Help! WTF is making me zone out like this?

[tek]

Before I start, I should add that I went off of Provigil (200mg/day) about a week ago...replacing it with good ol' Adderall (instant release). I definitely experienced some rebound (sedation, extreme grogginess, zero effect from Adderall). I know it was Provigil rebound because I took a dose and that stuff magically disappeared. My pdoc and I agreed to slowly titrate down over a period of days to ease the symptoms.

Anyway, unfortunately there wasn't time between the weaning off of Provigil and adding on Wellbutrin and Lunesta. I'm running into this bizarre mental fog/zoning out/sedation type of thing and don't know what med to blame! I need ideas, quick...I'm returning to work TOMORROW from an 8 week "went crazy" hiatus and this zoning out stuff won't fly.

Below is the regimen during the med changes, if it helps to spot anything...Day 1 is the FIRST day with ZERO Provigil (three days ago).

Day 1:

7:30 am -- Lamictal 150mg, Ativan 1mg, Adderall IR 20mg, Bactrim - Less sleepy/groggy than previous few days.

10am -- Pdoc appointment...not totally alert, but not sleepy either.

11:30am -- Wellbutrin XL 150mg

12:00pm -- Ativan 1mg, Adderall IR 20mg

1 - 2:30pm -- hyperfocused and feeling activated.

2:30 - 4:00pm -- VERY activated. Motivation still a bit low, but felt like I didn't want to sit down so I did a ton of chores.

5pm -- Ativan 1mg, Bactrim

6-8pm -- Activation over, and very very irritable.

8:30pm -- Lunesta 3mg

10pm -- Asleep

Day 2:

8am -- Wake up, feel well rested.

8:30am -- Lamictal 150mg, Ativan 1mg, Adderall IR 20mg, Wellbutrin XL 150mg, Bactrim

10am -- Realize I'm feeling very tired and almost sedated and HUNGRY, despite coffee AND Adderall. Very unusual.

12:00pm -- Ativan 1mg, Adderall IR 20mg

(afternoon-ish?) -- Bursts of activation coming and going, but overall still more "tired" than I felt I should be.

4:30pm -- Ativan 1mg, Adderall IR 20mg, Bactrim

(evening) -- nowhere near as activated as I should be, having taken Adderall.

8:30pm -- Lunesta 3mg

10:30pm -- Still awake, reading. Feeling a little drowsy so I try to sleep.

11:30pm -- Still awake with the regular stuff, like I hadn't even taken Lunesta (dumb thoughts popping into my head, tossing and turning...even feeling like I couldn't keep my eyes closed). Blamed this on late dose of Adderall

(night) -- My "turn" to sleep with the baby (5 month old that wakes up at least 2-3 times)

Day 3:

8am -- Wake up, feel like shit....sleep was fitful and baby woke me up at least 10 times. No kidding.

8:30am -- Lamictal 150mg, Ativan 1mg, Adderall IR 20mg, Wellbutrin XL 150mg, Bactrim

(all morning) -- Generally feel like shit, sedated and unmotivated. No feelings of stimulation or activation to speak of. Fairly irritable.

12:30pm -- Ativan 1mg, Adderall IR 20mg

1pm -- Went shopping. It was okay. I wasn't feeling too sedated but I wasn't completely into it.

2pm -- Still feel like complete shit, don't want to go anywhere else. Parked my car and sat there ZONING OUT for over a half-hour.

(afternoon) -- Hung out with a friend, had dinner with husband. Felt barely there.

5:30pm -- Ativan 1mg

6pm -- Zoning out, surroundings almost felt surreal...TV was making me feel dizzy or strange...something.

7pm -- Bactrim - Got some things together for work tomorrow. Sat down here to write this post

8pm -- Now. I'm not having trouble writing this post, but I could easily let the monitor go out of focus and zone out.

Bottom line: This stuff is VERY unusual for me, and seems almost bizarre for it to happen while taking Adderall (I've taken it in the past and it always had the exact opposite effect). What's the most likely culprit? Lunesta? Or, still Provigil rebounding? I can't imagine that Wellbutrin would be to blame since it was so activating the first afternoon I took it, and uh...it's not exactly known to sedate people.

[AnneMarie]

Why did you stop Provigil?

Without knowing much, I'd guess you are tired because you aren't sleeping enough. Maybe the Adderal plus Welbutrin is feeding the insomnia.

Edit cuz I can't spell.

[Cetkat]

If day 1 is the first day without Provigil, then day 2 is probably the first day that it's really out of your system. That could be the reason why you got tired. Add that to being overly stimulated (but not in a focused way) by wellbutrin & not being able to sleep.. and you get day 3. Sleep deprivation time.

Hopefully that will equate with you getting a good night's sleep tonight.

[tek]

I wish that it had. Lunesta was like a sugar pill. 2 hours rolling around in bed, then I had to take 2 Ativan in hopes I could konk out. About another 1.5 hours after that. I'm fortunate I could get up this morning!

Hmmm...you both make good points. I had considered that maybe Provigil was just masking the effects of little sleep enough for me to function. If that's the case, then I think I'd rather switch back and can Adderall. Anyone who has taken Adderall knows that it doesn't work all that well when you're tired! It's certainly a catch 22, huh?

[tek]

Why did you stop Provigil?

Without knowing much, I'd guess you are tired because you aren't sleeping enough. Maybe the Adderal plus Welbutrin is feeding the insomnia.

