Posted by Rick on November 6, 2001, at 19:16:24
aka: Pharmacology/Shmarmacology
aka: Hey, whatever works...
-------------
NOTE: THIS IS RATHER LONG. YOU CAN SKIP THE PARAGRAPHS MARKED [CAN SKIP] FOR A CONDENSED VERSION.
-------------As I’ve posted ad nauseum, I’ve had great, consistent success with my cocktail of Klonopin, Serzone and the novel, non-amphetamine, psychoactive stimulant Provigil (modafinil) for severe non-depressive Social Anxiety. And my doses have never gone up, only down.
Today I had vivid reinforcement of what a powerful contributor Provigil is to my treatment!
[CAN SKIP] Background: Because of concern over the bothersome benign floaters (hair-like and round, usually-opaque-appearing “debris” floating in my left eye’s field of vision under many condtions), I decided to stop the Provigil awhile on the slim chance that it could be potentiating my awareness of these cursed swirling dervishes of bound protein. (The floaters started showing up within a few months of the time I added Serzone and Provigil to the Klonopin I had been taking for over a year. One study shows a pre-optic region of the brain to be one of the main areas where Provigil increases alertness. Incidentally, as I mentioned in another thread, Serzone is notorious among AD’s for affecting visual perception.)
Well, I had long ago reduced my daily Klonopin to 1 mg since being on the cocktail. And while I still WASN’T getting fatigued after experimentally stopping the Provigil three days ago (even though Serzone and Klonopin can both be sedating ) I DID find myself getting more anxious. Still 50-60% better than pre-Klonopin, but I’ve been used to 80-90% since taking the cocktail. I take all my meds in the morning. But late this morning, as I found my voice getting a little shaky during an important conference call, so I added a mere .25 mg of Klonopin. Within 15 minutes, I could barely keep my eyes open. So I violated my no-Provigil experiment and took 100 mg (my usual daily dose) from my pocket pill holder. Withon a half hour, I was more awake, but still sleepy. So I impatiently took another 100 mg, since I occasionally take 200 mg in one day, (Doubling my Provigil dosage provides a nice added boost for a day or two, but then starts getting me a bit wired.) By the time the terminally-dull conference call was over, I was fully awake.
Later today, I was in a meeting and noticed that I was asserting myself so confidently, with great energy -- a 180-degree turnaround from the way things were in the “old days”. So I told myself, “hey, see, you don’t need Provigil to build energy and confidence.” Of course, moments later I remembered that I HAD violated the floater experiment by taking Provigil 5 hours earlier.
[CAN SKIP] (Aside re briefly forgetting I took the Provigil: the one troublesome aspect of my cocktail – assuming the vitreous floaters AREN’T med-related -- is some memory lapses, so my brief forgetfullness here wasn’t surprising. I can reason and come up with creative ideas better than ever, but will sometimes think, “now WHAT was it I did awhile back regarding this issue?”. The forgetfulness most likely comes from the other meds and perhaps age-related memory loss. Despite the amnesic reputation of benzos, this issue didn’t surface until I began Serzone.)
In any event, this episode just drove home what a greatly beneficial anti-anxiety, assertiveness effect Provigil adds to my social phobia treatment. For me, this novel stimulant is GREAT for anxiety. It was such a pleasant surprise after my disappointment using selegiline and Wellbutrin used as mild stimulants (I refused my pdoc’s desire that I take Ritalin, and convinced him into letting me be his guinea pig for Provigil).
[CAN SKIP ENTIRE SECTION] In all fairness, I have some caveats, although none change my enthusiasm over Provigil’s benefits:
(1) Without Provigil, I likely would have developed more fatigue tolerance to an increased dose of Klonopin within a week or two, as I did when I first took the med. I was, frankly, a little surprised to find that 300 mg Serzone + 1 mg Klonopin wasn’t tiring me out at all w/o Provigi. I’m also surprised that adding a mere .25 mg Klonopin to the usual 1.0 caused so much fatigue. However, I probably shouldn’t be surprised, because I long ago posted on this very board that taking more than 1 mg of Klonopin at a time always makes me sleepy, especially if taken in multiple doses less than four hours apart.
(2) Maybe the initial partial return of anxiety would have largely gone away as my body adjusted to not having Provigil – but I highly doubt it.
(3) I don’t know whether Provigil would work so wonderfully without the other two meds. I sometimes wonder if Serzone's contribution is primarly through metabolic interactions that prolong and intensify the effects of Provigil and Klonopin. But I DO palpably FEEL the Serzone (in a helpful way) when I first take it, and I doubt it could simply be affecting the other meds THAT quickly.
(4) Many users posting to this board have given negative assessments of Provigil. This should by no means be discounted, although I think the reaction can vary greatly according to condition; dosing (recall that 3 days at 200mg makes me wired, even though one or two days is great); kind of combo (Provigil not usually taken solo); mistaking loss of euphoria side-effect as poop-out; confusion with amphetamine-based stims (reflected either as reluctance to take/prescribe OR as an insufficient-effectiveness conclusion by previous (e.g.) Ritalin users – like trying to give BuSpar to a Xanax veteran); or simply expectations out of synch with the drug’s areas of strength.
(5) I went to bed very late last night. Fatigue does make me more prone to anxiety. So maybe the wakefulness-inducing Provigil is especially helpful on days like today. But again, I WASN’T tired this morning until I took that extra little .25 mg of Klonopin. But I don’t recall the time of peak action for Serzone, and certainly don’t know what it would be for possibly-potentiated Klonopin.
(6) While I wasn’t tired at all the previous 3 days sans Provigil (all low-sleep days, too), perhaps there was still some Provigil in my bloodstream.Despite these caveats, today’s episode just reinforces for me what a godsend Provigil is for my Social Phobia, at least in combo with the other meds.
I heard today that importer Cephalon announced record earnings this year based on Provigil. This is despite the failure to show clinical significance in the initial placebo-controlled ADD trial, which had been deemed a major blow to the company. (This may have been related to the way the study was done; I’ve heard they’re continuing to test for this indication based on some very favorable anecdotal evidence.) If they can do this well despite the ADD setback, it’s clear that off-label uses of this med must be exploding, and patients must be responding. (How else could such a high-priced drug drum enough usage to drive up earnings? Certainly not from the relatively small number of people with narcolepsy, the official indication). Unfortunately, I have a feeling anxiety disorders won’t be among any of of the investigated uses anytime soon. (Although benefits in this area may surface as use of Provigil for AD augmentation accelerates, given that AD’s are often prescribed for non-depressive anxiety.) Right now some of the possible focus areas seem to be AD Augmentation, ADD/ADHD. Sleep Apnea, Parkinson’s, and Alzheimer's (not sure if the latter is still under active consideration), and Multiple Sclerosis-induced fatigue (looks very promising here).
Rick
poster:Rick
thread:83383
URL: http://www.dr-bob.org/babble/20011104/msgs/83383.html