Shown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by Dinah on June 20, 2004, at 9:01:47
That's what my psychiatrist told me and I had no reason to disbelieve him. But while my neurologist hasn't yet directly addressed the point, he has sort of indirectly said it doesn't if I'm understanding him correctly.
Posted by King Vultan on June 20, 2004, at 11:00:29
In reply to Provigil affects norepinephrine, right?, posted by Dinah on June 20, 2004, at 9:01:47
> That's what my psychiatrist told me and I had no reason to disbelieve him. But while my neurologist hasn't yet directly addressed the point, he has sort of indirectly said it doesn't if I'm understanding him correctly.
This is a weird drug, and I don't believe there is a consensus on exactly how it operates. There was some thought early on that it worked on alpha adrenergic receptors, if I recall correctly, but this is now disputed. It does appear to have some effect on dopamine, as well as effects on the glutamate and GABA systems. I wouldn't be too hard on your doctors if they can't give you a good explanation because I did quite a bit of research into it last year after I had a bizarre reaction to it, and I was only able to achieve a vague comphrehension of what it's doing (maybe).Todd
Posted by zeugma on June 20, 2004, at 12:24:47
In reply to Re: Provigil affects norepinephrine, right?, posted by King Vultan on June 20, 2004, at 11:00:29
> > That's what my psychiatrist told me and I had no reason to disbelieve him. But while my neurologist hasn't yet directly addressed the point, he has sort of indirectly said it doesn't if I'm understanding him correctly.
>
>
> This is a weird drug, and I don't believe there is a consensus on exactly how it operates. There was some thought early on that it worked on alpha adrenergic receptors, if I recall correctly, but this is now disputed. It does appear to have some effect on dopamine, as well as effects on the glutamate and GABA systems. I wouldn't be too hard on your doctors if they can't give you a good explanation because I did quite a bit of research into it last year after I had a bizarre reaction to it, and I was only able to achieve a vague comphrehension of what it's doing (maybe).
>
> ToddWhat sort of reaction did you have, and how did it help you have a vague comprehension of what it's doing?
I took 100 mg Provigil this morning and promptly went back to sleep. I had some vivid dreams, more vivid than usual. This is the opposite of my experience with Strattera, where my dreams were completely suppressed by the drug's effect (NE reuptake inhibitors are specific inhibitors of REM sleep). But we already knew Provigil was not an NRI (that is why it is ineffective against cataplexy).
For me so far, the only effect has been a calming one. Definitely not the noradrenergic rush I got from strattera, or from nortriptyline at low doses.
Posted by Dinah on June 20, 2004, at 13:31:25
In reply to Re: Provigil affects norepinephrine, right? » King Vultan, posted by zeugma on June 20, 2004, at 12:24:47
Well, now I'm confused. Maybe I have the wrong drug... I thought this was the one the neurologist wanted to prescribe if by some odd chance I do have narcolepsy, as he strongly suggests I do. I guess I'll have to wait to my next appointment to find out, by which time the question may well be moot because I don't think I have narcolepsy.
It does explain the differing explanations from the differing doctors. But I'm not sure I want to take a drug that they don't understand yet...
Thank you for the information.
Dinah
Posted by psychosage on June 20, 2004, at 14:11:27
In reply to Re: Provigil - King Vultan, posted by Dinah on June 20, 2004, at 13:31:25
Provigil operates on a specific kind of norepinephrine receptor called alpha 1 i think. it also affects dopamine in some parts of the brain. that is why there is a concern over rage and psychosis to which my pdoc alerted me. It affects glutamate as well which is why some people have a calm focus and better thinking from it.
Psych drugs have become far more complicated than the big three neurotransmitters now. I read that NE increase can increase dopamine and serotonin increase can decrease dopamine. SO all of this gets extra confusing even when you don't get into subtypes of receptors.
Posted by King Vultan on June 20, 2004, at 14:51:56
In reply to Re: Provigil affects norepinephrine, right? » King Vultan, posted by zeugma on June 20, 2004, at 12:24:47
>
> What sort of reaction did you have, and how did it help you have a vague comprehension of what it's doing?
>
> I took 100 mg Provigil this morning and promptly went back to sleep. I had some vivid dreams, more vivid than usual. This is the opposite of my experience with Strattera, where my dreams were completely suppressed by the drug's effect (NE reuptake inhibitors are specific inhibitors of REM sleep). But we already knew Provigil was not an NRI (that is why it is ineffective against cataplexy).
>
> For me so far, the only effect has been a calming one. Definitely not the noradrenergic rush I got from strattera, or from nortriptyline at low doses.
>
What I meant was all the research I did gave me a vague conception of how it works, not my reaction to it, which I don't understand and is apparently in the "rare" category. The stuff was intolerably sedating, and I was so sleepy I could barely function. Out of the 11 drugs I've tried, it was the only one with zero therapeutic effects. I could have perhaps used it as a sleep aid, but seeing as though the stuff is supposed to be a stimulant and is used for people with narcolepsy or by Parkinson's patients falling asleep in the middle of the day from their dopamine agonists, that really made no sense to me.Todd
Posted by psychosage on June 21, 2004, at 12:16:57
In reply to Re: Provigil affects norepinephrine, right? » zeugma, posted by King Vultan on June 20, 2004, at 14:51:56
>
> >
> > What sort of reaction did you have, and how did it help you have a vague comprehension of what it's doing?
