Posted by Ron Hill on January 5, 2011, at 1:27:17
In reply to Going Off Parnate...Wellbutrin Poop Out Remedy?, posted by MissThang on December 23, 2010, at 14:30:24
Miss Thang,
Have you ever added a low dose of a stimulant to Wellbutrin? For, example:
Adderal XL
http://pi.shirecontent.com/PI/PDFs/AdderallXR_USA_ENG.PDFDexedine SPANSULE sustain-release capsules
http://www.gsksource.com/gskprm/htdocs/documents/DEXEDRINE-PI-MG.PDFConcerta
http://www.concerta.net/index.htmlProvigil
http://www.provigil.com/media/PDFs/prescribing_info.pdfLamictal is an AED also used as a moodstablizer. It also has an antidepressant effect. Have you ever considered adding Lamictal to wellbutrin and lithium?
http://us.gsk.com/products/assets/us_lamictal.pdfAsk your p-doc to write a script for Deplin (L-methylfolate). It is well worth a try as an add-on:
http://www.deplin.com/At the same time that you take your Deplin, it is very important to take sublingual methylcobalamin (the endogenous from of B12) and pyridoxal-5-phosphate (P-5-P, the endogenous form of B6). This is absolutely true despite the fact that it is not mentioned on the Deplin website.
It is essential to take Methyl-B12 sublingually instead of orally down-the-hatch. When swallowed, about 1% is absorbed. When taken sublingually, about 99% is absorbed.
http://www.iherb.com/Jarrow-Formulas-Methyl-B-12-1000-mcg-100-Lozenges/129?at=0
http://www.iherb.com/Jarrow-Formulas-Methyl-B-12-1000-mcg-100-Lozenges/129?at=0
http://www.iherb.com/Source-Naturals-Coenzymated-B-6-25-mg-120-Sublingual-Tablets/1038?at=0Why take P-5-P instead of the type found in most multivitamin supplements:
Vitamin B6: How A Deficiency In One Essential Nutrient Could Quadruple Your Risk Of Stroke
<Start Text>
Date: 01/11/03
The benefits of vitamin B6 are wide ranging - from supporting protein metabolism and muscle growth to overcoming premenstrual symptoms and depression by encouraging the production of 'feel-good' chemicals, such as serotonin and dopamine, in the brain that help maintain emotional balance.
The benefits of vitamin B6 are wide ranging - from supporting protein metabolism and muscle growth to overcoming premenstrual symptoms and depression by encouraging the production of 'feel-good' chemicals, such as serotonin and dopamine, in the brain that help maintain emotional balance.It is important to be aware that vitamin B6 comes in different forms and the type found in most multivitamin supplements is an inactive and cheaper form called pyridoxine hydrochloride, rather than the active form: pyridoxal-5-phosphate (P5P). This doesn't necessarily pose a problem since pyridoxine is converted in your liver to the active form P5P - the only form your cells can use, which goes to work straight away in your blood stream.1
However, this transformation is not always successful and a lack of the mineral magnesium in the diet or an underactive liver (due to too much alcohol, antibiotics or a generally unhealthy lifestyle) can soon interfere with this process. If this happens then large amounts of pyridoxine can soon accumulate in the body that cannot be utilised, which can cause nerve damage over time.2
It also causes a deficiency of P5P, which can have negative consequences in terms of your health and result in depression, mood swings, muscle weakness, fatigue, hair loss, worsening of premenstrual symptoms, and poor appetite.
So, instead of relying on ordinary vitamin B6 (pyridoxine) being converted properly to P5P in your body, it is best to take pure P5P in the first place. Better still, P5P possesses even more health-related benefits compared to the inactive form of vitamin B6. In addition to helping the conditions outlined above, it has also been shown to improve carpal tunnel syndrome (compression of the nerves in the wrist causing numbness and pain in the hand), and helps control homocysteine levels that in turn helps prevent cardiovascular disease, stroke and arthritis.
P5P helps keep homocysteine levels in check - reducing the risk of heart disease and stroke
P5P appears to be able to help disperse and inactivate a substance called homocysteine. If you're a long-time HSI member or reader of the daily health email alerts you'll know why this is so vital, as homocysteine promotes the build-up of plaque on blood vessel walls, which increases coagulation (clotting).So it's no surprise then that a high homocysteine level can significantly increase your risk of suffering a heart attack or stroke. Recent research has revealed that homocysteine may be one of the biggest culprits responsible for causing these conditions - possibly more so than cholesterol. If you'd like to receive the FREE daily health email alerts for more updates like this, then simply click on the Register link, above left.
