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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 22 of 22. This is the beginning of the thread.
Posted by Fivefires on November 6, 2007, at 16:29:09
Feels like can't get out of bed in morn' w/o one. Then it works for about 6hrs max. Don't like feeling this dependence -or- shall I say the addic---- word?
Getting in touch w/ pdoc very, very difficult.
Tried cold turkey a few days as don't like the feeling of needing extra per day.
Don't know what to do. Quite depressed re: this, the lack of a helpful AD, and had to turn down a job offer as could have been to my financial detriment.
Anyone else ever needed more than one 200mg tab Provigil per day?
tks, 5f
Posted by Dinah on November 6, 2007, at 18:19:42
In reply to Provigil dependence? - Feel need 2x 200mg a day, posted by Fivefires on November 6, 2007, at 16:29:09
100 mg a day quit working for me after a few years. Then I went to 200 mg, and that doesn't always feel like enough. My sleep doctor prescribes me one and a half 200 mg tablets a day. But the insurance is reluctant to pay for more than one a day.
Posted by d0pamine on November 6, 2007, at 19:41:29
In reply to Provigil dependence? - Feel need 2x 200mg a day, posted by Fivefires on November 6, 2007, at 16:29:09
It's been my experience that Provigil produces an extremely quick tolerance with daily use. I can find no stable way to use this medication on a daily basis. However it works great for emergencies. Daily use of it is a short dead end road. As an example 100 mg would work just fine for me on day 1 and possibly day 2, but by day 10 I'd be struggling to get the same effect from 400 mg. Stopping for a week or two resets everything.
Posted by War-Face on November 6, 2007, at 20:29:16
In reply to Re: Provigil dependence? - Feel need 2x 200mg a da, posted by d0pamine on November 6, 2007, at 19:41:29
Interesting to see 2 different perspectives on the rate at which tolerance is developed to modafinil.
Dinah: were you taking 100 mgs per day without breaks for a few years before tolerance developed?
D0pamine: How bad is the one week off of Provigil (i.e., withdrawal from Provigil)? Is it comparable to the stimulants?
Posted by Dinah on November 6, 2007, at 21:07:45
In reply to Re: Provigil dependence? - Feel need 2x 200mg a da, posted by War-Face on November 6, 2007, at 20:29:16
Probably not without breaks. I am not that constant about anything I do, except maybe my nighttime meds. If I don't take my nighttime meds, I wake up at three am with my ears ringing.
But at least a year, maybe two, of fairly consistent use at 100 mg. Then a while longer at 100 mg morning and 100 mg midday which wasn't much of an improvement from 100 mg total. I've been on 200 mg in the morning for two or three months, I think. And since my doctor says it's ok to take up to 300 mg, I sometimes take another half a tablet that I've saved from days I don't mind nodding off for a few hours midday.
My insurance company refused to cover it at all for a while until I got a new sleep neurologist, so I did go off it completely. I didn't find that I had any withdrawal symptoms other than a return of excessive daytime sleepiness. Since that's why I was on it to begin with, I'd say there was no withdrawal symptoms at all.
It also doesn't make me feel particularly energetic or jittery. I just somehow don't fall flat on my face from an overwhelming desire to sleep.
Posted by Phillipa on November 6, 2007, at 21:50:45
In reply to Provigil dependence? - Feel need 2x 200mg a day, posted by Fivefires on November 6, 2007, at 16:29:09
Five Fires please fill me in on the job and what happened. Love Jan
Posted by Mishal on November 7, 2007, at 4:52:20
In reply to Provigil dependence? - Feel need 2x 200mg a day, posted by Fivefires on November 6, 2007, at 16:29:09
> Feels like can't get out of bed in morn' w/o one. Then it works for about 6hrs max. Don't like feeling this dependence -or- shall I say the addic---- word?
Hi Fivefires,
Definitely it is not dependence. Your original symptoms are back. Provigil never causes dependence like SSRIS, Benzos etc.
> Tried cold turkey a few days as don't like the feeling of needing extra per day.
Why? needing an extra per day is not a felony. I spread my doses all along the day. 100mg in the morning, same dose right after three or four hours. Another 100mg at noon and if needed, I never hesitate to take 100mg evening or even at night. I still sleep well.
