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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 19 of 19. This is the beginning of the thread.
Posted by Thrud on December 12, 2001, at 6:55:51
Hi Rick, hope you're still out there....
As an anxiety guru, I was wondering if you could help me out.
I'm currently on 200mg Lamictal and 3mg Xanax per day for PD. It's strange, although the Xanax takes care of the anxiety, I need something stimulating like Lamictal to increase my "energy" levels; otherwise I feel calm but totally vegetated.
The Lamictal is pooping out on me: I know the feeling. The pdoc and I are running out of ideas. I read on a search of the archives here that someone (patc?) believed Klonopin to be effective for atypical depression (which includes very strong lethargy).
Is this true? If so, why haven't I heard more about it? My pdoc is quite willing to switch me over to Klonopin and see what happens. If Klonopin monotherapy doesn't work, could selegiline plus a benzo work as a way to getting a stimulant effect without sending my anxiety off and above all WITHOUT SEXUAL DYSFUNCTION?!?!?!?
Even Lamictal gives me sexual dysfunction, as does Xanax somewhat. Maybe you have other ideas you could share? I've even considered ECT for relief without sexual side effects, but apparently it is not an effective treatment for PD....
I'm starting to get REALLY desperate now and willing to listen to any kind of way-out suggestions!
Thrud
Posted by Bob on December 12, 2001, at 15:37:09
In reply to Rick: anxiety stuff, posted by Thrud on December 12, 2001, at 6:55:51
What is "PD"?
Posted by IsoM on December 12, 2001, at 16:16:46
In reply to Rick: anxiety stuff, posted by Thrud on December 12, 2001, at 6:55:51
How about modafinil (Provigil) or adrafinil (Olmifon)? These two are the only drugs in a new class of medication called "eugeroics" for good arousal. They're commonly used in Europe for early Alzheimer's, narcolepsy, ADD, & depression.
I've been on adrafinil for a little over a month now & find it gives me the calm that Xanax did & but the alertness Dexedrine did. I always thought it strange to take two opposite-affecting drugs to feel normal but adrafinil does all that for me. Just need to remember that one's panacea can be another's nightmare.
Here's an article about modafinil:
http://www.smart-drugs.com/ias-Modafinil.htmAnd here's an article about adrafinil & how it works:
http://www.smart-publications.com/articles/adrafinil.html> Hi Rick, hope you're still out there....
>
> As an anxiety guru, I was wondering if you could help me out.
>
> I'm currently on 200mg Lamictal and 3mg Xanax per day for PD. It's strange, although the Xanax takes care of the anxiety, I need something stimulating like Lamictal to increase my "energy" levels; otherwise I feel calm but totally vegetated.
>
> The Lamictal is pooping out on me: I know the feeling. The pdoc and I are running out of ideas. I read on a search of the archives here that someone (patc?) believed Klonopin to be effective for atypical depression (which includes very strong lethargy).
>
> Is this true? If so, why haven't I heard more about it? My pdoc is quite willing to switch me over to Klonopin and see what happens. If Klonopin monotherapy doesn't work, could selegiline plus a benzo work as a way to getting a stimulant effect without sending my anxiety off and above all WITHOUT SEXUAL DYSFUNCTION?!?!?!?
>
> Even Lamictal gives me sexual dysfunction, as does Xanax somewhat. Maybe you have other ideas you could share? I've even considered ECT for relief without sexual side effects, but apparently it is not an effective treatment for PD....
>
> I'm starting to get REALLY desperate now and willing to listen to any kind of way-out suggestions!
>
> Thrud
>
>
>
Posted by Willow on December 12, 2001, at 17:49:55
In reply to Re: Rick: anxiety stuff » Thrud, posted by IsoM on December 12, 2001, at 16:16:46
> How about modafinil (Provigil) or adrafinil (Olmifon)? These two are the only drugs in a new class of medication called "eugeroics" for good arousal.
Cam
Are these drugs available in Canada? Can they be taken with effexor?
Thanks again!
