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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 smith562 on March 11, 2005, at 6:13:54
Hey Mitch/Everyone,
Still feeling about 75% with my combo of zoloft 100, klonopin 1, lithium 450, wellbutrin 100 (for my panic/atypical depression with family history of BP II). I have been have problems with motivation (getting to work on time) and social phobia (not leaving the apartment or socializing ... apathy??). How do you go about adjusting your meds to correct your mood? For example, for my apathy/low motivation/phobia I could 1)lower zoloft for 4 weeks 2)increase wellbutrin for 4 weeks 3) lower lithium for 4 weeks. The problem you see is it might take *12* weeks to feel better! Or can I change several meds at the same time?
Thanks,
Smith
Posted by Ritch on March 11, 2005, at 10:37:49
In reply to Mitch/Everyone: Adjusting Meds, posted by smith562 on March 11, 2005, at 6:13:54
> Hey Mitch/Everyone,
>
> Still feeling about 75% with my combo of zoloft 100, klonopin 1, lithium 450, wellbutrin 100 (for my panic/atypical depression with family history of BP II). I have been have problems with motivation (getting to work on time) and social phobia (not leaving the apartment or socializing ... apathy??). How do you go about adjusting your meds to correct your mood? For example, for my apathy/low motivation/phobia I could 1)lower zoloft for 4 weeks 2)increase wellbutrin for 4 weeks 3) lower lithium for 4 weeks. The problem you see is it might take *12* weeks to feel better! Or can I change several meds at the same time?
>
> Thanks,
>
> SmithI think the WB is aggravating your anxiety.. just a suspicion. I get panic and WB definitely made it worse, and I also became avoidant of things I normally didn't avoid. Yep, it's great for motivation.. but maybe it would be better to find a motivating *replacement* for the WB that doesn't aggravate anxiety? I would tinker with one med at a time... otherwise it will be really tough to figure out what's causing what... been there done that a few dozen times... I would eye an alternative for the WB. B4 you do that.. you might experiment with *stopping* the WB for a day or two and see if you feel better anxiety-wise straight away.. if so, that is the likely culprit.
Posted by smith562 on March 11, 2005, at 16:28:27
In reply to Re: Mitch/Everyone: Adjusting Meds » smith562, posted by Ritch on March 11, 2005, at 10:37:49
> I think the WB is aggravating your anxiety.. just a suspicion. I get panic and WB definitely made it worse, and I also became avoidant of things I normally didn't avoid. Yep, it's great for motivation.. but maybe it would be better to find a motivating *replacement* for the WB that doesn't aggravate anxiety? I would tinker with one med at a time... otherwise it will be really tough to figure out what's causing what... been there done that a few dozen times... I would eye an alternative for the WB. B4 you do that.. you might experiment with *stopping* the WB for a day or two and see if you feel better anxiety-wise straight away.. if so, that is the likely culprit.
Hey Mitch,Thanks for the advice. Wellbutrin is a stranger drug, I have read your response and have had the same reaction. Works well the first couple of days, then anxiety builts up.
Any recommendations for motivation (I know you mentioned pamelor previously)? Stimulant, Provigil, Tyrosine, Desipramine, Lamictal ?????
Thanks,
Smith
PS I am trying to find something similar to nardil (nardil is great, but caused obesity-insomnia-memory loss-sexual disfunction)
Posted by Phillipa on March 11, 2005, at 17:25:04
In reply to Stimulant, Provigil, Tyrosine, Desipramine ?????? » Ritch, posted by smith562 on March 11, 2005, at 16:28:27
Do you find zoloft stimulating, sedative, or neutral? I'm trying to decide if I should up my dose. Thanks Phillipa
Posted by smith562 on March 11, 2005, at 18:29:28
In reply to Re: Stimulant, Provigil, Tyrosine, Desipramine ??????, posted by Phillipa on March 11, 2005, at 17:25:04
> Do you find zoloft stimulating, sedative, or neutral? I'm trying to decide if I should up my dose. Thanks Phillipa
I found zoloft to be stimulating up to 75 mgs ... helped me get out of bed and smile to people. Over 100 mgs and I get very "blah" ... apathetic and experience that "akithesia" stuff ... inner restlessness.
