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Dr. Bob is Robert Hsiung, MD,
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Posted by zeugma on August 7, 2005, at 9:59:08
In reply to Re: Perphenazine (Trilafon) - to zeugma » zeugma, posted by ed_uk on August 6, 2005, at 16:25:30
>
> The usual maximum dose for schizophrenia and acute mania is 24mg/day. I've heard of people benefiting from ~2-4mg/day for severe anxiety.I was severely anxious when entering the hospital.
>
> >I was in a hospital...
>
> For depression? For what reason were you prescribed perphenazine? Just out of curiousity, how old were you at the time?
>
age: 21. Perphenazine was the second drug prescribed, after molindone. I was retropsectively diagnosed with depression, but I think the initial diagnosis was schizophrenia. I think the clinicians thought I was delusional.-z
> Kind regards
>
> ~Ed
>
> PS. I wrote a post to you above - about ramelteon (Rozerem).i'll look at the ramelteon post as soon as I feel I can digest it- I had never heard of this drug.
-z
Posted by ed_uk on August 7, 2005, at 14:33:26
In reply to Re: Fluphenazine (Prolixin) - to SLS (Scott), posted by SLS on August 7, 2005, at 8:51:17
Hi Scott,
>> What doses did you take?
>I haven't a clue.Presumably the doses of Prolixin and Trilafon were quite low if you suffered a dystonia in response to Thorazine but not Prolixin or Trilafon.......... or perhaps the dose of Thorazine was quite high? Prolixin and Trilafon cause dystonias more frequently than Thorazine - at 'equivalent' doses.
~Ed
Posted by ed_uk on August 7, 2005, at 14:36:31
In reply to Re: Perphenazine (Trilafon) - to zeugma » ed_uk, posted by zeugma on August 7, 2005, at 9:59:08
Hi Z,
How were you affected by molindone? Have you taken any other APs?
>.....i'll look at the ramelteon post as soon as I feel I can digest it- I had never heard of this drug.
That's ok - read it when you've got the time (and energy).
Kind regards
~Ed
Posted by zeugma on August 8, 2005, at 18:44:13
In reply to Re: Perphenazine (Trilafon) - to zeugma » zeugma, posted by ed_uk on August 7, 2005, at 14:36:31
> Hi Z,
>
> How were you affected by molindone? Have you taken any other APs?
>I was not in a particularly receptive mode to pharmacological interventions when I was forced to sample molindone. I had had a harrowing experience with prozac not long before and was so naive (read: pre-Internet days) that I had no idea about the different classes of psych meds. I think perphenazine is more sedating, which 'calmed me down' enough to tolerate the drug minimally.
Perphenazine's sedation probably masked the akathisia that was (as best i recall) the reason for d/x'ing molindone, and I also developed intensified akathisia on Prozac. I have akathisia anyway, though less as I've gotten older and more lethargic.
> >.....i'll look at the ramelteon post as soon as I feel I can digest it- I had never heard of this drug.
>
> That's ok - read it when you've got the time (and energy).Time, energy, and focus. That third variable that is so essential and so elusive. I wrote this post on the bus,where focus was easier to come by, and am typing from memory. Focus..
-z
>
> Kind regards
>
> ~Ed
Posted by ed_uk on August 9, 2005, at 13:26:59
In reply to Re: Perphenazine (Trilafon) - to zeugma » ed_uk, posted by zeugma on August 8, 2005, at 18:44:13
Hi Z!
>prozac
I can't remember whether you've tried any other SSRIs. Perhaps you could try citalopram for your anxiety, starting at a very low dose - say 2.5mg.
>I wrote this post on the bus
You've got a good memory!
~Ed
Posted by zeugma on August 9, 2005, at 18:54:04
In reply to Re: Perphenazine (Trilafon) - to zeugma » zeugma, posted by ed_uk on August 9, 2005, at 13:26:59
> Hi Z!
