Comment by ineedasername | Hacker News Reader

Comment by ineedasername | Hacker News Reader

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Without going into too much detail on my own situation, in addition to other meds I'm also on Modafinil. This is mainly to combat fatigue side effects, but modafinil is also a very good (for me at least) anti-depressant. I'm depressed less often on it, and when depressed it keeps me much more functional. There's a decent body of research in its use for this purpose as a second-line anti-depressant, such as: https://pubmed.ncbi.nlm.nih.gov/16035049/

Not all doctors are familiar with its use in this way. When I had to switch doctors after mine retired, I had to educate them in its use so that they would continue prescribing it.

It is also not an automatic approval by insurance companies. However, if denied by your insurance, you can get it at a fairly reasonable price using GoodRX.

If you're still struggling after what you're already one, and have gone through a few other options (and maybe even if you haven't) then I would highly recommend talking to your doctor about this.

Something to keep in mind though is that this will, mostly in the first week, impact your sleeping patterns. Taking it first thing in the morning would be the best time, and perhaps ask your doctor about using an over-the-counter sleep aid such as diphenhydramine during initial usage.

Out of curiosity, do you feel antidepressive qualities from other dopaminergic substances? (Part of modafinil's mechanism of action is thought to be dopaminergic.) Also, do you feel like you might have ADHD?

Just asking this out of curiosity, because I'm also someone who consistently experiences antidepressive effects from modafinil. Though for me it's typically more of a feeling that lasts for about 1 - 4 hours after use rather than a steady, stable mood lifting effect.

I took modafinil for about 6 months while having under treated depression. It only seemed to improve wakefulness like super caffeine minus jitters and anxiety.

Like mainly sleep “aids”, DPH just puts you into a fatigued state that is unlike naturalistic sleep. If insomnia / rumination / etc would otherwise keep one up and the diphenhydramine allows one to fall asleep and get a night of suboptimal sleep as opposed to no sleep, it’s of course worth it, but otherwise stay well away.

Interestingly almost everything that induces sleep harms the actual sleep quality. However I remember reading that GHB appears to improve sleep architecture, although I’ve never tried it personally

1. Modafinil is the opposite of a sleep aid, so the first paragraph doesn't really apply.

2. Using GHB/Alcohol/Marijuana to help you feel more rested really depends on if the person has a medical condition or not. All of these drugs will suppress REM sleep (so will your typical SSRI), which for the average person may not be a good thing. However, those with narcolepsy have a much higher rate of REM sleep, preventing their body from going into deep sleep and thus (says the hypothesis) they don't get the awakeness/alerting benefits from sleep.

Interestingly, those with depression and PTSD also have increased rates of REM sleep, so there is an interesting question of causality there.

The first paragraph was about diphenhydramine (DPH) as a sleep aid. And I agree with the point. Any time I’ve tried to use it to help me sleep it sets me off on a downward spiral of bad sleep habits.

I can confirm DPH is awful. In general, I would only take it if were life-and-death.

>All of these drugs will suppress REM sleep (so will your typical SSRI)

Citation needed about the SSRI part, because one typical side effect of SSRIs is unusually vivid dreams.

"Reductions in the amount of REM sleep and increases in REM sleep onset latency are seen after taking antidepressants, both in healthy volunteers and in depressed patients. Antidepressants that increase serotonin function by blocking reuptake or by inhibiting metabolism have the greatest effect on REM sleep. The decrease in amount of REM sleep appears to be greatest early in treatment, and gradually diminishes during long-term treatment, except after monoamine oxidase inhibitors when REM sleep is often absent for many months."[1]

I agree that the two data points are paradoxical, and I'm not sure what to make of it. Personally I have a much larger than average amount of REM sleep (confirmed by professionals when I was tested for narcolepsy/daytime sleepiness), but I do not have vivid dreams and seldom recall dreaming at all, despite talking and moving in my sleep. Nevertheless it's quite interesting.

One hypothesis could be that less time in REM sleep leads to more intense bursts of REM, thus more vivid dreams? Or perhaps I am lacking knowledge and there is more to dreams than REM sleep.

[1]https://pubmed.ncbi.nlm.nih.gov/15892588/

Trazodone actually improves sleep quality when you take it for insomnia. Oddly I looked it up and apparently there is no evidence it objectively improves start time for sleep, but it sure feels like it does.

Melatonin isn't too bad for actual sleep I think, but almost all supplements give you way too much - something like 1/3mg is enough. It does give me really bad dry eyes in the morning for some reason.

Trazodone knocks me out. It also makes me lethargic the following day and less productive. I would only take half the lowest available dose (cut the lowest dose in half with a pill cutter) and it still gave me greatest sleep than anything else I'd ever tried. I still take it for flights and business travel (weird hotels) but otherwise it's too much for me.

For a number of years, Mirtazapine helped me sleep, although it reduced dreaming to nil. Interestingly, the antihistamine sedation effect of it decreases at increased doses.

In general, DPH seems like a terrible anticholinergic and obsolete antihistamine with limited uses. My ex-stepfather abused it nightly as a "sleep aid," his personality altered, became very depressed, and I think entered a pre-dementia/Alzheimer's state sooner than he would've otherwise.

Probably not a good idea to experiment personally with GHB because it's Class I in the US and associated with date-rape, but it's worth considering in studies and research.

It does seem to be the case that disordered sleep is the keystone of depression; I can also confirm missing one dose of mirtazapine at night feels exactly like an alcohol-induced hangover in the morning. I suspect depression accumulates during sleep.

Interestingly, mirtazapine is a powerful H1 antihistamine that induces sleep at lower doses that are swamped by noradrenergic effects at higher doses. I would guess patients on mirtazapine have fewer incidents of seasonal allergies.

I have Medicare now after a 9 year battle.

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