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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 23 of 23. This is the beginning of the thread.
Posted by Maxime on June 5, 2005, at 15:16:43
Hi.
I take Dexedrine to help with daytime fatigue cause partially by Parnate and partially by I don't know what.
Adderall XR was great until it was removed from Canada. If I had the money I would go to the US and see a doctor and get a prescription.
I crash on Dexedrine (even worse on Ritalin) which is why I hate it so much.
So what about Provigil? What are the pros and cons of this med? What is the most annoying side effect you get from it? Do you crash once it wears off? When I say crash I mean fall into a depressed state.
Any insight you can give me would be great. I know there have been many posts about this med, but no one has written about the crash and burn effect if there is any.
Thanks in advance.
Maxime
Posted by Declan on June 5, 2005, at 17:24:21
In reply to Provigil compared to stimulants? Thoughts pls, posted by Maxime on June 5, 2005, at 15:16:43
My experience is with Adrafinil, which may be a bit different. There was no post-effect depression as with amphetamine. It gave me what are described as 'states of inner tension'. You wouldn't call it a mood brightener, but it certainly activated me. It might be useful. I was taking it with Hydergine which may have been the problem.
How come Parnate is activating and at the same time fatigueing? These are different qualities of the drug?
Declan
Posted by Phillipa on June 5, 2005, at 18:51:31
In reply to Re: Provigil compared to stimulants? Thoughts pls, posted by Declan on June 5, 2005, at 17:24:21
An old friend of mine tried it. I think it made her very nervous. I know she didn't take it long. Fondly, Phillipa
Posted by Maxime on June 5, 2005, at 19:24:23
In reply to Re: Provigil compared to stimulants? Thoughts pls, posted by Declan on June 5, 2005, at 17:24:21
Hi Declan. Are you in Europe? Adrafinil isn't available here in Canada or in the U.S.
Yes, afternoon fatigue happens to many people who take Parnate. I don't know how a med can be stimulating and cause fatigue at the same time. But this one does!
Maxime
> My experience is with Adrafinil, which may be a bit different. There was no post-effect depression as with amphetamine. It gave me what are described as 'states of inner tension'. You wouldn't call it a mood brightener, but it certainly activated me. It might be useful. I was taking it with Hydergine which may have been the problem.
> How come Parnate is activating and at the same time fatigueing? These are different qualities of the drug?
> Declan
Posted by Maxime on June 5, 2005, at 19:25:25
In reply to Re: Provigil compared to stimulants? Thoughts pls, posted by Phillipa on June 5, 2005, at 18:51:31
> An old friend of mine tried it. I think it made her very nervous. I know she didn't take it long. Fondly, Phillipa
Thanks Phillipa.
Maxime
Posted by Racer on June 5, 2005, at 21:57:25
In reply to Provigil compared to stimulants? Thoughts pls, posted by Maxime on June 5, 2005, at 15:16:43
I've taken Provigil for most of the past year and a half, and I like it. Doesn't seem to have any really bothersome side effects for me -- although it is linked to headaches when you first start taking it, I found the headaches to be more like pressure than pain, and they did go away after a month or so -- and it brightens my mood. It doesn't seem to disrupt my sleep -- in fact, I seem to sleep better on it than off it. Go figure.
I do have some trouble with it wearing off midway through the afternoon, but that just leaves me fatigued, not depressed. When I've run out for a few days, I haven't noticed any problems -- beyond fatigue. I'd say it's definitely worth a try for you, since the worst that is likely to happen is that it won't be friendly for you.
I've heard reports that some people get kinda cranky on it, but that hasn't happened to me. I'd say it's still worth a try...
Posted by alohashirt on June 5, 2005, at 22:20:29
In reply to Re: Provigil compared to stimulants? Thoughts pls » Declan, posted by Maxime on June 5, 2005, at 19:24:23
I beleive Adrafinil is available in the US - yet I can't see it on drugstore.com.
Is it possible that it is non-prescription here?
Mail order even?I spoke with someone here who was using it, and I'd assumed it was prescribed by his internist.
How does a medication go from being some wacky food supplement (e.g. "creatine" to being a drug?) Can it be a drug
in Europe and a supplement in the US?
Posted by Declan on June 5, 2005, at 23:22:20
In reply to Re: Provigil compared to stimulants? Thoughts pls » Declan, posted by Maxime on June 5, 2005, at 19:24:23
No Maxime, I'm in Australia. It's OK here to import 3 months supply, especially if it's not available here. Certainly Adrafinil wasn't, perhaps Provigil is now, I don't know.
