Psycho-Babble Medication Thread 6943

Shown: posts 1 to 22 of 22. This is the beginning of the thread.

 

Add pindolol to serzone, wellbutrin and cytomel

Posted by Ash on June 2, 1999, at 11:01:08

Hello everyone,

I am on of those treatment-resistant depressives ( 50 yo male) who has tried a multitude of medications over the last 19 years. Nothing has worked for the depression, although some medications have helped to the extent that I am able to be somewhat functional instead of staying in bed all day.

My current regimen is 3x150 mg/day of Serzone along with Wellbutrin SR 3x100mg. The latter was added by my pdoc to give me some more energy during the day. For hypothyroidism, I take 100mcg of Synthroid(T4) together with 10mcg of Cytomel(T3) prescribed by my endo doc. This combo has had a noticeable improvement in my feeling of lethargy although the effect on the depression has been marginal at best.

To boost the A/D effect, my pdoc and I have been considering various approaches. My endocronologist (head of internal medicine at a University hospital) will not permit an increase in T3 to 25-50mcg, as he says that recent studies have shown that adding too much T3 has a long term deleterious effect on the incidence of coronary disease. Previously I was on 25mcg of T3 for a few months with no noticeable improvements. Boosting the WB SR dose is also out because of a previous seizure on high doses of WB. Finally more Serzone makes me too sleepy.

We come now to the other augentation agsnts, of which Pindolol seems to be among the more popular ones among pdocs. My questions are : Is there any reason I should avoid adding Pindolol to my drug cocktail? Anyone with experience with this or a similar comnbination? Any other approaches anyone can suggest?

Thanks in advance.

Ash

 

Re: Add pindolol to serzone, wellbutrin and cytomel

Posted by Elizabeth on June 2, 1999, at 12:53:26

In reply to Add pindolol to serzone, wellbutrin and cytomel, posted by Ash on June 2, 1999, at 11:01:08

Hi there.

Pindolol seems more useful as an antidepressant accelerator (i.e., to make them start working faster) than as an augmenter. However, I've heard of it being used as an addition to a partially-successful antidepressant therapy with success as well, turning partial responders into full responders. (It only works with ADs that affect serotonin, BTW.)

What other stuff have you tried, out of curiosity?

 

Re: Add pindolol to serzone, wellbutrin and cytomel

Posted by Ash on June 2, 1999, at 13:45:51

In reply to Re: Add pindolol to serzone, wellbutrin and cytomel, posted by Elizabeth on June 2, 1999, at 12:53:26

Hello Elizabeth,

Thanks for your quick response.

Staring in 1986, I have been on various TCA's, followed by MAOI's(Parnate, Nardil),combination TCA's and MAOI's, most of the SSRI's/SNRI's (Prozac, Zoloft, Effexor, wellbutrin, Serzone, Luvox, Remeron) and cylert and ritalin. Unless the meds caused me to become a total zombie, each drug was tried at the max recommended dose for 3-6 months before giving up. Haven't been on Celexa or tried ECT.

Do you have some suggestion for me other than adding pindolol?

Thanks.

Ash

 

Re: Add pindolol to serzone, wellbutrin and cytomel

Posted by Wayne R. on June 2, 1999, at 18:21:44

In reply to Re: Add pindolol to serzone, wellbutrin and cytomel, posted by Ash on June 2, 1999, at 13:45:51

Ash, I have had similar experiences. I tried Pindolol as an augmentation one time and it worked over night! However, its effectiveness disappeared in 4 days. See my postings here beginning in February regarding augmenting and SSRI AD with Naltrexone. This has been like a miracle for me after being on the med roller coaster for 25 years. Best regards... Wayne

 

Re: Add pindolol to serzone, wellbutrin and cytomel

Posted by Elizabeth on June 2, 1999, at 18:22:57

In reply to Re: Add pindolol to serzone, wellbutrin and cytomel, posted by Ash on June 2, 1999, at 13:45:51

You've tried a lot of the standard antidepressants. What I could suggest sort of depends on your symptoms, but here are some possible augmentation strategies:

-lithium: very good evidence for this (though not specifically with Serzone or Wellbutrin, I don't think)
-BuSpar: push the dose, up to 90mg, if it doesn't work at lower doses
-anticonvulsants: Lamictal in particular seems to be an antidepressant for many people
-naltrexone: controversial (little evidence other than case reports), but sometimes it seems to work wonders
-"alternative" approaches: the two things that I would consider are omega-3 fatty acids and SAMe. Ask doctors which brands they would use.

