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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by PhilipCarey on June 28, 2003, at 7:20:50
Hi all.
I'm going to the doc on Monday, and I'm going to ask him for Provigil.
I've had depression/anxiety issues for pretty much all my adult life.
Lately, I've been reading about adult ADD, and I seem to have that as well, if the little online self-tests are an idication. You know, poor concentration, a horrific memory. I've compensated for that for years in the workplace, being a very good note taker, documenting my projects really well, etc.
Over the years, I've tried a number of ADs. All of their side effects were too much to handle at what would be regarded as a therapeutic dose.
The only one that I CAN handle is Remeron 15mgs. It's done well on both depression and anxiety. I could use a little more energy though.
Hence, the checking out Provigil. Hoping it will gently help out with energy/motivation, and perhaps with a little focus and clarity too.
Anybody used it over a long period - to what result?
Anybody use it to augment a sedating AD - success?
Thanks in advance to any who feel like responding.
Phil
Posted by fallsfall on June 28, 2003, at 7:48:15
In reply to Provigil Vets - A Question, posted by PhilipCarey on June 28, 2003, at 7:20:50
I take Provigil to give me more energy. I have depression (but not ADD).
Currently I take Lithium, Prozac, Provigil and Strattera. I added the Provigil before the Strattera and it helped a little, but when I put the Strattera in too, it made a big difference. I did try just the Strattera without the Provigil and that didn't do it. So, for me, I needed both.
I've been taking the Strattera since early February and started the Provigil 4 - 6 weeks before that. Both made me nauseaus (sp?) at first so I had to raise the doses slowly. I have some dry mouth and wicked sweating, but I don't know which med is causing those.
The result is pretty good - I've gone from almost comatose to being ready to do some things if my situational stressors will ever let up... The Provigil/Strattera combination is also REALLY good at reducing suicidal ideation.
Good Luck!
Posted by PhilipCarey on June 28, 2003, at 7:58:39
In reply to Re: Provigil Vets - A Question » PhilipCarey, posted by fallsfall on June 28, 2003, at 7:48:15
Thanks Fallsfall. I tried Wellbutrin for a couple of days in hopes of benefiting from its stimiulating properties, but it sent my anxiety levels off the charts. Actually had to leave work one day. Hope the Provigil will be more subtle.
> I take Provigil to give me more energy. I have depression (but not ADD).
>
> Currently I take Lithium, Prozac, Provigil and Strattera. I added the Provigil before the Strattera and it helped a little, but when I put the Strattera in too, it made a big difference. I did try just the Strattera without the Provigil and that didn't do it. So, for me, I needed both.
>
> I've been taking the Strattera since early February and started the Provigil 4 - 6 weeks before that. Both made me nauseaus (sp?) at first so I had to raise the doses slowly. I have some dry mouth and wicked sweating, but I don't know which med is causing those.
>
> The result is pretty good - I've gone from almost comatose to being ready to do some things if my situational stressors will ever let up... The Provigil/Strattera combination is also REALLY good at reducing suicidal ideation.
>
> Good Luck!
Posted by Viridis on June 28, 2003, at 18:45:06
In reply to Re: Provigil Vets - A Question, posted by PhilipCarey on June 28, 2003, at 7:58:39
I'm not a veteran of Provigil -- I only took it for a couple of weeks. But I do have some experience. My pdoc gave me some samples for ADD and said it was a "hit or miss" drug for that, but worth a try. I liked it -- it was energizing without causing anxiety, and gave me a nice lift. It just didn't help enough with concentration, so I shifted to Adderall. But I'd definitely recommend you give it a try.
Like you, I found Wellbutrin extremely anxiety-provoking and had an awful time with it, but Provigil was very different. I'd just start with a low dose (maybe 25-50 mg -- the tablets are easy to break) and see how you react.
And, as fallsfalls suggested, definitely consider Strattera. I've just been on it a short time, but find it has a calming, focusing effect. I also had some initial mild nausea, dry mouth, etc., but that's pretty much subsided in just a couple of weeks, and wasn't too bad. I'm still in the process of optimizing the dose and don't have long-term experience, but so far it seems very helpful, and not anxiogenic at all for me.
Posted by Penny on June 28, 2003, at 23:21:06
In reply to Provigil Vets - A Question, posted by PhilipCarey on June 28, 2003, at 7:20:50
Hi! I took Provigil for several months, mostly because I was having major trouble staying awake during the day and while driving :-(
I started at 200 mgs, which worked pretty well - not too stimulating, but enough to keep me awake, but the effect didn't last long, so I went up to 300 and then to 400 (max recommended dose apparently), and with each increase it worked well for a while and then stopped working. Eventually I went off of it b/c it just wasn't working for me.
However, I never had any side effects on it - nothing! And when I quit, I just stopped, didn't have to taper down or anything (did this with my pdoc). He said it was one of the safer 'stimulants', moreso than the ADD drugs. Most recently was on Adderall and it was not good for me at all - actually made me sleepy! So, perhaps I'm just weird (okay, no perhaps about it...).