Smith
Posted by Phillipa on March 11, 2005, at 18:56:16
In reply to Re: Stimulant, Provigil, Tyrosine, Desipramine ?????? » Phillipa, posted by smith562 on March 11, 2005, at 18:29:28
I think I'll go up to 50mg. For how long do you think I should stay there? Fondly, Phillipa
Posted by Ritch on March 12, 2005, at 12:09:24
In reply to Stimulant, Provigil, Tyrosine, Desipramine ?????? » Ritch, posted by smith562 on March 11, 2005, at 16:28:27
> > I think the WB is aggravating your anxiety.. just a suspicion. I get panic and WB definitely made it worse, and I also became avoidant of things I normally didn't avoid. Yep, it's great for motivation.. but maybe it would be better to find a motivating *replacement* for the WB that doesn't aggravate anxiety? I would tinker with one med at a time... otherwise it will be really tough to figure out what's causing what... been there done that a few dozen times... I would eye an alternative for the WB. B4 you do that.. you might experiment with *stopping* the WB for a day or two and see if you feel better anxiety-wise straight away.. if so, that is the likely culprit.
>
>
> Hey Mitch,
>
> Thanks for the advice. Wellbutrin is a stranger drug, I have read your response and have had the same reaction. Works well the first couple of days, then anxiety builts up.
>
> Any recommendations for motivation (I know you mentioned pamelor previously)? Stimulant, Provigil, Tyrosine, Desipramine, Lamictal ?????
>
> Thanks,
>
> Smith
>
> PS I am trying to find something similar to nardil (nardil is great, but caused obesity-insomnia-memory loss-sexual disfunction)I would consider changing the WB > nortriptyline (Pamelor). A few years back I was on WB + Effexor (for AD's-with Depakote and clonazepam). I called it "Depaklonoeffexobutrin" and overall it was pretty potent combo for bipolar depression. However, I was still having really bad residual anxiety at times from the WB. I added 10mg of nortriptyline here and there during that time and got VERY good relief from the anxiety. I've also tried nort+Zoloft (which also worked pretty good), and nort+Celexa (not as good, blah). If you go the nortiptyline route, just take 10mg for a couple of weeks (the Zoloft will increase its blood level somewhat) and see what happens. It helped my ADD sx rather well. The anticholinergic effects.. really bad dry mouth.. is what made me not like it.. but on the plus side.. NO orthostatic hypotension.
Posted by ed_uk on March 12, 2005, at 14:58:17
In reply to Re: Stimulant, Provigil, Tyrosine, Desipramine ?????? » Phillipa, posted by smith562 on March 11, 2005, at 18:29:28
Hello!
>I found zoloft to be stimulating up to 75 mgs ... helped me get out of bed and smile to people. Over 100 mgs and I get very "blah" ... apathetic and experience that "akithesia" stuff ... inner restlessness.
Perhaps you could decrease the Zoloft down to 75mg. What do you think?
Ed.
Posted by smith562 on March 12, 2005, at 18:06:05
In reply to Re: Stimulant, Provigil, Tyrosine, Desipramine ?????? » smith562, posted by Ritch on March 12, 2005, at 12:09:24
> I would consider changing the WB > nortriptyline (Pamelor). A few years back I was on WB + Effexor (for AD's-with Depakote and clonazepam). I called it "Depaklonoeffexobutrin" and overall it was pretty potent combo for bipolar depression. However, I was still having really bad residual anxiety at times from the WB. I added 10mg of nortriptyline here and there during that time and got VERY good relief from the anxiety. I've also tried nort+Zoloft (which also worked pretty good), and nort+Celexa (not as good, blah). If you go the nortiptyline route, just take 10mg for a couple of weeks (the Zoloft will increase its blood level somewhat) and see what happens. It helped my ADD sx rather well. The anticholinergic effects.. really bad dry mouth.. is what made me not like it.. but on the plus side.. NO orthostatic hypotension.
I am fairly certain adding pamelor would help. I was on imipramine/lithium/klonopin for a year with good results. I really hate to sound like a whiner .... I usually don't complain about side effects .... I have been on "dirty drugs" for years and very few side effects will stop me from taking a med if relieve my deading depression/anxiety. The thing I am scaried of with pamelor is the cognitive problems ... my work requires an intact cognition .... peoples lives depend upon it. Lithium and klonopin already cause some mild cognitive problems ... but add in a tricyclic and even simple mathmatics can be difficult.
You know of anything without the cognitive problems of pamelor?
Thanks
Smith
Posted by smith562 on March 12, 2005, at 18:11:44
In reply to Re: Stimulant, Provigil, Tyrosine, Desipramine ?????? » smith562, posted by ed_uk on March 12, 2005, at 14:58:17
> Perhaps you could decrease the Zoloft down to 75mg. What do you think?
