![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 40 to 64 of 69. Go back in thread:
Posted by Ritch on May 21, 2002, at 20:57:51
In reply to Re: low dose Provigil update » Ritch, posted by Emme on May 20, 2002, at 10:28:31
> > IF I didn't get anxious on stimulants, they would be the best meds I had ever taken for seasonal recurrent major depression-most efficacious undoubtedly-with few side effects except for the anxiety. I think I will wind up back on nortripytline or imipramine this time around (TCA's).
>
> Do the TCA's give you less trouble than the SSRI's and other antidepressants?Hi, Emme. The most "effective" SSRI that I have taken is fluoxetine. The most "effective" TCA I have taken (esp. for ADHD) is probably desipramine. But I can't really tolerate SSRI's or TCA's. So, my troubles are not efficacy really, it is intolerable side-effects that are sometimes as bad as being depressed or having ADHD symptoms.
>
> > Unless..long shot....pdoc will go for Concerta.
>
> Is concerta supposed to make you less jittery than ritalin and dexedrine?Concerta *is* Ritalin (methylphenidate). It is just a very technical (and pricey) way to make a sustained release methylphenidate that you can take once in the morning.
>
> > > If only it were a good punch. MOrning was better, more normal. The afternoon punch is a bit much.
>
> > That *still* sounds good to me. Mid-late daytime I get the most profound fatigue, I am constantly yawning at work.
>
> Huh, well maybe that would time out nicely for you.
> Good luck with the search for the right stimulant-type drug. Have you mentioned how good ole caffeine works for you? I can't tolerate much, but a dash of it (a third of a cup of coke) has been known to keep me from falling asleep in seminars. :)
>
> EmmeCaffeine works OK. It just upsets my stomach and causes heartburn. It lasts about three hours. I can yawn at work and look at my watch and sure enough about three hours since my last cup.
Oh, I saw your SAMe question below. I have been taking it off and on and it does seem to be energizing, but not really *focusing*. I just feel kind of jumpy, but I don't feel any benefit with concentration (not as good as coffee, i.e.).
Mitch
Posted by krazy kat on May 22, 2002, at 9:47:29
In reply to Re: low dose Provigil update » Emme, posted by Ritch on May 21, 2002, at 20:57:51
i will be popping one in about an hour. will keep you all informed...
Posted by Ritch on May 22, 2002, at 9:55:37
In reply to concerta..., posted by krazy kat on May 22, 2002, at 9:47:29
> i will be popping one in about an hour. will keep you all informed...
KK, Interesting.I gather it is an 18mg tablet?
I am interested in how you feel mid-afternoon..
good luck,Mitch
Posted by krazy kat on May 22, 2002, at 12:09:50
In reply to Re: concerta... » krazy kat, posted by Ritch on May 22, 2002, at 9:55:37
ug. i am getting so tired of filling prescriptions. my pdoc wrote it for too many pills - not covered by insurance - and he's away. will have to wait until i can get another script.
until then, the ups and downs of ritalin continue...
Posted by Ritch on May 22, 2002, at 14:22:33
In reply to Re: concerta - prescription problem... » Ritch, posted by krazy kat on May 22, 2002, at 12:09:50
> ug. i am getting so tired of filling prescriptions. my pdoc wrote it for too many pills - not covered by insurance - and he's away. will have to wait until i can get another script.
>
> until then, the ups and downs of ritalin continue...
That's discouraging. That stuff must *really* be expensive! How much are they charging you per pill (not counting insurance)? I'm curious because I see my pdoc next week-and if it is *too* high-I am just going to ask about cheapo Adderall, or try out some imipramine. This sounds comical-but I suppose you could chop your pills up into thirds or something and take a chunk every two hours with a 1/2 cup of coffee, until you are ready to go to sleep!Mitch
Posted by krazy kat on May 22, 2002, at 14:47:39
In reply to Re: concerta - prescription problem... » krazy kat, posted by Ritch on May 22, 2002, at 14:22:33
Mitch:
That's not a bad idea at all. I can't figure out how quickly the ritalin goes through my system - it seems slow in the morning (I need at least 10 mg to get up), then faster, then slower, then faster. So I don't get to sleep until 1:00 am or so, even if I take the last 5 mg. of 20 mg. by early afternoon.
I get weepy as it wears off too. And I over react to things. I am so hopeful that won't happen with the Concerta.
