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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 27. This is the beginning of the thread.
Posted by Melanie1976 on January 21, 2005, at 13:38:43
I was just recently diagnosed with Narcolepsy. I started Provigil about two weeks ago. I hate it. Yes I'm awake but I feel like crap. I feel sick everyday and all I do is cry. Has anyone else felt this way? Any suggestions would be appreciated. I've been on depression medications before in the past, nothing recently. I haven't been depressed like this in a long time. I'm miserable
Posted by zeugma on January 21, 2005, at 16:13:09
In reply to Provigil and depression, posted by Melanie1976 on January 21, 2005, at 13:38:43
Provigil- made me awake. felt sick from first dose, and it never went away.
A fellow narcoleptic,
z
Posted by SLS on January 21, 2005, at 16:41:52
In reply to Provigil and depression, posted by Melanie1976 on January 21, 2005, at 13:38:43
> I was just recently diagnosed with Narcolepsy. I started Provigil about two weeks ago. I hate it. Yes I'm awake but I feel like crap. I feel sick everyday and all I do is cry. Has anyone else felt this way? Any suggestions would be appreciated. I've been on depression medications before in the past, nothing recently. I haven't been depressed like this in a long time. I'm miserable
I was miserable on Provigil too. I tried taking it twice for bipolar depression. It made the depression worse and produced anxiety. This drug is definitely one with a split personality.
- Scott
Posted by Racer on January 22, 2005, at 14:59:57
In reply to Re: Provigil and depression, posted by SLS on January 21, 2005, at 16:41:52
Scott's right about the split personality of Provigil -- there are a fair number of people here for whom it's caused this sort of reaction, but about an equal number like me, who found it great.
For me, Provigil helps with fatigue, lethargy, amotivation, and concentration, with damn near NO side effects. It also brightens my mood.
That's why the motto here is "Your Mileage Will Vary."
Posted by BJM on January 22, 2005, at 19:09:55
In reply to Provigil and depression, posted by Melanie1976 on January 21, 2005, at 13:38:43
What dose are you taking? My suggestion would be to try a lower dose or split the dose up through the day. When I first started Provigil I hated it sooooo much. I lowered the dose, started breaking it up and taking half my dose in the morning and half the dose late morning to early afternoon. It made a major difference. Over time the side effects diminished and tweaking the dose made me go from hating it to not being willing to go without it. Give it time, experience and a chance.
Posted by jujube on January 22, 2005, at 22:26:11
In reply to Re: Provigil and depression, posted by BJM on January 22, 2005, at 19:09:55
I have been doing research on Provigil as well as gathering information on people's experiences with the drug as I am hoping to use it to augment the Celexa I am on.
If you don't mind, could you please tell me if you have been using Provigil to augment an antidepressant? Also, has it had significant effects in terms of motivation and mood brightening (additional antidepressant effect) and reducing apathty? What start-up side effects did you experience? What dose are you currently using? And, finally, how long have you been using it?
Sorry for all the questions. Anything you can tell me would much appreciated.
Thanks in advance.
> What dose are you taking? My suggestion would be to try a lower dose or split the dose up through the day. When I first started Provigil I hated it sooooo much. I lowered the dose, started breaking it up and taking half my dose in the morning and half the dose late morning to early afternoon. It made a major difference. Over time the side effects diminished and tweaking the dose made me go from hating it to not being willing to go without it. Give it time, experience and a chance.
>
Posted by Racer on January 23, 2005, at 13:20:43
In reply to Re: Provigil and depression » BJM, posted by jujube on January 22, 2005, at 22:26:11
My answers:
I've been taking Provigil on and off for about a year and a half. I can't remember start up side effects too well, but know that I had some headaches -- but they were really weird, not something I recognized right away as headaches. (I'm used to migraines.) The headaches felt like a too tight headband, just pressure, no real pain. Other than a few of those in the first couple of months -- now and again, not regular -- I don't remember anything that might have been related to the med.
