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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 CarolAnn on June 21, 2000, at 8:59:45
In reply to Good place to order Adrafinil, posted by JohnL on June 20, 2000, at 18:02:37
Hey guys, if I decided to try Adrafinil, what should I do about my current meds.? Wellbutrin 200mgs. 2x/day, Celexa 40mgs. 1x/day, Adderall 10 mgs. 3x/day. I'm not scheduled to see my Pdoc for a couple months, also I feel a little uncomfortable suggesting specific meds. to him. I probably would end up telling him that I had tried the Adrafinil, but I kind of want to see if it works first. I don't know, I'm kinda just shooting in the dark here, because though my mood has improved, I still have terrible fatigue and anhedonia. Whatta ya think? CarolAnn
Posted by Cam W. on June 21, 2000, at 9:13:02
In reply to Re: Adrafinil to JohnL and Cam, posted by CarolAnn on June 21, 2000, at 8:59:45
CarolAnn - Stick with John or Andrew on a question like this. As a rule, stimulants can make one bitchy, but I do not know if this is th case with this one. Adrafinil isn't available in Canada, yet and most of what I know about it I learned from this board. I'd be interested in John's answer as well. Let me finished up the last foot of papers that I have to read and then I will start reseaching all of these new, interesting molecules - Sorry,Cam
P.S. Hope that you are going to have a great day, today. - C.
Posted by JohnL on June 21, 2000, at 18:11:15
In reply to Re: Adrafinil to JohnL and Cam, posted by CarolAnn on June 21, 2000, at 8:59:45
> Hey guys, if I decided to try Adrafinil, what should I do about my current meds.? Wellbutrin 200mgs. 2x/day, Celexa 40mgs. 1x/day, Adderall 10 mgs. 3x/day. I'm not scheduled to see my Pdoc for a couple months, also I feel a little uncomfortable suggesting specific meds. to him. I probably would end up telling him that I had tried the Adrafinil, but I kind of want to see if it works first. I don't know, I'm kinda just shooting in the dark here, because though my mood has improved, I still have terrible fatigue and anhedonia. Whatta ya think? CarolAnn
This is a tough question. I'm trying to think what I would do myself in your shoes.
The complicating thing that makes it so tough is that there are already multiple meds being used. And they are all at high enough doses that it wouldn't be that easy to just discontinue one or the other to try a different ingredient. I also wonder about the exaggerated NE effect that would occur with Wellbutrin+Adderall+Adrafinil.
I also wonder if one or two of the current ingredients aren't actually contributing to the fatique and anhedonia, rather than fixing them. I know for a long long time I battled anhedonia, and it wasn't until the SSRIs were removed that I realized a lot of it had to do with the SSRI. Paxil, Zoloft, and Prozac all kind of did the same thing. They made life flat. No lows, which was good. But no joys either. A welcome relief to someone who's been in the hole. But far from normal. It could be that stopping the Celexa alone might help a lot. But then, I don't know your history. And I don't know how bad off you were prior to Celexa, or how well you perceive Celexa as working. I don't know. I just get this gut instinct that when anhedonia is the prominent symptom, serotonin is best left alone. SSRIs have a way of numbing and actually making anhedonia worse, or making it so it can't respond to another med that should otherwise work. Does this make any sense?
I guess you could try Adrafinil with your other current meds. But if so, I would start by cutting pills in half and doing 150mg at first. Just to feel it out. If all is well, then go ahead and increase gently. But again, I think the other meds have the potential of confusing the issue. For example, maybe Adrafinil by itself would be wonderful, but when combined with Wellbutrin causes uncomfortable agitation. Or maybe no matter how well it works, the Celexa will numb it and dampen the whole affair. That could be what's already happening.
Sorry, I wish I had a better answer. I think the best thing to do is actually remove at least one of your current meds first, and then start Adrafinil. Just based on my own experience with anhedonia, I would remove the serotonin med. That is, unless you know that will cause deep depression. I would remove Celexa, reduce Wellbutrin, and reduce Adderall. Just to uncomplicate things. Who knows, you might even feel better. Wouldn't be the first time that happened.