>
> Ed.Hey Ed ... I actually was on 75 mgs for a few months before increasing to 100 mgs 3 weeks ago. I am not sure which dose was more benifical. I think at 100 mgs I have less anxiety ... but I am basically more apathetic to everything .... friends, work, family. SSRIs are so tricky!
Thanks for the advice. I might go back to 75mgs of zoloft and try to switch wellbutrin to something activating without the anxiety (any suggestions ???? I was thinking low dose selegiline).
Thanks again
Smith
Posted by ed_uk on March 12, 2005, at 18:17:54
In reply to Re: Zoloft reduction » ed_uk, posted by smith562 on March 12, 2005, at 18:11:44
Hi Smith!
>try to switch wellbutrin to something activating without the anxiety (any suggestions ???? I was thinking low dose selegiline).
Selegiline often causes anxiety, I'd suggest desipramine. It doesn't generally cause cognitive problems, which I see you are worried about.
Regards,
Ed.
Posted by smith562 on March 12, 2005, at 18:24:09
In reply to Re: Zoloft reduction » smith562, posted by ed_uk on March 12, 2005, at 18:17:54
> Selegiline often causes anxiety, I'd suggest desipramine. It doesn't generally cause cognitive problems, which I see you are worried about.
>
> Regards,
> Ed.I had tried desipramine with increased anxiety and mild cognitive problems. I think I need something with dopamine and norepinephrine. Mirapex help alot with the anhedonia but did not help with energy/motivation. Maybe I should go with ...
zoloft
lithium
klonopin
some norepinephrine med like reboxitine
mirapexI hate the idea of 5 meds, but I will do it if it means remission of my depression/anxiety.
What do you think?
Thank you,
Smith
Posted by ed_uk on March 12, 2005, at 18:41:58
In reply to Re: Go to *Five* medications » ed_uk, posted by smith562 on March 12, 2005, at 18:24:09
Hi!
I must admit I'm not a great fan of reboxetine, I haven't yet met anyone who's been able to tolerate it. Genito-urinary side effects seem problematic and some people have found that it makes their depression worse.
>Mirapex help alot with the anhedonia but did not help with energy/motivation.
You've tried it before? Why did you discontinue it?
Btw, have you tried Prozac? How did it compare with Zoloft?
Regards,
Ed.
Posted by smith562 on March 12, 2005, at 18:49:01
In reply to Re: Go to *Five* medications » smith562, posted by ed_uk on March 12, 2005, at 18:41:58
> You've tried it before? Why did you discontinue it?
I got a sample with 14 tablets .... Mirapex does exactly what it is purported to do .... activates dopamine and the pleasure centers. So I felt "excited" about things and the apathy abated from the SSRIs. It doesn't help with the energy/motivation problem ... I think that is more norepinephrine. Hence, maybe I need *five* meds .... ouch.
Ed, I can't seem to get a consistant answer as too whether wellbutrin/more so it metabolites have signficant dopamine uptake properties? Do you know?
Smith
>
> Btw, have you tried Prozac? How did it compare with Zoloft?
>
> Regards,
> Ed.
Posted by ed_uk on March 13, 2005, at 10:22:51
In reply to Re: Go to *Five* medications » ed_uk, posted by smith562 on March 12, 2005, at 18:49:01
Hi!
>Hence, maybe I need *five* meds .... ouch.
Maybe you do!
>Ed, I can't seem to get a consistant answer as too whether wellbutrin/more so it metabolites have signficant dopamine uptake properties? Do you know?
Wellbutrin and it's metabolites are only very weak dopamine reuptake inhibitors, possibly too weak to be significant. Wellbutrin may affect dopamine neurotransmission by another mechanism though.
Ed.
Posted by Ritch on March 13, 2005, at 12:44:13
In reply to Re: PameKlonoLithiLoft=Can't Think/Remember » Ritch, posted by smith562 on March 12, 2005, at 18:06:05
> > I would consider changing the WB > nortriptyline (Pamelor). A few years back I was on WB + Effexor (for AD's-with Depakote and clonazepam). I called it "Depaklonoeffexobutrin" and overall it was pretty potent combo for bipolar depression. However, I was still having really bad residual anxiety at times from the WB. I added 10mg of nortriptyline here and there during that time and got VERY good relief from the anxiety. I've also tried nort+Zoloft (which also worked pretty good), and nort+Celexa (not as good, blah). If you go the nortiptyline route, just take 10mg for a couple of weeks (the Zoloft will increase its blood level somewhat) and see what happens. It helped my ADD sx rather well. The anticholinergic effects.. really bad dry mouth.. is what made me not like it.. but on the plus side.. NO orthostatic hypotension.
