Posted by Sunnely on July 15, 2000, at 18:08:16
In reply to Re: Prozac and apathy, posted by Bronte on July 13, 2000, at 23:28:18
>Is there something else that can be recommended? I'm an active and busy person, and this fatigue and apathy are becoming a problem.
One late-emergent side effect with the SSRIs is a cluster of "frontal lobe" symptoms such as apathy, indifference, affective dullness, and occasional disinhibition. This side effect can be mistaken for loss of effectiveness or a return of depression. When such symptoms occur, think about going down with the dose as well as going up (not an easy call).
In cases like this, your idea of combining Prozac with Wellbutrin is really not a bad one. A couple of concerns (probably uncommon but has been reported). A case of myoclonus (muscle) jerkiness that progressed to delirium (acute confusional state) has been reported with this combination. A case of catatonic episode was reported with this combination. Nighttime panics with this combination have also been reported. Also, be aware that certain liver enzymes that Wellbutrin depend on for metabolism (break down) are inhibited by Prozac. This may lead to an usually high blood level of Wellbutrin. If you stick with the lowest effective dose for Wellbutrin, this is most likely not going to be a problem. As you may be aware, significantly high blood level of Wellbutrin may lead to seizures. BTW, ask for the SR (sustained-release) preparation. It avoid too high peaks in blood concentration thereby, avoiding possible seizures. Of course, Wellbutrin is not to be taken by those with seizure disorder or eating disorder. It should not be used with a MAOI (Parnate, Nardil, Marplan). It should be taken at least 6 hours apart, if given more than once a day. It should not exceed more than 150 mg per dose. It should not exceed more than 450 mg/day. These dosing recommendations are important to avoid the occurrence of seizures. Of course, you should not combine Wellbutrin and Zyban (smoking cessation). One is the spitting image of the other. Only their brand names are different. Again, high risk for seizures if combined.
Thyroid supplement with Prozac is also not a bad idea. Cytomel (T3) and Synthroid (T4) are the usual drugs used. Thyroid augmentation seems to benefit more the depressed women.
Other potential SSRI augmentation agents include (not arranged in any particular order):
1) lithium
2) buspirone (BuSpar)
3) trazodone (Desyrel)
4) tricyclic antidepressants
5) anticonvulsants (Tegretol, Depakote, Lamictal)
6) antipsychotics (atypical)
7) estrogen/testosterone
8) psychostimulants
Mirapex (pramipexole), an antiparkinsonian drug, is periodically reported may have antidepressant effect. Don't know much about this drug.
poster:Sunnely
thread:39734
URL: http://www.dr-bob.org/babble/20000708/msgs/40583.html