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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by AnneL on May 30, 2001, at 22:53:40
Now on Effexor 150 mg. and have not had any great improvement with lethargy, apathy and daytime somnolence which hits me hard especially on weekends.
10 minutes into a movie and I am out for 2 to 3 hours, the minute I give in to the sleepiness and close my eyes, its all over! I'am ok at work (so much to do, stimulating environment)but once I get home, same problem. Also take Klonopin 1 mg. at night and don't have any "hangover" effect in the morning and one cup of coffee gets the engine reving. Saw Pdoc today who instead of increasing dosage of Effexor (dosen't think Effexor causes somnolence, says its "activating in most individuals") suggested that I try Provigil and gave me samples of 200 mg. tablets, saying to take 1 tablet every morning. Is this drug safe? Will it make me nervous and jittery (I hate that feeling and have no anxiety or jitteriness with Effexor)? I have read other posts which suggest that increasing the dose to 225 up to 300 mg. ended the somnolence. Ideas, suggestions, is the Provigil worth a try? The label says it can cause "euphoria". Sounds scary and potentially abused (no abuse history). Why is this med classified as a Schedule IV medication and what does this mean? Thanks in advance, AnneL
Posted by Cam W. on May 31, 2001, at 8:25:11
In reply to Provigil to help with Effexor Fatigue - Cam?, posted by AnneL on May 30, 2001, at 22:53:40
Anne - I would like to begin with a caveat; I am Canadian (eh) and we don not have Provigil™ here, yet. I have no clinical experience with the drug, so I any advice I do give will be from my general experiences with stimulants. Others on this board will have greater insight into Provigil.
Effexor, at doses greater than 225mg, is stimulating. I was dragging my butt at the 225mg dose, but when my doc increased the dose to 262.5mg and then to 300mg, my energy returned greatly. Actually, it was at the 262.5mg dose that I had the energy and initiative to begin posting here again. Before that I had trouble stringing two sentences together.
As for adding the Provigil, I am of the school that the fewer medications one uses, the better. Every time you add another drug to the regimen, you increase the risk of side effects. From what I have heard about Provigil, it does seem safer and less likely to produce euphoria and other over-stimulating side effects seen with traditional stimulants like amphetamines or Ritalin™.
As for being a Schedule IV drug, I have enough trouble trying to stay ahead of the changes in Canadian drug laws, let alone trying to figure out your Yankee ones (my apologies if you live in the south). Sounds like they have it in the controlled drug and narcotic section (ie. the drugs that pharmacy inspectors closely count). Again, someone else will be much better able to help you here.
In closing, increasing the Effexor dose does work for many people (including me); it may be worth asking your doctor about. I hope that there is something in this post you can use. - Cam
Posted by AnneL on May 31, 2001, at 9:17:28
In reply to Re: Provigil to help with Effexor Fatigue - Cam? » AnneL, posted by Cam W. on May 31, 2001, at 8:25:11
>
> As for adding the Provigil, I am of the school that the fewer medications one uses, the better. Every time you add another drug to the regimen, you increase the risk of side effects.>Cam, thank you so much!! I agree with all that you said especially about adding more medications
and increasing risks of side effects.I was so frustrated yesterday with my pdoc, he just really wanted to keep me at 150 mg. Perhaps he was angry that my internist raised my Effexor to 150 mg.? This is merely supposition on my part. Either that or he is very inexperienced with Effexor. I gave him anecdoctal information from what I have gleaned from others on this board that point in the direction that higher doses of Effexor can stop the fatigue and lethargy. He didn't buy it and said that 150 mg. is a "therapeutic dose" and that I was getting seratonin as well as norepinephrine benefits and higher doses add dopamine reuptake (?). His entire take on my situation was that Effexor is not responsible for my fatigue and that it is either depression (I'am doing very well) or that the Klonopin is responsible because of its longer half-life. Could the 1 mg. of Klonopin at night be responsible for "narcolespy-like" response at 4PM? The only reason I am taking Klonopin was to control panic-like responses during start-up of Effexor which were exacerbated greatly by the rebound effect of the short-acting benzo, alpralozam. I'am sure I can start to phase Klonopin out, I believe its just become a nightly "ritual" and I probably risk becoming very dependent on it for sleep the longer I use it. Do you think it reasonable to taper of Klonopin and then increase Effexor (of course with a doctor's supervision) or to increase Effexor to see if it helps? Your opinions are highly respected and very much appreciated. Anne
Posted by Sulpicia on May 31, 2001, at 14:03:10
In reply to Provigil to help with Effexor Fatigue - Cam?, posted by AnneL on May 30, 2001, at 22:53:40
> Hi Anne--
sorry you're still not quite yourself yet.
