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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 23 of 23. This is the beginning of the thread.
Posted by adamCanada on September 15, 2006, at 0:01:12
I will try to make this short. I have been through 15+ different meds for extremely severe clinical depression caused by Vitamin A overdose by a med called Accutane.
Most seratonin meds made me worse such as Celexa (extremely), effexor (extremely), prozac, and several others but one has worked to the point where my life is tolerable.
I am on Paxil right now along with dexedrine. No Longer am I a zombie with harsh hot pains in my head (as if my brain chemicals are severely messed up in one way or another), and I am able to go about my daily life.
But I am not entirely better. Not even close. But it's better than wishing you were dead. One med that helped me through these past 5 or so years was Vivarint or Viloxazine/Viloxazina (Emovit, Vivalan, Vivarint, Vicilan).
For the limited time I took it I felt higher motivation, returning of hobbies and interests, for one I wanted to go out and meet people and DO THINGS and as an added bonus it gave me a HUGE sex drive. This medication I have not had any luck finding on any online order sites (taken off the market) and is not available in north america. I think only in France... so I am out of luck on that end.
.
So I am here asking what meds work on norepinephrine that can help me? I need something that can be taken With Paxil and not require me to stop taking paxil as I cannot function without Paxil Period.
Please offer any suggestions. I am sick of living my life as someone who is only half alive.
My problems right now are: Lack of motivation, Low Drive (for anything, not just sex), Anti-social, Tiredness, Apathy, Etc
Posted by notfred on September 15, 2006, at 0:42:22
In reply to What works on norepinephrine? possibly only hope, posted by adamCanada on September 15, 2006, at 0:01:12
Monoamine oxidase inhibitors (MAOI):
Harmaline, Iproclozide, Iproniazid, Isocarboxazid, Nialamide, Phenelzine, Selegiline, Toloxatone, TranylcypromineReversible inhibitor of MOA (RIMA): Brofaromine, Moclobemide
Norepinephrine-dopamine reuptake inhibitors: Bupropion, Adrafinil, Modafinil, Nuvigil
Norepinephrine reuptake inhibitor (NRI) or (NARI): Atomoxetine, Maprotiline, Reboxetine, Viloxazine
Serotonin-norepinephrine reuptake inhibitor (SNRI):
Duloxetine, Milnacipran, VenlafaxineTricyclic antidepressants (TCA): Amitriptyline, Amoxapine, Desipramine, Dothiepin, Doxepin, Imipramine, Lofepramine, Melitracen, Nortriptyline, Opipramol, Protriptyline, Trimipramine
Tetracyclic antidepressants:
Maprotiline, Mianserin, TrazodoneCNS stimulants:
Amphetamine, Methylphenidate, Phenylethylamine
Posted by dbc on September 15, 2006, at 1:04:37
In reply to Re: What works on norepinephrine? possibly only ho, posted by notfred on September 15, 2006, at 0:42:22
Is it possible that its not a norepinephrine issue and is dopamine related? Because effexor effects norepinephrine and there are numerous NRI drugs like strattera but you have positive results with dexedrine? Dexedrine releases a massive amount of dopamine...i mean if norepinephrine is just the problem than theres tons of drugs.
Ill just say that i suffer similar problems as you and have been diagnosed dysthymic and inattentive ADD(this probably is not what you think it is). Anyway once i was prescribed stimulants i was suddenly normal. After trying 20+ drugs it was this simple and easy.
Posted by qbsbrown on September 15, 2006, at 1:05:07
In reply to Re: What works on norepinephrine? possibly only ho, posted by notfred on September 15, 2006, at 0:42:22
How high was ur effexor dose? It typically takes 150 to touch norepinephrine. Cymbatla is the "new and improved" version of it, although yet to be proved. It is supposed to work more efficiently on nor and dopamine at lower doses.
I recently wanted only 75 mgs of effexor, but PDOC said it would only act as an SSRI at that low of dose.
Good luck,
Brian
Posted by Tom Twilight on September 15, 2006, at 1:36:09
In reply to Re: What works on norepinephrine? possibly only ho, posted by qbsbrown on September 15, 2006, at 1:05:07
Hey Adam
I'm sorry you've had no luck getting hold of Viloxazine
I'd love to try it myself, but have had no luck getting hold of it (I live in the UK)Would it be possible for a doctor to order it from abroad?
