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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by X-ray on September 26, 2009, at 13:19:02
Hi,
I have been looking for a drug to use in combination with Wellbutrin.
From Essential Psychopharmacology by Stahl:
Heroic combo 8:
Mirtazapine+bupropionNE is double-boosted
5HT and DA are single-boostedCan anyone explain what this means?
Best regards,
X-rayP.S. The point is to use safe and rational drug combinations
that exploit expected pharmacological and molecular synergies
while even promoting mutual tolerabilities.
(Heroic combos, Stahl)
Posted by bleauberry on September 26, 2009, at 19:50:14
In reply to Heroic combos, posted by X-ray on September 26, 2009, at 13:19:02
Well, for me, the most heroic combination I ever experienced was 100mg Doxycycline and 1.25mg Hydrocortisone combination. The Doxycycline was for a boil. The Hydrocortisone was for adrenal fatigue, though that dose was merely a microdose.
Little did I know at the time I had Lyme disease and had had it ever since my depression began 15 years earlier. Doxy sent the buggers into hiding. Doxy also lowered brain inflammation. It did not however do its intended purpose of healing the boil. I'm not sure if the HC did anything or not, probably helped lower inflammation a bit, and provided deep sleep and increased daytime endurance. And based on limited pubmed studies, it probably helped 5ht1a function and norepinephrine function a little bit.
No wonder all the SSRIs, SNRIs, antipsychotics, mood stabilizers, combinations and augmentations, never really did it. Makes me wonder about other people too.
Anyway, the accidental heroic combination brought 100% total absolute remission to about 20 years back in history long before illness was even on the radar screen.
The second most heroic combination was, well, just a single drug called DMSA that chelates heavy metals out of tissues. My provoked urine test was high, so this was a no-brainer. Amazing what a lift one gets when metals are removed from clogged receptors. Not to mention the high sulfur content of DMSA that can't help but beef up many of the body's natural defense mechanisms that were probably previously weakened. And not to mention how potent antibiotics are based on sulfur. Many unstudied things.
My most heroic combination in the psychiatric class was 20mg Prozac 5mg Zyprexa 300mg Adrafanil combination. A few decent highly productive years, though looking back I can see I was in a dazed dreamland the whole time before it all pooped out.
I think my case is not as unusual as people would at first glance think it is. Psychiatry is so limited in its view and scope. It basically ignores that the head is attached to a body, and that whatever goes on in that body directly impacts the head. And that if there isn't a so-called "proven" way to test for this or that, then it doesn't exist. Or if the doctor isn't familiar with it, then it doesn't exist. Never mind that they have not even a clue how to test for the things they attempt to treat.
Once in a while, as with Ace and Nardil, someone hits a jackpot. In clinical trials, that jackpot is what, maybe 12% of the entire study group? Kind of like Las Vegas, it takes the eyes off the big picture and lures one into a narrow focus at the gambling table right in front of them.
Anyway, for what it is worth, there are thousands of stories around the country of people's magical heroic combinations to end their psychiatric misery being herbs or meds that had nothing to do with psychiatry.
In reading this for errors before posting I notice it appears anti-psychiatry. It is not. It is merely to educate others that psychiatry is only a small piece of a larger puzzle, and that maybe just maybe too many people grasp that small piece with all their might while the whole puzzle remains in shambles the whole time.
Posted by jasmineneroli on September 27, 2009, at 21:56:27
In reply to Heroic combos, posted by X-ray on September 26, 2009, at 13:19:02
> Hi,
>
> I have been looking for a drug to use in combination with Wellbutrin.
>
> From Essential Psychopharmacology by Stahl:
>
> Heroic combo 8:
> Mirtazapine+bupropion
>
> NE is double-boosted
> 5HT and DA are single-boosted
>
> Can anyone explain what this means?
>
> Best regards,
> X-ray
>
> P.S. The point is to use safe and rational drug combinations
> that exploit expected pharmacological and molecular synergies
> while even promoting mutual tolerabilities.
> (Heroic combos, Stahl)I'm guessing they mean that since both mirtazapine & bupropion boost NE (norepinephrine), Combo 8 "double boosts NE".
And since only bupropion affects DA (dopamine), and only mirtazapine boosts 5HT(serotonin), the Combo "single boosts DA and 5HT"
Sometimes, Wellbutrin can make people anxious and have insomnia. Sometimes Remeron can cause excess drowsiness, and a contented apathy. The suggested Combo 8 might balance their individual effects well.
Hope that helps a bit.
I've never heard of that book/publication. Sounds really interesting. Thx for mentioning it.
Be well.
J
Posted by X-ray on September 29, 2009, at 7:37:06
In reply to Re: Heroic combos, posted by jasmineneroli on September 27, 2009, at 21:56:27
Thanks for your reply!
You have given a good explanation that I can understand.
So mirtazapine and bupropion will be my next combo.
If this combination doesn't work, my options are bupropion+trazodone or bupropion+quetiapine.
I'm as excited as a child on Christmas morning about this.
Best regards,
X-ray
Posted by jasmineneroli on October 2, 2009, at 14:39:43
In reply to Re: Heroic combos, posted by X-ray on September 29, 2009, at 7:37:06
> Thanks for your reply!
>
> You have given a good explanation that I can understand.
>
> So mirtazapine and bupropion will be my next combo.
>
> If this combination doesn't work, my options are bupropion+trazodone or bupropion+quetiapine.
>
> I'm as excited as a child on Christmas morning about this.
