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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by Malcolm64 on May 3, 2007, at 0:44:28
Someone here suggested that I talk to my doc about having him prescribe Provigil to counteract the drowsiness of Parnate and that this combination was safe, that he just needed to be educated.
However, I found the following information on Provigil on Wikipedia:
"MAOI's conflict with a very broad range of substances. Modafinil has not been tested with MAOIs, but is expected to significantly potentiate the drug response (factor of 4 or more). Using Modafinil within two weeks of an MAOI, such as Parnate (tranylcypromine), Nardil (phenelzine), Emsam (deprenyl), or Marplan (isocarboxazid) creates the potential for hazardous and potentially fatal side-effects."
I don't remember who posted the message, but what do you think about the above caution? "Potentially fatal side effects" doesn't sound to me like these two drugs can be combined. Is there a link that the person who posted it can provide that contradicts the above Wikipedia entry.
BTW, I found a very informative article on Provigil on Slate.com. Here's the link:
http://www.slate.com/id/2079113/
Malcolm
Posted by Honore on May 3, 2007, at 10:24:30
In reply to Can you take an MAOI and Provigil together?, posted by Malcolm64 on May 3, 2007, at 0:44:28
Short answer: I did. With both Parnate and Emsam. No problem whatever.
I think sometimes, in an excess of caution, these lists overestimate possible dangerous combinations.
Honore
Posted by Phillipa on May 3, 2007, at 11:20:52
In reply to Re: Can you take an MAOI and Provigil together? » Malcolm64, posted by Honore on May 3, 2007, at 10:24:30
I think the world is not getting the sleep it needs and that artificial means to stary awake can be dangerous to the body in the long run per your article. Love Phillipa
Posted by Jeff81 on May 3, 2007, at 22:39:05
In reply to Re: Can you take an MAOI and Provigil together?, posted by Phillipa on May 3, 2007, at 11:20:52
I feel your pain.
Honore, what dosage of Provigil where/are you on?I am dying without my Provigil. I have always used a stimulant. It is am important part of my med cocktail. I have been on Emsam for 8 weeks and off Provigil for 8 weeks. Any positive from Emsam is overshadowed by my tiredness. I have 2 sleep disorder which screws up my sleep. Also I have adhd and benefit greatly for some type of stimulant. I am extremely frustrated. My doc says he will look into me taking Provigil with Emsam since it says use with caution. He has been looking into it for 2 months now with no answer.AHHH. My life has been terrible bc of my tired/depressed state. Sorry for dropping my frustrations on you guys. Thanks for the Support
Please let me know anything you hear about this topic.
-Jeff
Posted by stargazer on May 4, 2007, at 5:51:43
In reply to Can you take an MAOI and Provigil together?, posted by Malcolm64 on May 3, 2007, at 0:44:28
I did for a few days with my pdocs authorizing it and he is very conservative. It just made me feel sleepier instead of more alert so after a few days I stopped it.
Stargazer
Posted by Honore on May 4, 2007, at 11:18:44
In reply to Re: Can you take an MAOI and Provigil together?, posted by Jeff81 on May 3, 2007, at 22:39:05
Hi, Jeff. I use about 200 mg provigil a day, 100 mg a little after I get up, and another 100 mg in the mid or late afternoon.
I didn't get much AD effect from Parnate until I was on 80 mg, and was on 100 mg/day for several years. The provigil helped a little but not much, even though I took 300 mg a day,, at the time.
With Emsam, I find it helps much more-- so I hope you pdoc finds his way to prescribing it. I've never had any problems with it, on either AD-- other than it can become less effective over time. That's why I'm keeping my dose at 200 mg now, in case it happens again. I had taken time off, so that it was effective when I went back on it.
I've always had insomnia too-- which is worse on Emsam, but nothing like the problems with Parnate.
Maybe your pdoc could talk to some other pdocs who use Emsam and provigil-- I really think in general it's a very safe combination. Certainly, you could try it, carefully, in smaller doses, so as to be sure it won't cause any complications. My pdoc suggested that at times when he wasn't 100% sure about substances-- He knows I'm careful, too.
If your pdoc trusts you to let him know at the first sign of trouble, maybe he could start you on a low dose for a while, and gradually build up, monitoring your progress closely for a while.