> >
> > I took 100 mg Provigil this morning and promptly went back to sleep. I had some vivid dreams, more vivid than usual. This is the opposite of my experience with Strattera, where my dreams were completely suppressed by the drug's effect (NE reuptake inhibitors are specific inhibitors of REM sleep). But we already knew Provigil was not an NRI (that is why it is ineffective against cataplexy).
> >
> > For me so far, the only effect has been a calming one. Definitely not the noradrenergic rush I got from strattera, or from nortriptyline at low doses.
> >
>
>
> What I meant was all the research I did gave me a vague conception of how it works, not my reaction to it, which I don't understand and is apparently in the "rare" category. The stuff was intolerably sedating, and I was so sleepy I could barely function. Out of the 11 drugs I've tried, it was the only one with zero therapeutic effects. I could have perhaps used it as a sleep aid, but seeing as though the stuff is supposed to be a stimulant and is used for people with narcolepsy or by Parkinson's patients falling asleep in the middle of the day from their dopamine agonists, that really made no sense to me.
>
> Todd
>
>according to similar reactions to strattera, provigil might be sedating you because you might not have enough of the neurotransmitter{s} it is working on.
check the 3rd paragraph in "how to take strattera"
Posted by zeugma on June 21, 2004, at 17:27:18
In reply to Provigil makes u sleepy...like strattera 4 some? » King Vultan, posted by psychosage on June 21, 2004, at 12:16:57
Reuptake is how neurotransmitter is conserved, so in theory a powerful reuptake inhibitor can deplete one of the transmitter in question. I have only heard of this happening, however, after massive overdoses of NRI's. I suspect the reason Strattera makes some sleepy (I would say fatigued) is because of some unknown property of the molecule, and not its norepinephrine reuptake inhibition.
On second thought, something else occurs to me: Strattera's rapid absorption in the CNS followed by its almost equally rapid exit (half-life under 5 hours). This can lead to sudden, tremendous fluctuations in NE levels, which could well put a lot of strain on the CNS and cause the fatigue/sleepiness reactions. Either or both of these theories could be true.
Provigil's mechanism, whatever it is, is not NE reuptake inhibition. It seems to act on hypocretins (recently discovered neuropeptides in the hypothalamus) and to some extent on dopamine, and maybe most of the other amines as well, but not through reuptake inhibition.
Posted by Racer on June 22, 2004, at 15:12:35
In reply to Re: Provigil - King Vultan, posted by Dinah on June 20, 2004, at 13:31:25
Hey, you know how I'm having all those problems with meds and am totally freaked out by life in general and the number 43 in particular? (<<OK, that last part only makes sense if you like Douglas Adams, but at least I'm amusing myself, right?)
I started taking some of the Provigil I had left over from that med-stopping episode some months back. This was after my short, ill-fated, nightmarish experience with Remeron -- one effect of which was to shut down my GI tract entirely. (Gross alert: not only classic constipation, not even any gas moving through there. You're welcome for the overshare.) Since stimulants can stimulate the GI tract, and I was desperate, I took it for a few days and behold! Not only did it help a lot with the problem I started it for, it also calmed me a lot. Obviously, it ain't a miracle cure for what ails me -- which is largely that unnamed agency, at this point -- but it really is helping me a lot. Considering how totally freaked out I am by the very thought of psych meds at this point, and considering the fact that I don't even take anything for a headache unless it gets to the point I can't move my head, that's a pretty dang strong recommendation that you consider it.
I've read a few studies about Provigil, too, and while I don't have nearly the same level of understanding as others here, what stood out for me is that it truly seems to be a very benign drug. Much more benefit than risk, based on all the studies done that I could find. Mind you, you know enough about my politics at this point, so you know I weight the studies I read -- some of the government studies and most of the drug company studies start out with a handicap, and I prefer independant studies when I can find them -- and this drug, while not well understood, really does seem to be about as safe as any of the new psychoactive drugs can be.
Of course, as usual, I'm not telling you to take it if it's prescribed. I'm only trying to relieve your worry if I can, so that you can make the best decision for yourself, and so that your decision is based on your own best judgement rather than fear that may or may not have a solid foundation.
If I can find it, later, when I feel better, I will post a link to the best article I found about it for you. It did help me feel better about taking it, and it really has stopped the total hysterical blowouts for me. (Yeah, I know, I get everything backwards: trust me to be calmed by a stimulant, huh?)
Posted by King Vultan on June 23, 2004, at 7:59:20
In reply to Re: Provigil - King Vultan » Dinah, posted by Racer on June 22, 2004, at 15:12:35
When my pdoc suggested I try Provigil, he did say that he thought it was an extremely safe drug, which agrees with that you've seen also. At some point, I do hope to gain an understanding of why it had the opposite effect on me and made me so sedated and sleepy. Zeugma mentioned that it may work on hypocretins; there happened to be an article in my local paper Monday reprinted from the NY Times on a recent study on the the roles of sleep chemicals. The focus of the article was serotonin, norepinephrine, and histamine, but they did mention hypocretin. They said that narcolepsy "appears to be caused by damage to structures that process another neurotransmitter, hypocretin, that in turn leads to lower levels of histamine." As the primary role (and only FDA approved use AFAIK) of Provigil is to treat narcolepsy, this hypocretin thing seems to tie in pretty well.
Todd
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD, bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.