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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by Jon Barnes on May 3, 2000, at 19:32:29
Hi Gang,
First time poster, reader for about a month. Any thoughts on this matter would be appreciated. Have been battling depression for about 3 years now. In addition to depression, I have fatigue and cognitive difficulties (concentration, reading, etc). Remeron + Buspar + T4 takes care of the depression but the fatigue/cognitive problems remain. I've tried several agents which speed up the normal person including Wellbutrin, Ritalin, Paxil, Prozac and Parnate (by itself). I have found that these types of drugs actually drain what energy I have and make the cognitive problems worse.
Have others with similar symptoms experienced similar results with these categories of drugs? If so, what other drugs worked?
Posted by AndrewB on May 4, 2000, at 2:06:33
In reply to Wellbutrin/Parnate/Ritalin, posted by Jon Barnes on May 3, 2000, at 19:32:29
> Hi Gang,
>
> First time poster, reader for about a month. Any thoughts on this matter would be appreciated. Have been battling depression for about 3 years now. In addition to depression, I have fatigue and cognitive difficulties (concentration, reading, etc). Remeron + Buspar + T4 takes care of the depression but the fatigue/cognitive problems remain. I've tried several agents which speed up the normal person including Wellbutrin, Ritalin, Paxil, Prozac and Parnate (by itself). I have found that these types of drugs actually drain what energy I have and make the cognitive problems worse.
>
> Have others with similar symptoms experienced similar results with these categories of drugs? If so, what other drugs worked?Welcome to the board Jon,
I used to have fatigue and cognitive problems which medication has taken care of. I would like to steer you to a website that describes something they call 'brain fatigue' in those with polioencephalitis. Now I know you don't have polioencephalitis, but the symptoms they describe here are shared by others including some of those with chronic fatigue syndrome. I also had symptoms like they describe. Anyway, I want you to take a look at the website below. If after having looked at it you think the symptoms roughly match yours, just post me back here and I can give you some medication strategies.
www.prys.net/articles/bruno/runninghead.html
Wishing you all the best,
AndrewB
Posted by ChrisK on May 4, 2000, at 6:30:29
In reply to Wellbutrin/Parnate/Ritalin, posted by Jon Barnes on May 3, 2000, at 19:32:29
I am struggling through something similar to you. Adderall helped a little when combined with Wellbutrin. I haven't tried Ritalin yet but that is next on my list. Some people respond well to Provigil but it just gave me constipation and I cried for half of the day. I've also heard that Anafranil may help.
Somethings worth trying,
Chris
Posted by Jon Barnes on May 4, 2000, at 7:40:18
In reply to Wellbutrin/Parnate/Ritalin, posted by Jon Barnes on May 3, 2000, at 19:32:29
> Hi Gang,
>
> First time poster, reader for about a month. Any thoughts on this matter would be appreciated. Have been battling depression for about 3 years now. In addition to depression, I have fatigue and cognitive difficulties (concentration, reading, etc). Remeron + Buspar + T4 takes care of the depression but the fatigue/cognitive problems remain. I've tried several agents which speed up the normal person including Wellbutrin, Ritalin, Paxil, Prozac and Parnate (by itself). I have found that these types of drugs actually drain what energy I have and make the cognitive problems worse.
>
> Have others with similar symptoms experienced similar results with these categories of drugs? If so, what other drugs worked?Also, I should have mentioned that these types of drugs make my throat feel like there is a lump in it, down near the thyroid gland. I've had my thyroid gland tested and of course it's normal. Anyone else get the lump-in-throat sensation from a/d's?
Posted by AndrewB on May 4, 2000, at 11:13:02
In reply to Re: Wellbutrin/Parnate/Ritalin, posted by Jon Barnes on May 4, 2000, at 7:40:18
Jon,
Did you experience an energy boost at first when taking wellbutrin, ritalin or parnate. This could be significant.
So your symptoms don't roughly mimic those of polioencephalitis?