>
> >prozac
>
> I can't remember whether you've tried any other SSRIs. Perhaps you could try citalopram for your anxiety, starting at a very low dose - say 2.5mg..hi Ed,
yes, that's the plan, if it comes to that- if I need further augmentation. I mentioned a good while ago that my pdoc gave me Lexapro samples in response to my suggestion about clomipramine. He told me 2.5 mg would be the place to start with those.
It's just that I have this feeling that more meds = multiplying s/x, and that my body is near its limit of reasonable toleration, with 100 mg nortriptyline, 200 mg Provigil, 30 mg buspirone, and 1 mg clonazepam daily. I'm substituting 30 mg Ritalin LA for the Provigil for the time being, because of an interaction with an antifungal, with reasonable results (I don't have to work long hours in the summer, so I can deal with Ritalin's ridiculous half-life as an annoyance).
As a matter of fact, my pdoc had to twist my arm to take buspirone, which is nearly side-effect free. And the buspirone does 'take the edge off'.
but yes, the plan is to take lex as the next AD, if needed. But I really don't want to take more meds.
by the way, my anxiety has improved after switching from Provigil to the low dose of Ritalin. I think the modafinil was building up in my system,due to the interaction with clotrimazole, causing it to become as anxiogenic as 60 mg Ritalin, if not more so. It suggests that 200 mg Provigil is my limit for anxiogenicity. Of course, being underdosed with a stim causes a horrible anxiety of its own, owing to the fact that I am in such a wretched haze. I think I'm finding a therapeutic window for stims, which is a good thing.
oh, and I tried Zoloft when it came out- AWFUL AWFUL AWFUL. I was in a nauseated fog.
-z
Posted by ed_uk on August 10, 2005, at 14:24:52
In reply to lex- and therapeutic window for stims » ed_uk, posted by zeugma on August 9, 2005, at 18:54:04
Hi Z!
>Lexapro (escitalopram)....
Too expensive. Try generic citalopram (Celexa) first!
>....It's just that I have this feeling that more meds = multiplying s/x.......
You don't take that many meds! A woman came to the pharmacy today with 5 (full) prescription forms - 25 drugs. This isn't uncommon.
>clotrimazole...
In the UK, clotrimazole only comes as a cream and a pessary. How are you taking it? - obviously not as a pessary LOL ;-)
>oh, and I tried Zoloft when it came out- AWFUL AWFUL AWFUL. I was in a nauseated fog.
Hmm. Definately start with a very low dose if you try citalopram!
~ed
Posted by zeugma on August 10, 2005, at 17:48:38
In reply to Re: lex- and therapeutic window for stims » zeugma, posted by ed_uk on August 10, 2005, at 14:24:52
> Hi Z!
>
> >Lexapro (escitalopram)....
>
> Too expensive. Try generic citalopram (Celexa) first!Ed, how dare you make that suggestion! Don't you know that single-isomer drugs are TWICE AS GOOD as the racemate, in every case? (just kidding)
>
> >....It's just that I have this feeling that more meds = multiplying s/x.......
>
> You don't take that many meds! A woman came to the pharmacy today with 5 (full) prescription forms - 25 drugs. This isn't uncommon.
>
It's not a phobia of taking too many meds. It's that no matter what I add to nortriptyline, buspirone, and clonazepam (which added together don't give me too many side effects, but also do nothing for sleepiness and ADHD) starts to feel like 'too much' before too long, whether it's increased anxiety, appetite suppression, dry mouth, or 'vaguely toxic' feeling (Provigil).
> >clotrimazole...
>
> In the UK, clotrimazole only comes as a cream and a pessary. How are you taking it? - obviously not as a pessary LOL ;-)
>
I don't think so ;-) It comes as a 'troche' (slowly dissolving tablet).> >oh, and I tried Zoloft when it came out- AWFUL AWFUL AWFUL. I was in a nauseated fog.
