![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 10 to 34 of 34. Go back in thread:
Posted by adniL on January 30, 2001, at 1:05:10
In reply to Re: Wellbutrin plus (Zoloft or Effexor)?, posted by SLS on January 29, 2001, at 9:06:21
> YES!
>
> Combining Wellbutrin with either Zoloft or Effexor are *excellent* strategies. Effexor in particular.Effexor plus Wellbutrin seems to be the magic combination for me. The Effexor takes care of my depression and anxiety. The Wellbutrin gives me some energy. I love it.
Posted by Quinn on May 15, 2003, at 22:06:09
In reply to Re: Wellbutrin plus (Zoloft or Effexor)?, posted by adniL on January 30, 2001, at 1:05:10
I had been on desipramine for over 15 years (I had a severe depressive episode in the mid '80s, and after trying most everything short of ECT available at that time, desipramine with Xanax finally pulled me through).
A few years later we added Prozac to the mix and life was good.
Until 9 months or so ago when things started to unravel. My Dr. added Zyprexa (2.5mg), and although I was functional, I felt overly sedated, weak, and sometimes a little agitated. I was also putting on weight. I asked to be taken off the zyprexa after 3 months.
My doc took me off the Zyprexa and gradually substituted Effexor, and then EffexorXR, for the desipramine. I had a rough time the next 6 weeks (I'm not sure if it was withdrawal from the desipramine or side effects caused by the Effexor, probably both). But once that unpleasant transition subsided; nothing . . . it didn't work. I was depressed and constantly fatigued and couldn’t concentrate. After another 6 weeks of 225 mg. EffexorXR daily (I think my doc wanted to take me up to 300mg., but held off because of the fatigue) we both agreed it wasn’t going to work and that I needed to try something else.
I started to taper off the EffexorXR and onto WellbutrinSL. This seemed to be working and in short time I was on 300mg. WellbutrinSL and 75mg. EffexorXR and feeling much better. A few days ago I went off the EffexorXR altogether and now I feel like I’m backsliding. Could it be that the 75mg. EffexorXR in combination with the 300mg. WellbutrinSR (and my other meds which we’ve held steady, Prozac 70mg. and Xanax 3mg. 3x a day) was working better than the WellbutrinSR alone?
Should I add back the 75mg. EffexorXR and see what happens? Or have my doc increase the WellbutrinSR? (doc said he'd put me up to 400mg of the Wellbutrin if I did start to backslide).
Posted by Quinn on May 15, 2003, at 23:18:36
In reply to Re: Wellbutrin plus Effexor? (and Prozac too!) » adniL, posted by Quinn on May 15, 2003, at 22:06:09
> I had been on desipramine for over 15 years (I had a severe depressive episode in the mid '80s, and after trying most everything short of ECT available at that time, desipramine with Xanax finally pulled me through).
>
> A few years later we added Prozac to the mix and life was good.
>
> Until 9 months or so ago when things started to unravel. My Dr. added Zyprexa (2.5mg), and although I was functional, I felt overly sedated, weak, and sometimes a little agitated. I was also putting on weight. I asked to be taken off the zyprexa after 3 months.
>
> My doc took me off the Zyprexa and gradually substituted Effexor, and then EffexorXR, for the desipramine. I had a rough time the next 6 weeks (I'm not sure if it was withdrawal from the desipramine or side effects caused by the Effexor, probably both). But once that unpleasant transition subsided; nothing . . . it didn't work. I was depressed and constantly fatigued and couldn’t concentrate. After another 6 weeks of 225 mg. EffexorXR daily (I think my doc wanted to take me up to 300mg., but held off because of the fatigue) we both agreed it wasn’t going to work and that I needed to try something else.
>
> I started to taper off the EffexorXR and onto WellbutrinSL. This seemed to be working and in short time I was on 300mg. WellbutrinSL and 75mg. EffexorXR and feeling much better. A few days ago I went off the EffexorXR altogether and now I feel like I’m backsliding. Could it be that the 75mg. EffexorXR in combination with the 300mg. WellbutrinSR (and my other meds which we’ve held steady, Prozac 70mg. and Xanax 3mg. 3x a day) was working better than the WellbutrinSR alone?
>
> Should I add back the 75mg. EffexorXR and see what happens? Or have my doc increase the WellbutrinSR? (doc said he'd put me up to 400mg of the Wellbutrin if I did start to backslide).
>CORRECTION: Xanax dose is 3mg. total (1mg. 3x a day).
Posted by Ritch on May 16, 2003, at 12:50:13
In reply to Re: Wellbutrin plus Effexor? (and Prozac too!) » adniL, posted by Quinn on May 15, 2003, at 22:06:09
> I had been on desipramine for over 15 years (I had a severe depressive episode in the mid '80s, and after trying most everything short of ECT available at that time, desipramine with Xanax finally pulled me through).
>
> A few years later we added Prozac to the mix and life was good.
>
> Until 9 months or so ago when things started to unravel. My Dr. added Zyprexa (2.5mg), and although I was functional, I felt overly sedated, weak, and sometimes a little agitated. I was also putting on weight. I asked to be taken off the zyprexa after 3 months.