I've heard of Docs doing this before.You could try contacting the company that makes it.
Posted by linkadge on September 15, 2006, at 6:49:07
In reply to Re: What works on norepinephrine? possibly only ho, posted by Tom Twilight on September 15, 2006, at 1:36:09
For staters I would look at omega-3 supplementation. There have been quite double blind placebo controlled studies demonstrating their efficacy in relieving depressive symtpoms.
see: http://biopsychiatry.com/eicosdep.htm
I have seen trials demsontrating their efficacy too in acutaine induce depression too. The logic being that acutaine altered the fatty acid profile of the brain and consequently inducing depression.
Even mild deficiancy of omega-3 will reduce dopamine and serotonin content in the brain and compromise membrane integrity.
I'd give it a shot if you havn't already, you can still add pharamacudicals on top of this.
Linkadge
Posted by SLS on September 15, 2006, at 7:27:38
In reply to Re: What works on norepinephrine? possibly only ho, posted by notfred on September 15, 2006, at 0:42:22
Notfred put together a wonderful list.
I think you might want to first try one of the MAO inhibitors (MAOI) - perhaps Parnate.
Reuptake inhibitors - desipramine or nortriptyline first.
- Scott
Posted by SLS on September 15, 2006, at 7:28:01
In reply to Re: What works on norepinephrine? possibly only ho, posted by notfred on September 15, 2006, at 0:42:22
Hi.
Nice post.
Do you have a comprehensive list of medications compiled? If you do, would you mind posting it? That would be a great contribution.
- Scott
Posted by blueberry on September 15, 2006, at 17:45:04
In reply to What works on norepinephrine? possibly only hope, posted by adamCanada on September 15, 2006, at 0:01:12
There are a lot of drugs that hit norepinephrine. However, just as you noted that serotonin meds are very different, it goes for norepinephrine meds too.
Two common ones easy to get would be bupropion or adrafinil.
If you can handle a bit more in the side effects department, desipramine would be a good choice, or nortriptyline.
Posted by adamCanada on September 15, 2006, at 18:18:22
In reply to Re: What works on norepinephrine? possibly only ho, posted by linkadge on September 15, 2006, at 6:49:07
dont omega-3 fatty acids have vitamin a? whenever i eat anything with vitamin A I feel worse such as when I eat eggs. I love eggs but refuse to eat them anymore because I feel bad after eating them.
Is the vitamin A in omega 3 fatty acids different and will not effect me in that way>?
Posted by linkadge on September 15, 2006, at 21:40:14
In reply to omega 3 fatty acids, posted by adamCanada on September 15, 2006, at 18:18:22
No, cod liver oil contains vitamin A, but omega-3 supplements in general do not. If it contains even minimal vitamin A, it will be listed on the bottle.
Essentially you just look for an omega-3 product with standardized EPA and DHA content. Aim for about 1 gram of EPA per day.
One theory is that Acutaine alters the neuronal lipid ballance from omega-3 to omega-6, and decreases the incorperation of omega-3 into neuronal membranes. In doing so, it may alter brain serotoin and dopamine content. Omega-3 have a very high turnover rate, so if something depletes the brain of omega-3 it can take a long while to restore a ballance.
Its easy to shrug it off as a supplement, but the popularity of omega-3 supplements are growing for a reason. I'd try it for a month and just see if you don't notice an improvement.
Linkadge
Posted by notfred on September 16, 2006, at 0:20:12
In reply to Re: What works on norepinephrine? possibly only ho » notfred, posted by SLS on September 15, 2006, at 7:28:01
> Hi.
>
> Nice post.thanks !
>
> Do you have a comprehensive list of medications compiled?For selfish reasons (norepinephrine effecting AD's
seem to be the only ones that work for me) I don't
have a comprehensive list of all AD's. SSRI's (all of them) have failed to do anything, even at high doses.Over the last 20 years my sucesses have been:
Imipramine & therefor Desipramine (horrid sweating) Nortriptyline & Protriptyline
Doxepin, which was my mainstay AD as I liked its sedating, anticolanergic & anithistimitic effects.After 10 yrs Doxepin pooped out, caused flat effect, & other TCA's were no better. MAOI's caused hypertensive events, I seem very sensitive to this. Otherwise they were very effective. Trazodone at high doses (300 mgs) worked but I never woke up.