Posted by Jon Barnes on May 4, 2000, at 14:16:17
In reply to Re: Wellbutrin/Parnate/Ritalin, posted by AndrewB on May 4, 2000, at 11:13:02
> Jon,
>
> Did you experience an energy boost at first when taking wellbutrin, ritalin or parnate. This could be significant.
>
> So your symptoms don't roughly mimic those of polioencephalitis?Andrew, I finally checked the site you referenced re: post polio fatigue. Yes, my remaining symptoms definitely are similar (fatigue, cognitive deficits (reading, concentration and word recall)). It is interesting that my mental problems did start following a bout with mono. Perhaps there is a connection, maybe just a coincidence.
I did get an immediate and significant boost from Wellbutrin and Adderall (I forgot to mention that I've tried that one too) which lasted for anywhere from 10 to 14 days then I declined significantly, feeling worse on the meds. Got a smaller boost from Ritalin and Parnate, each lasting a few days.
I welcome your thoughts on treatments. Again, I'm currently taking Remeron 30 mgs p/day + T4 + Buspar. I believe that the T4 and Buspar are hyping the Remeron benefits.
Posted by AndrewB on May 5, 2000, at 2:26:06
In reply to Re: Wellbutrin/Parnate/Ritalin, posted by Jon Barnes on May 4, 2000, at 14:16:17
Jon,
Fatigue can have a lot of causes. Finding the cause and appropriate treatment may be time consuming. You have already run through the common first option medicines for dealing with fatigue. Now you may have to scratch a little deeper. After quite a bit of searching around, I found ways to remove my fatigue. I’ve read that nearly all fatigue conditions can be effectively dealt with, but it will require on your part the patient, persistent, and wise pursuit of clues and solutions related to your condition. Here are some suggestions to get you on your way:
1) The fact that your norepinephrine (NE) active meds (Parnate, Ritalin and Wellbutrin) worked at first but then made you feel more fatigued than ever may indicate an underlying ‘metabolic fatigue’.
One strategy that can work in these cases is to pulse dose the NE med. In other words take frequent drug holidays from the medicine. For example, take the medicine one day on followed by one day off, or take the medicine five days on and two days off. The on/off schedule will have to be tailored to your individual metabolism. Also you may do better using a relatively low dose of your NE med.
So what is a good medicine to use. Provigil may work well. The active ingredient in Provigil is modafinil. Modafinil will generally increase one’s physical and mental arousal without interfering with night time sleep. It has relatively few side effects. It is available in the US. It seems to work exclusively on the alpha 1 adrenergic receptor. It builds up into the body into steady state concentrations fairly quickly (2-4 days) and leaves the body fairly quickly too.
2) Dopamine D2 postsynaptic receptor stimulator medicines have been shown also to be effective for some in taking away fatigue, especially mental fatigue. These medicines have been used to treat fatigue where stimulants like ritalin have failed. Bromocriptine and amisulpride are two such medicines. Bromocriptine is available in the US. It is also available from overseas without a prescription. It is inexpensive. Amisulpride is only available from overseas. I use it myself and it helps immensely with my mental fatigue. It is also an AD that is generally side effect free in men and can be mixed with other antidepressants. For ordering information on amisulpride as well general information pertaining to its safety and efficacy, please email me.
3) Finally I would suggest you learn all you can about your condition. A place to start would be to learn about Chronic Fatigue and Immune Dysfunction Syndrome (CFIDS) and Chronic Fatigue Syndrome (CFS). Regardless of whether or not you have either of these syndromes, you may be able to take away your fatigue by applying the strategies used to treat these conditions. I’m not sure, but I may have read that mono is sometimes seen at the onset of CFIDs. For more information on CFIDs go to www.cfids.com. For more information on CFS go to the excellent website www.beatcfsandfms.org. I suggest that you look at the section on increasing metabolic energy.
Best of luck,
AndrewB
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