>
> My doc took me off the Zyprexa and gradually substituted Effexor, and then EffexorXR, for the desipramine. I had a rough time the next 6 weeks (I'm not sure if it was withdrawal from the desipramine or side effects caused by the Effexor, probably both). But once that unpleasant transition subsided; nothing . . . it didn't work. I was depressed and constantly fatigued and couldn’t concentrate. After another 6 weeks of 225 mg. EffexorXR daily (I think my doc wanted to take me up to 300mg., but held off because of the fatigue) we both agreed it wasn’t going to work and that I needed to try something else.
>
> I started to taper off the EffexorXR and onto WellbutrinSL. This seemed to be working and in short time I was on 300mg. WellbutrinSL and 75mg. EffexorXR and feeling much better. A few days ago I went off the EffexorXR altogether and now I feel like I’m backsliding. Could it be that the 75mg. EffexorXR in combination with the 300mg. WellbutrinSR (and my other meds which we’ve held steady, Prozac 70mg. and Xanax 3mg. 3x a day) was working better than the WellbutrinSR alone?
>
> Should I add back the 75mg. EffexorXR and see what happens? Or have my doc increase the WellbutrinSR? (doc said he'd put me up to 400mg of the Wellbutrin if I did start to backslide).
>
For my bipolar depressions I've found Wellbutrin+Effexor to be the most effective antidepressants (thus far anyhow-haven't been on MAOI's yet). Either one by itself, just doesn't quite cut it for some reason, even if I crank up the dose of either. I'd ask your doctor about adding back the Effexor. Who knows, maybe just 37.5mg would be enough?
Posted by Quinn on May 19, 2003, at 13:06:24
In reply to Re: Wellbutrin plus Effexor? (and Prozac too!) » Quinn, posted by Ritch on May 16, 2003, at 12:50:13
I found Effexor alone to be too sedating, and ineffective on my depression, but at lower doses it does seem to have a calming, anti-anxiety effect that perhaps takes the edge off of the Wellbutrin. The Effexor also seems to help me sleep (I take it in the evening) although initially it seemed to keep me awake at night.
Posted by Quinn on May 21, 2003, at 21:25:10
In reply to Re: Wellbutrin plus Effexor? (and Prozac too!) » Quinn, posted by Ritch on May 16, 2003, at 12:50:13
I've been back on Effexor XR 75mg. for almost a week now. It's definitely settled me down from the levels of anxiety I was experiencing the previous week (after I stopped the Effexor for a few days) and made me feel more calm, but I’m beginning to think I’m getting a little too relaxed.
Although I’ve been feeling better overall the past few days, I've also been feeling that my motivation has been somewhat lacking. Today I've been feeling especially tired and unable to concentrate. Is the Effexor causing this? Could the increased anxiety I was experiencing last week have been a withdrawal side effect from discontinuing the Effexor? I’m starting to think that was part of it. I’m also concerned about what part the Prozac is playing in all of this.
I’m very confused. I believe that the Effexor really has done a good job with calming my anxiety, if not easing my depression, and may be an important piece of the puzzle, but it does seem to be too sedating. I’m wondering if the 70mg. of Prozac I’m taking is adding to the sedation that the Effexor seems to be causing (and whether I need the Prozac, and at what dose, if I’m on Effexor/Wellbutrin). I’ve been concerned about continuing the Prozac ever since I started taking the Effexor, but my doc doesn’t seem to want to make an adjustment in the Prozac right now (I suppose there are enough moving parts here as it is). I also believe that the Wellbutrin SR has had a very positive effect on my depression (perhaps with an assist from Effexor or Prozac), but I’m not sure I want to make the jump from 300mg. to 400mg. that my doc is recommending given all the other meds I’m on.
I’m not sure where to go from here. My doc’s suggestion is to increase the Wellbutrin to 400mg. and cut the Effexor back to 37.5mg. While the easing back on the Effexor seems reasonable, I’m nervous about cutting the Effexor if it’s contributing to my positive response to the Wellbutrin (perhaps I should be easing off on the Prozac instead). Also, 400mg. of Wellbutrin SR seems high to me. I’ve only been taking the Wellbutrin for 2 1/2 weeks, and moved up to 300mg. pretty rapidly. My inclination is to go ahead with decreasing the Effexor to 37.5, and hold steady on the Wellbutrin for now, but my doc seems really anxious to get me up to 400mg. (his first thought was to increase the Wellbutrin and leave the Effexor at 75mg. – the cut to 37.5mg. of Effexor was pretty much my idea). Perhaps after the apparent misfire I had with the Effexor, he wants to find out as soon as possible whether the Wellbutrin is going to work.
Meanwhile, I've been basically nonfunctional at work today (just going through the motions). I’ve been like this for a most of the past 3 months as I’ve come off the Zyprexa and desipramine, ramped the Effexor up and then down, and most recently added the Wellbutrin (I was also on dextra amphetamine for a few weeks before starting the Wellbutrin and ramping down the Effexor). I’m really getting behind in my work and people are starting to notice. I don’t see myself doing much better until all these meds are sorted out, which looks like it will take awhile, perhaps another 3 months or longer at this rate. I’m worried that I won’t be able to hold things together that long.
