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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by bark2323 on April 26, 2005, at 18:07:06
First, my current med regime and dx:
15mg zyprexa
4mg klonopin
400mg provigil
100mg of seroquel and 600mg of neurontin for sleep
diagnosis: either schizoaffective or depression and schizotypal personality disorderAnyways, my new insurance doesnt cover provigil, and its very expensive, so Im looking for a replacement. I take it mainly cause it helps me cognitively and lifts mood and sociability a bit.
I have a history of drug abuse, so I doubt my doc will prescribe traditional stims (although 2 months ago he prescribed adderall, but when I said it caused too much anxiety which I thought was due to the l-isomer, which he agreed with, but then he said no to future stims). I actually found the adderall to only help with focus anyway and nothing else, but I was only on 20mg.
Wellbutrin seems like a good alternative, but I get irritable on it unless I have an SSRI on board. Its a delayed reaction though, in that at first I feel good, then a week or so later get the irritability. I think this is due to the delayed NE action of wellbutrin, but who knows. The last time I was on it alone I was on 7.5mg of Zyprexa, so maybe now it would be ok? Or would it just be LESS irritable, or do people find that the edginess fades over time? (I would prefer not to have to take an SSRI with it)
I have also been considering amantadine, but I see few positive experiences with it; does anyone here do well on it?
My doc is also most likely not willing to prescribe an MAOI, but if anyone has anything to say about that, it would be welcome.
Im also considering some TCAs, especially desiprimine, but my doc is just very conservative (well actually it depends on which day you catch him on, hence the adderall)
So yeah the punchline is that I need something that gives me energy, and elevates mood and sociability to some extent. All suggestions/experiences welcome!
thanks,
matt
Posted by medhed on April 26, 2005, at 18:49:14
In reply to replacement for provigil, posted by bark2323 on April 26, 2005, at 18:07:06
I'm looking at Deprenyl and DLPA. I've only just started research so I'm not so sure what you would have to lose from your current med regiem. Welbutrin doesn't seem to fit in with this combo though. I myself take Welbutrin 300mg. and I am now kicking 300mg. Effexor, switched to Lexapro 10mg. Welbutrin i've been taking several years but I'm not sure it hasn't pooped out. Welbutrin/Lexapro mix is not my first choice but the Lex is keeping the Effexor's heebie-jeebies at bay so I'm thankful for that. I tryed to coldturkey a couple of months ago and it wasn't very pretty. I read that Deprenyl/DPLA is compared to ECT as far as dealing with depression. 80% success! I have to read more on it though...
My ideal regiem I like is:
Depreyl 5mg.
DPLA 250mg.
Lyrica ?mg.
Lunesta 3mg.
Low dose SSRI if needed
I wanted to try Provigil but I can't see where it's indicated here, but I guess that's why I have a PDOC.
I'm Major Depressive, OCD (light), PTSD, ADD,
I've been told before that I might be borderline, antisocial behavior disorder, and even a sociopath. But I believe it's all relative, to me I just don't feel so good alot of the time.
Oh, Ive been in cognitive therapy for ten yrs. now.
Posted by hawkeye on April 26, 2005, at 20:32:03
In reply to replacement for provigil, posted by bark2323 on April 26, 2005, at 18:07:06
Coffee.
In some trials for Provigil the results were similar between the group taking Provigil and those drinking coffee:
"there was a study conducted at the Walter Reed Army Institute of Research, down in Silver Spring, Maryland, that found six cups of coffee produce the same results on people as modafinil does."
Posted by alohashirt on April 26, 2005, at 23:53:31
In reply to replacement for provigil, posted by bark2323 on April 26, 2005, at 18:07:06
You don't mention where in the world you live which is germane to this question.
If you are in the EU you might
see if your doctor can prescribe Olmifon (Adrafinil) which is chemically similar to Provigil and about 15% of the cost.
If you google it appears that in some countries this is an OTC
or nutritional supplement available on the web.Weird these regional inconsistencies!
Posted by bark2323 on April 27, 2005, at 9:36:12
In reply to Re: replacement for provigil » bark2323, posted by alohashirt on April 26, 2005, at 23:53:31
Thanks everyone for posting. Unfortunately, if my insurance doesnt cover provigil for me, I doubt they would cover selegiline (sp?). Medhed, did wellbutrin ever make you edgy, and if so, did that feeling go away?
I also cant drink too much caffeine, as it makes me nervous, but thats interesting that such a high priced drug is about the same as a couple cups of coffee!
Oh, and I live in the US.
Thanks again,
matt
Posted by Declan on April 27, 2005, at 17:17:40
In reply to replacement for provigil, posted by bark2323 on April 26, 2005, at 18:07:06
You could try Adrafanil. It kind of spooked me (states of inner tension). Maybe you need to keep an eye on LFT enzymes.
Declan
Posted by medhed on April 27, 2005, at 17:42:52
In reply to Re: replacement for provigil, posted by bark2323 on April 27, 2005, at 9:36:12
> Thanks everyone for posting. Unfortunately, if my insurance doesnt cover provigil for me, I doubt they would cover selegiline (sp?). Medhed, did wellbutrin ever make you edgy, and if so, did that feeling go away?
> I also cant drink too much caffeine, as it makes me nervous, but thats interesting that such a high priced drug is about the same as a couple cups of coffee!
> Oh, and I live in the US.
> Thanks again,
> matthi matt
Welbutrin did give me a stim type reaction, but that was what I needed. Nervous for a week maybe, then a coffe and ciggarette type feeling. I never forget to take my dose, it's like a small craving when I wake up, just like coffee. I think it pooped out but I have no way of really knowing unless I stop taking it, And that little craving always keeps me on it. I will see soon as I think it's about time for a change, I wonder about withdrawl, my pdoc says no but I heard that one before...
Posted by gromit on April 28, 2005, at 2:35:25
In reply to Re: replacement for provigil, posted by bark2323 on April 27, 2005, at 9:36:12
> Thanks everyone for posting. Unfortunately, if my insurance doesnt cover provigil for me, I doubt they would cover selegiline (sp?). Medhed, did wellbutrin ever make you edgy, and if so, did that feeling go away?
Generic selegiline is not very expensive even if your insurance doesn't cover it. I paid $10 co-pay for 60 5 mg tablets, the cost would have been around $30 without insurance if I remember right.
> I also cant drink too much caffeine, as it makes me nervous, but thats interesting that such a high priced drug is about the same as a couple cups of coffee!
For me caffeine is an uncomfortable stimulant, even 400+ mg of provigil didn't make me jumpy like too much coffee.
Posted by bark2323 on April 29, 2005, at 13:58:23
In reply to Re: replacement for provigil, posted by gromit on April 28, 2005, at 2:35:25
thanks everyone for your suggestions. Were going to do either wellbutrin or amantadine, but not right now. For one thing he wants to read up on amantadine (sometimes I think the only time he sees pubmed or similar articles are when i bring them in), but I am also going to visit my parents, and I have enough provigil for that, so I dont want to ruin the vacation with a bad med trial.
Thanks again,
matt
This is the end of the thread.
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