Posted by zeugma on June 7, 2004, at 20:24:31
In reply to Re: BID dosing is a little better » zeugma, posted by Ktemene on June 7, 2004, at 19:15:25
Yes, I'm considering Provigil and also more conventional stimulants. I am very confused at the moment. My pdoc came with a high recommendation, he is a specialist in attention deficit disorder, and he stuck with me as I went through a very difficult period titrating up on nortriptyline. Even at that time (more than a year and a half ago), he seemed to have this idea that Strattera and nortriptyline would 'go well together,' despite the fact that they have similar pharmacologies and standard practice is to minimize redundancies. Strattera does feel very different as it hits my brain, it is a drug with a much more rapid absorption and does not have the antihistaminic effect nortriptyline has. I was willing to go along with all this as long as the results were good. The Strattera fatigue did not hit me all at once. At first it was mildly stimulating, then it became neutral, then finally I became so fatigued that I became vulnerable to a relapse of depression. It was only when I become seriously depressed again that I questioned him strongly on the combination (I had asked questions before about the rationale but the situation was less urgent so I accepted half-answers). This differential effect on the PFC as opposed to the other areas of the brain innervated by the NET is something I would need substantiation for, because in the past two months I have been juggling my meds trying to find what was aggravating my already prominent fatigue: I determined that it wasn't the nortrip , then I dropped the buspirone, with little change, and now it can only be the Strattera. Since fatigue is part of inattentive ADD as far as I am concerned, I would only want to keep the Strattera if I had a good reason for doing so, and I am definitely keeping the nortriptyline, even going through the ceremony of another plasma level later in the month to determine whether I'm in the therapeutic window.
He did not produce evidence, but I am going to ask him for evidence at the next session. Even if my fatigue lifts a little as a result of the BID dosing schedule, I am still going to need a stim, and it seems like absurdity to be on two NRI's plus a stimulant (and God knows what that would do to my brain) provided there is no evidence of real difference between the two NRI's and one of them is worsening my anergia. He alluded to Strattera's possible superiority to desipramine and I would *really* like to see ANY evidence of that.
The theory of anergic depression being synonymous with a severe inattentive ADD is simply my own reflection on the course my own symptoms have taken. I had become steadily more disengaged, drained, and anergic over the years and this lack of energy appeared to be related to my inability to carry out any actions on my own due to my increasingly fractured ability to perceive {myself and what was around me). I'm not aware of any literature on the subject, but I can tell you that I consider severe ADD to be a disorder that stikes at the heart of the self and its ability to relate to itself ( a kind of self-disconnection). The anergia may stem from the enormous expenditure in energy it takes to carry out any coherent activity in such conditions.
That's great that selegeline is working for you. I am probably going to try Provigil first, if I stay on Strattera, or some kind of amphetamine if not. Your post has given me a lot to think about.
poster:zeugma
thread:353502
URL: http://www.dr-bob.org/babble/20040602/msgs/354646.html