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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by Tom1982 on October 24, 2003, at 3:28:09
Hey everyone!
I am very interested in trying Provigil.
I am currently taking adderall for add and remeron for depression. The Remeron seems to help a lot but I know I could feel better because the adderall makes me happier and I actually have the ability to concentrate on tasks and the motivation to do them when I am on it. Unfortunately, I do not like taking adderall that much because I really need it for school and I am only prescribed 20mg a day! Anyway, back on point I want to try provigil. What do you think of me taking it with the remeron and adderall?
I really do not want to go off the remeron because when I do not take it I get very depressed, anxious, and paranoid... and I hate everything. :( BUT, is there is a chance provigil will help me even more? Even on the remeron I am still very bored and incredibly anti social (I get EXTREMELY anxious around other people), adderall helps with both but like I said I really hate taking it if I am not at school.
Sorry this post it so cluttered...
If I can't take adderall with Provigil I don't even want to try it because without adderall my life would really suck.
Please try to reply constructively… I know this post is terribly written but I was just curious and thought I would ask.
-Tom
Posted by blondegirl47 on October 24, 2003, at 17:08:58
In reply to Thinking about provigil, but I'm on adderall..., posted by Tom1982 on October 24, 2003, at 3:28:09
I don't think the doc will let you take provigil and adderall. I tried replacing adderall with provigil and it was a joke. It upset my stomach and made me dizzy. I was also sleepy on it. Its very expensive and there is no generic. If you don't have insurance its over 200 bucks a month. I stayed on it for 2 weeks and couldn't take it any more. Good luck
Blondegirl
Posted by Tom1982 on October 24, 2003, at 17:15:33
In reply to Re: Thinking about provigil, but I'm on adderall... » Tom1982, posted by blondegirl47 on October 24, 2003, at 17:08:58
Man that sucks.
I want to be happy and motivated all the time like I am when I'm on adderall.
Later,
Tom
Posted by Viridis on October 25, 2003, at 1:57:38
In reply to Thinking about provigil, but I'm on adderall..., posted by Tom1982 on October 24, 2003, at 3:28:09
Having tried both for ADD, I find Adderall much better. Provigil was fine, but didn't really address concentration issues or help as much with mood. I doubt your doctor would give you Adderall and Provigil at the same time, and Provigil is very expensive (although the doctors get lots of free samples to hand out, so you might be able to try it that way).
Have you tried Strattera? I take it with Adderall, and the two go well together for me. Again, doctors get samples of this (it's new, and quite expensive, but you might be able to get some for free). Just start with a low dose and move up gradually, since Strattera causes side effects for many people that disappear over time.
Posted by Tom1982 on October 25, 2003, at 8:26:08
In reply to Re: Thinking about provigil, but I'm on adderall.. » Tom1982, posted by Viridis on October 25, 2003, at 1:57:38
Sorry it took me so long to respond. Yeah, I would never take Provigil for my add. (I was just curious to see if it might help with my depression or tension.) I have a really hard time doing anything without Adderall so replacing it is most definitely not an option unless... well, I am somewhat curious about Dexedrine because I have heard a lot of positive reviews but Adderall works pretty good so I probably won't bother.
I think I am going to look for another doctor because while the Remeron does help A LOT... I am unsatisfied and I do not want to consult with my current doctor about it... I don't feel I can have an open conversation about my problems without him trying to force another medication on me... I figure I'll go explain my situation to an independant doctor and figure out my treatment options. Then, once I know what I want to do I'll go see my main doctor and tell him what I want prescribed and hope for the best.
I just hate being paranoid and depressed all the time. The tension is really wearing me down and I have no clue what to do about it. I know there is no miracle medication out there but perhaps there is something that will just work better, you know?
I checked out that Strattera stuff and the side effects are a major turn-off. (I have a sensitive stomach anyway.) I don't think it would help much with my depression either. I am really desperate though so I might check it out... I'm building up a tolerance to Adderall and I hate taking more than I am prescribed because it feels wrong.
Anyway, I'll probably end up switching to Zoloft, Effexor, or Lexapro... or something... Does anyone know if I could use any of those 3 drugs I just mentioned as an add-on to my existing medications?
PLEASE let me know either way.
