Take more nuvigil, take more

menuThis morning I took my prescribed 200mg of Nuvigil. The last two days I took 275mg, I split the last 150mg I had left.

After about an hour, I caved. Why? I am weak. I guess. Guilt, I feel some, but I also feel justified. I split a 200mg pill into four and then took an extra 50mg of Nuvigil.

It helps, more helps more. Is there an end to that? Unlikely. I’ll probably always want more… which is of course, problematic.

For now I am justifying it because it seems like that we will increase my dose to the maximum of 250mg at my next visit. Nuvigil is also unlikely to build up tolerance. Well, at least within the first few years. There are studies of up to three years that did not find much of a tolerance build up.

The start of the dose is always the best. I feel good. Yes, good. Not just content. So, it is a mild high, I guess. But it just makes my entire day so much more bearable. And if tolerance is unlikely, maybe this mild “high” is something I will get daily once increased to 250mg.

There is a drop off about four hours in, then it seems like a stronger release at six hours and a final strong release eight or nine hours it. Nuvigil is much more smooth than Vyvanse, but not as perfect as I hoped. Ha. Of course, I am depressed, part of that is never being satisfied.

Once again, I am writing a blog at the peak of Nuvigil releasing, it is the easiest time to accomplish tasks. Sigh. I do wish I didn’t have the constant nagging to cheat, to take more.

Oh well, that is a problem for tomorrow. I’m off to enjoy my Labor Day, I hope.

Current Medication: Nuvigil 200mg, Lamictal 200mg, Pristiq 100mg, Seroquel XR 100mg, Trazadone 50mg, Strattera 80mg

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Take more nuvigil, take more

Nuvigil, ADHD and depression

ay00vjwOn Tuesday my psychiatrist and I decided to up my Nuvigil dose from 150mg to 200mg. Also, I am tapering off of Seroquel since my clinical psychological evaluation diagnosed me with treatment resistant depression, Dysthymia and ADHD – ruling out my bipolar diagnoses.

The main symptom of my depression is apathy. Desire, no. Interest, no. Motivation, no. We are hoping that tapering off Seroquel will give me more energy throughout the day. I’m now using Trazadone 50mg as a sleep aide.

I am more and more aware of how my ADHD contributes to my depression. Nuvigil definitely helps, it is also much much smoother of a release than Vyvanse. However, Nuvigil does start strong and dip during the day for me, and during that dip I become unengaged, bored. It is these periods where my mind wonders into the depressive thoughts. If I not being aided with a stimulant my mind always wanders to the negative.

Stimulants impact dopamine, maybe my depression is caused by low dopamine levels. It would make so much sense. Stimulant based medications work to combat my depression in a way that nothing else has come close.

Of course, I am writing this blog on a day I took more than my prescribed amount of Nuvigil. I cut my last 150mg pill in half and took half on top of my 200mg pill. More is always better. I’m so weak. My psychiatrist even commented that I will likely be asking for an increased dose of Nuvigil in two weeks. That I tend to seek the maximum dose. I concurred. But I seek the maximum because more helps more.

Although, maybe I am just trying to justify past abuse of stimulants and current prescription for Nuvigil. I don’t know. I never know.

Current Medication: Nuvigil 200mg, Lamictal 200mg, Pristiq 100mg, Seroquel XR 100mg, Trazadone 50mg, Strattera 80mg

 

Nuvigil, ADHD and depression

Nothing is enough

annieMy psychiatrist prescribed me Nuvigil last Wednesday, 150mg. I took it Thursday, in the morning, it was alright. Certainly not as energizing as Vyvanse, but Vyvanse is real strong at first, so I wouldn’t mind a step down.

However, by mid-day I was struggling. Low energy, no focus and back to my depressive state. Of course, I opened up one of my 40 mg Vyvanse capsules and took a third of it with Nuvigil the next morning. That was nice, almost perfect. The Vyvanse still comes in waves through out the day, every few hours I get a bump of energy that protects me from the depressive lows. The last one just hit, it does around 4pm, it is how I got off the couch to write this blog. Sigh.

Here I am again, abusing my prescription. But it is so difficult to choose to be unhappy, to choose to feel depressed. At times, I am just not strong enough. I fully understand that I do not want to get a high, I don’t want to go down the path of my past abusive behavior. However, I do want to have days where I feel present — where I feel alive.

In two days I see my psychiatrist, she gave me a seven day prescription. I am hoping she will up it to 250mg, we shall see. I will be honest with here. She’ll be disappointed, maybe angry. I’ll call Dan with her and tell him he needs to dispose of my Vyvanse. I don’t want to go back, these last few days, I’ve felt alive, I just wish I could do this forever. I know I can’t. 