> Anyone else ever needed more than one 200mg tab Provigil per day?Many. I am one among them. Some days, I am going little upper as 500 or 600. Contrary to the drug literature which states 400mg as the maximum dose and doses beyond that don't seem to have any added benefit, I still get benefits if I go higher than 400mg.
And one thing all users should keep in mind is: Provigil is a unique med with some added benefits other than treating narcolepsy. It took more than a month for me to adjust to this drug. And during this period, I was really struggling with high and low caused by this stuff. I used to have a remarkable stimmulating effect right after dosing followed by huge crash when the drug wears off. This was on the first few weeks. But I was reluctant to give up and endured. Now my patience has been rewarded, and I feel like I am on the best ever medication I had in 20 plus years. No ups and lows now. Only an elevated mood with a magnificent calmness.
Please don't write off this wonderful stuff just because you had a horrible crash while you were on this drug. Crashes will happen, but upon repeated administration, they will without any doubt cease. If you wait with patience, you will never regret it.
And one last note: What many here describe as a tolerance is not the real tolerance. Provigil retains its efficacy all the time, but it is the initial euphoria that cease to exist upon repeated administration. NOT THE ALERTING, MOOD ELEVATING, CALMING, RELAXING EFFECT. It will always be there, but the problem is since you become used to the state of well being, you fail to notice it and complain of tolerance. That's all.
"Even orgasm, if it lasts for more time, one will become used to it and feel like not having any such thing at all"
With best wishes
Mishal
Posted by d0pamine on November 7, 2007, at 19:51:25
In reply to Re: Provigil dependence? - Feel need 2x 200mg a day » Fivefires, posted by Mishal on November 7, 2007, at 4:52:20
> What many here describe as a tolerance is not the real tolerance. Provigil retains its efficacy all the time, but it is the initial euphoria that cease to exist upon repeated administration. NOT THE ALERTING, MOOD ELEVATING, CALMING, RELAXING EFFECT. It will always be there, but the problem is since you become used to the state of well being, you fail to notice it and complain of tolerance. That's all.
I've never taken provigil for euphoria, mood elevating, calming, or relaxing and have never actually even experienced any of those effects from it. I've only used it when I've needed to stay awake during the day due to situational sleep deprivation at night and in those cases I can assure you that for me it is less effective every single consecutive day that I use it. The tolerance that I speak of pertains only to the ability to keep my eyes open and has nothing to do with mood or feelings. The crash at the end (once again speaking only in terms of sleep recovery) is also significantly worse for me with provigil than with amphetamine taken for the same reason for the same length of time.
Posted by Fivefires on November 7, 2007, at 20:13:55
In reply to Re: Provigil dependence? - Feel need 2x 200mg a da » Mishal, posted by d0pamine on November 7, 2007, at 19:51:25
Tks every1 for sharing all your experiences.
I feel less afraid of discussing this w/ my pdoc now.
5f
Posted by Mishal on November 8, 2007, at 4:08:36
In reply to Re: Provigil dependence? - Feel need 2x 200mg a da » Mishal, posted by d0pamine on November 7, 2007, at 19:51:25
> I've never taken provigil for euphoria, mood elevating, calming, or relaxing and have never actually even experienced any of those effects from it. I've only used it when I've needed to stay awake during the day due to situational sleep deprivation at night and in those cases I can assure you that for me it is less effective every single consecutive day that I use it. The tolerance that I speak of pertains only to the ability to keep my eyes open and has nothing to do with mood or feelings. The crash at the end (once again speaking only in terms of sleep recovery) is also significantly worse for me with provigil than with amphetamine taken for the same reason for the same length of time.
Hi d0pamine,No offence meant, but you should had gone through my post focusing a little more. I reiterate it again, Provigil will have many ups and downs at the initial stage. It is only after repeated dosing you are going to get the full benefit. It took more than a month for me to reap the whole fruits after dosing and adjusting.
Once again let me repeat: You can't assess provigil's potentials within a few days of dosing. You should have to be extremely patient. It is a painstaking process that will sometimes last for weeks or even months. But once you get into; you will never regret it.
Provigil worths a try. It is not like alcohol which comforts you first only to upset you later. Provigil is entirely different. It will upset you first but wait.. The reward will be there.