>
> Hmm. Definately start with a very low dose if you try citalopram!I would (but I insist on the single isomer if it bankrupts me!). I'm sure citalopram (ahem, escitalopram) is nothing like Zoloft- consider the differences between nortriptyline and atomoxetine. But I was told by the sleep doc that SSRI's can be disruptive to sleep, which corroborates my research.
speaking of which, do you have any thoughts on Focalin, the d-isomer of methylphenidate? An XR version just came out, and this report claims it has a duration of action of 12 hours:http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16026226&query_hl=4
-z
Posted by ed_uk on August 11, 2005, at 14:36:08
In reply to only single isomers for me » ed_uk, posted by zeugma on August 10, 2005, at 17:48:38
Hi Z!
>Ed, how dare you make that suggestion!
:-O
>It's that no matter what I add.........
....but surely the side effects depend on *what* you add ;-)
>........do you have any thoughts on Focalin?
I've haven't come across many people who've tried it. I've read nothing that suggests it would be superior to MPH. I suspect it's just a money making device but I could be wrong!
>An XR version just came out........
I never knew that! I just found this.....
http://www.docguide.com/news/content.nsf/news/8525697700573E188525700E00431D54
Kind regards
~ed
Posted by alohashirt on August 11, 2005, at 21:04:45
In reply to Focalin XR » zeugma, posted by ed_uk on August 11, 2005, at 14:36:08
I'm hoping to Focalin XR next month and will happily give feedback.
When I tried Focalin I found that the effects were very similar to the same dose of Ritalin, if anything it made me even grouchier than Ritalin.I wonder if the XR technology is the same technology used for Metadate? I know it isn't as sophisticated as the Concerta technology which makes me suspect that its duration will be shorter. I have always found that the time the ADHD meds are effective is between 60% and 80% of the documented time.
Unfortunately the amphetamines then keep me awake for another four hours after they stop working.
Posted by ed_uk on August 12, 2005, at 1:18:42
In reply to Re: Focalin XR, posted by alohashirt on August 11, 2005, at 21:04:45
Hi!
Please report your experience with Focalin XR :-)
~Ed
Posted by Paulbwell on August 13, 2005, at 7:14:35
In reply to Re: Focalin XR » alohashirt, posted by ed_uk on August 12, 2005, at 1:18:42
> Hi!
>
> Please report your experience with Focalin XR :-)
>
> ~EdAfter having been on stimulants SR and IR, I suspect Focalin XR is a Dope compamy stradety to extend a patent and make $$$.
Cheers
Posted by ed_uk on August 13, 2005, at 8:02:05
In reply to Re: Focalin XR, posted by Paulbwell on August 13, 2005, at 7:14:35
>I suspect Focalin XR is a Dope compamy stradety to extend a patent and make $$$.
It's all about $$$ in the pharm industry!
~Ed
Posted by zeugma on August 13, 2005, at 14:00:20
In reply to Re: Focalin XR » Paulbwell, posted by ed_uk on August 13, 2005, at 8:02:05
> >I suspect Focalin XR is a Dope compamy stradety to extend a patent and make $$$.
>
> It's all about $$$ in the pharm industry!
>
> ~Ed
So many cynics here!So you think there is enough of a disanalogy between amphetamine and methylphenidate to make isolation of the d-isomer significant in the case of amphetamine, but not MPH?
-z
Posted by ed_uk on August 13, 2005, at 18:14:54
In reply to Re: Focalin XR » ed_uk, posted by zeugma on August 13, 2005, at 14:00:20
Hi Z!
There doesn't seem to be much info about the different effects of the MPH isomers. The lack of info is not encouraging - hence the cynicism! You should try Focalin XR and see! Have you tried Concerta? I can't rememeber.
~Ed
PS. I just took a sleeping pill so I'm not sure whether I'm making sense.
Posted by zeugma on August 14, 2005, at 8:32:15
In reply to Re: Focalin XR » zeugma, posted by ed_uk on August 13, 2005, at 18:14:54
Hi Ed, hope your sleeping pill worked!
