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Suggest Cheaper Alternative To Modafinil For Treatment Of Bipolar Disorder

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Posted on Fri, 4 Jul 2014
Question: I have been treated for bipolar for 13 years. During this time I have also had an excessive sleepiness issue. I cannot stay awake for long periods of time. I sleep approximately 16 hours in a 24 hour period and never am rested. The need to sleep is excruciating. My psychiatrist began prescribing me Modafinil about 9 months ago. This has helped. I take 200 mg per day. The problem is I am on Medicare and due to the cost of the Modafinil I am now in the doughnut hole. I just paid $1,700 for a 90-day supply. I am on XXXXXXX disability and cannot afford this. Do you have any suggestions as to alternative meds I could take that would be "cheap?"
doctor
Answered by Dr. Manisha Gopal (26 minutes later)
Brief Answer:
caffine & L-Theranine, sepatrate or in combination

Detailed Answer:
Hello,
I have read the query and it reflects that you have chronic hypersedation or lethargy . It is quite unlikely that someone in his manic phase also has this complaint.
Lethargy is a part of depressive phase usually and is managed well with proper drugs. You have not mentioned what drugs are you on for treating bipolar disorder or I would have seen their possible role in this sedation.

However, as you have specifically asked for the alternatives to modafinil, I am providing you with two-
caffine and L- Theanine supplements.

Caffine in proper doses, may be in form of tea or coffee can are helpful in remaining awake.
L-Theanine in combination with caffine or separately is also good in countering sedation.
The combination of the above two is good as there is a smooth concentration.

You can even try someone close to accompany you, espically during the sleepy hours. He/ she will help you in remaining awake. People are more prone to sleep when alone.
Somehow I feel that revising your current dosage of bipolar can help.
You may folow the above two options after discussing them with your doctor.

Wish you good health.
Dr. Manisha Gopal
MD Neuropsychiatry

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
doctor
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Follow up: Dr. Manisha Gopal (26 hours later)
Tthe excessive sleepiness started the summer of 2002, before I was on any medications and before I collapsed in Feb 2003 from a depressive breakdown. The excessive sleepiness has not gone away. The medications I take are: Prozac 20mg/day, Divalproex 1500/day, Ziprasidone/Geodon, and Modafinil. When I have to sleep there is nothing that can keep me awake (i.e., having another person present to help keep me awake). I have seen 2 psychiatrists, a neurologist, a neuropsychiatrist, an ears/nose/throat (sleep disorder) doctor over these years. The sleep doctor has had me take 3 sleep studies -- hence on cpap machine for 10 years for sleep apnea. Even had a sleep study done last summer to make update the pressure setting. All of the doctors until my present psychiatrist said they thought my sleepiness was tied in with my depression. My present psychiatrist (I've been seeing him for over 6 years now) thinks I am mildly bipolar. I understand that's why I am taking the Ziprasidone/Geodon -- mood stabilizer, right? A past neurologist prescribed me Adderal for a short period of time for the sleepiness. I felt too "manic" with this prescription and stopped taking it. However that is how I felt when I first started taking Modafinil. I'm wondering if I could try the Adderal again and see if I can learn to tolerate it like the Modafinil. It is a cheap drug. I drink plenty of coffee and iced tea in my day. No alcohol and do not smoke. Very health conscious. Am looking for alternative cheap medications that might help me stay awake -- I am sleeping my life away!
I sincerely thank you for your time and feedback.
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Follow up: Dr. Manisha Gopal (8 minutes later)
Have been reading about hypersomonia and the symptoms sound exactly like what I experience with my excessive sleepiness.
doctor
Answered by Dr. Manisha Gopal (26 hours later)
Brief Answer:
try addreal and TMS; hike divalproex

Detailed Answer:
Hello,
According to your relpy- excess sleepiness came before everything else and an year later you developed depression.
This can be due to either simple hypersomnia; or prodrome of depression or some neurological cause.

I hope you must have got an MRI Brain/EEG to check for organicity. If not, you may get one to rule out this factor.

Secondly- you are on divalproex 1500mg..this is also a sedative drug and best taken at night to avoid day time sleepiness.
you mentioned a tendency your tendency to gointo mania- it is good that you get Sodium valpoate levels done. When they are in theraputic range only then the tendency for switch is handled effectively.

Thirdly- your antidperessant dosage prozac is very low -20mg. This can be increased to help in managing sedation. The dosage can go upto 40-80mg.

If you feel that this us not proeprly treating your sadness- you may shift to venalafaxine. It is good molecule to handle sleepiness.

There are drugs like adderal or therapies like TMS which might be helpful in your case. You will have to search for the availability of TMS near your place.

Such sleep attacks are also seen in narcolepsy when person is unable to control sleep and lies down anywhere he is. But many times it is stress related.

You have been taking caffine and tea and tried diferent drugs. So, I think you may go for therapies like above and see if they are helpful.

P.S. --Ziprasidone is an antipsychotic and not a mood stabiliser in any sense. The.doctor must have given you this drug to prevent the episode of mania as a precaution. This drug can be avoided by simply increasing the dosage of divalproex to its effective strength.


I hope the reply is useful for you
please ask if there is any doubt.
Dr. Manisha Gopal
MD Neuropsychiatry
Note: For more detailed guidance, please consult an Internal Medicine Specialist, with your latest reports. Click here..

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

Psychiatrist

Practicing since :2005

Answered : 947 Questions

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Suggest Cheaper Alternative To Modafinil For Treatment Of Bipolar Disorder

Brief Answer: caffine & L-Theranine, sepatrate or in combination Detailed Answer: Hello, I have read the query and it reflects that you have chronic hypersedation or lethargy . It is quite unlikely that someone in his manic phase also has this complaint. Lethargy is a part of depressive phase usually and is managed well with proper drugs. You have not mentioned what drugs are you on for treating bipolar disorder or I would have seen their possible role in this sedation. However, as you have specifically asked for the alternatives to modafinil, I am providing you with two- caffine and L- Theanine supplements. Caffine in proper doses, may be in form of tea or coffee can are helpful in remaining awake. L-Theanine in combination with caffine or separately is also good in countering sedation. The combination of the above two is good as there is a smooth concentration. You can even try someone close to accompany you, espically during the sleepy hours. He/ she will help you in remaining awake. People are more prone to sleep when alone. Somehow I feel that revising your current dosage of bipolar can help. You may folow the above two options after discussing them with your doctor. Wish you good health. Dr. Manisha Gopal MD Neuropsychiatry