Posted by Ant-Rock on June 16, 2000, at 8:09:21
In reply to Re: Parnate and Adrafanil?, posted by AndrewB on June 16, 2000, at 3:47:04
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> Anthony,
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> A question: Do you still have fatigue or is all that remains anhedonia and apathy?
>
>
> To set the record straight. Stimulants like ritalin act both on norepinephrine (NE) and dopamine (D) receptors. When someone finds a stimulant ineffective, it does not preclude subsequent success with a dopaminergic drug or a norandrenergic (NE) drug. As evidence, in the Tips section one can kind find an account of a psych. who used dopaminergics with success for fatigue where stimulants had failed. Similarly, CFS patients rarely respond to stimulants but often have success with norandrenergic drugs.
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> Let me explain why this may happen (and someone please tell me if I am wrong here). A stimulant like ritalin works by emptying the NE neurotransmitter out of its storage vesicle so the NE can flood the receptor site and create the increase in the stimulation of the receptor that makes us feel better. Sometimes the NE in the storage vesicle is not replaced fast enough, so as time passes, the stimulant is unable to empty NE out of the storage vesicle, the well is dry so to speak, and therefore the effect one enjoyed at first with the stimulant has quickly disappeared. A stimulant also acts with this mode of action on the dopamine (D2) receptor.
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> All this means is what you already know, if a stimulant doesn’t work, another class of NE or dopamine acting drugs might. I’m rooting for the adrafinil to work for you. John said it worked for his anhedonia I think.
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> But if Adrafinil doesn’t work I have another suggestion; try a dopamine D2/D3 agonist like Requip, Mirapex, or bromocriptine. I think Scott mentioned this. Just because amisulpride, a D2/D3 presynaptic receptor antagonist, did not work doesn’t mean an agonist won’t. Mirapex did NOT work for me, but amisulpride of course has. The reverse may be true in your case if you will accept a bit of counter reasoning. I mention all three of those agonists because which you would decide to use would depend on your circumstances: will you have a prescription, do you have insurance that covers the cost of the medicine, and how much are you willing to spend. But if you do decide to go the dopamine agonist route, let me know and I will help steer you through the decision.
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> One other option that I’ve read of is precursor loading the stimulant. I don’t know just how effective it is as a norm. You use Sinemet or tyrosine (Sinemet would have more efficacy I would think). It may take 6 weeks to see a difference.
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> Andrew BFirst of all, I am very grateful for all of the support and knowledge that has been given to me here. The impact of this help has improved my state of mind more than I can express
in words. I hope I have helped others even a fraction as much.
Andrew,
the parnate has helped with the fatigue a lot. In the past, this has also been the case. I still don't recover from exercise as well as I should, but I force my self to run or jog(20-30min.) three to four x a week. Certainly not 100%, but I will continue to try. I really notice a problem with my calf muscles, like they aren't getting enough oxygen or something. I hope to get some answers to this when i have my follow up visit with my new endo doc Monday, and address my low cortisol/ low testosterone outcome from my last bloodwork.
My ability to concentrate is a little better, but i think if i can get this anhedonia/apathy thing beat my concentration will also come back to normal.
I will certainly take you up on your offer if need be Andrew. I know very little about dopamine agonist.
I hope all is well with you, and I will let everyone know how things develop.
Sincerely,Anthony
poster:Ant-Rock
thread:37287
URL: http://www.dr-bob.org/babble/20000610/msgs/37499.html