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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by saturn on December 9, 2006, at 12:05:10
Provigil seems to be all the rage on remedyfind.com for MDD. Does anyone have any thoughts on this? Thanks.
Posted by Maxime on December 9, 2006, at 12:12:01
In reply to provigil monotherapy?, posted by saturn on December 9, 2006, at 12:05:10
>
> Provigil seems to be all the rage on remedyfind.com for MDD. Does anyone have any thoughts on this? Thanks.
>
> http://remedyfind.com/HealthConditions/9/
>Hi Saturn
I know people who have received an AD effect from 200 mg of Provigil a day.
Um, I didn't check the link. :)
Maxime
Posted by psychobot5000 on December 9, 2006, at 12:47:21
In reply to Re: provigil monotherapy? » saturn, posted by Maxime on December 9, 2006, at 12:12:01
I think that provigil is beneficial for depressives by giving a stimulant effect, rather than a genuine antidepressant effect. Not that stimulants can't be useful, but they aren't generally viewed as treating the underlying problem--only the symptoms.
And I think provigil is thought to have less mood-elevation than the traditional (more abusable) stims. But I'm sure it's useful for some people.
> >
> > Provigil seems to be all the rage on remedyfind.com for MDD. Does anyone have any thoughts on this? Thanks.
> >
> > http://remedyfind.com/HealthConditions/9/
> >
>
> Hi Saturn
>
> I know people who have received an AD effect from 200 mg of Provigil a day.
>
> Um, I didn't check the link. :)
>
> Maxime
>
>
Posted by Meri-Tuuli on December 9, 2006, at 13:29:04
In reply to Re: provigil monotherapy?, posted by psychobot5000 on December 9, 2006, at 12:47:21
> but they aren't generally viewed as treating the underlying problem--only the symptoms.
Aren't all ADs in this category through? I suppose it depends on how you view the cause of depression, is it 'just' faulty biochemistry or is it your thinking patterns etc.
M
Posted by SLS on December 9, 2006, at 13:58:23
In reply to Re: provigil monotherapy? » psychobot5000, posted by Meri-Tuuli on December 9, 2006, at 13:29:04
> > but they aren't generally viewed as treating the underlying problem--only the symptoms.
>
> Aren't all ADs in this category through? I suppose it depends on how you view the cause of depression, is it 'just' faulty biochemistry or is it your thinking patterns etc.Depression is a word. At the moment, the term is used to describe a clinical presentation of symptoms rather than a specific disease process.
When it comes to unipolar depression, I think there is a spectrum running from the predominantly biological to the predominantly psychological, depending on the individual. The two often interact.
When it comes to bipolar depression, I think the disorder is predominantly biological. Witnessing someone presenting with ultra-rapid cyclicity makes it difficult to avoid this conclusion.
When it comes to my depression, which is bipolar, I know it is 100% biological.
When it comes to unipolar depression, I think the more rigidly one adheres to the DSM definition of Major Depressive Disorder (MDD), the more likely one is to identify predominantly biological depressions. I believe that it is these people with MDD that are most likely to respond to antidepressants.
- Scott
Posted by Meri-Tuuli on December 9, 2006, at 14:21:36
In reply to Re: provigil monotherapy?, posted by SLS on December 9, 2006, at 13:58:23
Its the age old debate.
I've largely have come to the same conclusions as you Scott. I'm all in favour of spectrums and yes they do interact quite considerably I think.
For me, my depressions are pretty much caused by faulty thinking largely caused by a defunct childhood. I'm sure it has altered my neurobiology somewhat, but my problems are largely in the metaphysical realm, rather than the biological one. So, I've basically given up on chemical solutions, except those benzos which I'm too scared to take and some herbs, but again, I'm too scared to take them. Sigh. I'm desperately trying to alter my internal landscapes.
Anyway
Posted by med_empowered on December 9, 2006, at 17:24:59
In reply to Re: provigil monotherapy? » SLS, posted by Meri-Tuuli on December 9, 2006, at 14:21:36
well..when you think about it....antidepressants can be stimulaintg (MAOIs, certain TCAs), sedating (trazadone, for instance) or kind of neuroleptic-ish (Surmontil, most tricyclics--Tofranil was dervied directly from Thorazine), so it would make sense that for some people, drugs that are primarily stimulating (provgil, older stims) would be just as effective (or more so) on "depression", while other people could derive similar benefits from benzos, neuroleptics, anti-convulsants, therapy, and placebo. "Anti-depressant" is really a vague term for what's going on in the brain.
