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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by AndrewB on July 14, 2000, at 20:34:41
Scott,
This article may interest you.
Treatment of Depression in the Patient with Parkinson's Disease
www.mmhc.com/cq/articles/CG9810/tom.htmlI remember that Dr. Goldstein had mentioned a good response from the combo of moclobemide and a COMT inhibitor.
AndrewB
Posted by SLS on July 15, 2000, at 9:00:38
In reply to Scott, posted by AndrewB on July 14, 2000, at 20:34:41
Dear Andrew,
I couldn't get the URL to work.
> Treatment of Depression in the Patient with Parkinson's Disease> www.mmhc.com/cq/articles/CG9810/tom.html
I stopped taking Provigil. It seemed to affect me the same way it affected JohnL. I actually experienced a small improvement within the first few hours of taking my first 100mg dose. It lasted for about half the day. Then I began to feel kind of spacy or hazy, with the improvement having waned. This weird feeling wore off within 24 hours as I kept a 200mg/day schedule. I was left with a bit more energy, but I experienced a low level anxiety and a dull headache. After four days, however, any increase in energy and cognition disappeared, and I just plain didn't like the way I felt. I cut back to 100mg yesterday and do not plan to take any more. I have begun to feel more like my usual sick self.I don't know what to do next. That I felt anything positive at all argues in favor of trying adrafinil in the hope that my response to it will reflect the scenario I have seen here on Psycho-Babble. It seems that most people who have tried both Provigil and adrafinil, and who eventually responded well to adrafinil, had had disappointing results with Provigil.
Of course, I would like to know more about the true nature of the liver concerns. The other thing that occurs to me is that if the scientists are right, Provigil may have acted antagonistically with the Lamictal I have been taking. This would involve the opposing effects these two drugs *may* exert on extracellular glutamate levels. I imagine the same interaction might occur with adrafinil. Who knows.
When I experienced the short-lived improvement "blip" from Provigil, I thought it felt like it might complement Parnate. I am hoping that my experience with adrafinil would be positive enough to consider combining it with Parnate. Do you know of anyone who has actually used a combination of adrafinil with an MAOI?
Thanks for the reference. I would be interested to read it if you can locate it again.
- Scott
Posted by JohnL on July 15, 2000, at 9:44:43
In reply to Re: Scott » AndrewB, posted by SLS on July 15, 2000, at 9:00:38
Scott,I think you'll find Adrafinil quite a bit more tame than Provigil was. I wouldn't be too concerned with the liver thing. I would be more concerned with getting well. If the liver issue is troubling, you could always get monthly or quarterly bloodtests to monitor the situation. Maybe save the money you would have spent on more expensive meds to pay for the blood tests. And pick up some Milk Thistle herb. It's a powerful liver protector and rejuvenator.
Maybe I'm too brave for my own good, but I wouldn't be afraid of mixing Adrafinil with anything, including MAOIs. I do not approach anything in too cavalier a fashion. Always very cautious with very low starting doses. And so often I've seen things in the real world turn out to be totally different than what we would expect based on the theory world. We could take all the glutamate theory and alpha-1 theory and stuff and put it on a shelf for the moment. All that really matters is...does the med work for me or not? I don't care if it should or shouldn't work on paper, because the real world isn't likely to turn out the way it appears on paper. It's just my own experience, but everything that should have worked (in theory) didn't. Something that shouldn't have worked (in theory) did.
I'm just trying to relay to you that, in my experience, Adrafinil is the tamest med I've ever taken. You know how long my list of meds is. I know it's like a tug of war trying to decide to take that first dose of any new med, so I'm just trying to reassure you that I think you can be at ease with Adrafinil. I struggled for weeks looking at my Adrafinil, staring at the pill each morning, wondering, should I put it in my mouth? If I do, I'm on my own ya know? Oh man. I had too many doubts and set it down for another day. When I finally did take it, it was like, is this a sugar pill or what? Is that all there is to it? Where are the side effects? Did they rip me off and sell me junk that doesn't do anything? Tame. And as you know, for me, it has been pretty effective. I don't know or care what it does, only that it sure works. And I'll get several blood tests a year and take milk thistle to deal with the things I don't know enough about. Those might turn out to be a waste of money, but I guess it's good insurance. Not just with Adrafinil, but any medication for that matter.
Wishing you a good day.
