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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by dysthymia on January 19, 2000, at 12:02:24
Just wondering which meds, or combos of meds people have had some success - specifically with dysthymia? (Also the dosage - I've read that dysthymia often requires higher doses to acheive results)
For me, wellbutrin sr did nothing - all the way up to 200mg twice daily.
Now trying effexor xr. Helps me some w/concentration & being a bit more out-going/sociable, but I'm still low on energy/motivation. Also makes me sleepy.
Was taking 75mg/day, now trying 150mg/day.Thanks for any feedback.
michael
Posted by Scott L. Schofield on January 21, 2000, at 10:35:26
In reply to dysthymia & meds, posted by dysthymia on January 19, 2000, at 12:02:24
> For me, wellbutrin sr did nothing - all the way up to 200mg twice daily.> Now trying effexor xr. Helps me some w/concentration & being a bit more out-going/sociable, but I'm still low on energy/motivation. Also makes me sleepy. Was taking 75mg/day, now trying 150mg/day.
I know of someone with dysthymia who has had success with a combination of Effexor (venlafaxin) and Wellbutrin (bupropion).
I believe her dosages are:
- Effexor XR: 75 mg/day
- Wellbutrin SR: 150 mg/day
She seemed to have had a therapeutic "window" with Effexor. She began to feel better at 75 mg/day. When her doctor raised the dosage higher (150 mg ?), she felt worse. When the dosage was reduced to 75 mg/day, she felt better again. This combination has been working for her for over two years.
She described her response to Wellbutrin alone as giving her more energy, however it did little for her motivation (wanna do's). Effexor alone gave her more motivation, but no energy to do anything. I know it sounds silly, but 1+1=2.
Good luck.
- Scott
Posted by S. Suggs on January 21, 2000, at 14:04:53
In reply to dysthymia & meds, posted by dysthymia on January 19, 2000, at 12:02:24
> Just wondering which meds, or combos of meds people have had some success - specifically with dysthymia? (Also the dosage - I've read that dysthymia often requires higher doses to acheive results)
>
> For me, wellbutrin sr did nothing - all the way up to 200mg twice daily.
>
> Now trying effexor xr. Helps me some w/concentration & being a bit more out-going/sociable, but I'm still low on energy/motivation. Also makes me sleepy.
> Was taking 75mg/day, now trying 150mg/day.
>
> Thanks for any feedback.
> michaelMichael: I am taking Parnate 60/day and lithium 900/day with wonderful results. MAOI's have a reputation for a high success rate with dysthymia. I am dysthymic as well. I tried almost all the others and talked my doc into a trial of Parnate, and I am thankful. Blessings,
S. Suggs
Posted by michael on January 21, 2000, at 15:03:09
In reply to Re: dysthymia & meds-my combo, posted by S. Suggs on January 21, 2000, at 14:04:53
> > Just wondering which meds, or combos of meds people have had some success - specifically with dysthymia? (Also the dosage - I've read that dysthymia often requires higher doses to acheive results)
> >
> > For me, wellbutrin sr did nothing - all the way up to 200mg twice daily.
> >
> > Now trying effexor xr. Helps me some w/concentration & being a bit more out-going/sociable, but I'm still low on energy/motivation. Also makes me sleepy.
> > Was taking 75mg/day, now trying 150mg/day.
> >
> > Thanks for any feedback.
> > michael
>
> Michael: I am taking Parnate 60/day and lithium 900/day with wonderful results. MAOI's have a reputation for a high success rate with dysthymia. I am dysthymic as well. I tried almost all the others and talked my doc into a trial of Parnate, and I am thankful. Blessings,
>
> S. Suggs
Any luck with just the parnate? How about side effects?I'm a little hesitant to try maoi's, due to the diet restrictions...
Posted by Scott L. Schofield on January 21, 2000, at 20:04:11
In reply to Re: dysthymia & meds-my combo, posted by michael on January 21, 2000, at 15:03:09
> I'm a little hesitant to try maoi's, due to the diet restrictions...I just had a good idea (a rare event). Why not try to adhere to the MAOI diet for a few weeks and see how you do with it. You can use the link on Dr. Bob's home page to get a food list. It may be easier to stick to than you think.
Good luck.
- Scott
Posted by S. Suggs on January 22, 2000, at 5:11:07
In reply to Re: dysthymia & meds-my combo, posted by michael on January 21, 2000, at 15:03:09
> Any luck with just the parnate? How about side effects?