Yes, it helps a lot with brightening my mood, increasing motivation, etc. I'm taking it with Cymbalta and Wellbutrin, and the three together are OK. I think that the Cymbalta might be reducing my motivation, although it might have been the propranalol I was taking for anxiety, but have now stopped. Anyway, with the Provigil, I could get started, which I couldn't do without. Just being able to get something done helps my mood a lot.
I take 100mg AM now, but was taking 100mg AM and 50mg at noon. That helped avoid the afternoon crashes I had been having before getting onto antidepressants. (Long story...) At one point, I was taking 200mg in the morning.
For me, the Provigil has been one of those meds that you really only notice when you STOP taking it. (I would prefer to be on the lowest number and doses of medication that effectively control my depression and anxiety. So we keep trying to lower things until we find out the minimums involved.)
Hope that helps. You will find, though, that your mileage will vary. You really won't know until you try how something will effect you. Also, when I've stopped Provigil, there hasn't really been any problem related to stopping it.
Posted by alohashirt on January 23, 2005, at 19:29:08
In reply to Re: Provigil and depression » jujube, posted by Racer on January 23, 2005, at 13:20:43
Just curious - does your insurance cover Provigil for use in this capacity? If not, how much does it cost you?
I had read about Provigil being approved for ADHD in children and was intrigued by the idea of a less-stimulating stimulant.
I believe that Provigil is Schedule 4 Controlled Substance which would mean it could not be legally imported from foreign pharmacies.
Posted by jujube on January 23, 2005, at 19:49:11
In reply to Re: Provigil and depression » jujube, posted by Racer on January 23, 2005, at 13:20:43
Thank you so much Racer! I appreciate the time you took to respond to my questions. You are very kind. I have been through 5 AD trials in the past year with limited success, and it is getting harder to put up and keep a brave front. I know that if Provigil does not help me, I have other options. But I am just running out of strength and, some days, finding it hard to maintain a positive outlook. The pdoc I see is not the most progressive or creative, and seems set on one monotherapy after another. He cancelled my appointment last week (which I had been waiting a month for) and offered me an alternate appointment that conflicted with an appointment I had with the ortheopedic surgeon (to have my arm reset in a new cast). When his secretary (a.k.a The Palace Guard) told me the next available appointment was a month away, I said I'll think about it, but would likely just take care of things myself. The pdoc called me back and said I should be fine just on Celexa, so I said thanks, but I was getting close to the end of my rope and I would take care of things myself. Anyways, he called me back at the end of day and relented to let me try Provigil. He had said no initially to that as well as to nortriptyline and Wellbutrin (because of my extreme anxiety). Oh well. I'll be ok. Sorry for rambling!
Take care.
Tamara
Posted by alohashirt on January 23, 2005, at 20:11:07
In reply to Re: Provigil and depression » Racer, posted by jujube on January 23, 2005, at 19:49:11
Good luck - will you let us know how it works?
Posted by medhed on January 24, 2005, at 3:06:59
In reply to Re: Provigil and depression, posted by alohashirt on January 23, 2005, at 19:29:08
it IS available from international online pharmacies, under the name of modanafil. legality is a grey issue. as long as you don't start ordering all kinds of benzos, narcotics, barbs, and the like, they will not seize this type of drug at the borders. of course when you are ordering, you will want to make sure they are a reliable pharmacy.(fake drugs, no delivery, ect) ordering without a prescription puts you into that grey area, so beware.
check this site: xxx (it's free)
Posted by ed_uk on January 24, 2005, at 7:16:18
In reply to Re: Provigil and depression » Racer, posted by jujube on January 23, 2005, at 19:49:11
Hi,
>He had said no initially to that as well as to nortriptyline.......
Why did he refuse to let you try nortriptyline?
Ed.
Posted by jujube on January 24, 2005, at 18:52:46
In reply to Re: Nortriptyline » jujube, posted by ed_uk on January 24, 2005, at 7:16:18
Hi Ed,
He said that since I couldn't handle the dizziness and hypotension I was experiencing on Anafranil, that I would not be able to tolerate Nortrityline either. I was under the impression that nort's side effects were less severe than Anafranil's, but I am too tired at this point to argue with him. The other problem I was having with Anafranil was that it really didn't feel much different than a SSRI at the dose I could tolerate. Oh well, such is life.
