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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 17 of 17. This is the beginning of the thread.
Posted by SLS on November 22, 2006, at 4:42:58
I have been on Nardil for two weeks. I have been at 45mg for one week. I am convinced that Nardil or its metabolites have an acute beneficial effect that is independent of MAO inhibition. This includes mood brightening and pro-social effects. I felt these within the first week at a dosage of 30mg. I believe this is to be too low a dosage and too soon for there to be sufficient enzyme inhibition to exert an antidepressant effect. In the past, I have demonstrated a need to be within the dosage range of 60-75mg to maintain a response. Additionally, when I was responding well to Nardil many years ago, I would experience an energizing effect within an hour of each dose. I take this to be further evidence of an acute pharmacological effect of some sort separate from MAO inhibition.
I am still suffering from an exacerbation of my depression that is residual from my taking Lyrica. It has been almost two months since I discontinued that drug. I am much recovered, but I still experience episodes of acute worsenings. They hit me in waves. Lately, though, they have not lasted for more than a day. Two days ago, the wave lasted for about 8 hours.
I am hopeful that Nardil might produce a greater improvement now than it has over the last 15 years because of how it is being combined with other medication. It will be the first time that it will be used in conjunction with nortriptyline, Topamax, and Abilify.
Currently:
Nardil 60mg
nortriptyline 100mg
Lamictal 150mg
Topamax 100mg
Abilify 10mg
- Scott
Posted by tensor on November 22, 2006, at 5:48:04
In reply to Nardil - hopeful, posted by SLS on November 22, 2006, at 4:42:58
Scott,
good to see you're back, good luck with Nardil. You have increased Lamictal from 100mg to 150mg, haven't you? Do you feel any response from it?
I'm seeing my pdoc in a couple of hours, and I have a question. Current regime is: Lamictal 100mg, Nortrip 100mg and Remeron 15. Still depressed.
I'm thinking of replacing nortrip with Zoloft or Wellbutrin and to keep Lamictal and Remeron. Both works well with Remeron, what do you think? Maybe up the Lamictal dose?Hope you're doing ok.
/Mattias
Posted by SLS on November 22, 2006, at 6:27:45
In reply to Re: Nardil - hopeful » SLS, posted by tensor on November 22, 2006, at 5:48:04
> Scott,
>
> good to see you're back, good luck with Nardil. You have increased Lamictal from 100mg to 150mg, haven't you? Do you feel any response from it?
>
> I'm seeing my pdoc in a couple of hours, and I have a question. Current regime is: Lamictal 100mg, Nortrip 100mg and Remeron 15. Still depressed.
> I'm thinking of replacing nortrip with Zoloft or Wellbutrin and to keep Lamictal and Remeron. Both works well with Remeron, what do you think? Maybe up the Lamictal dose?
>
> Hope you're doing ok.
Thanks. :-)I would consider working the dosage of Lamictal up to 200mg at some point.
SSRI + Remeron probably makes more sense to start with. The synergistic effect of this combination is more widely recognized. I would consider raising the dosage of Remeron, though. Zoloft + Wellbutrin makes an excellent combination, too. So, your algorithm would be to add the Zoloft first and then swap the Remeron for Wellbutrin if necessary. I guess you could simply add the Wellbutrin if you don't mind the idea of being a walking pharmacy. It would save time. If the combination were successful, you could at that point try removing the Remeron to see if it were necessary. The pharmokinetic interactions between these drugs are minimal. Zoloft raises the levels of Wellbutrin a bit.
I wasn't aware that Remeron + Wellbutrin made such a good combination. I don't see why not. Unfortunately, I react badly to both drugs.
By the way, my doctor and his collegues have seen Lamictal + Wellbutrin work wonders for quite a few people.
You have chosen drug combinations that have a very good chance of working. I'll keep my fingers crossed for you.
- Scott
Posted by tensor on November 22, 2006, at 6:48:46
In reply to Re: Nardil - hopeful » tensor, posted by SLS on November 22, 2006, at 6:27:45
> I would consider working the dosage of Lamictal up to 200mg at some point.
Thanks for your input.
