![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 33. This is the beginning of the thread.
Posted by TamaraJ on July 10, 2005, at 11:09:29
I have been on Zoloft for a week now (I know, only a week, what could I possibly have to complain about :-)). I had previously been taking nortriptyline, 75mg, which I stopped a few days before I started the Zoloft. I also take Wellbutrin, 200mg.
Since starting the Zoloft, in addition to the nausea and tiredness, I have been incredibly irritable and feel so angry, like I just hate the world and my life, and, well, downright bitchy and agitated. I feel like I want to punch a wall or something (which is very odd or me because I am typically a soft-spoken and gentle person). I didn't feel like this when I was on the Wellbutrin with the nortriptyline.
So, my question is: Did anyone else experience these feelings when first starting Zoloft? Do the feelings pass as the body adjusts to the medication? I am getting to the point where I feel like giving up on medication. All I want is to be the content, enthusiastic and somewhat hyper individual I was before I got sick with iron deficiency (during which time I became depressed) and later had an extremely bad reaction to Depo (physically and mentally ill, including suicide ideation for months that the 225 mg of Effexor I was on would not touch). Is that too much to ask? Perhaps I should just accept that I had 43 pretty good years, and now I need to learn to exist in a state of joyless complacency.
Sorry to be on the pity pot :-( I am just frustrated with med trial after med trial. I know there are many people who have far greater problems than I, so I guess I should just suck it up and get on with things < sigh >
Posted by linkadge on July 10, 2005, at 20:21:30
In reply to Zoloft - temporary problems or not?!?!?, posted by TamaraJ on July 10, 2005, at 11:09:29
content, enthusiastic and somewhat hyper sounds like you're asking for too much (to me). You can definately be happy without being complacent.
Linkadge
Posted by TamaraJ on July 10, 2005, at 20:31:55
In reply to Re: Zoloft - temporary problems or not?!?!?, posted by linkadge on July 10, 2005, at 20:21:30
Perhaps I am being unrealistic to think that I can be the way I was before, which was content, enthusiastic and somewhat hyper. Sure I had my bad days once in a while, but they weren't lasting or persistent. Oh well. The times they do change, that's for sure.
Thanks, Link. Sorry to sound pessimistic and self-pitying. Just frustrated, I guess.
> content, enthusiastic and somewhat hyper sounds like you're asking for too much (to me). You can definately be happy without being complacent.
>
>
> Linkadge
Posted by Phillipa on July 10, 2005, at 21:11:46
In reply to Re: Zoloft - temporary problems or not?!?!? » linkadge, posted by TamaraJ on July 10, 2005, at 20:31:55
I don't think it's unrealistic at all. Think back to what you were doing with and in your life. Are you doing the same now? Then have you gone through menopause? Zoloft affected me acutely even at low doses when I was perimenopausal. And it made me tired. Now it doesn't tough me. Fondly, Phillipa
Posted by linkadge on July 10, 2005, at 21:17:36
In reply to Re: Zoloft - temporary problems or not?!?!? » linkadge, posted by TamaraJ on July 10, 2005, at 20:31:55
I know with myself that I have these flashbulb memories of really really good times, and I'd like to believe that they always were, and that they always should be.
They serve as a guidposts and motivators in my life, but in reality they were only snapshots.
The good memories can motivate us, but if we continue to try and "regain" something we close our eyes to all the new experiences that might await us.Zoloft might not be the best choice, I don't know. It made me a little blue, and yes it certainly made me angry unlike celexa. Infact it made me feel a little bit "possessed"
Linkadge
Posted by TamaraJ on July 11, 2005, at 6:56:09
In reply to Re: Zoloft - temporary problems or not?!?!? » TamaraJ, posted by Phillipa on July 10, 2005, at 21:11:46
Thanks, Phillipa. I don't want to live in the past, I just would like my personality back. It's hard because I have gone through 3 physical illness or sorts in the past year which exacerbated the depression I was experiencing. When I first got sick, I was dealing with severe iron deficiency, which wasn't responding to treatment. Once I started getting iron injections (10 over 10 weeks), I could feel my energy and enthusiasm returning and my mood brightening. I was just barely back on my feet when I was put on Depo Provera, and became extremely ill in reaction to that. Then, again, barely back on my feet when I fractured my arm and had to have surgery. I think I gave up a bit at that point, and have been having a hard time getting rid of the depression and anxiety. And, the pdoc I see thinks I may be perimenopausal, although the obgyn tested my fsh and lsh levels, and they were normal. I may go to a naturopath (I have found one that specializes in women's health who can request all the same blood work as a gp, plus uses saliva testing and other diagnostic tools) for more thorough testing.