Posted by War-Face on November 8, 2007, at 14:07:05
In reply to Re: Provigil dependence? - Feel need 2x 200mg a day » Fivefires, posted by Mishal on November 7, 2007, at 4:52:20
Mishal, what are you taking Provigil for?
I'm not necessarily trying to play the role of mediator here, but it seems possible that the differences in each of your experiences with Provigil might depend on what you each of you were taking it for.
Let's say that someone using it for Inattentive ADD might have problems with the initial eugeroic effects subsiding, while someone using it for mood or MDD might find more benefits from prolonged use, and might not mind the initial eugeroic effects subsiding.
Just a thought
Posted by Fivefires on November 9, 2007, at 20:46:05
In reply to Re: Provigil dependence? - Feel need 2x 200mg a da, posted by Fivefires on November 7, 2007, at 20:13:55
I was afraid to follow the thread any longer, the thread I started :(, because I knew I'd opened a 'can of worms' sts, and because I recently became overwhelmed with some events in my life.
My pcp may have more insight as to what is going on w/ 'the me in me' than my pdoc because I can't access the latter very easily at all in this county system.
It's important for me to judge whether what I'm doing is right or wrong. Giving myself the benefit of the doubt is the hardest thing for me to do.
I was just thinking how this thread began about a medication and now feels it has sort of become an issue of support (something discussed in re: board changes).
It is acceptable (and unacceptable) to use meds for purposes other than their very specific ones. Don't believe I've ever been dx'd specifically for the fit here, but w/ lack of funding and social company it can't be said it's not necessarily a fit.
I'm awaiting a return call from the system once again. I try really hard not to misuse meds and to keep in touch w/ the profs, but it's hard.
5f
Posted by Phillipa on November 9, 2007, at 21:16:01
In reply to Re: Provigil dependence? - Feel need 2x 200mg a da, posted by Fivefires on November 9, 2007, at 20:46:05
Five Fires so are you taking providgil? Phillipa
Posted by Fivefires on November 9, 2007, at 21:53:57
In reply to Re: Provigil dependence? - Feel need 2x 200mg a da » Fivefires, posted by Phillipa on November 9, 2007, at 21:16:01
Yep, w/ some caution. One doc endorsed, and, the other, .. well, haven't been able to reach yet.
5f
Posted by Mishal on November 11, 2007, at 0:17:21
In reply to Re: Provigil dependence? }} Mishal }} D0pamine, posted by War-Face on November 8, 2007, at 14:07:05
> Mishal, what are you taking Provigil for?
Hi War-face,
I am taking it for depression. BTW, my depression is combined with ADD and sort of narcolepsy. I don't know which contributes to which.
> Let's say that someone using it for Inattentive ADD might have problems with the initial eugeroic effects subsiding, while someone using it for mood or MDD might find more benefits from prolonged use, and might not mind the initial eugeroic effects subsiding.
Could be true. I tried Provigil out as an antidepressant, not caring the initial effects whatever they turn out to be and waiting for the benefits after sometime. It clicked that's why I advocate using it on regular basis for many weeks to reap the full benefits.
Cheers
Posted by florence on November 13, 2007, at 18:57:34
In reply to Re: Provigil dependence? - Feel need 2x 200mg a day » Fivefires, posted by Mishal on November 7, 2007, at 4:52:20
I RESPECTFULLY disagree with Mishal.
I have taken Provigil on and off for over 4 or 5 yrs. I started at 100 mgs and it worked well for my fatigue. (later diagnosed with a thyroid disease: the cause of my fatigue.I never drank coffee. I would wake up and "see" if I could get out of bed by myself. I would wait and finally take the Provigil. Told the pdoc this and she said: just take it.......It worked in about 20 minutes. So I took it daily.
Then started notiving a "drop" about 6 hrs later. Not just energy but mood. My hubby noticed I was breathing a little fast. But I felt okay.
Months go by and I find out what an anxiety??? type attack is?? Or maybe abnormal thinking...Just a depressive type feeling and overexaggerated response-- (our dog died at one time and I was thinking: how is my son gonna go on with his life-- he was about 14 yrs old??)I realized it was not ME- but the Provigil. So the pdoc gives me Xanax which helped.
