Posted by JohnL on June 18, 2000, at 5:27:17
In reply to Re: Adrafinil - Angela, Andrew, John - IMPORTANT, posted by Angela5 on June 18, 2000, at 2:19:52
Angela,
I did get a liver blood test at about 3 weeks into Adrafinil. I'm sure that was too soon, and everything tested fine. But I voluntarily get a blood test once every six months anyway, so that issue didn't bother me. The elevated liver enzymes that occur with Adrafinil in longterm use doesn't happen frequently. But it does happen sometimes, and thus the responsible warning to monitor it. If it is a concern, dose reduction or temporary withdrawal is the remedy. That's another reason why I reduced my dosage to 300mg after responding to 900mg. I wanted to see if I could maintain the response at a lower dose and simultaneously lower any infrequent risks to near zero.I wouldn't worry about that. And I wouldn't spend too much effort basing your decisions on theories or how I or anyone else respond to different meds. Psychiatry really does seem like more an art than a science, and you are a unique piece of canvas on which a unique masterpiece is in the process of being painted. Nobody else has your chemistry, your genes, your strengths, your flaws, your personality, or your brain. They are all unique to you.
What looks good on paper may turn out to be a total flop. That's happened to me so many times. The best layed theories ended up being interesting yet useless ponderings. I wish there was some accurate way to predict which med is correct. But the only way I've found is to actually try them one at a time and see. When you discover the right color for your canvas, there will be no doubt.
According to my pdoc, results of recent conferences indicate that while 80% of patients will improve if they try at least 2 different antidepressants, very few of them actually return to what he called 'normal baseline'. The difference between the 'recovered-to-functionality' patient and the 'completely well' patient is the determination to keep trying new things until the right color is discovered. With me as an example, I could have stayed on Paxil from years ago and been OK the rest of my life. Even though I was OK and relieved to be out of the depression dungeon, I knew I wasn't fully recovered. One trial after another finally allowed me to stumble onto the perfect color I had been looking for. I didn't know what it was until I found it. Reboxetine and other NE enhancing meds made me much worse, so I had no expectation at all that Adrafinil would do any good. In the real world however, it turned out to be magical. Go figure. But again, that's just me and my unique chemistry. What's right for you may or may not be right for someone else, and may or may not make sense on paper.
To complicate the statistics I mentioned above, 50% of those patients who improved were taking sugar pills.
In the absence of finances to enlist a real good pdoc this week (versus an appointment a month from now), the most attractive options for you as I see it at this very point in time with your unique circumstances are SJW, Adrafinil, SAMe, or any combination of two of these. These things are readily available to start today (except Adrafinil), inexpensive (except SAMe), and stand just as good a chance as anything else. SJW overall looks the best, but would be greatly enhanced by starting SAMe at the same time so as to have the potential for quick recovery while waiting for the SJW to do its thing. And if money is available, order some Adrafinil which will arrive in about a month. If at that time you are well, then the money would have been wasted. No need for the Adrafinil. On the other hand, if things aren't that good, then you have a new med on-hand to try.
You know, a lot of doctors and a lot of readers and patients would be upset at me for talking like this, because it sounds like I'm advocating self medication. And it sounds like I think I know what I'm doing. But that's not the case. All I care about is seeing you get well as fast as possible. Under your cirumstances, what are the best options to do that? The FDA is given the green light by default to self medicating with these things by not restricting them. Heck, you can buy them anywhere right alongside the vitamins. I don't know what I'm doing except for one thing...all choices stand an equal chance of working, and we never know for sure till we try.
JohnL
poster:JohnL
thread:37644
URL: http://www.dr-bob.org/babble/20000610/msgs/37681.html