Oh well, this too shall pass (but when?!?!?!).
Take care,
Tamara
> I don't think it's unrealistic at all. Think back to what you were doing with and in your life. Are you doing the same now? Then have you gone through menopause? Zoloft affected me acutely even at low doses when I was perimenopausal. And it made me tired. Now it doesn't tough me. Fondly, Phillipa
Posted by TamaraJ on July 11, 2005, at 7:07:13
In reply to Re: Zoloft - temporary problems or not?!?!?, posted by linkadge on July 10, 2005, at 21:17:36
Linkadge,
I agree with what you are saying. It's not that I am trying to regain or relive the past, what I am trying to regain is my personality. I recognize that good times come and go, and that is not hard for me to deal with - never really has been. I don't want to close my eyes to new experiences. I just want to have the new experiences with the personality I have had all my life. I don't know if that makes sense.
I am having the exact same reaction to Zoloft as you. I have been waking up in the morning feeling really down and blue with some morbid thoughts. Those feelings are with me on and off throughout the day. And, I, too, feel possessed. That is a good way to describe it. I have so much rage and anger and irritability inside me since I started taking the Zoloft that it is scary because I do not have much of a temper and, although hyper, tend to be laid back and patient with others (although not always with myself). I know it has only been a week, so maybe the possessed feeling, extreme anger, irritability and impatience will pass. What do you think? I could just return to the nortriptyline which was helping, and was pretty good in combination with Wellbutrin, but didn't seem to effectively touch the nameless dread I have been experience.
Tamara
> I know with myself that I have these flashbulb memories of really really good times, and I'd like to believe that they always were, and that they always should be.
>
> They serve as a guidposts and motivators in my life, but in reality they were only snapshots.
> The good memories can motivate us, but if we continue to try and "regain" something we close our eyes to all the new experiences that might await us.
>
> Zoloft might not be the best choice, I don't know. It made me a little blue, and yes it certainly made me angry unlike celexa. Infact it made me feel a little bit "possessed"
>
>
>
>
>
> Linkadge
>
>
Posted by SLS on July 11, 2005, at 8:29:46
In reply to Zoloft - temporary problems or not?!?!?, posted by TamaraJ on July 10, 2005, at 11:09:29
I tend to be an optimist, so don't place to much weight on what I have to say.
First of all, SSRI + Wellbutrin is a good combination. I know people who fail to respond adequately to each separately who end up achieving remission using the combination of these medications.
Second of all, anger and irritability are often an early indicator of a positive antidepressant response, as the lack of energy and passivity that are part of severe depression begin to improve. Things still suck, but now you have more energy to act on it. Think of it as being an "in-between" state that will shortly pass and leave you with a gradual process of improvement.
- Scott
Posted by TamaraJ on July 11, 2005, at 9:02:24
In reply to Re: Zoloft - temporary problems or not?!?!? » TamaraJ, posted by SLS on July 11, 2005, at 8:29:46
You are wonderful optimist, and it is an inspiration to many on the board, myself included. Optimism aside, you also are a wealth of knowledge and of solid, reasoned advice, so I have no problem placing weight on what you have to say. I have tended to be an optimist throughout my life, but I guess I am feeling discouraged. I need to snap out of that.
The morbid thoughts about why should I bother to even go on, and the anger and hostility I am feeling within myself are relatively foreign to me, and that, I think, is why I am scared to continue with the Zoloft. And, although I was doing relatively well on the Wellbutrin/nortriptyline combo, there was still something missing, something I can't put my finger on or name, but I know is crucial to my recovery (could that make any less sense LOL). And, the combo didn't really touch the "nameless dread" that has developed after months and months of setbacks and my isolating as a result.
