Posted by Elizabeth on October 15, 2001, at 10:31:03
Hi everyone.
A friend of mine who has had some troubles has recently embarked on a trial of Klonopin 4mg + Remeron 60mg + Effexor XR 400mg + Wellbutrin SR 300mg + Provigil 400mg. (He was already taking the Klonopin, and he added the others in a stepwise fashion in the order in which I listed them.) It may seem like overkill, but I've been amazed at the change in him -- to the point where I'm considering taking the risk of trying something similar myself (which would involve decreasing or eliminating some of my current cocktail). (I would probably use Cylert instead of Provigil (price concerns, plus I took Cylert before with some success), Trileptal or some other AED instead of Klonopin, and Xanax as-needed for panic attacks.)
Some things make me a little bit pessimistic about this mix for me:
* My friend responded to Remeron by itself (he gave it up because of weight gain), while I did not. OTOH, I had at least some response to Effexor XR, and I don't think that he was helped by Effexor alone.
* I had a major serious reaction (the so-called "serotonin syndrome") that was at least in part due to Effexor XR (there were probably other contributing factors since I'd been taking it for several weeks, although I can never be sure). I've heard that Remeron (due to it's 5-HT antagonist properties) can prevent such a reaction, but I'm not sure whether I should believe this claim. I know Remeron can block some of the side effects of SSRIs and Effexor, but I'm not sure if it would prevent the serotonin syndrome. I might try it using desipramine instead of Effexor, at least to start out. Of course, then I have to worry about pharmacokinetic problems.
* Despite the side effects, the buprenorphine-desipramine combination is doing so well for me that I hesitate to jeopardize my current state of full remission. My hope would be that the CRF+++ would help enough that I could take buprenorphine intermittently, or maybe even discontinue it altogether.
So, does anybody have any ideas or thoughts or whatever? I'm facing a tough choice, here. In partiucular: Dr. Bob, if you have any thoughts on this I'd really like to hear them. (This goes for any other MDs or DOs who might be lurking out there.)
-elizabeth
poster:Elizabeth
thread:81334
URL: http://www.dr-bob.org/babble/20011015/msgs/81334.html