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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by dennison on July 8, 2001, at 22:11:10
Hi --Well I'm continuing my follow-up posts on my trial on modafinil (provigil) . After about two weeks I was noticing improvement in my mood and energy and I became very optimistic concerning my prospects on provigil. Unfortunately the mental impairment has become extreme, very difficult to read,spell words follow thoughts etc. So I stopped the provigil and in about 2 days my cognitive abilities were much sharper I was extremely depressed but I could think. I've been on parnate(tranylcypromine) for many years and continue on it and one really large advantage on it has been absolutely no mental impairment. The mental impairment on provigil is very much like that I had on efflexor, the starring in the headlight effect, you look at something but nothing sinks in. Now my question is has anyone had similiar problems on provigil as I would like to give it another try and most likely will but has anyone had problems thinking on it that eventually cleared up. I'm taking the provigil in place of the cylert (pemoline) that I took but cylert is really tough to take frequently caused aches and pains etc. plus especially in morning it would make me very drowsy many times, but it never caused the cognitive problems that provigil has. Might have to go back on cylert I think but I'm not ready to through the provigil out the window yet. It's too bad in this age that patients are left out on their own to analyze their own medication regiments but as many of us know that's the nature of the business (mental health), there is simply no avenue available to reflect how your doing on these medications(psychiatrists) see patient less than 5 minutes every 2 months and other staff will never respond to medication questions. Dr. Bob's psychobabble serves a great service to many many of us, so I take a quick second here to thank him and I'll be waiting to hear from anyone that would like to respond to my provigil debacle!!
Posted by SalArmy4me on July 8, 2001, at 23:04:17
In reply to provigil -modafinil -trial update, posted by dennison on July 8, 2001, at 22:11:10
looks like you may be a candidate for methylphenidate or dexedrine: http://www.dr-bob.org/tips/split/MAOIs-in-high-doses-and-wi.html
Have you tried anything like buproprion before?
Posted by dennison on July 9, 2001, at 0:01:32
In reply to Re: provigil -modafinil -trial update, posted by SalArmy4me on July 8, 2001, at 23:04:17
> looks like you may be a candidate for methylphenidate or dexedrine: http://www.dr-bob.org/tips/split/MAOIs-in-high-doses-and-wi.html
>
> Have you tried anything like buproprion before?Hi Sal thanks for responding. Yes tried wellbutrin before as monotherapy years ago was totally useless except as an aid to very profuse sweating, made me sweat like crazy and caused slight hand tremor on fine hand movements. I think you mean along with the parnate though, no I haven't tried that combo yet but my doc is opposed to that even though wellbutrin is used with parnate (good point ) sal it is a viable option. Also I remember on wellbutrin noise sensitivity and very fatiqued even though supposedly wellbutrin is at least somewhat stimulatory in action that simply wasn't my response. As we all know clinical reports and neurochemistry don't always reflect true patient responses (manifestations) boy it sure would be nice if that were the case though. Ok the ritalin combo with parnate issue, yes tried the ritalin with my presentation of medline reports backing up my requests to do so . Strangely enough the ritalin was very ineffective with parnate just made me drowsy but I was takin just 5 mg twice daily and there have been reports where 5 mg doses actually did increase fatique etc while doses 10mg and up didn't as alerting and psychomotor effects became prominent. The cylert was actually much more effective than the ritalin but as I've stated cylert is very difficult to take it can give rather severe aches pains peripheral parethesias etc and I can attest to the fact these side-effects can be very troublesome. The cylert however has some times helped mood significantly and helped psychomotor retardation. Ok the dexedrine combo well as of yet that has not been tried with parnate with me and of course it has been used in combo with parnate (same studies that used ritalin pemoline etc). Of course the doc is reluctant to step onto that potential liabilty and even the provigil trial took a bit of promoting and presenting reports on my part to give it a shot, so I was really extremely hopeful that provigil would workout. One big problem I confront is that essentially anything before noon will make me drowsy regardless of what it is, strong diurnal variation in energy-mood etc as the day progresses. I have correlated very closely the blood pressure autonomic responsitivity with mood. The maoi really drives the blood pressure down but as the day progresses the blood pressure rises and autonomic responses return. Maoi's have that sympatholytic effect on the autonomic system and all autonomic responses especially cardio-vascular are severely blunted. Remember some very impressive studies that showed people on maoi's their cardiac output while exercise was less than a normal person's output while at rest --dramatically illustrating the inabilty of the autonomic system to respond to cardio-vascular challenge of exercise, there in lies the lethargy etc that sympathetic system blocking can produce.
