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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 phidippus on September 18, 2012, at 2:18:19
I have recently been having symptoms of depression. Depersonalization, slight anhedonia, negative thoughts and loss of mottivation have been affectine my groove. I need a boost and was thinking of augmenting my current treatment with either Wellbutrin or Nortryptaline. I would love you guy's input.
Current Rx:
Abilify 10 mg
Lithium 1200 mg
Klonopin 1 mg
Viibryd 60 mg
Vyvanse 60 mgEric
Posted by SLS on September 18, 2012, at 8:59:02
In reply to Wellbutrin or Nortryptaline?, posted by phidippus on September 18, 2012, at 2:18:19
> I have recently been having symptoms of depression. Depersonalization, slight anhedonia, negative thoughts and loss of mottivation have been affectine my groove. I need a boost and was thinking of augmenting my current treatment with either Wellbutrin or Nortryptaline. I would love you guy's input.
>
> Current Rx:
>
> Abilify 10 mg
> Lithium 1200 mg
> Klonopin 1 mg
> Viibryd 60 mg
> Vyvanse 60 mg
>
> Eric
You may have to flip a coin. I suppose there are people who can reliably predict which drug will work for you, but I am not one of them.Doesn't 5-HT1a agonism increase dopaminergic activity in the PFC? If so, you might not need the dopamine reuptake inhibition of Wellbutrin. However, it is apparent that SRI + Wellbutrin is effective. For me personally, Wellbutrin makes me feel worse. I had partial success when combining Effexor and nortriptyline. Have you tried to sneak the dosage of Abilify up at all?
If you have been under stress lately, you might see the depressive episode dissipate once the stress is reduced. This includes physical illness.
- Scott
Posted by Phillipa on September 18, 2012, at 11:09:50
In reply to Re: Wellbutrin or Nortryptaline? » phidippus, posted by SLS on September 18, 2012, at 8:59:02
Stress for me at least definitely causes non caring depression I guess. Phillipa
Posted by phidippus on September 18, 2012, at 17:53:10
In reply to Re: Wellbutrin or Nortryptaline? » phidippus, posted by SLS on September 18, 2012, at 8:59:02
>Have you tried to sneak the dosage of Abilify up >at all?
No, but I have been at 20mg before while on Clomipramine. I don't think I experienced much difference at the higher dose.
>Doesn't 5-HT1a agonism increase dopaminergic >activity in the PFC?
It does in rats.
http://ukpmc.ac.uk/abstract/MED/11277607/reload=0;jsessionid=oc6n4YR01gD9ZJinnTdB.4
Eric
Posted by jono_in_adelaide on September 18, 2012, at 18:51:23
In reply to Re: Wellbutrin or Nortryptaline?, posted by Phillipa on September 18, 2012, at 11:09:50
Agree with SLS, both are about equal in effectiveness, so it might be just a matter of trying one and seeing howe you go - if it works, then great, if it isnt what you're looking for, then try the other.
Posted by phidippus on September 18, 2012, at 21:58:04
In reply to Re: Wellbutrin or Nortryptaline?, posted by jono_in_adelaide on September 18, 2012, at 18:51:23
Do you have to have blood draws when taking Nortryptaline?
Eric
Posted by jono_in_adelaide on September 18, 2012, at 22:43:30
In reply to Re: Wellbutrin or Nortryptaline? » jono_in_adelaide, posted by phidippus on September 18, 2012, at 21:58:04
I think the blood tests are only somthing they do if treatment oesnt work - when i was prescribed nortriptyline 75mg at night, the quick and robust response after several failured, proved better than any blood test that I was in "the zone"
Posted by SLS on September 18, 2012, at 23:57:35
In reply to Re: Wellbutrin or Nortryptaline?, posted by jono_in_adelaide on September 18, 2012, at 22:43:30
> I think the blood tests are only somthing they do if treatment oesnt work - when i was prescribed nortriptyline 75mg at night, the quick and robust response after several failured, proved better than any blood test that I was in "the zone"
"Zone" is a good word. I have no proof of this, but I think nortriptyline may have two dosage zones that work based upon CPY2D6 metabolism. The zone for slow metabolizers is at 75 mg/day and that of rapid metabolizers is at 150 mg/day. Dosages in between will fail to work for both slow and rapid metabolizers. This is due primarily because of the therapeutic window that exists for this drug.
- Scott
Posted by bleauberry on September 19, 2012, at 13:54:01
In reply to Wellbutrin or Nortryptaline?, posted by phidippus on September 18, 2012, at 2:18:19
I don't think there is any way to predict what might work. Honestly, just my opinion, the symptoms could be at least partially if not completely from the meds themselves. Wellbutrin might be the more stimulating of the two. I'm not really seeing how either one though is going to accomplish what you want. If it were me, the toss up would be between savella and wellbutrin, but since wellbutrin makes me worse and savella makes me better, I already know the answer.
Posted by phidippus on September 19, 2012, at 22:12:27
In reply to Re: Wellbutrin or Nortryptaline?, posted by bleauberry on September 19, 2012, at 13:54:01
>I'm not really seeing how either one though is >going to accomplish what you want.
I've already got serotogenic compounds on board. I'm hoping some norepenephrine and maybe some dopamine will help with my depressive symptoms, most importantly motivation.
What is Savella?
Eric
Posted by phidippus on September 20, 2012, at 9:00:38
In reply to Re: Wellbutrin or Nortryptaline? » jono_in_adelaide, posted by SLS on September 18, 2012, at 23:57:35
I have to admit I am intimidated by Nortryptaline.
Eric
Posted by phidippus on September 20, 2012, at 9:21:29
In reply to Re: Wellbutrin or Nortryptaline?, posted by jono_in_adelaide on September 18, 2012, at 22:43:30
?How quicly does Nortryptaline work?
Eric
Posted by SLS on September 20, 2012, at 10:02:55
In reply to Re: Wellbutrin or Nortryptaline? » SLS, posted by phidippus on September 20, 2012, at 9:00:38
> I have to admit I am intimidated by Nortryptaline.
It is actually a rather tame drug once you allow the startup side effects to abate. These usually are limited to mild to moderate sedation and anticholinergic side effects. If you have already been on a TCA, these things might not be issues at all.
Is there anything in particular that you are concerned with?
- Scott
Posted by phidippus on September 20, 2012, at 19:24:50
In reply to Re: Wellbutrin or Nortryptaline? » phidippus, posted by SLS on September 20, 2012, at 10:02:55
Blood draws and its therapeutic window.
Alas, I chose Wellbutrin. I'll be starting Bupropion XL 150 mg tonight.
If it doesn't work out, I may turn to nortryptaline.
Eric
Posted by SLS on September 20, 2012, at 22:42:08
In reply to Re: Wellbutrin or Nortryptaline? » SLS, posted by phidippus on September 20, 2012, at 19:24:50
> Blood draws and its therapeutic window.
>
> Alas, I chose Wellbutrin. I'll be starting Bupropion XL 150 mg tonight.
>
> If it doesn't work out, I may turn to nortryptaline.
>
>
> Eric
Good luck.
- Scott
Posted by jono_in_adelaide on September 22, 2012, at 10:23:17
In reply to Re: Wellbutrin or Nortryptaline? » phidippus, posted by SLS on September 20, 2012, at 22:42:08
Good luck!
You'll need to take 300mg per day for 4-6 weeks before you make your decision on bupropion
Either drug will take 2-4 weeks to work in most cases
This is the end of the thread.
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