Posted by Tomatheus on January 17, 2007, at 13:57:33
In reply to Provigil poop-out or Lithium lethargy?, posted by gardenergirl on January 12, 2007, at 9:59:24
gg,
I apologize for the delay in my response.
I don't know a whole lot about Provigil, but it is my understanding that the medication does have a tendency to "poop out" in a lot of individuals. I certainly think it's possible that Provigil poop-out may be contributing to the fatigue that you've been experiencing. However, considering that your sleepiness is more pronounced now than it was before you started taking Provigil, it would be my guess that Provigil poop-out is probably just one factor, if it is a factor at all.
As far as lithium is concerned, I think there's a chance that it may be contributing to your feelings of fatigue, possibly by impairing the functioning of your thyroid gland. I didn't really feel any more tired when I was taking lithium than I did before I started taking it, but I did develop severe akathisia and problems with memory and concentration while I was taking lithium (in addition to the extrapyramidal side effects of tremor, dystonia, and muscle rigidity). These problems persisted after I stopped taking lithium and have since subsided to a noticeable extent, but not completely. I now suspect that at least some of the long-term effects of lithium that have plagued me since discontinuing the stuff more than a year and a half ago may be due to a lithium-induced change in my thyroid functioning (and I am planning to get my thyroid levels checked when I have the means to). Considering that fatigue is a common symptom of hypothyroidism and that muscle weakness can result from either hypothyroidism or hyperthyroidism (muscle "weakness" is said to be a symptom of hyperthyroidism, but muscle "aches and cramps" are said to be symptoms of hypothyroidism), I think that there's a possibility that the sleepiness that you've been experiencing could be a sign of a lithium-induced impairment in your thyroid functioning. I just read in another post of yours that you've had your thyroid levels checked in the past, but it might be a good idea to get them checked again if you haven't already done so since you started taking lithium. There is evidence that lithium-treated patients commonly develop clinical hypothyroidism and even more frequently develop subclinical hypothyroidism during the course of treatment.
Patrick Oakley, B.Med., FRACP, discussed the the relationship between lithium and thyroid functioning in a 2002 Psychiatric Times article. Here's a link to the article:
http://psychiatrictimes.com/article/showArticle.jhtml?articleId=175801622
Another potential contributing factor to your fatigue that I wouldn't rule out is the possibility that you might have received a subpotent lot of Nardil (assuming that you're still taking the med). I've taken several different versions of Nardil with varying results, but shortly after I started taking one particular batch of Nardil that I received from my pharmacy, I went into a mad rage that was unlike anything I had ever experienced before. This rage went away after I switched to a different batch of Nardil that I had previously been storing away. I ended up using this previously stored-away batch to taper off of Nardil completely. I'm not saying that your reaction to a "bad lot" of Nardil would necessarily be the same as mine was, but there is little doubt in my mind (based on my experience and those of some other Nardil users) that subpotent batches of the medication do occasionally make their way onto pharmacy shelves. If your feelings of fatigue first set in shortly after you received a Nardil refill, you might want to consider asking your pharmacist to fill your next Nardil prescription with tablets from an unopened manufacturer's bottle or getting your Nardil filled at a different pharmacy. It's possible (but not by any means definite) that you might notice a difference.
I hope this helps some.
Tomatheus
> Hi all,
> I've been feeling very fatigued and sleepy over the last couple weeks. Before I started Provigil, I used to need naps in the afternoon, often lasting for 3-4 hours. When I started Provigil several months ago (maybe even up to a year ago?), the need for naps went away, and my sleep was pretty regular. Now I'm nearly falling asleep at the computer, I've taken naps several days the last two weeks, and I'm falling asleep watching TV right after dinner.
>
> I've been taking Lithium for a couple months now. I never noticed feeling drowsy while on it (600 mg), though I've heard that's a side effect. What I have experienced is muscle weakness, which I talked about in another thread about a month ago.
>
> Anyway, what do you think is going on? Does Provigil suddenly poop out? If so, why/how? Anything to be done? The sleepiness is much more pronounced now compared to pre-Provigil, though.
>
> Or is Lithium suddenly making me very drowsy? The only change I've made is splitting my dose from 600 mg at night to 300 mg morning and night to try to calm down the muscle weakness and accompanying shakes which are so uncomfortable. Maybe taking 300 mg (such a tiny dose!) in the a.m. is messing me up late afternoon and evening?
>
> If it's Lithium, I'm going to be sad, because I think it's really helping my depression. :(
>
> Help, please! I don't want to get a permanent keyboard imprint on my forehead.
>
> gg
poster:Tomatheus
thread:721607
URL: http://www.dr-bob.org/babble/20070113/msgs/723240.html