>
> Best regards,
> X-ray* I hope that works for you. I found Remeron far too sedating (at any dose), but I was taking it alone. I've just started taking Seroquel (now up to 150mg) which is much too sedating also (am taking with Neurontin). So I'm going to try 100mg.
It's such a balancing act isn't it??
Best of luck to you.
J
Posted by X-ray on October 2, 2009, at 20:28:53
In reply to Re: Heroic combos » X-ray, posted by jasmineneroli on October 2, 2009, at 14:39:43
Hi,
Unfortunately, I have bad news.
I took 30 mg of Remeron at nine o'clock.I didn't fall asleep.
So I took another 30 mg at eleven o'clock.The time is now 0300 hours in Sweden where I live.
And I haven't slept a minute yet.I have a tootache, but I should have fallen asleep anyway.
Now I guess that I can forget about mirtazapine+bupropion.I will not sleep on this combo since bupropion is activating.
I'm anxious to try bupropion, but I'm going to need a drug for sleep.I have read a lot about Seroquel.
This drug is number eight on the "Top 200 List" in the U.S.I know a lot of people take Seroquel for sleep.
My next combo will be 150 mg Wellbutrin XL+100 mg Seroquel+40 mg Buspar.I'm struggling for a better life.
Yes, it's really a balancing act.Best regards,
X-ray
Posted by Justherself54 on October 2, 2009, at 21:30:12
In reply to Re: Heroic combos, posted by X-ray on October 2, 2009, at 20:28:53
Low dose seroquel should make you sleep. Good luck..I hope it works well for you..
Posted by jasmineneroli on October 2, 2009, at 22:29:32
In reply to Re: Heroic combos, posted by X-ray on October 2, 2009, at 20:28:53
> I will not sleep on this combo since bupropion is activating.
> I'm anxious to try bupropion, but I'm going to need a drug for sleep.*Did you start the Wellbutrin yet? It might be too activating for you.
> I have read a lot about Seroquel.
> This drug is number eight on the "Top 200 List" in the U.S.* I found Seroquel didn't get sedating until at 100mg, but some people seem to get sleep at as low as 25mg.
> I know a lot of people take Seroquel for sleep.> My next combo will be 150 mg Wellbutrin XL+100 mg Seroquel+40 mg Buspar.
* Worth a try, I guess.
I wonder if you have a parodoxical response to drugs that affect Histamine 1 receptor? Both Remeron & Seroquel effect Histamine 1.
> I'm struggling for a better life.
* Oh, I so know what you mean!Best wishes
J
Posted by X-ray on October 3, 2009, at 2:13:42
In reply to Re: Heroic combos, posted by jasmineneroli on October 2, 2009, at 22:29:32
Hi J,
I've been planning to start with Wellbutrin on Wednesday,
since I have an appointment with my dentist on Tuesday.I'm hoping that Wellbutrin will lift my mood.
This drug is supposed to be good for anhedonia.But sleep has always been my main problem.
I have been on Remeron a couple of times in the past.Remeron and Buspar is not a perfect combination for me.
Perhaps I need another anti-anxiety agent.I have tried Remeron and Fluanxol.
This combo was better for sleep than Remeron/Buspar.I've been on Seroquel one night, but I took only 25 mg.
Of course, that was too small a dosage.It's too early to give up on trazodone,
since I've only been on this drug for two nights.I'm desperate for something new,
but I'm groping in the dark.Best regards,
X-ray
Posted by jasmineneroli on October 3, 2009, at 21:20:29
In reply to Re: Heroic combos, J, posted by X-ray on October 3, 2009, at 2:13:42
> I'm hoping that Wellbutrin will lift my mood.
> This drug is supposed to be good for anhedonia.
>
> But sleep has always been my main problem.
> I have been on Remeron a couple of times in the past.* What is your diagnosis? GAD with depression?
I have had chronic insomnia for about 9 years. Some doctors believe GAD caused my sleeplessness, some say depression, and they say you should treat those first. I'm still waiting for that to work!
Have you tried taking standard sleep meds? Some simply didn't work for me at any dose. Ambien CR at 12.5mg sends me to sleep, but doesn't keep me asleep. Have you tried it?> I've been on Seroquel one night, but I took only 25 mg.
> Of course, that was too small a dosage.
* You could try 75mg to 100mg> It's too early to give up on trazodone,
> since I've only been on this drug for two nights.* I've never tried trazodone, but hear good things about it. Amitriptyline did nothing for me.
> I'm desperate for something new,
> but I'm groping in the dark.* I understand how that desperation for sleep is, so exhausting. I ended up in my doctors office years ago, begging for sleeping pills in the end, so I could function at work. Now my problem is feeling sedated in the daytime from Seroquel, LOL!
Keep on trying!
J
Posted by X-ray on October 4, 2009, at 6:28:19
In reply to Re: Heroic combos, J, posted by jasmineneroli on October 3, 2009, at 21:20:29
Hi J,
I've had a rough week, but now I'm on the right track again.
I have personality disorders. You name it, I've got it!
I've tried Ambien CR, but I need a more potent drug.
I've been on flunitrazepam two nights the last week,
but this drug is not right for me.I would like to try Wellbutrin XL,
but I also need a drug for sleep.From Essential psychopharmacology: the prescriber's guide
(Stephen M. Stahl, Meghan M. Grady)Bupropion
Best Augmenting Combos
for residual insomnia: trazodoneSo I'll give this drug a shot!
Keep on smiling,
X-ray
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