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Remeron+Wellbutrin-Remeron+Neurontin=? SLS

Posted by allisonm on October 21, 2000, at 5:43:32

In reply to Re: Remeron + Wellbutrin - Remeron + Neurontin = ?, posted by SLS on October 20, 2000, at 21:49:14

Scott,

Thanks for your reply. The Harvard Algorithm is located at: http://www.mhc.com/Algorithms/
(It's also on Dr. Bob's links page if you lose the address.) There's a Texas algorithm on the links page too, but I like the Harvard one. Go to the depression algorithm. I'd be interested to know what you think of it. There also is an algorithm on anxiety and one on schizophrenia there.

I know a lot of people here are taking 3,4,5 drugs at a time. Sometimes I wonder how they can keep track of them all. Other times I wonder how they know whether they all are contributing and how. I've been on two at the most, and my doctor seems not to want to go higher than that. That surprised me a little but I have not argued, either, because although I am getting used to the idea that I am going to have to take drugs probably for the rest of my life, I hate being a slave to them. I take drugs 3 times a day (morning, 3 pm and 9 pm) and am very aware of it -- I am always checking to see what time it is so that I don't forget a dose. I don't especially want to add to it. My doctor said almost cheerfully that I can take the Neurontin when I take the Wellbutrin in the morning and at 3. (Oh, yay! thought I ...not)

My doctor's suggestion was/is to stop the Remeron and start the Neurontin at bedtime, which I've done. He said the Neurontin could help wiith my sleep. Thursday night was OK -- I slept through the night without the Remeron and even had trouble waking up at 6 to get ready for work, but I also was up extra late -- till midnight. Last night I was tired and went to bed at 9:30. Took 200mg Neurontin then, no Remeron. Woke up at 4 and here I am at 6 am Saturday morning writing to you. I see my doctor again on Tuesday. If this keeps up, I'll ask about adding in the Remeron again. I didn't think of your good point that maybe the Neurontin needs the Remeron to work. I'll also ask him about adding an MAOI to the Wellbutrin. Is the MAOI diet as bad as it seems from the outside? I don't eat meat and the thought of losing tempeh, Miso, and especially cheese is pretty depressing right there. Is tahini fermented or is it OK to eat? I couldn't find tahini on the MAOI diet on Dr. Bob's links page. I don't want to give up hummous.

I haven't tried Serzone or Risperdal. I have tried lithium with Remeron and absolutely hated it. I tried a couple of preparations, but each gave me severe diarrhea at the same time every day, not to mention weight gain that I could not take off. At least when I was only on the Remeron, the weight gain seemed to level off. With the Li, it just kept going up no matter how much I exercised or how little I ate. I am just now getting back to the weight I was before Li/Rem, but not yet where I was before I started all of this (granted, weight loss was a symptom of my untreated depression, but I loved that part of it as I have always been a little heavier than I'd like to be.) I really like this Wellbutrin because it kills my appetite; I've lost 15 and am going on 20 lbs. Blood tests have found no thyroid problems.

Thank you for your ideas, support, and encouragement, Scott. They help a lot.

Best wishes,
Allison

PS: I think you're onto something with that Frankenstein web wallpaper... I've been looking at re-wallpapering my bathroom -- something aquatic, maybe with goldfish. But hey, maybe I should reconsider... ;-) Thanks again.


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


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poster:allisonm thread:46914
URL: http://www.dr-bob.org/babble/20001012/msgs/46946.html