Posted by JohnX2 on March 4, 2002, at 1:28:56
In reply to Re: Need advice:combo works differently 2nd time a, posted by Anna Laura on March 4, 2002, at 0:10:37
Hi Anna Laura,Good luck with the Wellbutrin.
Of the mood stabilizers, Lamictal has one of
the best anti-depressant profiles and won't turn
you into a vegetable. Few people complain of
emotional blunting. On average it is more stimulating.
You need a good doctor to help you dose it correctly.Topamax is supposed to be good for people who
went through traumatic times, but it can cause
a little brain fog.Best Wishes,
John
> > Hi Anna Laura,
> > I know you have been here for a while and I feel I know a little bit about you. You live in Italy and you have severe anhedonia. Im sorry to hear your medicine isnt helping. Your post was very medication focused. Has you ever tried augmenting the medication with psychotherapy.
> >
> > In regard to medication, I cant see the rationale for using Effexor and Reboxetine since Effexor will enhance norepinephrine. Your right though, anhedonia would be a condition associated more with norepinephrine and/or dopamine and therefore Effexor may not be a good choice because it increases serotonin as well. Reboxetine alone is a possibility however it hasnt made much of a bang, being as it is the first SNRI and from what I can gather over here in the UK not many are on it. Its metabolised by the Cytochrome P450 system the same as Paroxetine which is basically Reboxetine's twin, only it enhances Serotonin-potently, selectively and cleanly. The difference is that Paroxetine is prescribed in 20-60mg tabs/liquid formulation and Reboxetine in 4mg-12mg?. Studies have shown over and over again that at 10mg Paroxetine doesnt do much. Perhaps this is true of Reboxetine. Its a shame but all is not lost, far from it......
> >
> > I can forsee three possibilities for you:
> >
> > Wellbutrin-Blockade of norepinephrine re-uptake
> > Desipramine-Blockade of norepinephrine re-uptake
> > Maprotiline-Even more so than Desipramine, a re-uptaketer of norepinephrine
> >
> > Augment with T3. Much evidence is available for this augmentation stategy and I have reason to believe that it is a better augmentor with the norepinephrine antidepressants than others.
> >
> > If you got one of the TCA's I mentioned and T3 and still had problems you could consider an anticonvulsant such as Lamotrigine.
> >
> > This is just a viewpoint and not recommendation, rather something I would look into if I was you.
> >
> > In the past you mentioned L-Dopa. You are obviously aware of the importance of the catecholamines role in drive and energy. As I suggested back then why not try L-Tyrosine. Did you? Did you have any luck?
> > PaulB
>
>
> Hi Paul
>
> First of all, a mention about psychotherapy: i've been there, done that. Many times. Doesn't do much, as i believe my depression was triggered by severe stress and abuse. I've always been quite aware of my emotional difficulties and managed to resolve them at last but didn't help as i believe it's a chemical related problem now. I've been suffering from severe psychotic depression endogenous type (wasn't affected from positive events at all).
> I managed to get out of that hole but i've been suffering from anhedonia ever since.
> My anhedonia actually got worse throughout the years, that's why i'm getting so pessimistic right now.
> I was more "active" and had more energy and drive when i was depressed: major anxiety but far more lively. It's like i've got more negative symptoms now (Frontal syndrome? Am i degenerating? Probably. I believe my brain is dead. Don't want to live like that).
>
> I did CBT (Cognitive Behavioural Therapy) but again, it didn't help much. I guess it works for people who had disfunctional cognitive patterns before depression and got depressed because of that.
> I was quite optimistic and happy person before depression and was very well adapted and successful (especially under the social profile). I did a lot of different psychoterapies as well without success.
> I'm getting quite pessimistic at this point cause i seem to get the same lousy response with TCA (Tofranil, Amytryptiline) and SSRI (Zoloft, Prozac and now Effexor).
> With TCA it's even worse as they make my mood flat as hell : don't feel bad but don't feel good either as i turn in to a couch potato, Don't want to see anybody, no drive, no energy: very very distant form the flamboyant person i used to be. I used to be a leader.
> I think i 'm a little bit better with Effexor as i feel less medicated and more "natural" (still far from being cured though).
> I guess you're right : Reboxetine isn't doing much probably and i need higher effexor doses to get a full adrenergic effect. I believe to be a "high-dose" individual as i used to drink huge amounts of alchol when i was a teen-ager, i was the heaviest drinker of my school and i managed to stay on my own two feet when most of the people i knew were knocked out on the same amounts.
> I'm gonna get Zyban (Wellbutrin) tomorrow.
> Do i have to lower Effexor with Wellbutrin?
> T3 augmenting wouldn't be a bad idea as i turned out to have low T 3.
> Don't want to mess with mood stabilizers though cause i'm afraid i'll turn in to a vegetable (i'm in a semi-vegetative state already).
>
> Thanks for answering
>
> Anna Laura
poster:JohnX2
thread:96197
URL: http://www.dr-bob.org/babble/20020301/msgs/96272.html