Well, luckily I don't have really bad insomnia...currently, anyway. I have a difficult time believing Adderall is contributing to this because I was on it for over a year during which I was very sleep deprived, and never had these experiences.

I'm taking one med out of the equation tonight: Lunesta. I'm glad I did 3 days of the exact same meds, but though the results were consistent...they weren't good! Plus, the Lunesta doesn't seem to hold a candle to Ambien, anyway. I need something shut my brain off, and only Ambien has been able to do that.

[Cetkat]

I would definitely sub Ambien for Lunesta.

If you're still having problems sleeping - sleeping because otherwise it could just be withdrawal from Provigil; I'd temporarily drop the Wellbutrin before deciding to go off Adderall. See if that's the culprit & then decide how to handle it from there. It could be a Wellbutrin + no Provigil that's getting to you..

[AnneMarie]

Why did you stop Provigil?

Without knowing much, I'd guess you are tired because you aren't sleeping enough. Maybe the Adderal plus Welbutrin is feeding the insomnia.

Well, luckily I don't have really bad insomnia...currently, anyway. I have a difficult time believing Adderall is contributing to this because I was on it for over a year during which I was very sleep deprived, and never had these experiences.

I'm taking one med out of the equation tonight: Lunesta. I'm glad I did 3 days of the exact same meds, but though the results were consistent...they weren't good! Plus, the Lunesta doesn't seem to hold a candle to Ambien, anyway. I need something shut my brain off, and only Ambien has been able to do that.

Lunesta works well for me until something like, say, hypomania gets in the way. Then it does next to nothing unless something else like Seroquel is thrown into the equation, and even then, it's a maybe. Zyprexa isn't nearly as sedating as Seroquel, so I too feel like I'm taking sugar pills. Frustrating.

If Ambien works better for you, then give it a shot. If that's the med you tinker with, leave the rest alone. I'd still bet on the addition of Wellbutrin and the swap on Provigil. Anyway, it sounds like this has been going on long enough to give your pdoc a call to say what's up.

[Velvet Elvis]

I'd guess that's the adderall.

Adderall is a blend of several different amphetamine salts which supposedly have different durations of action. Some kick in faster and some stick around longer. They also have different effects and side effects. One of them didn't get along well with me at all. I've done much better on Dexedrine.

The dose could be off on the Adderall. The duration of action for the IR is 5 hours with it hitting the peak at around 3 hours. You might be taking the second dose too soon (or too late).

What's your diet like? It's easy to forget to eat enough when you're on stimulants but you really need to. That alone will do it. Go ahead and front end load the the carbs and protein at breakfast. It's a good idea for anyone who is on psych meds to take a B-complex but this is double true with stimulants. A multi as well if you can afford it.

If you know amphetamine based stims work better for you than methyphenidate, you might want to look into Dexedrine. Adderall is a blend of several substances and you only need to have trouble with one of them to have side effects. Since Dexedrine is just the one it seems like your

If you don't have consistently good sleep, there is nothing meds can do to make up for it during the day. Ditto with diet. If you don't eat and sleep right, stimulants won't do crap and will just wear you out over time.

[mrsloony]

I thought Bactrim was an antibiotic. if it is and you are treating some kind of illness could this account for some of it?

[tek]

I still have an Ambien refill, and requested to pick it up. Though I would really prefer to avoid a sleeping aid if at all possible, I know that more sleep will probably benefit me in numerous ways in the long run. Sleep dep isn't going to do anything good, period. I guess I won't know if something else is affecting my sleep badly until I try some Ambien. The are only two times Ambien didn't knock me out: 1) hypomanic-ish symptoms that pdoc blames on meds or thyroid; 2) 2-week bout of REAL insomnia, right around the time I got a low TSH...so again, thyroid was blamed. I don't feel hypomanic and I am definitely not an insomniac, so there's no reason to believe Ambien won't do the job. (crosses fingers) I don't know if I'll be able to pick it up tonight, but even so...no fucking Lunesta. Copper penny taste can die in a fire.

This morning, I couldn't bear the thought of getting discouraged on my first day back to work by being a zombified moron. I took half my regular dose (100mg) of Provigil with the other morning meds, sans Adderall...which I took 2 hours later (around when I got into work). Hmm...I was bright-eyed and bushy-tailed. Despite a relatively crappy night of sleep. So obviously, all this wierd stuff leads me back to coming off of Provigil. I mean, even if it's still some rebounding effect...I don't get regular sleep due to lifestyle (young baby) and chronic initial insomnia. It's true that stimulants don't do shit if you are tired...but Provigil still does! At least for me, anyway. I think I'm going to see how sleep goes with no Lunesta tonight, and pop another half-dose of Provigil tomorrow. Again, I really don't see how any of this stuff could be blamed on Adderall. I've taken Adderall in it's various forms for almost two years and never had these issues. Considering that new meds were added, and one taken away...it's got to have something to do with whatever was changed. At this point, I'm prepared to trade Adderall back for Provigil because at least I'm AWAKE! What good is increased focus and attention span when you're too exhausted to think, and this on top of med changes?

Tomorrow, I may even Provigil instead of Adderall. It was great when it was what I needed, but it honestly hasn't been able to get ahead of my depression-related issues for at least the last 8 months. I can focus, but I'm not interested or motivated...so it's pretty much a waste of amphetamines.