Provigil, Adderall for Depression & ADD?

[AuburnSunshine]

Currently on 150 mg Wellbutrin and 36 mg. Concerta...depression lifting somewhat but am definitely still depressed.

Am also wondering if Concerta is working or not because I still don't do much...makes me more sleepy than it helps with being alert, gettings things done, etc.

What would be your opinions regarding Provigil or Adderall for my depression and ADD? From reading information on the "My Remedy" page, it's obvious my current combination isn't doing what it's supposed to be doing but that Provigil or Adderall just may help me.

Any thoughts before I talk with my doctor?

[syncope]

Currently on 150 mg Wellbutrin and 36 mg. Concerta...depression lifting somewhat but am definitely still depressed.

Am also wondering if Concerta is working or not because I still don't do much...makes me more sleepy than it helps with being alert, gettings things done, etc.

What would be your opinions regarding Provigil or Adderall for my depression and ADD? From reading information on the "My Remedy" page, it's obvious my current combination isn't doing what it's supposed to be doing but that Provigil or Adderall just may help me.

Any thoughts before I talk with my doctor?

<{POST_SNAPBACK}>

Provigil helps some people (myself included) with ADD. It also screws around with my antidepressant (nortriptyline) less than Ritalin did, although I have the charming side effect of 'ulcerated tongue' from the med. (I'm going to see my PCP next week.  It is not only unsightly and painful, but I worry that I will go from ulcerated to unuseable tongue- not a happy thought.)

I took an extra 100 mg Provigil today, and that is the reason I am still awake at this not very late hour. I will have to see if I can tolerate 300 mg Provigil.  300 mg Provigil is the therapeutic equivalent of an optimal dose of Ritalin- for me, about 45 mg. My own idiosyncratic thought.  Provigil works better for organization issues than Ritalin at any dose, not as well at pure attentional processes. Provigil also causes less jitteriness. I literally shook all the time I was on Ritalin.

[Catnapper]

Adderall was the last addition to my multi-flavor cocktail; see my signature.  I like it pretty well.  The worst side effect is that it adds to the dry mouth I already had from Vivactil, but it's not a deal-breaker.  I've also learned to get my two doses in early or I'll end up staying up all night, which is easy to do anyway as I'm unemployed right now.

It's an off-label use because I don't have ADD, just depression/dysthymia.  However, I kept heading downhill even after upping the doses of the ADs and the pdoc wanted to put the brakes on.  Also, if you're a pharmo-geek, Adderall enhances the effect of how the tricyclic Vivactil works chemically, just don't ask me to explain!

I was worried some about getting hooked since their are plenty of substance abusers in my family, but the pdoc was more worried about depression.  He also noted I hadn't had drug/alcohol problems in the past (I'm 46), and since I was depressed, I probably wouldn't get high like I would if I started taking it from a normal state.  All of that's proven true as I have no signs of addiction; no desire to increase dose, and don't crave it on days I haven't taken because I've gotten up too late and don't want to be up all night.  It doesn't need a steady dose like an AD per my pdoc.  And since I'm overweight, the appetite reduction is a bonus.

If you have any tendency towards hypomania, I think it's a big no-no, but I'm out of my depth in bipolar land so you're best off checking other sources for that info.

Hope you find something that suits you.

[ldo]

I don't know about that stuff for depression, but it might help a lot with the ADD. From what I understand, it's hard to predict how any one person will react to a med for ADD, and it may be worth trying a couple of different ones. It's not like you have to wait very long to do it. You can tell within hours. Lots of people do well on one and not on another. I've heard that stimulants can have a temporary antidepressant effect.

I cope with dry mouth mostly by chewing sugarless gum. I'm kinda sick of the gum but it really helps. Also, I use Biotene mouthwash, which was very helpful when the dry mouth seemed to be giving me sore spots.

I took 3 days off of Adderall recently to try to figure out which side effects were from what. I had no urges to get back on it, but I started to notice that my behavior was more of a problem than it had been. Started taking again it just in time, because shortly afterward I was able to face a Kafkaesque situation with restraint.

[Velvet Elvis]

Provigil is pretty much a stimulant that has been neutered to have less of an effect of dopamine. 

It can help with executive functioning related ADD symptoms, planing, task changing, and the overall feeling of being "on the ball," but for reading dense texts and paying attention to lectures it doesn't do a whole lot.

If concerta doesn't do it for you, try one of the amphetimine based stims, adderal or dexidrine.  For whatever reason, people who dislike one tend to do much better on the other.