Sorry for the rant. My primary concern is avoiding the hospitalization, job loss and career damage I went through circa 1986. If anyone has any thoughts or insights here, your input is greatly appreciated.
Q.
Posted by lmm2003 on May 24, 2003, at 9:19:10
In reply to Re: Wellbutrin plus Effexor? (and Prozac too!), posted by Quinn on May 21, 2003, at 21:25:10
Hi, I have just become a group member after reading several of the messages posted over the years and I want to start by saying thanks to everyone who has contributed to this site! You are all really wonderful people.
So if anyone out there is able to respond to my situation, I would truly appreciate it. Here's the story (and I will do my best to keep it as short as possible-promise)
I have been on meds for about 10 years now and have tried almost all of them. I have used several antidepressants(Paxil, Zoloft, Effexor, Prozac, Wellbutrin, Serzone and Trazadone)stimulants (adderall, ritalin, dexedrine) anti-anxiety meds (Buspar, valium, xanax, and beta blockers) mood stabilizers (lithium, depakote, lamictal, topamax, neurontin) other meds for ADHD, fatigue and depression (provigil, straterra, gabitril) not to mention the ones I probably forgot.
I have been diagnosed with a variety of different "labels" depending on the doctor. These include bipolar II, atypical depression, anxiety and adult ADHD.
My current symptoms include irritability (especiaaly low frustration tolerance) fatigue, loss of motivation, low self esteem and anger.
Currently, I am taking adderall (20 mg a day) and xanax (to keep me sane at work) while waiting to switch to an MAOI (selgiline). Most recently I have found the SSRI's to "poop out" and leave me switching meds, with most other meds side effects completely unbearable.
So my questions are... Has anyone ever used adderall with selegiline?
Anyone experience these symptoms and if so what worked?
Any suggestions or comments?I want to thank anyone who will respond to this as I know it is hard to take the time to read this - far less post a response. Again THANKS!
Posted by SLS on May 25, 2003, at 9:28:51
In reply to Running out of med options..., posted by lmm2003 on May 24, 2003, at 9:19:10
Hi lmm2003.
I just wanted you to know that your post has not been ignored. I'm sure your situation is not at all hopeless. There are plenty of things you haven't tried. I guess no one has yet been struck with an idea specific to your case. Part of the frustration must lie in the fact that you have not been given a definitive diagnosis. In your case, it is important to ascertain whether or not you really suffer from ADHD. Without knowing this, it is difficult to recommend a specific treatment.
Selegiline is a drug that has certainly helped some people. However, I don't consider it to be an antidepressant with a high success rate. If depression is your main complaint, I would consider Parnate instead. You *can* combine Parnate with a stimulant like Ritalin or Adderall. Selegiline has been used to treat ADHD, but I don't know how effective it is. The NIMH tested Selegiline for ADHD at dosages between 20mg and 60mg. At this dosage, there is no advantage in terms of the necessity to follow the special diet. The diet would have to be adhered to for both Parnate and oral selegiline. It seems that inhibition of MAOI-A is necessary to treat both depression and ADHD.
- Scott
Posted by bretbe on May 25, 2003, at 23:43:01
In reply to Running out of med options..., posted by lmm2003 on May 24, 2003, at 9:19:10
Whether it gives you any kind of "comfort" or not, this board has made me at least aware that the frustration you've experienced in not uncommon. I have been on the same number of meds without great success although my symptoms are different...interesting that I've had similar "labels" (not so much ADHD however). I agree with one of the other postings that if you have never tried an MAOI, Seligiline might not be your first choice. Parnate and Nardil have longer track records and can be very activating. If you have troubles with anger and irritability, I wonder if you've ever considered Tegrital or Trileptal?...although in similar family as Depakote (which I see you've tried), Tegrital is reputation for helping irritability.
I also wonder about dosage levels on the other meds you've tried. For example, with the SSRI's that "pooped out" did you get any relief? If so, did you try higher dosages? I was on Luvox (SSRI)once and the doctor pushed up to 400mg and I got different results but fewer side-effects (still didn't help with my particular symptoms which appear to me more anxiety/mental pain related)
Also, I would recommend listing out all your meds and the reactions you had, e.g., did some help a little, did some make you worse, etc. This might at least give some idea so you don't keep trying the same approach over and over just with different meds. Actually, any that made you worse may be helpful towards a better diagnosis
If Zanax works for you, you might consider trying Klonopin instead.
Have your symptoms changed over time? (for example, have you always had the anger problem is is this after all your meds?) I ask because some of the irritability/anger can be the result of coming off of your ADHD meds which, as I'm sure you're aware, are typically amphetimines.
Have you taken any meds to address dopamine levels? (might help with the lack of motivation).
Finally, there are a number of new medications in the pipe-line so don't give up hope. There's a lot of people on this web-site who've tried all kinds of combinations so it can be a great resource.
Best of luck!
Posted by cybercafe on May 26, 2003, at 0:03:24
In reply to Running out of med options..., posted by lmm2003 on May 24, 2003, at 9:19:10
i also suffer from bipolar + ADHD
.... so what is your chief complaint? Adderall + SSRI doesn't work for depression?
> Hi, I have just become a group member after reading several of the messages posted over the years and I want to start by saying thanks to everyone who has contributed to this site! You are all really wonderful people.