Willow
Posted by Willow on December 12, 2001, at 17:50:43
In reply to Re: Rick: anxiety stuff, posted by Bob on December 12, 2001, at 15:37:09
Posted by Cam W. on December 13, 2001, at 2:45:05
In reply to Cam?, posted by Willow on December 12, 2001, at 17:49:55
Willow - I believe modafinil is available, although I have never dispensed it. I believe it is called Alertec™ in Canada. I don't know if a doc will write for it, as it is supposed to be used for narcolepsy. I think it is safe to use with Effexor in most people, but I am not positively sure. I have not read up on it enough to make any definite statements about it. - Sorry, Cam
Posted by Thrud on December 13, 2001, at 8:38:24
In reply to Re: Cam? » Willow, posted by Cam W. on December 13, 2001, at 2:45:05
> Willow - I believe modafinil is available, although I have never dispensed it. I believe it is called Alertec™ in Canada. I don't know if a doc will write for it, as it is supposed to be used for narcolepsy. I think it is safe to use with Effexor in most people, but I am not positively sure. I have not read up on it enough to make any definite statements about it. - Sorry, Cam
So I guess you have no feedabck from patients regarding side effects (and sexual ones in particular)? From what I've read, sexual dysfunction seems to be listed as one of the "less likely" side effects. Unfortunately, this is how ADs are often presnted as well.
It makes me suspect that they will give me sexual problems. I am sure my pdoc would let me try it: he is almost as desperate as I am to find a solution.
Maybe it is worth aa shot.Thrud
Posted by Thrud on December 13, 2001, at 8:41:28
In reply to PD penile dysfunction (nm) » Bob, posted by Willow on December 12, 2001, at 17:50:43
I actually meant panic disorder, but your description is unfortunately accurate as well.
Thrud
Posted by Thrud on December 13, 2001, at 8:44:12
In reply to Re: Rick: anxiety stuff » Thrud, posted by IsoM on December 12, 2001, at 16:16:46
Thnaks very much for your info. They may well be worth a shot.
Any idea on how they work? Did they affect your sexual functioning?Thrud
Posted by Willow on December 13, 2001, at 10:32:37
In reply to Re: PD penile dysfunction: Willow, posted by Thrud on December 13, 2001, at 8:41:28
> I actually meant panic disorder, but your description is unfortunately accurate as well.
Thrud
I'm thinking of all types of excuses for explaining why my mind slipped so low, the most obvious being is that there has been a host of commercials on about "PD" in the locker rooms.
BEST WISHES
Willow
Posted by Willow on December 13, 2001, at 10:44:17
In reply to Re: Cam?:Cam, posted by Thrud on December 13, 2001, at 8:38:24
> Maybe it is worth aa shot.
Thrud
I had gone through many different ADs of various types and actually had given up on finding a medication that would be of assistance for about two years. Then my ability to think got so bad it scared me and I was willing to try anything again. The doctor gave me some samples of effexor and to my suprise they helped.
Now I did have side effects, and sexual ones for the first time, but it was helping the cognitive problems. (ahh, i'm starting to ramble)
Keep trying different meds till you find the one that will help you. I'm going to check this med out to try and understand what it is. I too don't think I would have a problem get a prescription.
Keep in touch. Let me know if you do try it and how it helps if any.
Willow
Posted by IsoM on December 13, 2001, at 14:33:57
In reply to Re: Rick: anxiety stuff: IsoM, posted by Thrud on December 13, 2001, at 8:44:12
This is weird!! I wrote an answer, submitted it & when I went back to edit something, what I'd written was gone! Here goes again.
Both modafinil (yes, it's Provigil in Canada too as well as Alertec) & adrafinil (Olmifon) are called eugeroic drugs meaning "good arousal". They're supposed to stimulate what needs stimulating without affecting other areas.
That may be hype as I've read that some experience headaches & dizziness on it. I'm prone to headaches & if anything, I'm getting slightly less on adrafinil. Some people seem to get a better effect from stims like Ritalin & Dexedrine, but I prefer the smoothness of adrafinil myself. Plus it doesn't leave me worn out like stims do.
Now to your important question - you're asking the wrong person. I'd been married for 23 years & when he finally decided to leave, I chose to remain celibate & have been for 5 years now. It's not from any side-effects of drugs but my own choice. I've read over as many posts on these drugs as I could find (sleep.net has lots) & info about the drugs from other sites & honestly can't say I've found anything mentioning sexual problems. I'd almost imagine the opposite as it makes me feel so alert, yet so mellow & relaxed at the same time.