Effexor + Doxepin + Dexedrine, Atavin prn, was very effective for several years. I dropped the Doxepin for Remeron, seeking less flat effect. Success with this until Effexor started causing arterial hypertension (140/95 to 140/105). Dexedrine was also a minor player in causing
the hypertension.Dropped Effexor and Dexedrine for Wellbrutrin,
hypertension ended. Effective but I felt "less than well" 80-90 % better but apathty was an issue. Weight gain leading to pre diabetes II. Ativan prn.Started seeing a top psycopharmacologist & identified the Remeron as causing weight gain and
apathty. Dropped Remeron for Lunesta, added Provigil. Lost 20 lbs, diabetes resolved, A1C lowered to normal range.Presently I am on Wellbrutrin (300 mgs), Provigil
(400 mgs), Lunesta (6 mgs), and Ativan (1-2 mgs/day prn). This combo is the best yet, no side effects provided I do not take Provigil w/o having a small snack every 4 hrs. Ativan will cause some memory problems if I take it for more than 3 days in a row but excessive stress will cause me to crash so the trade off is worth it if I need to take Ativan every day. I do not find I take more
Ativan today than I did 15 yrs ago.For me the key to more than 20 yrs of remission
are a norepinephrine effecting AD, stress control,
and good restorative sleep. I have had a few breakthrough depressions, which resolve with a dosage adjustment of the AD, better control of stress and sleep, or poop out indicating it is time to try a new AD. I keep a short list of AD's to try next. It helps that I do not give a hoot if I take meds.
Posted by Tomatheus on September 16, 2006, at 1:09:36
In reply to Re: What works on norepinephrine? possibly only ho, posted by dbc on September 15, 2006, at 1:04:37
> Ill just say that i suffer similar problems as you and have been diagnosed dysthymic and inattentive ADD(this probably is not what you think it is). Anyway once i was prescribed stimulants i was suddenly normal. After trying 20+ drugs it was this simple and easy.
dbc,
Which stimulant(s) have you found to be the most effective?
I ask because I've been struggling with persistent depressive symptoms and some inattentiveness for more than six years. I was first diagnosed with dysthymia, then with bipolar disorder (due to the rapid cycling that I experienced while on Paxil), and most recently major depressive disorder - recurrent. I think the term "recurrent" is somewhat misleading because it implies that the depressive symptoms come in episodes that eventually remit to some extent, and that certainly hasn't been the case with me. The only time I ever experienced a clinically significant remission was for about a month when I was taking a specially prepared version of the Australian Nardil.
I've taken other antidepressants, mood stabilizers, and supplements with varying degrees of success, but aside from my month of remission on Nardil, I've never experienced significant relief from the severe psychomotor retardation that's associated with my disorder.
Considering that I've never been diagnosed with ADHD of any sort (inattentive, hyperactive, or mixed), I've never taken a stimulant. However, inattentiveness has always been a part of my condition, and I'm wondering if I might experience some relief from taking a stimulant.
Anyway, I was just wondering if you could let me know what stimulant(s) you've had success with.
Thanks,
Tomatheus
Posted by dbc on September 16, 2006, at 3:46:34
In reply to Re: What works on norepinephrine? possibly only ho » dbc, posted by Tomatheus on September 16, 2006, at 1:09:36
I've found amphetamines to be the most useful. Dextro-methylphendiate (focalin) may be useful in high doses but i cant comment since its much easier to get the state to pay for Adderall or Dexedrine.
While at first both myself and my doctor were kind of confused at the whole IADD thing, i've come to understand that only a very small percentage of people dont have mixed AD(H)D conditions. So a purely inattentive person makes up something like 4% of all ADD suffers. A purely inattenative male is basically like getting hit by lightning...they probably make up .5% of the demographic. Being dysthymic on top of this is sort of like getting hit by lightning twice and winning the lottery.
