Provigil is a relatively under-researched drug; only two published research documents have been found on the subject of dependence to Provigil, along with brief or cursory mentions of Provigil tapering protocols at the time of this writing. (1) Provigil is generally classed as a CNS stimulant for the treatment of narcolepsy. However, about 90% of Provigil prescriptions are for the off-label treatment of conditions relating to depression, for example, extreme lethargy, disinterest in life, lack of energy, inability to focus, and perhaps most notably, where MDD (major depressive disorder) has been resistant to antidepressant or other or even multiple drug treatment. (3)
It is not unusual for patients to have ended up taking quite a number of medications concurrently. A common scenario for some people suffering extreme daytime sleepiness is possibly because tiredness is a side effect of the other drugs they were prescribed, such as mood stabilizers, or similar. Provigil may have been additionally prescribed to counter-act drug-induced sleepiness, apathy, lethargy, etc. That approach may be useful in some cases, at least temporarily, yet doing so can only be regarded as a very limited approach to the problem. A prescribing doctor’s time may be short, but certainly the patient is more important than a series of quick fixes that seem inclined to ultimately escalate the complexity of the patient’s problems.
If a person loved fried chicken and had a habit to over-imbibe, indigestion may result. A one-dimensional approach to the problem would be to down a handful of tums or other heartburn tablets, and would likely provide temporary but welcomed relief. However, it would not prevent the problem from continuing to occur, and may even set up a sort of dependence on digestive aids. However, if a person discovered that if they could omit fried foods, perhaps cooking with a convection oven instead of deep-frying to prepare equally delicious chicken, the factor of indigestion could be significantly reduced or even eliminated, while still very much enjoying their food, and minus the health consequences.
With great apology, the above fried chicken scenario may seem trivial compared to the problems of MDD sufferers, but is only used as an analogy and probably not a very good one at that. But it is important to remember that any problem may have multiple root causes. Perhaps in modern medicine there should be more of a focus on vigorously exploring and investigating in order to isolate the root causes. In that way an individual could be guided to PREVENT a problem rather than be trapped into a sort of continuous-damage-control kind of lifestyle.
Regardless of why a person ended up looking for a drug to relieve lethargy, daytime narcolepsy or disinterest in life, it is possible that other avenues to correct the person’s unwanted symptoms may have been overlooked altogether in the rush to find relief. Quite apart from seeking help with Provigil tapering, a person who is looking to find root causes for their excess tiredness, lethargy or lack of interest in life may benefit significantly from what the Alternative to Meds Center has to offer.
After all, a healthy body should be able to convert food into energy, and should be capable of distributing energy when needed throughout the body. Discovering what is blocking that natural sequence of events may be many times more helpful, with much less potential damage in the long run than simply masking the symptom. Whether a person does that with Provigil or 10 cups of coffee a day, or whatever other artificial means a person may be utilizing in order to combat their fatigue, chasing symptoms does not always provide the relief that was desired.
Shift-workers have had their particular trouble with maintaining adequate sleep bestowed with their own DSM mental disorder label, known as Shift-Worker Disorder, or SWD for short. (2) Nonetheless, the use of a diagnostic label to simplify treating sleep deficiency may be speedy, but it does not mean that sleep deficiency is caused by a deficiency of Provigil. It is likely more from a deficiency in the number of hours of rest. In some cases it could simply be the result of a failure to sufficiently adapt one’s environment to one’s needs.
In some parts of the world, Provigil (and similar stay-awake pills) are even available over the counter, without a prescription and are used by shift workers to prevent falling asleep on the job. Some students have been convinced that these types of medications are able to help improve their grades at school by preventing tiredness during class. Airline pilots may be another group that might try to prevent sleepiness in order to function well on the job. These are common reasons to take a drug such as Provigil, but these reasons are all trying to prevent something that a drug cannot “cure”, but only temporarily mask or alleviate.
Regardless of the reason a person found themself using, or perhaps over-using Provigil, there may come a point where it would seem desirable to stop having to take a pill just to stay awake, or just to stay interested in life. The Alternative to Meds Center provides help for a person who is trying to quit Provigil, but more importantly, is very much focussed on discovering and treating/correcting the underlying causes for narcolepsy or daytime sleepiness or depressed mood, or lack of interest in one’s career or disinterest in life in general, but without the need of relying on drugs.
The scant early research on Provigil maintained although the drug created euphoric effects similar to opioid drugs, Provigil was not thought to be dopaminergic in action. More recent research, however, has shown a different picture. (2) Provigil does interact to some degree with dopamine receptors as well as serotonin receptors, GABA receptors, benzodiazepine receptors, norepinephrine, histamine, melatonin, and adrenal receptors. These are all subject to interactions with Provigil, though more needs to be understood about how exactly this interaction occurs.
In contrast, opioid drugs have a well-documented and intense interaction with dopamine receptors. Opioids result in a flooding effect of dopamine into the CNS, which is how it is thought that opioid drugs artificially create a euphoric mood. Consequently, the withdrawals from opioid drugs are predictably harsh, with enough intensity to act as powerful drivers of addiction just to avoid experiencing the withdrawal symptoms.
However, unlike the predictably horrible cold-turkey cessation of heroin, stopping Provigil even if not done abruptly, may cause quite a range of unpredictable results. For some, getting off Provigil may cause very little in the way of Provigil withdrawal symptoms. However, trying to quit Provigil could also cause quite alarming adverse reactions, due to the very wide range of possible interactions, and how little is known about the way the drug affects the CNS. Likely, however, a person trying to quit Provigil will see a return of the person’s original symptoms of lethargy or sleepiness, because it had never been actually addressed.
It is important to note that in some rare cases, stopping Provigil can initiate severe withdrawal symptoms known as multi-organ hypersensitivity, which can be life-threatening as it affects multiple vital organs. (1) Especially where multiple drugs are involved, and the person has been suffering from MDD and has been medicating their symptoms for many years, abruptly stopping Provigil is not recommended by the FDA.
This is most often the case, unless a life-threatening drug-induced condition has been precipitated where stopping the drug immediately is the only emergency action that can be done to save the person’s life.
It is thought that the longer a person has been taking Provigil, the more intense and longlasting the withdrawals are likely to be. Just as the body and the entire CNS adapts to the presence of any drug, it may take time for the body to re-adjust. Therefore, especially in these cases, Provigil tapering is recommended to be done slowly over time rather than abruptly stopping Provigil. There is no “one size fits all” approach when it comes to how to get off Provigil.
We invite you to contact us to find out more about the way Provigil tapering can be part of an overall health-restorative action available in an inpatient setting. The Alternative to Meds Center can provide the required level of attentive care that is required during Provigil tapering, as well as sorting out multiple drug dependencies that may also be part of the picture, and just as important, to effectively address the root causes of the symptoms that preceded starting the drug in the first place.
Dr. Samuel Lee is a board-certified psychiatrist, specializing in a spiritually-based mental health discipline and integrative approaches. He graduated with an MD at Loma Linda University School of Medicine and did a residency in psychiatry at Cedars-Sinai Medical Center and University of Washington School of Medicine in Seattle. He has also been an inpatient adult psychiatrist at Kaweah Delta Mental Health Hospital and the primary attending geriatric psychiatrist at the Auerbach Inpatient Psychiatric Jewish Home Hospital. In addition, he served as the general adult outpatient psychiatrist at Kaiser Permanente. He is board-certified in psychiatry and neurology and has a B.A. Magna Cum Laude in Religion from Pacific Union College. His specialty is in natural healing techniques that promote the body’s innate ability to heal itself.