"Just Do It", yeah, right...

October 14, 2007 12:58 PM

Tell me about Provigil.

With the change of daylight-savings-time, and winter getting closer, I am getting my usual blah, no motivation, just want to vegetate mood back; I get it every winter. A friend of mine has used Provigil and says it really makes a world of difference for her. Thing is, I also take Paxil for a generalized anxiety disorder. (Been on it for years; it was my savior.) OK? Not ok? Anyone have any experience along these lines? I know about SAD, light therapy--I have the light--it didn't seem to make much of a difference. I will be seeing a dr. but I want to be sure that it's not an off-the-wall request before I bring it up with him (the "drug shopping" thing and all...I want to avoid that label.)

posted by wafaa to health (16 comments total)

Provigil, as far as I know, isn't usually prescribed for SAD or depression. IANAD but I know provigil was traditionally prescribed for narcolepsy, as modafinil somehow "deletes" the brains default setting that requires sleep for normal function. In other words, its been described as a non-stimulant stimulant. I had a doctor give me a sample back in high school when i was trying out different solutions for ADD. I'm not sure how it would interact with an SSRI, but I can't imagine it being a cureall for your winter blahs. Try to make it to the gym and eat a little healther--I know its not the easy fix youre looking for, but it really is amazing how big of a difference regular excerise and proper diet can have on your mood and energy--and it won't take weeks to kick in. (BTW, this is coming from someone who's also had to deal with depression in the past and only recently improved diet and exercise habits)
posted by Kifer85 at 1:20 PM on October 14, 2007 [1 favorite]

Some antidepressants are sedating, and some psychiatrists have experimented with using provigil as a way of counteracting the sedation. It doesn't have the kind of side effects that amphetamine or other broad-acting stimulants have, and doesn't suffer from a tolerance buildup.
posted by Steven C. Den Beste at 1:33 PM on October 14, 2007

I've used (and continue to use) Provigil extensively. At least 150mg every morning for over a year now.

Provigil is not the end-all and be-all. As a regular morning wakeup pill it helps your concentration a bit, and reduces your tiredness a bit, but it's not as good as a solid caffeine pill. That said, compared to caffeine it a) lasts a lot longer and b) doesn't give you that jittery/frantic feeling.

It won't motivate you to get your life back together, or kick you out of the winter blahs.

Provigil has the advantage of being just about the only stimulant class of drug that doesn't muck with severe manic depressives, which is useful for some of us. And yes, would-be doctors (and any actual doctors) there's been at least one major study testing this fact. I have no idea what negative effect it might have on depressives, but I suspect the answer is 'very little.'

Having said that, there's an amount of Provigil that *will* start to mess with dopamine levels in non-sleep-related parts of your brain. For me it's about 250mg, but I tend to be extraordinarily sensitive to psychotropics.

It's a call for your doctor. It might help a little, it might not, and it's useful that Provigil has VERY little in the way of nasty secondary symptoms. It's worth a try if he's game, but to be honest, I don't think it's what you're looking for.
posted by Ryvar at 1:40 PM on October 14, 2007 [1 favorite]

IANAD but I know provigil was traditionally prescribed for narcolepsy, as modafinil somehow "deletes" the brains default setting that requires sleep for normal function. In other words, its been described as a non-stimulant stimulant.
Whoa, that sounds nasty. I'll be re-thinking that one...
...amazing how big of a difference regular excerise and proper diet can have on your mood and energy...
Yep, I think if I didn't subscribe to that I would feel much worse.
I know its not the easy fix youre looking for...
True. I do tend to search for the panacaea. (I know there's something out there, dammit!)
posted by wafaa at 1:49 PM on October 14, 2007

Another circumstance where I wish I could respond anonymously, but here goes.

Provigil (modafinil) is only FDA approved for sleepiness and sleepiness in disorders such as obstructive sleep apnea (in conjunction with other treatments), narcolepsy, and shift work disorder.

There are still ongoing trials to have this medication approved for other disorders. It did poorly in trials for depression, ADHD, etc (I'll let you go to pubmed for that one).

I don't think your doc will conclude you are drug shopping, modafinil is classified as a nontraditional stimulant whereas something like ritalin would. The actual mechanism of action is not yet determined despite the marketing that this pharmaceutical company is trying to promote (if you want more details on this, or references to articles that have eliminated some mechanisms of action for modafinil, feel free to e-mail me).

Information that may be relevant to you (and you could give this info to your doc and he could read the article if he wants, although it not yet approved for this purpose) --there was a recent trial with antidepressants + modafinil compared with patients receiving antidepressants + placebo, and the patients with the modafinil did better in terms of sleepiness and other symptoms associated with depression. That would suggest there are not problems, and I have no doubt that there are other physicians doing this off-label, but remember you may be a guinea pig until more studies are done. Here is the reference if you are interested, and if you plug this info into pubmed you can read ths abstract there:

Fava M, Thase ME, Debattista C, Doghramji K, Arora S, Hughes RJ. Modafinil Augmentation of Selective Serotonin Reuptake Inhibitor Therapy in MDD Partial Responders with Persistent Fatigue and Sleepiness.
Ann Clin Psychiatry. 2007 Jul-Sep;19(3):153-9.
posted by Wolfster at 1:49 PM on October 14, 2007

I really approve of all the marketing that was done to make people understand that modafinil has no side effects whatsoever.

I wish they'd spent the money on developing a drug that actually behaved like the drug they're advertising, though. While modafinil in large studies clearly has a more favorable side effect profile than its predecessors the amphetamines and methyphenidate, in individual patients it can have terrible effects. If you start looking closely at what these are, you start to see things like acute psychosis, heart arrhythmia, weight loss, dry mouth, depression - coincidentally, all the stuff that we know amphetamines can do.

