Posted by JohnL on October 29, 1999, at 3:19:22
In reply to Re: ENERGY, to JohnL, posted by Carol on October 28, 1999, at 7:37:33
Hi Carol. AAhhh yesss. Good answers. That makes the picture more clear. No clear answers though. But some ideas to think about.
If the Ritalin didn't do it, then I agree with you that nothing in a health store will. One thing to keep in mind with stimulants though is that if one doesn't work well, another likely will. There are a couple others that could be tried. So the prescrip stimulant approach is not exhuasted yet. Since ritalin did work at higher than normal doses, that's a good clue you were on the right track.
Concerning Wellbutrin, it's very encouraging you are at 400mg. Some comments on Wellbutrin. These are based on the "Collected Writings of Ivan Goldberg" (easily found with a search if you want to check it out). He's a noted psychiatrist that my own pdoc speaks very highly of. Goldberg pushes Wellbutrin in the 450mg to 600mg range. Unless you are predisposed to seizure risk, my pdoc confirms from his experience that the seizure risk is overblown. Ivan goldberg says Wellbutrin takes at least 8 weeks at 400mg or higher for a fair trial. And that if it hasn't been 400mg or higher for 8 weeks it has not been a good trial. Just to provide a little perspective on the med you are currently using. With you doc's OK, there is a ceiling higher than the current 400mg.
Since you've tried a TCA already (Elavil), there is another you may want to look at if needed. You would want to keep the Wellbutrin at the 400mg level if combined with another med because the combination increases seizure risk. But with or without Wellbutrin, the TCA Vivactil (Protriptyline) is known for being stimulating. It is even warned on the label not to dose late in the afternoon due to difficulty sleeping if dosed too late in the day. I have also read in some case reports where Wellbutrin+TCA was used successfully on refractory depression that didn't respond to other combinations.
So, some possibilities to ponder.... Higher dose Wellbutrin. Wellbutrin+Vivactil. Vivactil. Wellbutrin+different stimulant. Different stimulant. Vivactil+different stimulant. T3/T4 (thyroid) with any of the meds or combos of meds. And in the overseas arena, Reboxetine, Amineptine, Amisulpride. So, just when you thought it was near the end of the line, there are lots of other options in my opinion. The Wellbutrin alone might well do it though. Give it that full 8 weeks at the highest dose your doc will allow and make an evaluation then. In the meantime, lots of approaches to ponder. I sure feel for you and want something to work. Hope these ideas might help. There are others I haven't thought about, I'm sure. Lots of knowledgable people here with good ideas likely better than the ones I've thought of. I'm sure there are other things I haven't thought of yet. :)
poster:JohnL
thread:14028
URL: http://www.dr-bob.org/babble/19991028/msgs/14125.html