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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by blueberry on December 31, 2005, at 17:41:06
I am aware provigil is good for staying awake, staying alert, and being active. But what about its effects on depression?
For example, a classic depression symptom I have that persists on all antidepressants of all kinds is a lack of interest in anything. No pleasure. No zeal. I'm wondering if I took provigil if it would make me more active but at the same time not really interested in whatever I'm active doing. Or does it help to create interest and pleasure? Does that make sense?
I know for a fact that for me ritalin and adderal work good, too good, in a false way, a high more than a chemistry correction. And then the anxiety and ups and downs. They are too heavy duty for me, though highly effective and highly addicting like street drugs.
Cymbalta on the first 2 days works wonderfully, but then fades out real fast into blahness again. So I think there is a clue there about something to do with norepinephrine, but that the reuptake inhibition route isn't the right approach for me.
Any real mood enhancement with provigil?
Currently only taking 5htp at my doc's direction and weaning off zyprexa (now 1.25mg). So I'm clean and wide open for ideas. Provigil caught my attention, but I just don't know enough about its mood enhancement descriptions. Could you describe how it affects mood? Interest? Pleasure?
Posted by ed_uk on December 31, 2005, at 18:56:17
In reply to Provigil as mood enhancer?, posted by blueberry on December 31, 2005, at 17:41:06
How do you respond to tricyclic ADs such as nortriptyline?
Ed
Posted by Racer on December 31, 2005, at 19:54:07
In reply to Provigil as mood enhancer?, posted by blueberry on December 31, 2005, at 17:41:06
It helped me, all on its own, but that effect faded in a bad way: after about a year, Provigil seemed to make me MORE depressed, even though it had certainly brightened my mood at first. I took it with various other drugs, which kinda masked its effects, so I don't know how long it actually helped for.
It might be worth trying, and it might help, and it might not fade the same way for you. Other than it stopped helping, it was a very friendly drug for me.
Oh, and you know how we say 'your mileage may vary?' On Provigil, I needed a nap every day...
(Guess I'm a bit odd, huh?)
Posted by Phillipa on December 31, 2005, at 20:23:43
In reply to Re: Provigil as mood enhancer?, posted by Racer on December 31, 2005, at 19:54:07
Boy if it would only make me want to do something. And blueberry you say cymbalta only lasted a couple of days? At what dose? Fondly, Phillipa
Posted by tecknohed on December 31, 2005, at 21:12:35
In reply to Re: Provigil as mood enhancer?, posted by Racer on December 31, 2005, at 19:54:07
> Oh, and you know how we say 'your mileage may vary?' On Provigil, I needed a nap every day...
>
> (Guess I'm a bit odd, huh?)I was napping on it too untill I reached 4-500mg/day. Have not napped on it since.
What dose were you on?
Posted by tecknohed on December 31, 2005, at 21:40:22
In reply to Provigil as mood enhancer?, posted by blueberry on December 31, 2005, at 17:41:06
Hi
I dont find, or ever expected Provigil to enhance such things as pleasure, interest or even mood in me. And it doesn't, with the exception of mood (in a way). You might want to look at DA and maybe 'light' SE meds for that. Tryptophan (not 5HTP) I've found particularly 'enjoyable' and gives a nice 'glow' at 5g doses. Dont know what theraputic doses would be like. Otherwise MAOIs, Wellbutrin?
What Provigil does do is make me much more mentally active, good if you have trouble with boredom, daydreaming, excessive TV watching etc.
Lofepramine, a Noradrenergic tricyclic did much of the same.
Yet for me these effects are very much anti-depressant effects. When my mind slows down, I often get depressed. Both Provigil & lofepramine have done way more than any SSRI ever did. I even remember lofepramine allowing me to start IT college, despite being paralised with Social Phobia prior to it.Maybe it depends on whether you need 'livening up' or 'calming down'. I can see how an activating med might cause some to become more depressed when they may be practically burt out already.
Posted by Jedi on January 1, 2006, at 4:03:01
In reply to Provigil as mood enhancer?, posted by blueberry on December 31, 2005, at 17:41:06
> I am aware provigil is good for staying awake, staying alert, and being active. But what about its effects on depression?
...Hi,
I haven't used modafinil so I have no first hand knowledge. There is some current research that suggests efficacy in using modafinil as an augmentation stategy for depression.
Jedi
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16208839&query_hl=1&itool=pubmed_docsum
Nord J Psychiatry. 2005;59(3):173-8.
Modafinil augmentation in depressed patients with partial response to antidepressants: a pilot study on self-reported symptoms covered by the Major Depression Inventory (MDI) and the Symptom Checklist (SCL-92).Rasmussen NA, Schroder P, Olsen LR, Brodsgaard M, Unden M, Bech P.