Tamara
> Hi,
>
> >He had said no initially to that as well as to nortriptyline.......
>
> Why did he refuse to let you try nortriptyline?
>
> Ed.
>
Posted by jujube on January 24, 2005, at 18:56:00
In reply to Re: Provigil and depression, posted by alohashirt on January 23, 2005, at 20:11:07
> Good luck
Thanks.
- will you let us know how it works?
I'll try.
Posted by rudialexander on January 24, 2005, at 21:16:14
In reply to Re: Provigil and depression, posted by SLS on January 21, 2005, at 16:41:52
I use 200 to 300 mg of Provigil a day to augment various other antidepressants and mood stabilizers. It helps brighten my mood, helps alertness, though not concentration. I can fall asleep on 200. I think it does make me a bit nauseated though (although I'm taking so many meds that it's hard to tell what's what)
Posted by rudialexander on January 24, 2005, at 21:17:20
In reply to Re: Provigil and depression » alohashirt, posted by jujube on January 24, 2005, at 18:56:00
I use 200 to 300 mg of Provigil a day to augment various other antidepressants and mood stabilizers. It helps brighten my mood, helps alertness, though not concentration. I can fall asleep on 200. I think it does make me a bit nauseated though (although I'm taking so many meds that it's hard to tell what's what)
Posted by BJM on January 25, 2005, at 8:23:30
In reply to Re: Provigil and depression » BJM, posted by jujube on January 22, 2005, at 22:26:11
> I have been doing research on Provigil as well as gathering information on people's experiences with the drug as I am hoping to use it to augment the Celexa I am on.
>
> If you don't mind, could you please tell me if you have been using Provigil to augment an antidepressant? Also, has it had significant effects in terms of motivation and mood brightening (additional antidepressant effect) and reducing apathty? What start-up side effects did you experience? What dose are you currently using? And, finally, how long have you been using it?
>
> Sorry for all the questions. Anything you can tell me would much appreciated.
>
> Thanks in advance.
>
>
>
The Provigil definetly helped with mood brightening, motivation etc. I started using it as an add on to low dose Prozac because Prozac makes me beyond groggy and upping the dose makes my anxiety worse. Taking something for anxiety doesn't really help because then I am just sleeping again. Plus most anti-anxiety meds make me more depressed.
In the beginning the Provigil made me a little pleasantly hyper but then I started feeling anxious and even more depressed. I felt like I was sinking deeper into the depression. That was when I started breaking the dose up. Usually 50mg am and 50mg around 1pm. I've since gone up from there depending on how the lethargy is. Usually I take 150 - 200 mg per day. Sometimes all in the morning and sometimes broken up.
I've really had to play with the dosing for me. Provigil doesn't seem to effect me the same way every day. I've heard other people say the same thing. Ex: It works better for me if I don't drink coffee with it. Believe it or not when I drink coffee with it I end up getting more tired. Almost like the coffee makes the provigil not work. Also I've noticed that if I take it on an empty stomach and don't eat for awhile I will all of a sudden feel it kick in right after I eat.
I'm really sensitive to meds and it took me along time to get used to Provigil. I should have gone with my gut and not taken the usual starting dosages but I was afraid to not follow the docs and prescribing info to the letter. Once I got my docs o.k. to play around with smaller doses and different times of the day it made all the difference.
My doctor told me that Provigil could increase the effectiveness of my AD without my having to up the AD dose and she was right. I'm sure some people might disagree but Provigil seems to be a very safe med (safer even then a higher dose of AD's) with no problem discontinuing, getting addicted to like some stimulants and much less anxiety than stimulants.
Hope that wasn't too long but hopefully the info will help. I didn't have much info when I first started it and almost quit taking it and its made a world of difference for me that I would have missed out on if I had given up.