With the fatigue/stimulation thing, they don't happen at the same time, do they? You don't feel tired in the day and stimulated at night?
Declan
Posted by Cairo on June 6, 2005, at 7:35:34
In reply to Provigil compared to stimulants? Thoughts pls, posted by Maxime on June 5, 2005, at 15:16:43
My daughter takes Provigil for fatigue and because she can't take stimulants due to anxiety side effects. Provigil definitely helps with the fatigue and alertness and I think because of that also makes her a little more pro-social. She had headaches when we raised the dose to 200mg, so we now split the dose at 150mg in the am and 50mg at lunch which also seems to help with rebound fatigue. When we forget to give her a dose at lunch, she is more irritable and tired.
Because some of her fatigue was due to Lexapro, I researched and read that Provigil is used to combat SSRI fatigue and cognitive side effects. Switched her to Zoloft and definitely less fatigue and cognitive issues on that one. Perhaps you might look at your other meds and determine which one might be contributing most to fatigue and consider a switch, if possible. If not, Provigil might help.
Cairo
> Hi.
>
> I take Dexedrine to help with daytime fatigue cause partially by Parnate and partially by I don't know what.
>
> Adderall XR was great until it was removed from Canada. If I had the money I would go to the US and see a doctor and get a prescription.
>
> I crash on Dexedrine (even worse on Ritalin) which is why I hate it so much.
>
> So what about Provigil? What are the pros and cons of this med? What is the most annoying side effect you get from it? Do you crash once it wears off? When I say crash I mean fall into a depressed state.
>
> Any insight you can give me would be great. I know there have been many posts about this med, but no one has written about the crash and burn effect if there is any.
>
> Thanks in advance.
>
> Maxime
Posted by Maxime on June 6, 2005, at 12:10:59
In reply to Re: Provigil compared to stimulants? Thoughts pls, posted by alohashirt on June 5, 2005, at 22:20:29
Are you sure your friend wasn't take the AD Anafranil? Adrafinil is from France.
Maxime
> I beleive Adrafinil is available in the US - yet I can't see it on drugstore.com.
>
> Is it possible that it is non-prescription here?
> Mail order even?
>
> I spoke with someone here who was using it, and I'd assumed it was prescribed by his internist.
>
> How does a medication go from being some wacky food supplement (e.g. "creatine" to being a drug?) Can it be a drug
> in Europe and a supplement in the US?
>
>
Posted by ed_uk on June 6, 2005, at 12:38:32
In reply to Provigil compared to stimulants? Thoughts pls, posted by Maxime on June 5, 2005, at 15:16:43
Hi Maxi!
I didn't realise you hadn't tried Provigil :-) I think it would be useful to hear from people who have combined Provigil with an MAOI.
Ed xxx
Posted by Maxime on June 6, 2005, at 19:07:21
In reply to Calling all babblers who've taken Provigil + MAOI » Maxime, posted by ed_uk on June 6, 2005, at 12:38:32
> Hi Maxi!
>
> I didn't realise you hadn't tried Provigil :-) I think it would be useful to hear from people who have combined Provigil with an MAOI.
>
> Ed xxxI found this article re. Nardil and Provigil
Modafinil Augmentation of Phenelzine for Residual Fatigue in Dysthymia
ADAM KELLER ASHTON, M.D.
Williamsville, N.Y.To the Editor: Monoamine oxidase inhibitors (MAOIs) are sometimes required to treat refractory depressive disorders (1). Although effective, they require careful attention to concomitant medicines and foods to avoid a hypertensive crisis or other severe reactions (2, pp. 2557–2559). Modafinil is an agent used to promote wakefulness in patients suffering from excessive daytime somnolence (2, pp. 1160–1162). Most patients with depression complain of fatigue even after antidepressant treatment (3). Modafinil augmentation has been used to enhance antidepressant response (4). We know of no interaction studies that have been performed to evaluate the safety or efficacy of combining modafinil with an MAOI. I report what I believe to be the first published case of the use of modafinil to combat excessive daytime somnolence in a patient successfully treated for dysthymia with phenelzine and lamotrigine.
