![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 14 to 38 of 63. Go back in thread:
Posted by Dwight on June 17, 2000, at 5:26:38
In reply to Doesage of Adrafinil (JohnL or AndrewB), posted by Lynne on June 17, 2000, at 0:32:06
TO John, Andrew, Tina,
I also have been taking 300mg of adrafini and haven't noticed anything. When I took 600mg with Adderal at the same time, I noticed I was cursing aloud more than usual, e.g., when spilling water, when my cat knocked over a plant, etc. I have not noticed much of anything with 50mg of amisulpride either. If I go up to 100 will it's mechanism of action shift over dopamine enhancement to dopamine suppression? When does that shift take place? or does it? I thought someone said, the dosage was paradoxical like that.
Thanks Dwight.
> I took 300mg today of Adrafinil and didn't feel anything.I will take 600mgs tomarrow. Do I take both tablets at the same time? How will I know when I have the right doseage?Does this drug build up in your body? Or is it day to day like with Dexedrine.
>
> Thanks,Lynne
> >
> >
> >
> >
> >
Posted by AndrewB on June 17, 2000, at 7:59:23
In reply to Re: Dosage of Adrafinil (JohnL or AndrewB), posted by Dwight on June 17, 2000, at 5:26:38
Don't expect to see anything at all with adrafinil for the first two weeks. If after three weeks nothing happens, take your dosage up to 600. Dosage may go as high as 1200.
Give amisulpride 6 days at 50mg. If nothing, take dosage up to 100. Dosage may go as high as 200mg.
Keep us posted. I am tracking responses to amisulpride and adrafinil.
Andrew B
Posted by Lynne on June 17, 2000, at 9:09:42
In reply to Re: Dosage of Adrafinil (JohnL or AndrewB), posted by AndrewB on June 17, 2000, at 7:59:23
AndrewB,
I have a question for you. I am taking 40mg Prozac for 1 month and I can't see that it does anything much except make me sleepy. It has helped with obsessive thoughts. I am trying the Adrafinil now. Should I continue with the Prozac?
Can you recommend anything for sleep that doesn't make me have memory problems. I have been taking Tamazepan, but it makes me forgetful. Sonata didn't do anything for me.Thanks! I get more help from reading this board than any doctor I've been to.
Lynne
Posted by Dwight on June 17, 2000, at 9:34:41
In reply to Re: Dosage of Adrafinil (JohnL or AndrewB) » AndrewB, posted by Lynne on June 17, 2000, at 9:09:42
I read a post here earlier this morning about St.Johns Wort--I believe it was either JohnL or AndrewB--, saying that it was important to get a high enough dose, i.e., 2700mg/day. That's a lot! On the bottle I have it recommends only 150mg twice a day (but it also contains reishi mushroom, avena sativa and lavender). Anyway, a few hours ago I took 1000mg. Wow, what a difference! I'd taken SJW on numerous occassions in the past and had never felt much of anything. Why do the recommend such miniscule doses? This time I really felt something--a warm, kind of bouncy feeling, hard to describe, but pleasant. I'm wondering though if this might be due, not only to the increase in dose, but also to some sort of synergistic interaction with the adrafinil or amisulpride. I mention this because I remember JohnL saying that SJW worked better with these meds.
Posted by SLS on June 17, 2000, at 9:55:11
In reply to St. JohnsWort (high dose!) +adrafinil+ amisulpride, posted by Dwight on June 17, 2000, at 9:34:41
Hi Dwight.
> I read a post here earlier this morning about St.Johns Wort--I believe it was either JohnL or AndrewB--, saying that it was important to get a high enough dose, i.e., 2700mg/day. That's a lot! On the bottle I have it recommends only 150mg twice a day (but it also contains reishi mushroom, avena sativa and lavender). Anyway, a few hours ago I took 1000mg. Wow, what a difference! I'd taken SJW on numerous occassions in the past and had never felt much of anything. Why do the recommend such miniscule doses? This time I really felt something--a warm, kind of bouncy feeling, hard to describe, but pleasant. I'm wondering though if this might be due, not only to the increase in dose, but also to some sort of synergistic interaction with the adrafinil or amisulpride. I mention this because I remember JohnL saying that SJW worked better with these meds.
This is great. It must feel great. I hope you continue to feel great. Please send me any extra brain-juice via UPS.How would you describe the nature and severity of your depression?
What other drugs and dosages are you taking?
If you were to maintain a 1000mg - 2000mg daily dosage, how much would it cost?
Thanks.
- Scott
Posted by AndrewB on June 17, 2000, at 12:07:27
In reply to Re: Dosage of Adrafinil (JohnL or AndrewB) » AndrewB, posted by Lynne on June 17, 2000, at 9:09:42
Lynne and Dwight,
Give Prozac 6 weeks before you give up on it.
I don't really pay too much attention to what works with sleep but I have read good things here about both rememeron (sp?) and zyprexa for sleep. Or maybe take your prozac before you go to bed? Are you both sleepy and can't get to sleep?
