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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 20 of 20. This is the beginning of the thread.
Posted by KaraS on February 15, 2005, at 16:16:46
A while back my pdoc recommended that I augment Effexor with either lithium, Lamictal or Abilify. When you do this, you just end up lifting mood more, right? You don't end up getting rid of the SSRI apathy or amotivation, do you?
Posted by banga on February 15, 2005, at 16:35:04
In reply to Augmentors, posted by KaraS on February 15, 2005, at 16:16:46
Abilify for me tends to "activate" me a bit--but it seems to do so by lessening negative ruminations. Lamictal helped me stabilize moods, but did not really help with my motivation.
Have you talked to him about wellbutrin to help with that? And this is very tentative suggestion--but I am on a low dose of the antidepressant desipramine, which works more on norepinephrine, and it seems to cut through the fog and apathy of my depression. But in any case, I now wonder if it is a depletion of norepinephrine that is involved in the amotivation and apathy and braing fog from SSRIs.
Just a thought. Check with others and your pdoc before taking this idea more seriously.
Posted by Nixon on February 15, 2005, at 16:43:47
In reply to Re: Augmentors, posted by banga on February 15, 2005, at 16:35:04
Hi,
I found that my ssri efficacy increased dramatically along with my sleep duration and less anxiety when I augmented with low dose Remeron(15mg) 3 years ago. I have not gained any weight either. JN
Posted by KaraS on February 15, 2005, at 19:08:36
In reply to Re: Augmentors, posted by banga on February 15, 2005, at 16:35:04
> Abilify for me tends to "activate" me a bit--but it seems to do so by lessening negative ruminations. Lamictal helped me stabilize moods, but did not really help with my motivation.
>
> Have you talked to him about wellbutrin to help with that? And this is very tentative suggestion--but I am on a low dose of the antidepressant desipramine, which works more on norepinephrine, and it seems to cut through the fog and apathy of my depression. But in any case, I now wonder if it is a depletion of norepinephrine that is involved in the amotivation and apathy and braing fog from SSRIs.
> Just a thought. Check with others and your pdoc before taking this idea more seriously.Thanks for your input on this. I have tried Wellbutrin and I couldn't tolerate it - felt like it was hard to breathe. I don't know if it was an allergic reaction or maybe just chest tightness which might have passed with time. I may give it another try.
As for the SSRI apathy, I think the conventional wisdom on that is that the culprit is low dopamine - which can happen when you increase serotonin. I believe that when you increase norepinephrine that some dopamine may be increased as well - so that might help. Problem there is that I get tachycardia from the noradrenergic meds. I may look into trying beta blockers in order to tolerate them in the future.
Kara
Posted by KaraS on February 15, 2005, at 19:26:42
In reply to Re: Augmentors, posted by Nixon on February 15, 2005, at 16:43:47
> Hi,
>
> I found that my ssri efficacy increased dramatically along with my sleep duration and less anxiety when I augmented with low dose Remeron(15mg) 3 years ago. I have not gained any weight either. JNThanks. Do you still have the apathy or was it never a problem for you?
Posted by Nixon on February 15, 2005, at 19:39:08
In reply to Re: Augmentors » Nixon, posted by KaraS on February 15, 2005, at 19:26:42
Hi,
I know what you mean. For me sluggishness in the morning can come and go but it is not a big problem for me. When I have stopped Remeron and let it clear my system I realize how helpful the drug. The remarkable thing I find about Remeron for ME is the same effects I got 2 years ago from 15mg are the same I get now. I like it's positive effects as an augment. Have you taken Remeron? JN
Posted by KaraS on February 15, 2005, at 20:45:54
In reply to Re: Augmentors » KaraS, posted by Nixon on February 15, 2005, at 19:39:08
> Hi,
>
> I know what you mean. For me sluggishness in the morning can come and go but it is not a big problem for me. When I have stopped Remeron and let it clear my system I realize how helpful the drug. The remarkable thing I find about Remeron for ME is the same effects I got 2 years ago from 15mg are the same I get now. I like it's positive effects as an augment. Have you taken Remeron? JNNo, I've never tried it. I was always afraid of the weight gain plus I was looking for something activating to add to an SSRI rather than something more sedating. Now, however, I need the sedation as well as the motivation.
Posted by Dave1 on February 19, 2005, at 10:32:34
In reply to Augmentors, posted by KaraS on February 15, 2005, at 16:16:46
HI,
I think that Wellbutrin is the best thing for SSRI induced apathy, loss of sexual desire, etc. Atleast that's what they on my OCD site, where 'everyone' is on an SSRI, because that's the main treatment for OCD.
DAVE
Posted by KaraS on February 19, 2005, at 14:00:45
In reply to Re: Augmentors, posted by Dave1 on February 19, 2005, at 10:32:34
> HI,
>
> I think that Wellbutrin is the best thing for SSRI induced apathy, loss of sexual desire, etc. Atleast that's what they on my OCD site, where 'everyone' is on an SSRI, because that's the main treatment for OCD.
>
> DAVE
Thanks. I think you're right. Unfortunately, I wasn't able to tolerate it.K
Posted by Dave1 on February 23, 2005, at 5:58:54
In reply to Re: Augmentors » Dave1, posted by KaraS on February 19, 2005, at 14:00:45
I've been on it since the summer, but am cutting back because it is making my teeth dry and now I have a bunch of new cavities.