To prevent myself from taking Vyvanse with Nuvigil I just gave Dan the pill bottle and told him to hide it. Tomorrow shall be interesting.

Maybe we will increase my Nuvigil prescription at my appointment on Tuesday. An increase in Nuvigil will help some, although, having experienced 150mg, I doubt even an increase to 250mg will be enough.

It won’t be, nothing is enough.

Current Medication: Nuvigil 150mg, Lamictal 200mg, Pristiq 100mg, Seroquel XR 200mg, Strattera 80mg

Nothing is enough

Begging my Doctor for Provigil

After receiving the results from my clinical evaluation, I sent my psychiatrist an email. The evaluation hit me hard. I ended up begging for Provigil. The text of my email is below.

Hello,

The clinical evaluation confirmed much of what we expected. Bipolar disorder isn’t present, instead Dysthymia, major depression and adhd are.

I’m, I don’t know. The antidepressants I think are helping some, I don’t know. The best part of my day is still the first few hours of Vyvanse, I get to feel alive.

Having read the eval, I am really defeated. Nothing is shocking in this report, it confirms our expectations. I just, I, I am so tired of being sad. Dan deserves more.

The paragraph below I found most depressing, particularly the bold part. It sounds right, and it feels right. My personality makes me unlikely to “experience pleasure in life.” And even if the pills work, none claim to change my personality, to help me experience pleasure. It is so damning.

The patient’s profile was developed using the D (depression), Pt (psychasthenia – fear, anxiety, tension, depression, intruding thoughts, and obsessive-compulsive symptoms); and, Pd (psychopathic deviant – rebellious, non-‐conforming; family problems; impulsive, angry, irritable, and dissatisfied) scales. Patients with this pattern tend to exhibit a pattern of chronic psychological maladjustment. The patient appears to be quite anxious and depressed at this time. He may be feeling some tension and somatic distress along with his psychological problems. He endorsed several items related to suicidal ideation and should be monitored for risk. He indicated a history of impulsive acting-out and substance abuse for which he expressed guilt and remorse. His personality is such that he may have only a small capacity to experience pleasure in life and tends to be pessimistic in outlook. It appears he is experiencing disturbed interpersonal relationships. Patients with this profile are prone to substance use and abuse disorders and all treatments involving medication should be carefully monitored.

I have been Googling about medications, I need, I don’t know, more help. Like, this can’t be it. I hope not.

Provigil is the only thing I find particularly hopeful. It would likely wake me up a bit, give me a bit of energy to get up off the couch. It has been used off label for depression and adhd. It has a lower rate of addiction, it being a category IV and Vyvanse being a category II. Tolerance is much less likely with Provigil, having had studies go as long as three years.

I just, I don’t know. I guess part of me is still hopeful. There must be something else out there, something that can help a bit more.

I am trying really hard, really. I just want to feel alive.

Current Medication: Vyvanse 40mg, Lamictal 200mg, Pristiq 100mg, Seroquel XR 200mg, Strattera 80mg

Begging my Doctor for Provigil

Dr: “You’re unlikely to experience pleasure in life”

captain 1911Just read the report from my psychological evaluation that I had done last week. The line I can’t let go, “His personality is such that he may have only a small capacity to experience pleasure in life.”

It feels and sounds true. Yet, reading it, so damning, part of me is devastated. A little of the hope I still have just died.

Below is a section of my psychological evaluation:

Psychological Functioning: The patient completed the MMPI-2, an empirically based measure of personality and psychopathology. His responses suggest that he cooperated with the evaluation enough to provide useful interpretive information and the resulting profile is considered an adequate indication of his present personality functioning.

The patient’s profile was developed using the D (depression), Pt (psychasthenia – fear, anxiety, tension, depression, intruding thoughts, and obsessive-compulsive symptoms); and, Pd (psychopathic deviant – rebellious, non-‐conforming; family problems; impulsive, angry, irritable, and dissatisfied) scales. Patients with this pattern tend to exhibit a pattern of chronic psychological maladjustment.

The patient appears to be quite anxious and depressed at this time. He may be feeling some tension and somatic distress along with his psychological problems. He endorsed several items related to suicidal ideation and should be monitored for risk. He indicated a history of impulsive acting-out and substance abuse for which he expressed guilt and remorse.

His personality is such that he may have only a small capacity to experience pleasure in life and tends to be pessimistic in outlook. It appears he is experiencing disturbed interpersonal relationships. Patients with this profile are prone to substance use and abuse disorders and all treatments involving medication should be carefully monitored.