>
> I am fairly certain adding pamelor would help. I was on imipramine/lithium/klonopin for a year with good results. I really hate to sound like a whiner .... I usually don't complain about side effects .... I have been on "dirty drugs" for years and very few side effects will stop me from taking a med if relieve my deading depression/anxiety. The thing I am scaried of with pamelor is the cognitive problems ... my work requires an intact cognition .... peoples lives depend upon it. Lithium and klonopin already cause some mild cognitive problems ... but add in a tricyclic and even simple mathmatics can be difficult.
>
> You know of anything without the cognitive problems of pamelor?
>
> Thanks
>
> Smith
I've tried imipramine, desipramine, doxepin, amitriptyline, and nortriptyline of the TCAs, and desipramine and nortriptyline were the least *fuzzy* of the TCA's. In fact, after a couple of weeks of taking them, things got sharper. If you haven't tried Pamelor, you might find it quite different than imipramine. That said, have you tried Stratterra or Reboxetine? I'm trying to think an NE reuptake inhibitor that doesn't have antihistamine effects. Another possibility is switching the Zoloft to Prozac. Prozac was the only SSRI that seemed to improve my focus.
Posted by ed_uk on March 13, 2005, at 13:04:33
In reply to Re: PameKlonoLithiLoft=Can't Think/Remember » smith562, posted by Ritch on March 13, 2005, at 12:44:13
Hello!
Is Mitch your real name? Or is it Ritch? I think it's Mitch.
Just curious, hope you don't mind me asking :-)
Best regards,
Ed.
Posted by Ritch on March 13, 2005, at 17:41:01
In reply to Re: PameKlonoLithiLoft=Can't Think/Remember » Ritch, posted by ed_uk on March 13, 2005, at 13:04:33
> Hello!
>
> Is Mitch your real name? Or is it Ritch? I think it's Mitch.
>
> Just curious, hope you don't mind me asking :-)
>
> Best regards,
> Ed.
Hi Ed, it's Mitch. I had to re-register due to computer crash a long time ago..
Posted by TamaraJ on March 13, 2005, at 18:30:06
In reply to Re: Stimulant, Provigil, Tyrosine, Desipramine ?????? » smith562, posted by Ritch on March 12, 2005, at 12:09:24
> and nort+Celexa (not as good, blah).
Eeks! I am currently taking 25mg of nort plus 20mg of celexa. If you don't mind my asking, would you tell me what problems you experienced on the nort/celexa combo? I don't seem to be having any problems, but if I were to make a change in SSRIs, what would you recommend to replace the Celexa?
Thanks.
Tamara
Posted by Ritch on March 14, 2005, at 9:36:36
In reply to Re: Stimulant, Provigil, Tyrosine, Desipramine ?????? » Ritch, posted by TamaraJ on March 13, 2005, at 18:30:06
> > and nort+Celexa (not as good, blah).
>
> Eeks! I am currently taking 25mg of nort plus 20mg of celexa. If you don't mind my asking, would you tell me what problems you experienced on the nort/celexa combo? I don't seem to be having any problems, but if I were to make a change in SSRIs, what would you recommend to replace the Celexa?
>
> Thanks.
>
> TamaraTamara, that was just a personal anecdotal thing-don't read too much into it-YMWV. I'm taking a microdose of Celexa right now for anxiety. When I was making a comparison.. I was doing it between two different *combinations*, both including nortriptyline. I *respond* much better to Zoloft than I do Celexa, but Zoloft is very tough on my GI tract (worse than nearly anything), so Celexa is just a '2nd best' that's a lot more *tolerable* for me. I combined nortriptyline with the Zoloft originally, to try to treat the IBS effects of the Zoloft.. it worked somewhat well, but not as well as I hoped. Celexa is generally quite a bit more sedative than Zoloft for me.. and while this is ok for anxiety, it doesn't have as good an effect on my bipolar depression (which needs something activating), that's where the "blah" statement came from. If you're not having any problems, I would consider yourself lucky! Please take anything I say with a large grain of salt, but it is based on personal anecdotal experiences.. I wouldn't change something that works based on what I say..
This is the end of the thread.
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