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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by Christ_empowered on October 8, 2012, at 12:04:20
Can Provigil have mood-stabilizing properties? I've noticed that, even though I have a moody psychotic "problem" (call it Bipolar I, call it schizoaffective...whatever), low-dose stimulants help my mood. Somehow, my anxiety goes down a notch, I'm a little more productive, a little happier (but not euphoric...I'm not looking to hit the Rx speed real hard), and things are just...better.
Now, I go to a Public Health doc. As far as I know, most (all?) controlled substances are out. Not a big deal. I'm not freaking out to the point that I need a benzo, and I don't think I really have ADHD/ADD. What I have is some kinda moody, sometimes psychotic, sometimes mildly compulsive "thing" that seems to respond well to: reasonably dosed Abilify (15-30), occasional sedatives, and mild stimulation. Basically, its like the 60s all over again: uppers and downers till you hit the sweet spot.
Seriously, though: I'm not looking to perfect my cocktail or anything. I'm only Abilify right now. I just need a little bit of improved focus and concentration and mood elevation w/o having to worry about drug-induced agitation, (hypo)mania, psycosis, etc. In my dream world, I could get 20mgs adderall xr and be done with it. Since this isn't my dream world, I think Provigil (maybe Nuvigil?) might be the best I can do.
Would it help? There's some indication that amphetamines can help level mood, even in Bipolar I (I'm guessing they level it at a higher level), but I can't get an amphetamine unless I get a private practice doc. Do you think this applies to Provigil/Nuvigil as well? Is that even OK to use in Public Mental health?
Posted by rjlockhart37 on October 8, 2012, at 12:17:18
In reply to Provigil?, posted by Christ_empowered on October 8, 2012, at 12:04:20
provgil and nuvigil are used in sometimes low energy schizophrenia due to its indirect, or no dopamine stimulation much...yet it does have those qualities...its nothing compared to amphetamine's release of DA. It promotes wakefulness, not a psycho-stimulant. It will be difficult to convince a public health doctor to try it...but there's always wellbutrin and other stimulating antidepressants. Wellbutrin with Nuvigil promotes a slight psycho-stimulant effect. You can tell your doctor but there is a chance they will decline it or avoid the suggestion. But here's a source on it:
http://tpp.sagepub.com/content/early/2012/03/13/2045125312441815.abstractgood day...
r
Posted by phillipa on October 8, 2012, at 12:51:15
In reply to Re: Provigil?, posted by rjlockhart37 on October 8, 2012, at 12:17:18
CE are you stable on the abilify? If so I'd stick to it. Phillipa
Posted by Christ_empowered on October 8, 2012, at 13:49:08
In reply to Re: Provigil?, posted by phillipa on October 8, 2012, at 12:51:15
I am quite stable, phillpa. And you're right...don't mess with what works.
words of wisdom. :-)
Posted by phillipa on October 8, 2012, at 21:22:53
In reply to Re: Provigil?, posted by Christ_empowered on October 8, 2012, at 13:49:08
Care a lot for you as you know Phillipa
Posted by phidippus on October 8, 2012, at 21:24:49
In reply to Provigil?, posted by Christ_empowered on October 8, 2012, at 12:04:20
You have quite the reaction to stimulants-I wouldn't kick the idea of ADHD out the door.
Stimulants do they same exact thing for me. You know what's also unique about dextroamphetamine? You can treat OCD with it.Provigal is more of a wakefulness promoter. It doesn't increase focus or attention like stimulants do. It has no dopaminergic action. It has been studied as a treatment for bipolar depression.
Eric
Posted by Raisinb on October 12, 2012, at 5:34:22
In reply to Provigil?, posted by Christ_empowered on October 8, 2012, at 12:04:20
I've never tried Provigil, but as I posted below, Concerta has been almost a magic ingredient in my cocktail for treating bipolar depression. There's a lot of evidence that I do have comorbid ADHD, and the stimulant has pretty much eliminated all those ADD behaviors, but it has also had a really positive effect on mood. I think the stims are worth trying.
Now as to how to get it, I'm not sure how your public health system works. If all controlled substances are out, you probably will need to see someone privately.
Posted by Christ_empowered on October 13, 2012, at 12:24:04
In reply to Re: Provigil? » Christ_empowered, posted by Raisinb on October 12, 2012, at 5:34:22
I don't know that its all that big a deal, really. Especially with more severe mental illness, docs (the ones I've seen, anyway) are more concerned with getting the agitation, psychosis, and more severe mood issues under adequate control. After that...maybe they'll help with pesky residual problems.
I'm fortunate because Abilify, all by itself, does a lot for me. I do Orthomolecular Medicine, which undoubtedly does *something* to help me out, but the 1 pharmaceutical I take every day covers a lot of ground.
As much as I'd love to go private practice, its expensive. I'm on disability and no one around here takes Medicare/Medicaid for outpatient psychiatry. So, my parents would have to spend $$$ to get me that amphetamine Rx. I have one doc in mind--she's helpful, professional, good at her job--but an initial evaluation is almost #300. Ouch.
Thanks for your help, though. I think I'll ask my (very professional, very realistic, very intelligent) public health doc about Provigil at my next appointment.
Posted by Hombre on October 17, 2012, at 5:52:21
In reply to Re: Provigil?, posted by phillipa on October 8, 2012, at 12:51:15
Wellbutrin can give energy, but it can also cause terrifying anxiety and/rritability, depending on your condition, so you might wanna have a benzo handy or something.
So be careful, as it can happen quickly depending on your metabolism.
Effexor also seems to tickle the NE/D receptors, in conjunction with something like remeron, which I take as well, can help with anergic (sp? low energy) depression, which is my kind, where nothing feels good and I don't have energy to function well at all.
Peace.
This is the end of the thread.
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