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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by JohnBoy2000 on November 4, 2016, at 3:55:29
Currently on mirtazapine and bupropion/wellbutrin.
I found wellbutrin very good at 300 mg.
450 mg it sedates me; 150 mg it's not potent enough.
300 is good, but overall, not enough.I found mirtazapine beneficial, particularly from the point of view of inducing somnolance.
I also found the higher doses more effect/sedating - I'm aware some don't find this to be the case.
And it allows me to eat - fantastic.Chronic fatigue is the main symptom, so serotonin is not effective.
I'm on the fence about dopamine thus far (effexor was previously activating at 225mg, sedating at 300mg - the dose dopamine kicks in at), but noradrenergics work, every time.So - I think replacing the mirtazapine with a more potent noradrenergic.
The names I've got so far are:
Maprotiline (tetra0
Mianserin (tetra)
Lofepramine (tricyclic)
NortriptylineThere's also the option of making the addition of a third drug to the mix, to compliment bupropion; perhaps reboxetine (listed in stahls combination treatment list), or atomoxetine.
Now - drugs.com has very few reviews of the two other tetracyclics, maprotiline and mianserin, and difficult to find information on them in general.Avoiding mACH receptors may be a preference, due to their sedating properties.
Noradrenaline is really the only neurochemical I wish to target.Anyone experienced in pharmacology or with these meds have insight?
Posted by SLS on November 4, 2016, at 6:13:48
In reply to More potent noradrenergic/norepinephrine agents?, posted by JohnBoy2000 on November 4, 2016, at 3:55:29
I would try desipramine for norepinephrine (NE) reuptake inhibition. If you have no reason to discontinue Remeron, you can consider might first bring the level up to 45-90 mg/day. Before switching to, or adding, desipramine.
- Scott
Posted by JohnBoy2000 on November 4, 2016, at 7:22:38
In reply to Re: More potent noradrenergic/norepinephrine agents? » JohnBoy2000, posted by SLS on November 4, 2016, at 6:13:48
> I would try desipramine for norepinephrine (NE) reuptake inhibition. If you have no reason to discontinue Remeron, you can consider might first bring the level up to 45-90 mg/day. Before switching to, or adding, desipramine.
>
>
> - ScottDesipramine is not available here in the UK.
It cannot be sourced.I am currently on 45 mg remeron.
I tried 60 mg previous, to a very poor effect - heavy sedation that did not lift after weeks, a return on the symptoms I'm attempted to alleviate, IBS, fatigue, lethargy etc - though I was also on 225 mg effexor at the time, which I have since replaced with 300 mg bupropion.
Posted by SLS on November 4, 2016, at 21:41:32
In reply to Re: More potent noradrenergic/norepinephrine agents?, posted by JohnBoy2000 on November 4, 2016, at 7:22:38
> Desipramine is not available here in the UK.
> It cannot be sourced.What about dosulepin, (dothiepin; Prothiaden)? I don't know much about it.
- Scott
Posted by rjlockhart37 on November 8, 2016, at 14:12:38
In reply to More potent noradrenergic/norepinephrine agents?, posted by JohnBoy2000 on November 4, 2016, at 3:55:29
there's strattera and roboxetine which are both noradrenergic agents, NRI's : altough I've heard strattera has side effects that are not pleasant, it also increases a small amount of serotonin
I would look into getting started on robexetine, but if your on wellbutrin.....wellbutrin can skyrocket anxiety, adding robeztine would triple the noradrenergic effects - ask your doctor but be careful with adding norepinephrine agents to wellbutrin because of the anxiety could be created
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