Posted by SLS on January 3, 2007, at 8:46:23
In reply to Re: Has anyone here had a remssion for long? » SLS, posted by tensor on January 3, 2007, at 7:28:03
> Hi Scott,
>
> >Have you been up to 200mg with the Zoloft?
>
> >Have you tried Effexor in place of Zoloft in the combination? On paper, it should be a potent combination. Wellbutrin + Effexor is often more effective than either drug alone, and Remeron + Effexor is the noted "California Rocket Fuel" combination advocated by Stephen Stahl, MD. You might want to try working up to 300mg with the Effexor. Zoloft wasnt' a bad choice, though.
>
> High doses of Zoloft gives me akathisia, and effexor gave me horrible s/e. However, last night I took 15mg of Remeron to induce sleep + a hypnotic, it worked. More interestingly, I woke up this morning without being nauseous and without abdominal pain and not as shaky as I usually do. I wonder if this is indicating that Remeron + Wellbutrin would be a better choice than Wellbutrin + Zoloft. What do you think?
>
> I really don't like doing any changes this early in a trial(two weeks on Wellbutrin), but if the difference is the big I wonder if it could be clever anyway. I have a speical realtionship with remeron, though it has failed me many times, it still going strong when it does work.
>
> I have a book with Stephen M. Stahl, MD which I like a lot, he's also saying that Zoloft+Wellbutrin is used with success under the name "Well-loft".
>
> /Mattias
The Wellbutrin + Remeron combination is rather novel, and I would definitely not skip over it given the positive hints it has given you. I've tried the Well-oft combination, and received a short antidepressant effect. However, when we teased out the components in my regimen, it seems likely that it was Lamictal + Wellbutrin that was most contributory. My doctor has had quite a bit of success with the Lamictal + Wellbutrin combination, although I have seen a few people get a little manic and others get agitated on it. It is difficult for me to say whether or not these are self-limiting effects because these people discontinued the medication once they appeared. In my case, if mania were to appear, I wouldn't hesitate to add Zyprexa temporarily to see if it would squash the reaction. I would then attempt to remove it after a period of a month or two. I believe Lamictal is secondarily pro-dopaminergic via glutamate release inhibition, and might act synergistically with Wellbutrin to produce activated and perhaps less anhedonic states.If you have the patience, you might want to consider adding Lamictal before abandoning Wellbutrin.
I would be most interested to see how Remeron + Wellbutrin works out for you. There are quite a few mechanisms involved. It is suspected that the predominant final outcome of Wellbutrin is pro-noradrenergic, probably through mechanisms other than reuptake inhibition. This might be amplified by the NE alpha-2 antagonist properties of Remeron.
What has been your experience with tricyclics and MAOIs?
It is likely that the 5-HT3 antagonist property of Remeron acts as an antiemetic to reduce nausea. It's good that you are so tuned-in to your mind-body to recognize such things.
Hopefully, you can begin to sort all of this out. I am eager to see you benefit from either Wellbutrin + Remeron or perhaps Wellbutrin + Lamictal.
Good luck.
- Scott
poster:SLS
thread:718547
URL: http://www.dr-bob.org/babble/20070101/msgs/718828.html