Concerta price - it was going to be around $250.00 for 90 days, BUT I'm not certain if that was with insurance covering some of the first 30 days. I believe it was. So, 18 mg. tablets, one a day...let's see if I can do this anymore...$2.70 a pill. Is that expensive? I don't even know...
I have been drinking a beer or glass of wine when the ritalin goes too far the other way, when I get paranoid and anxious. Obviously not the best solution, but one drink does solve the jitters. And, luckily, when on Depakote, I don't desire more than a drink or two. Of course, I could not do this if I were at an office.
So, hopefully the Concerta will offer an even solution.
Here's a link with cost info:
http://www.medletter.com/freedocs/metadate.pdf
$73.13 for 30 days supply of 36 mg according to it.
And here's a person who says:
"My concerta 180 count was $416."!!!!! (Added the !!! for effect. :)). That was 2 36 mg. tabs a day -- http://www.healthboards.com/add/2435.html
- kk
Posted by Ritch on May 22, 2002, at 16:47:58
In reply to Re: concerta - prescription problem... » Ritch, posted by krazy kat on May 22, 2002, at 14:47:39
> Mitch:
>
> That's not a bad idea at all. I can't figure out how quickly the ritalin goes through my system - it seems slow in the morning (I need at least 10 mg to get up), then faster, then slower, then faster. So I don't get to sleep until 1:00 am or so, even if I take the last 5 mg. of 20 mg. by early afternoon.
Hey, you could try it and see what happens (several tiny doses spaced close together). Not needing any after early afternoon in order to get to sleep (much later) sounds mighty suspicious to me, IMO. That stuff (methylphenidate and d-methylphenidate) goes through your system so rapidly. When I was trying Focalin, the absolute maximum amount of time that I could even tell it was in my system was about 3 1/2 hrs. I could take 5.0mg of Focalin (that is 10mg Ritalin-wise) about 4 hrs before bedtime, be quite alert/focused and then crash and sleep like a rock (four hours later)! I wonder if your Depakote blood levels (fluctuating)or other meds have more to do with your responses than the Ritalin??>
> I get weepy as it wears off too. And I over react to things. I am so hopeful that won't happen with the Concerta.I wonder if you did break up your daily dosage into eight same-sized nuggets and took a nugget every two hours all daylong-could you still sleep OK, *and* would you feel less anxious *and* not feel a weepy "crash"??
I had to break down and take 37.5 mg of Wellbutrin today. I am just starting to get soooo fatigued and tired. It is starting early this year I am afraid. I wasn't taking any Depakote with Wellbutrin during my wintertime SAD episode, so...maybe I won't get grouchy. I need to find out if the Depakote is the *one* that is keeping my temper under control. So, by challenging myself with meds that have triggered temper flares previously (WB)with the Depakote staying the same..perhaps I can tolerate it this time around?
I think I am going to tinker with some imipramine, or possibly some Wellbutrin+imipramine (i.e.), unless my pdoc has something else in mind.
>
> Concerta price - it was going to be around $250.00 for 90 days, BUT I'm not certain if that was with insurance covering some of the first 30 days. I believe it was. So, 18 mg. tablets, one a day...let's see if I can do this anymore...$2.70 a pill. Is that expensive? I don't even know............
> - kk
That's all subjective and depends on what insurance you have and how much pocket money you carry around! I can tell you right now that I probably can not afford Concerta (or rather do not *want* to afford it). That is pricey. I remember Adderall and dexedrine being very, very, cheap.
Posted by JonW on May 22, 2002, at 20:56:48
In reply to Re: concerta - prescription problem... » Ritch, posted by krazy kat on May 22, 2002, at 14:47:39
Hi all,
In the study I've pasted below it says that both dextroamphetamine and modafinil were superior to placebo, but does anyone know more about this study? Were the two meds comparable or was one superior to another?
--------------------------------------------------
Efficacy of modafinil compared to dextroamphetamine for the treatment of attention deficit hyperactivity disorder in adults.Taylor FB, Russo J.
