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Dr. Bob is Robert Hsiung, MD,
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Posted by zeugma on February 16, 2005, at 17:18:43
In reply to Re: ed- your opinion please » ed_uk, posted by zeugma on February 16, 2005, at 16:22:44
I see that Provigil causes neck pain as a relatively common s/e. It can also cause eosoniphilia (sp.), which could have been responsible for why I always felt 'sick' on the drug.
I need to get myself to a GP asap. I'm on too many meds to take my health for granted.
-z
Posted by ed_uk on February 18, 2005, at 9:37:40
In reply to Re: ed- your opinion please » ed_uk, posted by zeugma on February 16, 2005, at 16:22:44
Hi Z!
>Don't you think ALL benzos have, as a consequence of GABA potentiation, a degree of sedative activity?
Yes, but some people seem to find certain benzos less sedative than others. There's no science to this, it's just a matter of experimenting and finding out which you prefer.
>So far no swollen lymph nodes or other weird reactions :)
Have you already restarted Provigil?
>certain drugs have caused potentially life-threatening reactions
Which drugs? How do you react?
Regards,
Ed.
Posted by zeugma on February 18, 2005, at 18:46:55
In reply to Re: ed- your opinion please » zeugma, posted by ed_uk on February 18, 2005, at 9:37:40
hey there Ed!
> >
>
> Have you already restarted Provigil?Yes, several days ago. On my third day.
>
> >certain drugs have caused potentially life-threatening reactions
>
> Which drugs? How do you react?
>I'm allergic to penicillin, and was told that if I didn't make that 5 am emergency app't with my local doctor, that I could have died. I was covered from head to toe in spots.
I suppose I'm guilty of some exaggeration, since that was the only drug that elicited a reaction termed 'life-threatening.' I had a lot of problems with psych meds. Wellbutrin didn't go over well with me. SSRI's caused panic attacks, secondary to intense nausea.
I am wondering if the response I had to Provigil was allergic, and if I'm in for more swollen nodes. So far nothing. If I'm due for them, that would be frustrating. Provigil works much better for my symptoms than Ritalin, and is not anxiogenic.I think the benzo is going to stay the same for a while. I have terrible social anxiety. Clonazepam has the best track record among the benzos for this particular type of anxiety. It does not make me more outgoing- I'm as introverted as ever. Unlike some others, I don't really want a 'pro-social' effect- my fatigue is so intense, anyway, that it precludes most socializing. (You can see the dilemma here. I need a stimulant to keep me awake enough to socialize- but most stims are anxiogenic! So it's kind of a vicious circle there. By all accounts, including yours, d-amphetamine is less anxiogenic than ritalin, but it's frowned upon in the US- although the recent controversy over Adderall may change that.) Also, its pharmacokinetics are better than alprazolam's for my purposes.
By the way, what do you think of buspirone? It is useless for social anxiety, but seems to have value as an antidepressant.
-z
> Regards,
> Ed.
Posted by ed_uk on February 19, 2005, at 12:32:29
In reply to Re: ed- your opinion please » ed_uk, posted by zeugma on February 18, 2005, at 18:46:55
Hi Z,
Is the Provigil helping yet? What dose are you on? What dose did you previously need to get a good effect?
>Clonazepam has the best track record among the benzos for this particular type of anxiety.
Clonazepam is the only benzo that has really been studied properly in social anxiety. I don't think it's actually likely to be any more effective than the other benzos though, provided that they are given at adequate doses (which they are often not).
>By the way, what do you think of buspirone?
It doesn't seem to help many people but if it helps *you*, keep taking it. At least it doesn't seem to cause any serious withdrawal symptoms.
Ed.
Posted by zeugma on February 20, 2005, at 5:48:09
In reply to Re: ed- your opinion please » zeugma, posted by ed_uk on February 19, 2005, at 12:32:29
> Hi Z,
>
> Is the Provigil helping yet? What dose are you on? What dose did you previously need to get a good effect?
