Posted by Blue Cheer 1 on February 8, 2002, at 0:59:58
In reply to Re: Aricept 'n' stuff, posted by Elizabeth on February 7, 2002, at 21:02:30
> Hi. You certainly are sounding better than last time we spoke. That's nice to see. I hope you're able to remain well and stable.
Thanks, Elizabeth. I was body-slammed with a depressive episode (if you want to call a year an "episode") that finally broke one month ago. Every day now, I have to consider the thought of relapsing. So, I'm just trying to get back in shape and keep a routine for now. Most of this Aricept info. is from a Currents Interview with Frederick M. Jacobsen, M.D. (Nov. 1999) that I'd never read.
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> I can see how it would be hard to tell what's doing what when you're taking all those different mood stabilizers. Do you notice anything from the Aricept (side effects, etc.)? I've been thinking about trying Aricept myself as a cognitive enhancer (not sure if it would help with the buprenorphine side effects since the mechanism is different). I haven't pursued the idea because a cholinergic drug might set off my sleep disorder, which I've managed to keep under control.Well, I started it when I was using Lamictal only, as a stabilizer (a mistake). Then, I added Trileptal a few months after Aricept, but I didn't feel any different. I was mixed and somewhat elevated at the time. I think I went up to 10 mg. QAM within two weeks. I took it in the morning, rather than evening, because of the reports of patients who were dosed in the evening (Currents Interview)......developing severe insomnia and behavioral activation (sometimes mania. All of them had affective illness that had been stabilized with psychotropic medication for several months; their mood was stable and they had only residual complaints of memory loss, constipation, and/or dry mouth. All of them were younger than sixty-five. As I treated more patients with donepezil, I was surprised when several of them developed mania soon after starting donepezil given in the evening (five milligrams at bedtime). Within an hour or so of taking it, they began to experience racing thoughts, felt 'speeded up,' and had difficulty falling asleep. (Other reports with larger samples (J Clin Psychiatry 60:10; 698-704, 1999; Editor) have shown patients who developed mood switching (up) with morning administration. These are bipolars taking mood stabilizers, and they have developed a mildly hypomanic state. It was surprising initially, because it seemed contrary to the cholinergic-adrenergic hypothesis of bipolar disorder, wherein cholinergic enhancement is posited to induce adrenergic diminution. (David Janowsky et al.) .....
So, starting it in the morning, maybe at 2.5 mg, then increasing if it doesn't interfere with sleep, might help.>
> How are you finding Trileptal? I've been taking it too. I don't notice any mood effects, or indeed any effects (but at least I haven't had any more seizures!).I recall you saying that Lamictal at high-doses had no mood-elevating effect. Maybe AEDs aren't helpful for mood in your case. I was definitely "high" when I started Trileptal, and at 1200 mg. qhs, it put me right to sleep. But, I fought it off and kept staying up all night - defeating its purpose. In September, I tapered down and d/cd it and got much more depressed.
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> > It's been studied lately for the treatment of tardive dyskinesia, panic disorder, performance anxiety or "stage fright" (given on a prn basis), personality disorder, and for augmentation of neuroleptics in schizophrenia, but its primary use in psychiatry has been for pharmacotherapy-related cognitive impairment.
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> Do you know anything about the results of the research on these various indications? I've heard of it being studied for ADD, too (I think there are even some publications regarding this).Only what I've read online, and in this Currents Interview. I'm going to try to get some info. about current Pfizer studies when I see my psychiatrist next week. In this Currents Interview, Dr. Jacobsen says, "I know of no published studies about donepezil in ADHD, but I do know that studies are planned in a variety of disorders associated with cognitive dysfunction." (He's probably saying this almost three years ago, though.)
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> > It's used for bupropion-associated memory dysfunction and anticholinergic side effects such as constipation and dry mouth.
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> Are memory problems especially common with bupropion? I've mostly heard of people having word-finding difficulty with the serotonergic drugs. (Effexor is starting to give me a little trouble in that department, I think.)I've never heard anyone complain of memory problems, but I think I've heard it from some people in forums like this (maybe here). I used it in a HUP/VA study in 1986, I think, for 8 weeks at 450 mg/day, and it was like drinking 10 cups of coffee/day -- that's all. I've tried it several times since then, but can no longer tolerate it. ---- Jacobsen: "It (donepezil) may be doing something else, but the cholinergic enhancing effects I have seen have been dramatic, with most patients reporting significant improvements in memory, constipation, and/or dryness of mouth. Incidentally, a substantial proportion of the patients I have treated with bupropion have developed those side effects (dry mouth, constipation, and memory loss). In my experience with the newer generation of antidepressants, bupropion has been the most likely to induce short-term memory loss."
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> > It can improve depression and possibly augment ADs, induce mania in some people (within hours), and act as a stabilizer in others.
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> Well -- I'm in favor of anything that can induce mania! < g > Seriously, that almost sounds like an ad for a "natural supplement" (or an SSRI): works for everything.Yeah, it really does, doesn't it? All it's missing is a jingle. :)
You know, after reading this Interview again, I'm wondering if it's such a good thing to use in bipolar disorder. It was recommended to me on the basis of two very small studies that found it had efficacy as a mood stabilizer, but since then, the majority of studies involve donepezil-associated mania.
When I almost had ECT, they were going to keep Valium and Aricept on board. Another concern is whether or not a tolerance develops with Aricept. Dr. Jacobsen says, "My experience has been that donepezil continues to work without diminution over a short term (up to 18 months or so). We don't know yet whether tolerance may develop in younger persons without dementia who take it over several years. (I see now that Dr. Tal Burt (the donepezil in bipolar disorder investigator) is now with Pfizer.
I guess that's what happens when you say nice things about a product. :)Blue
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> > Recommended starting dose is 2.5 to 5 mg. in the morning -- raising it to 5 mg to 10 mg in two weeks.
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> I thought it was supposed to be taken at bedtime. Am I misremembering? Does it matter?
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> -elizabeth
poster:Blue Cheer 1
thread:93141
URL: http://www.dr-bob.org/babble/20020131/msgs/93284.html