I just wonder how long these side effects will last? I am so bitchy and irritable that I would pity anyone who is brave enough to try to spend time with me right now, without being heavily medicated LOL. Also, my sleep has been really disrupted, and I wake up achy and exhausted. I wonder if it would be ok to take 25mg of nortriptyline before bed to ensure a good night's sleep while I adjust to the Zoloft, or would I be risking serotonin syndrome?
Thanks, Scott. You have a way of providing calm reassurance, coupled with sound, logical advice.
Tamara
> I tend to be an optimist, so don't place to much weight on what I have to say.
>
> First of all, SSRI + Wellbutrin is a good combination. I know people who fail to respond adequately to each separately who end up achieving remission using the combination of these medications.
>
> Second of all, anger and irritability are often an early indicator of a positive antidepressant response, as the lack of energy and passivity that are part of severe depression begin to improve. Things still suck, but now you have more energy to act on it. Think of it as being an "in-between" state that will shortly pass and leave you with a gradual process of improvement.
>
>
> - Scott
Posted by SLS on July 11, 2005, at 11:05:41
In reply to Re: Zoloft - temporary problems or not?!?!? » SLS, posted by TamaraJ on July 11, 2005, at 9:02:24
Hi Tamara.
Don't be scared to continue with Zoloft. As foreign as the feelings of anger and irritability are, I imagine so are the feelings of normalcy that you might *possibly* be headed for.
There are two, no, three, no, four alternate explanations.
1. These are side effects that may or may not disappear, perhaps due to an interaction with Wellbutrin. However, they do not represent an indicator that you are responding.
2. It is a sign that you are responding and improving. This phase will disappear within two weeks.
3. You are experiencing a point in your menstrual cycle that is producing a mood state that is now presenting because the Zoloft is beginning to work.
4. You really are a b*tch, but you just haven't felt well enough in the past to express it. LOL :-)
> And, although I was doing relatively well on the Wellbutrin/nortriptyline combo, there was still something missing, something I can't put my finger on or name, but I know is crucial to my recovery
Do you feel that you are missing a "mood brightener" that would give you the motivation to participate with cheer and get things done without it seeming like too much of a chore? My friend calls what SRIs do for her as giving her the "wanna do's". Wellbutrin gives her the mental energy to do them.
> And, the combo didn't really touch the "nameless dread" that has developed after months and months of setbacks
Does this include a background anxiety that is always there?
> and my isolating as a result.
Yeah, that's bad. I isolate when things get really bad.
Just because you experience setbacks does not mean that you must start all over again and begin an arduous climb from the bottom of the ladder. You do not lose the things that you have learned and internalized. You'd be surprised how much you retain, despite being in a chronic depressed state.
- Scott
Posted by TamaraJ on July 11, 2005, at 11:33:31
In reply to Re: Zoloft - temporary problems or not?!?!? » TamaraJ, posted by SLS on July 11, 2005, at 11:05:41
> Hi Scott,
>
> Don't be scared to continue with Zoloft. As foreign as the feelings of anger and irritability are, I imagine so are the feelings of normalcy that you might *possibly* be headed for.
>
-- That would be nice. I haven't felt normal for over a year. Well, actually, I was feeling quite a bit better once the severe iron deficiency I had been experiencing was finally adequately treated (10 week course of iron injections). Then, I was put on Depo, and that screwed me up really badly.> There are two, no, three, no, four alternate explanations.
>
> 1. These are side effects that may or may not disappear, perhaps due to an interaction with Wellbutrin. However, they do not represent an indicator that you are responding.
>
-- I suppose giving it 3 weeks should be enough time to make a decision as to whether I will be able to tolerate the med and would give me some kind of an indication of whether I will respond.> 2. It is a sign that you are responding and improving. This phase will disappear within two weeks.
>
-- That would be nice. I think I will try to stick it out.> 3. You are experiencing a point in your menstrual cycle that is producing a mood state that is now presenting because the Zoloft is beginning to work.
