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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by zeugma on May 17, 2004, at 17:53:14
I am thinking of making a trial of provigil after I finish ramping down on nortriptyline (currently at 50 mg). Lowering the nortriptyline dosage has already helped my fatigue, but I have always have serious anergia and many narcoleptic symptoms (frequent sleep paralysis and hypnagogic hallucinations), which are mostly blocked by Strattera, the nortrip I am discontinuing, and 15 mg buspirone just before I go to sleep. My ADD is improved by the Strattera, but I still expend lots of energy trying to concentrate, and I am anergic to begin with. I also have social phobia/ general anxiety which is helped by clonazepam (ciurrently, 1 mg/day). My recent depression (which i am still struggling with) is exacerbated by the fatigue, so lowering the nortriptyline has helped with this.
My questions are:
Did Provigil cause anxiety? Does it lessen fatigue? What sort of impact does it have on ADD?
I have heard that it works well in concert with Strattera. I currently take 80 mg in the morning. I think Strattera probably works better as a BID drug, owing to its short half-life, but I seem to need 80 mg to keep my concentration going into the early afternoon. Then it seems to fade. My thought is that with Provigil I could divide the doses of Strattera and still obtain the benefit of improved concentration during the workday, while the Strat in the late afternoon/evening would actually help my sleep (NE reuptake inhibitors block the secondary symptoms of narcolepsy that i mentioned above). I am looking for a stimulant, but one that will not increase anxiety or cause insomnia.
Posted by psychosage on May 18, 2004, at 11:59:58
In reply to Provigil, anxiety, ADD, posted by zeugma on May 17, 2004, at 17:53:14
> I am thinking of making a trial of provigil after I finish ramping down on nortriptyline (currently at 50 mg). Lowering the nortriptyline dosage has already helped my fatigue, but I have always have serious anergia and many narcoleptic symptoms (frequent sleep paralysis and hypnagogic hallucinations), which are mostly blocked by Strattera, the nortrip I am discontinuing, and 15 mg buspirone just before I go to sleep. My ADD is improved by the Strattera, but I still expend lots of energy trying to concentrate, and I am anergic to begin with. I also have social phobia/ general anxiety which is helped by clonazepam (ciurrently, 1 mg/day). My recent depression (which i am still struggling with) is exacerbated by the fatigue, so lowering the nortriptyline has helped with this.
>
> My questions are:
>
> Did Provigil cause anxiety?I do not take it for ADD, but I haven't found it to cause any extra anxiety.
Does it lessen fatigue?It does, but the results tend to taper off, and you will build tolerance. It definitely will pick you up for an indefinite period of time.
What sort of impact does it have on ADD?I am not sure if I should answer this, but it does help concentration and motivation though some people have had trouble finding words on it I have read. I had this problem at first too. I had the right word in mind, but the wrong word on the tip of my tongue. It was weird trying to fish out my own words.
>
> I have heard that it works well in concert with Strattera. I currently take 80 mg in the morning. I think Strattera probably works better as a BID drug, owing to its short half-life, but I seem to need 80 mg to keep my concentration going into the early afternoon. Then it seems to fade. My thought is that with Provigil I could divide the doses of Strattera and still obtain the benefit of improved concentration during the workday, while the Strat in the late afternoon/evening would actually help my sleep (NE reuptake inhibitors block the secondary symptoms of narcolepsy that i mentioned above). I am looking for a stimulant, but one that will not increase anxiety or cause insomnia.
Posted by zeugma on May 18, 2004, at 19:19:33
In reply to Re: Provigil, anxiety, ADD, posted by psychosage on May 18, 2004, at 11:59:58
Posted by Ktemene on May 19, 2004, at 1:49:49
In reply to Provigil, anxiety, ADD, posted by zeugma on May 17, 2004, at 17:53:14
> I am thinking of making a trial of provigil after I finish ramping down on nortriptyline (currently at 50 mg). Lowering the nortriptyline dosage has already helped my fatigue, but I have always have serious anergia and many narcoleptic symptoms (frequent sleep paralysis and hypnagogic hallucinations), which are mostly blocked by Strattera, the nortrip I am discontinuing, and 15 mg buspirone just before I go to sleep. My ADD is improved by the Strattera, but I still expend lots of energy trying to concentrate, and I am anergic to begin with. I also have social phobia/ general anxiety which is helped by clonazepam (ciurrently, 1 mg/day). My recent depression (which i am still struggling with) is exacerbated by the fatigue, so lowering the nortriptyline has helped with this.