My suggestion would be to try it for a short while to see if it works for you. If not, you simply stop them.
> Thnaks very much for your info. They may well be worth a shot.
> Any idea on how they work? Did they affect your sexual functioning?
>
> Thrud
Posted by Rick on December 17, 2001, at 0:52:26
In reply to Rick: anxiety stuff, posted by Thrud on December 12, 2001, at 6:55:51
Thrud -
I wasn't here when you started this thread but I am now. Actually I visited Babble for the first time in awhile a couple days ago, but just ran across this today.
An anxiety "guru" I ain't, but I *have* tried a number of meds and done some research on selected aspects of anxiety and its treatment.
Klonopin remains the linchpin of my own med therapy. I did take it with selegiline for awhile. And while Klonopin in doses under 3 mg has minimal-to-no negative sexual impact, adding the selegiline resulted in a marked increase in both libido and tactile sensitivity -- TOO much, sometimes. And the selegiline defininitely improved wakefulness and cognition as well.
The downside is that the selegiline also added back some anxiety. But not enough to keep me from rating it an effective combo. Keep in mind, though, that I have SP, without DP or (either type) of PD. So I don't know how dangerous a "little" increase in anxiety (vs. solo Klonopin, anyway) would be for you.
In retrospect, I realize that a very small amount of selegiline goes a loooong way in some respects. As the combo with Klonopin stabilized, I was taking only 2.5 mg of selegiline a day, which already *seemed* awfully low. But since then I've seen people who say that, once they've reached steady state, taking as little as 2.5 mg selegiline 2-3 times a week provides plenty of ongoing stimulation. (Which is not to imply that this would be a sufficient dosage for use as a primary antidepressant or in the third PD - Parkinson's Disease.)
Re modafinil/adrafinil, I currently take Provigil (modafinil) with Klonopin, and they form an excellent combo. By no means does the Provigil detract from the effectiveness of my Klonopin -- despite what some have postulated -- as long as I stay at 100 mg/day on the Provigil. (An occasional bump to 200 mg can be useful, but after two days at this level I start to get wired.) Provigil definitely adds unique, adjunctive anti-anxiety dimensions to my treatment, but they're qualitatively different than basic "stay calm!" effects provided by Klonopin. This leads me to believe that Provigil alone would be a much less effective treatment. (Maybe the story is different for adrafinil, even though modafinil *is* its primary metabolite.)
Provigil seems pro-sexual to me, but it's nothing compared to the 2.5 mg/day of selegiline!
Rick
> Hi Rick, hope you're still out there....
>
> As an anxiety guru, I was wondering if you could help me out.
>
> I'm currently on 200mg Lamictal and 3mg Xanax per day for PD. It's strange, although the Xanax takes care of the anxiety, I need something stimulating like Lamictal to increase my "energy" levels; otherwise I feel calm but totally vegetated.
>
> The Lamictal is pooping out on me: I know the feeling. The pdoc and I are running out of ideas. I read on a search of the archives here that someone (patc?) believed Klonopin to be effective for atypical depression (which includes very strong lethargy).
>
> Is this true? If so, why haven't I heard more about it? My pdoc is quite willing to switch me over to Klonopin and see what happens. If Klonopin monotherapy doesn't work, could selegiline plus a benzo work as a way to getting a stimulant effect without sending my anxiety off and above all WITHOUT SEXUAL DYSFUNCTION?!?!?!?
>
> Even Lamictal gives me sexual dysfunction, as does Xanax somewhat. Maybe you have other ideas you could share? I've even considered ECT for relief without sexual side effects, but apparently it is not an effective treatment for PD....
>
> I'm starting to get REALLY desperate now and willing to listen to any kind of way-out suggestions!
>
> Thrud
>
>
>
Posted by Rick on December 17, 2001, at 1:01:30
In reply to Cam?, posted by Willow on December 12, 2001, at 17:49:55
> > How about modafinil (Provigil) or adrafinil (Olmifon)? .... Can they be taken with effexor?
