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    Provigil for bipolar depression
    Joseph F Goldberg, MD posted:
    HI all,

    A number of people have expressed interest in the research behind the antidepressant efficacy of Provigil for bipolar depression. I've attached the link to the original research paper by Dr. Mark Frye on this. When used with an antimanic drug, 44% of depressed bipolar patients responded...which ain't bad.

    Be aware that most insurance companies after July 1st are switching over their willingness to pay for Provigil to its new-and-improved (or at least new-and-cheaper) offshoot, Nuvigil. Also be aware that these medicines are only approved by the FDA for narcolepsy or for shift-work sleep disorder, so, even though there is research to support its value as an antidepressant for bipolar depression, that is a so-called "off label" use which means that insurance companies can decline to pay for it. Provigil is about $13-$14/pill and Nuvigil is about $8/pill. The manufacturer offers a one-time 7-day free coupon that can be downloaded at which, if combined with a doctor's prescription for 7 days of Provigil or Nuvigil, at least offers a free way to find out if it may help work for bipolar depression.

    - Dr. G.
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    pixe5 responded:
    Just to let people know that according to my research it may be addictive so be careful if you've had any substance abuse problems.
    VivienLeigh responded:
    Is it possible for Provigil to have the opposite effect over time? I've been on it for years to help me to function esp. at work - but now it seems to have no effect or actually makes me sleepy.

    I am menopausal, BP II, with lithium induced adenoma in one of my parathryroid glands with an underactive thryoid as well.I am slightly anemic w/hypercalcemia - an endocrinologist and psychiatrist at PENN are following my case but I feel so lethargic and exhausted day in, day out. Do you have any suggestions so that I can feel better? My affect is fine, stabilized on Lamictal, Lithium, Effexor XR.

    I appreciate the help and I will await your response!

    VivienLeigh replied to pixe5's response:
    My psychiatrist assures me that Provigil is not addictive but over the past 3 years I have been experiencing addictive behavior with reference to this drug.
    Joseph F Goldberg, MD replied to VivienLeigh's response:
    Dear Ilene,

    Assuming you are not currently hypothyroid or anemic, then it is possible the Provigil may just be less effective than it was before. The dose typically can go up to 400 mg/day.

    - Dr. G.
    Joseph F Goldberg, MD replied to VivienLeigh's response:
    Provigil has abuse potential, which is why it is a controlled (Schedule IV) drug. But it does not cause physiologic tolerance or withdrawal, which are the hallmark features of physical dependence.

    - Dr. G.
    skypper responded:

    How do you suggest I approach my own psychiatrist to try Provigal and see if it would work for me?
    What would be some good points to reference to in it's favor?
    Is it now used in bipolar treatment in place of an add-on anti-depressant? Or in addition to?
    I'm selfish,impatient
    bpcookie replied to skypper's response:
    I can't be bothered with a cell phone in my car....I am too busy making finger gestures at everyone!!!-Maxine
    Joseph F Goldberg, MD replied to skypper's response:
    Dear Skypper,

    You can let your doctor know about the placebo-controlled study of Provigil for bipolar depression published in 2007 in the American Journal of Psychiatry by Dr. Mark Frye, and ask his opinion if it would be appropriate for you.

    It should be the doctor's job, not the patient's, to recommend what treatments are most appropriate, so I wouldn't think of this as trying to make points in its favor. It is simply one of several options that has been shown to treat bipolar depression without a clear risk of inducing or worsening mania symptoms.

    - dr. G.
    An_188873 responded:
    Thank you for the info-
    I have been on both Provigil & Nuvigil in the past, and have found Provigil to be MUCH more effective. For me, it is definitely worth the extra cost if it will be able to help stabilize me & my life!
    (The best combination for me: Lamictal, Provigil, and Cymbalta. I'm BP type 1 & love this combo of meds!)
    maxine729 replied to An_188873's response:
    Can Nuvigil cause mania?
    I have dysphoric mania and I had it taking lamictal.
    Joseph F Goldberg, MD replied to maxine729's response:
    Dear Maxine,

    anything is possible...but in the controlled studies that were done with Nuvigil, there was no evidence that it was associated with a higher risk for developing mania than was the case with placebo. Lamictal also is not known to cause mania, or dysphoric mania. Neither Lamictal nor Nugivil treats dysphoric mania, so it is also possible that the manic episode occurred despite (not because of) those medicines, since neither is an anti-manic treatment.

    - Dr. G.
    Torcal responded:
    When I "break through" into depression I wait for about 24 hours. If it does not go away I take 10 -20 mg of Dexedrine and I pop out of it within an hour. I understand that Dexedrine has its own detremental side effects, that it cannot be used as a maintenance drug and that it does have the potential of inducing mania. However, I always have a fresh supply in my arsenal if things get really bad.
    DoOvers replied to Torcal's response:

    Torcal I have never used this. I am med resistant to anti-depressants which is why currently we keep me on a very low dose of wellbutrin. It needed to be tested this year and the theory that keeping me on a low dose and cutting out the wait time would work held true. I am interested to see what Dr. G says about this (using amphetamines). Before my 2nd round of ect's we used a low dose and then a not so low dose of a different amphetamine to try and snap me out of it abruptly, but it was too little to late. I know in my case both my pdoc and tdoc kept a very close eye on me because of the very real potential the amphetamine could throw me directly in to a mania.
    ddnos replied to DoOvers's response:
    ACT, has your pdoc ever suggested trying an MAOI such as Nardil, Parnate, or EmSam? I take Nardil - I am also resistant to treatment, but have been on Nardil for 20 years, minus a month or two here and there a couple times due to unrelated reasons. You might want to ask your doc

    You can`t change what people are without destroying who they were
    --The Butterfly Effect

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