John
Posted by AndrewB on July 15, 2000, at 10:28:13
In reply to Re: Scott » AndrewB, posted by SLS on July 15, 2000, at 9:00:38
Try this:
http://www.mmhc.com/cg/articles/CG9810/tom.htmlSorry I gave the wrong URL (a 'g' looked like a 'q' on my printout)
You are so polite Scott not to have mentioned my mistake directly.
And I'm truly sorry the sulpiride and provigil haven't helped.
Anthony (Ant-Rock) has (is?) taking Parnate and Adrafinil together.
Adrafinil seems like a reasonable next choice for you. I've ordered some and will compare it to reboxetine.
I will trial memantine in a day or two.
Probably trial low dose lamotrigine in the future. Dr. Goldstein recommends a low dose. How long of trial is necessary. Any other advice?
I tried hydergine. It made me tired, socially anxious and very irritable. Hydergine is dopaminergic.
I took two online tests for adult ADD. Both times I was indicated to have it. I'll have to look into this. I guess I will read and research more and then talk to my psych about it. Perhaps a stimulant trial is in my future.
AndrewB
Posted by Ant-Rock on July 16, 2000, at 19:09:28
In reply to Re: Scott » AndrewB, posted by SLS on July 15, 2000, at 9:00:38
>I am hoping that my experience with adrafinil would be positive enough to consider combining it with Parnate. Do you know of anyone who has actually used a combination of adrafinil with an MAOI?
--------------------------------------------------
Scott my friend,
Don't you read my posts anymore? (Just kidding!)
I am currently on 60mgs parnate and 300mgs adrafanil daily. I haven't been on the adrafanil long enough to evaluate it fairly, but so far no side effects with the combo. My Psy-doc wants me to increase the parnate up to 80mgs, but I would rather wait and see how this augmenting goes first. As soon as I get a response, good, bad, or neutral I will post it for you.
Please be well,
Sincerely,
Anthony
Posted by SLS on July 17, 2000, at 7:47:06
In reply to Re: Scott » SLS, posted by Ant-Rock on July 16, 2000, at 19:09:28
> >I am hoping that my experience with adrafinil would be positive enough to consider combining it with Parnate. Do you know of anyone who has actually used a combination of adrafinil with an MAOI?
> --------------------------------------------------
> Scott my friend,
> Don't you read my posts anymore? (Just kidding!)
> I am currently on 60mgs parnate and 300mgs adrafanil daily. I haven't been on the adrafanil long enough to evaluate it fairly, but so far no side effects with the combo. My Psy-doc wants me to increase the parnate up to 80mgs, but I would rather wait and see how this augmenting goes first. As soon as I get a response, good, bad, or neutral I will post it for you.
> Please be well,
> Sincerely,
> Anthony
Anthony - Thanks.Did you experience any sort of improvement during the first three days after starting adrafinil? Do you feel that it is helping you at all at this point? How long have you been taking it?
What sort of information did you present your doctor with that allowed him to be comfortable with the combination? I may be headed in the same direction as you. Good luck. If you are not already aware, Parnate has been used at dosages higher than 120mg a day for treatment-resistance cases. You can find some reference to this in Dr. Bob's tips. Some people have taken more than 200mg/day. I don't know what guidelines are followed to titrate to such high dosages.
It was a bad weekend.
Thanks again, Anthony.
- Scott
Posted by Ant-Rock on July 19, 2000, at 17:49:01
In reply to Re: Scott » Ant-Rock, posted by SLS on July 17, 2000, at 7:47:06
> Anthony - Thanks.
>
> Did you experience any sort of improvement during the first three days after starting adrafinil? Do you feel that it is helping you at all at this point? How long have you been taking it?
>
> What sort of information did you present your doctor with that allowed him to be comfortable with the combination? I may be headed in the same direction as you. Good luck. If you are not already aware, Parnate has been used at dosages higher than 120mg a day for treatment-resistance cases. You can find some reference to this in Dr. Bob's tips. Some people have taken more than 200mg/day. I don't know what guidelines are followed to titrate to such high dosages.
>
> It was a bad weekend.
>
> Thanks again, Anthony.
>
>
> - ScottI've only been on 300mgs for one week, I may increase to 450mg ina few days. As far as my Dr. goes, he is very open minded and I simply told him adrafanil was related to provigil, which is being studied as an AD augmentor.
So far, no changes to speak of.
I'm sorry to hear you had a bad weekend Scott, I also have been sliding backwards and am getting very frustrated and down. I feel like I've been given a prison sentence with no chance of parole.
Anyway, I'll let you know how it's going with this combo after I give it some more time.
Take care,
Sincerely,
Anthony
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