Some studies may have used as much as 2,700mg of SJW but that is really high. John L uses 900mg of St. Johns (or did) and I use 1200mg. It is a matter of personal experimentation. I would start out at 900 and see if anything happens after 2 weeks. Sometimes too much SJW can cause a little agitation but that seems to be about it.
Dwight you are adding on meds and supplements so quickly it is impossible to tell what is doing what. You are supposed to add on only one drug at a time so you can tell what helps and what hurts. You might want to stay away from those kitchen sink herbal supplements for mood that have a bit of everything in them. If you want to try SJW, buy a bottle that contains SJW exclusively and in a standardized formula (.3% hypericin, 4% hyperforin)
Posted by michael on June 17, 2000, at 12:28:20
In reply to Doesage of Adrafinil (JohnL or AndrewB), posted by Lynne on June 17, 2000, at 0:32:06
The package insert says 2 to 4 tablets per day, taken in the morning and at noon (i.e. 300mg am & 300mg pm OR 600mg am & 300mg pm, etc.)
Btw - don't forget that you need to have your liver enzymes checked if you're taking it for "extended periods" (e.g. more than a couple months?)
> I took 300mg today of Adrafinil and didn't feel anything.I will take 600mgs tomarrow. Do I take both tablets at the same time? How will I know when I have the right doseage?Does this drug build up in your body? Or is it day to day like with Dexedrine.
>
> Thanks,Lynne
> >
> >
> >
> >
> >
Posted by JohnL on June 17, 2000, at 17:52:50
In reply to Doesage of Adrafinil (JohnL or AndrewB), posted by Lynne on June 17, 2000, at 0:32:06
Quite a discussion going on here. Pretty cool. I couldn't resist jumping in, since I'm pleasantly familiar with all the topics being discussed here.
Anyone trying Adrafinil should not expect anything for at least two weeks. Four is better, six even better. Contrary to my usual belief pattern, Adrafinil really does require time. It has an accumulating effect. The messy analogy I made in another post is that it's like throwing handfuls of spaghetti at the wall. Some of it will stick, some of it will fall to the floor. Keep throwing until the whole wall is covered. That really takes at least two weeks in my experience. Longer is better. (in case you're wondering, no, I've never thrown spaghetti at the wall :-))
Concerning Amisulpride, sources of information vary a little bit. But basically I think the turnaround pivot point is in the 250mg to 300mg range. That's where its mechanism reverses. I don't know though, based on symptoms and side effects Andrew talked about a while ago, I think I experienced that pivot mechanism at 100mg. Who knows.
Concerning SJW, 2700mg does seem like a lot. I mean, it was used in clinical trials at that dose with few side effects. But at that dose I get agitation sortof side effects. My optimum dose is the 1200mg range, though recently I've only been taking 300mg once every other day. That doesn't seem like much, but I do notice in a negative way when I stop taking it.
One observation I've made with SJW is that it seems to have a lot more ooomph when combined with something else, like Prozac, Adrafinil, Amisulpride, or whatever (but NOT Paxil! stay away from that combo). SJW seems to me to have a nice synergy with other things. But not all other things. Definitely not Paxil. If used as monotherapy, I really do think the recommended dose is way too low. One study indicated 300mg of SJW is roughly the same as 10mg of a tricyclic. Based on that, 5 to 8 pills a day seems to be in the right ballpark. And as was mentioned, brands that have minimum %hyperforin are good ones. Like 3%, 4%, 5%. There's even a new brand called New Chapter that has 10%hyperforin designed to be dosed once daily. I personally don't like the brands that have other ingredients mixed in, because then it's hard to tell what's doing what.
For me anyway, Adrafinil with a little SJW ended my very prolonged multiyear anhedonic melancholic depression. I had one more trick up my sleeve to try in place of Adrafinil, and it's working great. But, that's another post for another day...
JohnL
Posted by SLS on June 18, 2000, at 19:46:54
In reply to Re: Doesage of Adrafinil - all, posted by JohnL on June 17, 2000, at 17:52:50
Hi John.
Thanks for such a comprehensive post.
I was wondering what the problem is with combining St. John's Wort with Paxil?
Also, when the comparisons are made between SJW and tricyclics, is there any particular mechanism being referred to, such as reuptake inhibition?
Thanks.
- Scott
Posted by rick_number1001@yahoo.com on August 25, 2001, at 12:02:17
In reply to Re: MOST EFFECTIVE MED FOR SOCIAL PHOBIA! , posted by Lynne on June 8, 2000, at 0:03:12
I think the research (and experts agree) that Nardil
is more effective than Paxil for Social Phobia.
(My experience too by a longshot).With both antidepressants a higher dose is required
for more severe cases.Unfortunately both of these drugs produce significant
sexual side effects at the high doses.
(ie; Paxil 30-50mg and Nardil 90mg)
In my case over comparable dose ranges Nardil had
LESS side effects than Paxil, Zoloft, and Celexa.