IT IS A CONTROLLED SUBSTANCE! DR NEVER TOLD ME.
As recently as summer this yr she said she didnt have a problem with my taking 600 mgs a day. She gave me samples to supplement what insurance didnt pay for.I was nuts!!!! BUT it stopped working at 100 mgs so she gave me 200 mgs. more Xanax.
Now I know what Benzos are; withdrawal;
I agree with poster who said not to take it on a daily basis. Benzos are also in same controlled substance class.
Provigil always works when I restart it- much to my surprize; then it stops after 3-10 days.
I didnt think it would work again- tried Adderall, Ritalin, and even dex-amph (this past December) Since Dex didnt get me out of bed- why would Provigil.
The higher the dose- the deeper the withdrawal effects: irrational thinking- extreme irritability; headaches.
I thought it was a benign drug since original posts about it here YRS ago compared it to caffeine...Those people probably gave it a week or so at best........AND I am just GUESSING here but MANY insurance companies didnt cover it then so it was not in such widespread use.
I never craved it. It NEVER improved my mood. It kills my appetite.
YOU CAN BECOME TOLERANT- DEPENDENT- call it what you want.
Go to the FDA website and read the official package insert- the one they dont give you at the drug stores.... Anxiety and Headache are clearly stated as side effects that are dose-related.
Go to the SUBSTANCE board here at PB and read my response to a post about someone who took megadoses and felt a euphoria. I wish I had checked out that board yrs ago.....
I think any controlled sched. IV drug taken every day causes tolerance.
I weigh 100 lbs. Normal for me is 118. I had note about this drug yrs ago- a love/hate thing. Got me out of bed was the best effect.
No appetite, bouncy eyes, dry eyes; depressed/irritable mood.
It totally screwed with my brain. Try to take it on and off.... I always went back to it- not because of cravings for it.But my fatigue is SO bad I am bed-ridden. So I took it just to get out of bed.
Now, 200 mgs barely lasts 2 hrs. I can tell time w/o a clock- just by when the provigil if wearing off.
Goal is to stop it by end of year. "Have to" since Xanax will run out this week or so. It's hell.. mentally more than physically (except for headaches: which radiate into my ears- Provigil seems to control a certain part of my brain: I am a creative person and laid back.....it has made me overly sensitive; irritable;) But I try to focus on my mood improving when I stop it. And tasting food again. Even if I am in bed.
The metabolites (2 major ones) one lasts 3xs as long as the parent drug so it took me over3 days to get my appetite back. Cannot imagine how long it will take to clear out 4-600 mgs.
100 mg worked well to get me out of bed for months. Now 200 mgs barely makes me feel alert. And it only lasts about 2 hrs. Then I start crying or become foggy.
Be careful..... Tolerance develops to any drug. It's the most basic pharmac. principle. Body wants return to homeostasis. florence
> Feels like can't get out of bed in morn' w/o one. Then it works for about 6hrs max. Don't like feeling this dependence -or- shall I say the addic---- word?
>
> Hi Fivefires,
>
> Definitely it is not dependence. Your original symptoms are back. Provigil never causes dependence like SSRIS, Benzos etc.
>
> > Tried cold turkey a few days as don't like the feeling of needing extra per day.
>
> Why? needing an extra per day is not a felony. I spread my doses all along the day. 100mg in the morning, same dose right after three or four hours. Another 100mg at noon and if needed, I never hesitate to take 100mg evening or even at night. I still sleep well.
>
> > Anyone else ever needed more than one 200mg tab Provigil per day?
>
> Many. I am one among them. Some days, I am going little upper as 500 or 600. Contrary to the drug literature which states 400mg as the maximum dose and doses beyond that don't seem to have any added benefit, I still get benefits if I go higher than 400mg.
>
> And one thing all users should keep in mind is: Provigil is a unique med with some added benefits other than treating narcolepsy. It took more than a month for me to adjust to this drug. And during this period, I was really struggling with high and low caused by this stuff. I used to have a remarkable stimmulating effect right after dosing followed by huge crash when the drug wears off. This was on the first few weeks. But I was reluctant to give up and endured. Now my patience has been rewarded, and I feel like I am on the best ever medication I had in 20 plus years. No ups and lows now. Only an elevated mood with a magnificent calmness.