I've met one other person with my similar "condition" and he had almost the exact same story except it took his doctors 8 years to figure out what was wrong while it took me about a year of personal investigation and showing my doctors my research.
So yeah, when a doctor is faced with someone like me they dont know what the to do. But so far stimulants have left me depression free and semi functional. Where as without the meds i sleep large amounts of time, am fatigured, bored, life is rather grey and meaningless.
I realize this invites the response of "well no duh you're taking a stimulant of course it makes you undepressed". I've pushed my brain as far as it will go with SSRIs/SNRIs/NRIs, probably almost killed myself with the california rocket fuel cocktail and never got even close to this relief.
Posted by dbc on September 16, 2006, at 3:54:58
In reply to Re: What works on norepinephrine?, posted by dbc on September 16, 2006, at 3:46:34
I've given some thought to EMSAM but the price is astronomical and i cant imagine any way i can go about getting it or if i really want to make a commitment to an MAO, the thought sort of scares me.
Theres also mirapex and some other Dopamine Reuptake Inhibitors that are generally used for parkinsons that may be helpful but i doubt im going to find a doctor that can justify their usage to the state/government/whoever.
Posted by ed_uk on September 16, 2006, at 9:47:07
In reply to omega 3 fatty acids, posted by adamCanada on September 15, 2006, at 18:18:22
Hi Adam
Have you tried desipramine or nortriptyline?
Ed
Posted by Tomatheus on September 16, 2006, at 17:32:00
In reply to Re: What works on norepinephrine?, posted by dbc on September 16, 2006, at 3:46:34
dbc,
Thanks for your responses. I found them to be helpful.
I'm not sure that I'd respond to amphetamines as favorably as you have, given the fact that I didn't find Wellbutrin to be all that stimulating. Then again, even though the effects and mechanism of action of Wellbutrin are similar to those of amphetamines, there are obviously some differences, as well. So, it's quite possible that I might find Adderall or Dexedrine to be significantly more stimulating than Wellbutrin.
I just started a trial of low-dose T3/T4 (thyroid hormones) for my depressive disorder, so I'm obviously hoping that the T3/T4 medication will provide me with enough relief that I won't need to think about switching and/or adding meds any time soon. However, if my current medication trial does not turn out to be successful, an amphetamine will probably be near the top of my list of meds to try next, assuming that my pdoc would be willing to prescribe it. If my current pdoc refuses to prescribe me Adderall or Dexedrine (which is a possibility, considering that he specializes in treating mood and anxiety disorders), I may consider seeing a doc who specializes in treating ADHD. Based on my own self assessment, I think that I should meet the DSM-IV criteria for inattentive ADHD (or just plain ADD, as it used to be called).
I have also been considering asking my pdoc about EMSAM, but like you, I'm avoiding it for the time being mostly because of its outrageous price. I have been paying for my meds out of pocket for a few years now (even when I did have insurance as a student, it covered next to nothing), and I don't think that I'll be getting any halfway decent insurance any time soon. So, even though I could probably handle paying for 1-2 months' worth of EMSAM without much of a problem, I don't think that I'll realistically be able to afford it long-term without going bankrupt. Considering that I've responded better to MAOIs than I have to any other class of medications, I'd really like to try EMSAM at some point. However, I think that I'd be best served by trying some more affordable options first.
Anyway, thanks again for your responses. I appreciate them.
Tomatheus
Posted by dbc on September 16, 2006, at 18:44:57
In reply to Re: What works on norepinephrine? » dbc, posted by Tomatheus on September 16, 2006, at 17:32:00
I didnt do all that well with wellbutrin either. It was like a dopamine tease, i'd feel like it might be working for a day or so and then nothing. We'd up the dose and i'd get that little bit of dopamine and then it'd stop working. This went on untill i hit around 300 and we decided there was no point in continuing.
Posted by Tomatheus on September 16, 2006, at 19:21:30
In reply to Re: What works on norepinephrine? dbc, posted by dbc on September 16, 2006, at 18:44:57
> I didnt do all that well with wellbutrin either. It was like a dopamine tease, i'd feel like it might be working for a day or so and then nothing. We'd up the dose and i'd get that little bit of dopamine and then it'd stop working. This went on untill i hit around 300 and we decided there was no point in continuing.