Only Prozac had fewer. (Luvox was a bad experience).Though I never went over 30 Paxil, I experienced
as much negative sexual side effects at that dose
than I did at the usual max dose of Nardil, 90mg90mg Nardil was VERY effective for me - 2 years
straight taken all by itself.I can claim nothing close for an SSRI.
Also, Nardil (poop out) is due to doctors not
knowing about it. Nardil dose needs to escalate
1 tablet every 1-3 weeks (when the good effects
start to diminish). As with a benzodiazepine,
dose escalation stops at the "therapeutic dose
level". Usually this is 60-90mg.I HIGHLY recommend Nardil if other meds are not
satisfactory to you.
Also, John Marshall's book "Social Phobia" is
EXCELLENT. He runs U. of Wisc. Psychiatric clinic.Good luck - I hope you give it a try and report
back!!!Craig (rick_number1001@yahoo.com to be anonymous)
http://www.socialfear.com
> > > DOES ANYONE KNOW IF NARDIL IS MORE EFFECTIVE AGAINST
> > > SOCIAL PHOBIA THAN PAXIL?! I KNOW EVERYONE REACTS
> > > DIFFERENTLY TO MEDICATIONS, BUT WHAT SEEMS TO USUALLY
> > > BE THE MOST EFFECTIVE MED FOR SOCIAL PHOBIA?!
> > > ANY INPUT WOULD BE GREATLY APPRECIATED!!
> > >
> > > THANX,
> > > Z
> >
> > Disclaimer: We do all respond differently, depending on what chemistry is at fault causing the social phobia.
> >
> > Having said that, the best 100% effective medication I've ever taken for social phobia symptoms is Adrafinil. You can mailorder it for about $30 from overseas. I've tried EVERYTHING except Nardil or Parnate. Adrafinil is far superior to anything else normally prescribed for social phobial.
> >
> > Here is a little info I found on it. Notice how it says passive people become more outgoing and talkative. I can personally attest to that as being true. I've always been the shy guy in the corner, all my life. Not any more. I'm perfectly comfortable in any group of people. What's the secret? Adrafinil.
> >
> >
> > ADRAFINIL (Olmifon)
> >
> > Rapidly restores vigilance and alertness in older people and the physically and mentally tired. Has a powerful
> > antidepressant action far superior to that of fluoxetine (Prozac) and clomipramine (Anafranil) and is without any serious
> > side effects. Adrafinil restores your powers of concentration, memory and intellectual function. When administered to
> > older people who have lost interest in life, adrafinil makes them want to take part in life again and they find that they
> > have renewed energy and vigor. Adrafinil may be correctly described as an anti-aging drug because it directly combats
> > degeneration in the part of the brain that allows you to take pleasure in life. Elderly people very often have disturbed
> > sleep patterns and take many naps during the day. Adrafinil restores a youthful sleep/wake cycle of full alertness in the
> > daytime and deep restorative sleep at night. After several weeks of treatment with Adrafinil daytime sleepiness
> > disappears, interest in intellectual activity is restored and depression lifts. It is very important to note that this improved
> > quality of alertness is NOT accompanied with mental excitation and insomnia as occurs with amphetamine or caffeine.
> > The correct dosage is 300 to 600 mg per day. The dosage can be adjusted according to response. Remember it takes
> > three weeks for all the effects of Adrafinil to become apparent. Do not use Adrafinil if you have any type of kidney or liver
> > problem or if you suffer from epilepsy.
> >
> >
> > ADRAFINIL: What is; (a.k.a. Olmifon) (Description & information below)
> > NOTE:not to be confused with "Anafranil (a.k.a. clomipramine)" the Antidepressant.
> >
> > Adrafinil provides alertness in most without the feeling often felt with stimulants that usually are prescribed for a person with
> > narcolepsy. Such as amphetamines etc. Also the possibility of tolerance is low with its continued use. There is however a
> > need for certain Liver function tests
> > on a regular basis with its continued use. Normally the same types of required testing as with the medication " cylert " which is
> > commonly prescribed in the USA. It is also used in certain parts europe as a "antidepressant". It is the combination of
> > Adrafinil's releasing stimulantive arousal effect(s), and its antidepressant effects that some doctors in europe recommend
> > Adrafinil over its newer form of Modafinil. There have been studies done in the United States "measuring depression in
> > individuals with sleep disorders",. In one study it was suggested that the
> > "rate of narcolepsy and depression is estimated to be between 30-52%".
> >
> > ADRAFINIL
> >
> >
> > Adrafinil: Alertness Without Stimulation
> >
> > Adrafinil is the prototype of a new class of smart drug - the eugeroics (ie, "good arousal") - designed to promote vigilance
> > and alertness. Developed by the French pharmaceutical company Lafon Laboratories, adrafinil (brand name, Olmifon) has
> > been approved in many European countries for treating narcolepsy, a condition characterized by excessive daytime sleepiness
> > and other unusual symptoms.
