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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by SLS on December 28, 2022, at 15:48:18
Adding Wellbutrin (bupropion) to Effexor (venlafaxine) or Pristiq (desvenlafaxine) is one of treatments that I see the most success with in treatment-resistant cases. If intolerance to side effects is not an issue, I think Effexor would carry with it a higher probability of working than Pristiq. When you introduce venlafaxine into the body, most of it is metabolized into desvenlafaxine - Pristiq. That leaves Effexor as being two drugs in one - much like tertiary tricyclics are. I wouldn't call these drugs "pro-drugs" though. That's because the parent compound is biologically active. For me, Effexor can budge my depression. Pristiq was without effect. My guess is that some people don't need venlafaxine, and may actually have more side effects with it. This leaves Pristiq being a better choice for some people.
In practice, I don't think it makes sense to stop increasing the dosage of Effexor until 300 mg/day is reached. 225 mg/day just doesn't cut it for many people. It never did for me. An ideal target treatment might be to combine Effexor 300 mg/day with Wellbutrin 300 mg/day. The dosage of Pristiq that works most of the time is 100 mg/day. I don't know if there is any advantage to going higher than that. That's what doctors get paid to know. They might be treating as many as one hundred people at any given time in their practice. They know from working with 100 real people what works and what doesn't. They accomplish this without knowing the details of G-protein second-messenger cascades.
I feel that the role that Wellbutrin might serve best as is that of an adjunct / augmenter to serotonin reuptake inhibitors - selective or not.
Remember when Zoloft first came out? The combination of Wellbutrin and Zoloft was nick-named "Welloft" by psychiatrists. I have no idea which among the SRIs work best in combination with Wellbutrin.
- Scott
Posted by undopaminergic on December 28, 2022, at 16:48:12
In reply to Does Wellbutrin plays the role of adjunct to SRIs?, posted by SLS on December 28, 2022, at 15:48:18
> Adding Wellbutrin (bupropion) to Effexor (venlafaxine) or Pristiq (desvenlafaxine) is one of treatments that I see the most success with in treatment-resistant cases. If intolerance to side effects is not an issue, I think Effexor would carry with it a higher probability of working than Pristiq. When you introduce venlafaxine into the body, most of it is metabolized into desvenlafaxine - Pristiq. That leaves Effexor as being two drugs in one - much like tertiary tricyclics are. I wouldn't call these drugs "pro-drugs" though. That's because the parent compound is biologically active. For me, Effexor can budge my depression. Pristiq was without effect. My guess is that some people don't need venlafaxine, and may actually have more side effects with it. This leaves Pristiq being a better choice for some people.
>
> In practice, I don't think it makes sense to stop increasing the dosage of Effexor until 300 mg/day is reached. 225 mg/day just doesn't cut it for many people. It never did for me. An ideal target treatment might be to combine Effexor 300 mg/day with Wellbutrin 300 mg/day. The dosage of Pristiq that works most of the time is 100 mg/day. I don't know if there is any advantage to going higher than that. That's what doctors get paid to know. They might be treating as many as one hundred people at any given time in their practice. They know from working with 100 real people what works and what doesn't. They accomplish this without knowing the details of G-protein second-messenger cascades.
>
> I feel that the role that Wellbutrin might serve best as is that of an adjunct / augmenter to serotonin reuptake inhibitors - selective or not.
>
> Remember when Zoloft first came out? The combination of Wellbutrin and Zoloft was nick-named "Welloft" by psychiatrists. I have no idea which among the SRIs work best in combination with Wellbutrin.
>
>
> - ScottI tried bupropion (Wellbutrin, Zyban, Voxra) at very high doses, chasing (at least an inkling of) a stimulant effect. It was ineffective. I would be interested in trying it again in combinations with other agents.
-undopaminergic
Posted by SLS on December 28, 2022, at 17:23:38
In reply to Re: Does Wellbutrin plays the role of adjunct to SRIs? » SLS, posted by undopaminergic on December 28, 2022, at 16:48:12
> > Adding Wellbutrin (bupropion) to Effexor (venlafaxine) or Pristiq (desvenlafaxine) is one of treatments that I see the most success with in treatment-resistant cases. If intolerance to side effects is not an issue, I think Effexor would carry with it a higher probability of working than Pristiq. When you introduce venlafaxine into the body, most of it is metabolized into desvenlafaxine - Pristiq. That leaves Effexor as being two drugs in one - much like tertiary tricyclics are. I wouldn't call these drugs "pro-drugs" though. That's because the parent compound is biologically active. For me, Effexor can budge my depression. Pristiq was without effect. My guess is that some people don't need venlafaxine, and may actually have more side effects with it. This leaves Pristiq being a better choice for some people.