Scientists from the Department of Neurology, Massachusetts General Hospital in the US, have found that levels of P5P in stroke patients is about half that of healthy individuals. Having these low P5P levels has been shown to increase the risk of stroke by up to four-fold.3
The US scientists believe that the increased risk of stroke is due to high homocysteine levels that deficient supplies of P5P are unable to lower. It follows that supplementing with P5P, therefore boosting the body's own levels of this nutrient, helps lower homocysteine and reduces the risk of stroke.
Low P5P levels also implicated in Parkinson's disease and rheumatoid arthritis
Homocysteine levels have also been found to be high in Parkinson's disease patients who are taking the drug L-dopa. This is a commonly prescribed drug for treating the disease but it has one serious drawback - it causes homocysteine levels to rise. So it is vital to keep homocysteine levels low in these patients, in order to prevent an additional illness like cardiovascular problems from developing.Dr J. Miller and co-workers from the Vitamin Bioavailability Laboratory, Human Nutrition Research Centre on Ageing, Tufts University in the US, studied 40 Parkinson's disease patients and found that those who had high homocysteine levels also had low concentrations of P5P in their blood. This tallies with the research findings already mentioned and confirms that when levels of P5P are low homocysteine rises.
Dr Miller concluded: 'The vitamin B requirements necessary to maintain normal homocysteine concentrations are higher in patients who are on L-dopa. Vitamin B (P5P) supplements may be warranted for Parkinson's disease patients'.4
In another clinical trial, US scientists from the Cooper Institute for Aerobics Research in Dallas, Texas, studied 150 volunteers who agreed to take a daily vitamin preparation containing P5P (25 mg), folic acid (5mg) and vitamin B12 (50 micrograms). They found that after 12 weeks of treatment, concentrations of P5P in the blood were significantly increased and that homocysteine levels plummeted by up to 25 per cent.5
Patients with rheumatoid arthritis also tend to have low levels of P5P in their blood. Researchers from the Human Nutrition Research Centre, Tufts University, Boston, in the US, studied 33 patients with the disease. They measured P5P concentrations in the patients' urine, blood and red blood cells. They found that low levels of P5P are significantly implicated in cases of rheumatoid arthritis.6
What to take for best results
The recommended dosage amount for the maintenance of overall health is 20-25mg of P5P daily. For the treatment of specific diseases, the dosage can be increased to 50mg three times a day - this amount should only be taken under proper medical supervision. Pregnant and breast-feeding women should only take P5P following medical advice. As always it is extremely important that you consult your doctor before taking P5P if you are currently on any medication.1. Bor MV et al. Clin Chem 2003, 49(1):155-161
2. Wang H, Kuo M, Brain Res Bull 2002, 58(6):541
3. Kelly PJ et al. Stroke 2003, 34(6):e51-54
4. Miller JW et al. Neurology 2003, 60(7):1125-1129
5. Earnest C, Cooper KH, et al Nutrition 2002, 18(9):738-742
6. Chiang EP et al. J Nutr 2003,133(4):1056-1059
<End Text>I have taken lithium a few times in the past. If I were you, I would not take more than 600 mg/day due to adverse side effects at high dosages.
I have a hunch that you would do well on Nardil (phenelzine). It is a very good antidepressant and it treats social anxiety and other types of anxiety disorders. In addition to the increases in dopamine, norepinephrine, serotonin, and trace neurotransmitters due to the mao inhibition, Nardil has a GABA effect that, for me, causes a peaceful less anxious feeling throughout my body.
The problem with Nardil is very problematic weight gain and, for some like me, erectile dysfunction and delayed orgasm are side effects. The ED can usually be treated adequately with Viagra, or a similar brand. For a male, the delayed orgasm can be a good thing for his partner. But, obviously, delayed or anorgasmia is problematic for a female.
I've been taking Nardil for 4 1/2 years and it is a very good med for me except for the side effects discussed above. If I had it to do over again, I would be almost obsessive about weight monitoring and control right from the beginning. It is hard to loss the weight once it's on. I encourage anyone going on Nardil to be rigorous about weight control right from the day you start taking the medication.
Because of my weight gain, I switched to Parnate for a trial. I gave Parnate four months to work, but it never provided any antidepressant action for me. As soon as I went back to my beloved Nardil the antidepressant effect immediately returned.
Parnate is more likely to cause a hypertensive crisis than Nardil.