>Hi Ed,
yes, the Provigil is helping. I'm taking 100 mg/day. This is somewhere around the dose I needed to get a good effect previously, although Provigil is so unlike Ritalin, and seemingly less dose-specific (for Ritalin LA, I needed the 30 mg capsule to get any effect at all; lower doses came with neither side effects nor therapeutic ones). The situation is somewhat confounded by the fact that I was taking Provigil in conjunction with low dose Ritalin (10 mg/day) during much of my previous trial of it, and the two drugs, although both dopaminergic, are completely different in terms of how they affect my cognitive process and mood. Ritalin would speed me up, but also make me feel jagged and irritable. Provigil slows me down, and that is how it seems to help the ADD stuff (for example, I feel the urge to make a sarcastic comment at work, and the Provigil seems to slow me down enough to reflect on it, and as a consequence I 'filter' the comment out of my behavior.) The Ritalin improved my reaction time, but also pushed anxiety to the point where it was difficult to think clearly, and there was no 'filtering' effect on my mental processes.
I should note that although I needed the 30 mg capsule to get an effect when Rit was my only stim, the 10 mg capsule seemed to do something when combined with Provigil. I realize now that the benefits of the combination did not outweigh the confounding effect it had on my assessment of provigil.
I felt something (a slight 'slowing' effect) even at 50 mg provigil. It's the slowing, and the need for less caffeine, that I like. I was able to get up to 150 mg Provigil during my previous trial, and I'd like to try 200 mg, since although I am feeling noticeably more awake, I still don't feel fully awake (maybe two-thirds awake, as opposed to half-awake or less when unmedicated). I also feel less of a drop-off later in the day, compared to Ritalin LA, due to Provigil's longer half-life. But I still feel unable to do much of anything after 4 pm, and that is a substantial limitation.
I think increasing the morning dose, rather than taking split doses, would be better for me. I think if I took 100 mg at noon I would have serious insomnia problems. I wouldn't be up all night, but when I go below eight hours of sleep, I start feeling sleep debt issues, and since narcolepsy *is* sleep debt, it compounds the problem and was the reason (besides the weird side effects) that I did a very slow titration last year.
Buspirone has no withdrawal syndrome whatsoever. I went from 30 mg to 0 in two days, and felt no ill effects. It does seem to help me with sleep-wake transitions (i.e. it helps with the hypnagogic hallucinations, which are less of an issue with 100 mg nortriptyline anyway, and also helps me wake up feeling less groggy).
-z
Posted by ed_uk on February 20, 2005, at 10:44:44
In reply to Re: ed- your opinion please » ed_uk, posted by zeugma on February 20, 2005, at 5:48:09
Hi Z!
>the Provigil is helping
Yay :-)
>Ritalin LA
Out of curiosity, did you ever try any of the other controlled release methylphenidate brands. Have you ever taken Concerta?
>I still feel unable to do much of anything after 4 pm, and that is a substantial limitation.
Have you ever tried taking a high dose in the morning and a small dose at noon? eg. 100mg in the morning + 50mg at noon.
>Buspirone has no withdrawal syndrome whatsoever.
I vaguely remember (once) hearing someone complain that they'd had some withdrawal symptoms. I don't remember what they were though.
Thanks for keeping me up-to-date :-)
Ed.
Posted by zeugma on February 21, 2005, at 7:08:55
In reply to Re: Provigil » zeugma, posted by ed_uk on February 20, 2005, at 10:44:44
Hey there Ed.
>
> >Ritalin LA
>
> Out of curiosity, did you ever try any of the other controlled release methylphenidate brands. Have you ever taken Concerta?No. Just standard IR Ritalin and Ritalin LA. Oh, and Cylert, which has a half-life similar to Provigil's. Concerta is interesting, it provides increasing plasma levels throughout the day, and my experience was that for focus, increasing plasma levels were necessary. The LA would work best from 1 to 2:30 pm, when the noon dose and the 6:30 am dose would 'collide.' Concerta might be a great idea for someone. I had therapeutic effects from MPH, but anxiety and irritability are really common s/e with this med, and I am predisposed to both.
>
> >I still feel unable to do much of anything after 4 pm, and that is a substantial limitation.
>
> Have you ever tried taking a high dose in the morning and a small dose at noon? eg. 100mg in the morning + 50mg at noon.