> >
> > In practice, I don't think it makes sense to stop increasing the dosage of Effexor until 300 mg/day is reached. 225 mg/day just doesn't cut it for many people. It never did for me. An ideal target treatment might be to combine Effexor 300 mg/day with Wellbutrin 300 mg/day. The dosage of Pristiq that works most of the time is 100 mg/day. I don't know if there is any advantage to going higher than that. That's what doctors get paid to know. They might be treating as many as one hundred people at any given time in their practice. They know from working with 100 real people what works and what doesn't. They accomplish this without knowing the details of G-protein second-messenger cascades.
> >
> > I feel that the role that Wellbutrin might serve best as is that of an adjunct / augmenter to serotonin reuptake inhibitors - selective or not.
> >
> > Remember when Zoloft first came out? The combination of Wellbutrin and Zoloft was nick-named "Welloft" by psychiatrists. I have no idea which among the SRIs work best in combination with Wellbutrin.
> >
> >
> > - Scott
>
> I tried bupropion (Wellbutrin, Zyban, Voxra) at very high doses, chasing (at least an inkling of) a stimulant effect. It was ineffective. I would be interested in trying it again in combinations with other agents.
>
> -undopaminergic
>
I was treated with Wellbutrin while it was still investigational. An ideal dosage range had not yet been established. I took 900 mg/day for perhaps four weeks. If anything, Wellbutrin made me feel tired and slowed-down. When I discontinued it, I experienced a rebound-improvement that lasted a day or two. I get the feeling that dopamine and norepinephrine may not be the most important targets for Wellbutrin. I think nitric oxide should be looked at more closely. So, thinking of Wellbutrin as being a DA / NE reuptake inhibitor might lead people to expect a decrease in anhedonia. I would look instead at the SRI for improvements in motivation and reward. An SRI is more likely to cause you to want to do things and experience pleasure while doing it. I think Wellbutrin helps by increasing one's sense of mental energy and allows someone to persist at performing tasks. So, a primitive notion might be that a SRI gets you to want to do stuff and Wellbutrin gives you the mental energy to do it. Of course, apathy can be a side effect of SSRIs. However, my guess is that this is far less of a problem with Effexor and Pristiq. I don't know about Cymbalta.
- Scott
Posted by Christ_empowered on December 31, 2022, at 6:15:52
In reply to Re: Does Wellbutrin plays the role of adjunct to SRIs?, posted by SLS on December 28, 2022, at 17:23:38
wellbutrin was ok for me. with aripiprazole. maybe the dosage was too high? shrink prescribed 200..I tolerated it...doubled to 400. I started feeling jittery and I dropped it. Discontinuation was very mild, sort of like stopping a low dose of Ritalin. pensive, more introspective, some napping. done in one week, maybe less.
I seem to recall reading a patent on the combination of amphetamine (maybe also ritalin?) AM and Remeron PM for some sorts of depression. Perhaps wellbutrin could be used AM to substitute for stimulants? I don't know that wellbutrin would be stimulting enough in that case, though.
Posted by SLS on January 16, 2023, at 8:30:57
In reply to Re: Does Wellbutrin plays the role of adjunct to SRIs? » SLS, posted by undopaminergic on December 28, 2022, at 16:48:12
Hey, UD
> I tried bupropion (Wellbutrin, Zyban, Voxra) at very high doses, chasing (at least an inkling of) a stimulant effect. It was ineffective. I would be interested in trying it again in combinations with other agents.
>
> -undopaminergicUnless you have already had persistenly bad experiences (not start-up side-effects), the drugs that I would favor to combine with bupropion are venlafaxine (Effexor) or desvenlafaxine (Pristiq). My guess is that Effexor gets more people well than Pristiq, but I don't know now how large is the difference in response rate between the two.
I guess it makes sense to try Pristiq first. It is the active metabolite of Effexor. I think once you establish equalibrium, desvenlafaxine becomes the predominant compound in the blood stream.
I know someone who has remained in total remission for about 15 years with a combination of Pristiq 100 mg/day and bupropion sustained release (Wellbutrin SR) 300 mg/day. She has never shown medication breakthrough or diminishing returns, despite multiple episodes of severe stress. With Pristiq, she was taking pure desvenlafaxine.
I think some people are absolutely worse off when exposing their brains to the parent compound, Effexor, than the daughter compound, Pristiq. However, in other cases, it, might be necessary to have the parent compound, venlafaxine, in the brain along with desvenlafaxine. If this is not the cased, one might find Pristiq more tolerable than Effexor with respect to side-effects, including start-up anxiety or brain-fog.
