Posted by JohnL on March 29, 2000, at 3:29:29
In reply to what to try next...anyone???, posted by CarolAnn on March 24, 2000, at 7:35:41
> Well, it's that time again. It's been almost 8 weeks on Celexa(20 mgs), which was added to the Wellbutrin(400mgs.), which I've been on for 4 months. I really don't think this mix is doing much for me. The only time I really feel improved is when I take my Adderall. I have my Pdoc appt. a week from Monday, so...any suggestions for where to go next? I don't think that I want to stop the Wellbutrin, although I don't even know if it is effecting me at all. The thing is, I just can't handle anything that will increase fatigue and from what I've read, Wellbutrin is the most "activating" AD. I'm considering switching the Celexa to Prozac. I was on Prozac when I first started Wellbutrin, but at the time the Pdoc didn't want to mix ADs in case the Wellbutrin would be effective on it's own. At this point, I'm almost ready to try a MAOI, but...I don't know, I'm just so tired of being tired and having no motivation, but aren't we all? Sorry to ramble...any and all suggestions, advice, ect., are welcomed! Thanks! CarolAnn
CarolAnn,
Sorry to hear about your difficulties. I wish there was an easy answer. Here's a suggestion or two to think about though.First, just to see if a serotonin deficiency is really involved or not, maybe increase the Celexa to 40mg or 60mg quickly for about a week or two just to see what happens. The answer might be that simple. If there is either no response with increased side effects, or a negative response with increased side effects, that will be a pretty good clue that focusing on serotonin may not be the way to go. It's likely for you that any of the other SSRIs--except Prozac--will be too sluggish. Prozac has the best chance of providing some activation. Could always try it for a month just to see how it goes.
How about tricyclics? When the SSRIs just don't cut it, the tricyclics often can. Wellbutrin+tricyclic is a very powerful combo for hard to treat depression. The same goes for a tricyclic+stimulant. The two concerns would be dry mouth and constipation. But those won't be too hard to accept and deal with if you're feeling a lot better. If you notice a decent response to a tricyclic, you may be able to drop the Wellbutrin partially or completely.
I saw a research study that suggested a positive mood response to Ritalin predicts a positive response to Desipramine. A negative mood response to Ritalin predicts a postive response to Nortriptyline. That helps put the odds in your favor when choosing which tricyclic to try.
So, suggestions to consider would be:
1. Increase Celexa to the maximum tolerated dose for two weeks to see what happens.
2. Compare Prozac for a couple weeks to a month.
3. Try either Desipramine or Nortriptyline. Possibly drop the Wellbutrin after identifying a better response to something else.Just my thoughts. There are still plenty of other angles to try, such as Lamictal or Zyprexa (which will target chemistries that you haven't touched upon yet). But for someone in need of activation, I think the above suggestions would be reasonable places to experiment and compare. Wishing you the best.
JohnL
poster:JohnL
thread:28013
URL: http://www.dr-bob.org/babble/20000321/msgs/28368.html