Posted by Rick on October 29, 2001, at 23:43:31
In reply to Re: Cal Rocket Fuel - Clarification on modaf study » houstongirl, posted by Rick on October 29, 2001, at 22:50:10
Cristy -
Just recalled from another thread that you're taking a *very* high dose of Celexa (100mg.)
Given that the most likely interaction would cause Provigil to INCREASE blood levels of Celexa (through inhibition of the CYP 2C19 enzyme that Celexa needs for elimination), I'm not surprised you're having trouble keeping your eyes open!Sounds like you've been through about all the SSRI's, plus Tricyclics and Wellbutrin. Have you tried Serzone or Remeron? These can be even more sedating than SSRI's (Remeron even more so than Serzone), but Provigil would likely work a lot better with these than with Celexa, and the their unique mechanisms often help folks who were unresponsive to other AD's. I like Serzone -- as long as I can counteract the sedation effects (which not EVERYONE has) with Provigil -- because it maintains sexual function without added anxiety, among other benefits. As you well know everyone reacts differently, but these might be worth considering, or maybe an MAOI as I believe kregpark suggested (these often work wonders for nonresponders to other AD's, although there are some food restrictions).
Sorry to hear you lost your job. Hang in there, you'll get where you need to be.
Rick
> Yeah, I noticed that too but didn't want to open a can of worms. I can easily think of a dozen possible explanations, starting with methodological isssues (e.g., small sample size for the 7-person study; lack of AD dosage info for both that study AND the study citing the frequent metabolic interaction between Celexa (citalopram) and Provigil; the latter study's stronger focus on reduction of fatigue side effects (vs. enhancing AD response), etc. And there's always YMMV -- plenty of people do well on a med that has been shown to have a *statistically* insignificant effect for their disorder. I wonder when, and if, the study mentioning the metabolic reaction will appear in Medline, given that it was presented to the APA convention in May?
>
> I *have* done a little seraching through the newsgroups and do sense lower success combining Provigil (modafinil) with Celexa than with other AD's. One person reported better depression response from Provigil alone than from a Provigil/Celexa combo! And for the record, there were plenty of people taking other AD's who were by no means enamored of Provigil as an augmentor. ( But you certainly can't count me among the disenchanted group with my 2-years-and-stronger-than-ever Serzone/Klonopin/Provigil Social Phobia cocktail!)
>
> Perhaps a telling point from the 7-person study is that the two patients taking Provigil with Celexa alone (a third took it in tandem with activating Wellbutrin) had the slowest response to their combo with Provigil (although still relatively quick). Also note that these same patients had the lowest baseline depression severity, so maybe they didn’t need as big a punch from the Provigil.
>
> Again, I can think of lots more possibilities, such as inter-individual variation in enzyme production, but I’ll stop here.
>
> Rick
>
> > I thought there was a known metabolic interaction between citalopram and modafinil?
> >
> > > >I don't know if it is relevant, but the majority of patients who responded in the small open-label study of modafinil-augmentation often cited were taking bupropion. I think this was more the result of patient selection than rate of response.
> > >
> > >
> > > - Scott
> > >
> > > >Clin Psychiatry 2000 May;61(5):378-81 Related Articles, Books
> > >
> > >
> > > >Modafinil augmentation of antidepressant treatment in depression.
> > >
> > > >Menza MA, Kaufman KR, Castellanos A.
> > >
> > >
> > > This may be even *less* relevant, but for the record there were 7 patients in the Provigil (modafinil) augmentation study often cited. Here's the lineup:
> > > #1 Celexa (citalopram) and Wellbutrin (bupropion)
> > > #2 Wellbutrin and Deseryl (trazodone)
> > > #3 Celexa
> > > #4 Celexa
> > > #5 Wellbutrin, Depakote (divalproex), and Lamictal (limotrigine)
> > > #6 Serzone (nefazodone) and Paxil (paroxetine)
> > > #7 Effexor (venlafaxine)
> > >
> > > The attached link gives more patient details including age, diagnosis, previous meds, time to initial effect, and brief analysis.
> > >
> > > Rick
> > >
> > > http://alertpubs.com/august2000psych.htm#Stimulant Augmentation in Depression
>
>
>
>
>
>
> > I thought there was a known metabolic interaction between citalopram and modafinil?
> >
> > > >I don't know if it is relevant, but the majority of patients who responded in the small open-label study of modafinil-augmentation often cited were taking bupropion. I think this was more the result of patient selection than rate of response.
> > >
> > >
> > > - Scott
> > >
> > > >Clin Psychiatry 2000 May;61(5):378-81 Related Articles, Books
> > >
> > >
> > > >Modafinil augmentation of antidepressant treatment in depression.
> > >
> > > >Menza MA, Kaufman KR, Castellanos A.
> > >
> > >
> > > This may be even *less* relevant, but for the record there were 7 patients in the Provigil (modafinil) augmentation study often cited. Here's the lineup:
> > > #1 Celexa (citalopram) and Wellbutrin (bupropion)
> > > #2 Wellbutrin and Deseryl (trazodone)
> > > #3 Celexa
> > > #4 Celexa
> > > #5 Wellbutrin, Depakote (divalproex), and Lamictal (limotrigine)
> > > #6 Serzone (nefazodone) and Paxil (paroxetine)
> > > #7 Effexor (venlafaxine)
> > >
> > > The attached link gives more patient details including age, diagnosis, previous meds, time to initial effect, and brief analysis.
> > >
> > > Rick
> > >
> > > http://alertpubs.com/august2000psych.htm#Stimulant Augmentation in Depression
poster:Rick
thread:81334
URL: http://www.dr-bob.org/babble/20011025/msgs/82635.html