> >
> > Non-narcoleptic users generally find that adrafinil gives them increased energy and reduces fatigue, while improving cognitive
> > function, mental focus, concentration, and memory. It has been reported that quiet people who take adrafinil become more
> > talkative, reserved people become more open, and passive people become more active.
> >
> > Of course, many stimulant drugs, ranging from caffeine to methamphetamine, are known to produce similar alerting/energizing
> > effects. Adrafinil has been described by some users as a "kinder, gentler" stimulant, because it provides these benefits but
> > usually with much less of the anxiety, agitation, insomnia, associated with conventional stimulants.
> >
> > Adrafinil's effects are more subtle than those of the stimulants you may be used to, building over a period of days to months.
> > They appear to be based on its ability to selectively stimulate 1-adrenergic receptors in the brain.2 These receptors normally
> > respond to norepinephrine (noradrenaline), a neurotransmitter linked to alertness, learning, and memory. This is in contrast to
> > conventional stimulants, which stimulate a broader spectrum of brain receptors, including those involving dopamine. Its more
> > focused activity profile may account for adrafinil's relative lack of adverse side effects.
> >
> > Dosing
> >
> > The standard dose is 2 to 4 300-mg tablets per day for improving cognitive function, although some people may find lower
> > doses produce a desirable degree of improvement. Higher doses have been used to treat narcolepsy.
>
>
> What doseage did you start out with?
>
> did you take it all at one time? How long before you noticed the effects?
>
> Thanks, Lynne
Posted by Joe Schmoe on August 26, 2001, at 9:15:39
In reply to Re: MOST EFFECTIVE MED FOR SOCIAL PHOBIA! » Lynne, posted by rick_number1001@yahoo.com on August 25, 2001, at 12:02:17
It sounds like the problems Nardil causes are in the body while the benefits are in the brain.
The scientists need to develop some way to make a MAOI that only works in the brain and is not utilized by the rest of the body. Maybe some second pill that you take an hour later that destroys the MAOI, but that cannot cross the blood-brain barrier.
Posted by Mitch on August 26, 2001, at 17:48:57
In reply to Re: MOST EFFECTIVE MED FOR SOCIAL PHOBIA!, posted by Joe Schmoe on August 26, 2001, at 9:15:39
> It sounds like the problems Nardil causes are in the body while the benefits are in the brain.
>
> The scientists need to develop some way to make a MAOI that only works in the brain and is not utilized by the rest of the body. Maybe some second pill that you take an hour later that destroys the MAOI, but that cannot cross the blood-brain barrier.
There are transdermal patches of phenelzine, and I believe tranylcypromine (parnate), that are supposed to be in clinical studies right now. I would really want to try an MAOI, but my doc says NO. The patches are supposed to be a way of bypassing the gut so you don't have the diet restrictions, but still would have to be cautious about drug interactions. Does anybody know what the status of these patches is??
Posted by rick_number1001@yahoo.com on August 27, 2001, at 2:20:17
In reply to Re: Doesage of Adrafinil - all, posted by SLS on June 18, 2000, at 19:46:54
I haven't heard Mitch.
The Dr. who I was taking 90mg Nardil under told me that Nardil
is statistically safer than penicillin. Also, that those
who develop hypertensive crisis with Nardil normally already
have some sort (I don't remember what) of heart problem and
there likely would be a problem occuring later anyway.I would point out that Medline searches will show that hypertensive
crisis in the last 10-15 years are difficult to find
Much easier to find are all sort of other problems, serotonin syndrome
with SSRI and other serotonin combos (or even Paxil alone),
(serotonin syndrome is often deadly). Viagra alone killed something
like over a 150 in a few months didn't it?Frankly, I eventually tried stimulants, Wellbutrin, yohimbine,
and other dopaminergics/noradrengerics with Nardil and generally
if I got any reaction my blood pressure tended to down a bit.
(Blood pressure cuff).Unfortunately many doctors are so unfamiliar with MAOI's
and often even benzodiazepines.MAOI's are not a first choice for normal depression,
because Prozac frankly usually does the job.It is a shame that MAOI's get such bad press.
The best Dr. (run universities, researchers, etc)
typically are the ones pointing out how much
underused Nardil and Parnate are.Many good Dr. claim there most robust responses
to a variety of disorders with MAOI's, often
Parnate simply with a low dose with if anything
is prosexual.OK - end of babble.
By the way, that Joe Schmoe guy sounds like he
is afraid to go for good results. I would ask
him why he is so negative, critical,
and what his productive ideas are, but I know
how these guys are. They just want attention
for there complaints.BTW, personally I did get fed up with Nardil
after 2 years at 90mg. Only 1 side effect,
sexual side effects but as I said nothing like
most SSRI's, even 20mg Celexa was worse.Now I keep Nardil at 60 and augment. Keeps
side effects minimal, sexual side effects no
problem. Results good.Lots of options, Nardil is not required.