>
-- I never thought of that. I will check the calendar. I think it may be PMS time actually.> 4. You really are a b*tch, but you just haven't felt well enough in the past to express it. LOL :-)
>
-- ROTFLMAO!!! Or, maybe everybody has been too afraid to tell me :-) But, seriously, I have been pretty consistently a soft-spoken, mild-mannered person pretty much all my life, with the exception of the times I have had EXTREME PMS (hey, perhaps that should be a new reality t.v. show LOL).> Do you feel that you are missing a "mood brightener" that would give you the motivation to participate with cheer and get things done without it seeming like too much of a chore? My friend calls what SRIs do for her as giving her the "wanna do's". Wellbutrin gives her the mental energy to do them.
>
-- I think you hit it on the head. It's like things seem like a chore. I mean, I was always the type of person who could find pleasure in simple, little things, including grocery shopping or organizing a closet, and lately it's been like "why bother". I guess it is a case of the blahs. That's interesting that your friend says the SRIs give her the "wanna do's". I hear so much about people experiencing apathy on the SRIs. I never experienced apathy when I was on Paxil, and I stayed on it for about 6 or 7 years, although the last few years I only used a small dose.> Does this include a background anxiety that is always there?
>
-- I don't think it is really anxiety, as in generalized anxiety, but it is like I have become fearful. Like the thought of going out and doing stuff causes some kind of phobic reaction. Weird, I know. And, I have been feeding it, which is terrible.
> Yeah, that's bad. I isolate when things get really bad.
>
-- It is bad. I find that after a while, it's almost like I forget how to be social.> Just because you experience setbacks does not mean that you must start all over again and begin an arduous climb from the bottom of the ladder. You do not lose the things that you have learned and internalized. You'd be surprised how much you retain, despite being in a chronic depressed state.
>
-- I have to keep reminding myself of that. I am fortunate to have a good, patient pdoc, who always spends an entire hour with me when I have an appointment discussing meds and other issues. I am now looking into doing EMRD therapy, so that may make a difference in terms of the avoidant behaviours I have developed as a result of the depression.
>
One final question (sorry), do you think it would be ok if I continued to take 25mg of Nortriptyline for a couple of weeks while I get used to the Zoloft. I am finding that I am not sleeping very well since starting the Zoloft, and wake up feeling really drained and achy.Thanks again, Scott.
Tamara
Posted by linkadge on July 11, 2005, at 15:42:14
In reply to Re: Zoloft - temporary problems or not?!?!? » linkadge, posted by TamaraJ on July 11, 2005, at 7:07:13
The posessed feeling is a strange one. Unfortunately it didn't pass for me.
Thats kind of why I quit it. Not sure what to say. Don't want to assume that thats how it will be for you but I have to be honest with how it affected me.Linkadge
Posted by TamaraJ on July 11, 2005, at 15:45:35
In reply to Re: Zoloft - temporary problems or not?!?!? » TamaraJ, posted by linkadge on July 11, 2005, at 15:42:14
Thanks, Linkadge. I appreciate your honesty. I'd rather know the good and the bad, so if the bad does happen, I at least know why.
Tamara
> The posessed feeling is a strange one. Unfortunately it didn't pass for me.
> Thats kind of why I quit it. Not sure what to say. Don't want to assume that thats how it will be for you but I have to be honest with how it affected me.
>
> Linkadge
Posted by blueberry on July 11, 2005, at 19:00:04
In reply to Zoloft - temporary problems or not?!?!?, posted by TamaraJ on July 10, 2005, at 11:09:29
If it were me, I would cut a pill in half and just do a half the next time. Stay there a few days at least before moving up. That's what I would do anyway.
Wellbutrin is thought to be a dopamine reuptake inhibitor, and even though zoloft is a serotonin reuptake inhibitor, it actually does have some dopamine reuptake inhibition also. So maybe with the two combined you might experience something like a dopamine overload with rage and agitation and stuff. I would cut the dose back and approach it more gradually.
There could be withdrawals from nortriptyline mixed in there confusing things. I was on nortriptyline for just a couple weeks, but went through some fairly tough withdrawals.
Posted by TamaraJ on July 11, 2005, at 19:26:06
In reply to Re: Zoloft - temporary problems or not?!?!?, posted by blueberry on July 11, 2005, at 19:00:04
Thanks, Blueberry. Unfortunately, I can't cut the pill in half, they are caps. But, they are 25mg caps, so I could go back to 25mg for a few days. I also just thought that maybe I could reduce the Wellbutrin to 100mg for a few days, while I adjust to the 50mg of the Zoloft. Would that also make sense? The other thing that may be exacerbating the side effects is that I have not yet completely quit smoking, so perhaps there is even more dopamine activity going on because of the smoking.
