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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by kristeenamarie on August 23, 2007, at 15:31:13
I am being treated for Bipolar I with Lamictal, Wellbutrin, Abilify, and Adderall XR. The issue lately has been my daytime sleepiness, cloudy mind, and chronic fatigue. This is why I have been taking Adderall, which has worked tremendously well. The only problem is, the XR takes way too long to start working in the morning causing me to lag and get depressed in bed until I feel like getting up finally. Also, in the late afternoon/evening the sleepiness returns and so does my rather resistant depression.
I told my psych this and he decided that I should try Provigil. I've been taking 100mg/day along with my regular 20mg Adderall XR/day for one week, with the eventual goal (according to my doctor) being switching from Adderall to 200mg Provigil.
In this short period of time I feel like the Provigil has had some positive effects for me, mostly a quicker waking period in the morning. But, I feel like my thoughts are more introspective, sometimes bordering on obsessive, and "inside my head" and as a consequence my social anxiety and discomfort has returned in a big way. Also, in the evenings, I still seem to get depressed, even moreso than before.
So, is it unusual for Provigil to induce depression and social anxiety? Or, could it possibly be something else and not this? I don't know what to tell my doctor, if it will even make sense. I know one week is a short period and I should probably wait it out, but honestly it's not something I imagine going away with time.
Posted by Racer on August 23, 2007, at 21:26:12
In reply to Provigil inducing depression and social anxiety?, posted by kristeenamarie on August 23, 2007, at 15:31:13
There are a couple of things I can think of on reading this. One is that Adderall may be involved, another would be the combination of Adderall and Provigil, and finally that it might actually be the Provigil...
Adderall is known to increase depression in some people. It did for me, in a very big way. I wouldn't call that likely, though, since my increased depression happened within the first month of taking it.
The combination might not be a great one, just because sometimes drugs don't make friends with one another. I know nothing about that combination, but it's a thought....
(Hey, I never said my thoughts were good ones -- only that I had some...)
And Provigil can boost mood, and apparently can decrease mood. I know I took it for a couple of years, and for a long time it helped a lot with mood brightening. Then, all of a sudden, after a couple of years, it -- stopped helping, then started to increase my depression. Go figure...
Have you tried any other psychostimulants? For me, Dexedrine helped much more than Adderall, and methylphenidate is most helpful of all. I took immediate release Ritalin for a long time, now take Concerta, which is better because it's once a day dosing.
Good luck.
Posted by kristeenamarie on August 23, 2007, at 22:15:39
In reply to Re: Provigil inducing depression and social anxiet, posted by Racer on August 23, 2007, at 21:26:12
I've been taking Adderall for about 5 months now. First immediate release and then XR. It has helped tremendously with my moods, energy, focus, and social anxiety. But, since the switch to XR, the long time it takes to start working effectively (about an hour for me) is a long time in the mornings. I feel like this is the reason, but my doctor didn't pinpoint it at all.
I've never tried any other stimulants. Well, ritalin once recreationally, but not enough for me to discern a difference. I'm hoping my doctor will consider a change in the same class of drugs, instead of immediately switching me to something different.
> There are a couple of things I can think of on reading this. One is that Adderall may be involved, another would be the combination of Adderall and Provigil, and finally that it might actually be the Provigil...
>
> Adderall is known to increase depression in some people. It did for me, in a very big way. I wouldn't call that likely, though, since my increased depression happened within the first month of taking it.
>
> The combination might not be a great one, just because sometimes drugs don't make friends with one another. I know nothing about that combination, but it's a thought....
>
> (Hey, I never said my thoughts were good ones -- only that I had some...)
>
> And Provigil can boost mood, and apparently can decrease mood. I know I took it for a couple of years, and for a long time it helped a lot with mood brightening. Then, all of a sudden, after a couple of years, it -- stopped helping, then started to increase my depression. Go figure...
>
> Have you tried any other psychostimulants? For me, Dexedrine helped much more than Adderall, and methylphenidate is most helpful of all. I took immediate release Ritalin for a long time, now take Concerta, which is better because it's once a day dosing.
>
> Good luck.
Posted by Fivefires on August 27, 2007, at 11:28:36
In reply to Provigil inducing depression and social anxiety?, posted by kristeenamarie on August 23, 2007, at 15:31:13
> I am being treated for Bipolar I with Lamictal, Wellbutrin, Abilify, and Adderall XR. The issue lately has been my daytime sleepiness, cloudy mind, and chronic fatigue. This is why I have been taking Adderall, which has worked tremendously well. The only problem is, the XR takes way too long to start working in the morning causing me to lag and get depressed in bed until I feel like getting up finally. Also, in the late afternoon/evening the sleepiness returns and so does my rather resistant depression.
>I have the same problem with anything that is supposed to be *extended release*. Before Effexor-XR came out, I was doing fine on Effexor. When I took Effexor-XR, instead of taking one a day like some people could w/ satisfactory results, I'd 'come down' 6-7hrs later. If I'd taken it @ 9a, I'd have to take another smaller dose at least by @ 5p or so, unless I wanted to feel terribly uncomfortable from 5p till whenever I was ready to go to bed.
I believe it is because I am a fast metabolizer, so 'not enough' and 'not quickly does the not enough' medication, get into your system.
> I told my psych this and he decided that I should try Provigil. I've been taking 100mg/day along with my regular 20mg Adderall XR/day for one week, with the eventual goal (according to my doctor) being switching from Adderall to 200mg Provigil.