Rick_number1001@yahoo.com
http://www.socialfear.com
> There are transdermal patches of phenelzine, and I believe tranylcypromine (parnate), that are supposed to be in clinical studies right now. I would really want to try an MAOI, but my doc says NO. The patches are supposed to be a way of bypassing the gut so you don't have the diet restrictions, but still would have to be cautious about drug interactions. Does anybody know what the status of these patches is??> > It sounds like the problems Nardil causes are in the body while the benefits are in the brain.
> >
> > The scientists need to develop some way to make a MAOI that only works in the brain and is not utilized by the rest of the body. Maybe some second pill that you take an hour later that destroys the MAOI, but that cannot cross the blood-brain barrier.
>
> > Hi John.
>
> Thanks for such a comprehensive post.
>
> I was wondering what the problem is with combining St. John's Wort with Paxil?
>
> Also, when the comparisons are made between SJW and tricyclics, is there any particular mechanism being referred to, such as reuptake inhibition?
>
> Thanks.
>
>
> - Scott
Posted by Dr. Bob on August 27, 2001, at 13:30:22
In reply to Re: Doesage of Adrafinil - all » SLS, posted by rick_number1001@yahoo.com on August 27, 2001, at 2:20:17
> By the way, that Joe Schmoe guy sounds like he
> is afraid to go for good results. I would ask
> him why he is so negative, critical,
> and what his productive ideas are, but I know
> how these guys are. They just want attention
> for there complaints.Please don't jump to conclusions about others or put them down. Thanks,
Bob
PS: Follow-ups, if any, regarding civility should be redirected to Psycho-Babble Administration; otherwise, they may be deleted.
Posted by Rick on August 28, 2001, at 1:32:13
In reply to Re: Doesage of Adrafinil - all » SLS, posted by rick_number1001@yahoo.com on August 27, 2001, at 2:20:17
To Craig:
> Now I keep Nardil at 60 and augment. Keeps
> side effects minimal, sexual side effects no
> problem. Results good.What do you think was the key element in reducing the sexual side effects from Nardil?
To Joe Schmoe:
>It sounds like the problems Nardil causes are in the body while the benefits are in the brain.
Many, if not most, of the physically-expressed side effects are probably brain-driven, as in a stroke victim who can write fluently but has trouble speaking -- even though the muscles that control speech are intact.
To Mitch -
I hadn't heard anything about the Parnate or Nardil patches. That would be great for a lot of people. If the MAOI never enters the gut, I belive there's no chance for tyramine inhibition.
I know that a poster here, Adam, was in the clinical trials for a selegiline patch (at high doses which would necessitate food restrictions if taken orally).To me the most exciting news is the phase II (or is it III) trials of the reversible (no food restrictions, ostensibly low-side-effect) MAOI befloxatone. So far it is reported to be about as effective as Nardil, and much more effective than the currently=marketed reversible MAOI moclobemide.
Rick
Posted by rick_number1001@yahoo.com on August 28, 2001, at 3:22:21
In reply to Re: Doesage of Adrafinil - all, posted by JohnL on June 17, 2000, at 17:52:50
To members: I apologize for my unnessary and
unfriendly comments in my earlier post.(BTW, some follow posts give me a box too short
for my email name so I reply to certain ones
that give a box with enought letters in it, sorry
for confusion caused by that).Rick:
Mainly just the dose is keeping down Nardil related
sexual side effects in my case. Dose is related
to weight and my weight is about 200 at 6'3".
Nardil 60 alone gives me only barely noticable
effects, and adding Klonopin probably reverses
those.I will add that I've been taking 1.25 finasteride
(ie; Propecia) for hair loss for several years.
I've gone lower or off at times and I can tell
that probably I'd have absolutely no sexual side
(or overall prosexual) effects if I dropped
finasteride. I guess I'd
rather not go bald right now, who knows maybe I'll
change my mind one day. I'm pretty certain
efficacy of my SP regimen goes down some too
with the addition of finasteride. Vanity !Finasteride raises testoterone, but lowers
dihydrotestorone by a greater percentage. They
are (I read), the 2 most potent male hormones.I feel that some psychotropics mediate these
and other hormones. Provigil and Wellbutrin,
are 2 prosexual (at least for me, both clearly
enhance libido, and Wellbutrin enhances every
aspect of sexual response), meds that also reverse part or
most (positive and negative) aspects of my
finasteride as well. !! I was not surpirsed
to see the post of the female mentioing that
Provigil was not recommended for use with
contraceptives!!!Also, Klonopin increases my libido and
agression, as does Provigil. Nardil really does
not at 60mg,
but on the other hand also does not sap my energy
and libido the way that Celexa 20mg, Paxil 30mg,
and Zoloft 50mg does.In the last year it has been humbling to realize
for me to realize that probably the biggest
factor reducing overall satisfaction of my
treatment has been my hormone altering hair loss
med!!!> To Craig:
>
> > Now I keep Nardil at 60 and augment. Keeps
> > side effects minimal, sexual side effects no
> > problem. Results good.