The l-isomer of MPH appears to be inactive. Dosing for Focalin appears to be similar to that of lexapro, i.e. half that of the parent molecule. You don't need me to remind you of your love for lexapro, so I suppose no more need be said.
The problem I have with Ritalin is that it is VERY difficult for me to find the right dose. At 30 mg Ritalin LA no serious loss of appetite, no chest pain, mild increase in anxiety that seems to be subsiding; but duration of effect is a problem. I make sure to have caffeine in the afternoon, and that alleviates the disorganization, fatigue, etc., somewhat, but the effect of the Ritalin is much less optimal than Provigil at an equivalent time. My guess is that optimal dosing of Ritalin would be 45 mg/day. It's impossible to get this dose with Ritalin LA however. One idea would be to take a 15 mg IR tablet in the early afternoon, which would produce an effect very different from a second 30 mg LA dose as I was doing last year. The 30 mg LA mid afternoon caused severe appetite loss and also kept me in a sustained state of anxiety that I did not develop tolerance to.
On the other hand, if Focalin really has a longer duration of action and/or fewer s/e, then the situation would be simplified and I could take 20 mg of the XR and not worry about the deleterious effects of repeated dosing.
All this is contingent on the results I get on my lab workup that my PCP gave me last week. If I am basically healthy, then I'll probably go back on Provigil as soon as possible, because its psychotropic effect is easier to deal with, assuming it isn't 'vaguely toxic' in some way to the rest of my body.
-z
Posted by ed_uk on August 14, 2005, at 9:30:35
In reply to Re: Focalin XR » ed_uk, posted by zeugma on August 14, 2005, at 8:32:15
Hi Z!
>You don't need me to remind you of your love for lexapro.....
LOL, I don't dislike it - it's just OVERPRICED and overhyped!
>It's impossible to get this dose with Ritalin LA however.
Could you use a different brand? You could try 36mg or 54mg Concerta.
>chest pain
Verapamil might help.
>On the other hand, if Focalin really has a longer duration of action and/or fewer s/e, then the situation would be simplified and I could take 20 mg of the XR and not worry about the deleterious effects of repeated dosing.
Good point. It's really imporant to have different sizes of tablet.
Warm regards
~Ed
Posted by ed_uk on August 14, 2005, at 11:29:07
In reply to Re: Focalin XR » ed_uk, posted by zeugma on August 14, 2005, at 8:32:15
Hi Z!
What you said about NRIs and circadian rhythms was extremely interesting.
~Ed
Posted by ed_uk on August 14, 2005, at 11:29:32
In reply to Re: Focalin XR » ed_uk, posted by zeugma on August 14, 2005, at 8:32:15
Hi Z!
What you said about NRIs and circadian rhythms was extremely interesting.
Have you ever tried melatonin?
~Ed
Posted by zeugma on August 14, 2005, at 13:44:14
In reply to Re: Focalin XR » zeugma, posted by ed_uk on August 14, 2005, at 11:29:32
hi Ed,
did lofepramine have a positive effect on your circadian rhythms?
Nope, never tried melatonin. I have an aversion to OTC remedies, phobic; I make an exception for various caffeine pills (this is how get myself to drink water when it's not med time ;-))and I have been forced to use decongestants for aesthetic reasons (you can imagine).
Right now I'm wondering where my Vivarin went...
-z
Posted by ed_uk on August 14, 2005, at 16:41:04
In reply to Re: Focalin XR » ed_uk, posted by zeugma on August 14, 2005, at 13:44:14
Hi Z,
>did lofepramine have a positive effect on your circadian rhythms?
No - it didn't make any difference.
>Nope, never tried melatonin.
IMO, it's weird that melatonin's OTC.
Kind regards
~Ed
Posted by zeugma on August 15, 2005, at 7:19:33
In reply to Re: Focalin XR » zeugma, posted by ed_uk on August 14, 2005, at 16:41:04
Hi Ed!