Sorry I'm going long here, but you really do ask a tough question.:-) I would feel pretty confident about this next statement though. That is, I don't think ANY of your current meds are correct for you. You've had them for long enough at pretty healthy doses. Either one of two things is happening as I see it: 1.They are all missing the mark, 2.One of them is numbing the entire process, basically nullifying or numbing whatever benefit the others are trying to provide. Or maybe I'm just babbling. :-)
JohnL
Posted by michael on June 22, 2000, at 9:08:04
In reply to Re: Adrafinil to JohnL and Cam, posted by JohnL on June 21, 2000, at 18:11:15
> > Hey guys, if I decided to try Adrafinil, what should I do about my current meds.? Wellbutrin 200mgs. 2x/day, Celexa 40mgs. 1x/day, Adderall 10 mgs. 3x/day. I'm not scheduled to see my Pdoc for a couple months, also I feel a little uncomfortable suggesting specific meds. to him. I probably would end up telling him that I had tried the Adrafinil, but I kind of want to see if it works first. I don't know, I'm kinda just shooting in the dark here, because though my mood has improved, I still have terrible fatigue and anhedonia. Whatta ya think? CarolAnn
>Just to let you know, I'm taking 500mg welbutrin SR and 600 - 1,200mg adrafinil, and have not had any problems.
The only other thing I have to say is to be cautious with the adderall & adrafinil combination - Of course I can't pull it up right now, but I've read of some research on provigil (similar to adrafinil) combined with the classic stimulants. I believe what it said was that adverse effects were limited to incr. nervousness, etc. The kind of thing you might expect from taking too much of a stimulant...
However, I think that it said this was based on a single dose (not evaluated over any extended period of time). I believe it also noted that the onset of the effect of the provigil was delayed about an hour.
I'll try to access that site/info again later, and I'll post it here.
Posted by michael on June 22, 2000, at 9:15:36
In reply to Re: Adrafinil to JohnL and Cam, posted by michael on June 22, 2000, at 9:08:04
Naturally, as soon as I posted my previous msg, I was able to access that site again.... anyway, here's what it had to say:
The use of modafinil with other psychostimulants, including methylphenidate and dextroamphetamine, has not been extensively studied. Single-dose studies of methylphenidate and modafinil administered in combination did not note changes in the metabolism or the extent of absorption of either medication. However, the rate of absorption of modafinil was delayed up to one hour by the presence of methylphenidate. Similar single-dose studies have been performed with dextroamphetamine and modafinil. No pharmacokinetic interactions ocurred between dextroamphetamine and modafinil, but a slight increase in stimulant-associated side effects was noted. Patients receiving combination therapy of modafinil with other psychostimulants should be closely observed for signs of nervousness, irritability, insomnia, arrhythmias, or other CNS stimulant-related side effects.
Hope that helps...
michael
> > > Hey guys, if I decided to try Adrafinil, what should I do about my current meds.? Wellbutrin 200mgs. 2x/day, Celexa 40mgs. 1x/day, Adderall 10 mgs. 3x/day. I'm not scheduled to see my Pdoc for a couple months, also I feel a little uncomfortable suggesting specific meds. to him. I probably would end up telling him that I had tried the Adrafinil, but I kind of want to see if it works first. I don't know, I'm kinda just shooting in the dark here, because though my mood has improved, I still have terrible fatigue and anhedonia. Whatta ya think? CarolAnn
> >
>
> Just to let you know, I'm taking 500mg welbutrin SR and 600 - 1,200mg adrafinil, and have not had any problems.
>
> The only other thing I have to say is to be cautious with the adderall & adrafinil combination - Of course I can't pull it up right now, but I've read of some research on provigil (similar to adrafinil) combined with the classic stimulants. I believe what it said was that adverse effects were limited to incr. nervousness, etc. The kind of thing you might expect from taking too much of a stimulant...
>
> However, I think that it said this was based on a single dose (not evaluated over any extended period of time). I believe it also noted that the onset of the effect of the provigil was delayed about an hour.
>
> I'll try to access that site/info again later, and I'll post it here.
This is the end of the thread.
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