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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by becksA on December 10, 2004, at 8:36:16
Morning,
I read an earlier reply to one of my posts suggesting I try a TCA, or ask my pdoc about it. I have not tried one as far as I know, at least none that you mentioned. Tofrinil rings a bell, but it would have been a long time ago when I was just a kid and I didn't have the same symptoms at all. How are they different?Secondly, how is provigil different from SSRI's and SNRI's? As you may know I'm taking lamictal in hopes of helping my BP2 depression, which seems to be taking some effect, which would be nice because I think a lot of the anxiety stems from that depression.
Thanks for the help.
Posted by jujube on December 10, 2004, at 11:07:23
In reply to jujube or others - TCAs, provigil-Pdoc TODAY! PLZ., posted by becksA on December 10, 2004, at 8:36:16
The TCAs are the older generation antidepressants, and most of them work on both serotonin and norepinephrine. I am a real novice at this stuff, but as I understand it, they tend to be better for adhedonic, anxious depressions than the SSRIs and even SNRIs like Effexor. The side effects can be more bothersome than those associate with the SSRIs and SNRIs, including dizziness (particularly when standing up), dry mouth, constipation, and a few others. If you have adhedonic, anxious depression, you might want to discuss Tofranil, Anafranil (which is also supposed to be excellent for OCD) and Pamelor (nortripyline)(is a bit more activating, but apparently has both antidepressant and anxiolytic properties) with your doctor. If you are prone to anxiety, you will probably want to stay away from Desipramine I think. I am currently using Anafranil, and at 50 mg, the side effects have been minimal. I will be going up to 75 mg in the next few days. The effect has been pretty good so far, even at such a low dose.
Provigil is neither a SSRI nor a SNRI. It is a type of stimulant, but has a chemical make-up different than traditional stimulants. Here is a little bit of info on Provigil:
Provigil etc. (Modafinil) is a unique wake-promoting agent that is chemically distinct from traditional stimulants. Officially an Alpha1-adrenergic agonist medication (also known as an "eugeroic" drug), Modafinil was approved in 1998 (U.S. FDA) for the treatment of excessive daytime sleepiness associated with narcolepsy. A small number of clinical trials have also suggested that Modafinil also has memory-improving and mood-brightening effects. For these reasons it is now being used to augment treatment in depression patients who have had only a partial response to antidepressant therapy. Similarly, Modafinil has also found a number of other potential uses like reducing fatigue and cognitive problems commonly found in health conditions like Multiple Sclerosis, Chronic Fatigue Syndrome etc..
Modafinil appears to be well-tolerated and to be free of side-effects like agitation, irritability, nervousness, euphoria or the potential for paranoid delusion and addiction that are common to other stimulants like amphetamines or cocaine. This may be because Modafinil targets very specific regions of the brain believed to regulate normal wakefulness, like the the neurotransmitter dopamine. As Modafinil has a fairly long half life of approximately 15 hours (the amount of time before half of the drug's peak plasma level is eliminated by the body), it can be taken once-daily - usually in the morning to avoid impacting night-time sleep.
Hope the above information is helpful. As I mentioned, I am no expert on this stuff, but have been doing some research because of my own depression in the past month or so.Good luck to you.
Tamara
> Morning,
> I read an earlier reply to one of my posts suggesting I try a TCA, or ask my pdoc about it. I have not tried one as far as I know, at least none that you mentioned. Tofrinil rings a bell, but it would have been a long time ago when I was just a kid and I didn't have the same symptoms at all. How are they different?
>
> Secondly, how is provigil different from SSRI's and SNRI's? As you may know I'm taking lamictal in hopes of helping my BP2 depression, which seems to be taking some effect, which would be nice because I think a lot of the anxiety stems from that depression.
>
> Thanks for the help.
Posted by becksA on December 10, 2004, at 11:41:16
In reply to Re: jujube or others - TCAs, provigil-Pdoc TODAY! PLZ. » becksA, posted by jujube on December 10, 2004, at 11:07:23
Hmmm very interesting. Thanks very much for the post. My much-awaited pdoc appointment is only 5 hours away, and I really want to make some changes. On such a high dose of Xanax I'm confused why I have all this severe social anxiety. I'm taking 3mg of XR 3 times a day! (And it's not a tolerance issue either, it's been like this from the start pretty much).
I've actually written down a list of things to suggest/ask about. If anybody could let me know based on my symptoms what I might not need to ask about let me know. Here's what I'm taking right now:-Lamictal 100mg daily, still slowly increasing...
-Xanax XR 3mg 3x daily, hoping to taper off eventually
-Adderall XR morning and noon, short acting at dinner. (I recently decreased my morning dose from 60mg to 30 because I think it was adding to my anxiety. I am unsure though, because before those couple of days of increased anxiety, I felt it was making me very sociable and outgoing. However, when I went down to the 30 instead, I noticed no decrease in that sociability, which leads me to believe I may have been right.Here's my list of things to ask about:
-Take lamictal PM dose earlier instead of before bed?
-Cymbalta, Provigil?
-Desoxyn for my ADD instead of Adderall?
-TCAs
-For benzos, take smaller doses when not necessary to reduce tolerance buildup.thanks guys.
Posted by jujube on December 10, 2004, at 12:07:19
In reply to Re: jujube or others - TCAs, provigil-Pdoc TODAY! PLZ., posted by becksA on December 10, 2004, at 11:41:16
If your anxiety is not responding to that much Xanax, you might want to consider having your thyroid and blood sugar levels checked. Perhaps part of your problem is either hyperthyroidism or hypoglycemia. Anyways, it is something to raise with your pdoc as well since the Xanax does not seem to be helping and you are confident that it is not a tolerance issue.
Good luck today.
Tamara
> Hmmm very interesting. Thanks very much for the post. My much-awaited pdoc appointment is only 5 hours away, and I really want to make some changes. On such a high dose of Xanax I'm confused why I have all this severe social anxiety. I'm taking 3mg of XR 3 times a day! (And it's not a tolerance issue either, it's been like this from the start pretty much).
> I've actually written down a list of things to suggest/ask about. If anybody could let me know based on my symptoms what I might not need to ask about let me know. Here's what I'm taking right now:
>
> -Lamictal 100mg daily, still slowly increasing...
> -Xanax XR 3mg 3x daily, hoping to taper off eventually
> -Adderall XR morning and noon, short acting at dinner. (I recently decreased my morning dose from 60mg to 30 because I think it was adding to my anxiety. I am unsure though, because before those couple of days of increased anxiety, I felt it was making me very sociable and outgoing. However, when I went down to the 30 instead, I noticed no decrease in that sociability, which leads me to believe I may have been right.
>
> Here's my list of things to ask about:
> -Take lamictal PM dose earlier instead of before bed?
> -Cymbalta, Provigil?
> -Desoxyn for my ADD instead of Adderall?
> -TCAs
> -For benzos, take smaller doses when not necessary to reduce tolerance buildup.
>
> thanks guys.
Posted by becksA on December 10, 2004, at 12:27:39
In reply to Re: jujube or others - TCAs, provigil-Pdoc TODAY! PLZ. » becksA, posted by jujube on December 10, 2004, at 12:07:19
Thanks, I'm looking forward to it. Through all this though I have learned, I'm pretty sure, that most if not all the anxiety, at the very roots comes from the depression, which my pdoc believes is BP2. So if that is properly treated, the anxiety should come down.
This is the end of the thread.
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