I'm sorry lofepramine did not affect your circadian rhythms. It might be relevant that NRI's have age-dependent pharmacodynamics, but it is more likely that an NRI would have positive effects on a narcoleptic's CR, because the hypnagogic hallucinations etc. were terribly disruptive of sleep and hence any attempt to maintain a normal sleep time. In fact I suffered from terrible insomnia as a result of these problems.
As regards Focalin, this is one of several studies
J Child Adolesc Psychopharmacol. 2004 Winter;14(4):542-54. Related Articles, Links
A double-blind, placebo-controlled withdrawal trial of dexmethylphenidate hydrochloride in children with attention deficit hyperactivity disorder.Arnold LE, Lindsay RL, Conners CK, Wigal SB, Levine AJ, Johnson DE, West SA, Sangal RB, Bohan TP, Zeldis JB.
Ohio State University, Columbus, Ohio 43210-1296, USA. arnold.6@osu.edu
OBJECTIVES: d,l-threo-methylphenidate HCl (D,L-MPH) is the most common treatment of attention deficit hyperactivity disorder (ADHD). A previous report showed placebo-controlled efficacy for the purified d-isomer (dexmethylphenidate hydrochloride, d-MPH, Focalin) with a 2:1 potency compared to dl, and suggested a 6-hour duration of action. This study complements that report by studying the effect of placebo-controlled discontinuation and retesting the duration of action. METHODS: A 6-week, open-label titration of d-MPH (2.5-10 mg twice-a-day) was followed by a double-blind, placebo-controlled, 2-week withdrawal study of responders. RESULTS: In the open titration, 82% of the 89 enrolled patients achieved a Clinical Global Impression-Improvement (CGI-I) rating of much or very much improved. Only 5 patients discontinued for adverse events. Seventy-five patients continued into the placebo-controlled discontinuation. For the randomly assigned d-MPH (n=35) and placebo (n=40) groups, mean ages, respectively, were 10.1 +/- 2.9 and 9.9 +/- 2.7 years, 86% and 78% were male, and 70.6% and 80.0% took the ceiling dose of 10 mg twice-daily, respectively. Each group had 80% combined type ADHD and 20% inattentive type. By the end of the 2-week, placebo-masked withdrawal, significantly more placebo patients (24 of 39) than d-MPH continuers (6 of 35) relapsed (61.5% versus 17.1%, p=0.001). Compared to d-MPH continuers, placebo patients deteriorated significantly more in the 2-week period on teacher ratings of the 18 ADHD symptoms rated 0-3 (p=0.028), the 3 p.m. and 6 p.m. parent ADHD symptom ratings (p=0.0026 and p=0.0381, respectively), and clinic (2-3 p.m.) and home (6 p.m.) Math Tests (p=0.024 and p<0.0001, respectively). The 6 p.m. scores replicated the significant effect at 6 hours reported in the previous study. CONCLUSIONS: d-MPH is safe, tolerable, and effective, with a 6-hour duration of effect suggested by the significant difference from placebo at 6 hours on a double-blind discontinuation.>>
that claims that Focalin has a 6-hour duration of action. This would be highly significant, as Ritalin LA has a 6-8 hour duration of action, and that is not sufficient to get me through a demanding workday (actually nothing is, but every bit helps LOL). The problems I have had with Rit have been directly related to the need to take increased amounts to maintain the effect. I know the theme of this thread is a reappraisal of marketing claims for 'improved efficacy' of new-generation products over older drugs that were dosed improperly (20 mg haloperidol? 48 mg perphenazine? Of course Zyprexa will look good compared to the effects of these dosages!) and I am as cynical as anyone when it comes to marketing claims. But the situation appears to be the reverse (of the relationship e.g. between haloperidol and olanzapine)with Rit and Focalin: higher dosages, hence more s/e, are required to get similar results. And specifically, since unlike Celexa/Lexapro, MPH has a short half-life and effects that are highly variable based on when the med is taken, the duration of effect difference would be of real use to me (and others).
