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Is Provigil Effective In Treatment Of Depression?

Posted on Sat, 7 Jun 2014

Question: my husband has been dually diagnosed with Bipolar ADHD with Depression disorder. He is currently taking citalopram, risperadone, and methacarbamol (for shakes). He also has disc disease and takes oxycodone (5m) as needed. The weather in AZ has has helped with the pain for the disc disease and there is talk of surgery to help with the pressure on his nerves in him back. He had surgery last year on one side, and it completely relieved the pain so we are hopeful for the next surgery, but the depression is bad, he wakes up at night with leg spasms, has a hard time going back to sleep and he is tired all day. He served in the military, and then worked nights for almost 10 years as a laborer before retiring. Our research has showed us that he may be a good candidate for Provigil, but that doesn't address the leg spasm or the pain issue. How do we advocate for him and what would be your suggestion medication support for his issues if he was to change to provigil?
One website has suggested that he take Provigil

Answered by Dr. Srikanth Reddy (4 hours later)

Brief Answer:
Not the good option

Detailed Answer:
Hello,

Thanks for choosing health care magic for posting your query.

I have gone through your question in detail and I can understand what you are going through.

Provigil is used to augment the antidepressant and to adress the excess sleepiness. But its not among the first line options for treating a bipolar depression. Further there is a chance for precipitating mania as well.

Infact better options in such cases would be adding a mood stabilizer like divalproex sodium or carbamazepine or another anti psychotic like quetiapine or olanzapine etc. May be switching the antidepressant to another drug like bupropion or eecitalopram should also be a good option.

Hope I am able to answer your concerns.

If you have any further query, I would be glad to help you.

If not, you may close the discussion and if possible you may rate the answer for me, so that I get a good feedback.

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Wish you good health,

Kind regards

Dr. Srikanth Reddy M.D.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Srikanth Reddy (2 hours later)

Thank you for your response, but you did not answer my question. We are pretty certain that we want to go in the direction of the requesting Provigil. I am aware that it may trigger a manic episode however because he is both Bipolar Depressive and ADHD, the research supports use of Provigil: below are links.

http://journals.psychiatryonline.org/article.aspx?volume=164&page=1242

http://psychcentral.com/blog/archives/2007/09/25/provigil-for-bipolar-depression/

To repeat and clarify my question: "What would be your suggested medication support for his other issues (pain, muscle spasm, and sleep apnea) if he was to change to provigil?"

Answered by Dr. Srikanth Reddy (25 hours later)

Brief Answer:
Hello

Detailed Answer:
Sorry for the confusion. I understand that there is an evidence for the use of provigil for bipolar depressionbut just wanted to let you know that there are better unexplored options available. However its a personal choice of the patient and the prescribing doctor to decide about the medicines. You may go ahead with the use of provigil, and there is a use of it in bipolar depression. It will help in symptoms of sleep apnoea as well.
Regarding the pain and spasm issues, the cause is known and the surgery is the best answer. However the medicines can help him with the symptoms. I have personally tried giving carbamazepine or amitriptyline to my patients. Not all but a significant of them had good response in such pains and spasms. The same may be tried in this case as well, as per the discussion with your treating psychiatrist. However on the long run, surgery is a better cure for such pains.
Hope I am able tohelp you with your concerns,
Kind regards
Dr,. Srikanth Reddy

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Srikanth Reddy (2 days later)

Thank you Dr. XXXXXXX

Answered by Dr. Srikanth Reddy (2 days later)

Brief Answer:
Its been a pleasure

Detailed Answer:
Its been a pleasure

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Above answer was peer-reviewed by : Dr. Prasad