>
> So if anyone out there is able to respond to my situation, I would truly appreciate it. Here's the story (and I will do my best to keep it as short as possible-promise)
>
> I have been on meds for about 10 years now and have tried almost all of them. I have used several antidepressants(Paxil, Zoloft, Effexor, Prozac, Wellbutrin, Serzone and Trazadone)stimulants (adderall, ritalin, dexedrine) anti-anxiety meds (Buspar, valium, xanax, and beta blockers) mood stabilizers (lithium, depakote, lamictal, topamax, neurontin) other meds for ADHD, fatigue and depression (provigil, straterra, gabitril) not to mention the ones I probably forgot.
>
> I have been diagnosed with a variety of different "labels" depending on the doctor. These include bipolar II, atypical depression, anxiety and adult ADHD.
>
> My current symptoms include irritability (especiaaly low frustration tolerance) fatigue, loss of motivation, low self esteem and anger.
>
> Currently, I am taking adderall (20 mg a day) and xanax (to keep me sane at work) while waiting to switch to an MAOI (selgiline). Most recently I have found the SSRI's to "poop out" and leave me switching meds, with most other meds side effects completely unbearable.
>
> So my questions are... Has anyone ever used adderall with selegiline?
> Anyone experience these symptoms and if so what worked?
> Any suggestions or comments?
>
> I want to thank anyone who will respond to this as I know it is hard to take the time to read this - far less post a response. Again THANKS!
>
Posted by lillabelle on May 26, 2003, at 3:54:03
In reply to Re: Running out of med options..., posted by cybercafe on May 26, 2003, at 0:03:24
Your post was interesting as I am in the same awful situation. I also have bipolar 11 plus add and like you have tried so many meds. The SSRI's make me feel drugged and unwell. On my first day of prozac I almost jumped out of my skin I was so anxious and paranoid. On effexor I felt speedy and dopey at the same time with terrible acidic stomach pains. Wellbutrin not only made my hair fall out in clumps but made be anxious and did not relieve my depression. Lamictal on it's own produced a seething dysphoric mania. With other meds such as serzone, tolerable but no real relief. Gabapenten made me retain water and my weight shot up by 15 pounds in one month, no kidding! I hate the way lithium makes me feel. Now I take 150mg of trazadone at night with lamictal and serzone in the day. But still deeply depressed and the add is getting worse. I was recently sacked from my job for lack of concentration. Huge shock, but I know to some extent it is true. Because I live overseas in a country where stimulants are banned I resorted to ordering the diet pill ionomin from the net. Well, the ionomin (phentermine) caused a paranoid anxious reaction and now I have to stop taking it after one week of trying to ignore the anguish. My question to all you kind and caring people out there, is this. Is phentermine related to the other stims and therefore will I have a similiar anxious reaction to them? Is strattera also the same kind of drug and again would it produce a similiar reaction? Final question, does anyone know when strattera will be available in Canada? I am returning there to live this summer and I know that as of now it is not available, and neither is adderal. Wishing all of you happiness and contentment however you find it.
Posted by SLS on May 26, 2003, at 10:25:23
In reply to Re: Running out of med options..., posted by lillabelle on May 26, 2003, at 3:54:03
> Because I live overseas in a country where stimulants are banned I resorted to ordering the diet pill ionomin from the net. Well, the ionomin (phentermine) caused a paranoid anxious reaction and now I have to stop taking it after one week of trying to ignore the anguish. My question to all you kind and caring people out there, is this. Is phentermine related to the other stims and therefore will I have a similiar anxious reaction to them?
Hi lillabelle.Phentermine does not share all of the properties of psychostimulants (amphetamine, Adderall, Ritalin, Cylert, etc.) Phentermine causes the release of norepinephrine only. Psychostimulants affect the release or reuptake of dopamine in addition to norepinephrine. This seems to be critical in the modulation of reward mechanisms. Phentermine seems to be regionally specific to the hypothalamus. The psychostimulants affect other regions in the brain (limbic and cortical) associated with vigilance and reward. I don't think one can extrapolate how the psychostimulants will affect them based upon their reaction to phentermine.
The diet drug that most closely approximates the actions of typical antidepressants is the antiobesity drug, sibutramine (Meridia). It inhibits the reuptake of dopamine, serotonin, and norepinephrine. I think it was originally developed as an antidepressant. I guess it didn't show sufficient efficacy for depression to get it approved for that indication. However, I still have sibutramine on my list of drugs to try if nothing else works.
- Scott
Posted by lillabelle on May 27, 2003, at 3:24:33
In reply to Re: Running out of med options..., posted by lillabelle on May 26, 2003, at 3:54:03
Thanks Scott for informed reply to my post. As you seem to know your biochemistry, I'm wondering now about strattera. Are strattera and phentermine at all similiar? Have you tried strattera? Thanks again and look forward to replies.
Posted by SLS on May 27, 2003, at 7:06:56
In reply to Thank-you Scott..., posted by lillabelle on May 27, 2003, at 3:24:33
> Are strattera and phentermine at all similar? Have you tried strattera? Thanks again and look forward to replies.
Hi again.