- Scott
Posted by undopaminergic on January 17, 2023, at 9:45:30
In reply to Re: Does Wellbutrin plays the role of adjunct to SRIs? » undopaminergic, posted by SLS on January 16, 2023, at 8:30:57
> Hey, UD
>Hey SLS!
> > I tried bupropion (Wellbutrin, Zyban, Voxra) at very high doses, chasing (at least an inkling of) a stimulant effect. It was ineffective. I would be interested in trying it again in combinations with other agents.
> >
> > -undopaminergic
>
> Unless you have already had persistenly bad experiences (not start-up side-effects), the drugs that I would favor to combine with bupropion are venlafaxine (Effexor) or desvenlafaxine (Pristiq). My guess is that Effexor gets more people well than Pristiq, but I don't know now how large is the difference in response rate between the two.
>
> I guess it makes sense to try Pristiq first. It is the active metabolite of Effexor. I think once you establish equalibrium, desvenlafaxine becomes the predominant compound in the blood stream.
>
> I know someone who has remained in total remission for about 15 years with a combination of Pristiq 100 mg/day and bupropion sustained release (Wellbutrin SR) 300 mg/day. She has never shown medication breakthrough or diminishing returns, despite multiple episodes of severe stress. With Pristiq, she was taking pure desvenlafaxine.
>
> I think some people are absolutely worse off when exposing their brains to the parent compound, Effexor, than the daughter compound, Pristiq. However, in other cases, it, might be necessary to have the parent compound, venlafaxine, in the brain along with desvenlafaxine. If this is not the cased, one might find Pristiq more tolerable than Effexor with respect to side-effects, including start-up anxiety or brain-fog.
>
>
> - Scott
>I don't know why I've never tried venlafaxine. I guess there was always something else to try that seemed more exciting.
They (Wyeth) gave up on getting desvenlafaxine approved in Europe, so it's not available to me.
I'm also a bit wary about giving it a full trial due to the withdrawal syndrome. But maybe I shouldn't worry, as I've always been able to quit any drug cold-turkey.
-undopaminergic
Posted by SLS on January 17, 2023, at 19:24:58
In reply to Re: Does Wellbutrin plays the role of adjunct to SRIs? » SLS, posted by undopaminergic on January 17, 2023, at 9:45:30
Hi, UD.
If it works, you would no longer have to concern yourself with withdrawal. It is only a concern if you should fail to respond to it. I suggest that if you do achieve remission with any treatment, you should consider yourself to be a lifer of that treatment.
In my estimation, Effexor will produce more remissions than any SSRI - with the possible exception of fluoxetine (Prozac). Prozac is grossly underutilized now. Something that I don't see taken into consideration is that Effexor has a lower incidence of "poop-out" compared to the SSRIs.
Actually, I know very little about your condition(s). Why are you being treated with antidepressants?
- Scott
Posted by undopaminergic on January 18, 2023, at 7:02:24
In reply to Re: Does Wellbutrin plays the role of adjunct to SRIs?, posted by SLS on January 17, 2023, at 19:24:58
> Hi, UD.
>Hi SLS.
>
> Actually, I know very little about your condition(s). Why are you being treated with antidepressants?
>
>
> - ScottOften when I try to go into depth, it looks like I'm a smorgasbord of mental disorders, so I don't want to get started on that. The most relevant condition, however, is bipolar depression. Apathy and cognitive impairment are the main complaints.
-undopaminergic
Posted by SLS on January 18, 2023, at 15:10:35
In reply to Re: Does Wellbutrin plays the role of adjunct to SRIs? » SLS, posted by undopaminergic on January 18, 2023, at 7:02:24
> > Hi, UD.
> >
>
> Hi SLS.
>
> >
> > Actually, I know very little about your condition(s). Why are you being treated with antidepressants?
> >
> >
> > - Scott
>
> Often when I try to go into depth, it looks like I'm a smorgasbord of mental disorders, so I don't want to get started on that. The most relevant condition, however, is bipolar depression. Apathy and cognitive impairment are the main complaints.
>
> -undopaminergic
>
I totally get that.Have you ever tried searching Google, PubMed, or the Bipolar News Network (BNN) for bipolar depression? The BNN website is run by Robert M. Post, MD. He is the director of the biological psychiatry department of the National Institutes of Health (NIH). The BNN is focused on treatment (clinical psychiatry). Most of the article don't mention neurotransmitters or brain function.
Links for Bipolar Depression:
BNN: https://bipolarnews.org/index.php?s=bipolar+depressionPubMed: https://pubmed.ncbi.nlm.nih.gov/?term=bipolar+depression&size=100
Google: https://www.google.com/search?q=%22bipolar+depression%22
- Scott
This is the end of the thread.
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