Dave
Posted by FredPotter on February 23, 2005, at 13:52:01
In reply to Re: Augmentors » KaraS, posted by Dave1 on February 23, 2005, at 5:58:54
I found L-Tyrosine to be a good augmentor after years of taking an SSRI. The tiredness went away and the motivation came back. Larry Hoover says it should be taken on an empty stomach, 20 minutes before eating. I take 1.5 mg twice a day. Quite a lot really
Fred
Posted by KaraS on February 23, 2005, at 15:02:04
In reply to Re: Augmentors » KaraS, posted by Dave1 on February 23, 2005, at 5:58:54
> I've been on it since the summer, but am cutting back because it is making my teeth dry and now I have a bunch of new cavities.
>
> Dave
from Wellbutrin?
Posted by KaraS on February 23, 2005, at 15:08:16
In reply to Re: Augmentors, posted by FredPotter on February 23, 2005, at 13:52:01
> I found L-Tyrosine to be a good augmentor after years of taking an SSRI. The tiredness went away and the motivation came back. Larry Hoover says it should be taken on an empty stomach, 20 minutes before eating. I take 1.5 mg twice a day. Quite a lot really
> Fred
While I was on either 75 or 150 mg. of Effexor, I tried adding l-tyrosine. I took a couple of good quality brands on an empty stomach with the proper B vitamin but got no response at all. I even went up to 4,000 mg. per day. I am usually very sensitive to norepinephrine so I think that something in the process wasn't working at all.Did you take take the l-tyrosine while you were still taking the SSRI or were you off of the SSRI completely at that point?
Posted by FredPotter on February 23, 2005, at 18:01:31
In reply to Re: Augmentors » FredPotter, posted by KaraS on February 23, 2005, at 15:08:16
I'm still on Celexa. I should said 1.5 grams twice a day
Posted by FredPotter on February 23, 2005, at 18:05:34
In reply to Re: Augmentors » FredPotter, posted by KaraS on February 23, 2005, at 15:08:16
Perhaps you weren't depleted in norepinephrine (or dopamine). Effexor inhibits intake of norepinephrine at higher doses and dopamine at even higher doses. So perhaps Effexor wouldn't cause nor and dop depletion as an SSRI would. This depletion thing is just a theory of mine
Posted by KaraS on February 23, 2005, at 18:57:39
In reply to Re: Augmentors » KaraS, posted by FredPotter on February 23, 2005, at 18:05:34
> Perhaps you weren't depleted in norepinephrine (or dopamine). Effexor inhibits intake of norepinephrine at higher doses and dopamine at even higher doses. So perhaps Effexor wouldn't cause nor and dop depletion as an SSRI would. This depletion thing is just a theory of mine
Effexor is mostly an SSRI. No significant NE in there until you hit about 225 mg. and even then you've got more SE proportionally. When you hit 300 mg. and over it supposedly has a small effect on DA. I was only taking either 75 or 150 mg. at the time. Also, it seems that Effexor causes that same SSRI type apathy for most people. Some people are fine initially but later develop the apathy. I don't know of anyone who has been on it a long time and still maintained motivation (but that could also be because my perception is skewed from reading this board full of treatment resistant depressives).
Anyway, I had no motivation while on Effexor though it did lift my mood somewhat. I went up to 225 mg. for a couple of months but it didn't seem to help. I have a friend who just went off of it and he was on 300 mg. It did a great job on his mood but he had absolutely no motivation.
Posted by eugenia on February 26, 2005, at 7:02:30
In reply to Re: Augmentors » FredPotter, posted by KaraS on February 23, 2005, at 18:57:39
Has anyone used cytomel as an augmenter? If it worked, how long did it take to kick in? Did you have any side-effects? I just started it, feel nothing, but am scared about the risk of osteoporosis, so unless it's really fantastic I won't continue.
Posted by lars1 on February 26, 2005, at 17:23:58
In reply to Re: Augmentors » KaraS, posted by Dave1 on February 23, 2005, at 5:58:54
> I've been on it since the summer, but am cutting back because it is making my teeth dry and now I have a bunch of new cavities.
>
> DaveIf cavities are the only reason you're cutting back, there are prescription toothpastes and dental rinses available with a high concentration of fluoride. Examples would be Prevident (toothpaste with 1.1% sodium fluoride) and Colgate Point-Two dental rinse (0.2% sodium fluoride). Both are very effective at preventing decay, even if you have dry mouth, and can even reverse existing decay if it hasn't advanced too far.
Lars
Posted by Bill LL on February 28, 2005, at 8:42:19
In reply to cytomel as an augmenter, posted by eugenia on February 26, 2005, at 7:02:30
I have not tried it, but I have read a lot about it. I guess it would take a few weeks to fully work.
The higher risk of osteoporosis is after menopause in women. It is a theoretical risk which I think has not been proven. But I think that if you keep your TSH above 1, the extra risk is kept to a low level.
> Has anyone used cytomel as an augmenter? If it worked, how long did it take to kick in? Did you have any side-effects? I just started it, feel nothing, but am scared about the risk of osteoporosis, so unless it's really fantastic I won't continue.
>
Posted by Maxime on March 2, 2005, at 19:47:25
In reply to cytomel as an augmenter, posted by eugenia on February 26, 2005, at 7:02:30
I have. It works quickly and has a short half life. But it will give you an energy boost. Actually most doctors worry about the effect it will have on your heart because it can make your heart race etc. So maybe you have been started on a low dose to see how you react. It might be increased later. It's meant for hypothyroidism but it often used as an augmentor. I hope your doctor is planning on monitoring your levels of T3 in your body. Have you tried any other augmenters? Why did your doctor prescribe Cytomel over other possible augmenters?
Maxime
> Has anyone used cytomel as an augmenter? If it worked, how long did it take to kick in? Did you have any side-effects? I just started it, feel nothing, but am scared about the risk of osteoporosis, so unless it's really fantastic I won't continue.
>
This is the end of the thread.
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