I would say that the two are dissimilar. Although they both affect the neurotransmitter norepinephrine NE, they do so in different ways. Phentermine increases the amount of NE released by the first neuron into the synapse (the gap separating the first and second neurons). In this regard, it is similar to Dexedrine or Adderall. Strattera increases the amount of NE in the synapse by preventing the first neuron from recapturing it once it has been released. In this regard, it is similar to many antidepressants. I am considering using Strattera for any antidepressant properties it may have. Although seemingly different from the classical stimulants, Strattera has shown itself to be effective in treating ADD/ADHD. I don't have ADD/ADHD, but I have seen plenty of people here report using it successfully. I am impressed that Strattera can improve both attentional deficits and behavioral and hyperkinetic disturbances. Strattera was originally investigated for depression under the name tomoxetine, although I don't know how effective it was shown to be. Perhaps it would be helpful when treating comorbid (occurring at the same time) ADD/ADHD and depression. I wish I had a more definitive recommendation for you.
- Scott
Posted by jemma on May 27, 2003, at 10:29:11
In reply to Re: Running out of med options... » lmm2003, posted by SLS on May 25, 2003, at 9:28:51
> Hi lmm2003.
>
> I just wanted you to know that your post has not been ignored. I'm sure your situation is not at all hopeless. There are plenty of things you haven't tried. I guess no one has yet been struck with an idea specific to your case. Part of the frustration must lie in the fact that you have not been given a definitive diagnosis. In your case, it is important to ascertain whether or not you really suffer from ADHD. Without knowing this, it is difficult to recommend a specific treatment.
>
> Selegiline is a drug that has certainly helped some people. However, I don't consider it to be an antidepressant with a high success rate. If depression is your main complaint, I would consider Parnate instead. You *can* combine Parnate with a stimulant like Ritalin or Adderall. Selegiline has been used to treat ADHD, but I don't know how effective it is. The NIMH tested Selegiline for ADHD at dosages between 20mg and 60mg. At this dosage, there is no advantage in terms of the necessity to follow the special diet. The diet would have to be adhered to for both Parnate and oral selegiline. It seems that inhibition of MAOI-A is necessary to treat both depression and ADHD.
>
>
> - ScottHi Scott -
I took a combination of low-dose selegiline (10 mg) and modafinil (200 mg) and it did wonders for my ADD AND my depression. I'd still be on it if I hadn't developed peripheral edema, an occasional side-effect of selegiline.
It seems to me that low-dose selegiline is often overlooked because it's tainted with the food-restriction label, even though it doesn't apply. It took about two weeks for the good effects to kick in, but they were strong and very positive. For a while, I felt more calm, cheerful, awake and clear-headed than I ever have in my life. The modafinil and selegiline may well have been synergistic, as each is an augmenter.
Another reason low-dose selegiline may be overlooked is that people don't realize they have to take it with food. The presence of food in the stomach augments the effect as much as tenfold for some reason.
Selegiline does so many good things for the brain besides inhibiting dopamine breakdown. It increases NO, or nitric oxide, which has various beneficial effects including vasodilation, which permits much more oxygen uptake. It's also a powerful antioxidant, and has been shown to be especially protective of those fragile dopamine neurons. All in all, a wonderful drug.
- Jemma
Posted by SLS on May 27, 2003, at 18:57:43
In reply to Re: Running out of med options..., posted by jemma on May 27, 2003, at 10:29:11
Hi Jemma.
> I took a combination of low-dose selegiline (10 mg) and modafinil (200 mg) and it did wonders for my ADD AND my depression. I'd still be on it if I hadn't developed peripheral edema, an occasional side-effect of selegiline.
Well, that certainly stinks.
> It seems to me that low-dose selegiline is often overlooked because it's tainted with the food-restriction label, even though it doesn't apply. It took about two weeks for the good effects to kick in, but they were strong and very positive. For a while, I felt more calm, cheerful, awake and clear-headed than I ever have in my life. The modafinil and selegiline may well have been synergistic, as each is an augmenter.
A friend of mine has found 5.0mg of selegiline to be very helpful for his dysthymia (minor depression) and CSF (chronic fatigue syndrome). It seems to work synergistically with the amisulpiride and Adderall he takes.
> Another reason low-dose selegiline may be overlooked is that people don't realize they have to take it with food. The presence of food in the stomach augments the effect as much as tenfold for some reason.It is too bad that the selegiline patch has not been approved. It seems to make for a better antidepressant and avoids the necessity for food restrictions.
> Selegiline does so many good things for the brain besides inhibiting dopamine breakdown. It increases NO, or nitric oxide, which has various beneficial effects including vasodilation, which permits much more oxygen uptake. It's also a powerful antioxidant, and has been shown to be especially protective of those fragile dopamine neurons. All in all, a wonderful drug.
What are you taking now in place of selegiline?
- Scott
Posted by jemma on May 28, 2003, at 10:01:12
In reply to Re: Running out of med options..., posted by SLS on May 27, 2003, at 18:57:43
Hi Scott -For the moment, I'm back on a modafinil ritalin sr cocktail. I hate the rebound off the ritalin, though, and I get bruxism and muscle tightness. When I see my pdoc in a week, I'm going to suggest trying wellbutrin again along with 200 mg modafinil. I tried wellbutrin before - all the way up to 450 for eight weeks - and felt nothing, no side effects, just a bit of sleepiness. I'm wondering if modafinil might work synergistically with it, as it seems to do with almost everything.
