Posted by Iago Camboa on August 8, 2002, at 3:35:36
In reply to Re: DOPAMINE-AD's -Mischief, posted by BekkaH on August 7, 2002, at 0:35:10
Hi Bekka (and anyone),
Please allow me to kindly disagree with your 'classification' of Effexor (at lower doses!!??) as a serotonin reuptake inhibitor (i.e. another SSDD SSRI, to put things your very way...). As a matter of fact, both at lower & higher doses, both venlafaxine (= Effexor) and its metabolite O-desmethylvenlafaxine are POTENT inhibitors of neuronal serotonine AND NOREPINEPHRINE reuptake and weak inhibitors of dopamine reuptake...
I tried lately Prozac (a true SSRI) and then Effexor and they were to me like night and day. I tried both of them (in succession) to (partially at first) substitute clomipramine/Anafranil, not because the latter was pooping out (it worked just fine) but because I wanted to find other (alternative) effective ADs (to my system, of course...)[ My whole combo was 112.5mg/day clomipramine, 2mg/day Xanax and 300mg/day adrafinil ]
Famous Prozac (that 'stupor mundi'?) at 20mg/day felt to me like 'fog' (or 'noise') added into my brain: I had no single positive effect on that s**t and gave it up after 12 days (no s.e., no stimulation, no sedation, no withdrawal, only fog & fog...). Was it my fault because I had clomipramine and Xanax in my system? Were 12 days of fog just too short an interval for the benefits to kick in? Who knows? To speak the whole truth I should also tell I always have caffeine in my system too, but for me caffein and Xanax don't really matter anything: I just don't feel them anymore long since... No need either to augment or to diminish those two, though I feel they both are doing a positive role in the background and don't find any use or desire in abolishing (or lowering) them... Also adrafinil was not important at this time...
As for Effexor, I did feel its effects in less than two hours after I swallowed 37.5mg of it one beautiful day at 4 pm (a most welcome mild stimulation, a very gentle 'high', no jitters at all and no agitation/anxiety, but a very calm and 'focused' unforgettable positive effect...) Only negative side effect: I could not sleep at all that night (I had at hand almost two full boxes of Ambien/Stilnox (more than 50 pills) but that night I decided to take no hypnotic at all nor any extra amount of Xanax just to assert to myself WHO was in charge... (LOL)).Sorry to have disturbed (your) normal flow of ideas but I thought it could be useful for someone to hear an 'unconventional' way of speaking of two well-known and (for me) so very different ADs: Prozac, a SSRI, and Effexor, a SNRI. (Please forgive me but I just couldn't stand it to see Prozac in the same class of Effexor!!). Thank you for your kind attention,
Iago
> Wellbutrin, which you said you tried, is supposed to have some slight effect on dopamine, but I think it affects norepinephrine much more.
>
> Effexor, at very high doses, supposedly blocks the reuptake of dopamine, and at the lower doses it acts as a serotonin reuptake inhibitor, I believe.
>
> Parnate, a monoamine oxidase inhibitor (MAOI), is one of the most dopaminergic medicines available. If you take an MAOI, you have to be careful not to eat aged or fermented foods, like cheese,etc. Another dopaminergic MAOI is Eldepryl/Selegiline.
>
> Then, there are the psychostimulants, like dexedrine (dextroamphetamine), Adderall (a mixture of amphetamine salts) and Ritalin/Concerta (methylphenidate). Sometimes, in severe, difficult-to-treat depressions, doctors will use stimulants alone, but stimulants are usually more effective over the long term when they are used to "augment" another antidepressant.
>
> In recent years, some doctors are prescribing dopamine agonists, like Mirapex (Pramipexole) to augment other antidepressants. Dopamine agonists like Mirapex are actually used for the treatment of Parkinson's disease, but they are also helpful in some antidepressant combinations.
>
> How is your psychopharmacologist? Is he/she creative and willing to try out some medication combinations? It takes a certain amount of imagination, creativity, time and patience for a doctor to work closely with you to come up with a combo that works for you. Some doctors are too conservative or too scared to try augmentation with psychostimulants. Perhaps some of those meds you've tried are not lost causes. If you could find one that could be combined with something else, like a dopamine agonist or a psychostimulant, perhaps you'd feel better.
>
> There are some other possibilities for antidepressant augmentation that do NOT involve the use of meds that affect dopamine. For example, many patients here have been helped by augmenting their antidepressants with lithium, lamictal/lamotrigine, topamax, thyroid supplementation, among others. Lamictal (lamotrigine) appears to be one of the best meds for antidepressant augmentation; however, the dose must be raised VERY gradually, over many weeks, to avoid some rare, but dangerous, side effects.
>
> Perhaps you can discuss some medication combinations and augmentation strategies with your pdoc on Thursday. I hope your appointment goes well!
poster:Iago Camboa
thread:115489
URL: http://www.dr-bob.org/babble/20020807/msgs/115643.html