Rainier Associates, Tacoma, Washington 98467, USA. taylor2@earthlink.net
Our objective was to compare the efficacy of the new wake-promoting drug modafinil to that of dextroamphetamine for the treatment of attention deficit hyperactivity disorder (ADHD) in adults. Twenty-two adults who met DSM-IV criteria for ADHD participated in a randomized, double-blind, placebo-controlled, three-phase crossover study comparing placebo, modafinil, and dextroamphetamine for the treatment of ADHD. The twice-daily study medications were titrated to doses of optimum efficacy over 4-7 days and then held constant during the rest of each 2-week treatment phase. Measures of improvement included the DSM-IV ADHD Behavior Checklist for Adults, the Controlled Oral Word Association Test (COWAT, using the letters C, F, and L version), Stroop, and Digit Span (Wechsler Adult Intelligence Scale version). For the 21 (96%) completers, the mean (+/- SD) optimum doses of modafinil and dextroamphetamine were 206.8 mg/day +/- 84.9 and 21.8 mg/day +/- 8.9, respectively. Scores on the DSM-IV ADHD Checklist (p < 0.001) were significantly improved over the placebo condition following treatment with both active medications. Performance on the COWAT (p < 0.05) reached trend levels of significance. Both medications were generally well tolerated. This preliminary study suggests that modafinil may be a viable alternative to conventional stimulants for the treatment of adults with ADHD.
Publication Types:
Clinical Trial
Randomized Controlled TrialPMID: 11191692 [PubMed - indexed for MEDLINE]
--------------------------------------------------
Posted by Rick on May 22, 2002, at 22:11:50
In reply to Re: provigil jitters, posted by Lorraine on May 12, 2002, at 11:50:24
Hi, Lorraine -
Glad to hear that Provigil has continued to prove helpful for you, and at a low dose. Does the small 25mg still raise your blood pressure some? If so, are you taking something else to help counter that side-effect?
I've been so busy lately I've had to steer clear of P-B for awhile, and that will continue after this short break -- except that I've set an auto-notification for updates to this specific thread.
I have to admit I'm a more than a tad frustrated to see that I missed the "live" appearance by the esteemed Dr. Thomas A.M. Kramer a few weeks ago. I've posted here in the past about how logical,level-headed and on-the-money his Medscape commentaries are, and his posts here sure did nothing but reinforce my admiration! In fact, it was a Kramer column in Medscape about two years that first gave me the idea of asking my pdoc to add Provigil to my Klonopin+Serzone Social Anxiety Cocktail. Glad I did!!
I've found this thread fascinating, from IsoM's continued fantastic response to adrafinil, to Emme's micro-dosing saga (jeez, I can barely cut a 100 mg Provigil in *half* cleanly, even with a pill splitter!) to everything else.
Rick
> I take 25 mg a day to keep me alert and awake, some mood elevation, without the wired feeling. If it is making you jittery for more than the first week, you might try cutting your dose until you find one that works for you or you might find that even with cutting the dose it doesn't work for you.
>
> Lorraine
Posted by krazy kat on May 22, 2002, at 22:22:29
In reply to Re: concerta - prescription problem... » krazy kat, posted by Ritch on May 22, 2002, at 16:47:58
Mitch:
>> Not needing any after early afternoon in order to get to sleep (much later) sounds mighty suspicious to me, IMO.
-- Sounds suspicious to me, too. It's as if it builds up during the day. I take all my Depakote at night so maybe that does affect it. Thanks for the good observation. I'm also a "night person" which may contribute to it.
>> I wonder if you did break up your daily dosage into eight same-sized nuggets and took a nugget every two hours all daylong-could you still sleep OK, *and* would you feel less anxious *and* not feel a weepy "crash"??-- I am going to try this starting tomorrow. Thanks for the advice. Getting those leetle tablets into even smaller pieces is going to be tough though.
>> I had to break down and take 37.5 mg of Wellbutrin today. I am just starting to get soooo fatigued and tired. It is starting early this year I am afraid.-- I recall that you have seen a seasonal relationship to your disorder.
>> I wasn't taking any Depakote with Wellbutrin during my wintertime SAD episode, so...maybe I won't get grouchy.
-- I reacted Horribly to Wellbutrin. Interesting, isn't it? I'm a 31 year old female, and similar reactions. But if you survived it w/o Dep. last winter...
>> I need to find out if the Depakote is the *one* that is keeping my temper under control.
-- Stressful test, Mitch. Good luck! Have you ever taken Lithium? That will be my next trial (should have been my first :)).
