Posted by LouisianaSportsman on May 14, 2014, at 22:21:05
In reply to Re: Wellbutrin » Beckett, posted by Chris O on May 14, 2014, at 15:49:27
Chris, with the partial response to Brintellix, maybe we can work on that?
If you claim to have had response to augmenting bupropion, a dopaminergic, maybe you try a stimulant-- a clean one such as the Daytrana patch? It metabolizes the methylphenidate through the stomach so you essentially get the whole dosage. Multiply the strength of the patch by 2 to get the Ritalin IR dosage. The lowest strength of the patch is 10mg. so that is like taking IR 10mg. X2 a day or 2.2mg./hr. It's very clean, stimulating and effective. It might brighten your mood and be a good maintenance therapy.
If the patch is not available, Focalin IR (dexmethylphenidate) tablets are just almost as good of an alternative. It's a very clean stimulant.
If you can't get stimulants and have to do bupropion, try doing it as an instant-release form as it may give you more energy and it might not have been tried in the past. It is effective for anhedonia moreso than extended-release.
I highly suggest you try the Daytrana patch as well as Lyrica. I actually got addicted to Lyrica if that says anything about its effectiveness.
Daytana is my highest suggestion to you, Chris, after much reflection. It is what I'd write as a theoretical PDOC.
I would also try adding Pexeva (paroxetine mesylate) tablets at a target GAD dosage of 20mg. to augment the Brintellix. You can start right at 20mg. and try the patch at 10 and 20 and see what you think. You might like the 20mg. See if you could get 45 10mg. patches so you could try 20mg. dosage for 15 days and see how well the Paxil is working for you with the Brintellix.
Next visit, try seeing if your PDOC would allow augmenting:
#45 10mg. Daytrana or Focalin IR if not stimulants, then do instant-release bupropion and not extended-release bupropion target dose of 100mg. IR X 2 then try 150mg. X 2 next month if not effective
#30 Pexeva 20mg.
#90 Lyrica 150mg. TID (PRN) or #90 Klonopin 0.5mg. TID (PRN) or #45 15mg. BusparTake the Lyrica throughout the day but feel free to skip doses on particularly good days. 450mg. a day would provide a response, for sure, no doubt, but it would also generate many side effects, but you could manage your dosing accordingly and might need as many next visit. I would do two (300mg.) in the morning and one at night QHS if you really want to see what Lyrica is about at an effective dosage. If you can't do Lyrica, I still suggest that you need a benzo like Klonopin dosed similarly.
If not a benzo, low dosages of Buspar such as 15mg. PM and 7.5mg. AM could be dopaminergic and anxiolytic, but very subtle. #45 15mg. Buspar would get you there.
I think these additions might help your mood and get you to where you want to be.
Keep in touch and good luck, buddy!
poster:LouisianaSportsman
thread:1065529
URL: http://www.dr-bob.org/babble/20140512/msgs/1065634.html