>
> I'm a little hesitant to try maoi's, due to the diet restrictions...Michael: It has worked very well. More outgoing, sleep better, more energy, much better outlook on life, enjoy doing things I did not before, etc... Side effects: Around 8pm or so I get sleepy, but in a nice way. Diet restrictions, from what I understand hinge somewhat on dosage (the higher you go, the greater the chance of a hypertensive episode). From previous post I've read, this problem with maoi's is somewhat overblown, but does exist. It's a small price to pay for getting rid of your depression. You just have to keep an eye on it. Best of blessings to you!
S. Suggs
Posted by michael on January 22, 2000, at 12:04:04
In reply to Re: dysthymia & meds-my combo, posted by S. Suggs on January 22, 2000, at 5:11:07
> > Any luck with just the parnate? How about side effects?
> >
> > I'm a little hesitant to try maoi's, due to the diet restrictions...
>
> Michael: It has worked very well. More outgoing, sleep better, more energy, much better outlook on life, enjoy doing things I did not before, etc... Side effects: Around 8pm or so I get sleepy, but in a nice way. Diet restrictions, from what I understand hinge somewhat on dosage (the higher you go, the greater the chance of a hypertensive episode). From previous post I've read, this problem with maoi's is somewhat overblown, but does exist. It's a small price to pay for getting rid of your depression. You just have to keep an eye on it. Best of blessings to you!
>
> S. Suggs
S. -Thanks for the info. Just wondering if that was the result of the parnate alone, or in conjunction with the lithium? Was the lithium added to the parnate? (i.e. To address side effects? Or as an augmenting agent?) Thanks again,
michael
Posted by Seedwoman on January 22, 2000, at 18:56:50
In reply to Re: dysthymia & meds-my combo, posted by S. Suggs on January 22, 2000, at 5:11:07
I'm lucky in having responded well, if temporarily, to SSRIs and Wellbutrin...currently I am doing very well on Zoloft, Buspar, Wellbutrin, and Trazodone for sleep...hope to be able to cut out the Buspar, not sure it adds anything though it was a great temporary booster for the Zoloft before both pooped out. Wellbutrin gives a much more lasting, if less euphoric, mood adjustment.
good luck.
Posted by S. Suggs on January 24, 2000, at 6:04:22
In reply to Re: dysthymia & meds-my combo, posted by michael on January 22, 2000, at 12:04:04
Michael: The lithium was added several years ago to augment an antidepressant. I noticed a drastic effect (very positive) and kept it on board. Lithium has a reputation of losing its effectiveness when stopping and quitting. So, along my journey of med searches, I kept taking it. I honestly cannot tell you if it is responsible for the excellent response I've recieved from Parnate. If you feel your meds are not up to par, adding lithium carbonate is almost always a safe choice. In reasoning this thing out, I feel that most of my positive response was due to the Parnate, since I've tried so many over the past several years (while taking lithium) without good results. Best wishes and keep us up to date, blessings,
S. Suggs
Posted by Scott L. Schofield on January 26, 2000, at 10:44:19
In reply to Re: dysthymia & meds-my combo, posted by S. Suggs on January 24, 2000, at 6:04:22
> Lithium has a reputation of losing its effectiveness when stopping and quitting. So, along my journey of med searches, I kept taking it.
You are very fortunate that you discovered this information early enough to make decisions base upon it.
A friend of mine who suffers from bipolar II (and probably dysthymia) remained symptom-free for over three years while receiving lithium monotherapy. During this time, she experienced no side-effects, and her thyroid and renal tests were normal. When she relocated, her new doctor decided that she had been taking lithium for long enough, and that it was about time to discontinue it. She weaned off of it gradually over the course of a month or two. I think she relapsed into severe depression within three months. Of course, the doctor decided to restart the lithium. Fifteen years worth of therapeutic drug trials have passed since.
> I honestly cannot tell you if it is responsible for the excellent response I've received from Parnate.
Not that I've performed any kind of extensive survey or anything, but I seem to remember hearing or reading about quite a few success stories involving lithium augmentation to Parnate. I don't recall coming across as many with Nardil. However, this may reflect a tendency for many doctors to try Parnate before Nardil when treating depression in bipolar disorder, a scenario that may frequently include an ongoing regime using lithium.
- Scott
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Am J Psychiatry 1992 Dec;149(12):1727-9Lithium-discontinuation-induced refractoriness: preliminary observations.
Post RM, Leverich GS, Altshuler L, Mikalauskas K
Biological Psychiatry Branch, National Institute of Mental Health, Bethesda, MD 20892.The authors used a systematic life-chart methodology to observe four patients with bipolar disorder in whom long periods (6-15 years) of effective lithium prophylaxis were followed by relapses on lithium discontinuation. Once the drug was reinstituted, it was no longer effective. The incidence, predictors, and mechanisms underlying this phenomenon all require further systematic study. The current preliminary observations suggest an additional reason for caution when lithium discontinuation in the well-maintained patient is considered.
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