Posted by Zo on July 10, 2001, at 14:56:11
In reply to provigil -modafinil -trial update, posted by dennison on July 8, 2001, at 22:11:10
Sounds like you might really like Dexedrine SR or Adderall. Ritalin made me sleepy too, it's a lousy med for adults. Neither Dex nor Adderall are hard on the liver like Cylert. Just had a friend get nothing from Provigil who is doing very well on Adderall. You can even combine the two, to hit as many dopamine receptor sites as possibile!
Zo
> Hi --Well I'm continuing my follow-up posts on my trial on modafinil (provigil) . After about two weeks I was noticing improvement in my mood and energy and I became very optimistic concerning my prospects on provigil. Unfortunately the mental impairment has become extreme, very difficult to read,spell words follow thoughts etc. So I stopped the provigil and in about 2 days my cognitive abilities were much sharper I was extremely depressed but I could think. I've been on parnate(tranylcypromine) for many years and continue on it and one really large advantage on it has been absolutely no mental impairment. The mental impairment on provigil is very much like that I had on efflexor, the starring in the headlight effect, you look at something but nothing sinks in. Now my question is has anyone had similiar problems on provigil as I would like to give it another try and most likely will but has anyone had problems thinking on it that eventually cleared up. I'm taking the provigil in place of the cylert (pemoline) that I took but cylert is really tough to take frequently caused aches and pains etc. plus especially in morning it would make me very drowsy many times, but it never caused the cognitive problems that provigil has. Might have to go back on cylert I think but I'm not ready to through the provigil out the window yet. It's too bad in this age that patients are left out on their own to analyze their own medication regiments but as many of us know that's the nature of the business (mental health), there is simply no avenue available to reflect how your doing on these medications(psychiatrists) see patient less than 5 minutes every 2 months and other staff will never respond to medication questions. Dr. Bob's psychobabble serves a great service to many many of us, so I take a quick second here to thank him and I'll be waiting to hear from anyone that would like to respond to my provigil debacle!!
Posted by dennison on July 10, 2001, at 20:47:07
In reply to Re: provigil -modafinil -trial update » dennison, posted by Zo on July 10, 2001, at 14:56:11
> Sounds like you might really like Dexedrine SR or Adderall. Ritalin made me sleepy too, it's a lousy med for adults. Neither Dex nor Adderall are hard on the liver like Cylert. Just had a friend get nothing from Provigil who is doing very well on Adderall. You can even combine the two, to hit as many dopamine receptor sites as possibile!
