Posted by Cam W. on January 29, 2000, at 14:22:03
In reply to Re: Which ADs affect dopamine and norepinephrine?, posted by jamie on January 29, 2000, at 11:43:26
> Wellbutrin (Bupropion)
Wellbutrin does have NE and DA reuptake binding properties, but these happen at dosages higher than are normally used in depression (at doses of 600mg or more). At dosages this high you significantly increase the risk of having a seizure with Wellbutrin (at 600mg there is a 4% risk of seizure in those not prone to seizures). This opens a new kettle of fish on the mechanism(s) of action of all antidepressants. (eg stabilizing the glucocorticoid receptors or action at NMDA receptors or re-establishing the feedback mechanisms of the HPA axis - to name a few.) Even Glaxo-Wellcome who make Wellbutrin say this. All said and done Wellbutrin does inhibit the uptake of NE and DA, but weakly.
As for choosing an antidepressant, the augmentation of desipramine with fluoxetine (Prozac) does make sense. Have you been giving the other antidepressants and adequate trial? It may take 8 weeks (sometimes more depending on the sub-type of depression) to have a noticeable and lasting effect. Most treatment failures may be due to inadequate length of trials. Hang in there, different antidepressants work for different people and then, if you run through all of them, then there are many augmentation strategies and combinations that can be tried. Usually ECT will work, but many doctors use this as a last resort in treatment refractory, irretractable depression.
Don't give up hope and keep trying. Maybe another TCA (like desipramine) can be used; one that has more serotonin properties (like Elavil). Good luck - Cam W.
poster:Cam W.
thread:19950
URL: http://www.dr-bob.org/babble/20000128/msgs/20003.html