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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by shellie on July 17, 2000, at 11:23:17
Since my last trial of provigil wasn't pure (new generic of aderex added variable), I am trying provigil again. Day 1- 100mg. The only reason I am trying again is that my pdoc would prefer provigal over adrafinil with an MAOI. (And I love my pdodc). I'll keep you informed. I have already ordered Adrafinil. (which actually gives the provigil a better chance of working, if you can follow superstitious logic). My new med trials don't seem to last very long. Last trial was ritalin with Nardil (3 days)--no energizing, no anything, but I felt suicidal (probably from changing pills every couple of days), so goodbye to ritalin. Shellie
Posted by Rick on July 17, 2000, at 21:17:52
In reply to For all you Provigil vs. adrafinil watchers; N=1, posted by shellie on July 17, 2000, at 11:23:17
> Since my last trial of provigil wasn't pure (new generic of aderex added variable), I am trying provigil again. Day 1- 100mg. The only reason I am trying again is that my pdoc would prefer provigal over adrafinil with an MAOI. (And I love my pdodc). I'll keep you informed. I have already ordered Adrafinil. (which actually gives the provigil a better chance of working, if you can follow superstitious logic). My new med trials don't seem to last very long. Last trial was ritalin with Nardil (3 days)--no energizing, no anything, but I felt suicidal (probably from changing pills every couple of days), so goodbye to ritalin. Shellie
Shellie -
I got a kick out of your superstitious logic! Believe me, I can relate (on a hundred different levels, not specifically regarding meds).
After I first talked with my pdoc about taking a stimulating med, I ended up with Wellbutrin, which brought back much of my anxiety even at a pretty small dose. He then wanted me to try Ritalin. But he FINALLY caved to my desire to try Provigil when I used persistence, research/anecdotal reports and threats (just joking on that last one...kind of) to talk him into letting me be his Provigil guinea pig instead. I'm sure glad I did! I know Ritalin has helped millions so very much, but it struck me as having lots more potential downside, especially as part of anxiety treatment. Heck, just the fact that he could simply phone in new prescriptions or refills for Provigil was appealing.I think another thing that swayed my pdoc (who is a big Ritalin fan) is that, the very same day I brought up Provigil, he received a notice from Caremark (a prescription benefits company) practically begging doctors to prescribe Provigil for narcolepsy instead of the more traditional stimulants. He was floored, saying he had never seen anything like that before. He said, "it must be cheap", and then was double-floored when I informed him that, to the contrary it's an extremely pricey med.
But seeing all of the things (besides AD's) people have taken in tandem with Provigil, I wonder if I'm the only one who's ever taken it with a benzo (Klonopin). While Scott cited some interesting research suggesting that Provigil may work at cross-purposes to benzos by inhibiting GABA, it sure seems to be a nice, complementary combo for me. It feels like I'm mentally calm but at the same time cognitively stimulated and wide awake (when I want to be). Of course, for those who have a paradoxical fatigue reaction to Provigil (WITHOUT a possibly confounding factor like the generic aderex), it seems unlikely that Provigil could prove stimulating in the presence of a benzo. You know the old refrain..."Everbody Reacts Differently"
Anyways, has anyone besides me taken Provigil in tandem with a maintenance benzo? Results?
Thanks,
"N=1" (aka Rick...or were you referring to someone else?...don't worry, I won't be insulted!)
Posted by shar on July 18, 2000, at 2:27:26
In reply to Re: For all you Provigil vs. adrafinil watchers; N=1, posted by Rick on July 17, 2000, at 21:17:52
I am confused now about what meds are available where. I talked to my pdoc today and she was reluctant to try adrafinil and talked about Ritalin.
I'm going to go ahead and try it, with her grudging "I won't say no" and I said I'd start off really low dose (150 or less, and work up slowly).
I know I need to order adrafinil, but I could talk to my pdoc about Provigil instead if it is about equivalent and available in the U.S. She would be happier, I know.
Any info will be appreciated!
Thanks,
Shar
Posted by shellie on July 18, 2000, at 4:52:10
In reply to Question--is Provigil approved in U.S.?, posted by shar on July 18, 2000, at 2:27:26
> I am confused now about what meds are available where. I talked to my pdoc today and she was reluctant to try adrafinil and talked about Ritalin.
>
> I'm going to go ahead and try it, with her grudging "I won't say no" and I said I'd start off really low dose (150 or less, and work up slowly).
>
> I know I need to order adrafinil, but I could talk to my pdoc about Provigil instead if it is about equivalent and available in the U.S. She would be happier, I know.
Shar, I don't know really if it could be considered equivalent since some people seem to respond to adrafinil better, but yes, provigil is an approved, available, and expensive prescription drug in the U.S.
Btw, ritalin does work well as augmentation for lots of people, you might want to try it first--you'll know in a short time if it works. Shellie
Posted by shellie on July 18, 2000, at 13:19:23
In reply to Re: For all you Provigil vs. adrafinil watchers; N=1, posted by Rick on July 17, 2000, at 21:17:52
Hey Rick. Actually, I was the N=1 for this trial, but donŐt feel bad, you are also an N = 1.
And I do take klonopin also. Mostly 2mg to sleep, but also 1/2-1mg if I feel anxious or spacey. Yesterday I started with 50mg provigil--instead of the 25 I had intended, so I also took 1mg of klonopin.