Yeah, that pretty much describes my experience with Wellbutrin monotherapy, except that I went all the way up to 400 mg of Wellbutrin SR and just got more of the same. I actually responded partially but still largely inadequately to a combo of Wellbutrin and lithium. The combo (which produced the second-best response of anything that I've tried behind the specially prepared version of the Australian Nardil that I used to take) allowed me to just barely get by in my capacities as a university student and a student worker, but I still felt that each day and every simple task was a monumental struggle. That response was pretty much the best that I could get with Wellbutrin.
Tomatheus
Posted by adamCanada on September 16, 2006, at 22:56:53
In reply to Re: omega 3 fatty acids » adamCanada, posted by ed_uk on September 16, 2006, at 9:47:07
> Hi Adam
>
> Have you tried desipramine or nortriptyline?
>
> Ed
I believe i tried it and it didnt work or made me worse. dont recall exactly what it did
Posted by adamCanada on September 16, 2006, at 23:13:47
In reply to Re: What works on norepinephrine? » dbc, posted by Tomatheus on September 16, 2006, at 19:21:30
i am thinking of giving this a shot. i recall taking it before for a short time and it didnt help but with paxil together maybe it will.
or maybe i should try an NARI... ill see after i do some research.
and i will pick up some omega 3 fatty acids. maybe it will take a while for them to work. months maybe? i'll take them for a while and hope they do soemthing
Posted by Tomatheus on September 17, 2006, at 0:19:29
In reply to Wellbutrin, posted by adamCanada on September 16, 2006, at 23:13:47
Adam,
Thanks for your message. I'm sorry for sort of hijacking your thread, so to speak.
It's possible that you might be able to get a synergistic effect from combining Paxil and Wellbutrin that could be noticeably more effective than taking either drug alone. However, it's my impression based on having read a limited number of posts on this board that Wellbutrin generally tends to be less stimulating than Dexedrine. So, I think it is somewhat unlikely that you'll find a Paxil-Wellbutrin combo to be more effective than your current Paxil-Dexedrine combo. Of course, there are individual-to-individual variations in medication responses, which means that it's quite possible that my guess might be wrong.
It's difficult for someone in my position to predict which antidepressant, stimulant, or combination thereof would be of the greatest therapeutic value to you. On one hand, I wonder if it might be best to discontinue Paxil given the fact that you generally don't respond favorably to SRIs, and try something like a stimulant (as monotherapy), an MAOI, or a tricyclic. On the other hand, it might not be such a good idea to stop taking the only medication that's provided you with any benefits so far. Unfortunately, psychiatry involves a lot of trial and error, and so it's difficult even for psychiatrists (despite their expertise) to accurately predict which med(s) a patient might respond to.
It probably wouldn't be a bad idea to give an Omega 3 fatty acid supplement a try. Linkadge mentioned that Omega 3s have demonstrated some efficacy in treating Accutane-induced depression, and I definitely think that it would make sense to try taking something that has been shown to be effective in treating your specific subtype of depression. I'm not sure how long it would take for you to notice the therapeutic benefits of Omega 3s, but if the theory that Accutane alters the brain's fatty-acid profile is indeed correct, I think it would be sensible to give the supplement at least a month to work.
Tomatheus
> i am thinking of giving this a shot. i recall taking it before for a short time and it didnt help but with paxil together maybe it will.
>
> or maybe i should try an NARI... ill see after i do some research.
>
> and i will pick up some omega 3 fatty acids. maybe it will take a while for them to work. months maybe? i'll take them for a while and hope they do soemthing
Posted by linkadge on September 17, 2006, at 10:41:32
In reply to Wellbutrin, posted by adamCanada on September 16, 2006, at 23:13:47
I'd just aim for a preparation containing about 1 gram of EPA (~ the same of DHA). Should be available at any pharmacy OTC. Just ask for omega-3 products.
Take it for about a month. I'd say if you're going to notice an effect it will happen within 2 months or so.
They tend to reduce depression, anxiety, feelings of agression etc.
Linkadge
This is the end of the thread.
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