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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by Racer on August 30, 2007, at 11:23:17
Hi, I got a Babblemail the other day asking me about Provigil. I hope the sender will read this, since it is in response to that babblemail, and I do want to answer as best I can.
In general, if it's a question that I think might be helpful to others, I prefer to have these interactions on the board, rather than privately, and this was about why I chose to discontinue Provigil after a couple of years. I figure that's something that might be of use to someone later on, so here's the answer on the board.
The questions, with the answers:
"Did you d.c. Provigil because you developed a tolerance you think?"
No. It still worked as well as ever as far as alertness went. What changed was its effect on my mood. I took it to augment my response to antidepressants, and found that it had good mood brightening properties of its own. It did more for my mood for a time than anything else, and it did a great job.
After about two years, though, it lost its mood brightening effects, and seemed to increase my depression. At that point, I stopped it, which is too bad, because I didn't sleep nearly as well without it. (Go figure -- take an alertness drug, and I sleep better...)
"How does Provigil differ from Adderall?"
Adderall is an amphetamine, while Provigil is not. Provigil inhibits GABA, as well as the reuptake of dopamine and norepinephrine. Adderall was not my friend -- increased depression -- so I don't know much about its effects from a subjective standpoint. I do know that Provigil was much smoother for me than pretty much all the conventional psychostimulants.
"Is Provigil 400mg a day way out of line?"
Depends on the doctor. I found 150mg to be ideal for me -- 100mg at breakfast, and 50mg at lunchtime. I think the official story is that 200mg is the highest dose ever necessary. I don't think that's true, based on clinical pictures. Too many people have written about needing higher doses, and at one point I asked about raising it. (VERY conservative pdoc at that point.) The 200mg didn't last me through out the day, and I'd crash heavily about mid afternoon. By splitting the dose, and front loading it -- taking more in the morning, less at lunchtime -- I didn't crash, and my sleep was just wonderful.
Whether 400mg would work for you, you'd have to talk to your doctor about whether it's worth trying.
I hope that answers your questions.
Posted by Racer on August 30, 2007, at 11:23:43
In reply to Response to a question sent via Babblemail, posted by Racer on August 30, 2007, at 11:23:17
Posted by Phillipa on August 30, 2007, at 11:51:00
In reply to Response to a question sent via Babblemail, posted by Racer on August 30, 2007, at 11:23:17
Racer so it compares to an ADD med without the side effects but not even the anxiety of something like coffee very confusing med to me. I'm sure this will be a very helpful thread for providgil users. I've wondered so long and have googled it but still it didn't make sense to me and still don't see how something to keep you awake lets you sleep? Confused again. Thanks Phillipa
Posted by Brody on August 30, 2007, at 13:34:33
In reply to Response to a question sent via Babblemail, posted by Racer on August 30, 2007, at 11:23:17
> After about two years, though, it lost its mood brightening effects, and seemed to increase my depression. <
Hello. First a little info:I have been on EMSAM for 3+ months now, to which my p-doc added 100mg Provigil 14 days ago.
We added the Provigil after I had to reduce my EMSAM dose from 12mg to 9mg due to severe orthostatic hypotension. (We tried Florinef to get the blood pressure up, but I just blew up like a balloon and felt pretty awful.)
The reduced EMSAM dose seemed to cause the loss of any activating action, although the mood improvement was still there (thankfully!). For me, the activating action from EMSAM was pretty nominal even at 12mg, so we would probably have decided to augment anyway.
I feel I am fortunate to have a very good p-doc who listens and doesn't act all screwy when I make inquiries/suggestions. She reacted with a little wince when I asked her opinion about adding a stimulant, but she did some checking into the MAOI/Provigil combination and we agreed to try that instead.
Okay, so now my question for you is: How did you know that it was the Provigil that seemed to increase your depression, and not a lessening of the effectivness of your anti-depressant? (I am assuming you were still using the Provigil to augment your AD when you discontinued?)
I am having relatively good success with this combination so far. How could I detect which drug might be the culprit if it were to start pooping out. It seemed pretty clear to you.
Thank you kindly for putting your original post on the board for all to see and learn from!
Janet
Posted by Brody on August 30, 2007, at 14:09:44
In reply to Re: Provigil d/c, posted by Brody on August 30, 2007, at 13:34:33
Posted by Racer on August 31, 2007, at 2:24:33
In reply to Re: Provigil d/c, posted by Brody on August 30, 2007, at 13:34:33
> >
> Okay, so now my question for you is: How did you know that it was the Provigil that seemed to increase your depression, and not a lessening of the effectivness of your anti-depressant?That's hard to say. For one thing, it's hard to remember that far back. In terms of how I feel, it's hard for me to remember what anything felt like, ever. Does that make sense? What does it feel like to be depressed? I don't remember, when I'm not depressed. What does it feel like not to be depressed? I can only remember when I'm not depressed. This was also about two years ago, and my memory isn't so great, thanks to some non-psych treatment in that time period.
As far as I can recall, the benefits I'd had from Provigil went away, which is why I associated the increased depression with the Provigil. Also, stopping it eased that increased depression, which was a pretty strong clue to me. Of course, that was only clear after the fact, but then -- Provigil is one of those drugs you can start up again.
>
> I am having relatively good success with this combination so far. How could I detect which drug might be the culprit if it were to start pooping out. It seemed pretty clear to you.Honestly, I think it's mostly instinct and luck. In my case, I'd been taking Provigil for most of the previous two years or so, and was pretty familiar with what effects it produced in me. That did help me figure it out. Also, with the doctor I was seeing at the time, only one drug was changed at a time. (The doctor before that used to switch multiple drugs at once, so it was a lot harder to know what each was doing, or which was the culprit.) That meant that I could "get to know" each drug pretty well.
Hm... I think what I'm trying to say is that you'll likely know which one it is, if any start pooping out on you.
>
> Thank you kindly for putting your original post on the board for all to see and learn from!
>
> JanetYou're welcome. That's exactly why I prefer to post this sort of thing on the board, rather than via BabbleMails -- this way, it may benefit others, as well as the person who asked the question.
Good luck with it. I really liked that drug, and have considered asking my new pdoc to see if it's working again for me. Concerta is my good and trusted friend -- mostly. But when Provigil was working, it really was the very best of all the stimulants for me. I hope it works as well for you.
This is the end of the thread.
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