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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by Al22 on February 12, 2001, at 14:24:00
I was currently taking Effexor for depression and was interested in trying Provigil or modafinil, because of the study posted about its use in augmenting AD drugs. I asked my psychiatrist about it and showed him the article (in amer psych jour I think) and he wouldn't prescribe it because he hadn't heard of it before. He did end up prescribing ritalin, but I was sort of still interested in trying the provigil. Would it be unethical or unusual to go to another doctor and ask about taking provigil (explaining the situation)? Has anybody ever had one doctor prescribe one thing and another prescribe something else and that seemed to work (as far as the 2 doctors not feeling any kind of conflict)? Or would anybody else I go to pretty much not consider it becuase my first doctor wouldn't do it?
Thank you if anybody can share any experience in this situation.
Posted by mars on February 12, 2001, at 16:05:46
In reply to getting provigil, posted by Al22 on February 12, 2001, at 14:24:00
hiya ~
I would not go behind the back of a professional treating me. I think it's asking for trouble. Here's the full story:
I was arguing a few years ago with my pdoc about whether or not I have ADD. (I have seen her for seven years - her diagnosis of my condition is bipolar II.) She was, I felt, being extremely rigid about the possibility of ADD, making the assertion that all of my cognitive/learning problems were attributable to depression only, despite the fact that my father has ADD w/o depression. She was totally unwilling to engage in a dialogue about my possibly having ADD.
My GP had recommended a doctor I could see about ADD. When I mentioned this to my pdoc she became rather upset, and warned me that if I had any other MD's prescribe psychiatric meds for me she would regard that as grounds for terminating our relationship.
I have abided by that, and that felt right, since I prefer honesty as a policy. However, due to continuing problems (esp. the rigidity mentioned above) I am now in the process of searching for another pdoc, and wish I had started doing so a few years back. Not going behind her back, however, did push me to realize her limitations.
Hope that makes sense, and best of luck to you.
mars
Posted by SalArmy4me on February 12, 2001, at 17:10:45
In reply to getting provigil, posted by Al22 on February 12, 2001, at 14:24:00
Provigil is going to be very expensive. Ritalin is like a penny a pill!
Provigil is weak, compared to Ritalin. Besides, Ritalin is now being used to augment MAOIs (giving the MAOI more efficacy)--that shows that Ritalin may have antidepressat properties too.
The first antidepressants were stimulants.
Posted by kazoo on February 12, 2001, at 21:37:51
In reply to Re: getting provigil, posted by SalArmy4me on February 12, 2001, at 17:10:45
> The first antidepressants were stimulants.
^^^^^^^^^^^^^^
For the short term, perhaps ... but for the long term, they failed miserably.
kazoo
Posted by kazoo on February 12, 2001, at 21:49:58
In reply to getting provigil, posted by Al22 on February 12, 2001, at 14:24:00
> I was currently taking Effexor for depression and was interested in trying Provigil or modafinil, because of the study posted about its use in augmenting AD drugs. I asked my psychiatrist about it and showed him the article (in amer psych jour I think) and he wouldn't prescribe it because he hadn't heard of it before. He did end up prescribing ritalin, but I was sort of still interested in trying the provigil. Would it be unethical or unusual to go to another doctor and ask about taking provigil (explaining the situation)? Has anybody ever had one doctor prescribe one thing and another prescribe something else and that seemed to work (as far as the 2 doctors not feeling any kind of conflict)? Or would anybody else I go to pretty much not consider it becuase my first doctor wouldn't do it?
> Thank you if anybody can share any experience in this situation.^^^^^^^^^^
I don't know why people don't get second opinions when it comes to mental health! They wouldn't think twice about it if the doctor said "You have cancer."
I suggest you tell your first doctor to get with it and start reading what's new and available. PROVIGIL isn't that new a drug anymore, and from the way these drug companies blitz doctors with material heralding new products, I find it incredulous that "he hadn't heard of it before."
By all means go to a different doctor if you're in the position to do so. This isn't slighting the first one either, and even if this were the case, so what? YOU have YOU to take care of.
kazoo
Posted by MarkinBoston on February 13, 2001, at 18:42:54
In reply to getting provigil, posted by Al22 on February 12, 2001, at 14:24:00
> I was currently taking Effexor for depression and was interested in trying Provigil or modafinil, because of the study posted about its use in augmenting AD drugs.
I'm on Effexor and have tried Ritalin, Adderall, and Provigil. I like the first two better than Provigil. I just wasn't very impressed with it at all, hardly making a dent in the bottle before going back to Adderall. Besides, Provigil costs about four times as much as generic Ritalin.
I don't think you're missing out at all and rate the chance that Provigil is beter for you than the other drugs your doc has experience with as very unlikely. Chance that your relationship with your doc would get rockier are more likely.
Instead, I'd suggest after a month on Ritalin that you might give Adderall a try. Its a different drug structurally with a longer half-life so it may work better and is more convenient.
I don't know what paper you are talking about, but take some of them with a grain of salt. Who funded the study? Did it show Provigil as better than Ritalin or Adderall for adding to Effexor? Or did it show that the combo was better than Effexor alone? If that's the case, I'd read the fine print to see who funded it. It doesn't mean the researchers lied, just that other combos may have been better, but they weren't being paid to publish that finding.
As best I can recall, Dr. Jensen's order of trying stims is Adderall, Ritalin, dexamphetamine, Provigil, methamphetamine, and one other. Meth is low on the list because of the abuse potential and many pharms don't stock it.
Posted by Lorraine on February 18, 2001, at 10:33:05
In reply to Re: getting provigil » Al22, posted by kazoo on February 12, 2001, at 21:49:58
>
> I don't know why people don't get second opinions when it comes to mental health! They wouldn't think twice about it if the doctor said "You have cancer."
>
> By all means go to a different doctor if you're in the position to do so. This isn't slighting the first one either, and even if this were the case, so what? YOU have YOU to take care of.
>
> kazoo
Kazoo: This is a very good point. We treat therapists like hair dressers that we have to be loyal to and not hurt their feelings. I agree.
This is the end of the thread.
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