I have tried to raise the dosage to 200mg but it gave me anxiety and panic attacks. Lmaictal also makes me tired, which seems to be dose related. Probably because of its inhibiting effect on glutamate, maybe modafinil could conquer this?
> SSRI + Remeron probably makes more sense to start with. The synergistic effect of this combination is more widely recognized.
Zoloft + Remeron is the combo that has worked best ever, that's why it's more appealing now than Wellbutrin + Zoloft. But as you said, swap nortrip with Zoloft and then, if necessary, swap Remeron with Wellbutrin. Maybe I will increase Lamictal dosage a bit, 125 or 150mg.
>I guess you could simply add the Wellbutrin if you don't mind the idea of being a walking pharmacy. It would save time. If the combination were successful, you could at that point try removing the Remeron to see if it were necessary.
That'sa also a good idea, I will se what my pdoc says today.
> By the way, my doctor and his collegues have seen Lamictal + Wellbutrin work wonders for quite a few people.
That sounds good.
> You have chosen drug combinations that have a very good chance of working. I'll keep my fingers crossed for you.
Thanks! I will let you know what we decided.
/Mattias
Posted by SLS on November 22, 2006, at 7:11:22
In reply to Re: Nardil - hopeful » SLS, posted by tensor on November 22, 2006, at 6:48:46
I double-checked the interaction between Zoloft and Wellbutrin on a CYP450 website. It stated that the increase in blood levels of Wellbutrin were substantial: + 75-150% change in exposure to the drug. I guess it makes sense to begin at 75mg and increase gradually from there.
Zoloft inhibits CYP450 2B6, which is a major route of metabolism of Wellbutrin and its hydroxy- metabolites.
- Scott
Posted by tensor on November 22, 2006, at 7:22:06
In reply to Re: Nardil - hopeful, posted by SLS on November 22, 2006, at 7:11:22
>It stated that the increase in blood levels of Wellbutrin were substantial: + 75-150% change in exposure to the drug. I guess it makes sense to begin at 75mg and increase gradually from there.
Ouch! Thanks for that info, we have only Zyban 150mg here. So I guess I will have to take the Remeron+Zoloft path after all.
Again thanks,
Mattias
Posted by SLS on November 22, 2006, at 8:10:38
In reply to Re: Nardil - hopeful » SLS, posted by tensor on November 22, 2006, at 7:22:06
> >It stated that the increase in blood levels of Wellbutrin were substantial: + 75-150% change in exposure to the drug. I guess it makes sense to begin at 75mg and increase gradually from there.
>
> Ouch! Thanks for that info, we have only Zyban 150mg here. So I guess I will have to take the Remeron+Zoloft path after all.
No, no, no!Don't let that stop you. 150mg might be exactly the right target dosage of Wellbutrin when combined with Zoloft. It might even be too low for you. 300mg is the most common effective dosage when used monotherapeutically. Treatment with Wellbutrin or Zyban is actually initiated at the target dosage of 300mg. With Zoloft, I doubt you would need to reduce that by more than half, so you should be okay at 150mg. You should cut the tablets in half and take 75mg twice a day, as Zyban is equivalent to Wellbutrin SR (not XL). I do know someone who combined Zoloft with Wellbutrin 300mg without a problem. People metabolize drugs differently. If it were me, I would split the pills and titrate to 300mg if I did not respond to lower dosages.
- Scott
Posted by tensor on November 22, 2006, at 9:35:15
In reply to Re: Nardil - hopeful » tensor, posted by SLS on November 22, 2006, at 8:10:38
>Treatment with Wellbutrin or Zyban is actually initiated at the target dosage of 300mg. With Zoloft, I doubt you would need to reduce that by more than half, so you should be okay at 150mg. You should cut the tablets in half and take 75mg twice a day, as Zyban is equivalent to Wellbutrin SR (not XL).
Ok, thanks for that update, it's certainly an option.
I just came back from my appointment. We decided to swap nortrip with sertralin(generic, it costs 10e/100st, Zoloft costs 64e/100st), as I wanted. I'm keeping my Lamictal dosage at 100mg. Since bupropion is only marketed as Zyban for smoking cessation here, I asked him about it. He said he had never heard of Wellbutrin and the use of bupropion as an AD. I informed/updated him with some articles I had with me and he agreed to let me try it in the future if the rem+ser+lam combo isn't successful.