I certainly think it's worth a shot. Haven't heard too many negatives about Provigil.
Good luck!
Posted by Penny on June 28, 2003, at 23:22:12
In reply to Re: Provigil Vets - A Question » PhilipCarey, posted by fallsfall on June 28, 2003, at 7:48:15
Fallsfall,
Can you give me a bit more info on the Strattera and how it works with your other meds? What symptoms does it alleviate?
thanks.
Penny
Posted by fallsfall on June 29, 2003, at 10:14:10
In reply to Strattera? » fallsfall, posted by Penny on June 28, 2003, at 23:22:12
I was in a depression state where I could get out of bed to get my daughter to school, make dinner 3 times a week (paper plates and who knows how long it took to get the pans washed), feed my dogs, laundry & grocery shopping & showering & eating happened about 1/4 as often as they should. I did get to two support groups and therapy. Nothing was interesting, nothing was fun, sleeping and staring into space were the excitement for the day. No motivation, no initiative, no energy.
When I started the Strattera and Provigil I could actually stand up from the chair. I cleaned my kitchen (and it is even clean today!). I took the dogs for a walk once in a while. I argued with my daughter about doing her homework in front of the TV (before that I couldn't muster the energy to confront her).
Unfortunately, at the same time my therapy situation started to fall apart. Given that stress I was doing incredibly well. Particularly with suicidal thoughts - I couldn't believe that I was taking the therapy demise without going back to the hospital. So I have never really (and still haven't) seen what these drugs could do during "normal" times. But what I see in abnormal times is quite impressive.
Suicidal control, energy, initiative, motivation.
I'm impressed.
Posted by jemma on June 30, 2003, at 12:14:18
In reply to Re: Provigil Vets - A Question » PhilipCarey, posted by fallsfall on June 28, 2003, at 7:48:15
I find provigil a lifesaver. It lets me wake up, stay awake, get things done. I take 100 mg twice a day, and if I forget a dose, my mood drops and I start to feel like a nap.
Provigil seems to work well with every drug I try it with. It augments ssris, stimulants, and mao inhibitors. As for remeron, I have a friend who takes this combo - provigil in the morning, remeron at night. He finds the provigil works well to counteract remeron daytime drowsiness.
All in all, I've found provigil to be a very benign and helpful med. It never makes me feel drugged, and I'm never aware of side effects. It doesn't help me concentrate, though - for that I need ritalin.
- jemma
Posted by utopizen on June 30, 2003, at 18:16:47
In reply to Re: Provigil Vets - A Question, posted by jemma on June 30, 2003, at 12:14:18
> I find provigil a lifesaver. It lets me wake up, stay awake, get things done. I take 100 mg twice a day, and if I forget a dose, my mood drops and I start to feel like a nap.
>I envy you. I'm in an out-of-state internship. And trust me, enough drug fiends envy me for it, but I don't envy myself for it-- the Desoxyn (methamphetamine HCL) I take for my ADD leaves me crashed and depressed by the end of the day, tired during the day, so crashed by the time I leave work I cry. And I'm 19, with absolutely no history of depression. It doesn't happen on days I don't take it.
I have fatigue during the day, even after 10 hours of sleep. So if I don't take it, I'll be tired. And can't concentrate. But if I do take Desoxyn, I'll feel painfully tired in a few hours after taking it, and depressed by the end of the day.
It's not Desoxyn, it's me on Desoxyn. Desoxyn was, and still is, a great med. I even suggest people try it if they've had too much from side-effects of others (but try Dexedrine first). But for whatever reason, Desoxyn has me crashing on it these days, and this just started a month ago. It was fine when I started taking it in December. Even Ritalin did this to me after a few months, I can't stay on the same med for too long or it causes dysphoria.
But getting back to Provigil, I envy you because my p-doc won't return my calls, and my GP here won't prescribe it because he feels overwhelmed with all my meds (oh no, a saliva stimluant Evoxac, Minocycline, an antibiotic for acne, Desoxyn for ADD, Klonopin for Social Anxiety, Nalodol, a beta blocker for social anxiety).
So everyday is hell. I'm sure I'll eventually get it. I just called home and burst into tears, so depressed from Desoxyn's crash today and the hopelessness of not having a doctor return your calls. My dad said he'd give my doctor a call, tell him to stop ignoring me. I never thought about that, that gives me some hope it'll scare him into calling me back finally.
If he doesn't call back tomorrow, I'm calling the colleague that referred me to him and my former p-doc, another colleague who "admires him" or whatever, at this prestigious hospital, and telling him he doesn't answer his calls.
Then I'm sure there's some ombudsman for the hospital (his office is at a huge Boston hospital), that's definitely going to here from me. I'm not a very assertive person until I realize my passitivity is being taken advantage of. Then that's when I start to shock people. People really get scared of me when they see me in action on the phone, my roommates are like "let me know if I ever get on your bad list so I can get off it." I don't let people get away taking advantage of my politeness.
