Posted by Mitch on June 18, 2001, at 23:39:07
In reply to Re: Any success with Provigil (Modafinil) for ADHD? » Mitch, posted by Sulpicia on June 18, 2001, at 18:00:20
> > Anybody had any success with this for ADHD or as an augmentor for anergic bipolar depression?? It looks like it might be helpful. Any input would be nice. This is available in the US. Obviously from what I found in the monograph (excerpt below) it isn't an alpha-1 agonist after all. Hmmm.
> >
> > In vitro, modafinil binds to the dopamine reuptake site and causes an increase in extracellular dopamine, but no increase in dopamine release. In a preclinical model, the wakefulness induced by amphetamine, but not modafinil, is antagonized by the dopamine receptor antagonist haloperidol.
> > Modafinil does not appear to be a direct or indirect alpha-adrenergic agonist. Although modafinil-induced wakefulness can be attenuated by the a1-adrenergic receptor antagonist, prazosin, in assay systems known to be responsive to a1-adrenergic agonists, modafinil has no activity. Modafinil does not display sympathomimetic activity in the rat vas deferens preparations (agonist-stimulated or electrically stimulated) nor does it increase the formation of the adrenergic receptor-mediated second messenger phosphatidyl inositol in in vitro models. Unlike sympathomimetic agents, modafinil does not reduce cataplexy in narcoleptic canines and has minimal effects on cardiovascular and hemodynamic parameters.
> > In the cat, equal wakefulness-promoting doses of methylphenidate and amphetamine increased neuronal activation throughout the brain. Modafinil at an equivalent wakefulness-promoting dose selectively and prominently increased neuronal activation in more discrete regions of the brain.The relationship of this finding in cats to the effects of modafinil in humans is unknown.
>
> Mitch--
> the trials in adults failed [and the co.'s stock dropped!] --
> you should be able to find the reference[s] to this at the ADD site at
> About.com. Just search for provigil.
> Regarding the ped study, aside from 15 being a *very* small number, I would be
> interested to find out how old the children were. It's no biggie to control hyperactivity:
> caffeine does this for many with ADHD. Inattention is the crucial problem which pstims address successfully.
> I wonder about their ages in terms of their ability to recognize the difference between the effect of an agent
> that works primarily on alertness versus one more narrowly targeted on attention.
> My daughter [16 y/o] tried this both as an ADD med and an add-on AD with no result save a headache.
> And it's pricey too.
> At the university where our pdoc works they are in month 8 or 9 of a 1 year trial of provigil as an
> AD add-on and the preliminary results are not great -- tho that may change.
> A doc friend with ADD tried it and said it woke him up but did little for focus/attention.
> The pdoc, looking at the pharmacology [or reading the tea leaves] opined that provigil would selectively
> work on the centers of alertness in the brain, rather than the specific areas [and dopamine issues] involved in
> ADHD.
> Good luck with this -- I don't have to tell you that what doesn't work for one person may work for another.
> S.Sulpicia,
Thanks for that information. I actually have more troubles with inattention than I do with hyperactivity/impulsivity. Dopamine agonists (pergolide) helped somewhat, but made me too sleepy (esp. Mirapex). It looks like a couple of months of nortriptyline again this year! Although you did say the crucial word ("wake-up"), and that is the problem I have when I cycle into this seasonal major depressive episode (I term it the "sleeping sickness"). I just want to sleep ALL THE TIME. I get up just in time to go to work in the afternoon-feel sleepy there all nite, and then go home and crash and SLEEP AND SLEEP AND SLEEP. Don't want to go ANYWHERE, am not interested in doing ANYTHING. It really sucks.
Maybe I can get some samples, I don't know.
Mitch
poster:Mitch
thread:66963
URL: http://www.dr-bob.org/babble/20010618/msgs/67024.html