>
> What do you think was the key element in reducing the sexual side effects from Nardil?
>
> To Joe Schmoe:
>
> >It sounds like the problems Nardil causes are in the body while the benefits are in the brain.
>
> Many, if not most, of the physically-expressed side effects are probably brain-driven, as in a stroke victim who can write fluently but has trouble speaking -- even though the muscles that control speech are intact.
>
> To Mitch -
>
> I hadn't heard anything about the Parnate or Nardil patches. That would be great for a lot of people. If the MAOI never enters the gut, I belive there's no chance for tyramine inhibition.
> I know that a poster here, Adam, was in the clinical trials for a selegiline patch (at high doses which would necessitate food restrictions if taken orally).
>
> To me the most exciting news is the phase II (or is it III) trials of the reversible (no food restrictions, ostensibly low-side-effect) MAOI befloxatone. So far it is reported to be about as effective as Nardil, and much more effective than the currently=marketed reversible MAOI moclobemide.
>
> Rick
Posted by Mitch on August 28, 2001, at 7:16:32
In reply to Re: Most Effective Med For Social Phobia, posted by Rick on August 28, 2001, at 1:32:13
> To Mitch -
>
> I hadn't heard anything about the Parnate or Nardil patches. That would be great for a lot of people. If the MAOI never enters the gut, I belive there's no chance for tyramine inhibition.
> I know that a poster here, Adam, was in the clinical trials for a selegiline patch (at high doses which would necessitate food restrictions if taken orally).
>
> To me the most exciting news is the phase II (or is it III) trials of the reversible (no food restrictions, ostensibly low-side-effect) MAOI befloxatone. So far it is reported to be about as effective as Nardil, and much more effective than the currently=marketed reversible MAOI moclobemide.
>
> Rick
Thanks for the info. I also asked my doc about selegiline and got another NO. Perhaps befloxatone would be okeedokee. I can't tolerate SSRi's mainly because they worsen my mood cycling and cause dystonia. TCA's have too many cardiovascular sfx. Wellbutrin and pstims have no antipanic efficacy. I wonder if befloxatone has a lot less orthostatic hypotension than the other MAOi's? (I can't handle Remeron primarily because of that)Mitch
Posted by Dr. Bob on August 28, 2001, at 8:31:14
In reply to Reply to Rick and apology to board » JohnL , posted by rick_number1001@yahoo.com on August 28, 2001, at 3:22:21
> To members: I apologize for my unnessary and
> unfriendly comments in my earlier post.Thanks.
> (BTW, some follow posts give me a box too short
> for my email name so I reply to certain ones
> that give a box with enought letters in it, sorry
> for confusion caused by that).Sorry, I shortened the box. You may be the only one affected. What about re-registering as, say, "rick_number1001"? Sorry for the inconvenience,
Bob
Posted by Rick on August 28, 2001, at 17:45:35
In reply to Re: Most Effective Med For Social Phobia, posted by Rick on August 28, 2001, at 1:32:13
>
> To me the most exciting news is the phase II (or is it III) trials of the reversible (no food restrictions, ostensibly low-side-effect) MAOI befloxatone. So far it is reported to be about as effective as Nardil, and much more effective than the currently=marketed reversible MAOI moclobemide.
>
> RickUnfortunately, my info was a little out of date. I found out after posting that befloxatone was abandonded late last year, when Phase III trials for depression failed to show clinically significant results.
Rick
Posted by Rick on August 28, 2001, at 18:43:31
In reply to Reply to Rick and apology to board » JohnL , posted by rick_number1001@yahoo.com on August 28, 2001, at 3:22:21
> I will add that I've been taking 1.25 finasteride
> (ie; Propecia) for hair loss for several years.
> I've gone lower or off at times and I can tell
> that probably I'd have absolutely no sexual side
> (or overall prosexual) effects if I dropped
> finasteride. I guess I'd
> rather not go bald right now, who knows maybe I'll
> change my mind one day. I'm pretty certain
> efficacy of my SP regimen goes down some too
> with the addition of finasteride. Vanity !
>
> Finasteride raises testoterone, but lowers
> dihydrotestorone by a greater percentage. They
> are (I read), the 2 most potent male hormones.Interesting. Were you taking Propecia BEFORE Klonopin? I'm sure you know that many psychotropics, including Klonopin and Wellbutrin, can sometimes cause hair loss.
My understanding was that sexual dysfunction from Propecia was fairly uncommon (1-2% incidence), and that when it occurs it usually goes away after awhile. But I got that mainly from Merck's literature, and you're the second person who I've seen mention anti-sexual effects in just the last few days. I do know one guy who confided to me that he was a little worried about trying it for that reason, but later reported that he needn't have been concerned.
I started Propecia months after stopping Nardil, when I was taking Klonopin and noticed a small but worsening amount of hair loss that didn't seem natural because of the pattern and suddenness. So I started both Propecia and a mineral combo that my pdoc recommended (I had been thinking about starting a multi-vitamin/mineral anyway). It's worked out great, and my strong feeling is that its the Propecia that's doing the trick (I hope so, given that insurance doesn't cover it!)