Psychiatric Research Unit, Frederiksborg General Hospital, Dyrehavevej, Hillerod, Denmark.Treatment-resistant depression, i.e. partial or non response to antidepressants in spite of various treatment attempts with optimized doses and combinations, is rather common. With residual symptoms such as tiredness, anhedonia and concentration disturbances, the treatment strategy has often been to use monoamino-oxidase inhibitors (MAOIs). Their use, however, is limited due to interaction problems. Modafinil is recently developed wake-promoting drug with only minor side-effects. Pilot studies indicate that it appears to have an augmentation effect in treatment-resistant depression. This open-label study performed in the private psychiatric practice setting is the first to make a comprehensive evaluation of the target patient profile based on patient-reported symptoms. Modafinil in doses of 100-400 mg was administered as augmentation to ongoing antidepressant therapy in patients with partial response and suffering from hypersomnia. The total number of patients was 21 and 43% of these were responders (i.e. had a score reduction of >50% on the Major Depression Inventory (MDI) as well as remitters, i.e. the remission rate was 43%. At endpoint, the responders had psychological distress scores on the Symptom Checklist (SCL-92) on the level of the general Danish population. Baseline characteristics for responders were lower scores on depression, hostility, anxiety, somatization, obsession and psychoticism. Modafinil thus appears to be an appropriate augmentation to antidepressant treatment, leading to a remission rate of 43%. However, the results from this open-label study need ot be confirmed in a placebo-controlled trial.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15096082&query_hl=5&itool=pubmed_docsum
J Clin Psychiatry. 2004 Mar;65(3):414-20.
Adjunctive modafinil at initiation of treatment with a selective serotonin reuptake inhibitor enhances the degree and onset of therapeutic effects in patients with major depressive disorder and fatigue.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15669893&query_hl=5&itool=pubmed_docsum
J Clin Psychiatry. 2005 Jan;66(1):85-93.
A multicenter, placebo-controlled study of modafinil augmentation in partial responders to selective serotonin reuptake inhibitors with persistent fatigue and sleepiness.
Posted by blueberry on January 1, 2006, at 14:17:57
In reply to Re: Provigil as mood enhancer? » blueberry, posted by ed_uk on December 31, 2005, at 18:56:17
> How do you respond to tricyclic ADs such as nortriptyline?
>
> Ed
Actually I kind of liked nortriptyline, but could barely handle a dose of 25mg and had to quit. The usual TCA side effects for me were intense.Desipramine was even better...nice mood effect, but again the side effects...they were even worse than nortriptyline. Desipramine was up and down dramatically too. For a few hours it had me relaxed and feeling good, but then the stimulation would kick in and it was way over intense. There were good moments inbetween. But again, I just can't handle TCAs. Too rough for me. I have to be as clear headed as I can be at my job, and you know how foggy and blurry the TCAs can be. It was pretty bad.
So I would think reboxetine would be a good choice...not! It created severe depression on top of my already existing depression. There is something special about the TCAs. Now if only they could reinvent them without the anticholinergic part. :(
Posted by blueberry on January 1, 2006, at 14:25:01
In reply to Re: Provigil as mood enhancer? » blueberry, posted by tecknohed on December 31, 2005, at 21:40:22
You mentioned 5g of tryptophan? Wow, that seems like a lot. According to a book I'm using for treatment right now, their highest tryptophan dose recommended is 6 - 500mg capsules, or 3g. I am currently taking 50mg 5HTP 3 times a day. It is only numbing me, not fixing whatever is wrong. The book says 50mg 5htp is equivalent to 500mg tryptophan, and I have some, so I think I'll try switching over and see if there is a difference. I've heard some people can't tell the difference, while other people notice a big difference.
TCAs...I really like them, except that I can absolutely not handle the side effects.
Posted by Cairo on January 1, 2006, at 16:32:01
In reply to Provigil as mood enhancer?, posted by blueberry on December 31, 2005, at 17:41:06
Partially responsive to Lexapro for social anxiety/dysthymia, Provigil augmented the pro-social effect as well as mood a bit in my teen daughter. But raising the dose too much increased anxiety. I felt the Provigil increased desire to socialize, but not confidence.
We've switched to Zoloft from Lexapro due to noticeable cognitive effects from Lexapro, but she's on low dose Seroquel for augmentation now, rather than Provigil.
It's my gut feeling that in persons who have a "sluggish" HPA axis, stimulation with Provigil or psychostimulants may brighten mood, but there are some that need to be careful of too much stimulation.
Cairo
Posted by ed_uk on January 1, 2006, at 23:01:41
In reply to Re: Provigil as mood enhancer? » ed_uk, posted by blueberry on January 1, 2006, at 14:17:57
Hi Blueberry
Some people are slow metabolisers of TCAs and respond best to very low doses that would be subtherapeutic for other people. It certainly sounds like you were benefitting from the TCAs even at a very low dose.
Why not try nortriptyline again starting at 5mg/day? You could increase in steps of 5mg until you find a suitable dose. You'll need the 10mg tablets.
Regards
Ed
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