You have plenty of room to go up on the dose on both of the meds you are on.  That might be worth a try before moving over to somthing new.

[AuburnSunshine]

Thanks for the input...I have a call into my pdoc...my depression is increasing big time...all I can do is cry, sleep...then not sleep...cry some more...no energy to do anything...haven't left the house in two weeks.

I've done a lot of thinking about this Wellbutrin/Concerta combination. I've taken Wellbutrin for 12 years and never had a problem with it and I actually stopped taking it this summer. Then when the depression started back up my pdoc put me back on 150 Wellbutrin...but when I saw her a month ago she refused to up it.

She has a real thing about Wellbutrin and seizures (I read someone else on the board say his/her pdoc did as well). I guess she's had a patient or two have a seizure and it must have freaked her out.

But I've been on 400 mg in the past...and I'm going downhill fast with just the 150 so I hope she'll up it or we'll try something else...although I've tried so many already that I'm not hopeful.

As for the Concerta and ritalin not only is it not working the way I'm reading it should be...I've gained weight on it. A lot of weight...my pdoc says it's my imagination but after a physical last week I have the numbers and I've gained 15 pounds since I began Concerta and ritalin last March.

I get sleepy on the Concerta, it doesn't help me concentrate as much as it did at first, and I've gained weight...wouldn't you say it's not working anymore? I'm hoping she'll put me on Adderall because I've got graduate school starting up again and I would love to be able to concentrate and complete the quarter.

Thanks for listening...I'm just so tired of all of this. My doctor says I'm BP II...but I really and truly don't agree with that diagnosis because I have never had any kind of a manic period...not even a mild one.

Right now I think I'm moving quickly into MDD and I can feel myself sinking...and that's scary because I know how low I can go and how dangerous it can get. I just hope she listens to me...hears me...I feel that she's thinks she's already got it figured out and so it doesn't matter what I say.

HELP anyone have a suggestion or two????

[syncope]

Thanks for the input...I have a call into my pdoc...my depression is increasing big time...all I can do is cry, sleep...then not sleep...cry some more...no energy to do anything...haven't left the house in two weeks.

I've done a lot of thinking about this Wellbutrin/Concerta combination. I've taken Wellbutrin for 12 years and never had a problem with it and I actually stopped taking it this summer. Then when the depression started back up my pdoc put me back on 150 Wellbutrin...but when I saw her a month ago she refused to up it.

She has a real thing about Wellbutrin and seizures (I read someone else on the board say his/her pdoc did as well). I guess she's had a patient or two have a seizure and it must have freaked her out.

But I've been on 400 mg in the past...and I'm going downhill fast with just the 150 so I hope she'll up it or we'll try something else...although I've tried so many already that I'm not hopeful.

As for the Concerta and ritalin not only is it not working the way I'm reading it should be...I've gained weight on it. A lot of weight...my pdoc says it's my imagination but after a physical last week I have the numbers and I've gained 15 pounds since I began Concerta and ritalin last March.

_____________________________________________

You gained weight on Ritalin?? Please, can I have your metabolism? Maybe I could take Ritalin, and you could try my Provigil. Just be sure to buy some really good saliva substitute- the beautiful women at the pharmacy, all of whom I have a great affection for, know just how dry my mouth is, because I just ordered some more saliva substitute and lozenges from a company that caters to those who suffer from REALLY dry mouth.

I think Provigil is closer, on my subjective sliding scale, to an antidepressant than Ritalin.

Tricyclics are good antidepressants (both nortriptyline and protriptyline [Vivactil] are relatively nonsedating drugs in this family). They also cause really dry mouth.

_________________________________________________

I get sleepy on the Concerta, it doesn't help me concentrate as much as it did at first, and I've gained weight...wouldn't you say it's not working anymore? I'm hoping she'll put me on Adderall because I've got graduate school starting up again and I would love to be able to concentrate and complete the quarter.

I would say an ADD drug that doesn't help you concentrate isn't working. I would not use weight gain as evidence of inefficacy. It might not cheer your mood, however, much as radical weight loss disheartens me.

Thanks for listening...I'm just so tired of all of this. My doctor says I'm BP II...but I really and truly don't agree with that diagnosis because I have never had any kind of a manic period...not even a mild one.

___________________________________________

IMO the more a psychiatric term is used, the less meaning it has. It seems BP II is used an awful lot lately.

__________________________________________

Right now I think I'm moving quickly into MDD and I can feel myself sinking...and that's scary because I know how low I can go and how dangerous it can get. I just hope she listens to me...hears me...I feel that she's thinks she's already got it figured out and so it doesn't matter what I say.