Propecia didn't affect me sexually, as far as I can tell, but Celexa and high-dose Neurontin certainly did. I've had sexual enhancement on the current med combo, but I don't know how much to attribute to the Provigil vs. the Serzone. I'm leaning toward the Provigil. (I already knew that Klonopin acted as a bit of a sexual enhancer for me overall, as it does for you, although in my case it might be just slighlty inhibitive in terms of the "stamina" aspect.)
> In the last year it has been humbling to realize
> for me to realize that probably the biggest
> factor reducing overall satisfaction of my
> treatment has been my hormone altering hair loss
> med!!!If you have no problem going lower or off the Propecia for awhile, as you mentioned above, maybe you could try Rogaine (topical minoxidil) or the mineral supplement or both for awhile to see if they help without the sexual effects. A couple of weeks ago, someone here reported excellent success with Rogaine. On the otherhand, if you're having a lot of success with Propecia I can see why you might be be hesitant to change.
BTW, re taking 1.25 mg Propecia:
1. How do you split those tiny hexagonal pills??
2. The mfr claims that doses over 1 mg give no add'l benefit (although maybe they're assuming the next step up is 2). Do you find less effectiveness at 1? But with some lessening of sexual impact, perhaps?Rick
Posted by Rick on August 28, 2001, at 20:09:28
In reply to Re: Most Effective Med For Social Phobia » Rick, posted by Mitch on August 28, 2001, at 7:16:32
>Perhaps befloxatone would be okeedokee.
Well, by now you've seen my post about the decision to pull the plug on befloxatone.
> Thanks for the info. I also asked my doc about selegiline and got another NO.
If it was to be used as a primarily agent for any kind of anxiety disorder or anxious depression -- rather than as low-dose augmentor in a safe combo such as with a benzo or BuSpar -- selegiline is probably the LAST thing you should try. Believe me, it ain't no Nardil!
I'm assuming that you're being treated for depression, too. If so, have you tried the lower-side-effects and no-food-restrictions reversible MAOI moclobemide? (If you're in the U.S., you can order it, with your Doctor's prescription, from Canada.) Its success rate isn't nearly as high as Nardil's, but you just never know...it's been great for some people for both Social Phobia and depression. How about Neurontin? It also works for some. (Didn't work for me, and at very high doses caused some sexual dysfunction.)
If you're not depressed, have you tried Klonopin? (Daily, not as-needed.) It's generally the most effective SP med there is, with the highest treatment-effect yet seen in placebo-controlled SP studies. And this is one case where study results actually seem to be mirrored in personal reports. For most people it has none-to-mild side effects after the initial week or two, especially if the dosage is kept reasonably low. In my case it beat a whole series of AD's hands-down with respect to both the SP treatment and lack of side effects (except for a few unexpected GOOD ones and some POSSIBLE memory implications.)
Posted by SLS on August 28, 2001, at 21:09:45
In reply to Re: BefloxaGONE (Most Effectve Med For Soc Phobia), posted by Rick on August 28, 2001, at 17:45:35
> >
> > To me the most exciting news is the phase II (or is it III) trials of the reversible (no food restrictions, ostensibly low-side-effect) MAOI befloxatone. So far it is reported to be about as effective as Nardil, and much more effective than the currently=marketed reversible MAOI moclobemide.
> >
> > Rick
>
> Unfortunately, my info was a little out of date. I found out after posting that befloxatone was abandonded late last year, when Phase III trials for depression failed to show clinically significant results.
>
> Rick*^$#!
What was your source of information? I had planned to call Sanofi tomorrow. A doctor Palumbo was supposed to be directing the project. Damn.
- Scott
Posted by Rick on August 28, 2001, at 21:53:02
In reply to Re: BefloxaGONE (Most Effectve Med For Soc Phobia), posted by SLS on August 28, 2001, at 21:09:45
> > >
> > > To me the most exciting news is the phase II (or is it III) trials of the reversible (no food restrictions, ostensibly low-side-effect) MAOI befloxatone. So far it is reported to be about as effective as Nardil, and much more effective than the currently=marketed reversible MAOI moclobemide.
> > >
> > > Rick
> >
> > Unfortunately, my info was a little out of date. I found out after posting that befloxatone was abandonded late last year, when Phase III trials for depression failed to show clinically significant results.
> >
> > Rick
>
>
>
> *^$#!
>
> What was your source of information? I had planned to call Sanofi tomorrow. A doctor Palumbo was supposed to be directing the project. Damn.
>
>
> - ScottThe 9/18/2000 issue of R & D Focus Drug News says:
"Sanofi-Synthelabo announced at a company presentation in London, UK, that its selective and reversible monoamine oxidase A inhibitor, befloxatone (MD 370503), is no longer in active development. This oxazolidone derivative was being evaluated as a treatment for depression and smoking cessation in Europe and the USA. The company stated that no significant beneficial effect was achieved in phase III studies for either indication."
