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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 20 of 20. This is the beginning of the thread.
Posted by theo on June 10, 2004, at 18:48:25
My doc gave me the option for either Provigil or Wellbutrin XL to add to my SSRI (Luvox) for feeling slow and maybe adding antidepressant benefits.
Anyway, I have samples for both and insurance will cover both, I need input please.
Posted by King Vultan on June 10, 2004, at 19:53:49
In reply to PROVIGIL OR WELLBUTRIN XL?, posted by theo on June 10, 2004, at 18:48:25
> My doc gave me the option for either Provigil or Wellbutrin XL to add to my SSRI (Luvox) for feeling slow and maybe adding antidepressant benefits.
>
> Anyway, I have samples for both and insurance will cover both, I need input please.
I think both are good choices. I had better luck with Wellbutrin (I took the SR version), but my reaction to Provigil was bizarre and atypical, as it made me intolerably sleepy. Inspite of this, I actually have a higher opinion of Provigil. It doesn't have a lot of side effects, and I think it has a greater chance of working well with a wider variety of people. The biggest drawback is that it is quite expensive, but apparently, your insurance renders this point moot.Todd
Posted by Racer on June 10, 2004, at 20:09:55
In reply to Re: PROVIGIL OR WELLBUTRIN XL?, posted by King Vultan on June 10, 2004, at 19:53:49
LOL!!! Honest to gonest, Todd, your "atypical" reaction to Provigil made me laugh -- for the first time in AGES, I might add -- because it makes me feel a little leaden, too. (It's currently the only thing I'm taking, because my pdoc -- and the agency he works for -- are convinced that, when a med fails for any reason, the patient MUST still wait for their next scheduled appointment, a month later, because rescheduling would promote dependancy. Good thing I was able to tell my husband how much of a priority dying was when the last med trial failed, because he and our marriage counselor helped keep me safe from myself.) The leaden feeling is a major improvement for me right now, though, so I'm not going to complain -- I'll be grateful and keep taking it.
Now, my own "atypical" response to Provigil varies a lot. When I was taking it with anti-depressants, I was speeding out of my mind. The first few days of taking it alone, I was speeding out of my mind. Right now, though, I'm not speeding in the same way, although I am kinda speedy in another way. It's hard to describe, but basically if I can get going on anything mental, I can keep going and going and going and going -- but I can't channel that very productively. I *think*, although I can't prove it, that the depression is keeping me from being able to channel it, but the Provigil is providing the energy I would need if I could channel it.
(Yes, the speedy response is probably contributing a lot to the length of my posts. But then, I'm pedantic and long winded, anyway, so who can tell?)
As for the choice between them, I'm with you: the side effect profile would make me try Provigil first, knowing that there's an alternative if it doesn't work out.
Posted by Ktemene on June 10, 2004, at 22:52:44
In reply to PROVIGIL OR WELLBUTRIN XL?, posted by theo on June 10, 2004, at 18:48:25
It might make sense to try Provigil first, because you should be able to tell quite soon whether it was giving you more energy or not. A fair trial of Wellbutrin, especially with a view to added antidepressant effect, would require several weeks.
Posted by Carlos C on June 11, 2004, at 0:41:50
In reply to PROVIGIL OR WELLBUTRIN XL?, posted by theo on June 10, 2004, at 18:48:25
Here my experience with the two. Wellbutrin made me very anxious. Provigil didn't agitate my anxiety much. In addition to helping me with some sleepiness it also gave me a subtle brightening of mood but is unpredictable. As I'm sure you know you may have a different reaction.
I tried them both while not on any other drugs. I have no idea what the they would have been like while on an SSRI.
Posted by Viridis on June 11, 2004, at 4:40:07
In reply to PROVIGIL OR WELLBUTRIN XL?, posted by theo on June 10, 2004, at 18:48:25
Wellbutrin made me extremely anxious and caused all sorts of strange side effects, even after two months of use. I finally had to stop taking it, and had no problem doing so. My pdoc says that it's notorious for causing anxiety in some individuals, although it works very well for others.
Provigil (for me) was mildly energizing without causing anxiety, and as has already been pointed out, you should know how you react very quickly. With Wellbutrin, you really need to give it a few weeks before you can make a decision. So, it seems most reasonable to me to try Provigil first (maybe for a week or two) and then move to Wellbutrin if Provigil doesn't help. If you're anxiety-prone, I'd recommend that you start with a very low dose of either med and work up carefully (especially with Wellbutrin).
