![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by TrishP on November 26, 2006, at 7:42:04
Ok - since I am having terrible akathesia and a few rage incidents on Abilify I have quetions about my brain chemicals.
Wellbutrin also gave me energy and a few rages (like Abilify), but not the akathesia (shaky feeling inside) like Abilify. BUT, when I countered the Wellbutrin with Effexor, I felt like a nicer person.
I'm guessing that Wellbutrin & Effexor hit all 3 brain chemicals?
Cymbalta only hits neuephanephrine (sp?) ? Is that right? It doesn't effect Serotonin?
It's like I need to hit all 3 chemicals just slightly to get a good balance. Too much Dopamine manipulation and I get edgy and could fly into a rage. Too much neurephanephrine and I get depressed. Too much Serotonin and I get bladder problems.
I've tried taming Wellbutrin with Klonopin and it doesn't work. Kinda like taming Abilify with Xanax or Klonopin didn't work either.
I feel like I'm close to an answer, I just don't know.
Would Cymbalta and Wellbutrin be a good combo? Does Cymbalta effect serotonin at all?
Posted by tensor on November 26, 2006, at 8:12:16
In reply to The right mix?, posted by TrishP on November 26, 2006, at 7:42:04
>Would Cymbalta and Wellbutrin be a good combo?
It's used, would probably boost noradrenergic action quite powerfully since both are NE reuptake inhibitors.
Does Cymbalta effect serotonin at all?
It blocks both NE and 5HT reuptake pumps, I think it have only a weak effect on DA reuptake pump.
/Mattias
Posted by Quintal on November 26, 2006, at 9:19:57
In reply to Re: The right mix? » TrishP, posted by tensor on November 26, 2006, at 8:12:16
I'm just thinking Wellbutrin and Cymbalta AAARRRRGGGGGGHHHHHHH!!!!!! All that NA reuptake. We were discussing the flaws of NA reuptake inhibitors yesterday in this thread: http://www.dr-bob.org/babble/20061123/msgs/707093.html. Worth considering before taking the plunge?
Q
Posted by rosa63 on November 26, 2006, at 9:23:37
In reply to Re: The right mix? » tensor, posted by Quintal on November 26, 2006, at 9:19:57
> I'm just thinking Wellbutrin and Cymbalta AAARRRRGGGGGGHHHHHHH!!!!!! All that NA reuptake. We were discussing the flaws of NA reuptake inhibitors yesterday in this thread:
> QQ, What is your opinion of Cymbalta with Remeron?
Posted by Quintal on November 26, 2006, at 9:38:52
In reply to Cymbalta + Remeron? » Quintal, posted by rosa63 on November 26, 2006, at 9:23:37
Well Cymbalta may be energising and could help break through some of the Remeron fog , but Remeron alone has some strong NA actions at high doses (>30mg) and can be stimluating. I suspect most pdocs would be reluctant to combine them.
Q
Posted by rosa63 on November 26, 2006, at 9:49:53
In reply to Re: Cymbalta + Remeron? » rosa63, posted by Quintal on November 26, 2006, at 9:38:52
> Well Cymbalta may be energising and could help break through some of the Remeron fog , but Remeron alone has some strong NA actions at high doses (>30mg) and can be stimluating. I suspect most pdocs would be reluctant to combine them.
Where do y'all learn all this stuff? Where can I learn all this stuff in layman's terms about the DA, SA, and NA and all the receptors and what they do and how the various meds work within those systems? Are there books you can reccommend?
Posted by tensor on November 26, 2006, at 9:54:35
In reply to I want to learn this stuff too!!! » Quintal, posted by rosa63 on November 26, 2006, at 9:49:53
INTERNET + a few books in psychopharmacology. I can recommend books by Stephen M. Stahl. At least, these are my sources.
/Mattias
Posted by Quintal on November 26, 2006, at 10:06:36
In reply to I want to learn this stuff too!!! » Quintal, posted by rosa63 on November 26, 2006, at 9:49:53
Yes, I mainly used the internet and a few medical textbooks to answer any questions I had, and I've learned a lot over the years. I used 'The BMA guide to drugs & medicines' and bought the UK doctor's handbook, the BNF, fromt their onine store because it contains prices of drugs and guidelines etc. Their website is here: http://www.bnf.org.uk.
I'm sure you can do the same in the US. Here are some books you may find helpful: http://www.amazon.com/s/ref=nb_ss_gw/105-5389519-5526827?url=search-alias%3Daps&field-keywords=pharmacology+basics.