The pindolol seems like a pretty good idea, actually, though. How's your blood pressure? You don't have a history of asthma, do you? Those are the only things I can think of that would really count against it.

If you do try pindolol, I'm sure people here would be interested to hear how it turns out.

The other possibility is reconsidering the diagnosis. Sometimes I think depression is diagnosed quickly because it's so common, and other things can be missed. I'm blanking out on what "other things" might be in your case; it's just a general statement. :-}

Well anyway, good luck to you!

 

Re: Add pindolol to serzone, wellbutrin and cytomel

Posted by James on June 27, 1999, at 19:24:39

In reply to Re: Add pindolol to serzone, wellbutrin and cytomel, posted by Elizabeth on June 2, 1999, at 18:22:57

> You've tried a lot of the standard antidepressants. What I could suggest sort of depends on your symptoms, but here are some possible augmentation strategies:
>
> -lithium: very good evidence for this (though not specifically with Serzone or Wellbutrin, I don't think)

I have been treated with Wellbutrin (3x150 SR/day) with only moderate effect. Within three days of adding lithium (2x 150/day I think) I found much greater releif of depression, but with a
slight mood 'flattening' effect, but no serious interactions

 

Re: Add pindolol to serzone, wellbutrin and cytomel

Posted by Ash on July 1, 1999, at 19:01:07

In reply to Add pindolol to serzone, wellbutrin and cytomel, posted by Ash on June 2, 1999, at 11:01:08

Thanks much to all who responded. Wayne, I will keep the naltrexone suggestion in mind. James and Elizabeth re: your lithium suggestion, I forgot to mention in my earlier post that I have also tried Lithium to augment other A/D's a few years back ( over 600mg/day). All it did for me was cause me to run to the bathroom every half hour or so... until I got so tired waking up 10 plus times a night that I had to discontinue it.

Elizabeth, your comment on comorbid conditons masquerading as or causing depression is very perceptive. I have known for years that I have anywhere from mild to severe sleep apnea (OSA) depending on when and where the sleep study was done, and periodic leg movements (PLMD) in sleep. The latter is controlled by anti-parkinson's meds. Unfortnuately I am one of those rare individuals who have not benefited from continous positive air pressure (CPAP)therapy. I currently have between 20 and 40 arousals from sleep every hour at night (long story)and never get into deep sleep. Sort of a chicken and egg situation -- which came first the sleep disorder or depression?

Anyhoo, my latest A/D regimen is Serzone (450mg), Wellbutrin SR (300mg), Buspar (30mg) plus a bunch of meds for other conditions. So far, no benefit...sigh.. but it's only been two weeks.

Ash

 

Re: Add pindolol to serzone, wellbutrin and cytomel

Posted by Chas. on July 1, 1999, at 20:02:02

In reply to Re: Add pindolol to serzone, wellbutrin and cytomel, posted by Ash on July 1, 1999, at 19:01:07


> You certainly have tried just about everything under the sun but I did'nt see if you tried Deprenyl or not. I noticed that you were taking a Parkinsons medication what was it? I wish I had the time to show you the reference I found on Deprenyl. Any basically 10 treatment resistant depressives were put on Deprenyl 10mg. daily along with 1500mg of L-Phenylalanine. Supposedly almost all of them experienced quick and dramatic relief of their depressions. If I find time later I will post the site. Anyway its worth a try maye it will help.

 

Re: Serzone +Buspar warning.