> I think I am going to tinker with some imipramine, or possibly some
-- I'm not certain what this is...
-- I have problems with anger and irritable moods, too, though it's different since I am a woman (or at least it's perceived differently).
Has Depakote helped me? I don't know! When manic on AD's, I'm sweet and interesting as can be. What did my husband say? Oh, "unusually pleasant". ;) The way spouses can stick their foots in their mouths sometimes...
Depakote is definitely a "life-saver" for me - stops the up's and down's - but the in-between ain't so very great. ;)
- kk
Posted by Ritch on May 22, 2002, at 23:02:12
In reply to Provigil/Dex Study Details, posted by JonW on May 22, 2002, at 20:56:48
> Hi all,
>
> In the study I've pasted below it says that both dextroamphetamine and modafinil were superior to placebo, but does anyone know more about this study? Were the two meds comparable or was one superior to another?
>
> --------------------------------------------------
> Efficacy of modafinil compared to dextroamphetamine for the treatment of attention deficit hyperactivity disorder in adults.
>
> Taylor FB, Russo J.
>
> Rainier Associates, Tacoma, Washington 98467, USA. taylor2@earthlink.net
>
> Our objective was to compare the efficacy of the new wake-promoting drug modafinil to that of dextroamphetamine for the treatment of attention deficit hyperactivity disorder (ADHD) in adults. Twenty-two adults who met DSM-IV criteria for ADHD participated in a randomized, double-blind, placebo-controlled, three-phase crossover study comparing placebo, modafinil, and dextroamphetamine for the treatment of ADHD. The twice-daily study medications were titrated to doses of optimum efficacy over 4-7 days and then held constant during the rest of each 2-week treatment phase. Measures of improvement included the DSM-IV ADHD Behavior Checklist for Adults, the Controlled Oral Word Association Test (COWAT, using the letters C, F, and L version), Stroop, and Digit Span (Wechsler Adult Intelligence Scale version). For the 21 (96%) completers, the mean (+/- SD) optimum doses of modafinil and dextroamphetamine were 206.8 mg/day +/- 84.9 and 21.8 mg/day +/- 8.9, respectively. Scores on the DSM-IV ADHD Checklist (p < 0.001) were significantly improved over the placebo condition following treatment with both active medications. Performance on the COWAT (p < 0.05) reached trend levels of significance. Both medications were generally well tolerated. This preliminary study suggests that modafinil may be a viable alternative to conventional stimulants for the treatment of adults with ADHD.
>
> Publication Types:
> Clinical Trial
> Randomized Controlled Trial
>
> PMID: 11191692 [PubMed - indexed for MEDLINE]
> --------------------------------------------------
I think one would have to gain access to the complete study, not just the abstract. My question is--when was this study done? Sounds interesting. I learned something new: there are *tests* that have *names* for ADHD testing! The COWAT test sounds interesting. I need to find a sample of that one.Mitch
Posted by Ritch on May 22, 2002, at 23:26:30
In reply to more on these mood/energy shifts... » Ritch, posted by krazy kat on May 22, 2002, at 22:22:29
> Mitch:
>
> >> Not needing any after early afternoon in order to get to sleep (much later) sounds mighty suspicious to me, IMO.
>
> -- Sounds suspicious to me, too. It's as if it builds up during the day. I take all my Depakote at night so maybe that does affect it. Thanks for the good observation. I'm also a "night person" which may contribute to it.
Aha! That Ritalin isn't building up--I'll bet you are getting a Depakote *withdrawal* in the late afternoon-evenings. You take 2G of Depakote all at nite? No wonder you get that weird stuff in the evening! I would strongly suggest pulling out 500mg of that 2G hs dose and take that midday. I have withdrawn from Depakote before and it can be fairly nasty (agitation/anxiety/insomnia) withdrawing from just 500mg/day. Keep in mind it just has a half-life of 14-18 hrs.....
>
> >> I wonder if you did break up your daily dosage into eight same-sized nuggets and took a nugget every two hours all daylong-could you still sleep OK, *and* would you feel less anxious *and* not feel a weepy "crash"??
>
> -- I am going to try this starting tomorrow. Thanks for the advice. Getting those leetle tablets into even smaller pieces is going to be tough though.
Let us know what happens? I guess we are becoming real-time guinea pigs.>
>
> >> I had to break down and take 37.5 mg of Wellbutrin today. I am just starting to get soooo fatigued and tired. It is starting early this year I am afraid.
