been on Ocrevus since 2023 and fatigue is still the hardest part to manage. neuro suggested modafinil a few months back - not for narcolepsy, just the MS fatigue that sleep doesn’t fix. first three weeks were solid. could actually stay alert past 3pm, word-finding was sharper, felt like myself again.
then around week four the crash started. not just tired - it was like my baseline fatigue came back but meaner. word-finding got fuzzy again, couldn’t concentrate at work. tried pushing through but gave up.
looked into the mechanism - modafinil doesn’t actually give you energy. it’s a dopamine agonist that masks the tired signal. so when you stop, that rebound hits hard. some studies show the crash can worsen baseline fatigue for a bit after you quit, especially in autoimmune conditions where dopamine signaling is already compromised.
only took it for 5 weeks but the crash lasted almost 3 weeks. neuro said some patients need to taper instead of cold turkey. didn’t know that the first time. has anyone else tried modafinil for MS fatigue?
did you taper? did the rebound hit you the same way?