And, as you say, part of the problem could still be nortriptyline withdrawal. I stopped just over a week ago, going immediately from 75mg to 0. I have a question for you, if you feel you can answer. As I am adjusting to the Zoloft, I am finding that my sleep is not very restorative, and I wake up achy, exhausted and foggy. I wonder if I could take 25mg of the nortriptyline for a few days, or would that be unwise with the Zoloft?
Thanks so much.
Tamara
> If it were me, I would cut a pill in half and just do a half the next time. Stay there a few days at least before moving up. That's what I would do anyway.
>
> Wellbutrin is thought to be a dopamine reuptake inhibitor, and even though zoloft is a serotonin reuptake inhibitor, it actually does have some dopamine reuptake inhibition also. So maybe with the two combined you might experience something like a dopamine overload with rage and agitation and stuff. I would cut the dose back and approach it more gradually.
>
> There could be withdrawals from nortriptyline mixed in there confusing things. I was on nortriptyline for just a couple weeks, but went through some fairly tough withdrawals.
Posted by SLS on July 11, 2005, at 21:05:55
In reply to Re: Zoloft - temporary problems or not?!?!? » blueberry, posted by TamaraJ on July 11, 2005, at 19:26:06
Hi Tamara.
As Blueberry suggested, it is possible that your withdrawal from nortriptyline might be a factor in what you are feeling. However, I would have expected these things to develop within three days of discontinuation rather than a week later. It is hard to know for sure.
There is nothing wrong with continuing on a reduced dosage of nortriptyline while taking Zoloft and Wellbutrin. Zoloft moderately increases the blood levels of nortriptyline, so 25mg would be a very reasonable dosage to remain on.
SRI + TCA can sometimes work well when SRI monotherapy does not. Don't neglect the possibility that Zoloft + nortriptyline might work. You would probably want to go to 50mg and then return to 75mg if you want to adequately explore the combination.
- Scott
Posted by TamaraJ on July 11, 2005, at 21:28:45
In reply to Re: Zoloft - temporary problems or not?!?!? » TamaraJ, posted by SLS on July 11, 2005, at 21:05:55
Thanks, Scott. It is probably start up side effects from the Zoloft, because it really hit me when I increased my dose to 50mg last Tuesday. I will use 25mg of nortriptyline for a few days, if only to help me get a good night's sleep while I adjust to the Zoloft. I feel like I have had a wicked hangover for a week now, and I don't even drink anymore :-) I am taking some ginger capsules to help with the nausea, so that should help.
Thanks again. And, I am so sorry that you are not having the response you had hoped for with the Trileptal :-( That really stinks!
Take care,
Tamara
> Hi Tamara.
>
> As Blueberry suggested, it is possible that your withdrawal from nortriptyline might be a factor in what you are feeling. However, I would have expected these things to develop within three days of discontinuation rather than a week later. It is hard to know for sure.
>
> There is nothing wrong with continuing on a reduced dosage of nortriptyline while taking Zoloft and Wellbutrin. Zoloft moderately increases the blood levels of nortriptyline, so 25mg would be a very reasonable dosage to remain on.
>
> SRI + TCA can sometimes work well when SRI monotherapy does not. Don't neglect the possibility that Zoloft + nortriptyline might work. You would probably want to go to 50mg and then return to 75mg if you want to adequately explore the combination.
>
>
> - Scott
Posted by TamaraJ on July 12, 2005, at 16:11:55
In reply to Re: Zoloft - temporary problems or not?!?!? » TamaraJ, posted by SLS on July 11, 2005, at 21:05:55
Hi Scott,
Just one last thing, if you have time and don't mind.