Posted by JohnL on July 2, 1999, at 3:17:24

In reply to Re: Add pindolol to serzone, wellbutrin and cytomel, posted by Ash on July 1, 1999, at 19:01:07


>
> Anyhoo, my latest A/D regimen is Serzone (450mg), Wellbutrin SR (300mg), Buspar (30mg) plus a bunch of meds for other conditions. So far, no benefit...sigh.. but it's only been two weeks.
>
> Ash


Just a sidenote Ash. I read that caution is advised in coadministering Serzone and Buspar because they inhibit the exact same enzymes that break them down, leading to higher concentrations of each and possibly more side effects. Headaches and insomnia were specifically cited. Hope you're doing well. Just wanted you to be aware of the possible harmful interaction between the two. I was amazed too at how fast you got up to those doses in just two weeks. That's not abnormal, I'm just so sensitive I have to go much slower. Anyway, I'm wishing you some great days ahead. JohnL.

 

Re: Add pindolol to serzone, wellbutrin and cytomel

Posted by Elizabeth on July 2, 1999, at 4:24:12

In reply to Re: Add pindolol to serzone, wellbutrin and cytomel, posted by Ash on July 1, 1999, at 19:01:07

> Elizabeth, your comment on comorbid conditons masquerading as or causing depression is very perceptive. I have known for years that I have anywhere from mild to severe sleep apnea (OSA) depending on when and where the sleep study was done, and periodic leg movements (PLMD) in sleep. The latter is controlled by anti-parkinson's meds. Unfortnuately I am one of those rare individuals who have not benefited from continous positive air pressure (CPAP)therapy. I currently have between 20 and 40 arousals from sleep every hour at night (long story)and never get into deep sleep. Sort of a chicken and egg situation -- which came first the sleep disorder or depression?

Yeah! I know that my attention problems (sub-ADD) are most pronounced when I'm sleep-deprived as well as when I'm depressed.

Are there any alternatives for OSA? I don't know too much about the treatment of this disorder.

 

Re: Add pindolol to serzone, wellbutrin and cytomel

Posted by Ash on July 5, 1999, at 17:33:10

In reply to Add pindolol to serzone, wellbutrin and cytomel, posted by Ash on June 2, 1999, at 11:01:08

Hi Chas, JohnL and Elizabeth,

For Chas: Could you provide any references on deprenyl in the future? Is it a primary A/D or augments other A/D's? For PLMD I am using Permax (pergolide), after trying Sinemet and Klonopin unsuccesfully. Sleep studies have confirmed that the PLMD is fully controlled now.

JohnL: My psych doc told me that Buspar is quite benign in terms of minimal interaction with other meds. I couldn't find any Serzone-Buspar reaction in the product literature either. Perhaps you have some other source of information.

Elizabeth: I am going to Stanford Sleep Disorders clinic, the granddaddy of them all, so I feel (I hope?) I am in "good hands". BTW Elizabeth,I must commend you for your informative and sympathetic replies to so many posters, especially when it is evident from your own posts, that you are having to struggle with your own problems.

Thanks to all of you.

Ash


 

Re: Add pindolol to serzone, wellbutrin and cytomel

Posted by JohnL on July 9, 1999, at 2:05:24

In reply to Re: Add pindolol to serzone, wellbutrin and cytomel, posted by Ash on July 5, 1999, at 17:33:10

> Hi Chas, JohnL and Elizabeth,
>
> For Chas: Could you provide any references on deprenyl in the future? Is it a primary A/D or augments other A/D's? For PLMD I am using Permax (pergolide), after trying Sinemet and Klonopin unsuccesfully. Sleep studies have confirmed that the PLMD is fully controlled now.
>
> JohnL: My psych doc told me that Buspar is quite benign in terms of minimal interaction with other meds. I couldn't find any Serzone-Buspar reaction in the product literature either. Perhaps you have some other source of information.
>
> Elizabeth: I am going to Stanford Sleep Disorders clinic, the granddaddy of them all, so I feel (I hope?) I am in "good hands". BTW Elizabeth,I must commend you for your informative and sympathetic replies to so many posters, especially when it is evident from your own posts, that you are having to struggle with your own problems.
>
> Thanks to all of you.
>
> Ash

Ash, I'm sorry, I can't recall where I read about caution with Serzone+Buspar. I was considering Serzone for a second trial and was doing a word search on it when I stumbled on to some piece of information somewhere. If I can find it, I will let you know. Sorry I couldn't be more help. JohnL.

