Posted by zeugma on February 16, 2005, at 16:22:44
In reply to Re: ed- your opinion please » zeugma, posted by ed_uk on February 16, 2005, at 7:06:14
> Hi Zeugma!
Hi Ed!
>
> >i needed to be simultaneously calmed and stimulated
>
> Me too!!! I don't like caffeine either, it does nothing for me, I still feel tired.
>
> >there's clonazepam 1 mg, which keeps a lid on the anxiety but which adds to the asthenia, so i keep the dose as low as possible.
>
> Do you think it's worth trying a different benzo? I think I've asked you that before but I don't remember what you said. You could try a low dose of chlordiazepoxide or something like that? For whatever reason, some people find certain benzos more fatiguing than others. I have a friend who found chlordiazepoxide made him more tired than clonazepam but other people seem to find the opposite.
>Don't you think ALL benzos have, as a consequence of GABA potentiation, a degree of sedative activity? In my case, atomoxetine had more fatiguing/depressogenic activity than clonazepam, although clonazepam is a natural suspect. I also differentiate between the sedative activity of nortriptyline, which is antihistaminic in nature, and the unusual fatigue that atomoxetine induced. I find myself fairly tolerant of antihistamines, and they do help me sleep (another paradox: I am sleepy all day, but sometimes feel too agitated to sleep at night. My circadian rhythms have been totally off since childhood!)
> >he wants me to retry Provigil at 50 mg tomorrow am.
>
> Perhaps it could be worth one last try. I'm a bit concerned that what you experienced before was some kind of unusual allergic/hypersensitivity reaction. The swollen lymph nodes (lymphadenopathy) reminded me of 'serum sickness'. It's probably way off but here's a link, may drugs can cause serum sickness but I've never heard of a case with modafinil......
> http://www.emedicine.com/EMERG/topic526.htm
>Thanks for the link. It is obviously a major concern. It was frustrating because I did not discontinue Provigil because of lack of efficacy, and I stayed on it as long as I could because I was clearly getting a lot of benefit from it. So far no swollen lymph nodes or other weird reactions :) But of course, I am going to be careful, and I'm glad my pdoc app't is next week. At the time, I didn't know that the lymph node problem could have been serum sickness or allergic reaction. I do have a multitude of allergies, and certain drugs have caused potentially life-threatening reactions, and I am hugely concerned that this will happen with provigil again too. At the same time I have been falling asleep at work, so you can see my dilemma. And the caffeine pills I was taking every three hours were more effective at causing anxiety than having any kind of therapeutic effect.
I'm terrified of the amphetamines ,too. It seems like I run into big problems when I go below 75 mg nortriptyline, so I can't really take any drug that has substantial sympathomimetic activity without seeing a cardiologist.
As far as I recall, the adverse reactions to Provigil began with the first dose, and were not dose-dependent. So maybe the fact that so far I've gotten through unscathed is a good sign. On the other hand, I am going to have my pdoc look at my lymph nodes regardless of how I feel just to be sure.
> >I know it's a long shot, but I suppose it's just possible that the weird s/e I experienced on provigil were specific to nortriptyline, and that switching to desipramine might alleviate them.
>
> It's possible, that's all I can say really. Your Provigil side effects were quite unique, I really don't know what caused them.
>
> >And provigil, unlike d-amphetamine, would not send me to the cardiologist
>
> I wonder whether a cardiologist might suggest bisoprolol, it's more beta1 selective than atenolol- I think it penetrates the blood brain barrier to a greater extent though.
>
> >if it's something like akathisia, an SSRI or an AP would be a very bad idea
>
> What makes you think it was akathisia?
>I have terrible difficulty initiating movements. I constantly feel this 'resistance'to actual physical movement though I am simulataneously tense within. It has been improved by nortriptyline, which is mildly antimuscarinic, and is specifically mitigated by provigil, which appears to act on circuits intimately tied to movement:http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=9774168
you can see that provigil is under investigation for Parkinsonian disorders. There is a very close connection between Parkinson's disease, depression, and sleep disorders. I am afraid that if I don't treat my various sleep/attentional./affective disorders properly, I'll wind up with Parkinson's soon (this also is what terrifies me about the atypical AP's).
Best,
z
> Best Regards,
> Ed.
poster:zeugma
thread:446337
URL: http://www.dr-bob.org/babble/20050212/msgs/458894.html