Also, if you go to Sanofi's website and download the 2000 annual report, you'll see it listed as one of the three development-discontinued drugs, no explanation given.
Posted by SalArmy4me on August 28, 2001, at 22:19:27
In reply to Re: Most Effective Med For Social Phobia » Rick, posted by Mitch on August 28, 2001, at 7:16:32
Moclobemide for Social Phobia: The Best Med?
The British Journal of Psychiatry
Volume 172(5) May 1998 pp 451-452:"Sir: The claim made by Schneier et al (1998) [2] that moclobemide is not indicated as a first-line therapy in social phobia should be challenged. Social phobia is a relatively common anxiety disorder, which rarely presents to psychiatrists even when there is marked impairment in occupational and social functioning (Weiller et al, 1996) [3]. Thus, a first-line therapy for social phobia should be effective, well tolerated and suitable for prescription within primary care.
Addressing the latter two issues, moclobemide has a simple dosing regime and is well tolerated; Schneier et al found eight-week drop-out rates were 24% on moclobemide v. 25% on placebo. Their most serious objection to the use of moclobemide as a first-line treatment is one of efficacy. They found 23% of patients with severe or very severe social phobia treated with moclobemide for eight weeks were rated as much or very much improved (v. 0% in the placebo group), although numbers were too small to reach statistical significance. This finding of greater efficacy in more severe social phobia is also supported by the International Multicenter Clinical Trial Group on Moclobemide in Social Phobia (1997) [1] who found patients with severe social phobia treated with 600 mg moclobemide had a 52% response rate (v. 32% on placebo)."
Dimensional Versus Categorical Response to Moclobemide in Social Phobia: Reply to Letter
University of Iowa College of Medicine; Psychiatry Research; Iowa City, Iowa 52242-1000:"Drs. Blanco and Liebowitz feel that we may have demonstrated efficacy for moclobemide in our social phobia trial that we failed to appreciate. [1] Their letter gives us an opportunity to clarify several points.
First, not all controlled trials have shown efficacy. [1-4] For instance, Schneier and associates [2] observed few differences between moclobemide (mean dose of 728 mg daily) and placebo after 8 weeks, and the International Multicenter Trial [3] indicated modest superiority for 600 mg daily (47% at least moderately improved on moclobemide vs. 34% on placebo) but not for 300 mg.
It is not clear whether the difference between drug (moclobemide 900 mg) and placebo that we observed on the Liebowitz Social Anxiety Scale at 12 weeks (mean +/- SE, 55.7 +/- 3.5 vs. 51.6 +/- 3.5) is clinically, although statistically, significant. When evaluating results it is important to consider all measures, and in this case, few statistically significant differences were observed at the end of 12 weeks for any of the fixed doses ranging from 75 to 900 mg daily.
In our trial the clinical impression of change was used to determine responder status (rating scale of 1 [very much improved] to 7 [very much worse]). As Drs. Blanco and Liebowitz indicate, categorical measures of this kind are often less sensitive to drug-placebo differences. This is not always the case, however, and this measure was selected as the primary measure of efficacy before starting the trial. Such global ratings of change are important because they reflect meaningful change; without them it can be difficult to gain a clinical sense of the outcome of a trial.
Drs. Blanco and Liebowitz noted that in our trial, subjects receiving moclobemide 900 mg daily continued to improve between 8 and 12 weeks, and they attributed this improvement to the drug. Unfortunately, data concerning change in effect size between 8 and 12 weeks were not available, so we could not support their inference.
Had our trial ended at 8 weeks, we might have concluded that the highest fixed dose of moclobemide (900 mg daily) is effective. However, most of the differences seen at 8 weeks disappeared at 12 weeks for unknown reasons. Differences at 8 weeks may have been chance findings; tolerance to early drug effects may have developed by 12 weeks, or robust response to placebo may have overwhelmed the small drug effects seen earlier.
It is certainly possible, as we stated in our report, that moclobemide is effective for social phobia but at doses higher than those used. Nevertheless, the safety of such doses has not, to our knowledge, been established. Given the proven efficacy of standard monoamine oxidase inhibitors (MAOIs) (i.e., phenelzine), [4] reversible MAOIs remain an attractive alternative. Further efforts to establish efficacy or lack of it are warranted."
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Posted by gilbert on August 28, 2001, at 23:39:04
In reply to Most Effective Med For Social Phobia: Moclobemide, posted by SalArmy4me on August 28, 2001, at 22:19:27
I am getting seriously worried about Salarmy4me the posts are getting more and more propagandish in nature and I have really respected alot of sal's opinions and help on drugs before but all this talk about the General and the war cry makes me hope an pray that sal is still seeing someone who is monitoring his medical situation. I am not being synical either I am dead serious.... Sal are you feeling O >K >
Concerned,
Gil
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