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Dr. Bob is Robert Hsiung, MD,
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Posted by karel on July 1, 2000, at 20:52:25
there have been a lot of posts recently about adrafinil and depression; does anyone have any experience with adrafinil and bipolar disorder? every antidepressant sends me into dysphoric hypomania, but without them, i get depressed (sluggish, can't concentrate or sleep well, anhedonia-- the whole nine yards). i've tried about every mood stabilizer out there, but i still get hypomanic. i'd be grateful for any info about using adrafinil for bipolar depression.
thanks
Posted by SLS on July 2, 2000, at 7:30:39
In reply to bipolar disorder and adrafinil, posted by karel on July 1, 2000, at 20:52:25
> there have been a lot of posts recently about adrafinil and depression; does anyone have any experience with adrafinil and bipolar disorder? every antidepressant sends me into dysphoric hypomania, but without them, i get depressed (sluggish, can't concentrate or sleep well, anhedonia-- the whole nine yards). i've tried about every mood stabilizer out there, but i still get hypomanic. i'd be grateful for any info about using adrafinil for bipolar depression.
>
> thanks
I'm sorry to hear that mood stabilizers do not prevent mania. Perhaps using one of the newer neuroleptics would address both the depression and hypomania at the same time. Zyprexa is a good drug. It might be worth adding it to one of the antidepressants you find helpful, as it would probably prevent mania.You would make a great test subject for using adrafinil alone as a treatment. I would be interested to see whether or not it produces mania. Many of us fill the role of guinea pig here, often with success. Modafinil (Provigil), a relative of adrafinil that is sold in the U.S., has been shown to be effective to treat bipolar depression when combined with antidepressants. I think that there is plenty enough reason to try either of these drugs alone.
Just in case you haven't tried it, Wellbutrin is probably the best first choice for treating bipolar depression. It is effective and carries with it the least risk of producing mania, although it does happen.
I look forward to seeing you get well. Please post your results with adrafinil.
Good luck.
- Scott
Posted by shellie on July 2, 2000, at 10:01:30
In reply to Re: bipolar disorder and adrafinil, posted by SLS on July 2, 2000, at 7:30:39
Karel, have you tried lamictal or topomax? shellie
Posted by karel on July 2, 2000, at 14:14:39
In reply to Re: bipolar disorder and adrafinil, posted by shellie on July 2, 2000, at 10:01:30
first, thanks for the responses. this was my first time posting, and i didn't know what to expect. i have an appointment with a psychopharmacologist in a few weeks, and after that, hopefully, i'll start adrafinil. i'm reluctant to start it on my own because i know it can cause liver complications and i'm currently on depakote, which can also damage the liver.
for mood stabilizers, i've tried lithium (no effect), depakote (best of the bunch, but far from 100% effective), tegretol and topomax (cognitive side effects were intolerable), and lamictal. i haven't tried lamictal with an antidepressant, but on its own, the lamictal didn't help with the depression. i've also tried risperidal and zyprexa, but they really made me feel numb, nothing. oh yeah, gabapentin, also. no side effects, but once i started with the antidepressants, the hypomania came back.
anyway, sorry for the long post, and i'll write about my (hopefully) sucessful trial on adrafinil in a few weeks.thanks,
karel
Posted by shellie on July 2, 2000, at 14:52:55
In reply to Re: bipolar disorder and adrafinil, posted by karel on July 2, 2000, at 14:14:39
Karel, If you and your pdoc are concerned about your liver, you might want to consider provigil first, rather than adrafinil. The compounds are supposedly similar, but I don't think provigil is related to liver problems. It is available in the US, expensive as hell, but if you have prescription coverage that wouldn't matter.
I just started a trial of provigal this week--so far no results re depression (but it has only been a few days). I am using it for major depression to augment an MAOI, not bipolar.Keep us posted. shellie
Posted by JohnL on July 4, 2000, at 5:58:29
In reply to bipolar disorder and adrafinil, posted by karel on July 1, 2000, at 20:52:25
> there have been a lot of posts recently about adrafinil and depression; does anyone have any experience with adrafinil and bipolar disorder? every antidepressant sends me into dysphoric hypomania, but without them, i get depressed (sluggish, can't concentrate or sleep well, anhedonia-- the whole nine yards). i've tried about every mood stabilizer out there, but i still get hypomanic. i'd be grateful for any info about using adrafinil for bipolar depression.
>
> thanks
Karel,It's too bad the hypomania you experience is the dysphoric type. Not exactly the type they refer to when they use the phrase "the manic advantage".
Will Adrafinil do that to you? Don't know. I think only a personal trial will tell. Of all the meds you might choose however, I think Adrafinil does have a very low potential for causing those dysphoric feelings. It is overall very gentle and slow acting. Not at all like other stimulants.
I know that dysphoric feeling you talked about. A lot of meds made me feel that way too. But Adrafinil doesn't. If Adrafinil does spark a hypomanic state, hopefully it will be the good kind...energetic, interested, motivated, sharp. Hypomania isn't a bad thing, as long as it's the good kind of hypomania. Lots of aggressive happy successful people are actually in that good hypomanic state and don't even know it. That's the 'manic advantage', as my doc calls it. It's common with artists and musicians.
Only one way to find out. You could start with 300mg a day. If there is any immediate reaction--good or bad--on the first day or two, try to ride it out and see how things develop over the next two weeks. I responded immediately on day 1, fell into depression day 2, but then witnessed a slow yet stunning retreat of all depressive and/or dysphoric symptoms over about a two week period. If all is well (either neutral or somewhat positive response) after two weeks, then you could consider upping to 600mg.
Certainly Adrafinil could spark that dysphoric hypomania. Any medication could. But in general I think the odds are in your favor with Adrafinil to experience good things without that dysphoric stuff.
JohnL
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