>
I'm thinking about it. i meet with my pdoc this week. The insomnia I had from 100 mg am has dissipated. I suppose what i'm thinking is that the long half-life of Provigil can be used to advantage to maintain efficacy through to the evening by taking enough in the am.I wonder if somehow my experience with Ritalin made me tolerant of the effects of dopaminergic meds. The feelings I had on high doses of Ritalin (30 mg BID) were similar at times to what I got from Provigil (a certain numb feeling, combined with an increased ability to focus).
-z
> >Buspirone has no withdrawal syndrome whatsoever.
>
> I vaguely remember (once) hearing someone complain that they'd had some withdrawal symptoms. I don't remember what they were though.
>
> Thanks for keeping me up-to-date :-)
>
> Ed.
Posted by lorilu on February 21, 2005, at 23:35:44
In reply to Re: Provigil » ed_uk, posted by zeugma on February 21, 2005, at 7:08:55
hi,
I take a full 200 in the am. If I take 100 mg I am sleepy all day and in bed by 8. I have even taken 100 mg at lunch time and have gone to bed at a normal time. I can also take 100 mg and take a nap. 200 mg will will sometimes wane for me in the early afternoon but then I will perk up again and can stay up late, like tonight it is 9:30 and I am wide awake. I have stayed awake until the wee hours of the night. If I go too many days or weeks at 200 mg I will get too obsessive and then I will go back to 100 for a day or 2 to get some extra sleep. People will notice a difference, though, I will look exhausted.FYI I take a lot of Topamax and Effexor so that makes me tired, plus I used to have sleep apnea and I haven't got retested since my deviated septum surgery to see if I still have it, plus I'm pretty busy so I have a lot of reasons to be tired.
lorilu
Posted by zeugma on February 22, 2005, at 4:48:55
In reply to Re: Provigil, posted by lorilu on February 21, 2005, at 23:35:44
hi lorilu,
That's very encouraging. I was in bed by 8 last night. 100 mg leaves me exhausted, but I feel that it helps my ADD, and i'm a little less exhausted than I would be normally.
Btw, I get the same comments, "You look exhausted," "You look like you don't sleep," even though I generally get a full eight hours of sleep a night.
-z
Posted by SLS on February 22, 2005, at 7:48:47
In reply to Re: ed- your opinion please » ed_uk, posted by zeugma on February 20, 2005, at 5:48:09
You might want to save your caffeine intake for your 4:00 lull. Don't use caffeine at all except for this time, and you will probably retain or enhance an energizing effect from it.
- Scott
Posted by SLS on February 22, 2005, at 8:02:47
In reply to Re: Provigil » zeugma, posted by ed_uk on February 20, 2005, at 10:44:44
> > Buspirone has no withdrawal syndrome whatsoever.
> I vaguely remember (once) hearing someone complain that they'd had some withdrawal symptoms. I don't remember what they were though.
I would be curious to know if anyone has tried to discontinue an SSRI or Effexor while taking Buspar. I am wondering if the agonism of 5-HT1a autoreceptors won't help buffer the understimulation of these receptors that might occur when serotonin reuptake inhibition rapidly vanishes.
- Scott
Posted by lorilu on February 22, 2005, at 8:45:20
In reply to Re: ed- your opinion please » zeugma, posted by SLS on February 22, 2005, at 7:48:47
> You might want to save your caffeine intake for your 4:00 lull. Don't use caffeine at all except for this time, and you will probably retain or enhance an energizing effect from it.
>
>
> - ScottI will have an icetea at that time if I have only had 100 mg and it does wonders! Thanks for reminding me. I can't have any caffeine on 200 mg or I will never go to sleep.
lorilu
Posted by ed_uk on February 22, 2005, at 8:58:56
In reply to Re: Provigil » ed_uk, posted by SLS on February 22, 2005, at 8:02:47
Hi Scott!
>I would be curious to know if anyone has tried to discontinue an SSRI or Effexor while taking Buspar. I am wondering if the agonism of 5-HT1a autoreceptors won't help buffer the understimulation of these receptors that might occur when serotonin reuptake inhibition rapidly vanishes.
Yes, I'm curious too. Perhaps you should start a new thread to ask people whether they've found this strategy useful.