Ms. A was a 54-year-old Caucasian woman who was seen for the treatment of dysthymia, which had lasted 6 years. She had not improved after psychotherapy with three different therapists and did not respond to treatment with adequate trials of 80 mg/day of fluoxetine, 300 mg/day of extended-release venlafaxine, 600 mg/day of nefazodone, 62.5 mg of mirtazapine at bedtime, and 100 mg/day of clomipramine. She had a partial response to a trial of tranylcypromine, 30 mg b.i.d., and a more significant response with phenelzine, 30 mg t.i.d. Clinical improvement was further enhanced with lamotrigine augmentation at 200 mg b.i.d., although she had no evidence of bipolar symptoms according to her history. Ms. A essentially described remission of depressive symptoms lasting 1 year with this combination but continued to describe fatigue and hypersomnolence, whereby she could sleep all night and part of the day. These complaints did not appear to be brought on by her medication. Neither she nor her husband described signs of a sleep disorder, such as snoring or restlessness. Modafinil was added to her regimen, and Ms. A described rapid clinical improvement in energy and motivation, taking 100 mg/day to the extent that she felt more productive. She described no side effects or any sign of hypertensive reaction and was stable with this combination for at least 6 months.
This report may be the first to describe a safe and effective combination of modafinil and an MAOI. There are some obvious limitations. The patient did not have a sleep study performed, so perhaps modafinil was treating an underlying sleep disorder, although no change in nighttime sleep was described. A placebo control would have been helpful, although years of taking other agents did not elicit this kind of response. Long-term safety cannot be guaranteed. Perhaps a drug interaction had not had time to develop, although usually this kind of adverse reaction can occur after as little as a single dose, and this individual had already taken hundreds of doses. Further study on the safety and usefulness of modafinil augmentation with MAOIs would be helpful. Despite these drawbacks, this case does suggest that some individuals taking MAOIs may be able to derive clinical benefit to manage the persistent fatigue and hypersomnolence that may occur during treatment of depressive disorders by adding modafinil.
References
1. Himmelhoch JM: Monoamine oxidase inhibitors, in Comprehensive Textbook of Psychiatry, 6th ed. Edited by Kaplan HI, Sadock BJ. Baltimore, Williams & Wilkins, 1995, p 2045
2. Physicians’ Desk Reference, 58th ed. Montvale, NJ, Thomson PDR, 2004
3. Nierenberg AA, Keefe VR, Leslie VC, Alpert JE, Pava JA, Worthington JJ, Rosenbaum JF, Fava M: Residual symptoms in depressed patients who respond acutely to fluoxetine. J Clin Psychiatry 1999; 60:221–225[Medline]
4. Menza JA, Kaufman KR, Castellanos A: Modafinil augmentation of antidepressant treatment in depression. J Clin Psychiatry 2000; 61:378–381[Medline]
Posted by ed_uk on June 6, 2005, at 19:16:56
In reply to Re: Calling all babblers who've taken Provigil + M » ed_uk, posted by Maxime on June 6, 2005, at 19:07:21
Very interesting! Do you think you'll try it??
Ed xxx
Posted by Maxime on June 6, 2005, at 20:08:06
In reply to Re: Calling all babblers who've taken Provigil + M » Maxime, posted by ed_uk on June 6, 2005, at 19:16:56
> Very interesting! Do you think you'll try it??
>
> Ed xxxYes, I think I will. I have to make an appointment with my pdoc. I know he won't mind prescribing it since he has let me use stims.
xxx
Maxime
Posted by lara53 on June 7, 2005, at 8:15:37
In reply to Provigil compared to stimulants? Thoughts pls, posted by Maxime on June 5, 2005, at 15:16:43
Maxine,
Iv'e been taking it since 5/20.It worked right away in waking me up and lifting my mood.Didn't last all day though,around 8 hrs.[200mg] I don't feel more depressed on it when it wears off.
I have been taking another around 3 for about a week. Headaches only when I get 3-4 hrs sleep for few days.Appoint. today,think I need to get off lamictal and try ??. Sorry this is late;haven't been on board. My thoughts are with you.
Laura
Posted by lara53 on June 7, 2005, at 8:19:45
In reply to Re: Provigil compared to stimulants? Thoughts pls (nm), posted by lara53 on June 7, 2005, at 8:17:08
Posted by Mr.Scott on June 8, 2005, at 1:37:31
In reply to Provigil compared to stimulants? Thoughts pls, posted by Maxime on June 5, 2005, at 15:16:43
I have used all the stimulants from caffeine to cocaine extensively... as if that somehow qualifies my next statement or something.
Provigil made me anxious. almost a 'direct' anxiey producer by day 3. Adderall XR seems to be the best for me. I don't notice much let down at all from it.