>
> -- I recall that you have seen a seasonal relationship to your disorder.Yes, most definitely.
>
> >> I wasn't taking any Depakote with Wellbutrin during my wintertime SAD episode, so...maybe I won't get grouchy.
>
> -- I reacted Horribly to Wellbutrin. Interesting, isn't it? I'm a 31 year old female, and similar reactions. But if you survived it w/o Dep. last winter...
>
> >> I need to find out if the Depakote is the *one* that is keeping my temper under control.
>
> -- Stressful test, Mitch. Good luck! Have you ever taken Lithium? That will be my next trial (should have been my first :)).
Oh yeah, I was on that for many, many years. It works good for grouchiness, too. But, I must say that Dep. is a little better in that department. Lithium clearly has better antidepressant properties for me, however.
>
> > I think I am going to tinker with some imipramine, or possibly some
>
> -- I'm not certain what this is...
Imipramine (Tofranil)-the first tricyclic antidepressant developed (TCA). It is the most serotonergic TCA of the bunch except for clomipramine. Have't tried it yet. Tried its metabolite-desipramine and it made me too nervous, but worked as good as Adderall for inattentiveness/focus problems. So..I am wondering if it will be as good for focus/attentiveness as desipramine, but also actually *reduce* anxiety rather than aggravate it.
>
> -- I have problems with anger and irritable moods, too, though it's different since I am a woman (or at least it's perceived differently).
>
> Has Depakote helped me? I don't know! When manic on AD's, I'm sweet and interesting as can be. What did my husband say? Oh, "unusually pleasant". ;) The way spouses can stick their foots in their mouths sometimes...
>
> Depakote is definitely a "life-saver" for me - stops the up's and down's - but the in-between ain't so very great. ;)
>
> - kk
I seem to have this "two-fold" problem with explosiveness (like an intermittent explosive disorder) that Depakote really helps, and really bad fatigue, excessive daytime drowsiness, inattentive probs., that stimulants or stimulating AD's seem to work on. Who knows, maybe Depakote+stimulant might be the perfect combo? I have never actually done that one, just yet.Mitch
Posted by Rick on May 22, 2002, at 23:30:22
In reply to Re: Provigil/Dex Study Details » JonW, posted by Ritch on May 22, 2002, at 23:02:12
> > Hi all,
> >
> > In the study I've pasted below it says that both dextroamphetamine and modafinil were superior to placebo, but does anyone know more about this study? Were the two meds comparable or was one superior to another?
> >
> > --------------------------------------------------
> > Efficacy of modafinil compared to dextroamphetamine for the treatment of attention deficit hyperactivity disorder in adults.
> >
> > Taylor FB, Russo J.
> >
> > Rainier Associates, Tacoma, Washington 98467, USA. taylor2@earthlink.net
> >
> > Our objective was to compare the efficacy of the new wake-promoting drug modafinil to that of dextroamphetamine for the treatment of attention deficit hyperactivity disorder (ADHD) in adults. Twenty-two adults who met DSM-IV criteria for ADHD participated in a randomized, double-blind, placebo-controlled, three-phase crossover study comparing placebo, modafinil, and dextroamphetamine for the treatment of ADHD. The twice-daily study medications were titrated to doses of optimum efficacy over 4-7 days and then held constant during the rest of each 2-week treatment phase. Measures of improvement included the DSM-IV ADHD Behavior Checklist for Adults, the Controlled Oral Word Association Test (COWAT, using the letters C, F, and L version), Stroop, and Digit Span (Wechsler Adult Intelligence Scale version). For the 21 (96%) completers, the mean (+/- SD) optimum doses of modafinil and dextroamphetamine were 206.8 mg/day +/- 84.9 and 21.8 mg/day +/- 8.9, respectively. Scores on the DSM-IV ADHD Checklist (p < 0.001) were significantly improved over the placebo condition following treatment with both active medications. Performance on the COWAT (p < 0.05) reached trend levels of significance. Both medications were generally well tolerated. This preliminary study suggests that modafinil may be a viable alternative to conventional stimulants for the treatment of adults with ADHD.