Honore
Posted by UgottaHaveHope on May 5, 2007, at 0:05:28
In reply to Re: Can you take an MAOI and Provigil together?, posted by stargazer on May 4, 2007, at 5:51:43
Your pdoc or other literature advises against Provigil and every other med known to man because of L-I-A-B-I-L-I-T-Y,
Posted by UgottaHaveHope on May 5, 2007, at 0:06:44
In reply to Re: Can you take an MAOI and Provigil together? » Jeff81, posted by Honore on May 4, 2007, at 11:18:44
What dose are you taking?
How long did it take to feel an effect?
What was that effect?
Did it do anything specifically for anxiety?
Thanks Michael
sportscarvell@yahoo.com
Posted by Jeff81 on May 5, 2007, at 1:20:58
In reply to Re: Can you take an MAOI and Provigil together? » Jeff81, posted by Honore on May 4, 2007, at 11:18:44
I think my pdoc is going to prescribe Provigil for me (Thank God)!!! He said he recovered literature (from Emsam) about the Emsam Provigil situation. He explained this to me over the phone but I am seeing him next week and will look closer to the letter from Emsam. I will let you guys know the details next week. He told me that they recommend not taking both medications but in every instance they have recorded this combination has never been a problem.
My doc says it's up to me to decide what I want to do. I want to go back on Provigil. I don't know how much dose to take. I was taking 400mg two months ago (pre Emsam). Has anyone gone this high on Emsam? I am on 12 mg of Emsam and I think it is starting to work. I pray it does. In the past I when I took Provigil I would build up a tolerance which led me to 400 mg a day. That might be dangerous with 12mg of Emsam.? Please share your Provigil/Emsam dosage? Thanks for your help!!
Posted by Honore on May 5, 2007, at 11:45:10
In reply to Re: Honore, can you please update me on Emsam » Honore, posted by UgottaHaveHope on May 5, 2007, at 0:06:44
Hi, Michael.
I'm taking between 9 and 12 mg. (I sometimes take the patch off at night, but I've started taking 12 mg recently). This time around, I've been taking it since the beginning of December, 2006, or about 5 1/2 months. I also took it for almost four months last spring-summer.
I felt an effect pretty quickly, within about 7-10 days, but it was not a strong effect. Still I 'm pretty sure it was the Emsam.
It helps a great deal with anxiety and energy. Even though I had some initial agitation, that disappeared and I found, even with the agitation, I had a simultaneous lessening of anxiety. I know that doesn't sound sensible, but I felt a distinction. In general, my social and general anxiety are much less.
I've always used xanax for anxiety, and I still use it fairly often, if I have a lot of anxiety, which still sometimes happens. However, I'm doing things that before I never would have considered because of the amount of anxiety I had about them. I use seroquel and ambien for insomnia.
I'd say the effect strengthened at some point after several months. In fact, I noticed a much greater change in affect and energy after several months, than I did during the first couple of months.
I'll write you a more detailed email, if you'd like. I'm also using some other things that I think augment the effect of Emsam for me.
Honore
Posted by UgottaHaveHope on May 5, 2007, at 14:45:28
In reply to Re: Honore, can you please update me on Emsam » UgottaHaveHope, posted by Honore on May 5, 2007, at 11:45:10
Honore:
Yes, if you could, please write me an email with more specifics on Emsam and what you augment it with, in your opinion, to get it the most effective in your body.
I am just amazed about how you and a few others have said that 12mg actually helped your anxiety more. You would think that MORE of an "energizing drug" would make you feel MORE anxious, but based on your post and some of the others, the opposite is true, which greatly excites me.
My email is sportscarvell@yahoo.com
I took Emsam 6gm for generalized anxiety (along with 4mg or less of Klonopin and 50mg of Seroquel) and felt like 6 on scale of 1-10. I am on two-month trail of Nardil. aiming for 10. So-so after one month.
If Nardil does not work, the post of you and others about the 12mg patch will make me go to that ASAP after this trial. Thanks so much for sharing your story, Michael
Posted by KayeBaby on May 7, 2007, at 13:38:07
In reply to Re: Honore, can you please update me on Emsam » UgottaHaveHope, posted by Honore on May 5, 2007, at 11:45:10
I would be very interested in your findings with EMSAM.
Would you post it here?
Thanks!
Kaye
Posted by Honore on May 7, 2007, at 19:38:00
In reply to Re: That amazes me » Honore, posted by UgottaHaveHope on May 5, 2007, at 14:45:28
Hi, Michael (and Kaye).