In 1996, my first p-doc misdiagnosed me as ADHD and prescribed Ritalin and Paxil. Due to the fact that I am actually bipolar II and NOT ADHD, the stimulant and SSRI pushed me into a full blown mania and caused me to start ultra rapid cycling. My cycle was 15 days; six days of debilitating depression followed by nine days depression free. The 15 day cycle never stopped; when one ended the next one immediately started. This occurred over and over and over, for 14 1/2 years. As you can imagine, I went through an enormous number of med trials over the years of trying to treat my ultra rapid cycling.
I wrote the previous paragraph in order to share with you the fact that four months ago I started a medication called Valdoxan (agomelatine). I immediately stopped ultra rapid cycling and, thereby, all of my depression stopped. My 14 1/2 years of hell are over. Valdoxan is another antidepressant that you might consider as an add-on. I realize that you are not rapid cycling nor are you bipolar. However, Valdoxan works, in part, by resychronizing the circadian clock. Recent research indicates that the circadian clock may play a role in some, or most, depressive disorders.
Valdoxan is an M1 and M2 agonist and a 5ht2c antagonist. M1 and M2 are melatonin receptors. As an agonist of M1 and M2, Valdoxan is thought to reset the circadian clock. When 5ht2c is antagonized, dopamine and norepinephrine are released in the frontal cortex.
Valdoxan is not U.S. FDA approved and, therefore, it is not sold in the U.S. But, it is available on the internet. Insurance companies in the U.S. do not pay for it since it is not FDA approved. So, if you order it, you have to pay full price which is currently about $100 per one month supply.
Below is the URL to an extensive Valdoxan website by Servier, the pharmacutical company. Click all of the links that you can find inside the document. Since Valdoxan is a rather new medication, released in Europe in 2009, you might want to give your p-doc a copy of the URL. If e-mails are not accepted by your p-doc, then either put the URL on a thumb drive and have him copy the URL onto his/her computer, or just hand-copy the URL and give it to your p-doc. Here is the link; click on the Doctor link:
http://www.valdoxan.co.uk/landing.aspx?redirect=/Default.aspxFinally, please look at my list of vitamins and supplements. If I do not take them for two or three days in a row, I become noticeably depressed. My point is they work. I have spent a lot of time researching vitamins and supplements that are known to treat depression. Do your homework on these vitamins and supplements and give each of them a trial. Phosphatidylserene is a little expensive but well worth it. Please do not exclude it due to price.
-- Ron
dx: Bipolar II and mild OCPD
600 mg/day Trileptal (oxcarbazepine)
200 mg/day Lamictal (lamotrigine)
500 mg/day Keppra (levetiracetam)
90 mg/day Nardil (phenelzine)
12.5 mg at betime Valdoxan (agomelatine)
3.75 mg/day Deplin (taken with 2500 mcg/day of sublingual methyl B-12, and 12.5mg/day of sublingual P-5-P)
2.5 mg/day Adderal XR45 ml/day of Carlsons Bottled Fish Oil
100 mg/day phosphatidylserene
One Multi-vitamin/day; Only 100% of all the usual vitamins; Look for good chelations. NO VANADIUM!!
2000 IU/day Vitamin D-3
850 mg/day of Mg 212% of RDA (as 5 grams of Mg Malate)
200 mcg/day GTF Chromium
600 mcg/day Chromium Picolinate
200 mg/day Co-Q10
1000 mg/day Cinnamon
480 mg/day Milk Thistle
2 g Vitamin C
Whats next to add?:
NAC, + 8 to 10 glasses of water, + Acetyl-L-Carnitine, + Alpha-Lipoic Acid
----------------------> Hi Everyone -- I have been obsessively reading this board the past few months in an attempt to remedy my double depression (dysthemia with bouts of major depression). I had reached the conclusion that parnate was the cure for all my ails, but I've now been on it 6 weeks and nada...no initial stimulent effect, not an ounce of improvement in my major depression, nothing except constant hypertension. I'm only on 50 mg at this point because that's all my body will handle -- each dose sends my blood pressure up and even with the beta block I'm on (atenolol), my bp stays around 145/94 most of the time. (I didn't have hypertension prior to taking parnate.) I've been very careful with my diet and it doesn't seem to be a food-induced reaction, I just happen to be one of the lucky few who have responded with this side effect.