Scott
Posted by Maxime on June 8, 2005, at 17:28:41
In reply to Re: Provigil compared to stimulants? Thoughts pls » Maxime, posted by Mr.Scott on June 8, 2005, at 1:37:31
Ah yes. My beloved Adderall. Why did they have to remove it from Canada? How I miss it. You are right. It was so smooth. I just came down gradually and naturally.
Maxime
> I have used all the stimulants from caffeine to cocaine extensively... as if that somehow qualifies my next statement or something.
>
> Provigil made me anxious. almost a 'direct' anxiey producer by day 3. Adderall XR seems to be the best for me. I don't notice much let down at all from it.
>
> Scott
Posted by Mr.Scott on June 8, 2005, at 23:53:17
In reply to Re: Provigil compared to stimulants? Thoughts pls » Mr.Scott, posted by Maxime on June 8, 2005, at 17:28:41
It might be different for you...For me it was an literally anxiety disorder in a pill, so was Wellbutrin..
What about a different dosing schedule of Dexedrine for you, or Concerta (best form of ritalin for me, but certainly edgier than Adderall XR too). Is regular Adderall still available?
Scott
Posted by Maxime on June 9, 2005, at 16:39:18
In reply to Re: Provigil compared to stimulants? Thoughts pls » Maxime, posted by Mr.Scott on June 8, 2005, at 23:53:17
We never had regular adderall and we didn't even have the XR for that long. Oh, my experience with Ritalin and Ritalin SR makes want to stay away from that stuff. I crashed so hard. I know Concerta is smoother, but I am sure the Dexedrine is better for me. I know it sounds silly to say that without having tried it but my reaction to Ritalin was so bad. I almost killed myself one night. Seriously.
Maxime
> It might be different for you...For me it was an literally anxiety disorder in a pill, so was Wellbutrin..
>
>
> What about a different dosing schedule of Dexedrine for you, or Concerta (best form of ritalin for me, but certainly edgier than Adderall XR too). Is regular Adderall still available?
>
>
> Scott
Posted by alohashirt on June 9, 2005, at 23:53:38
In reply to Re: Provigil compared to stimulants? Thoughts pls » alohashirt, posted by Maxime on June 6, 2005, at 12:10:59
I asked him - he said it was a French drug, French insert, some kind of sample. Sorry can't be more help, don't know name of drug or anything. He did say it could be legally purchased online
Posted by pulse on June 11, 2005, at 19:29:13
In reply to Re: Provigil compared to stimulants? Thoughts pls » Maxime, posted by Mr.Scott on June 8, 2005, at 23:53:17
very interesting reactions & first i've seen posted here that (almost completely) mirror mine. i also have a caffeine to cocaine history, and even before reading your post, i HAVE wondered what the deal is. one woud think re: wb esp., the dopamine/ pleasure centers help would hit the RIGHT spot. nothing could be further from my experience! yes, anxiety in pilll form & just off the charts. almost scary! plus for me, literally constant urping from the minute wb went down my gullet, which only subsided when i (very briefly) could sleep on it.
provigil was perhaps almost as disappointing. for me:
day 1 - perty good
day 2 - less good
day 3 - major crash into depression (here is where we differ.)i'm a stubborn cuss, so i had to try it 2 more times - with the exact same reults.
also some headaches (no biggie for me), but just too much nausea, constipation, urping, just an all round yucky GI feeling. i felt i over focused on that 1 day out of 3 i got. never again.
ritalin is ok for me, but decided to quit stims due to GI and crash effect. just not worth it for me. prozac gives me enough stimulation at lower than standard dosage and tolerable GI SEs. weak iced coffee i can still tolerate gut-wise and of course nicotine. caffeine pills i cannot.
saddest of all is i well know that if i ever went back to cocaine, i'd have NO GI problem. (while dying...lol)
thankfully, my depression is in full remission....finally.
do you understand why wb & provigil were both such disasters for us? that's the eternal mystery of all these meds to me. (parnate was similar to wb for me.)
Posted by Maxime on June 13, 2005, at 1:46:06
In reply to Re: Provigil compared to stimulants? Thoughts pls » Maxime, posted by alohashirt on June 9, 2005, at 23:53:38
> I asked him - he said it was a French drug, French insert, some kind of sample. Sorry can't be more help, don't know name of drug or anything. He did say it could be legally purchased online
Declan who lives in Australia used something called Adrafinil and it's French. I wonder if it was that?
Maxime
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