Btw, I'd like to be able to contribute to your thread about avoiding Effexor withdrawal symptoms. Sadly, I don't have any useful experiences to post because I discontinued Effexor 'cold turkey' when my mother threw the capsules in the bin. I also discontinued Seroxat (Paxil) without tapering but I started Prozac the next day and so it's not really surprising that I didn't have any withdrawal symptoms.
Ed.
Posted by ed_uk on February 22, 2005, at 9:01:09
In reply to Re: Provigil » ed_uk, posted by zeugma on February 21, 2005, at 7:08:55
Hi Z!
How are you doing? Any side effects from the Provigil? Have you increased the dose?
Ed.
Posted by zeugma on February 22, 2005, at 15:28:20
In reply to Re: ed- your opinion please » zeugma, posted by SLS on February 22, 2005, at 7:48:47
> You might want to save your caffeine intake for your 4:00 lull. Don't use caffeine at all except for this time, and you will probably retain or enhance an energizing effect from it.
>
>
> - Scott
Hi Scott. I just got home from work, and am experiencing the 4:00 lull in a *big* way. I went shopping for dinner, and wondered if I would be able to stay alert and awake enough to eat it! (It's low preparation stuff, but when I went off stims altogether a few weeks ago, I had to eat dinner at 3:30 p.m. in order to ensure that I would actually have the energy to consume food.)I am making my pot of coffee now.-z
Posted by zeugma on February 22, 2005, at 15:33:13
In reply to Re: ed- your opinion please, posted by lorilu on February 22, 2005, at 8:45:20
lorilu, I have a question: did you experience increased anxiety when you went to 200 mg? Or irritability? It seems that provigil is totally non-anxiogenic for me at 100 mg, in fact I start feeling anxious around 1 pm when I start becoming hazy and exhausted again. I had an iced tea at that time (great minds think alike :)) and it helped but I am still exhausted and am making the pot of coffee scott suggested.
Thanks,
z
Posted by SLS on February 22, 2005, at 15:48:08
In reply to Re: ed- your opinion please » SLS, posted by zeugma on February 22, 2005, at 15:28:20
> > You might want to save your caffeine intake for your 4:00 lull. Don't use caffeine at all except for this time, and you will probably retain or enhance an energizing effect from it.
> >
> >
> > - Scott
>
>
> Hi Scott. I just got home from work, and am experiencing the 4:00 lull in a *big* way. I went shopping for dinner, and wondered if I would be able to stay alert and awake enough to eat it! (It's low preparation stuff, but when I went off stims altogether a few weeks ago, I had to eat dinner at 3:30 p.m. in order to ensure that I would actually have the energy to consume food.)I am making my pot of coffee now.
>
> -z
>Hi Z.
You need to treat caffeine as if it were a drug. You would like to find the optimum dosage for you to glean the desired effect. Too much caffeine for some people can produce a "paradoxical" loss of energy, brain fog, and sleepiness. You actually should experiment with low dosages first and work your way on up. Try 1/2 to one cup to start with. If after a 1/2 hour you feel nothing, then take more. Don't be reluctant to experiment with caffeine as you have with Provigil.
Sweet dreams...
:-)
- Scott
Posted by zeugma on February 22, 2005, at 15:50:57
In reply to Re: Provigil » zeugma, posted by ed_uk on February 22, 2005, at 9:01:09
> Hi Z!
>
> How are you doing? Any side effects from the Provigil? Have you increased the dose?
>
> Ed.Hi Ed!
The only side effect i have had from Provigil so far is gastrointestinal distress.
[z pauses to gulp down some dark caffeinated liquid]
I am at a loss to explain why Provigil would cause such severe side effects on my first trial, and be apparently so tolerable now.
I see my pdoc tomorrow. I do want to try a higher dose, especially since its effects seem to be the opposite of Ritalin's (i.e. increased appetite, slowed rather than speeded thinking, calming rather than agitating). The effects wear off around noon- 1 pm, with less of a steep fall than I had with the Ritalin but unpleasant nonetheless. I'm trying the experiment of some 4 o'clock coffee to see if I can get anything constructive done on Provigil 100 mg after 4 p.m. The iced tea at 1 pm did help :)
-z
Posted by SLS on February 22, 2005, at 16:20:42
In reply to Re: ed- your opinion please » zeugma, posted by SLS on February 22, 2005, at 15:48:08
Ideally, you would like to find the optimum amount of caffeine such that you only need to take a single dose at 4:00. If you are lucky, this might be all you need to get you through the rest of the day. I like the way I feel using coffee rather than caffeine pills. However, I always carry around with me a few pills just in case.