Effexor was one of several AD's used in two open depression-treatment studies. The studies found that adding modafinil provided substantial benefits in terms of speeding up treatment response; eliciting response in previous nonresponders, and countering AD-induced fatigue.
Rick
Posted by Willow on December 17, 2001, at 7:52:29
In reply to Re: Cam? » Willow, posted by Rick on December 17, 2001, at 1:01:30
Rick
Did you find these studies on the internet, and if so would you mind giving me links to them that I may print them to bring in to my doctors? I wonder if the positive effect would still apply if the fatigue isn't just caused by the AD.
Will it help fatigue caused by the condition, other medications, ... ?
Just thinking out loud.
Willow
Posted by Thrud on December 17, 2001, at 8:46:57
In reply to Re: Rick: anxiety stuff » Thrud, posted by Rick on December 17, 2001, at 0:52:26
Hi Rick (&Willow)
I would also like your opinion on Willow's question regarding fatigue.
In your experience, is fatigue more likely to be reduced by the Selegiline-benzo combo or the Modafanil-benzo(?) combo? It is wierd that I can feel totally calm on Xanax monotherapy but still left with very strong fatigue. Current thought seems to focus on "nervous fatigue": get rid of the anxiety and your energy returns. This is not true in my case.
Thank you very much for your info: they have confirmed my suspicions that you are indeed an anxiety guru!
Thrud
Posted by Rick on December 17, 2001, at 17:10:52
In reply to Rick, Willow :anxiety stuff, posted by Thrud on December 17, 2001, at 8:46:57
I'd say it’s pretty much a tossup between Provigil and selegiline as a fatigue-fighter and alertness-maintainer. For me the edge definitely goes to Provigil because it helps my social anxiety and seems more predictable. And there are no MAOI –interactions with Effexor (or many other meds) to be concerned with, as would be the case with selegiline. (That said, using very-small selegiline doses probably eliminates almost all the risks. Celexa’s website even used to link to an article citing common co-prescription of low-dose selegiline and SSRI’s to Parkinson’s patients with apparent safety and only rare, mild cases of serotonin syndrome – even though Celexa’s own monograph contra-indicates the combo. I’d personally be hesitant to take chances.)
Now, if maintaining sexual function is a key issue, I’d give selegiline a hard look.
Provigil definitely can treat non-medication-induced fatigue of various types, and I’d imagine the same is true for selegiline. As far as Provigil, it can work within hours…or it might take up to 7-10 days to start helping…or it might seem to work for awhile and then poop out. If the latter happens, stick with it awhile longer; it’s very likely the wakefulness effect will come back. Incidentally, every two-four weeks I have a day where Provigil doesn’t seem to be doing the trick, but the next day things are usually back to normal. (I WOULD say this results from modafinil’s ability to occasionally induce its own metabolism, but my understanding was that this is unlikely to occur at lower doses.)
Below is some of the requested literature.
Rick
1. In the link below, go to the section entitled “Stimulant Augmentation in Depression.” (it’s the second article). This isn’t the full study, but it gives more detail than an abstract. (Interestingly, this small study cites success augmenting Celexa (citalopram) with modafinil, even though #3 suggests this doesn’t work well due to a metabolic interaction.)
http://alertpubs.com/august2000psych.htm
2. In the following link, go to the letter to the editor, which describes a case of successful augmentation of Effexor by Provigil. (I suggest you right-click and “save as” to keep the entire pdf file. There are some other interesting articles in here as well.)
http://www.psychiatrist.com/pcc/pccpdf/v03n01.pdf
3. The following is a recap (probably a press release) on some studies of modafinil for treatment of AD-induced fatigue:
New Data Show PROVIGIL Reduces Fatigue and Sleepiness in Patients With Depression - Results from Two New Pilot Studies Are Reported at the American Psychiatric Association Meeting in New Orleans
WEST CHESTER, Pa., May 10, 2001 /PRNewswire/ -- Data from two new pilot studies show that PROVIGIL(R) (modafinil) Tablets [C-IV] reduces fatigue and sleepiness in people who are clinically depressed and who are partial responders to antidepressant therapy.