Q
Posted by tensor on November 26, 2006, at 10:08:24
In reply to Re: The right mix? » tensor, posted by Quintal on November 26, 2006, at 9:19:57
>Worth considering....
Sure. Remeron + Cymbalta could work well too. As for the urological problems, check out PMID 12126873, 14633083 and 15017228 at http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=search&DB=pubmed
/Mattias
Posted by Quintal on November 26, 2006, at 10:25:28
In reply to Re: The right mix? » Quintal, posted by tensor on November 26, 2006, at 10:08:24
I'd never heard of tamsulosin. I think you said you'd tried it yourelf tensor? Was it effecive and did it help with the other side effects like penis shrinkage?
Q
Posted by tensor on November 26, 2006, at 10:38:26
In reply to Tamsulosin » tensor, posted by Quintal on November 26, 2006, at 10:25:28
No I never got the chance to try it with Edronax and Ixel, because the pdoc I had back then thought that we should wait six months and see if the s/e diminish. Yeah, right. It was too bad because I reponded well to both but I had to discontinue them and I changed pdoc.
However, Ixel is up for discussion once again and then I will sure try tamsulosin. I asked my pdoc about it and he agreed./Mattias
Posted by Phillipa on November 26, 2006, at 11:41:31
In reply to The right mix?, posted by TrishP on November 26, 2006, at 7:42:04
Since cymbalta is an SSNRI wouldn't that mean it would also affect serotonin? Love Phillipa
Posted by Quintal on November 26, 2006, at 11:52:33
In reply to Re: The right mix? » TrishP, posted by Phillipa on November 26, 2006, at 11:41:31
Yes, Cymbalta would strongly inhibit serotonin reuptake, so may have advantages over Remeron which is weak in this department. It's the potential for severe side effects that taking two drugs that block NA reuptake may cause that is the concern. My reaction to reboxetine was so awful I wouldn't dare risk it myself.
Q
Posted by Phillipa on November 26, 2006, at 18:46:17
In reply to Re: The right mix? » Phillipa, posted by Quintal on November 26, 2006, at 11:52:33
So serotonin doesn't matter? I'm not a chemical expert. So I just don't know the answer thanks. Love Phillipa
Posted by Quintal on November 26, 2006, at 19:20:09
In reply to Re: The right mix? » Quintal, posted by Phillipa on November 26, 2006, at 18:46:17
I suppose it depends on how you've responded to SSRIs in the past, if you react badly to them it makes sense to generally avoid drugs that strongly inhibit serotonin reuptake. I was mainly worried about the side effects such a cocktail as Cymbalta and Wellbutrin would have as they both work strongly on the noradrenline receptors and the side effects are very, very harsh when they do occur. Many people become very panicky and suicidal.
Q
Posted by TrishP on November 27, 2006, at 6:22:32
In reply to Re: The right mix? » Phillipa, posted by Quintal on November 26, 2006, at 19:20:09
> I suppose it depends on how you've responded to SSRIs in the past, if you react badly to them it makes sense to generally avoid drugs that strongly inhibit serotonin reuptake. I was mainly worried about the side effects such a cocktail as Cymbalta and Wellbutrin would have as they both work strongly on the noradrenline receptors and the side effects are very, very harsh when they do occur. Many people become very panicky and suicidal.
>
> Q
Hi - thanks for your replies. I've never been suicidal. SSRIs make me feel great - sometimes too great. The usual reason I stop taking SSRIs is becuase they effect my bladder/urinary problems. I can't take that pain.I didn't notice the same happy feeling when I took 30mg of Cymbalta. It felt like it was missing something.
The only reason why I took Effexor with Wellbutrin is because it seemed to calm down the Wellbutrin.
Not really sure what to take now. I like the good sexual side effects (interest in sex) when I take drugs like Geodon, Abilify, Lamictil. I think I just need baby doses of those drugs.
For some reason, my liver metabolizes them very slowly.
Its been 3 days now since I took Abilify and I still have that shaky feeling inside. Xanax and Klonopin help, but they don't get rid or manage that problem.
When I tried Lamicitl is the "theraputic" dose it made my mouth break out in canker-like things. Maybe I neeed a much smaller dose of that to be theraputic for me.
When my old doc wanted me to take Geodon - 160mg! I said no way and took 80mg. He said Geodon is only effective in the higher range.
Maybe I should have taken a tiny dose of that.I don't know. Sometimes I think these docs are too concerned about what the "theraputic" dose is. I can handle a much, much, smaller dose with a much bigger outcome.
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.