> >
> > Publication Types:
> > Clinical Trial
> > Randomized Controlled Trial
> >
> > PMID: 11191692 [PubMed - indexed for MEDLINE]
> > --------------------------------------------------
>
>
> I think one would have to gain access to the complete study, not just the abstract. My question is--when was this study done? Sounds interesting. I learned something new: there are *tests* that have *names* for ADHD testing! The COWAT test sounds interesting. I need to find a sample of that one.
>
> MitchThe study cited above is apparently over two years old. The Medline header is:
J Child Adolesc Psychopharmacol 2000 Winter;10(4):311-20
Take a look at the passage below, from
http://www.ncpamd.com/NewADD_Meds.htm
The last line indicates that modafinil was found no better than placebo for adult ADHD. Despite this, I know that anecdotal reports indicate it works quite well for some people. And if memory serves (no guarantees on that count!), Cephalon plans additional study for Provigil in adult ADHD.
"Modafinil (Provigil) has been approved for treatment of narcolepsy in adults. It is chemically unrelated to methylphenidate or amphetamine. When compared to methylphenidate and amphetamine, it seems less likely to cause irritability and jitteriness. It appears to act on the frontal cortex and is more selective in its area of action than the traditional stimulants. Cephalon will be doing studies to assess the efficacy of modafinil in children with ADHD. In studies of adults with ADHD, there was a promising study (Taylor and Russo) suggesting that it might be effective for adults with ADHD. However a larger study sponsored by Cephalon indicated that Modafinil was no more effective than placebo."
Rick
Posted by zoe on May 23, 2002, at 9:28:49
In reply to Re: more on these mood/energy shifts... » krazy kat, posted by Ritch on May 22, 2002, at 23:26:30
Hi, all.
Well, it took about 2-3 weeks to get the jitters (i love that word, it describes it so perfectly) out of my system, and i restarted the provigil 2 days ago at 1/4 of a 200 mg tab (theoretically 50 mg but i'm not the greatest pill splitter). thus far i feel okay, but i am hypersensitive now to that spacey, awful feeling. we'll see how it goes. i have pretty high hopes now for the whole stimulant class, it seems to be one of the few areas i haven't tried yet. fortunately i have a doc who is pretty open to new things.
social anxiety is a very weird thing. i have a hard time convincing people who know me that i really have it. my psychiatrist is the only one who seems to agree with me that it is a real thing. others are like, 'you are fine, everyone gets a little nervous in big groups'. i guess that's the difference between the subjective and objective experience.
cheers.
zoe
Posted by krazy kat on May 23, 2002, at 10:34:50
In reply to Re: more on these mood/energy shifts... » krazy kat, posted by Ritch on May 22, 2002, at 23:26:30
Thanks. That really clarifies it. I wonder why pdoc said all at night? I'll try the 500 mg during the day.
I'm having some trouble with my social skills on the site right now, apparently, and feel quite certain a block is coming. So if I don't post immediately, that will be why.
Probably won't have Concerta until sometime next week anyway.
- kk
You've been such a help. Thank you.
Posted by Ritch on May 23, 2002, at 10:40:22
In reply to Re: Provigil/Dex Study Details » Ritch, posted by Rick on May 22, 2002, at 23:30:22
> > > Hi all,
> > >
> > > In the study I've pasted below it says that both dextroamphetamine and modafinil were superior to placebo, but does anyone know more about this study? Were the two meds comparable or was one superior to another?
> > >
> > > --------------------------------------------------
> > > Efficacy of modafinil compared to dextroamphetamine for the treatment of attention deficit hyperactivity disorder in adults.
> > >
> > > Taylor FB, Russo J.
> > >
> > > Rainier Associates, Tacoma, Washington 98467, USA. taylor2@earthlink.net
> > >
> > > Our objective was to compare the efficacy of the new wake-promoting drug modafinil to that of dextroamphetamine for the treatment of attention deficit hyperactivity disorder (ADHD) in adults. Twenty-two adults who met DSM-IV criteria for ADHD participated in a randomized, double-blind, placebo-controlled, three-phase crossover study comparing placebo, modafinil, and dextroamphetamine for the treatment of ADHD. The twice-daily study medications were titrated to doses of optimum efficacy over 4-7 days and then held constant during the rest of each 2-week treatment phase. Measures of improvement included the DSM-IV ADHD Behavior Checklist for Adults, the Controlled Oral Word Association Test (COWAT, using the letters C, F, and L version), Stroop, and Digit Span (Wechsler Adult Intelligence Scale version). For the 21 (96%) completers, the mean (+/- SD) optimum doses of modafinil and dextroamphetamine were 206.8 mg/day +/- 84.9 and 21.8 mg/day +/- 8.9, respectively. Scores on the DSM-IV ADHD Checklist (p < 0.001) were significantly improved over the placebo condition following treatment with both active medications. Performance on the COWAT (p < 0.05) reached trend levels of significance. Both medications were generally well tolerated. This preliminary study suggests that modafinil may be a viable alternative to conventional stimulants for the treatment of adults with ADHD.