- Scott
> > > You might want to save your caffeine intake for your 4:00 lull. Don't use caffeine at all except for this time, and you will probably retain or enhance an energizing effect from it.
> > >
> > >
> > > - Scott
> >
> >
> > Hi Scott. I just got home from work, and am experiencing the 4:00 lull in a *big* way. I went shopping for dinner, and wondered if I would be able to stay alert and awake enough to eat it! (It's low preparation stuff, but when I went off stims altogether a few weeks ago, I had to eat dinner at 3:30 p.m. in order to ensure that I would actually have the energy to consume food.)I am making my pot of coffee now.
> >
> > -z
> >
>
> Hi Z.
>
> You need to treat caffeine as if it were a drug. You would like to find the optimum dosage for you to glean the desired effect. Too much caffeine for some people can produce a "paradoxical" loss of energy, brain fog, and sleepiness. You actually should experiment with low dosages first and work your way on up. Try 1/2 to one cup to start with. If after a 1/2 hour you feel nothing, then take more. Don't be reluctant to experiment with caffeine as you have with Provigil.
>
> Sweet dreams...
>
> :-)
>
>
> - Scott
>
>
>
>
Posted by zeugma on February 22, 2005, at 16:51:48
In reply to Re: ed- your opinion please, posted by SLS on February 22, 2005, at 16:20:42
Ideally, you would like to find the optimum amount of caffeine such that you only need to take a single dose at 4:00. If you are lucky, this might be all you need to get you through the rest of the day. I like the way I feel using coffee rather than caffeine pills. However, I always carry around with me a few pills just in case.>>
I don't like using the pills all that much either. When i was off stims completely, though, I was taking a lot of them, and in spite of warnings from my former ADD coach I did not find them addicting in the least.
I've got a cup of mostly caffeinated coffee in me now, and I definitely feel the effect. It's much closer to ritalin than Provigil in its peripheral effects. I think the pills had less in the way of this, for some reason.
-z
Posted by zeugma on February 22, 2005, at 18:36:05
In reply to Re: ed- your opinion please » SLS, posted by zeugma on February 22, 2005, at 16:51:48
I remember this negative caffeine-Provigil interaction from last summer. The small amount of caffeine in the iced tea was tolerable, but I had one cup of two-thirds caffeinated coffee and now I feel overstimulated. I felt awful last week too when I absolutely HAD to drink some coffee to stay focused at work when the Provigil lessened in effect, about 1 pm.
It's interesting that for me, Provigil and caffeine don't go well together at all, whereas with ritalin, I was able to tolerate a cup late in the afternoon pretty well.
-z
Posted by zeugma on February 22, 2005, at 20:16:57
In reply to results are lousy, posted by zeugma on February 22, 2005, at 18:36:05
I guess tomorrow I can try 1/2 cup of half-caffeinated coffee, and see if the peripheral stimulation and anxiogenicity is less pronounced.
By the way, Scott, what was the result of your abilify experiment?
-z
Posted by SLS on February 23, 2005, at 6:23:51
In reply to addendum-and an SOS for SLS, posted by zeugma on February 22, 2005, at 20:16:57
> I guess tomorrow I can try 1/2 cup of half-caffeinated coffee, and see if the peripheral stimulation and anxiogenicity is less pronounced.
You are pretty sensitive to caffeine. I hope you can find a dose that enhances your functional state rather than detract from it.
> By the way, Scott, what was the result of your abilify experiment?I discontinued Abilify using a rapid taper. I went from 10mg to 5mg for a few days and then stopped completely. Abilify has a long half-life. The only withdrawal symptom I had was some mild anxiety. I did experience a return of some libido. However, without the Abilify, I began to lose some energy and motivation, and was getting less done. Since I really, REALLY can use all the help I can get to attenuate the depression, I restarted the Abilify. I also found that Abilify reduces ruminations during difficult times (for which any sane person *would* ruminate) and helps prevent the evolution of suicidal states.