Dr: “You’re unlikely to experience pleasure in life”

I want Provigil, I want it now

iran 1880Again, I did a bit of research this morning, sorting through the endless array of drugs for depression. The most significant problem I face is my lack of energy, my difficulty just getting up and doing things.
My psychiatrist has been resistant to Provigil before, given my history of stimulant abuse. But I’ve done relatively well with Vyvanse. Provigil appears to be less addictive. Below is my notes on the drug. Yes, I used wikipedia, and I am not ashamed.
If you take Provigil, let me know your thoughts on it, I’d greatly appreciate it.
Modafinil (Provigil)
 
Off-label use for fatigue
Modafinil has also found off-label use with the neurological fatigue
  • reported by some with multiple sclerosis.[12]
  • In 2000, Cephalon conducted a study to evaluate… A group of 72 people with MS… Participants taking a lower dose of modafinil reported feeling less fatigued and there was a statistically significant difference in fatigue scores for the lower dose versus the placebo. The higher dose of modafinil was not reported to be significantly more effective.[13][14]
  • Modafinil is also used off-label to treat sedation and fatigue in many conditions, including depression
 
Addiction and dependence potential
  • addiction and dependence liabilities of modafinil are very low.[1][2][33]
  • shares biochemical mechanisms with addictive stimulant drugs, and some studies have reported it to have similar mood-elevating properties, although to a lesser degree.[33]
  • In accordance, although very rare, case reports of modafinil abuse exist.[36][37]
  • schedule IV controlled substance, a category for drugs with valid medical uses and low but significant addiction potential.
    • Adderall and Vyvanse have significant more abuse potential, schedule II
 
Tolerance
Large-scale clinical studies have found no evidence of tolerance with modafinil at therapeutic dosages even with prolonged use (for 40 weeks and as long as three years).[39][40][41]
I want Provigil, I want it now

I want to feel alive or be dead

pin boys 1918I don’t want to blog. I don’t want to do anything. Why me? I should be stronger, but I am tired of being strong.

Yesterday I got the results of a full psychological examination I completed. My psychiatrist wanted it due to the difficultly we’ve had successfully treating my depression.

First, allow me to be boastful, I don’t take pride in much, probably a result of me hating myself, however, my IQ is in the 120s. That I am proud of. The actual diagnoses weren’t exactly surprising.

Bipolar disorder, nope. As expected, my psychiatrist and I have been doubting my bipolar diagnoses the past couple months. My manic episodes were a result of my Adderall abuse, not bipolar disorder. My depression is severe, my psychiatrist and I were also aware of this. The clinical psychologist stated that my depression is severe, the test recommended immediate intervention to prevent a suicide attempt. Again, no surprise.

Thankfully, the psychologist and I had chatted before the tests, she was aware that I have never actually been suicidal, I doubt I ever will be. But I do relish the thought of taking my own life on almost a daily basis.

One of the tests involved staring at a black computer screen and clicking the mouse every time a letter other than “X” appeared, every few seconds. The exam was a dull fifteen minutes. The results, 99% chance that I have ADHD. I took this test at 11am, three hours after I had taken 40mg of Vyvanse, meaning Vyvanse was at its peak. I also take Strattera for ADHD. And yet, 99%.

The ADHD results are validating. Maybe that is why I slipped into abusing Adderall, nothing calms my racing thoughts like stimulants do – nothing.

Unfortunately, the results are fairly useless. It confirms our suspicions, maybe I’ll go off some of the bipolar medications. But know what?

Pristiq is helping. I am no longer as concerned about my depression. Like, I the worry and guilt I used to feel about laying around and doing nothing is largely gone. But I still don’t have much desire to live. My emotions are mostly flat and I feel tired much of the day.

Adderall was such a miracle. Suicidal thoughts, gone. Self-hate, replaced by confidence. It gave me a bounce in my step, even when not manic. I am confident that those first two years on Adderall will remain the best years of my life.

Now I am left to piece things together, to tolerate life, to keep going through the motions. Part of my desire to die is due to already feeling dead.

Even this post, do you know how I am accomplishing it? Vyvanse abuse. I opened up one of my 40mg pills and took a third, on top of the 40mg I already took. I’m not remotely high, I wish. But I do have the energy to get up, to shower for the first time in four days and to sit at a computer. I’m not happy. I wish it made me happy. I am a void, nothing, but at least I am functioning.

I just want to feel alive – or be dead.

Current Medication: Vyvanse 40mg, Lamictal 200mg, Pristiq 100mg, Seroquel XR 200mg, Strattera 80mg

 

 

I want to feel alive or be dead