> > >
> > > Publication Types:
> > > Clinical Trial
> > > Randomized Controlled Trial
> > >
> > > PMID: 11191692 [PubMed - indexed for MEDLINE]
> > > --------------------------------------------------
> >
> >
> > I think one would have to gain access to the complete study, not just the abstract. My question is--when was this study done? Sounds interesting. I learned something new: there are *tests* that have *names* for ADHD testing! The COWAT test sounds interesting. I need to find a sample of that one.
> >
> > Mitch
>
> The study cited above is apparently over two years old. The Medline header is:
>
> J Child Adolesc Psychopharmacol 2000 Winter;10(4):311-20
>
> Take a look at the passage below, from
>
> http://www.ncpamd.com/NewADD_Meds.htm
>
> The last line indicates that modafinil was found no better than placebo for adult ADHD. Despite this, I know that anecdotal reports indicate it works quite well for some people. And if memory serves (no guarantees on that count!), Cephalon plans additional study for Provigil in adult ADHD.
>
> "Modafinil (Provigil) has been approved for treatment of narcolepsy in adults. It is chemically unrelated to methylphenidate or amphetamine. When compared to methylphenidate and amphetamine, it seems less likely to cause irritability and jitteriness. It appears to act on the frontal cortex and is more selective in its area of action than the traditional stimulants. Cephalon will be doing studies to assess the efficacy of modafinil in children with ADHD. In studies of adults with ADHD, there was a promising study (Taylor and Russo) suggesting that it might be effective for adults with ADHD. However a larger study sponsored by Cephalon indicated that Modafinil was no more effective than placebo."
>
> RickThanks Rick,
That still is fairly recent (2 years). Isn't it interesting how one study can show no better effectiveness than placebo and yet another one shows equal effectiveness to dexedrine? I guess about the only thing you can trust is anecdotal experience (here for example), or a large clinical trial (even then..). I wonder if there has been or will be a study done with "stimulant naive" adult subjects?
Mitch
Posted by Ritch on May 23, 2002, at 10:43:32
In reply to Ritch..., posted by krazy kat on May 23, 2002, at 10:34:50
Posted by krazy kat on May 23, 2002, at 12:36:49
In reply to provigil update, posted by zoe on May 23, 2002, at 9:28:49
Heh, zoe.
I've got my 200 mg tablet down to 25 mg pieces. That was tough. I couldn't believe it didn't just turn to dust!
I, too, suffered jitters from Provigil, which is why we switched to Ritalin, but it's too quick-acting, so I'm waiting on a Concerta prescription.
This is fun, isn't it?
So, I took 5 mg of Ritalin this morning and 25 mg of Provigil (this is all O.K. with my pdoc). Now, three hours later, I've taken 25 mg. of Provigil again.
Then, in three hours, thought I'd go back to 5 mg of Ritalin and 25 mg of Provigil (maybe), then probably stop for the day.
No jitters thus far...
- kk
Posted by JonW on May 23, 2002, at 13:01:42
In reply to Re: Provigil/Dex Study Details » Rick, posted by Ritch on May 23, 2002, at 10:40:22
> That still is fairly recent (2 years). Isn't it interesting how one study can show no better effectiveness than placebo and yet another one shows equal >effectiveness to dexedrine? I guess about the only thing you can trust is anecdotal experience (here for example), or a large clinical trial (even then..). >I wonder if there has been or will be a study done with "stimulant naive" adult subjects?
Hi Mitch,
Seemingly inconsistent performance in controlled clinical trials could be explained by a drug not being very potent. Moclobemide, for example, isn't a very potent drug for treating social phobia. In at least two controlled studies it performed no better than placebo, while there are at least two other controlled studies where it was shown to be effective for social phobia.