>
> Zo
>
>
> > Hi --Well I'm continuing my follow-up posts on my trial on modafinil (provigil) . After about two weeks I was noticing improvement in my mood and energy and I became very optimistic concerning my prospects on provigil. Unfortunately the mental impairment has become extreme, very difficult to read,spell words follow thoughts etc. So I stopped the provigil and in about 2 days my cognitive abilities were much sharper I was extremely depressed but I could think. I've been on parnate(tranylcypromine) for many years and continue on it and one really large advantage on it has been absolutely no mental impairment. The mental impairment on provigil is very much like that I had on efflexor, the starring in the headlight effect, you look at something but nothing sinks in. Now my question is has anyone had similiar problems on provigil as I would like to give it another try and most likely will but has anyone had problems thinking on it that eventually cleared up. I'm taking the provigil in place of the cylert (pemoline) that I took but cylert is really tough to take frequently caused aches and pains etc. plus especially in morning it would make me very drowsy many times, but it never caused the cognitive problems that provigil has. Might have to go back on cylert I think but I'm not ready to through the provigil out the window yet. It's too bad in this age that patients are left out on their own to analyze their own medication regiments but as many of us know that's the nature of the business (mental health), there is simply no avenue available to reflect how your doing on these medications(psychiatrists) see patient less than 5 minutes every 2 months and other staff will never respond to medication questions. Dr. Bob's psychobabble serves a great service to many many of us, so I take a quick second here to thank him and I'll be waiting to hear from anyone that would like to respond to my provigil debacle!!Hi Zo (thanks for responding) Dexedrine non-sustained release or adderall (the sustained release) version probably would be a good alternative trial only thing is since I'm taking the maoi parnate(tranylcypromine) the strong contra-indication battle again becomes an issue. Hypertensive-crisis of course the concern there. Of course as I mentioned in my above post indeed cylert-ritalin-dexedrine have all been used with maoi's with good results for refractory depressions or to treat maoi side-effects. Strategy simply requires slow introduction of the c.n.s. agent and careful monitoring of any blood pressure responses. I was given the ritalin and cylert in conjunction with the maoi as I'm very adept at home monitoring of blood pressure. Actually the maoi's get used so infrequently and many times they could be really helpful but doctor's concern about possible food interactions (cheese affect) or possible inadvertent drug interactions (meperidine-demerol) or some type of sympathomimetic drug cause this class of anti-depressants to be under utilized. Just to illustrate the point I'm the only client at this clinic in over 20 yrs. that has been allowed to take a maoi!!! I still haven't fully given up on the provigil yet but it doesn't seem that I'm going to continue on it but I have to experiment(adjust) dosages around of cytomel or time scheduling of dosages to see if I can improve my response!!!! Would have been really nice if the provigil had just flat out worked but as we know trial and error is extremely common.
Posted by AMenz on July 14, 2001, at 0:22:44
In reply to Re: provigil -modafinil -trial update » dennison, posted by Zo on July 10, 2001, at 14:56:11
Can you comment on Adrafanil for adult ADD?
> Sounds like you might really like Dexedrine SR or Adderall. Ritalin made me sleepy too, it's a lousy med for adults. Neither Dex nor Adderall are hard on the liver like Cylert. Just had a friend get nothing from Provigil who is doing very well on Adderall. You can even combine the two, to hit as many dopamine receptor sites as possibile!
>
> Zo
>
>
> > Hi --Well I'm continuing my follow-up posts on my trial on modafinil (provigil) . After about two weeks I was noticing improvement in my mood and energy and I became very optimistic concerning my prospects on provigil. Unfortunately the mental impairment has become extreme, very difficult to read,spell words follow thoughts etc. So I stopped the provigil and in about 2 days my cognitive abilities were much sharper I was extremely depressed but I could think. I've been on parnate(tranylcypromine) for many years and continue on it and one really large advantage on it has been absolutely no mental impairment. The mental impairment on provigil is very much like that I had on efflexor, the starring in the headlight effect, you look at something but nothing sinks in. Now my question is has anyone had similiar problems on provigil as I would like to give it another try and most likely will but has anyone had problems thinking on it that eventually cleared up. I'm taking the provigil in place of the cylert (pemoline) that I took but cylert is really tough to take frequently caused aches and pains etc. plus especially in morning it would make me very drowsy many times, but it never caused the cognitive problems that provigil has. Might have to go back on cylert I think but I'm not ready to through the provigil out the window yet. It's too bad in this age that patients are left out on their own to analyze their own medication regiments but as many of us know that's the nature of the business (mental health), there is simply no avenue available to reflect how your doing on these medications(psychiatrists) see patient less than 5 minutes every 2 months and other staff will never respond to medication questions. Dr. Bob's psychobabble serves a great service to many many of us, so I take a quick second here to thank him and I'll be waiting to hear from anyone that would like to respond to my provigil debacle!!
This is the end of the thread.
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