I had a look at the chart you created on psychtropic meds (great chart, by the way. I refer to it often). I noticed that Wellbutrin and Zoloft appear to be equal in terms of Dopamine reuptake or inhibition. I also read in a couple of places that Wellbutrin actually only has a mild effect on dopamine and norepiphedrine. Yet, Nortriptyline seems to be quite a potent or at least be a significant inhibitor of norepiphedrine. So, the question I have is that is Nortriptyline less activating than Wellbutrin because of its other mechanisms, which result in certain side effects? Also, which of the two, Wellbutrin or Nortriptyline, do you think would be better for melancholic depression with adhedonia?
Just wanted to keep myself informed in case I find the Wellbutrin/Zoloft combination continues to cause too much nausea.
Thanks.
Tamara
Posted by ed_uk on July 12, 2005, at 17:48:05
In reply to Question for Scott (if you have time) » SLS, posted by TamaraJ on July 12, 2005, at 16:11:55
Hi T!
Although Zoloft has a higher affinity for the dopamine transporter than Wellbutrin, only Wellbutrin has significant dopaminergic effects at therapeutic doses. Zoloft is a very potent serotonin reuptake inhibitor and a very 'weak' dopamine reuptake inhibitor. Therapeutic doses of Zoloft produce low levels of Zoloft in the brain, not enough to affect dopamine reuptake. Because therapeutic doses of Wellbutrin produce high drug levels in the brain, Wellbutrin is believed to inhibit the reuptake of dopamine at normal doses. Wellbutrin has a low affinity for the norepinephrine transporter. Nevertheless, it does have some effect on the reuptake of norepi at therapeutic doses because of the high drug levels produced. Bear in mind, the mechanism of action of Wellbutrin is not well understood. It's various active metabolites also contribute to its AD effect.
>Yet, Nortriptyline seems to be quite a potent or at least be a significant inhibitor of norepiphedrine.
True :-)
Ed xxx
Posted by linkadge on July 12, 2005, at 17:53:10
In reply to Re: Zoloft - temporary problems or not?!?!? » TamaraJ, posted by SLS on July 11, 2005, at 21:05:55
Zoloft + nortryptaline would be like a triple uptake inhibitor.
Linkadge
Posted by TamaraJ on July 12, 2005, at 18:14:25
In reply to Re: Question for Scott (if you have time) » TamaraJ, posted by ed_uk on July 12, 2005, at 17:48:05
Hey Ed!
Thanks, Ed. Just trying to decide whether the Zoloft/Nortriptyline combo may be more effective for me than the Wellbutrin/Zoloft combo. I know I certainly sleep better on Nortriptyline, but the disrupted sleep may go away once I adjust to the Zoloft. Would the nort be a more potent inhibitor of norepiphedrine than Wellbutrin? I guess, I am just investigating my options, so that I can keep the options open. One option that I can also consider, if the nausea from the Wellbutrin/Zoloft combo does not subside, is Zoloft/Nortriptyline with some L-Tyrosine and possibly DMAE along with the occassional dose of NADH. Oh, decisions, decisions. I am a flake :-(
Tamara xoxo
> Hi T!
>
> Although Zoloft has a higher affinity for the dopamine transporter than Wellbutrin, only Wellbutrin has significant dopaminergic effects at therapeutic doses. Zoloft is a very potent serotonin reuptake inhibitor and a very 'weak' dopamine reuptake inhibitor. Therapeutic doses of Zoloft produce low levels of Zoloft in the brain, not enough to affect dopamine reuptake. Because therapeutic doses of Wellbutrin produce high drug levels in the brain, Wellbutrin is believed to inhibit the reuptake of dopamine at normal doses. Wellbutrin has a low affinity for the norepinephrine transporter. Nevertheless, it does have some effect on the reuptake of norepi at therapeutic doses because of the high drug levels produced. Bear in mind, the mechanism of action of Wellbutrin is not well understood. It's various active metabolites also contribute to its AD effect.
>
> >Yet, Nortriptyline seems to be quite a potent or at least be a significant inhibitor of norepiphedrine.
>
> True :-)
>
> Ed xxx
Posted by TamaraJ on July 12, 2005, at 18:19:20
In reply to Re: Zoloft - temporary problems or not?!?!?, posted by linkadge on July 12, 2005, at 17:53:10
But, wouldn't Zoloft + Wellbutrin also be like a triple uptake inhibitor? In any event, in your opinion, which would have the potential for being a more effective combo: Zoloft + Wellbutrin or Zoloft Nortriptyline to deal with anergic depression with some adhedonia, coupled with some social and anticipatory anxiety and nameless dread? Also, what do you think of the Zoloft + Nortriptyline combo, with perhaps a low dose of L-Tyrosine, and perhaps some DMAE and NADH (a few times a week)?