Well, if I do try Focalin XR, you can be sure to get a report that is uninfluenced by corporate grants, however placebo effects cannot be completed excluded ;-)
-z
Posted by ed_uk on August 15, 2005, at 7:37:47
In reply to Re: Focalin XR » ed_uk, posted by zeugma on August 15, 2005, at 7:19:33
Hi Z!
I just started a new thread about SSRIs. I'm beginning to wonder whether escitalopram really is more effective than the racemate LOL! I don't like to disagree with myself but I think it's important to challenge one's beliefs from time to time!
>Well, if I do try Focalin XR, you can be sure to get a report that is uninfluenced by corporate grants, however placebo effects cannot be completed excluded ;-)
I will be very interested to hear how it affects you :-)
Kind regards
~ed
Posted by Bowtie Bob on August 25, 2005, at 7:17:13
In reply to only single isomers for me » ed_uk, posted by zeugma on August 10, 2005, at 17:48:38
> > Hi Z!
> >
> > >Lexapro (escitalopram)....
> >
> > Too expensive. Try generic citalopram (Celexa) first!
>
> Ed, how dare you make that suggestion! Don't you know that single-isomer drugs are TWICE AS GOOD as the racemate, in every case? (just kidding)
> >
> > >....It's just that I have this feeling that more meds = multiplying s/x.......
> >
> > You don't take that many meds! A woman came to the pharmacy today with 5 (full) prescription forms - 25 drugs. This isn't uncommon.
> >
> It's not a phobia of taking too many meds. It's that no matter what I add to nortriptyline, buspirone, and clonazepam (which added together don't give me too many side effects, but also do nothing for sleepiness and ADHD) starts to feel like 'too much' before too long, whether it's increased anxiety, appetite suppression, dry mouth, or 'vaguely toxic' feeling (Provigil).
> > >clotrimazole...
> >
> > In the UK, clotrimazole only comes as a cream and a pessary. How are you taking it? - obviously not as a pessary LOL ;-)
> >
> I don't think so ;-) It comes as a 'troche' (slowly dissolving tablet).
>
> > >oh, and I tried Zoloft when it came out- AWFUL AWFUL AWFUL. I was in a nauseated fog.
> >
> > Hmm. Definately start with a very low dose if you try citalopram!
>
> I would (but I insist on the single isomer if it bankrupts me!). I'm sure citalopram (ahem, escitalopram) is nothing like Zoloft- consider the differences between nortriptyline and atomoxetine. But I was told by the sleep doc that SSRI's can be disruptive to sleep, which corroborates my research.
>
> speaking of which, do you have any thoughts on Focalin, the d-isomer of methylphenidate? An XR version just came out, and this report claims it has a duration of action of 12 hours:http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16026226&query_hl=4
>
> -z
>
> Good Morning. I have been on Focalin XR since it came out--previously Ritalin LA. Both have worked very well, but the Focalin XR seems to work longer for me. Because I have long work day--I am at my desk by 5:30 AM I need to supplement about 9 hours later with a short acting Focalin. This gets me thru early evening. I still love to eat and sleep extremely well. It only took 40 years to figure out that I had ADD...
Posted by zeugma on August 25, 2005, at 18:10:45
In reply to Re: only single isomers for me, posted by Bowtie Bob on August 25, 2005, at 7:17:13
Hi, I have always known I had ADHD, and have accrued numerous other diagnoses as I've gotten older. I am very encouraged to hear your positive experience with Focalin XR, especially with respect to the extended duration of action.
By the way, I went back to 200 mg Provigil a week ago, and the start-up side effects are rough- much worse than I had on Ritalin. I felt awful earlier in the week even though I was able to function (I think) at work. I'm feeling a little better now,EXCEPT for the dry mouth... there is nothing like Provigil to suck the life out of the salivary glands.
I don't know if my pdoc would consider very low-dose Focalin (5 mg) on top of Provigil, but I think it might be a good idea.
-z
This is the end of the thread.
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