Posted by SLS on April 13, 2011, at 18:18:49
In reply to Re: Pristiq + Wellbutrin anyone? » SLS, posted by Bob on April 13, 2011, at 16:43:57
> I am amazed at your recall of all the details of the various treatments you've undergone.
I guess my memory for these things is good because so much depends on my finding an effective treatment.
> Seems like 900mg of bupropion is super high compared to what is FDA approved these days, right?
Yes. The original clinical trials for major depression used the higher dosages. When it was discovered that people with bulimia suffered seizures, the drug company decided to withdraw the medication temporarily. The dosage recommendations were refined to dosages that were about half of that originally approved for.
> Wellbutrin is a strange med
For sure. I don't think its efficacy is produced by acting as a dopamine reuptake inhibitor. Preskhorn differs on this point, though.
http://www.preskorn.com/columns/0001.html
> 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.
I recommend that you test your blood level of nortriptyline and make treatment decisions based upon the results. You might be a rapid-metabolizer. Effective drug levels range between 50-150 ng/ml.
> Why would you try nortriptyline with Pristiq?
Primarily because I had partial success with combining Effexor and nortriptyline. However, I was underdosed on nortriptyline, so I can justify giving a try to adding either Pristiq or Effexor to the dose of nortriptyline that I now know is therapeutic for me.
> What do you think the augmentation with nortrip is doing?
I can't be sure. Obviously, it is a more potent NE reuptake inhibitor than is Pristiq. However, nortriptyline does other things. For instance, it is an antagonist at 5-HT2a receptors and a calcium channel antagonist.
> Obviously if you tried Pristiq you'd have to come off of the Nardil.
Definitely. It doesn't take much desvenlafaxine to produce a serious serotonin syndrome reaction when given to someone taking a MAOI.
> Then it seems that you wouldn't be taking any drug that theoretically directly acts on dopamine?
This is true. However, the decrease in dopamine turnover produced by an MAOI should be an indicator of an increase in presynaptic stores. In addition, the 5-HT2a receptor antagonism will likely increase dopaminergic activity in the PFC (prefrontal cortex).
Sometimes, I think it is fruitless to try to guess at the clinical result of a specific drug treatment. There is much data, but little understanding.
- Scott
Some see things as they are and ask why.
I dream of things that never were and ask why not.
poster:SLS
thread:982583
URL: http://www.dr-bob.org/babble/20110406/msgs/982703.html