Modafinil/Provigil? I recently started taking this (prescribed by my pulmonologist for excessive daytime sleepiness). It was great the first week then it's effectiveness lessened dramatically, but it's still enough that I can function more effectively at work than before. My new rheumy seemed surprised I was taking it; she didn't tell me to stop but it sounds like I'll be starting a biologic sometime this fall (after recovering from surgery) so perhaps then she'll suggest I cease and see if the biologic helps with the fatigue/sleepiness.

From what I read seems tnf blocker further lowers levels of serotonin.
Would be interesting to know if people with AS like people with fibromyalgia have lower levels of dopamine in substantia nigra, I recently read documented research that great way, beside drugs which eventually wane off and can cause other problems, to increase dopamine would be walking minimum 3 times a week for several miles. This was in relation to patient with Parkinson disease. But what was even more interesting is they say people with low dopamine level have decreased motivation to make a first step, as the cost benefit ratio is higher. All in relation to neurotransmitters. Seems that the sedentary ways of modern life are killing our 🧠 . I a very active male 39 and beside AS I am looking way younger than most of my peers.