To be honest about provigal vs. adrafinil, in some sense I'd rather adrafinil work, because it is an antidepressant, and maybe I could get off the nardil. Nardil doesn't really bother me, it does make me tired in the afternoon, no matter what time I take it; also combining other meds would just be a bit simplier. Actually, you truly ARE your own study, because our symptoms differ so much.
My depression feels so physiological at this point, although there are things (people) that can trigger it.(e.g., minor failures, hurt, at times). I am so much stronger though, than I used to be emotionally. But it sits in my chest even when things seem excellent. The Nardil by itself was fine until about this January. I am using vicidin, if I feel very depressed or very premenstrual, but still not more than 1/2 pill per day. My therapist and pdoc are not happy, but I really don't care, but do hope that one of these other meds will eliminate the need for it, since I know it's a risk. I don't want to go sneaking around for it when I run out of my rather large supply. (A pdoc gave me a prescription for 60 x 2--At a half a pill a 5 or 6 days a month, that's a couple of years. And I do remember (I think it was you?) your experience, so I try not to forget how dangerous it can be.
I hardly got any sleep last night, then had to get up and put in a couple of hours of hard work. I'm about ready for a nap, then I will get up and work again. That is one of the real advantages for me of owning my own business; the disadvantage is always being responsible for everything!
Well, always glad to get your feedback. Thanks for your support; I'll let you know how this WF N is doing, as the trial proceeds. Shellie
Posted by PattyG on July 20, 2000, at 22:01:53
In reply to Re: For all you Provigil vs. adrafinil watchers; N=1, posted by Rick on July 17, 2000, at 21:17:52
///You refer to this as a "stimulating med." I know little or nothing about Provigil, but would love to know more about it. Is it actually considered to be an amphetamine? My son's doc wouldn't consider Ritalin, Adderall, etc. and we're still searching for something that would energize him. (He's taking Effexor SR 150 mg.) Would be very interested in all view points. Also, is this a drug that could be provided through a patient assistance program?
Posted by Rick on July 22, 2000, at 1:33:41
In reply to Re: For all you Provigil vs. adrafinil watchers; N=1, posted by PattyG on July 20, 2000, at 22:01:53
> ///You refer to this as a "stimulating med." I know little or nothing about Provigil, but would love to know more about it. Is it actually considered to be an amphetamine? My son's doc wouldn't consider Ritalin, Adderall, etc. and we're still searching for something that would energize him. (He's taking Effexor SR 150 mg.) Would be very interested in all view points. Also, is this a drug that could be provided through a patient assistance program?
Patty --
The official FDA indication for Provigil (modafinil) is excessive daytime sleepiness due to narcolepsy, but once a drug is approved in the U.S. a doctor is not bound to the official indication. I'm guessing your son doesn't have narcolepsy, which is often misdiagnosed as depression by the way, but doctors (especially psychiatrists) commonly and legally prescribe medications for "off label" uses. I read in a medical business journal that it is estimated that 40% of Provigil prescriptions to-date are for disorders other than narcolepsy. In fact, it is actively being tested for a number of other disorders such as ADD, Alzheimers's and daytime sleepiness due to sleep apnea (it has already demonstrated effectiveness in early-stage testing for the latter). Wile Provigil has been used in Eurpope for about 12 years it has only been in the U.S. since late 1998. As such doctors --even some psychiatrists -- tend to be unfamiliar with it.
Provigil is NOT an amphetamine; it provides a gentler kind of stimulation with fewer side effects and less addiction potential (although I personally believe the addiction potential for Ritalin -- when used for valid theraputic reasons -- is highly overstated). Ritalin and Adderall are Class II controlled substances which have higly restrictive prescription and refill requirements that do not apply to Provigil (Class IV). That may help sway your doctor's thinking, as might the fact that research has proven it unlikely to cause dependence, addiction or withdrawal symptoms (I temporarily stopped my 200 mg/day a "cold turkey" a week before getting gall bladder surgery with no difficulty at all). Another great thing about Provigil is that, even though it provides stimulation, it is all taken in the morning and does not cause insomnia or even interfere with daytime naps. It certainly has energized me, in a benign way that did not decrease the effectiveness of my anxiety treatment. Virtually all studies to date (both on healthy individuals and those with narcolepsy) show a similar reaction. Of course, everyone's body chemistry is different, and I've seen a number of anecdotal reports from people who did not like it at all. But you never know until you try. Which brings up another point: Provigil usually elicits a theraputic response very quickly -- often immediately and usually no later than one week.Finally, you may have seen the recent research study abstract that I and other have posted here suggesting that Provigil can act synergistically with antidepressants. (E-mail me if you can't locate it on this board or elsewhere and would like me to e-mail the abstract).
Although drug-makers' websites should always be taken with a grain of salt, Provigil's has credibility -- at least for me, based on my benefits and ack of side effects. There is a section on financial assistance, but I haven't read it. Also, I don't recall what they say about use in children (you didn't give your son's age).
www.provigil.com
Hope this helps.
Rick
www.provigil.com
Posted by PattyG on July 28, 2000, at 21:42:42
In reply to Re: For all you Provigil vs. adrafinil watchers; N=1 » PattyG, posted by Rick on July 22, 2000, at 1:33:41
Finally, you may have seen the recent research study abstract that I and other have posted here suggesting that
Provigil can act synergistically with antidepressants. (E-mail me if you can't locate it on this board or elsewhere
and would like me to e-mail the abstract).
///Thank you SO much for responding. Sorry for not getting back sooner - my mother is in critical care after having a ruptured intracranial aneurysm. Everything is surreal right now.Please e-mail any info you have - my son is a young adult. Thanks again for your assistance.
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