 

Serzone and Buspar

Posted by Elizabeth on July 11, 1999, at 18:53:11

In reply to Re: Add pindolol to serzone, wellbutrin and cytomel, posted by JohnL on July 9, 1999, at 2:05:24

Ash,

I don't believe there are any interactions between these two drugs. Buspar is neither a substrate nor an inhibitor of the cytochrome p450 enzymes that cause so much trouble with interactions, so it really doesn't have pharmacokinetic interactions with much of anything.

Good luck with things....

 

Serzone +Buspar warning confirmed

Posted by Erin on July 13, 1999, at 1:29:10

In reply to Re: Serzone +Buspar warning., posted by JohnL on July 2, 1999, at 3:17:24

I was prescribed Buspar today by my doctor and was rather alarmed when I read on the buspar homepage (http://buspar.com) that buspar negatively interacts with Serzone (Nefazodone). I called the doctor on call (at 11:30 PM tonight) and he confirmed what I had read. I think it's time to switch doctors-

To read the full rundown on Serzone and Buspar interaction go to: http://www.buspar.com/prodinfo.htm
(look for Nefazodone aka Serzone interactions).I don't understand what all of it means but I do know that when I took both my Serzone and Buspar together tonight I felt extremely lightheaded which is one of the interaction side-effects mentioned.

Erin

 

Re: Serzone +Buspar warning confirmed

Posted by elizabeth on July 13, 1999, at 15:46:13

In reply to Serzone +Buspar warning confirmed, posted by Erin on July 13, 1999, at 1:29:10

Ahh, thank you Erin. This is important to know, since Serzone is often prescribed for anxiety or anxious depression, and Buspar is labelled for anxiety.

According to the updated PI, Buspar is metabolized into 1-pyrimidinylpiperazine (1-PP) by CYP3A4, an enzyme inhibited by nefazodone. Therefore, buspirone levels will be higher and 1-PP levels lower if Buspar and Serzone are taken together. Therefore, they recommend starting at a very low dose of Buspar (i.e., starting at 2.5mg bid) if you're on Serzone as well.

 

Re: Serzone +Buspar warning confirmed

Posted by Elizabeth on July 13, 1999, at 21:25:29

In reply to Re: Serzone +Buspar warning confirmed, posted by elizabeth on July 13, 1999, at 15:46:13

Elizabeth-

I didn't understand all of the medical terminology relating to the interaction between Buspar and Nefazodone. Could you possibly explain it in non-medicalese?

> According to the updated PI, Buspar is metabolized into 1-pyrimidinylpiperazine (1-PP) by CYP3A4, an enzyme inhibited by nefazodone. Therefore, buspirone levels will be higher and 1-PP levels lower if Buspar and Serzone are taken together.

> Therefore, they recommend starting at a very low dose of Buspar (i.e., starting at 2.5mg bid) if you're on Serzone as well.

Does this mean that you can take Buspar with Serzone?

Thanks for the clarification, I am really confused about this and don't feel comfortable talking to my doctor (fairly obvious from my last post).

Erin


 

Re: Serzone +Buspar warning confirmed

Posted by Erin on July 14, 1999, at 1:22:51

In reply to Re: Serzone +Buspar warning confirmed, posted by Elizabeth on July 13, 1999, at 21:25:29

Elizabeth-

I just checked the message board and imagine my surprise when I saw that the message that I wrote to you appeared under your name instead of mine. So sorry about that, I'm not quite sure what happened.