>
> My questions are:
>
> Did Provigil cause anxiety? Does it lessen fatigue? What sort of impact does it have on ADD?
>
> I have heard that it works well in concert with Strattera. I currently take 80 mg in the morning. I think Strattera probably works better as a BID drug, owing to its short half-life, but I seem to need 80 mg to keep my concentration going into the early afternoon. Then it seems to fade. My thought is that with Provigil I could divide the doses of Strattera and still obtain the benefit of improved concentration during the workday, while the Strat in the late afternoon/evening would actually help my sleep (NE reuptake inhibitors block the secondary symptoms of narcolepsy that i mentioned above). I am looking for a stimulant, but one that will not increase anxiety or cause insomnia.I've been taking Provigil for more than a year now, for depression (I have the sleepy kind) and ADD. For the last three months I have been taking Provigil together with 80 mg Strattera, and before that I took Provigil with Wellbutrin. My experience has been that Provigil does not cause anxiety but it does lessen fatigue dramatically. The strangest thing about Provigil for me is that it does not seem to have any effect I can notice apart from reducing sleepiness and fatigue. Since I haven't tried Provigil by itself, I can't say whether it is helpful for ADD, but the combination of Provigil and Strattera has helped my ADD a lot. I take 200 mg Provigil as soon as I wake (I keep the bottle and a glass of water on a table next to my bed so I don't even have to get up to take it) and in the late afternoon when I begin to fade I take another 200 mg Provigil. It always gives me more energy, but if I want to sleep, it does not keep me awake. It has been a great medicine for me. I hope it works for you.
Posted by Viridis on May 19, 2004, at 4:34:43
In reply to Provigil, anxiety, ADD, posted by zeugma on May 17, 2004, at 17:53:14
I found Provigil great for energy and motivation, but no help whatsoever with ADD. My pdoc says it's hit-or-miss for ADD, with about half of his patients responding positively. I had no anxiety (but then, I did take it with Klonopin). I prefer Adderall, which is much better (for me) for concentration.
I took Strattera for about six months, liked it at first, then just found the side effects too weird (plus, the positive effects disappeared). It may be good for some people, but I'd be careful. I haven't tried Provigil and Strattera together, but used Adderall and Strattera simultaneously for quite a while.
Posted by zeugma on May 19, 2004, at 19:30:51
In reply to Re: Provigil, anxiety, ADD, posted by Ktemene on May 19, 2004, at 1:49:49
> > I am thinking of making a trial of provigil after I finish ramping down on nortriptyline (currently at 50 mg). Lowering the nortriptyline dosage has already helped my fatigue, but I have always have serious anergia and many narcoleptic symptoms (frequent sleep paralysis and hypnagogic hallucinations), which are mostly blocked by Strattera, the nortrip I am discontinuing, and 15 mg buspirone just before I go to sleep. My ADD is improved by the Strattera, but I still expend lots of energy trying to concentrate, and I am anergic to begin with. I also have social phobia/ general anxiety which is helped by clonazepam (ciurrently, 1 mg/day). My recent depression (which i am still struggling with) is exacerbated by the fatigue, so lowering the nortriptyline has helped with this.
> >
> > My questions are:
> >
> > Did Provigil cause anxiety? Does it lessen fatigue? What sort of impact does it have on ADD?
> >
> > I have heard that it works well in concert with Strattera. I currently take 80 mg in the morning. I think Strattera probably works better as a BID drug, owing to its short half-life, but I seem to need 80 mg to keep my concentration going into the early afternoon. Then it seems to fade. My thought is that with Provigil I could divide the doses of Strattera and still obtain the benefit of improved concentration during the workday, while the Strat in the late afternoon/evening would actually help my sleep (NE reuptake inhibitors block the secondary symptoms of narcolepsy that i mentioned above). I am looking for a stimulant, but one that will not increase anxiety or cause insomnia.
