Questions about Provigil
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Q:  Questions about Provigil

Dear Dr. Plyler,

Hello!  I have some questions about the drug Provigil.  I read in a NAMI journal that it is showing promising results in fighting off bipolar depression.

I am bipolar and have terrible depressions complete with psychosis and suicidal thinking.  So....I tried Provigil with the guidance of my psychiatrist.  I was also taking Geodon, Lithium, Effexor (225 mg), Inderal, Artane, Klonopin, and Synthroid (25 MCG) at the same time.

Well, it made me do a full circle.  I became manic within 2 weeks of taking Provigil 100 mg.  I spent thousands of dollars, didn't sleep, drank, had racing thoughts and felt super good.  Then, I leveled out and just felt good for about a month.  It didn't last.  I became severely depressed, started hearing voices and tried to commit suicide.  I just got out of the psych hospital and am wondering if you have heard of this happening to anyone else who has tried Provigil.  What went so wrong??
 Any insights that you have would be greatly appreciated.  Thank you so much.

Warm regards,

As you have unfortunately found out, the stimulants (e.g. Provigil) can also be very harmful in bipolar illness.  There is always a risk of mania developing when stimulants are added to a medication regimen.  Though there has been some evidence showing a benefit in bipolar depression,  I always add the stimulant slowly and follow up frequently to assess manic symptoms.  Effexor, though a very good medication, has been associated with the highest risk of mood instability in bipolar illness, so the combination of that and the stimulant may have also caused your mania.  Another factor may be the synthroid - are you hypothyroid or was that for the depression as well?  Obviously, you should not try stimulants in the future since the Provigil caused so much mood instability for you.  You may want to consider Abilify, Depakote, Zyprexa, or possibly even ECT for your depressive episodes.
Dr Plyler


Published May, 2011


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