Data from one study were presented on May 9 in a symposium at the annual meeting of the American Psychiatric Association (APA) in New Orleans. This study was a six-week pilot, double-blind, randomized study among 136 patients with major depressive disorder, who were partially responsive to their current antidepressant treatment. Study participants received between 100 mg and 400 mg of PROVIGIL daily. The most common side effects potentially attributable to PROVIGIL treatment included headache and nervousness.
Results of the study indicated that patients receiving PROVIGIL plus antidepressant treatment -- as compared to patients on antidepressant treatment plus placebo -- achieved statistically significant reductions (p< 0.05) in fatigue, as measured by the Fatigue Severity Scale, and in sleepiness, as measured by the Epworth Sleepiness Scale.
Statistically significant improvements (p< 0.05) in energy and concentration as measured by a sub-scale of the Hamilton Depression Scale (HAM-D retardation scale) were seen in patients taking PROVIGIL and various antidepressants including Prozac(R) (fluoxetine HCl), Zoloft(R) (sertraline HCl), or Paxil(R) (paroxetine HCl) but as anticipated, not in patients taking Celexa(TM), (citalopram HBr), a compound with which PROVIGIL has a known metabolic interaction. Results on the overall Hamilton Depression Scale (HAM-D 1-21), which contains elements that are not influenced by fatigue and cognitive function, did not distinguish PROVIGIL from placebo.
"Fatigue is a significant component of depression and a major problem in this patient population," reported Karl Doghramji, M.D., associate professor, department of psychiatry and human behavior at Jefferson Medical College of Thomas Jefferson University and Director, Sleep Disorders Center, Thomas Jefferson University Hospital, Philadelphia, one of the investigators in the multi-center study. "This study demonstrates that this medication may help the approximately 80 percent of patients that continue to experience fatigue and sleepiness associated with their depression."
This is the second pilot study to demonstrate the positive effects of PROVIGIL treatment on the symptom of fatigue. The first study in patients with Multiple Sclerosis related fatigue was presented last year at the American Academy of Neurology.
Investigator-Initiated Study
In a separate pilot study presented at a poster session at the APA meeting by Dr. Charles DeBattista of Stanford University, PROVIGIL was shown to significantly reduce fatigue in patients with depression. In the four-week, prospective, open-label study of 24 adults with major depressive disorder who were being treated with antidepressant therapy, patients treated with PROVIGIL demonstrated significant reductions in fatigue, as measured by the Fatigue Symptom Inventory and Fatigue Analog Scale. Improvements in cognition were also observed, particularly in concentration. Benefits were observed within two weeks of the start of therapy, and PROVIGIL was shown to be well tolerated in combination with a variety of antidepressants. The most reported side
effect was headache.
Depression
Depression is a serious illness that affects more than 19 million American adults, according to the National Institutes of Mental Health. Fatigue is one of the most common complaints in depressed patients. Sleep complaints are also common, with approximately 20 percent of patients suffering from excessive sleepiness. These symptoms are often exacerbated by current treatments, since adverse events associated with many antidepressant therapies include hypersomnia and fatigue.
PROVIGIL is a novel, wake-promoting agent currently approved in several countries for the treatment of excessive daytime sleepiness (EDS) associated with narcolepsy. The most common side effects associated with PROVIGIL in treating EDS associated with narcolepsy include nausea, infection, nervousness, anxiety and insomnia.
Cephalon, Inc., (Nasdaq: CEPH) markets PROVIGIL in the United States, the United Kingdom, Ireland, and Italy and promotes the product in Austria and Switzerland under the brand name MODASOMIL(R). In addition, Cephalon holds exclusive marketing and distribution rights to PROVIGIL in Japan, South Korea, Taiwan and Latin America.
Cephalon, Inc., headquartered in West Chester, Pennsylvania, is an international biopharmaceutical company dedicated to the discovery, development and marketing of products to treat sleep and neurological disorders, cancer and pain.
Posted by Thrud on December 18, 2001, at 3:28:54
In reply to Studies and Anxiety Stuff -- Willow and Thrud, posted by Rick on December 17, 2001, at 17:10:52
Posted by Willow on December 18, 2001, at 7:13:49
In reply to Thanks Rick (nm), posted by Thrud on December 18, 2001, at 3:28:54
This is the end of the thread.
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