Posted by Bob on April 13, 2011, at 16:43:57
In reply to Re: Pristiq + Wellbutrin anyone? » Bob, posted by SLS on April 13, 2011, at 6:22:41
>
> > Scott,
> >
> > Have you ever spent a significant length of time on a therapeutic level of bupropion?
> >
> > Bob
>
> Hi Bob.
>
> Good thought.
>
> Yes, I have been on Wellbutrin 900 mg for a month or more on an open-label basis before it was finally approved by the FDA. I have tried it several times subsequently; each of which exacerbated my depression moderately. At the time, I thought that Wellbutrin was dopaminergic. That was my reason for trying it. Of course, we have learned since that it is not a potent dopamine reuptake inhibitor.
>
> As an aside, I did respond briefly, but robustly to nomifensine (Merital), a potent DA reuptake inhibitor that is no longer available. If I were to add anything to Pristiq, it would be nortripyline. I tried Effexor in combination with nortriptyliine with partial success. Unfortunately, we stopped titrating nortriptyline at 75mg. We later found that I need 150mg. If I need to change strategies, I would try adding Pristiq 100mg to nortripyline 150mg. Who knows, perhaps the right dosage of Pristiq is 200mg for some people. Clinical experience is sparse at such high dosages. However, it took many years before dosages of Effexor of 300mg and higher were accepted as therapeutic.
>
>
> - Scott
>
>
Scott,I am amazed at your recall of all the details of the various treatments you've undergone. Seems like 900mg of bupropion is super high compared to what is FDA approved these days, right? Wellbutrin is a strange med - it gave me one of the best initial responses of any med I've ever taken and then turned into one of the worst poop outs. I was under the impression that the med does affect dopamine in at least modest levels. What is your understanding of the mechanism? I thought the going theory is norepinephrine, dopamine, and some nicotinic actions?
Your response to nomifensine is not unlike my response to pramipexole in that there was an initial robust response that faded away. Interestingly, my current and long time dose of nortriptyline is 70mg... not far from your previously mentioned 75mg. I'm taking it with sertraline at 125mg. I'm not sure I could stand 150mg of nortrip though.
Why would you try nortriptyline with Pristiq? What do you think the augmentation with nortrip is doing? Obviously if you tried Pristiq you'd have to come off of the Nardil. Then it seems that you wouldn't be taking any drug that theoretically directly acts on dopamine?
poster:Bob
thread:982583
URL: http://www.dr-bob.org/babble/20110406/msgs/982691.html