolepsy, attention difficulties, and depression. Though this could be true of all stimulants, I find Adrafinil to be the kindest gentlest and most effective of them all. The one thing I've noticed that makes it very different than other stimulants is that it takes weeks to build up to full therapeutic value, whereas most stimulants work very rapidly.I was on 300mg for a while, felt great, and decided to see how I would be without it (did my longstanding depression just coincidentally resolve itself or did Adrafinil deserve the credit?) It came on so slowly and subtly I wasn't sure if it was the drug or just coincidence. Within a week I was falling quickly into the dark dungeon again. The same place I've been for years. So I restarted. Same pattern as the first time...immediate response day 1...faded by day 2...depression proceeded to slowly lift from day 3 to 2 weeks. I now prefer 600mg Adrafinil. I really stay active, motivated, interested, socially comfortable, without any of the usual stimulant feelings of speediness or anxiety.
I would think Adrafinil + Celexa could be a good combo. My only concern would be that the serotonin effect of Celexa could possibly numb the beneficial effects of Adrafinil. That's just my experience. You could consider reducing the Celexa and increasing the Adrafinil. It's just my opinion only, but in my own experience I think you could get far more benefit from Adrafinil than Celexa, so put the emphasis on Adrafinil. Of course, we're all different, and what works for me could be all wrong for you. Serotonin meds do prevent my lows, but prevent the highs too. Life becomes undepressed yet very flat. No real joy. No motivation. No interest. No depression either. Just kinda flat and numbed. If serotonin meds are like that with you, then decreasing Celexa and increasing Adrafinil could make sense. Overall I find 600mg better than 300mg, though it takes a couple weeks to really notice the difference.
I think what really deserves special mention is that Adrfinil has worked so well with me when just about every other med you can think of didn't in all the years I've been unsuccessfully treated.
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.
> ADRAFINIL
>
> Submitted to the BIAM: 2/18/98
> Final entry: 3/23/2000
> Status: Validated
>
> Identification of substance
> Pharmacological properties
> Mechanisms of action
> Researched effects
> Therapeutic indications
> Side effects
> Genetic toxicity
> Drug Dependence
> Precautions
> Routes of administration
> Dosage and administration
> Pharmacokinetics
> Bibliography
>
> Identification of substance:
>
> Chemical formula:
> 2-[(diphenylmethyl)sulfinyl]-N-hydroxyacetamide
>
> List of names:
>
> CAS: 63547-13-7
> DCIR: ADRAFINIL
> Memorandum: Experimental code 2755: CRL 40028
> Dci: Adrafinil
> DCIp class: 69
> DCIr class: 22
> rINN ADRAFINIL
>
> Chemical class:
>
> Acetohydroxyamic Acid
>
> Regulation: Class I
>
> 1. Psychostimulant (primary usage)
>
> Mechanisms of action:
>
> 1. Principal
> Stimulant, central nervous system alpha-1 adrenergic agonist. Causes release of
serotnin and dopamine at high doses.
>
>
> Researched effects:
>
> 1. Psychotonic (primary)
>
> Therapeutic indications:
>
> Cerebral Senescence (primary)
>
> 1) Treatment for the symptoms of age-related difficulties with vigillance and
depression. Double-blinded studies against placebo demonstrated an improvement in
mental state in elderly subjects.
>
> Side Effects:
>
> 1) Determined to be very rare: Skin eruptions, gastric distress, psychomotor
excitation, mental confusion, depression, mania (in manic-depressive patients),
increase in alkaline phosphatases (with prolonged treatment).
>
> Genetic toxicity:
>
> 1. Non-teratogenic in animals (studies done in rat and rabbit)
> 2. Information lacking in humans
>
> Dependance:
>
> 1. None.
>
> Contraindications:
>
> 1) Epilepsy
> 2) Severe hepatocellular deficiency
> 3) Cirrhosis (marked increase in biodisposal in cirrhotics)
> 4) Severe renal deficiency
> 5) Athletes (Prohibited substance, Journal Officiel, 3/7/2000)
>
> Routes of administration:
>
> 1 - Oral
>
> Dosage and administration:
>
> Usual dose for oral administration in adults:
> 600 to 1200 mg/day.
> In the case of renal or hepatic deficiencies, reduce the dosage to 300-600mg/day.
>
> Pharmacokinetics:
>
> 1. Half-life: 1 hour
> 2. Elimination: Renal
>
> Absorbtion:
> One hour after taking orally, plasma concentration is maximal.
>
> Distribution:
> Bound to plasma proteins: 80%
> Half-life
> 1 hour
> Metabolism
> 75% level of hepatic metabilism in the liver to an acid derivative, then glucoronic
acid conjugation.
> Elimination
> Renal, essentially in the form of a glucoronic acid conjugate
>
> Bibliography:
> -Prescrire 1991;11:68-69
>
> Patents
>
> Unique active constituent in the following current French patents:
>
> Olmifon, 300mg tablets.
> ..
Posted by Joy on July 4, 2000, at 7:13:37
In reply to Re: Adrafinil [Olmifon] for Depression, posted by JohnL on July 4, 2000, at 5:41:29
John,Thank you for all the info on Adrafinil. It's very helpful. I am only taking 10 mg of Celexa with the 300 mg Adrafinil. I want to give it a chance to work.
Posted by SLS on July 4, 2000, at 7:54:38
In reply to Re: Adrafinil [Olmifon] for Depression » JohnL, posted by Joy on July 4, 2000, at 7:13:37
Dear Joy,
Just an opinion:
I would not reduce the dosage of an SSRI or take less of it than what produces an antidepressant effect when adding adrafinil. What JohnL describes regarding Celexa is not a worsening of depression, but the emergence of mental side effects that are known to occur in many people - apathy, passivity, and emotional blunting. He did describe his experience with Celexa as such, but I just wanted to emphasize the point. I do not believe that you can "get away" with less Celexa simply because you have added adrafinil. If you need a minimum of 20mg of Celexa to produce an antidepressant response, I don't think that adding adrafinil will allow you to reduce the dosage to 10mg.
- Scott
This is the end of the thread.
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