I don't think anecdotal research is useless, but it should definitely be confirmed by controlled studies. If there is one type of research you can trust, it's not anecdotal. Anyone could get lucky and be led to the drug that saves their life, but the chances of success are far greater if you try drugs based on real data. Interestingly, I remember reading an article not too long ago about how the majority of outpatients wouldn't qualify for many of the clinical studies that get drugs approved. I wonder how significant that is. As a treatment resistent case, I can't help but think that's a bad thing.
Jon
Posted by Ritch on May 23, 2002, at 20:54:45
In reply to Research (Re: Provigil/Dex Study Details) » Ritch, posted by JonW on May 23, 2002, at 13:01:42
> > That still is fairly recent (2 years). Isn't it interesting how one study can show no better effectiveness than placebo and yet another one shows equal >effectiveness to dexedrine? I guess about the only thing you can trust is anecdotal experience (here for example), or a large clinical trial (even then..). >I wonder if there has been or will be a study done with "stimulant naive" adult subjects?
>
> Hi Mitch,
>
> Seemingly inconsistent performance in controlled clinical trials could be explained by a drug not being very potent. Moclobemide, for example, isn't a very potent drug for treating social phobia. In at least two controlled studies it performed no better than placebo, while there are at least two other controlled studies where it was shown to be effective for social phobia.
>
> I don't think anecdotal research is useless, but it should definitely be confirmed by controlled studies. If there is one type of research you can trust, it's not anecdotal. Anyone could get lucky and be led to the drug that saves their life, but the chances of success are far greater if you try drugs based on real data. Interestingly, I remember reading an article not too long ago about how the majority of outpatients wouldn't qualify for many of the clinical studies that get drugs approved. I wonder how significant that is. As a treatment resistent case, I can't help but think that's a bad thing.
>
> Jon
Hi Jon,Good points. I wasn't really advocating individual anecdotal experiential "hearsay" should *replace* "hard data", I just think that the "hard data" that you see floating about unfortunately just *probably*, isn't a lot more *trustworthy* than a *collection* of anecdotal experiences that you might find here (or elsewhere). The trouble is..how do you get the "hard data" to be *MORE* reliable than a collection of shared anecdotal experiences? You can't do that with a dozen people here and there, IMO. A lot of the abstracts that you read have a very small number of subjects-I have seen "studies" done on eight people. Hmmmm. Also, treatment resistant and treatment intolerant cases tend to be statistical *anomalies* that fall "outside the curve". As a treatment resistant or treatment intolerant *individual*, the findings of a given "study" aren't going to be nearly as relevant to *you* as it wouldbe to a random "typical" person experiencing a major depressive episode, panic attack, etc.
Mitch
Posted by zoe on May 24, 2002, at 8:23:08
In reply to Re: provigil update » zoe, posted by krazy kat on May 23, 2002, at 12:36:49
what is concerta? is it in the US?
Posted by krazy kat on May 24, 2002, at 11:29:03
In reply to Re: provigil update » krazy kat, posted by zoe on May 24, 2002, at 8:23:08
It is in the US. It's basically an extended version of Ritalin, from my understanding.
Posted by schuyler on June 1, 2002, at 17:42:19
In reply to Re: provigil update » krazy kat, posted by zoe on May 24, 2002, at 8:23:08
> what is concerta? is it in the US?
I believe that Concerta and Metadate CD are timed-release (up to 12 hours) versions of Ritalin. Metadate CD comes only in 20 mg, I think, and Concerta comes in 18. 36, and 54? mg.
Posted by noelle on June 2, 2002, at 15:00:27
In reply to Re: provigil update » zoe, posted by schuyler on June 1, 2002, at 17:42:19
My pdoc gave me samples of provigil after some failed attempts on adderal, welbutrins. I split 100 mg. The first day was fine, but now even hours after taking it my heart feels like it is going to jump out of my chest. The last time I went to the doctor I had elevated bp on wellbutrin, never happened. I'm not sure if its axiety or what but last night it had me scared to death!
Noelle
Posted by noelle on June 4, 2002, at 14:44:42
In reply to Re: provigil update/ elevated heartrate???help, posted by noelle on June 2, 2002, at 15:00:27
I know I shouldn't that this personally but since I've been posting questions, I haven't gotten one response, am I missing something
Noelle
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