Posted by Allie Blue on June 11, 2004, at 7:16:03
In reply to PROVIGIL OR WELLBUTRIN XL?, posted by theo on June 10, 2004, at 18:48:25
> My doc gave me the option for either Provigil or Wellbutrin XL to add to my SSRI (Luvox) for feeling slow and maybe adding antidepressant benefits.
>
> Anyway, I have samples for both and insurance will cover both, I need input please.
Which insurance company do you have that will pay for provigil? My insurance company won't pay for provigil unless it is for narcolepsy. I would like to know from posters if their insurance company pays for provigil if they do not have narcolepsy. It is expensive without insurance coverage. Thanks for any input.
Posted by theo on June 11, 2004, at 7:51:24
In reply to Re: PROVIGIL OR WELLBUTRIN XL? » theo, posted by Viridis on June 11, 2004, at 4:40:07
How low should I start with Provigil? I have 200mg pills and cut one in half and even in quarters and they cut fine. Would a quarter (50mg) be to low to start?
Posted by Hattree on June 11, 2004, at 8:23:52
In reply to PROVIGIL OR WELLBUTRIN XL?, posted by theo on June 10, 2004, at 18:48:25
Go with the Provigil first because you will see right away how it affects you.
Posted by Viridis on June 11, 2004, at 9:00:05
In reply to Thanks, One more question, posted by theo on June 11, 2004, at 7:51:24
As far as I know, cutting the pills is fine. That's what I did, and they have no special coating etc.
Posted by Racer on June 11, 2004, at 11:24:45
In reply to Thanks, One more question, posted by theo on June 11, 2004, at 7:51:24
As far as I have been able to find out, Provigil is one of those amazing drugs that are so generally benign -- outside of their intended effects -- that you can start at almost any dosage. The first couple of days of taking it alone, I was speedy, but that passed after two or three days. I did reduce from 100mg to 50mg because of the speediness, but once that passed, 100mg was fine for me. I could probably up it to 200mg, without being overly speedy, but I haven't because I'm getting enough relief to "white-knuckle" my way through the days right now.
I think you can probably start at 100mg without trouble, although you might want to start on a Saturday in case you do go through a speedy day or two.
Best luck! Provigil is currently saving me from the belief that ALL medications are evil.
Posted by psychosage on June 11, 2004, at 12:28:23
In reply to Re: Thanks, One more question, posted by Racer on June 11, 2004, at 11:24:45
I have been on both Provigil and wellbutrin XL in the last year. In fact I was on both at the same time with a mood stabilizer. I have posted quite a bit about provigil on here, so you can search to see what I have written.
I suggest you keep the second option available for a future trial because both drugs are quite different from each other. The only real problematic side effect of Wellbutrin is the agitation. Provigil is a lot more smooth.
I was on Wellbutrin xl 300 with Provigil 100mg and Trileptal, but I have dropped Wellbutrin after a year and my third trial for a second trial of Effexor XR 150mg.
I kind of think Provigil is more appropriate for the cognitive dulling and fatigue caused by an SSRI.
You can start at 50mg, and you may need to experiment with dose splitting {100mg morning and then 100mg in the afternoon}or how much you need {100mg vs. 200mg} to determine the right effect for you.
At first 25mg had a profound effect on me, so take advantage of your pill cutter.
I do believe tolerance does occur, so be aware that in a few months you may have to tinker with the dosage. I believe 400mg is the max for Provigil.
Decreased sleep {8 to 6 hours a night}, decreased appetite, speediness, euphoria, very very mild headache all went away after a couple of weeks.
I would suggest giving Provigil a good month to watch all the side effects evaporate. As I have said before on here, Provigil is a stimulant that works in the background for you, so you may not even notice its effects unless you need to be alert.
Posted by theo on June 12, 2004, at 10:44:45
In reply to PROVIGIL OR WELLBUTRIN XL?, posted by theo on June 10, 2004, at 18:48:25
I started Provigil at 50mg yesterday and this morning took 50mg also. I can tell even at 50mg that it helps me come out of my shell a little. How long should I wait to go to 100mg? I don't want to jump the gun but didn't know if going slow really matters with this med as far as dose increase?
Posted by Racer on June 12, 2004, at 11:58:41
In reply to Started Provigil at 50mg and have a question, posted by theo on June 12, 2004, at 10:44:45
I'm not the expert on chemistry, but I have taken Provigil and am taking it now, so I'll answer based only on my own experience -- so keep in mind that n = 1 is statistically meaningless.