Good Luck
BJM
Posted by Dr. Bob on January 25, 2005, at 8:24:02
In reply to Re: Provigil and depression, posted by medhed on January 24, 2005, at 3:06:59
> ordering without a prescription puts you into that grey area, so beware.
> check this site: xxx (it's free)Please don't use this site to exchange information that could be used to import into the US prescription medication without a prescription.
If you or others have questions about this or about posting policies in general, please see the FAQ:
http://www.dr-bob.org/babble/faq.html#illegal
Follow-ups regarding these issues should be redirected to Psycho-Babble Administration.
Thanks,
Bob
Posted by medhed on January 25, 2005, at 9:15:38
In reply to Re: medication without a prescription » medhed, posted by Dr. Bob on January 25, 2005, at 8:24:02
it will not happen again.
Posted by ed_uk on January 25, 2005, at 10:09:32
In reply to Re: Nortriptyline » ed_uk, posted by jujube on January 24, 2005, at 18:52:46
Hi Tamara,
Nortriptyline can sometimes cause hypotension but to quote PubMed.... 'Nortriptyline has been shown to cause significantly less serious postural blood pressure drops, an important difference between this drug and other TCAs.'
>I was under the impression that nort's side effects were less severe than Anafranil's.
You are correct!
>The other problem I was having with Anafranil was that it really didn't feel much different than a SSRI at the dose I could tolerate.
Another good reason to try nortriptyline since it is a norepinephrine reuptake inhibitor. Be persuasive!
Regards,
Ed.
Posted by Dr. Bob on January 25, 2005, at 13:23:48
In reply to Re: Sorry Dr. Bob., posted by medhed on January 25, 2005, at 9:15:38
Posted by Racer on January 25, 2005, at 17:29:46
In reply to Re: Nortriptyline » ed_uk, posted by jujube on January 24, 2005, at 18:52:46
I've got what seems to be the world's most sensitive blood pressure, dropping if I walk near a bottle of TCAs, and I had no problem with hypotension on Nortriptyline.
I have been told that the two most blood pressure neutral TCAs are Nort, and desipramine. Des did give me trouble, lots of unexpected close up views of our carpetting, but nort never did.
Congrats on the Provigil trial, and I hope it helps. My insurance hasn't made any noise about Provigil, although it is the highest cost tier. ($40, instead of $25 -- beats hell out of $200 retail, though.) If it helps, our insurance is Blue Cross/Blue Shield of Texas.
Posted by jujube on January 25, 2005, at 23:06:21
In reply to Re: Nortriptyline » jujube, posted by Racer on January 25, 2005, at 17:29:46
Thank you Racer for sharing that with me. I'm glad about the Provigil, and am so hoping that it helps me. The nice thing about Provigil, from what I gather, is that it has a quick onset of action. So, I would probably know if it is going to work quicker than I would an AD. And, if it doesn't work, I will move on to Nort.
Thanks also for the insurance company info. I'm in Canada actually, and have a really good prescription drug plan through the place where I work which covers 80% of the cost. All that needs to be submitted is the official receipt from the pharmacy (there is no need for substantiating documentation or anything else). No fuss, no muss and no headaches.
Well, bye bye and take care.
Tamara
Posted by jujube on January 25, 2005, at 23:09:51
In reply to Re: Nortriptyline » jujube, posted by ed_uk on January 25, 2005, at 10:09:32
Thank you Ed. I don't mean to be lazy, but if it is not too much trouble, could you please provide me with a link to the PubMed study or article. I would really appreciate it.
Tamara
Posted by ed_uk on January 26, 2005, at 14:15:22
In reply to Re: Nortriptyline » ed_uk, posted by jujube on January 25, 2005, at 23:09:51
J Clin Psychiatry. 1993 Feb;54 Suppl:16-22.
Review of the cardiovascular effects of heterocyclic antidepressants.
Glassman AH, Preud'homme XA.
Department of Clinical Psychopharmacology, New York State Psychiatric Institute, NY 10032.