_________________________________________

That is something I most definitely do not enjoy. It is the reason I no longer pursue psychotherapy.

<{POST_SNAPBACK}>

[Steve@3AM]

Long ago I had Rx for Ritalin. Was AWFUL! Jittery, but no help w/ ADD issues. Actually then, shrink was doing it to try to get me away from meth! Was not a good option! (I stopped meth on my own. Cold Turkey. Because I got bored!)

The thing that originally got me thinking that some of my issues MIGHT be ADD (This was a LONG time ago before anyone really talked about it.) was that initially, meth relaxed me. Took a lot to get me a speedy focused "high". Is it possible the same thing applies to the current meds you are taking? The dose is just not high enough yet?

I have read that the concerns re seizures are overblown with Wellbutrin and that they usually are not "serious" and go away if you stop. (However THAT is not advice. I think a lot might depend on WHERE you had the seizure!) Also the dose you are at is not up to what I've seen listed as "theraputic" dose, so why stop before then? Especially if you've used higher doses in past with no seizure issues!

Velvet Elvis -

Thanks for your comments re Provigil. My pdoc had said it was something to consider for my ADD issues. I had previously used Adderall. Limited success, but possibly not high enough dosage. From your info, Adderall would be better for my issues than Provigil.

Steve

[Penny Century]

I've done a lot of thinking about this Wellbutrin/Concerta combination. I've taken Wellbutrin for 12 years and never had a problem with it and I actually stopped taking it this summer. Then when the depression started back up my pdoc put me back on 150 Wellbutrin...but when I saw her a month ago she refused to up it.

She has a real thing about Wellbutrin and seizures (I read someone else on the board say his/her pdoc did as well). I guess she's had a patient or two have a seizure and it must have freaked her out.

there is a genuine risk of seizures with wellbutrin, but, from what i've read 300 mgs is a safe dosage.  some doctors will even go beyond that, but from what i've read the risk of seizures on 300 mgs seems to be very minimal. 

according to  Rx List on Wellbutrin

"Dose: At doses up to 300 mg/day of the sustained-release formulation of bupropion (WELLBUTRIN SR), the incidence of seizure is approximately 0.1% (1/1,000)."

But I've been on 400 mg in the past.

did you have any seizures on this dose?

does your doctor know you've been on it before at this dosage?

i've noticed that if you are very open with your doctor and explain that you understand the risks of a medication, they are often more open.  medication regimines are in some ways about comming to a mutual agreement with your doctor, and if she understands that you are fully aware of the risk, she may be more willing to let you try a higher dosage.  maybe even print out the info from rx list about the seizure risk so she knows that you've looked into the risks?

I get sleepy on the Concerta, it doesn't help me concentrate as much as it did at first, and I've gained weight...wouldn't you say it's not working anymore? I'm hoping she'll put me on Adderall because I've got graduate school starting up again and I would love to be able to concentrate and complete the quarter.

not everyone responds to concerta.  i know that i didn't. 

that said, most doctors usually will only make one change at a time.  (which is wise, so you can see what is doing what.)  which change is more important to be made first is hopefully something you and your doctor can work out.

Right now I think I'm moving quickly into MDD and I can feel myself sinking...and that's scary because I know how low I can go and how dangerous it can get. I just hope she listens to me...hears me...I feel that she's thinks she's already got it figured out and so it doesn't matter what I say.

have you told her that you don't feel like she's really hearing your concerns?

it is so important to have a good and open relationship with your doctor.  i know it can be hard to bring things like this up, but it is important for both of you that she knows how you are feeling. 

[Dweii]

I just woke up and can't be bothered to read the whole thread. So forgive me if I'm just repeating what someone else said.

Keep in mind that 36 mgs of Concerta isn't that much. It sure didn't do much for me. I know the highest recommended dose is 54 mg, but it's usually safe to go higher than that. I'm on 72 mg, and that has helped a lot.

[lrdriscoll]

When I was on Concerta, I had to be on 72MG for it to help my ADD at all. What you described was exactly my experience; I gained weight, slept and drifted off into my own mind fuzz, then got manic, then back down again. Adderall XR changed the world for me.

I took Provigil for quite a while when I was in a depressed state and not rapid cycling as usual. It did a really decent job of waking me up, keeping me from crawling back under the covers, and forcing  myself to do a few minor tasks. But I do think it helped the depression, I really do. It definitely helped it more than the 300MG of Wellbutrin I was on.

So, maybe Provigil and Adderall wouldn't be a bad combination for you. I've never taken the two at the same time, though.

L