I don't want to go off Remeron for any time at all. (Trust me you would not want me to either if you saw what I'm like.) I just REALLY need something to help with my anxiety (besides Paxil or benzodiazepines) because it is making me really hate life. I don't like taking pills but anything is better than this. (Well ALMOST anything... obviously being on Paxil and stuff like Xanax and Valium isn't. lol ;) )
-Tom
P.S. I really appreciate the help.
-----------------------------------------------
A brief summary of everything I wrote above is:What medication can I take in ADDITION to Adderall and Remeron to help relieve my anxiety (and possibly further alleviate my depression) besides Paxil or a benzodiazepine?
Posted by wsj on October 25, 2003, at 13:14:52
In reply to What could I try instead?, posted by Tom1982 on October 25, 2003, at 8:26:08
ive used adderall, provigil, and dexedrine for add and depression. dexedrine works the best for me.
Posted by Viridis on October 25, 2003, at 15:17:38
In reply to What could I try instead?, posted by Tom1982 on October 25, 2003, at 8:26:08
I'm not sure about the SSRIs -- I can't tolerate those at all, but everyone is different. I've found Strattera quite helpful. It seems to have some antidepressant qualities (apparently they're doing trials to see if they can market it that way) and I actually find it has kind of a mellowing effect too.
My experience with side effects was that at 25 mg I had no problems; when I went to 40 I felt slightly nauseous and achy for about a week, and then that went away; then I went to 65 mg and had a similar reaction that just lasted a couple of days; now I'm at 80 mg and it's fine. The one side effect that lasted a long time was dry mouth, but that's pretty much cleared up now, and I just had to make sure I always had water to sip on. Oh, and it can give me heartburn if I take it on an empty stomach or with coffee. But really, the side effects weren't bad with gradual titration, and at least they went away, most quite quickly.
I talked to my pdoc and he said this is very similar to what several of his other patients have described. His approach is to start with 25 mg for a week or so, move to 40 or 50, then 65, and then 80 if appropriate, at about 1-2 week intervals. He lets his patients work out the details and is quite flexible. It comes in quite a few doses (I think the lowest is 18 mg), so you might be able to tolerate that. There seem to be lots of free samples available.
Some people here have reported antidepressant effects from Provigil, and I found it increased my confidence and energy, just not my concentration. You should be able to get some samples to try. My pdoc says that it seems to help some people with ADD but is very hit-or-miss in that department.
For anxiety (and depression), I really think Klonopin (clonazepam, a benzo) is best, for me at least. Plus, it goes very well with Adderall. As for tolerance, I skip Adderall for a day or two every couple of weeks and that seems to minimize tolerance issues. I've been taking it for a couple of years and don't notice any withdrawal when I go off it.
And, there's also Serzone. I haven't tried it, but have two friends who have done very well with it for depression. It's supposed to be less activating than most of the standard antidepressants.
Finally, you might consider Neurontin. I found it wonderfully relaxing for the first couple of days, then had absolutely no effect. But some people here report sustained results. It's very safe and can be combined with almost everything. It should be available soon as a generic (already is in Canada). Its successor, Pregabalin, looks promising, and I think will be marketed in the next year or two.
Good luck!
Posted by Kacy on October 25, 2003, at 15:18:23
In reply to Re: What could I try instead? » Tom1982, posted by wsj on October 25, 2003, at 13:14:52
Have you considered Wellbutrin? It's a norepinephrine and dopamine re-uptake inhibitor. Isn't Remeron an ssri? If so, since seratonin works for you, Wellbutrin might not be a good replacement.
Adderal is a dopamine drug so the Wellbutrin might give you some of the positive benefits of that in a different way. Norepinephrine is the key to quelling my anxiety, so it might help that, too.
If seratonin is the key, though, and you don't have too many side effects on Remeron, you may not want to give that up.
Wellbutrin was the best for me (for one day I can hardly remember now) until I broke out in hives just as I got to a therapeutic level. I have add/inattentive.
Posted by Viridis on October 26, 2003, at 1:18:30
In reply to Re: What could I try instead?, posted by Kacy on October 25, 2003, at 15:18:23
Wellbutrin is a good idea, but be careful -- if you're anxiety-prone it can be risky. I had a severe adverse reaction, and so did a friend of mine (but then others respond very well). My psychiatrist won't prescribe it for patients with anxiety problems. If you try it, be sure to start with a low dose (75 mg or less). It's great for some people, but be cautious with this one.