He said I had probably more knowledge about psychopharmacology than most doctors here, I'm not sure wheather I should laugh or not./Mattias
Posted by Phillipa on November 22, 2006, at 12:19:55
In reply to Re: Nardil - hopeful » tensor, posted by SLS on November 22, 2006, at 8:10:38
Scott I'm so glad the nardil is helping you. I know a lot of people that do good on zoloft up to 200mg . Any idea why this SSRI would be different? Love Jan
Posted by Crazy Horse on November 22, 2006, at 14:53:32
In reply to Nardil - hopeful, posted by SLS on November 22, 2006, at 4:42:58
> I am still suffering from an exacerbation of my depression that is residual from my taking Lyrica.
Wow, we must be wired very differently Scott. Lyrica causes you to be depressed, and for me it is the best antidepressant i have taken in 26 yrs. I am glad you are feeling somewhat better on Nardil..and hope you continue to get better and better. :)
-Monte
Posted by blueberry on November 22, 2006, at 17:31:01
In reply to Nardil - hopeful, posted by SLS on November 22, 2006, at 4:42:58
I am hopeful for you too. I want you to be very well. I wish upon you many blessings.
Posted by stargazer on November 22, 2006, at 19:31:55
In reply to Re: Nardil - hopeful » SLS, posted by blueberry on November 22, 2006, at 17:31:01
Nardil was the second AD I tried after Elavil and it well for a few years. I knew nothing about depression back then and never thought it would still be hitching a ride from me all these years. For many of us, it is a disease for life.
I still think I have a brain deficiency in the dopamine system since MAO's gave me a complete response twice (marplan worked too). I was on SSRI's too but never got complete responses with them, only lots of apathyand SE's.
I'm trying Emsam now, only one week into trial with some positive effects, like reduced negative thoughts and more organized thinking with task completion. My pdoc said Emsam can causes increased energy before it reduces depressive symptoms. I'm happy with the energy it has given me since I have done very little for the last 6 months.
I keep reading about Amisulpride being great for
depression like I have, with symptoms of anhedonia and social anxiety, and wonder about this drug as being a possibility for me in the future. I'm starting to gather info on it for this reason. Did you ever try it?BTW, when I was on NArdil I was on 15 mg twice a day, for total of 30 mg.
I'll be following your post with hopes for success since I know when it works it can be a good one. I think I got 3 years from it. Better than most for me...SG
Posted by CrimsonVik on November 29, 2006, at 17:57:26
In reply to Nardil - hopeful, posted by SLS on November 22, 2006, at 4:42:58
Interesting you're on Topamax...the pharmacist said my Topa came up today as contraindicated to the Nardil he's ordering me.
Nobody here seems to have it in stock.
C.
Posted by SLS on November 29, 2006, at 18:05:58
In reply to Re: Nardil - hopeful » SLS, posted by CrimsonVik on November 29, 2006, at 17:57:26
> Interesting you're on Topamax...the pharmacist said my Topa came up today as contraindicated to the Nardil he's ordering me.
I've never heard that. Do you know why?
- Scott
Posted by CrimsonVik on November 29, 2006, at 21:38:53
In reply to Re: Nardil - hopeful » CrimsonVik, posted by SLS on November 29, 2006, at 18:05:58
No. I'd used Paxil in Oct. and that's contra. No shock there.
I'll ask the Dr. next week if I think to.
C.> > Interesting you're on Topamax...the pharmacist said my Topa came up today as contraindicated to the Nardil he's ordering me.
>
> I've never heard that. Do you know why?
>
>
> - Scott
>
>
Posted by gardenergirl on November 29, 2006, at 23:35:28
In reply to Re: Nardil - hopeful » CrimsonVik, posted by SLS on November 29, 2006, at 18:05:58
I took Topamax with Nardil. I had no problems with the combo, though the Topamax made me more depressed.
It's not contraindicated according to Epocrates.gg
Posted by CrimsonVik on December 1, 2006, at 0:47:20
In reply to Re: Nardil - hopeful » SLS, posted by gardenergirl on November 29, 2006, at 23:35:28
This is the end of the thread.
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