We review the effects of heterocyclic antidepressant compounds on the cardiovascular system. It has been shown that tricyclic antidepressants (TCAs) slow intraventricular conduction, and this can be seen on a standard ECG as the increased QRS, PR, and QTc intervals. This prolonged conduction is dangerous to patients in two conditions. In overdose, delayed conduction may lead to a complete heart block or ventricular reentry arrhythmias. Either of these complications, or a combination of both, may lead to death. When treated with TCAs at therapeutic plasma levels, depressed patients with preexisting conduction disease, particularly bundle-branch block, are at higher risk to develop symptomatic A-V block than depressed patients free of conduction disorders. Clinically, the effects of TCAs on conduction does not differ significantly within the family of drugs. Who gets complications is much more a function of severity of the patient's preexisting cardiac condition. The most common cardiovascular effect of TCAs is orthostatic hypotension. Postural hypotension is more dangerous in elderly patients because it may lead to falls that cause serious physical injuries. Severe orthostatic hypotension is more likely to develop in depressed patients with left ventricular impairment and/or in patients taking other drugs like diuretics or vasodilators. ***Nortriptyline has been shown to cause significantly less serious postural blood pressure drops, an important difference between this drug and other TCAs.*** Another cardiovascular effect of TCAs is that they reduce ventricular arrhythmias. They share this property with Type 1A antiarrhythmic compounds, and a variety of Type 1 antiarrhythmics have recently been shown to increase mortality in postmyocardial infarction patients.
Clin Geriatr Med. 1992 May;8(2):323-34.Using tricyclic antidepressants in the elderly.
McCue RE.
Department of Psychiatry, Beth Israel Medical Center, New York, New York.
Only a few of the eight tricyclic antidepressants available today have been studied systematically in the elderly. Tertiary amine tricyclics such as amitriptyline and imipramine have been reported to be effective in depressed geriatric patients, but because of their potential for side effects, it is not advisable to use them in the elderly. Desipramine has a less toxic side effect profile, especially with respect to anticholinergic effects, but its efficacy has not been well studied. This does not mean, however, that it is not an effective drug for the elderly depressed. Nortriptyline is the tricyclic that has been the most studied. The results of those studies show that it should be recommended as an antidepressant for older patients. It is effective in both the acute and continuation treatment of depression in the elderly. As far as its use in maintenance treatment, the results are mixed but at this moment there is nothing with which to compare it. It has a favorable side effect profile: low anticholinergic activity; relatively few cardiac side effects, even in patients with preexisting cardiac disease; and ***relatively less orthostatic hypotension.*** Nortriptyline also has the virtue of an established therapeutic range for its steady-state plasma level. The role of its 10-hydroxy metabolite needs to be further explored, but when its contribution to efficacy and toxicity is better understood, it may be possible to use nortriptyline in a more precise and safe way in elderly patients. The bulk of evidence suggests, partly by default, that nortriptyline should probably the tricyclic-of-first-choice in treating an elderly patient with major depression.
Psychopharmacology (Berl). 1981;74(4):360-4.
Cardiovascular effect of imipramine and nortriptyline in elderly patients.
Thayssen P, Bjerre M, Kragh-Sorensen P, Moller M, Petersen OL, Kristensen CB, Gram LF.
Cardiovascular effects in elderly depressed patients (age 62-78 years) treated with imipramine (N = 11) or nortriptyline (N = 10) were recorded by monitoring of heart rate, blood pressure, systolic time intervals, standard ECG and 24-h ECG. The two drugs exhibited distinctly different cardiovascular reactions. The use of imipramine was severely limited by orthostatic hypotension occurring at subtherapeutic plasma levels, which resulted in falls with fracture in two patients. In contrast, ***nortriptyline at therapeutic drug levels did not significantly influence orthostatic blood pressure regulation.*** Nortriptyline caused moderate changes in systolic time intervals, indicating impairment in myocardial contractility. This effect was not seen with imipramine, but a majority of the patients did not reach therapeutic plasma levels because of blood pressure reactions. Neither imipramine nor nortriptyline induced changes in cardiac conduction time measurements or arrhythmias. In addition to the blood pressure reactions, the use of imipramine was complicated by dose dependent kinetics.
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