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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by Eljakeo25 on November 2, 2004, at 13:57:52
As some of you already know, I am Dx with Major Depression, ADHD, and Intermittent Explosive Disorder. For me, I.E.D. is like having an negative emotional seizure, it comes out of no where and leaves quickly. The medications I am on right now to treat this are:
Provigil 600mg/day
Adderall XR 20mg BID
Klonopin 1mg BID
Cymbalta 60mg
Risperdal 2mg bedtime.I can tell that the stimulant Provigil does something pretty good for my symptoms when I have been off of adderall and provigil for a few days, feel all my symptoms come back with the ADD, such as amotivation, restlessness, lack of drive and concentration. Since Cymbalta treats my depression fairly well I believe, I have strong thoughts of psychological drive, but just not motivated "lazy" to carry them out, and if I force myself too, I sit studying my book for a grueling 10 minutes and get frustrated that I cannot concentrate and walk all the way home. What is interesting is that I finally got my Provigil prescription refilled and took 600mg. I still had to force myself to school because I knew it takes an hour or so before the Provigil to start working, and the incentive Placebo type effect knowing that your symptoms will be relieve allowed me enough motivation to get to the library. Again, as in earlier posts, after an agonizing hour or so of distracted studying, BAM! The external motivation is back, My concentration is back, and I can reasonable focus for a much longer period of time on a task. Also my restlessness went away. My mood was brighter and no impulsive ideations about others, I had a friendly outgoing, smiley (not euphoric or manic) disposition. Just a sense of well being, and I know how I am suppose to feel when I am well and it was that feeling. THe Provigil worked the rest of the day and I got my homework done which a day before I was stressed out that I would not be able to finish my homework, because I cannot even pull myself out of my room due to amotivation. The Provigil has worked like this now for a couple weeks. It helps me about 75%, but I still missed my adderall for that "kick in the butt," lets gets some goals rollin' type attitude (not grandiose). So we switched to the adderall XR which will help me control my intake better than the immediate release, which I was honost with the doctor and he trusts me. I was not becoming dependent on the adderall or addicted, I just needed more multiple daily doses, which pushed my total to like 90mg/day to relieve the symptoms of impulsivity. And psychologically, I see those super motivated graduate students, all so focused, younger than me, and no college problems attaining their dreams that were significant enough to hinder them unlike me. This comparison towards others who I want to be like, gives me a drive to want to operate at my peak perfomance too. I am only given one life, I don't want to waste it being amotivated, restless in bed. So I was pushing myself with the medication so I can feel the focus that I so much deserve with all the perserverence that I had put in so far. However, medications relieve the symptoms and aren't really intended to help your peak performance, self actualization stuff, so thats where I was getting in trouble with the adderall. Because with my dreams and aspirations, I want to feel like they do (or what I perceive they do). However I am self conscious and know the adderall is only to treat my Attention symptoms. So I reduced myself to 40/mg day XR. The Adderall then seems to mask the effect of the Provigil because they are both working to treat the same symptoms, but it "feels" like the adderall now is lasting all day because the Provigil is filling in the gaps making it a smooth ride through the day. For me 100-200 mg of Provigil never did much, but 600mg (which was clinically proven tolerable) seems to be very effective to treating my condition. Finally the last two medications, Risperdal and Clonazepam play their own role in helping fight the impulsive behavior and psychological social anxiety. And at my doses, they are not that sedating and don't cancel the effects of the stimulants. I found out the reason why I can effectively take a low dose of a AP and Adderall without cancelling the effects is because Risperdal from what I read is an antagonist of the D5 dopamine receptor and Adderall is an agonist of the D1, D2 dopamine receptor. So there you go, I am feeling fine again, except for that one impulsive outburst that came out of the blue. I experience very little side effects. No drastic swings in motivation from hour to hour when I used to be just on the adderall alone and not with the Provigil. In fact adderall for me can be the most sedating of all of them because when it reaches its full effect, I am motivated, focused, and relaxed, thus having somewhat of a sedating anti social anxiety effect which is good with the clonazepam. I hope this trend will continue, NO impulsive outbursts or ideations, and take it day by day slowly intensifying my academic goals without raising medication. I will keep you updated because of course everyday cannot be a good day and medications may fluctuate in my system. Finally I believe this is the best combination I can possibly be on to treat my acute conditions. Basically it is a formula for treating a Dopamine Hypofunction Disorder. Thanks for reading, I hope I gave other people with similar conditions some insight.
Jake
Posted by jboud24 on November 2, 2004, at 19:59:32
In reply to Medication update on my treatment. (Provigil), posted by Eljakeo25 on November 2, 2004, at 13:57:52
Thanks for the update Jake. Keep me posted on your Provigil progress. I too take Adderall, and am looking for something to 'bridge the gap' between doses. It looks as though provigil might just be something to consider to get me through my University day in conjunction w/ the adderall. If you could say, how long does your single 600mg dose of Provigil last? Does it really last all day long with no peaks or dips to its effect? That'd really be something.
Glad to hear your doing good bro,
Justin
Posted by Eljakeo25 on November 3, 2004, at 14:01:14
In reply to Re: Medication update on my treatment. (Provigil), posted by jboud24 on November 2, 2004, at 19:59:32
jboud24
Since we are all different it is hard to say if the Provigil will work like me, but if you have a good bunch of Provigil. Try this: Quit adderall and do not take the Provigil for a few days (if possible, because of school) until you feel amotivated, restless, lazy, etc. Then take 600mg of Provigil or even 800mg. DOn't go much higher than that. Give it about 1-3 hours. If you become wide awake, motivated (wanting to go back to school and study for example), and a brighter mood, you will see the difference. When the medicine starts working, it slowly creeps up on you, then you may notice 3/4 of your symtoms gone. It feels smooth, it seems to give you positive body language and mood, and it does not wear off. It has a half life of like 15 hours. And you should be able to go to sleep when its bedtime. However, then after that you may want to start adding the adderall again, because the adderall gives you the analytical focusing a drive that Provigil does not. But Provigil will fill in the gaps, but you will feel adderall over the Provigil, but 4 hours after your last adderall dose, you may still notice a "good feeling in your head" Thats the Provigil, but I still like to take another dose of adderall to keep pushing myself free of disability (that extra 25%) Hope that helps...The doctor may prescribe it to you off label, but he might want to write "Dx narcolepsy" on the prescription because the drug is very expensive $428.00 for 60 of them. ANd I am very lucky the insurance is approving that....hope that helps. =)
Posted by Eljakeo25 on November 3, 2004, at 14:04:22
In reply to Re: Medication update on my treatment. (Provigil), posted by Eljakeo25 on November 3, 2004, at 14:01:14
The other reason why Provigil at higher doses is working for me is that it may also be augmenting the cymbalta I take. So talk to your doctor and tell him about my experience. However, he may not be able to prescribe you over 400/mg day
Posted by jboud24 on November 4, 2004, at 8:06:04
In reply to Re: Medication update on my treatment. (Provigil), posted by Eljakeo25 on November 3, 2004, at 14:04:22
Thanks for getting back at me. I'll probably use Provigil to fill in the gaps in between drug holidays and to smooth out the effect of the adderall. Keep me informed of how Provigil does for you.
Thanks,
Justin
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