>
> I was in touch with Dr. Gillman from Australia who said only about 2% of the 1000+ patients he's treated with parnate get this side effect and that it would wear off over time, but when you inlclude the 2-week washout I did after wellbutrin, I've basically been out of commission for 2 months and being self-employed, I'm going bankrupt so I can't just keep waiting and hoping my blood pressure's going eventually calm down enough for me to get to a therapeutic dose.
>
> So...I'm wondering what I could do to make my old med work again. I was on 450mg wellbutrin xl with vyvanse and 15mg abilify, though I stopped the abilify about a month prior to going off the wellbutrin because I realized it was making me "flat" and I don't really want to take it again. I think all it was doing really was addressing the additional anxiety brought on by the vyvanse, which in hindsight, I realize didn't work as well as provigil with the wellbutrin.
>
> I was determined to try parnate because I read so many wonderful things about it and my wellbutrin began pooping out on me several years ago. For the first year and a half or so, it worked very well all on its own, at which point it began pooping out. I thought maybe I'd gotten a bad batch or something, so I had the dr. write me a new script for that month's dose and went to a different drugstore to ensure I got another batch, but it still was less effective. I went from being treated with about 90% effectiveness to about 50% virtually overnight, and as the years wore on, it petered down to probably 15% effectiveness, despite our attempts to augment with lamictal, abilify, provigil and vyvanse. Before we switched, the dr. actually suggested that I try lithium as an augment, but I didn't like the idea of having to mess with the blood level business and the possibility of weight gain, but in hindsight, perhaps I should have tried it.
>
> Right now, I'm on 50mg parnate and just yesterday I started autmenting with 600mg lithium, with the idea being that my dr. said I'd know within a week if the parnate/lithium combo was going to do me any good and by the time I see him at my scheduled appointment next week, we'd know whether we wanted to continue along that path or go in another direction. I've been on him to possibly autment the parnate with nortrip, but his concern there is that sometimes nortrip increases bp as well and I really don't have any wiggle room in my bp right now.
>
> Some options I've thought of are either going ahead and taking 600mg of wellbutrin (probably along with the provigil) or augmenting wellbutrin with lithium if I do end up getting any benefits from it this week. I realize the increase in seizure risk between 450mg and 600mg increases from .4% to 2%, but with no family history of seizure, that still seems pretty low to me, especially when I think of the high likelihood of my haviing a hypertensive crisis on the parnate given my history of high blood pressure on it.
>
> I forgot to mention that at one point (shortly after the wellbutrin started pooping out on me) I, on my own, went up to 600mg a day and felt great again. This only went on a few days before it was time for my regular apppointment with my pdoc and when I told him what I'd done, he had a near conniption fit talking about risk of seizures and so forth. So I dropped back down to 450mg and tried augmenting with a few things (I listed some here, but I think we tried a couple of others too and they didn't work.)
>
> In the past, I've failed on every ssri I've tried and also on emsam (flat, unmotivated and eating all the time were the effects got from all of these -- along with sexual disfunction, which is unnaceptable to me). Before I started pushing for the parnate, I went through a 3-day period where I was adding 5htp along with another combined supplement that contained things to increase dopamine (velvet bean, aka, dopabean, was one of the primary componants), and for 3 days, I felt wonderful! Not down anymore, not pretending to smile anymore, actually enjoying people's company, etc. In short, my depression went totally into remission! Problem is, the effect stopped after 3 days and no matter what I did (increase the doses, take them on an empty stomach, whatever) I couldn't get the effect to last.
>
> I mention that last scenario because that's what spurred me to want "more" -- more than a 15% response rate again...closer to a 100% response rate. I also mention it because since I responded both to an increase in seratonin and in dopamine, it's quite possible an increase in both with help me, though I do feel I'm primarily lacking in norpenephrine and dopamine, the two main chemicals wellbutrin addresses.
>
> So that's primarily what I feel like I need help with -- norpenephrine and dopamine, with maybe a touch of seratonin.
>
> Do you really think 2% seizure risk is all that high? (Assuming my dr. does let me end up taking 600mg wellbutrin.) What can I take to augment the N and D primarily, with maybe only a touch of S?
>
> I'm really desperate here and need your help...being self-employed, I really may go bankrupt if I don't get my butt in gear again soon and the way I feel now, I haven't bathed in 4 days and I just sit around watching tv all day. Hoping this lithium may kick in in time for Christmas with my family, but so far, nothing from it.
>
> What would you suggest? (Sorry my post is so long.)
poster:Ron Hill
thread:974433
URL: http://www.dr-bob.org/babble/20101231/msgs/975868.html