My apologies,
Erin

 

Re: Serzone +Buspar warning confirmed

Posted by Ash on July 14, 1999, at 1:28:50

In reply to Re: Serzone +Buspar warning confirmed, posted by elizabeth on July 13, 1999, at 15:46:13

Elizabeth,

I also need to understand this Serzone-Buspar interaction you and Erin described. I started at 7.5mg bid and after a week went to 15 bid. The latter is the typical dosage for anxiety. As posted originally, the Buspar is to augment 450mg serzone plus 300 mg Wellbutrin SR. I've been taking the latter combination for about 3 months prior.

I haven't noted anything significantly different, positive or otherwise- except perhaps for some occasional lightheadedness on rising from a prone position- since I started the Buspar.

Does the warning mentioned by Erin mean that that Buspar should not be taken with Serzone?

Thanks for your help.

Ash

 

Re: Serzone +Buspar, Ash

Posted by JohnL on July 14, 1999, at 4:24:29

In reply to Re: Serzone +Buspar warning confirmed, posted by Ash on July 14, 1999, at 1:28:50

> Elizabeth,
>
> I also need to understand this Serzone-Buspar interaction you and Erin described. I started at 7.5mg bid and after a week went to 15 bid. The latter is the typical dosage for anxiety. As posted originally, the Buspar is to augment 450mg serzone plus 300 mg Wellbutrin SR. I've been taking the latter combination for about 3 months prior.
>
> I haven't noted anything significantly different, positive or otherwise- except perhaps for some occasional lightheadedness on rising from a prone position- since I started the Buspar.
>
> Does the warning mentioned by Erin mean that that Buspar should not be taken with Serzone?
>
> Thanks for your help.
>
> Ash


Hi Ash. As I understand it, the interaction of the two drugs is just as Elizabeth described. It doesn't mean they have to be discontinued, it means "caution is warranted during co-adminstration due to the possibility of increased side effects". Just watch for excessive side effects. That's all. So far all seems OK with you. We're all different. Best to you, JohnL.

 

Buspar warning and question

Posted by Erin on July 18, 1999, at 23:02:32

In reply to Serzone +Buspar warning confirmed, posted by Erin on July 13, 1999, at 1:29:10

I talked with a different doctor last week and found out that Buspar essentially amplifies the effects of Serzone. I guess the two can be taken together but that the dosage of Buspar should be significantly reduced. My doctor reduced my dosage of Buspar from 15 to 5 mg (2.5 mg twice a day).

I haven't been taking even the lower dosage of Buspar because I find that it makes me extremely lightheaded and somewhat nauseous. Anyone else out there taking Buspar who experienced these same symptoms? Did they go away after a while?

Thanks for any replies-
Erin

 

Re: Buspar warning and question

Posted by Elizabeth on July 19, 1999, at 9:36:33

In reply to Buspar warning and question, posted by Erin on July 18, 1999, at 23:02:32

> I talked with a different doctor last week and found out that Buspar essentially amplifies the effects of Serzone.

Actually I think it's the other way around.

>I guess the two can be taken together but that the dosage of Buspar should be significantly reduced. My doctor reduced my dosage of Buspar from 15 to 5 mg (2.5 mg twice a day).

That's what the manufacturer recommends, yes (they're both made by the same company BTW).

> I haven't been taking even the lower dosage of Buspar because I find that it makes me extremely lightheaded and somewhat nauseous. Anyone else out there taking Buspar who experienced these same symptoms? Did they go away after a while?

Those are the main side effects of Buspar, and yes, they do go away after a while. Did you at least try taking the low dose?

 

Re: Buspar warning and question

Posted by Ash on July 19, 1999, at 10:32:11

In reply to Buspar warning and question, posted by Erin on July 18, 1999, at 23:02:32

Erin, Elizabeth:

An update, FYI....

More than a month after starting the Buspar, my usually moderate nasal congestion had started becoming so severe that I had a hard time beathing during sleep, and was constantly getting up at night. Since nothing else had changed, I decided to reduce the Buspar. I think this has helped moderate the congestion.

In the last few days, I started acting like a zombie, sleeping 18 hrs a day with even more depression and zero energy.

Since I take so many meds, more than likely these symoptoms are just a coincidence. Right now I am almost off the Buspar since I haven't noticed any improvement.

Ash


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