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Re: Remeron + Wellbutrin - Remeron + Neurontin = ?

Posted by SLS on October 20, 2000, at 21:49:14

In reply to Remeron + Wellbutrin - Remeron + Neurontin = ?, posted by allisonm on October 20, 2000, at 19:33:09

Hi Allison.

First, I have a question. What is the Harvard algorithm and where can I find it on the Internet?


I recall seeing one algorithm (NIMH?) that said to change mood stabilizers and then go through another sequence of antidepressant trials. This, however is not going back to the beginning. There are far too many permutations of drug combinations to try before you could possibly get to the point of having to start all over again. If you doubt this, make believe you are going to get well on a combination of three different drugs. Figure you have 20 to work with (there are at least twice this). Sit down and figure out how many combinations are possible before you would have to go back and and start over again.

* Does anyone know how to calculate the number of possible permutations of a three drug combination using 20 drugs?

Are you going to stop Remeron to add the Neurontin?

To me, logic suggests that you not subtract the Remeron to make room for the Neurontin. I have never heard of a problem using them in combination. Perhaps Remeron is helping. Even more - maybe the Neurontin needs the Remeron to work! If magic happens after establishing the Neurontin dosage (600mg-2400mg), you may then try to discontinue the Remeron to see if you need it.

The other thing that occurs to me is that it is not necessary to discontinue Wellbutrin before beginning an MAOI. They can actually work well together when neither by itself is adequate. I have tried Parnate + Wellbutrin twice. The "recommended" order of establishing such a combination is to add the MAOI second, so you are currently in the ideal position to do so. As far as Remeron is concerned, I wish I knew one way or the other whether it is compatible with an MAOI. I don't recall bumping into anyone who has tried this, but that doesn't mean that it is not safe. Off hand, I cannot think of any reason why such a combination would represent any more of a risk than someone who takes an MAOI with trazodone, a tricyclic, and yohimbine - all of which have been done here on Psycho-Babble. Only theoretical.

Given that you now feel that Wellbutrin is the major contributor to your partial, although inadequate, improvement, I would press your doctor to research the clinical use of Wellbutrin in combination with MAOIs. Perhaps you don't have to go through two weeks of pure hell - only a watered-down version of it.

Out of curiosity, have you ever tried Serzone or Risperdal?

I'm sorry that things are so difficult for you. I don't think it is reasonable to look at an MAOI as being the last card in the deck to be played. I think that an MAOI is a reasonable choice at this point, but I'm sure there are others. Here's one: Tofranil (imipramine) + lithium (300-600mg) + thyroid. Or how about adding all of those to everything you are currently taking. I doubt you have tried that yet. I haven't. It is a reasonable combination, though. Notice, no SRIs.

You'll get there.

- Scott

P.S. I am tickled that you enjoyed my webpage. :-) Yes, it is a gargoyle.

> Maybe this is a rant, or if not a rant, then a vent, or just an open question that isn't necessarily asking for an answer.
> I've been on Remeron for about 2.5 years for major depression, single episode, moderate. It didn't work well enough by itself, so Li was added and then subtracted 6 months later. Then Wellbutrin was added almost a year and a half ago to augment, and over time became the primary AD, while Remeron became the augmentor. I have tried Effexor and Zoloft with results scarier than Scott's Halloween web page monsters with the bugging-out eyes (very nice, Scott, I especially like the one with wings - a gargoyle? It reminds me of someone I work with.)
> Anyway, I am currently on 400mg Well, was on 15mg Rem until yesterday when my doctor brought up -- what seemed out of the blue at the time -- the idea of changing the augmentor from Rem to Neurontin. No drug combo has worked completely, but the Well/Rem was the best so far. But now I can see where things have not been going so well lately. I thought that maybe it was pressure at work (there has been a lot) but I have noticed that I am much more anxious and sensitive to good/bad things and they affect my mood quite a lot. I hate the unpredictibility. So onto Neurontin - starting at 100mg and working up to 300 over 3 days. It was either that or a 2-week washout and an MAOI, which kinda scares me.
> All of this was sort of OK yesterday when it happened, but thinking more about it, it is starting to bother me. I suppose I have been expecting this deep down. I have this bad feeling that the Neurontin won't do the trick either and I'll have to go to an MAOI. I know I am jumping the gun, but nothing has worked completely -- or to my doctor's and my satisfaction. Looking back, I have had a med change about every 6 months for the last couple of years. I know people here take MAOIs and I need to educate myself further on them. As it is, I found more than 1,100 items when I did a PB search on Neurontin - I have not even scratched the surface there and have a lot of reading to do.
> So I'm not going to ask about others' experiences on Neurontin because no doubt I'll find them in the searched posts. It is just so frustrating, though, to keep changing and changing and never finding the really right combo. I ranted similarly here last spring when my Wellbutrin got upped to 400 and the Remeron reduced from 30 to 15.
> Is this refractory depression? How long do you have to be depressed to be refractory? If the Neurontin doesn't cut it, and I move to an MAOI, how hellish are those two weeks going to be (not to mention waiting for the therapeutic effects)? I am beginning to fear for my job, or maybe it's just the current drug combo failure that's affecting my thoughts on this. I don't know anymore.
> I do know that I am crossing bridges, but what if the MAOI doesn't work? Nothing else has so far. Then what? I think the Harvard algorithm, which mirrors my doctor's tack, says something to the effect of: if the MAOI doesn't work, start at the beginning again. I wonder if I can stand this that long.
> I am not suicidal. I have felt pretty good, considering, or about as good as I've ever felt in the last 3 years, up until recently. The Wellbutrin seems to help. I am just so tired of this hit-and-miss, feeling sort of better, or kind of better but not entirely, even though I think my doctor is on the right track -- at least in recognizing when things aren't working anymore (if they ever did). One other thing -- I have had a wicked sinus headache ALL DAY today. Is this from the absence of the histimine action of the Remeron?
> This stinks and I'm tired, damn it. I feel like I'm never going to get fixed.




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