If it wasn't for this guy, who promised me he would phone scripts in on a Thursday, I would have avoided a trip to the ER on the following Tuesday after 2 nights of not sleeping.
Posted by jemma on July 1, 2003, at 11:11:39
In reply to Re: Provigil Vets - A Question, posted by utopizen on June 30, 2003, at 18:16:47
Sorry you're having such a tough time. I respond the same way to stimulants, even ritalin sr - I've decided they just aren't worth the crash, which for me involves muscle pain, irritability, and extreme scatteredness. Provigil - or Alertec, as it's called here - is much gentler and more even. But my pdoc isn't perfect. He won't prescribe klonopin, which I'd like to try.
In fact, looking at your cocktail, I'd suggest a trial of just provigil in the morning and klonopin at night (plus the antibiotic - you may not need the saliva stimulant if you stop the meth). You'd have to give it a couple of weeks for the antidepressant properties of the provigil to kick in, but it might work really well. Just my opinion, of course, and I'm no pdoc.
- Jemma
> I envy you. I'm in an out-of-state internship. And trust me, enough drug fiends envy me for it, but I don't envy myself for it-- the Desoxyn (methamphetamine HCL) I take for my ADD leaves me crashed and depressed by the end of the day, tired during the day, so crashed by the time I leave work I cry. And I'm 19, with absolutely no history of depression. It doesn't happen on days I don't take it.
>
> I have fatigue during the day, even after 10 hours of sleep. So if I don't take it, I'll be tired. And can't concentrate. But if I do take Desoxyn, I'll feel painfully tired in a few hours after taking it, and depressed by the end of the day.
>
> It's not Desoxyn, it's me on Desoxyn. Desoxyn was, and still is, a great med. I even suggest people try it if they've had too much from side-effects of others (but try Dexedrine first). But for whatever reason, Desoxyn has me crashing on it these days, and this just started a month ago. It was fine when I started taking it in December. Even Ritalin did this to me after a few months, I can't stay on the same med for too long or it causes dysphoria.
>
> But getting back to Provigil, I envy you because my p-doc won't return my calls, and my GP here won't prescribe it because he feels overwhelmed with all my meds (oh no, a saliva stimluant Evoxac, Minocycline, an antibiotic for acne, Desoxyn for ADD, Klonopin for Social Anxiety, Nalodol, a beta blocker for social anxiety).
>
> So everyday is hell. I'm sure I'll eventually get it. I just called home and burst into tears, so depressed from Desoxyn's crash today and the hopelessness of not having a doctor return your calls. My dad said he'd give my doctor a call, tell him to stop ignoring me. I never thought about that, that gives me some hope it'll scare him into calling me back finally.
>
> If he doesn't call back tomorrow, I'm calling the colleague that referred me to him and my former p-doc, another colleague who "admires him" or whatever, at this prestigious hospital, and telling him he doesn't answer his calls.
>
> Then I'm sure there's some ombudsman for the hospital (his office is at a huge Boston hospital), that's definitely going to here from me. I'm not a very assertive person until I realize my passitivity is being taken advantage of. Then that's when I start to shock people. People really get scared of me when they see me in action on the phone, my roommates are like "let me know if I ever get on your bad list so I can get off it." I don't let people get away taking advantage of my politeness.
>
> If it wasn't for this guy, who promised me he would phone scripts in on a Thursday, I would have avoided a trip to the ER on the following Tuesday after 2 nights of not sleeping.
Posted by utopizen on July 3, 2003, at 14:20:38
In reply to Re: Provigil Vets - A Question » utopizen, posted by jemma on July 1, 2003, at 11:11:39
I'm trying Seroquel now, right now 50mg at night and if it doesn't help I'll try more.
my pdoc will likely give me provigil next week, and switch me from Desoxyn to a Dex spansule.
You should see a different doc if you really thin the Klonopin will help you. I've been taking 1mg 3/day since early March, and accidentally spilled mouthwash all over it (long story) in my bag two days ago (way after insomnia was a problem). I'll likely not bother to refill it until it's refill date in 2 weeks, just because. I could, but I don't care to. And I certainly am not experiencing any "withdrawl" B.S. that docs told me I would experience before I finally found a more rational doc who laughed at the very idea. It's widespread, my current p-doc gave a frown when I told her I take 1mg 3/day for social anxiety. She goes "well that's not the best for social anxiety" and I explained to her I tried a year and half of antidepressant, antipsychotic trials and other drugs. She knew that.
She wouldn't say to a psychotic patient "oh, the atypicals aren't working, looks like you can't be treated or something." She'd give Haldol. So that's not rational for her to think differently just because it's social anxiety disorder. What this is is discounting the disorder, which is wrong to do in the first place and the reason why it's not properly treated with Klonopin after the others have failed.
This is the end of the thread.
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