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Alternative To Provigil?


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I need Provigil for fatigue and deprx/anxiety related to BPII with seasonal pattern and for Fibro fatigue.

BUT

My insurance won't cover off-label use and my doc has tried reasoning with them to no avail.

Has anyone found a good alternative to Provigil or an AD or CNS stimulant that works similarly?

My pdoc did suggest Wellbutrin XL which I plan on starting unless I figure out something better. I've not responded well in the past to Wellbutrin but I wasn't on a mood stabilizer the first time and gave up befre becoming therapeutic the last time.

Any input is much appreciated!

Hmmmmm...just thought of Amantadine...I'll have to look into that.

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Hmmmmm...just thought of Amantadine...I'll have to look into that.

Unlike Provigil, amantadine is a dopaminergic med (aside from whatever it does to the flu,) not a stimulant, so it's not very likely to help keep you awake unless it triggers mania for you. Also, Provigil isn't much of an anxiolytic either(I can't think of any of the wakey-wakey meds that are, aside from SSRI-driven insomnia)

What about a pure SNRI like Strattera, at a *low* initial dose instead?

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Hmmmmm...just thought of Amantadine...I'll have to look into that.

Unlike Provigil, amantadine is a dopaminergic med (aside from whatever it does to the flu,) not a stimulant, so it's not very likely to help keep you awake unless it triggers mania for you. Also, Provigil isn't much of an anxiolytic either(I can't think of any of the wakey-wakey meds that are, aside from SSRI-driven insomnia)

What about a pure SNRI like Strattera, at a *low* initial dose instead?

I have seen amantadine used for fatigue related to meds and MS..(Google- amantadine treatment for fatigue). I've not seen it used a lot and it would be off label so probably not covered either. ARGH!

I've read several articles related to efficacy of Provigil to combat SAD (my cycling pattern includes a seasonal deprx)...I mostly wanted it for that...and Fibro fatigue.

Strattera is a very good idea...I am hoping someone here has experience with it.

Thanks!

I'm so med naive when it comes to my own treatment...sorry. ;)

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Hmmmmm...just thought of Amantadine...I'll have to look into that.

Unlike Provigil, amantadine is a dopaminergic med (aside from whatever it does to the flu,) not a stimulant, so it's not very likely to help keep you awake unless it triggers mania for you. Also, Provigil isn't much of an anxiolytic either(I can't think of any of the wakey-wakey meds that are, aside from SSRI-driven insomnia)

What about a pure SNRI like Strattera, at a *low* initial dose instead?

Strattera is an ADHD med.....and is only an NRI, not an SNRI. It was intended as an AD, but was not found to be very effective for it. It may increase focus and some motivation, though.

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I need Provigil for fatigue and deprx/anxiety related to BPII with seasonal pattern and for Fibro fatigue.

BUT

My insurance won't cover off-label use and my doc has tried reasoning with them to no avail.

Has anyone found a good alternative to Provigil or an AD or CNS stimulant that works similarly?

My pdoc did suggest Wellbutrin XL which I plan on starting unless I figure out something better. I've not responded well in the past to Wellbutrin but I wasn't on a mood stabilizer the first time and gave up befre becoming therapeutic the last time.

Any input is much appreciated!

Hmmmmm...just thought of Amantadine...I'll have to look into that.

Wellbutrin has been known to be very energizing and motivating. It did this for me, but poooped out after about 4 months.

Other than Provigil you only have stimulants such as Ritalin and Adderal. They are cheap and are used off-label for depression and fatigue-related illnesses, so you may still have a problem getting your insurance to cover them.

With your BP diagnosis, and the fact that Lamictal invoked rage, you may have a high chance of sparking mania from the above recommended meds. Start off with low doses and use the sustained-releases of both.

Discuss all of this with you doc, of course.

I wish you luck!

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This might be a bit out there. Last I checked Provigil is used to promote wakefulness when dealing with obstructive sleep apnea, narcolepsy, or shift work sleep disorder. I saw that it says you work in Nursing, a field that is notorious for it's odd hours, and rotating shifts. So if your schedule isn't a regular 9-5, would it be possible to use your schedule as your reasoning for the Provigil and perhaps get your insurance to cover it that way?

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I need Provigil for fatigue and deprx/anxiety related to BPII with seasonal pattern and for Fibro fatigue.

BUT

My insurance won't cover off-label use and my doc has tried reasoning with them to no avail.

Has anyone found a good alternative to Provigil or an AD or CNS stimulant that works similarly?

My pdoc did suggest Wellbutrin XL which I plan on starting unless I figure out something better. I've not responded well in the past to Wellbutrin but I wasn't on a mood stabilizer the first time and gave up befre becoming therapeutic the last time.

Any input is much appreciated!

Hmmmmm...just thought of Amantadine...I'll have to look into that.

I had to stop taking Provigil because it interfeared with my birth control- ladies, if your doctor hasn't told you this, do some research. Unless you're using a copper IUD or condoms there is basically no way to be on provigil without risking getting knocked up.

However, when I was on it, I LOVED it for my depression/anxiety/fatigue (and school).

Now that I'm off it my doctor tried Adderall extended release, which was great for about 4 months before it started to 'turn' on me and slowly aggravate my anxiety to unheard of levels. I also lost a lot of weight, which I didn't mind but had my doctor concerned.

Now I've moved on to Concerta, which is okay (if Provigil is a 10 then this is a 6), it gives me the occasional mean headache and doesn't provide the focus that the Provigil does, but it has helped me get out of bed. Since you're bipolar your doctor might shy away from this but it was notably less activating for me than Adderall and Provigil- so I'd say its less likely to trigger a manic episode.

Wellburtin XL (which I am on and was on with the Provigil) will also give you that extra bump so I absolutely recommend giving it a try. I've had no negative side effects but I do have friends who tried it and said it made them forgetful or crazy, so who knows.

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