Plus, it seems like docs are finally admitting that ADs aren't that great. AD prescribing is down, and more and more docs seem to be using mood stabilizers, stims, benzos, etc. w/ ADs or w/o them to help their patients. I think that the SSRIs and SNRIs may fall from grace, and I don't think they'll be terribly missed.
Posted by Phillipa on December 9, 2006, at 23:42:12
In reply to Re: provigil monotherapy?, posted by SLS on December 9, 2006, at 13:58:23
Scott sounds like mine is more psychological. And I hope you're doing well. Love Phillipa
Posted by LlurpsieBlossom on December 10, 2006, at 0:38:04
In reply to Re: provigil monotherapy? » SLS, posted by Phillipa on December 9, 2006, at 23:42:12
I got AD effect from cymbalta, but I had a lot of afternoon fatigue and lots of napping. even after being on a therapeutic dose for several months.
added 200mg provigil, and suddenly life was easier. Easier to get my work done when I wasn't worried about fallin asleep every 2 hours. some mild mood boost, perhaps like a cup of coffee.
having energy helped me get my work done, which in turn helped my (unipolar) depression. Oh yeah. I had therapy too
100% biological? no way jose. But I guess I have been lucky that I respond well to medications (knock on wood).
Posted by SLS on December 10, 2006, at 15:33:43
In reply to Re: provigil monotherapy?, posted by SLS on December 9, 2006, at 13:58:23
> When it comes to unipolar depression, I think the more rigidly one adheres to the DSM definition of Major Depressive Disorder (MDD), the more likely one is to identify predominantly biological depressions. I believe that it is these people with MDD that are most likely to respond to antidepressants.
--------------------------------------------------
Severity of Depression and Response to Antidepressants and Placebo: An Analysis of the Food and Drug Administration Database.Articles
Journal of Clinical Psychopharmacology. 22(1):40-45, February 2002.
Khan, Arif MD *+; Leventhal, Robyn M. BA *; Khan, Shirin R. *; Brown, Walter A. MD ++Abstract:
Some studies suggest that more severely ill patients with depression respond well to antidepressants and poorly to placebo, whereas those who are mildly ill respond equally well to antidepressants and placebo. This notion has implications for the design of clinical trials. To further assess and substantiate these putative predictors of antidepressant and placebo response, we assessed the Food and Drug Administration database of 45 phase II and III antidepressant clinical trials. The frequency of statistically significant differences between antidepressants and placebo was higher in the trials that included patients with more severe depression. In the antidepressant-treated groups, the magnitude of symptom reduction was significantly related to mean initial Hamilton Rating Scale for Depression (HAM-D) score; the higher the mean initial HAM-D score, the larger the change. With placebo treatment, however, the higher the mean initial HAM-D score, the smaller the change. Early discontinuation was more frequent among patients whose mean initial HAM-D scores were higher. These data may help inform the design of future antidepressant clinical trials.
Posted by Phillipa on December 10, 2006, at 17:56:04
In reply to Re: provigil monotherapy?, posted by SLS on December 10, 2006, at 15:33:43
Scott I know I'm not the sharpest cookie but are you saying that if it's psychological more than biological that placebos has the same success or non success rate? Love Jan
Posted by SLS on December 10, 2006, at 20:06:04
In reply to Re: provigil monotherapy? » SLS, posted by Phillipa on December 10, 2006, at 17:56:04
> Scott I know I'm not the sharpest cookie but are you saying that if it's psychological more than biological that placebos has the same success or non success rate? Love Jan
It is my belief that the more severe cases of depression as determined by rating scales designed to diagnose MDD are more likely to respond to antidepressants than milder cases that do not qualify for a diagnosis of MDD. I think the former has a greater biological component, and is more likely to respond to a biological intervention. For people with a psychological depression, antidepressants might be no better than placebo.
- Scott
Posted by Phillipa on December 10, 2006, at 21:45:03
In reply to Re: provigil monotherapy? » Phillipa, posted by SLS on December 10, 2006, at 20:06:04
Scott thank-you as I have the feeling this may be my case. Love Jan
This is the end of the thread.
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