I change my dose on a day to day basis, with no troubles. Some days, I take 50 because I felt speedy the day before, some days I take 150 because I was too leaden the day before. It doesn't seem to make any difference -- the days I take 50 I'm less speedy, the days I take 100 or 150 I'm less leaden. Provigil doesn't seem to have a real long effect the way anti-depressants do, it seems to be more of a 'hey, I'm here for you when you need me' sort of a drug, you know?
My guess? If you're doing well with 50, but feel that you need a little more boost, try the 100 whenever you're ready to. If it's too much for you, you can go back to 50 the next day and probably not have any problems with it. Heck, you can probably start right up on 200 if you want to, but if you don't want to feel speedy, you might want to start more modestly with the 100 ;-)
Posted by psychosage on June 12, 2004, at 12:18:15
In reply to Re: Started Provigil at 50mg and have a question, posted by Racer on June 12, 2004, at 11:58:41
I think you should just test it, and "take as needed" is an option my pdoc gave me if I had to do extra work. However, I think on the assumption that eventually I will have built tolerance, so i want to be modest as far as how often I deviate from my regular dose. My assumption is that I will just be increasing dosage over time, so I kind of want to stay as low as I can.
Some people are different, and I may find my situation changes. I may find that the same dose works for a very very long time.
In your case, I would definitely do some personal testing with whether one dose in the morning alone or half in the morning and half in the afternoon works best, and naturally, I would look at how 50mg works, then move up the next day to compare how that feels.
Good luck, and keep us posted!
Posted by theo on June 12, 2004, at 13:14:50
In reply to Started Provigil at 50mg and have a question, posted by theo on June 12, 2004, at 10:44:45
I do have a very light headache. Does this go away in time?
Posted by Racer on June 12, 2004, at 14:10:54
In reply to I forgot to mention slight headache side effect, posted by theo on June 12, 2004, at 13:14:50
I can't really tell you if it does or not. I was aware of a slight, really weird headache at first, but then I was no longer aware of it. I don't know if it went away, though, because I tend to kinda dissociate mild to moderate chronic pain. (Lots of practice doing so) The headache I'm getting with it is kinda like someone put a very tight skullcap on just the part of my head/brain that's above the ears. It's almost more of a feeling as if that part of my head/brain has been stuffed with jello -- hard to explain -- rather than a real 'pain', if that makes any sense.
The best news I can give you, though, is that the headache is a known adverse effect, and studies have shown that when it does happen, it is limited to the adjustment phase. The only thing I've seen about duration only said that it resolved "within three months" -- but it didn't say how many patients stopped having problems within a shorter time frame. What I do know is that, for me, it certainly never got any worse than it was initially, it never really even got bad enough for me to take any advil, and it was less and less noticeable after the first couple of weeks. (Again, I can't say if it went away, or I just stopped noticing.)
Best luck to you. As I said, I am really liking this drug right now.
Posted by psychosage on June 12, 2004, at 16:56:09
In reply to Re: Started Provigil at 50mg and have a question, posted by Racer on June 12, 2004, at 11:58:41
It should go away, but if it is persistent and the same exact level for a month, then there should be some reconsideration.
I had only a slight pain in my head similar to racer's.
YOu may want to search for some narcolepsy bulletin boards because I have read their posts, and they are pros with Provigil and stims.
Good luck!
Posted by theo on June 12, 2004, at 18:16:18
In reply to Re: Started Provigil at 50mg THEO, posted by psychosage on June 12, 2004, at 16:56:09
What sight has a good narcolepsy board?
> It should go away, but if it is persistent and the same exact level for a month, then there should be some reconsideration.
>
> I had only a slight pain in my head similar to racer's.
>
> YOu may want to search for some narcolepsy bulletin boards because I have read their posts, and they are pros with Provigil and stims.
>
>
> Good luck!
Posted by psychosage on June 13, 2004, at 13:38:37
In reply to Re: Started Provigil at 50mg THEO » psychosage, posted by theo on June 12, 2004, at 18:16:18
> What sight has a good narcolepsy board?
>
> > It should go away, but if it is persistent and the same exact level for a month, then there should be some reconsideration.
> >
> > I had only a slight pain in my head similar to racer's.
> >
> > YOu may want to search for some narcolepsy bulletin boards because I have read their posts, and they are pros with Provigil and stims.
> >
> >
> > Good luck!
>
>
This is the end of the thread.
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