>
> In this short period of time I feel like the Provigil has had some positive effects for me, mostly a quicker waking period in the morning. But, I feel like my thoughts are more introspective, sometimes bordering on obsessive, and "inside my head" and as a consequence my social anxiety and discomfort has returned in a big way. Also, in the evenings, I still seem to get depressed, even moreso than before.
>When I first began Provigil, I wasn't comfortable w/ taking 200mg, so took just 100mg, and had similar response as you. I was very uncomfortable and confused. But, when I finally got up the nerve to take 200mg, it worked and I could 'get out of your head'. But, even on the 200mg, I was having like a 'nose dive' around 4p and, of course, my day wasn't over and it wasn't time to sleep yet. It's *extended release* wasn't extended enough for me. I was 'coming down' sts. This med is intended to carry a person through an entire day until h.s., but not this person. I have to take 200mg a.m. and 100mg around 4-5p. Also, sounds like Adderall-XR may be doing the same thing w/ you.
> So, is it unusual for Provigil to induce depression and social anxiety? Or, could it possibly be something else and not this?>
>I was scared to take 200mg in the beginning so chose to take 100mg instead. I felt as you describe, more depressed by the frustration and I'd get a hint of energy, just to be slammed face down on the bed. I mean, in a matter of a couple hours!
I believe this was because it just was not enough to get me, a person who metabolizes fast, (There is then less medication released into your body as well.) to an altered state, a state where I felt some substantial energy. After a 2-3weeks of trying to work w/ it, I took the 200mg. First few days were a little rough, then I was also realizing the 'drop off feeling' disrupting my late afternoon as well. But, chose the latter dosing I mention above I believe
>I don't know what to tell my doctor, if it will even make sense. I know one week is a short period and I should probably wait it out, but honestly it's not something I imagine going away with time.>
>If what happened to me is happening to you, I'm afraid I agree with you not imagining it going away. You could try do as I did, or, as unfortunately, it pooped out altogether for a prior poster, maybe your pdoc will allow one of the others.
The reason I'm being given it is because I'm on a lot of 'downing meds', Valium or Xanax and at least three for chronic pain.
I printed the first post following yours, should Provigil 200mg a.m. and 100mg late afternoon quit serving me well at some point in the future.
You never know, when comparing ourselves to another re: how meds will work, if life circumstance or drug interaction or tolerance (There are so many reasons.) may be reasons a drug poops out. For me, guess will cross bridge when comes.
I don't know much about Adderall-XR. Were you feeling 'a dropping off' during your days on it or did it carry you through an entire day? Maybe you were and this is the reason your doc put you on Provigil?
If you feel like I did, you just wanted to 'flush' the Provigil, but the switch in dosage and dosing times made a lot of difference and now it is helping me.
I'm sorry I don't know enough to say anything about Adderall-XR. Did I already ask you if you had a 'dropping off' on it as well?
I apologize if repeating. Wish we could see a full screen here. Hope you talk w/ doc asap and get some comfort kristeenamarie. I would be interested to hear your decision, if you'd wish to share.
5f
Posted by SometimesBlue on August 27, 2007, at 13:34:49
In reply to Provigil inducing depression and social anxiety?, posted by kristeenamarie on August 23, 2007, at 15:31:13
I took Provigil with zoloft, and it increased my anxiety and depression in the evenings...although it did help me start my day ina better mood, and faster.
So, i think our experience has been the same. I had switch from zoloft to lexapro to stop the anxiety.
However, my depression in the evenings was there before and after provigil. So i think it may a seperate issue all in its own.
Hope that helps :)
Posted by Fivefires on August 27, 2007, at 13:58:29
In reply to Re: Provigil inducing depression and social anxiety? » kristeenamarie, posted by SometimesBlue on August 27, 2007, at 13:34:49
> I took Provigil with zoloft, and it increased my anxiety and depression in the evenings...although it did help me start my day ina better mood, and faster.
>
> So, i think our experience has been the same. I had switch from zoloft to lexapro to stop the anxiety.
>
> However, my depression in the evenings was there before and after provigil. So i think it may a seperate issue all in its own.Have you heard of 'sundowning'? It is like knowing the day is coming to an end and feeling as if you've not really 'had a day'. That's my off-the-wall definition. Googling will come up w/ nursing homes or Alzheimer's especially.
When I began to live alone and didn't have anyone visit or call for a day, OMgoodness, I felt sad.
Just another thought.
> Hope that helps :)
U don't think the depression in eve' differed in any way w/ or w/o Provigil?
tks, 5f
Posted by SometimesBlue on August 28, 2007, at 15:26:04
In reply to Re: Provigil inducing depression and social anxiety?, posted by Fivefires on August 27, 2007, at 13:58:29
> U don't think the depression in eve' differed in any way w/ or w/o Provigil?
Well, i may not have been as bad, i think the Provigil somewhat extended my lex. But i think i suffer from SAD...i say "I think" because i haven't been formally diagnosed. Although who can know me better than me, right?
-SB
Posted by Fivefires on August 29, 2007, at 22:23:32
In reply to Re: Provigil inducing depression and social anxiety? » Fivefires, posted by SometimesBlue on August 28, 2007, at 15:26:04
Yeah, thought maybe might have been just a little less on Provigil.
Oh. I don't know very much about SAD. Just know what it stands for. I've been inpatient about 3-4times and it was always some time around April, if that means anything.
I think I had a bit of sundowning before settled into new place and med changes. I finally told my daughter she didn't need to call me every night and 'throw me a kiss'!
tks, 5f
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