What meds are you on these days? If I recall, don't you also suffer from anergic bipolar depression?
- Jemma
> Hi Jemma.
>
> > I took a combination of low-dose selegiline (10 mg) and modafinil (200 mg) and it did wonders for my ADD AND my depression. I'd still be on it if I hadn't developed peripheral edema, an occasional side-effect of selegiline.
>
> Well, that certainly stinks.
>
> > It seems to me that low-dose selegiline is often overlooked because it's tainted with the food-restriction label, even though it doesn't apply. It took about two weeks for the good effects to kick in, but they were strong and very positive. For a while, I felt more calm, cheerful, awake and clear-headed than I ever have in my life. The modafinil and selegiline may well have been synergistic, as each is an augmenter.
>
> A friend of mine has found 5.0mg of selegiline to be very helpful for his dysthymia (minor depression) and CSF (chronic fatigue syndrome). It seems to work synergistically with the amisulpiride and Adderall he takes.
>
> > Another reason low-dose selegiline may be overlooked is that people don't realize they have to take it with food. The presence of food in the stomach augments the effect as much as tenfold for some reason.
>
> It is too bad that the selegiline patch has not been approved. It seems to make for a better antidepressant and avoids the necessity for food restrictions.
>
> > Selegiline does so many good things for the brain besides inhibiting dopamine breakdown. It increases NO, or nitric oxide, which has various beneficial effects including vasodilation, which permits much more oxygen uptake. It's also a powerful antioxidant, and has been shown to be especially protective of those fragile dopamine neurons. All in all, a wonderful drug.
>
> What are you taking now in place of selegiline?
>
>
> - Scott
>
Posted by SLS on May 28, 2003, at 22:49:34
In reply to Re: Running out of med options... » SLS, posted by jemma on May 28, 2003, at 10:01:12
> For the moment, I'm back on a modafinil ritalin sr cocktail. I hate the rebound off the ritalin, though, and I get bruxism and muscle tightness. When I see my pdoc in a week, I'm going to suggest trying wellbutrin again along with 200 mg modafinil. I tried wellbutrin before - all the way up to 450 for eight weeks - and felt nothing, no side effects, just a bit of sleepiness. I'm wondering if modafinil might work synergistically with it, as it seems to do with almost everything.
Have you tried Parnate? It doesn't usually produce edema, and there is no reason why you couldn't combine it with Provigil. You can even combine it with amphetamine, Ritalin, or a tricyclic. Parnate is usually chosen over Nardil for bipolar depression.
> What meds are you on these days? If I recall, don't you also suffer from anergic bipolar depression?
My depression is indeed anergic. There are times when the psychomotor retardation leaves me motionless in a chair. Fortunately, I am gleaning a mild benefit from combining Lamictal 250mg + imipramine 300mg. I am just beginning to take trimipramine (Surmontil). It occasionally works when other tricyclics fail. The only time I ever sustained a remission beyond a week was during a trial of Parnate 60mg + desipramine 150mg. I felt alive (normal) for at least 6 months. Unfortunately, my doctor at the time had me discontinue the combination due to the precipitation of mania. He should have continued it and simply added antimanic agents. I am now resistant to that combination. 20-20 hindsight.
I am looking forward to the FDA approval of duloxetine (Cymbalta). Hopefully, it will pack a more potent punch than Effexor. I found Effexor somewhat helpful when combined with imipramine.
- Scott
Posted by jemma on May 30, 2003, at 11:51:26
In reply to Re: Running out of med options... » jemma, posted by SLS on May 28, 2003, at 22:49:34
Hi Scott -Thanks for the suggestion of parnate. If I run out of options, I'll certainly try it, though my pdoc is very resistant to MAOIs. He did suggest desipramine, however, and I may well go there, though the possibility of weight gain worries me.
I'm glad you're getting at least some benefit from the meds you're on. I tried lamictal for several months - I titrated all the way up to 350 mg. Unfortunately, it started making me stupid, and my vocabulary shrank to half its normal size. It might have been the mild seratonin effect. After 10 years on zoloft, I've developed an intolerance to drugs that increase seratonin levels - they make me very foggy, as though my head is full of cotton batten. Effexor was like that for me, so I didn't last long on it.
Of course, the lamictal might have made me so dumb and unmotivated because it was blocking glutamate. Certainly, glutamate release seems to be one of the main factors in modafinil's action. Too much glutamate isn't good, but modafinil seems to have an inbuilt ablity to protect neurons against glutamate-induced excitotoxicity. And the energy and motivation is wonderful - I marvel several times every day at how alert and awake I feel, and I've been taking it for months!
Good luck finding the meds that work best for you. I'm sorry about the parnate - I know what it's like to feel really well, then have that snatched away from you.
- Jemma
> > For the moment, I'm back on a modafinil ritalin sr cocktail. I hate the rebound off the ritalin, though, and I get bruxism and muscle tightness. When I see my pdoc in a week, I'm going to suggest trying wellbutrin again along with 200 mg modafinil. I tried wellbutrin before - all the way up to 450 for eight weeks - and felt nothing, no side effects, just a bit of sleepiness. I'm wondering if modafinil might work synergistically with it, as it seems to do with almost everything.