My daughter tried provigil as an add-on to Wellbutrin for
depression: it made her feel horrible [nausea and headache, not
to mention Mom's empty wallet -- very pricey pills] and didn't do
anything for depression or energy. She was up to 400mgs per day.
I know there has been some success with provigil as an AD add-on
but in the study that's ongoing at our hospital the early results have
not been spectacular.As for it's classification as a Schedule IV drug, off hand I *believe* that
sched I is banned stuff, as in no medicinal use [recent supreme court/legislative
idiocy put pot here], sched II is controled substances like opiates and amphetamines
inter alia, sched III is weaker pain meds, and IV is the least restricted -- less/no
problems with dependency etc. Don't quote me here: it's been a long time since I looked
at this.I do recall our pdoc explaining that provigil worked selectively on the part of the brain
responsible for alertness. As for euphoria, certainly not like amphetamines, and more like
caffeine. My daughter did experience jitteriness, when she was awake, which wasn't that
often. This is also the only drug she ever complained about having to take -- and this from
the kid who went into shock from lithium...It's probably not dangerous, at least from the stuff I've read.
Try for samples if you go this route. No sense in paying for it until you figure out if it
works.Be well,
Liz
Posted by AnneL on May 31, 2001, at 23:49:31
In reply to Re: Provigil to help with Effexor Fatigue - Cam? » AnneL, posted by Sulpicia on May 31, 2001, at 14:03:10
> Hi Liz, nice to hear from you! I must say that I am doing 98% better and am pleased with Effexor.
My only complaint as I mentioned above is daytime sleepiness, apathy mostly on weeknights and weekends when I do not have the stimulation of work. Pdoc suggested Provigil, he was pretty much against increasing the Effexor at this point. He also suggested that my usage of Klonopin 1 mg at bedtime may be responsible for daytime somnolence, but with a half-life of 12 hours, I would not expect to drop into the "dead-zone" at 4PM not awakening until 7:30 or 8:00 PM.
Anyway, with some encouragement from my colleague
I took 1/2 tablet (100 mg.) of Provigil, and boy am I glad I only took one-half of the recommended starting dose. Pretty activating! Most trouble was with focus and concentration. I wonder if this will improve with time? I don't think I could handle any more than 100 mg. and I might break a tab into quarters and take 50 mg. tomorrow. I like a caffeine "buzz", but this was a little intense! But I came home, cooked dinner, and had some really good energy tonight!
Who knows? I'll take it one day at a time. Hope you and your daughter are doing well and school is going well for you. Take care, Laurie
Posted by JohnL on June 1, 2001, at 15:02:11
In reply to Provigil to help with Effexor Fatigue - Cam?, posted by AnneL on May 30, 2001, at 22:53:40
It was strange, but Provigil actually made me more fatigued. I mean, severely. I like its ancestor Adrafinil tons better. It not only works a lot better, for me, but it is dirt cheap. Provigil is really pricey.
John
Posted by paulk on June 2, 2001, at 4:01:04
In reply to Re: Provigil to help with Effexor Fatigue, posted by JohnL on June 1, 2001, at 15:02:11
> It was strange, but Provigil actually made me more fatigued.
Dito - Used it with Effexor at 75mg - took provigil - 3 day I would take it int eh morning - and lay down and go back to sleep at 10:30AM.
Posted by AnneL on June 2, 2001, at 10:14:39
In reply to Re: Provigil to help with Effexor Fatigue, posted by paulk on June 2, 2001, at 4:01:04
> > It was strange, but Provigil actually made me more fatigued.
>
> Dito - Used it with Effexor at 75mg - took provigil - 3 day I would take it int eh morning - and lay down and go back to sleep at 10:30AM.>Well I've taken it for 2 days, 1/2 tablet (100 mg.) both days and I find it quite stimulating, perhaps too jittery for about 1/2 hour, I find it poops out about 5:00 PM on my drive home from work and then seems to pick up again. Gives me a slight headache too. I would not call it a wonder drug (what med is?) and probably will stop it. Let's put it this way, if I had to shell out hard cash for this expensive med, I wouldn't. Any others with experiences with Provigil?
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