>
> Please don't write off this wonderful stuff just because you had a horrible crash while you were on this drug. Crashes will happen, but upon repeated administration, they will without any doubt cease. If you wait with patience, you will never regret it.
>
> And one last note: What many here describe as a tolerance is not the real tolerance. Provigil retains its efficacy all the time, but it is the initial euphoria that cease to exist upon repeated administration. NOT THE ALERTING, MOOD ELEVATING, CALMING, RELAXING EFFECT. It will always be there, but the problem is since you become used to the state of well being, you fail to notice it and complain of tolerance. That's all.
>
> "Even orgasm, if it lasts for more time, one will become used to it and feel like not having any such thing at all"
>
> With best wishes
> Mishal
>
Posted by Astounder on November 15, 2007, at 21:07:42
In reply to Re: Provigil dependence? - Feel need 2x 200mg a da » War-Face, posted by Dinah on November 6, 2007, at 21:07:45
Provigil potently induces its own metabolism, through the CYP3A4 enzyme, and being that Provigil is extensively metabolized after being absorbed through the portal vein system, this will obviously affect its bioavailability. It also induces P-glycoprotein which Provigil is also ligand for, and this would affect its absorption.
This induction might by permanent. After 100 mg became ineffective for me after the first week, I shot up to 400 mg, which then too became useless. Even after months of staying off, neither the 100 mg dose or the 400 mg dose had any effect. This is opposite true psychostimulants which would display reverse tolerance after an extended holiday.
I've never experienced any withdrawal symptom after suddenly going off Provigil, unlike with Adderall. There was rebound fatigue and hypersomnia, sure, but it wasn't worse than before I started taking it.
It's really a shame because Provigil was the first truly anti-avoidant drug I've ever taken. Nothing else I've taken has ever touched this.
Posted by Fivefires on November 15, 2007, at 21:35:35
In reply to Tolerance to Provigil is probably only hepatic., posted by Astounder on November 15, 2007, at 21:07:42
This was my thinking about metabolizing meds so quickly ... they all get eaten up there inside before distribution (layman's words). So, if Provigil were given subcu or intravenous, would it work better? (No Worries. Not gonna' stick a needle in my arm!) Could put under the tongue for a while though if it would help. Adderall is being discussed alongside Provigil here, I think more than once. RU saying Adderall doesn't quite meet the efficacy(sp?) of Provigil Astounder?
tks, 5f
Posted by Astounder on November 15, 2007, at 22:53:13
In reply to Re: Tolerance to Provigil is probably only hepatic., posted by Fivefires on November 15, 2007, at 21:35:35
Since it's metabolized hepatically, any way that ignores the portal vein system should work; honestly, though I haven't done so, you could try insufflating it--right to the brain. If I remember the pills, they too large to do sublingual.
They felt really different for me. Adderall made me feel great, that I could do anything, let's clean my room, let's clean the bathroom. Teeth clenching--no need for food. I began a lot of projects at once that I would forget about and start another. I was very talkative and social. 12 hours later I was in the depths of an extremely hostile, irritated depression, intolerable of frustration, left crying and ashamed. I became very sad and disappointed when I went off of it. Very similar to the way I felt when I went off EmSam.
Provigil made me much more reactive than proactive. A phone rang? I picked it up. Mess on the counter? I cleaned it up. Clothes are dirty? Put em in the wash. Need something from the store? I'll go out and get it. No euphoria, no anxiolysis, no psychomotor activation, just not avoidant. This was an amazing change for someone as avoidant as I am. When the drug wore off 12 hours later I became depressed again, but in a more cataleptic, apathetic way, the way I was before I started taking it.
I didn't become behaviorally sensitized to Provigil, meaning I didn't feel any compulsion to take it for the sake of taking it like Adderall. But after a few weeks, it pooped out and I was never again able to catch that spark--taking it at any dose merely made me awake & alert.
Posted by Fivefires on November 16, 2007, at 15:28:19
In reply to Re: Tolerance to Provigil is probably only hepatic » Fivefires, posted by Astounder on November 15, 2007, at 22:53:13
I see. Thanks for such a clear explanation.
Damn that spark! Does nothing last? (I know; a depressing thought is all we need!)