>
> Have you tried Parnate? It doesn't usually produce edema, and there is no reason why you couldn't combine it with Provigil. You can even combine it with amphetamine, Ritalin, or a tricyclic. Parnate is usually chosen over Nardil for bipolar depression.
>
> > What meds are you on these days? If I recall, don't you also suffer from anergic bipolar depression?
>
> My depression is indeed anergic. There are times when the psychomotor retardation leaves me motionless in a chair. Fortunately, I am gleaning a mild benefit from combining Lamictal 250mg + imipramine 300mg. I am just beginning to take trimipramine (Surmontil). It occasionally works when other tricyclics fail. The only time I ever sustained a remission beyond a week was during a trial of Parnate 60mg + desipramine 150mg. I felt alive (normal) for at least 6 months. Unfortunately, my doctor at the time had me discontinue the combination due to the precipitation of mania. He should have continued it and simply added antimanic agents. I am now resistant to that combination. 20-20 hindsight.
>
> I am looking forward to the FDA approval of duloxetine (Cymbalta). Hopefully, it will pack a more potent punch than Effexor. I found Effexor somewhat helpful when combined with imipramine.
>
>
> - Scott
>
Posted by lillabelle on May 31, 2003, at 1:51:56
In reply to Re: Running out of med options... » SLS, posted by jemma on May 30, 2003, at 11:51:26
It's so informative and helpful to follow these threads. As I currently reside in the Persian Gulf (I'm Canadaian; an expat) I have zero support. There are no pdocs here worth 10 minutes of your time. No only are they in the dark ages but they're totally unsympathetic. It's a cultural and educational thing, so be it. The upshot is that I've had to help myslf. This board (and I've used it over many years) is a life saver.To keep it short I will summarize my unfortunate situation. Years and years ago at age 21 I became very depressed. I saw a GP (quack) who put me on nardil. She perscribed 60- 120mg. Before I knew it I was flying in full-blown mania. She perscribed halcion to get me to sleep at night. I had no idea I was bipolar. Never really heard of it. My doc told me to keep on the nardil, I felt euphoric so I certainly did. She saw me every two months or so and loaded me up on pills each time. After two years of this wild, wild, ride and I know I was in trouble. No apt, no job and barely the person I once was. The pdoc told me to keep on the pills or I would have a nervous breakdown. She didn't even suggest lowering the dose. At his time I knew nothing about fine tuning meds etc. I went off the nardil fell into a miserable depression and swore off antdepressants.
Several months later I tried the nardil again out of desperation, but alas the effect was gone. Basically I felt nothing. A year after that a doctor put me on ritalin. A horrible reaction, nervous, uptight, socially phobic and sleepy. Some time after that I tried cocanie at a party. Complete paradoxical reaction. Socially phobic, stricken with anxiety, nervousness and fear, hideous. Then for the longest time I took nothing. The bipolar worsened, I developed rapid cycling and extreme mood changes, lots of anger and rage and an ongoing depression with no motivation, focus or joy. I didn't like myself and so didn't a lot of others. By this time I was working here in the Gulf. That's when I found this site and realized a number of things. That's when I started the round of SSRI's, available here as they seem to flourish everywhere. For some people they are a godsend, for me, they worsened the mood swings and the add as well as migraine. Prozac gave me a similar reaction to stims only I was angry too. I now take serzone, lamictal and sulpride and sometimes a small bit of trazadone. I am currently in a bad depression. As I mentioned in a previous post I ordered phentermine online to give me some energy and focus and address the add. Like the ritalin, cocaine, and prozac I was stricken with anxiety, paranoia and phobia. So what gives? Is there an agent common to all of these drugs? Does it mean that neurotransmitters in my brain are malfunctioning as just about everyone else has an opposite reaction? Is there anyone who has also experienced this? I am at my wits end as I need a stimulating med and yet cannot tolerate one. These other meds make somewhat even the mood swimgs but do nothing for the atypical depression and lack of focus and concentration I daily experiece. Lastly If one med has burned out for you is it possible it may work again years later? There are probably no answers to these questions. I return for good to Canada this summer as I have to see a professional pdoc for the first time in my life. I would like to try the selegiline but wonder if it at all resembles the others in it's action. Thanks and sorry for the length of this altho it has felt good to tell someone after so many years
Posted by lmm2003 on May 31, 2003, at 6:18:57
In reply to Re: Running out of med options..., posted by lillabelle on May 31, 2003, at 1:51:56
Wow, your experience is very similar to mine. (However, I have never experienced mania symptoms.) My pdoc has eluded to the fact that parnate and seligiline are somewhat more stimulating than nardil so maybe if the nardil worked for you a little "too much" and the stimulating med is what you need, it may be worth it to try parnate or seligiline. Just a thought. Hope it helps.