Thanks, Link, your insights are appreciated.
Tamara
> Zoloft + nortryptaline would be like a triple uptake inhibitor.
>
> Linkadge
Posted by SLS on July 12, 2005, at 18:37:28
In reply to Question for Scott (if you have time) » SLS, posted by TamaraJ on July 12, 2005, at 16:11:55
> I noticed that Wellbutrin and Zoloft appear to be equal in terms of Dopamine reuptake or inhibition.
Actually, thinking simplistically, it is not surprising that you should get nausea from combining two pro-dopaminergic drugs. Nausea can occur for any number of reasons, but dopaminergic activation in certain areas of the brain does. Actually, I think that's why people have nausea attacks over the first few days of starting Effexor, a drug with a "weak" dopamine reuptake property. I once tried nomifensine (Merital), the most potent dopamine reuptake inhibitor antidepressant ever marketed in the U.S. I did not suffer any nausea with this drug. So much for being simplistic.
> I also read in a couple of places that Wellbutrin actually only has a mild effect on dopamine and norepiphedrine.
I don't know what the heck Wellbutrin does. Sheldon Preskorn, MD, is very adamant that Wellbutrin is a potent enough DA/NE reuptake inhibitor such that it explains its mechanism of action. Currently, I don't agree with him. I cannot offer an alternative, though.
> Yet, Nortriptyline seems to be quite a potent or at least be a significant inhibitor of norepiphedrine.
It is. It also tickles serotonin a wee bit.
> So, the question I have is that is Nortriptyline less activating than Wellbutrin because of its other mechanisms,
I don't find Wellbutrin to be activating at all. But that's just me and my enigmatic brain chemistry. It might be that its metabolite is the source for the activation and anxiety that Wellbutrin is known to frequently produce. So the question becomes: is Wellbutrin the active antidepressant compound or is it the metabolite or both? Is the metabolite the source of the amphetamine like effects? Can a Wellbutrin-like compound be synthesized that doesn't produce this metabolite and perhaps avoid the unwanted side effects? I don't know. I'm just thinking out loud.
Wellbutrin makes me feel worse.
Nortriptyline makes me feel better.
Nortriptyline has been associated with successful treatment of melancholic depression. However, I don't think Wellbutrin has been scrutinized in this area. It might be just as good, but I think I would opt for a TCA for melancholia with psychomotor retardation.
I doubt I threw any light on the subject. Just a ramble. Sorry.
- Scott
Posted by linkadge on July 12, 2005, at 19:58:52
In reply to Re: Question for Scott (if you have time) » TamaraJ, posted by SLS on July 12, 2005, at 18:37:28
Yeah, I think that nortryptaline is a more effective antidepressant.
Linkadge
Posted by TamaraJ on July 12, 2005, at 20:36:21
In reply to Re: Question for Scott (if you have time) » TamaraJ, posted by SLS on July 12, 2005, at 18:37:28
Thanks, Scott. Your musings were interesting and useful. It is incredible just how much conflicting information there is on this particular AD. I seem to recall reading in two places that it is a weak inhibitor of dopamine and norepinephrine. Yet, I have heard the opposite as well. It may well have to do with the metabolites, and even that is a mystery I think because I seem to recall reading that there is also a second metabolite but nobody is sure what exactly it does. I imagine that Wellbutrin must be quite hard on the liver with all the metabolism it goes through.
Until I get through the start-up side effects from the Zoloft, it is difficult to say if the Wellbutrin is making me fatigued. I know in the morning after I take my Wellbutrin/Zoloft, I get really tired for a couple of hours. So, I will keep an eye on that. It may turn out that Zoloft (for the anticipatory anxiety and nameless dread) and Nortriptyline (for the depression and adhedonia) may be the right combo, but I will stick with the Zoloft/Wellbutrin until I have made it through the worst of the start-up side effects.
Thanks again. Your insights are much appreciated.
Tamara
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