I guess I'll just stay on it until it seems clearly more unfortunate than fortunate for me.
I heard from my doc earlier this week and began Deplin, which I've posted about today. Two days into it and I've gotten very physically ill. Called doc wondering if may be side effect. Front desk peeps told me to check the net or call my pharmacy; didn't even take a message for doc. :(
I'm sorry. This thread is supposed to be about Provigil, not Deplin.
I should probably post somewhere that I'm feeling just generally depressed about pretty much every med and everything at this time.
tks, 5f
Posted by tecknohed on November 19, 2007, at 17:48:38
In reply to Re: Tolerance to Provigil is probably only hepatic, posted by Fivefires on November 16, 2007, at 15:28:19
> Damn that spark! Does nothing last? (I know; a depressing thought is all we need!)
>
> I guess I'll just stay on it until it seems clearly more unfortunate than fortunate for me.
>
> I heard from my doc earlier this week and began Deplin, which I've posted about today. Two days into it and I've gotten very physically ill. Called doc wondering if may be side effect. Front desk peeps told me to check the net or call my pharmacy; didn't even take a message for doc. :(> I should probably post somewhere that I'm feeling just generally depressed about pretty much every med and everything at this time.
Hi Fivefires & Astounder.
When I took Provigil I got up to 600mg+/day within 2 months & that hardly touched me. What DID work was crushing the pills & snorting them. In fact the effect remained consistent until my nose started to bleed after a couple of weeks when I obviously stopped. Perhapse this was actually caused by something else in the pills, like hydrochloric acid. Would be good if they made a nasal spray version!
Fivefires - what side effects are you getting from the Deplin? Anything resembling allergies and/or worsening of depression? Insomnia? Histadelics are supposed to avoid all supplement forms of folic acid (which increases histamine production) & I'd imagine Deplin would also be contraindicated. For more info just do a simple web search for 'histadelia'. Heres some basic info: http://www.diagnose-me.com/cond/C447056.html
teck
Posted by Fivefires on November 19, 2007, at 19:21:51
In reply to Re: Tolerance to Provigil is probably only hepatic » Fivefires, posted by tecknohed on November 19, 2007, at 17:48:38
Yep, I can take a tab of Provigil and actually fall asleep; have done a few times. Other times, it will work.
I have an Spiriva inhaler, think prescribed because smoke, Astelin nasal spray, and Albuterol puffer thing. I have a lot of postnasal drainage problems and am blowing my nose like mad lately, tho' that's from crying I think. I do always awaken w/ sore throat and clogged-up nose tho'.
I tend to speculate I may be getting a tiny bit of gastro-intestinal upset, likely could be w/ the Deplin, but not sure. I have to take Lactase, a lot of it; even w/ a cookie that butter or grease has been used to make. Then I take dicyclomine for stomach upset.
My rbc count was very low (lose no blood - female reproductive organs gone) alongside the B12 and folate last lab test.
Obviously, I need 'something' to pull me up out of this nose-dive depression .. it's real bad, and no one really knows, because they won't listen to me. I've tried and tried to reach out but no one is listening.
I cannot tolerate ERs because we have like 6hr waits here before you get a bed and then another 2hr wait there. During all that time, I am not allowed a cigarette. Now I know this sounds ridiculous to you all who don't smoke or maybe even some of you who do, but I will literally 'lose total control of my emotions' if I can't have a cig at least every 2 to 2-1/2hrs. Last time I told them of this, they just laughed at me. I was crying and a nurse walked by and said 'She thinks she's special!' This is very true. By the time I saw the doctor, I could only blubber because I'd been crying for hours, and he just sent me home.
If have to go to ER to get care, I just can't get care.
Years ago w/ divorce called pdoc and he arranged immediate admittance. Why does no one do this anymore??????
I'm sorry covered three subjects here, not sure I answered anything or made anything clear, or if I even understand about the histamine thing.(?)
Sounds like I sort of fit that dx though.
I'm awfully damn depressed, but I felt this coming on b4 I started Deplin. It's not pulling me out of it though, if that's what my pdoc thought would happen.
Sorry if response wrong or unclear; I'm unable to focus very well. Tks for trying to help.
5f
This is the end of the thread.
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