I hate having to rely on so many drugs for so little benefit.
<growl>
Parnate 70mg
nortriptyline 100mg
Lamictal 300mg
Abilify 10mg
memantine 20mg
- Scott
Posted by lorilu on February 23, 2005, at 18:34:33
In reply to Re: ed- your opinion please » lorilu, posted by zeugma on February 22, 2005, at 15:33:13
> lorilu, I have a question: did you experience increased anxiety when you went to 200 mg? Or irritability? It seems that provigil is totally non-anxiogenic for me at 100 mg, in fact I start feeling anxious around 1 pm when I start becoming hazy and exhausted again. I had an iced tea at that time (great minds think alike :)) and it helped but I am still exhausted and am making the pot of coffee scott suggested.
>
> Thanks,
> z
Yes! You are going to have anxiety for the first week or two. I have posted that before on earlier posts a few months back. It needs to get in your system. Now if you want to take it with Adderall, like my PDoc wants me too, that will reverse that. I don't like to focus that much. :) It slows me down and makes me feel like everything is in slow motion. I guess that's how the real world is. I was driving to my other doctor, my therapist, after taking Adderal, and I was going 80 on the freeway, and I told him it felt like I was going 55 on the freeway. I thought the medicine wasn't working. I thought it was a "stimulant". He said that was what it was supposed to do. Since that day I haven't taken it. Crazy isn't it. I like the energy Porvigil gives me. My therapist would rather I get off Porvigil and only take Adderall, go figure.When I first started Provigil my skin would crawl, I was overstimulated by little sounds and any noise. Elevator noise would drive me crazy! Work through it!!!!!!!!!!!!!!!!!!! It is really worth it! Gotta go or I will be late to pick up the kids. See I am always in a rush, my brain works better that way.
Any suggestions... :)
Posted by zeugma on February 24, 2005, at 15:46:55
In reply to Re: addendum-and an SOS for SLS » zeugma, posted by SLS on February 23, 2005, at 6:23:51
> > I guess tomorrow I can try 1/2 cup of half-caffeinated coffee, and see if the peripheral stimulation and anxiogenicity is less pronounced.
>
> You are pretty sensitive to caffeine. I hope you can find a dose that enhances your functional state rather than detract from it.I self-medicated with caffeine for years. So the sensitivity to caffeine is a recent phenomenon, and is most pronounced with concomitant Provigil usage. I first encountered the phenomenon with Strattera, and that's why I'm convinced the latter drug has stimulant properties, regardless of how fatiguing I later found it. I took about 50 mg Provigil with lunch, and found the onset of pm drowsiness very much attentuated. That's especially noteworthy considering this is Thursday, and I experience a steady increase in drowsiness as the week progresses. Going without caffeine today was not a planned move, although I had planned not to take any after the second modafinil dose. I was simply too run down this morning to make coffee this morning. But Provigil's onset of action seems rapid enough to wake me up by the time my morning commute is over.
I also experienced a burst of ravenous appetite around 1:30. That's a good sign when you consider that stimulant-induced anorexia has been a lifelong obstacle to treatment for me.
>
>
> > By the way, Scott, what was the result of your abilify experiment?
>
> I discontinued Abilify using a rapid taper. I went from 10mg to 5mg for a few days and then stopped completely. Abilify has a long half-life. The only withdrawal symptom I had was some mild anxiety. I did experience a return of some libido. However, without the Abilify, I began to lose some energy and motivation, and was getting less done. Since I really, REALLY can use all the help I can get to attenuate the depression, I restarted the Abilify. I also found that Abilify reduces ruminations during difficult times (for which any sane person *would* ruminate) and helps prevent the evolution of suicidal states.
It sounds like the Abilify is worth the s/e then. Have you experienced similar benefit from any other atypical AP? It seems that Seroquel is considered least likely to cause sexual s/e:http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15672600 But it might well be too sedating for you to tolerate an effective dose.
>
> I hate having to rely on so many drugs for so little benefit.
>
> <growl>
>
> Parnate 70mg
> nortriptyline 100mg
> Lamictal 300mg
> Abilify 10mg
> memantine 20mg
>
>Any discernible effect from memantine yet?
-z
> - Scott
>
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