Posted by BK on June 1, 2003, at 7:55:31
In reply to Re: Running out of med options..., posted by lillabelle on May 31, 2003, at 1:51:56
jemma,
Your experiences very much parallel my own. I first tried Nardil about 17 years ago for depression. It was an absolute miracle drug for me. It completely eliminated my depression as well as my social anxieties. It also increased my cognitive and language skills. However, the side affects were nasty: constipation, insomnia, and sexual dysfunction.
Unfortunately and tragically, after about three months all the benefits ceased. It started to make me anxious and I couldn't concentrate or focus. I stop taking the medication and after three years tried again, but only the nasty side affects resurfaced.
Since that time I tried just about everything out there. In addition to suffering from depression and social phobia, I'm also ADD. I suspect that all three conditions are interrelated. I can have some good days where I almost feel good. But I'd say the ratio to good to bad days is 1 to 10.
I've gotten some relief from Lamictal and Adderall. However, it was limited and unreliable. I tried Selegine and felt absolutely nothing, which is not always a bad thing, since many of the medications I tried actually exasperated my condition. My last “experiment” was with Strattera, which made feel extremely anxious. I just couldn’t tolerate the medication and stop its use after a week. I’m thinking of giving the Nardil a try again until someone can come up with a better suggestion. There’s got to be a magic bullet out there somewhere!
Good luck and try the Adderall. It was far superior to Ritalin. Keep posting your experiences!
Posted by jemma on June 2, 2003, at 11:27:47
In reply to Re: Running out of med options..., posted by BK on June 1, 2003, at 7:55:31
Hi Bk -I'd love to try Adderall, but it's not available here in Canada. Neither is Concerta, which is a real pain. But thanks for the suggestion.
As far as the selegiline goes, I didn't feel anything for about two weeks. And it has to be taken with food, as this increases its potency. I used modafinil to augment it - I love modafinil, and can't imagine life without it anymore.
Take care, and good luck with your retrial of Nardil. I'm convinced that the right combo is out there for everyone, if not now, then in the near future when some of the new drugs I've heard rumours of make it out of the pipeline.
- Jemma
> jemma,
>
> Your experiences very much parallel my own. I first tried Nardil about 17 years ago for depression. It was an absolute miracle drug for me. It completely eliminated my depression as well as my social anxieties. It also increased my cognitive and language skills. However, the side affects were nasty: constipation, insomnia, and sexual dysfunction.
>
> Unfortunately and tragically, after about three months all the benefits ceased. It started to make me anxious and I couldn't concentrate or focus. I stop taking the medication and after three years tried again, but only the nasty side affects resurfaced.
>
> Since that time I tried just about everything out there. In addition to suffering from depression and social phobia, I'm also ADD. I suspect that all three conditions are interrelated. I can have some good days where I almost feel good. But I'd say the ratio to good to bad days is 1 to 10.
>
> I've gotten some relief from Lamictal and Adderall. However, it was limited and unreliable. I tried Selegine and felt absolutely nothing, which is not always a bad thing, since many of the medications I tried actually exasperated my condition. My last “experiment” was with Strattera, which made feel extremely anxious. I just couldn’t tolerate the medication and stop its use after a week. I’m thinking of giving the Nardil a try again until someone can come up with a better suggestion. There’s got to be a magic bullet out there somewhere!
>
> Good luck and try the Adderall. It was far superior to Ritalin. Keep posting your experiences!
>
>
>
>
Posted by GreenP on August 5, 2010, at 17:24:21
In reply to Re: Wellbutrin plus Effexor? (and Prozac too!), posted by Quinn on May 21, 2003, at 21:25:10
I've taken all those meds (Zyprexa, Prozac, Zoloft, Wellbutrin, Effexor). I'm currently on Zoloft and Wellbutrin and its working well.
When I was on Prozac it worked well for my depression, but I was extremely blah. I would recommend cutting out the Prozac and increasing the Zoloft in its place. Zoloft plus Prozac is just too much stuff working to keep your anxiety down and dumb down your mood in general. I was behind in my studies as well when I was on Prozac, and had to drink Energy drinks to get myself going (which I do NOT recommend, very addictive and so expensive!) Good luck to you!!! And hang in there!!!
P
Posted by KarenRB53 on November 7, 2010, at 18:31:45
In reply to Re: Wellbutrin plus Effexor? (and Prozac too!), posted by GreenP on August 5, 2010, at 17:24:21
> I've taken all those meds (Zyprexa, Prozac, Zoloft, Wellbutrin, Effexor). I'm currently on Zoloft and Wellbutrin and its working well.
> When I was on Prozac it worked well for my depression, but I was extremely blah. I would recommend cutting out the Prozac and increasing the Zoloft in its place. Zoloft plus Prozac is just too much stuff working to keep your anxiety down and dumb down your mood in general. I was behind in my studies as well when I was on Prozac, and had to drink Energy drinks to get myself going (which I do NOT recommend, very addictive and so expensive!) Good luck to you!!! And hang in there!!!
> PPresently I'm on Wellbutrin and Celexa. Its not working well and I've been on the combo for over 6 months. I find the Wellbutrin even with the Celexa to increase my anxiety and cause body tension. I thought Zoloft was rather stimulating also and so using Zoloft with Wellbutrin would cause even more anxiety or tension, wouldn't it? I need to find something to work with the Wellbutrin so just looking for some information and feedback on what works for others.
Karen
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