Posted by not exactly on February 5, 2003, at 13:25:19
In reply to Re: Provigil » not exactly, posted by Stan on February 5, 2003, at 4:43:56
Stan,
Good questions. I'll try to answer them as well as I can. Sorry if this turns out to be more information than you wanted. :-)
> why were you reluctant to increase the provigil dosage in an attempt to recapture your initial good fortune with this med?
If I thought that the poop-out proved that I had not been at an effective level, and expected that a *single* dosage increment would reinstate the benefits *indefinitely*, then of course I would have done so. But I don't think that was the case. It was clearly an effective level at first, and even seemed "too much" at times. The poop-out was a tolerance effect, and my understanding of this (based on my readings and personal experience) is that chasing after the lost "high" only leads to a frustrating and dangerous spiral of repeated dose escalation. I did not want to become a Provigil "junkie". I figured I had given it a fair try, and it had failed to provide an ongoing benefit. Time to move on.
> also, you mentioned that you'd taken mirapex (with good results) during a clinical trial some years back, but you weren't specific about whether you had revisited it later on in life -- did you try it again, and if so, how did you make out the second time 'round? i'm guessing it pooped out on you since you're apparently not using it now.
Since Mirapex was not an option after the trial, I began a search for an effective substitute. Almost everything I tried was useless or worse. Eventually I settled on Wellbutrin + Ritalin, which actually worked rather well for an extended period with no sign of waning benefit. But it never lived up to my glorious memory of my pramipexole experience. So I anxiously awaited the approval and release of Mirapex. Once it became available, I immediated switched over to it, with mixed and overall disappointing results.
One of the problems was determining the right dose. The trial data had not yet been "unblinded", so I could not find out what my dose had been (trial participants were randomly assigned different dosage regimens). At first I was actually taking about 8 times (!) the optimal (for me) dose. When I finally adjusted to the appropriate level, the previous "overdose" exposure may have predisposed me for reduced benefit and premature tolerance effects. I continued on it for about a year, while its effectiveness slowly and imperceptably diminished until I finally realized that I was depressed again.
I could have gone back to the Wellbutrin/Ritalin combo, but instead I volunteered for another AD drug trial: the selegiline patch. It was "deja vu all over again" - dramatically positive results, return to depression after the trial, and a new "magic bullet" that was not available. Damn.
So now I know of 3 completely different drug treatments that have helped - all dopamine boosters, but by different mechanisms. I've been trying to use this knowledge to lead me to another "cure" that hopefully will combine effectiveness, freedom from troublesome side effects, enduring benefits, convience of administration, and low maintenance cost. A tall order, to say the least. But because I know that I have some acceptable (tho not optimal) fallback options, I'm willing to risk the quest. Kinda like rock climbing - you drive in a piton and climb a little higher, reassured by the expectation that a fall won't be fatal.
I recently started desipramine - so far so good. Augmenting with Ritalin or BuSpar (the dopamine thing again) are possible strategies if monotherapy proves disappointing. I'll report on my progress once it fully kicks in.
- Bob
poster:not exactly
thread:138954
URL: http://www.dr-bob.org/babble/20030204/msgs/139600.html