I thought I would try to describe why I found Emsam better for anxiety at 12 mg than 6 mg and what other meds I've used with it.
I've had a pretty severe chronic form of atypical depression for my whole life (since adolescence). I've also experienced radical worsenings of it, at intervals of pressure to perform, or under other stress or when in destructive relationships.
I never took any ADs before I went to a pdoc in my city about five years ago, at which point he recommended an Maoi (which is something he's very experienced with and has used, despite their unpopularity).
I had been taking provigil before that, which I had gotten at a foreign pharmacy, for my own use-- because I had no energy or motivation and was trying to help myself do some work.
So I used Parnate with the provigil, and also xanax, because he observed that I had pretty severe anxiety attacks also.
I had to stop the Parnate, because of a rare side effect, after about three and a half years.
When I started Emsam, in May 2006, , the depression had gotten pretty bad, so I was starting from a bad state-- although I hadn't been suicidal since prior to the Parnate. So I was pretty depressed when I started and also not doing much work, and avoiding contact with other people entirely.
I did feel what I would have called anxiety on the Emsam, but I also simultaneously found that I was more able to get through or past it. So I would have an anxiety attack, and then instead of becoming avoidant, I would still want to try going out, and would feel much more able to meet people, or do things.
I should point out, I'm also in therapy and I feel that that interacted with the Emsam in a very helpful way.
At one point, I was using 18 mg for 12 hours, rather than 9 mg for 24, because of sleep problems, and I noticed that I was starting to have a sense of internal agitation-- very strong repetitive or obsessive negative thoughts about things that had happened or about my surroundings (if I was outside). But it was different from anxiety-- it was heightened, but it was also almost like a very aggressive feedback loop in my head that was pushing everything else aside and that I couldn't relieve.
So I reduced the amount to 12 mg/18 hours and this agitation completely remitted. I did have some level of anxiety, which decreased over time. But even when this lesser agitation was palpable, I found that there was some sort of compensating greater openness and willingness to try social things., It wasn't a huge change, but it was progressive, so that by the end of the summer, I was, with difficulty, doing things I hadn't been able to do for years.
I think, also, that I was somewhat less likely to become totally discouraged and was more able to think in a hopeful way about solutions to things that had come up that I was upset about. I would initally get upset, but somehow, I found that the Emsam opened up some space for me to think more about possible ways of handling things, and to move away from the panic--and also not to return to the fearful thoughts, again and again, but to stick with the idea that I could handle the problem.
And as I say this was rather modest at the beginning-- although it was noticeable after a few weeks, but it became much more noticeable during the late summer and early fall.
In Sept., I had to stop the Emsam because of another reaction to another med.
I resumed the Emsam in December 2006.
This first time around, I was taking Emsam, provigil, adderall and/or ritalin often but not all the time, xanax, at times, sometimes everyday and other times less often, but fairly frequently, and about 12 .5 mg seroquel for sleep. I found 12 mg to be a much more effective dose, because it accentuated the positive, without increasing my anxiety-- so the openness and ability to handle things seemed much stronger, and the Emsam-specific anxiety had seemed, over time, to have abated, possibly from accommodation-- as had the insomnia. I still did have insomnia-- but I always have had that.
So I guess I'd say there's accommodation that makes the anxiety much less problematic.
Activation doesn't always mean anxiety for me, though, because I have such reduced energy and motivation, with a lot of anxiety. I don't know how that would work for you.
For example, provigil has given me energy, but has never made me anxious. Adderall does involve some anxiety, but I don't find that ritalin does.
Sorry this is so long-- I do think everyone is so different, sometimes it's hard to answer questions abstractly. The second time around has been much better, but it's kind of different, and maybe this answers the main question.
Honore
Posted by Jeff81 on May 7, 2007, at 21:34:31
In reply to Re: Can you take an MAOI and Provigil together? » Jeff81, posted by Honore on May 4, 2007, at 11:18:44
Hi I am going to the Pdoc tomorrow. I hope I leave with a RX for Provigil.
BTW I am feeling much better on Emsam since I jumped to 12mg a week ago.
Thanks for your support.
Posted by UgottaHaveHope on May 8, 2007, at 1:05:20
In reply to Re: That amazes me » UgottaHaveHope, posted by Honore on May 7, 2007, at 19:38:00
I appreciate you taking the time to share most of your story. I learned a lot from reading that post and have saved it. Thanks man.
This is the end of the thread.
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