Posted by Elle2021 on October 27, 2003, at 3:16:20
In reply to What could I try instead?, posted by Tom1982 on October 25, 2003, at 8:26:08
Try BuSpar, that might help the anxiety.
Posted by Tom1982 on October 27, 2003, at 6:08:07
In reply to Re: What could I try instead? » Tom1982, posted by Viridis on October 25, 2003, at 15:17:38
Hey thanks for all the advice you guys are great! :)
Just an FYI - Remeron is not an SSRI (I don’t think it is anyway) it’s a tetracyclic antidepressant. I have no clue what that means, but my doctor described it as a modified tricyclic.
Wellbutrin sounds ok I guess... I don’t know. Honestly, I hate taking medications and it does not seem like it's worth it.
Buspar... I read the reviews on remedyfind.com and I would rather take a benzo. There is not much chance I would be able to stay on it long enough for it to "kick in" anyway... lol 6 weeks? Whenever I hear about some medication you have to take for a month before it starts working I know it's not for me. The only reason I’ve been able to stay on Remeron as long as I have is because I get soltabs and when I go off of it for a couple days it's no fun.
I wish there was something to make me happier without turning me into a zombie or impairing my judgment... I can’t take much more of this. The only thing that helps is Adderall. Being able to focus my mind and concentrate on stuff is great... without it my life would be totally non-functional.
Viridis - I have taken several benzo’s before and... well, to be frank I do not like how they affect my mind. I’m really paranoid about taking any of them ever again.
You said:
>Some people here have reported antidepressant effects from Provigil, and I found it increased my confidence and energy, just not my concentration. You should be able to get some samples to try. My pdoc says that it seems to help some people with ADD but is very hit-or-miss in that department.<
I think that Provigil sounds great, but like I said there is no way I can go off adderall... do you think there is any chance my doctor will put me on both? (I don’t even want to ask for a sample if you think he won’t...)
Let me know.
-Tom
P.S. Those other medications you mentioned sound ok... if you don't think he will put me on Provigil I might try Serzone...
Posted by Viridis on October 27, 2003, at 13:37:39
In reply to Hmm..., posted by Tom1982 on October 27, 2003, at 6:08:07
I'm not sure if your doctor would let you try Provigil together with Adderall, but you could certainly ask. I did look at the prescribing portion of the Cephalon website (the company that makes Provigil) and they mention that it didn't affect the metabolism of Ritalin, an amphetamine relative. There doesn't seem to be any obvious contraindication with other stimulants, but then I'm not an expert.
One thing you could do is call Cephalon yourself and ask -- most of these pharmaceutical companies have experts who are happy to answer your questions, and that might provide more info that you could share with your doctor. A useful thing about Provigil (at least the samples that I got) is that they're easy to break, so you can try small doses to start. Regarding its price, I have seen somewhere that there's a push by some other companies to allow manufacturing of generics. I'm not up on the technicalities, but at least that's encouraging.
I've never tried Remeron, and have seen very mixed reviews of it here. My understanding is that it works on a subset of serotonin receptors, and also on norepinephrine. Apparently, dosing can be very important, with some side effects actually diminishing with increased doses. But, it sounds kind of complicated -- I just wonder if, since you're using it, you might discuss dosing issues with your doctor.
Despite my negative comments about Wellbutrin, you might want to give it a try, cautiously. Everyone responds so differently to these meds that some bad reactions don't necessarily mean that everyone will respond negatively. This seems to be a very good med for some people; I'd just try a low dose first.
For anxiety, benzos seem to be the best for a lot of people, but again, they're not right for everyone. One thing, though (and I've found this especially true of Klonopin) -- generally, with regular use, the side effects disappear quite quickly but the anti-anxiety effects don't. So if anxiety really is a severe problem and the other meds don't help, it may be worth a couple of weeks of feeling odd to achieve lasting relief. I was able to minimize sleepiness etc. from Klonopin by taking small, divided doses through the day at first. After a couple of weeks I had no side effects at all and just started taking the whole dose at once. I'm still getting the same anxiety relief from the same dose 2 1/2 years later. Of course, that's just me, but disappearance of side effects does seem to be pretty standard with Klonopin, according to my pdoc and others here.
This is the end of the thread.
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