Posted by psychosage on June 22, 2004, at 15:17:03
In reply to Re: strattera AND effexor AND wellbutrin? » King Vultan, posted by lisaj32 on June 22, 2004, at 10:17:55
> Thanks,Todd. I don't understand all the biochemistry stuff--psychopharmacology was the one course I should have taken in grad school that I didn't. But clearly my pdoc made a hasty decision on this one and didn't consider interaction effects beyond the question of would she get sued for doing something the books say not to.
>
> Whatever her limitations, she's all I've got right now in terms of available pdocs. I'm going to call her today and see what she suggests. It's very hard for me to give up on Strattera, as I so much NEED something that will help me focus. I've avoided stimulants because I was addicted to a stimulant--cocaine--though I've been clean for 3 1/2 years.
>
> I'm really struggling, but today I feel that I can function and I don't have suicidal thoughts, which is a big improvement over yesterday. Which I spent playing computer solitaire and telling myself this too, my friend, shall pass.
>
> --Lisa
i've had stimulant issues myself, and I've been clean from booze and drugs for 2.5 years and haven't done speed in over 3.Provigil {modafinil} might interest you since it is also used for ADD, and there is research being conducted with it for stimulant abuse.
I do have to warn you that it does have some euphoric effects. I take 100mg a day, but I am also on a mood stabilizer. Are you bipolar?
Good luck.
http://www.pennhealth.com/phys_forum/pto/jan_feb04/glutamate.htmlGlutamate Enhancing Agent Found to Blunt Cocaine High
In a controlled study, PENN Behavioral Health psychiatrists demonstrated that a glutamate-enhancing agent blunts the cocaine high experienced by cocaine addicts. A subsequent open-label study also indicated that the drug promotes cocaine abstinence and reduces craving. “About 16 percent of people who try cocaine become addicted and this addiction is driven by a cycle of euphoria and craving which often leads to a binge pattern of use,” says Charles A. Dackis, MD, addiction specialist and chief of psychiatry at the University of Pennsylvania Medical Center-Presbyterian.{i spent a week in the dual diagnosis ward at presbyterian while at school}
In addition to regular craving, cocaine addicts experience cue craving, an intense craving that occurs when they see something that reminds them of their addiction, such as a person, place or thing. Studies at the University of Pennsylvania Medical Center demonstrated that when shown videos of cocaine paraphernalia, participants who were addicted to cocaine underwent tremendous metabolic changes in the brain. “Although cocaine acutely stimulates the brain, over time a chronically exposed person will experience dysregulation of the pleasure centers in the brain, which appears to include the depletion of two neurotransmitters, glutamate and dopamine,” adds Dr. Dackis, who also works in the University of Pennsylvania Center for Studies on Addiction. “Chronic exposure to cocaine puts cocaine addicts in a negative mood state, termed ‘hedonic dysregulation,’ that involves malfunctioning pleasure circuitry, and they complain that they can’t enjoy life or anything without cocaine.”
Cocaine addicts also have markedly reduced activity in the frontal lobe of the brain, which is largely comprised of glutamate-containing pyramidal cells. Neuropsychological tests that examine frontal lobe function find deficits in cocaine addicts who have impaired executive function, decision-making, ability to weigh risks against benefits, and ability to suppress impulses.
Despite 20 years of intensive research, no drug has been identified with proven ability in cocaine addiction. However, modafinil is the first glutamate enhancing agent to be tested. “The preliminary open-label results are very promising and we are currently testing modafinil in a controlled study. Modafinil is a novel, awakening drug that enhances executive function and concentration. Since it reaches the pleasure centers of the brain, we believe it may reverse some of the long-term affects of cocaine,” explains Dr. Dackis. “And, even more importantly, it has demonstrated an ability to block the cocaine high.”
In the open-label study, 17 cocaine-dependent individuals (with severe cocaine withdrawal) were randomized to receive either 200 or 400 mg/day of modafinil for a period of eight weeks. When compared to a group of placebo-treated subjects from another study, those who received modafinil had significantly higher abstinence (47 percent vs. 6.5 percent) and treatment retention. Both dosages were well tolerated and the four participants who used cocaine in combination with modafinil reported absent or diminished euphoria.
PENN psychiatrists are currently conducting a double blind placebo controlled clinical trial studying modafinil and its affect on cocaine dependence. In addition, the National Institute on Drug Abuse is soon launching a multi-center study (which will likely include PENN as a site) on modafinil and cocaine.
poster:psychosage
thread:358766
URL: http://www.dr-bob.org/babble/20040621/msgs/359132.html