It really does appear to be less habit-forming than the amphetamines, and that's a major plus. I honestly doubt that it would be any good at all for complaints like the winter blahs, but in this particular case the discussion is for wafaa and her doctor, not anyone else.
posted by ikkyu2 at 2:29 PM on October 14, 2007

ikkyu2, while I have a great respect for you in all medical threads, I have to take issue with two things you said:

I really approve of all the marketing that was done to make people understand that modafinil has no side effects whatsoever.

Nobody has said this, so I'm not sure why you feel it's necessary to burn a straw man. It makes me feel uncomfortable to see a doctor say anything that gives off the slightest indication of intellectual dishonesty, even if fighting drug marketing is a daily frustration for them.

in this particular case the discussion is for wafaa and her doctor, not anyone else.

She's already said she intends to see a doctor about this (she could hardly do otherwise, seeing as it's a Schedule 4), and what she specifically asked for was other people's experiences, so I'm not sure what you think your statement accomplishes.
posted by Ryvar at 3:09 PM on October 14, 2007

requisite link to the Salon.com article.
posted by neilkod at 3:15 PM on October 14, 2007

This does not answer you question about medication. But I have a relative that uses "light therapy" during the winter and she is able to get out of the doldrums of dark winter.

You might do a google search for "light therapy."
posted by JayRwv at 5:19 PM on October 14, 2007

I may be an unusual case, but I tried Provigil and found that it didn't do anything for me. I took it for 2 months and didn't notice any positive or negative effects.
posted by spira at 5:35 PM on October 14, 2007

she could hardly do otherwise, seeing as it's a Schedule 4

Wrong. She, or another person reading this thread, could easily take her friend's, or order it directly from another country without a prescription. People do this kind of thing all the time. It's a bad idea.

As far as drug marketing, Ryvar, the idea I'm trying to get across is that a lower incidence of side effects is only great for you if you're not one of the people who gets the terrible side effect. If you are one of the people who gets the terrible side effect and dies from it - and acute psychosis is no joke, it often results in people coming to great harm as they start taking actions that aren't appropriate to their situations or environment - the fact that your drug had only a 0.1% rate of acute psychosis in clinical trials doesn't help you at all.

I fall firmly in the camp that says that drugs like these should be taken under the supervision of a doctor. The original poster's plan is to go ask her doctor about this. That makes sense, so I don't think there's much to argue about here.
posted by ikkyu2 at 5:36 PM on October 14, 2007

You have the full-spectrum light, but are you using it 'as prescribed'? You should be 1-2 feet away from it when it's on -- the farther away you sit from it, the longer period of time you'll need. (Mine is right next to my bed and is plugged into a timer: it greets me every morning from 6:55am-7:55am.) Do some experiments [I read an unrelated article recently where the author suggested "Be your own scientist," which I thought was a nice phrase] and see if you can get it to work any better for you.
posted by oldtimey at 6:14 PM on October 14, 2007

I have (so far) been diagnosed with "idiopathic hypersomnolence", which is a fancy way of saying "you're excessively sleepy and we don't know why". My sleep doctor gave me some samples of modafinil to try, and after I reported that it helped, prescribed it to me. I've been on 200mg/day about six weeks now, and it has made a significant difference to my life. I feel awake! Even mid-afternoons!

I still don't feel refreshed after waking in the morning, but what I have found helps a lot on workdays is to keep a bottle of water by my bed, set an alarm for 5:30, wake up briefly, swallow my pills, fall back to sleep, then wake up with a second alarm at 6:30. This seems to drastically shorten the time it takes me to get from "just woke up" state to "ready to face the day", down to 5 or 10 minutes. Weekends I sleep in, though the medium-term use of modafinil seems to have pulled my natural time of waking back from 10am to 8am. I'm not regularly sleeping with anyone at the moment; may have to negotiate that practice.

If I want to be fully awake after 10pm or so, I take an extra pill early afternoon, or a half-pill before going out. This will keep me functional at least until 2am.

Side effects I've noticed: mild anti-depressant; minor unpleasant reaction with fluvoxamine, specifically mild nausea and drowsiness; heightened sensitivity to caffeine, to the point where a strong caffeinated drink can give me anxiety; occasional "disconnection/unreality" sensations; nervous tics & talking to oneself. None of these have reached the point of being noticeable to others, that I know of.

YMMV, and that's the problem really. Your doctor will no doubt tell you to start with 100mg, and ramp it up if it doesn't much help. You'll need to experiment with when to take the pills; taking it too early may make you sleepy again by afternoon, and taking it too late may make it hard for you to get to sleep at night. Splitting a dose (say, 6am and 10am) may work for you.

Good luck with it. :)
posted by aeschenkarnos at 9:47 PM on October 14, 2007

Provigil, as far as I know, isn't usually prescribed for SAD or depression.

I was prescribed it for depression about six years ago, but it was added on to celexa after celexa didn't seem to work. It didn't really help the depression, but I was less fatigued. The only side effects I noticed were dry mouth and reduced appetite. I didn't take it for very long, though, since it didn't work on the depression.
posted by Violet Hour at 10:39 PM on October 14, 2007

It's prescribed "off-label" for depression by some doctors, and IMO could be very useful. Tiredness without apparent physical cause is a common symptom in depression. Modafinil can assist the user to find the time and energy to do the exercise that actually helps their depression. Working on that myself actually. :)
posted by aeschenkarnos at 11:21 PM on October 14, 2007

Provigil can interact badly with SSRIs (e.g., Prozac). My doctor wouldn't consider Provigil, even though I often fall asleep at work in the afternoons, as long as I was on an SSRI.
posted by KRS at 2:56 PM on October 15, 2007