Posted by europerep on January 18, 2010, at 15:58:39
In reply to Re: switching from venlafaxine/mirtazap to moclobe, posted by West on January 16, 2010, at 15:08:10
hmm, well last week seems to have been some sort of "interlude", because now I am feeling (much) worse than before, without an apparent reason.. so staying on this combination is certainly not an option.. if I switch to venlafaxine/bupropion, I'd necessarily have to gone down on venlafaxine, because (as I said earlier) when I reduce mirtazapine I start to have a very weird sleep and dreams (just like when I started venlafaxine.. it seems mirtazapine is just so heavily anti-histaminergic that it "offsets" this side effect), and to make things worse, I know that bupropion is associated with similar problems.. since bupropion is purely DA/NE, I wonder whether I'd still have enough action at 5HT.. but I think venlafaxine is already one of the strongest serotonergic agents, no? so I guess adding a third agent wouldn't really make sense, would it?
I did look into dopaminergic agents a little earlier, and I was wondering why they are not more frequently prescribed for depression, or why wikipedia always lists them at best as being on trial for depression, but I think my doc wouldn't prescribe me something "experimental" before I haven't spent 1/2 year hospitalized trying all kinds of "regular" meds..
I know it's not how it is supposed to be, but I guess I will start to try what I think is best for me.. I did already obtain a box of bupropion some time ago, haven't touched it yet, but I guess I'll go with that now, after I have stopped taking mirtazapine..
some time ago my doc was mentioning lithium as an add-on strategy, indeed there are some studies suggesting effectiveness for TRD, but is it a good idea? I mean of course one never knows which medication might work, but I am sure there are certain strategies that are (purely statistically) more likely to help than others..
poster:europerep
thread:930533
URL: http://www.dr-bob.org/babble/20100113/msgs/934206.html