>
> I've been taking Provigil for more than a year now, for depression (I have the sleepy kind) and ADD. For the last three months I have been taking Provigil together with 80 mg Strattera, and before that I took Provigil with Wellbutrin. My experience has been that Provigil does not cause anxiety but it does lessen fatigue dramatically. The strangest thing about Provigil for me is that it does not seem to have any effect I can notice apart from reducing sleepiness and fatigue. Since I haven't tried Provigil by itself, I can't say whether it is helpful for ADD, but the combination of Provigil and Strattera has helped my ADD a lot. I take 200 mg Provigil as soon as I wake (I keep the bottle and a glass of water on a table next to my bed so I don't even have to get up to take it) and in the late afternoon when I begin to fade I take another 200 mg Provigil. It always gives me more energy, but if I want to sleep, it does not keep me awake. It has been a great medicine for me. I hope it works for you.
>Ktemene,
it sounds like the combination of Strattera and Provigil is ideal. I am looking for something that will energize me, lessen my reliance on caffeine (a lousy psychostimulant anyway), and keep me going through those afternoon doldrums that sap my morale in a big way. By 1 pm I am exhibiting classic symptoms of inattention and fatigue, staring off into space at my desk, calculating the energy expenditure of grading my students' papers vs. simply doing nothing, which still expends energy! I am sick of this anergia. If Provigil is a stimulant that does not heighten anxiety or cause insomnia, I am all for it.
Posted by zeugma on May 19, 2004, at 20:48:03
In reply to Re: Provigil, anxiety, ADD » zeugma, posted by Viridis on May 19, 2004, at 4:34:43
> I found Provigil great for energy and motivation, but no help whatsoever with ADD. My pdoc says it's hit-or-miss for ADD, with about half of his patients responding positively. I had no anxiety (but then, I did take it with Klonopin). I prefer Adderall, which is much better (for me) for concentration.
>
> I took Strattera for about six months, liked it at first, then just found the side effects too weird (plus, the positive effects disappeared). It may be good for some people, but I'd be careful. I haven't tried Provigil and Strattera together, but used Adderall and Strattera simultaneously for quite a while.I consider strattera an AD with pro-attentional properties (much like the TCA's but less sedating and easier to combine with other meds). I have primary dx's of depression, ADD, and anxiety, so I need some kind of AD to keep my mood up. The s/e i get are even reminsecent of a TCA- constipation, dry mouth, dry skin, dry hair. I have been on strattera for over a year now.
if provigil fails a more conventional stim is on the horizon. i hate having to drink seven to ten cups of coffee a day in order to function.
Posted by Viridis on May 19, 2004, at 22:33:32
In reply to Re: Provigil, anxiety, ADD » Viridis, posted by zeugma on May 19, 2004, at 20:48:03
I'd definitely give Provigil a try. I'm prone to episodes of severe anxiety, and much caffeine at all makes these worse. Wellbutrin just about sent me through the roof in terms of anxiety/panic. So, I'm definitely sensitive to some stimulants. Yet, Provigil made me feel energetic without nervousness or side effects (Adderall makes me feel calm and focused, and I had no increase in anxiety with Strattera).
The Provigil tabs are easy to break into pieces if you want to try a small amount first, and free samples seem to be all over the place. Good luck!
Posted by oldadd on June 16, 2004, at 22:47:56
In reply to Provigil, anxiety, ADD, posted by zeugma on May 17, 2004, at 17:53:14
I have been taking Provigil for 3 months and have not experienced any anxiety. I have ADD, depression and sleep aphnea. I am in a very positive place right now.
Posted by Dave001 on June 20, 2004, at 20:38:32
In reply to Re: Provigil, anxiety, ADD, posted by psychosage on May 18, 2004, at 11:59:58
<snip>
> > My questions are:
> >
> > Does it lessen fatigue?
>
> It does, but the results tend to taper off, and you will build tolerance. It definitely will pick you up for an indefinite period of time.
>This may be due at least partially by modafinil's ability to induce its own metabolism via its effect on several of the various Cytochrome P450 enzyme families, the most significant of which is probably CYP3A4. Be advised that this can affect the levels of some other drugs and you should pay particular attention if you're taking hormones for contraceptive use.
Dave
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