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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by Althea8869 on February 27, 2004, at 11:07:23
Im curious about others experience and thoughts on the following:
Currently on Wellbutrin @300mg - doing nothing for me, Remeron was a bust, so was prozac, celexa & lexapro. Im thinking of either augmenting wellbutrin (with lithium, lamictal, pindolol or buspirone)
OR
Trying a TCA(desipramine, nortriptyline or clomipramine seem clinically the most popular), which I have never done. Can a TCA be added safely to Wellbutrin? Also, If I have failed on Remeron, does this mean its more likely I will fail on a TCA given there is some similarity in their actions on the brain.Any thoughts on this from those that have been down this road would be so greatly appreciated.
Thanks in advance.
Posted by zeugma on February 27, 2004, at 16:17:33
In reply to Some TCA/Wellbutrin Questions - Concerns, posted by Althea8869 on February 27, 2004, at 11:07:23
> Im curious about others experience and thoughts on the following:
> Currently on Wellbutrin @300mg - doing nothing for me, Remeron was a bust, so was prozac, celexa & lexapro. Im thinking of either augmenting wellbutrin (with lithium, lamictal, pindolol or buspirone)
> OR
> Trying a TCA(desipramine, nortriptyline or clomipramine seem clinically the most popular), which I have never done. Can a TCA be added safely to Wellbutrin? Also, If I have failed on Remeron, does this mean its more likely I will fail on a TCA given there is some similarity in their actions on the brain.
>
> Any thoughts on this from those that have been down this road would be so greatly appreciated.
> Thanks in advance.Augmentation is a good idea when the main drug is working, but things aren't quite there yet. Augmenting a drug that's a "bust" doesn't sound like a good idea; why not get rid of the Wellbutrin, if it's really useless for you?
And TCA's and WB do not mix at all. WB, like many other of the newer AD's, blocks the crucial metabolic pathways that process the TCA's, leading to a potentially quite dangerous buildup of TCA in the blood.
Remeron, in my opinion, is not a good probe to see if your depression is TCA-sensitive. True, it's sedating, as are many TCA's. But I'll put it this way: I don't believe Remeron would have been discovered to be an 'antidepressant' if people hadn't been looking real hard to see such an effect. The TCA's on the other hand were discovered to be antidepressants before anyone had really known there were such things. A drug that is powerful enough to be discovered by serendipity is a different proposition from a drug developed in its wake by a pharmaceutical company that has a major financial stake in developing a drug with a fresh patent.
Posted by Althea8869 on February 27, 2004, at 17:23:42
In reply to Re: Some TCA/Wellbutrin Questions - Concerns » Althea8869, posted by zeugma on February 27, 2004, at 16:17:33
Wow - thank you zeugma. Thats some seriously well thought out advice. Regarding remeron, I tend to agree with you - I think many people who suffer from depression induced insomnia sleep so well on remeron that this alone can improve mood. Ive never been in that camp.
Given your response, I'll post one follow up question: Which TCA offers the best side effects/efficacy profile for severe depression, melancholic with anhedonia. Ive done a fair share of reading and it seems to point to clomipramine first, followed by either Nortriptyline or Desipramine. Desipramine seems to have the best side effect/tolerance profile of the group.
Again thank you in advance for any advice.
Posted by zeugma on February 27, 2004, at 19:38:31
In reply to Re: Some TCA/Wellbutrin Questions - Concerns » zeugma, posted by Althea8869 on February 27, 2004, at 17:23:42
Althea,
the only TCA I've ever taken is nortriptyline. I've also read that clomipramine is the most effective TCA (possibly most effective AD) but it also has a steeper side-effect profile than nortriptyline or desipramine. Nortriptyline has the 'therapeutic window', a plasma concentration range which defines the optimal concentration for a given person. If nothing else, it provides a strong placebo response when one undergoes the ceremony of having your blood drawn and sent to a distant lab for determination of what the ideal dose is for you. I know that after I went through all that last year and had my dosage adjusted as a result, I started feeling a whole lot better.
Clomipramine is clearly the most serotonergetic of the TCA's, and desipramine is the most noradrenergic and activating. Nortriptyline is somewhere in between but much closer to desipramine than clomipramine. Plus it has that famous therapeutic window.
Posted by Althea8869 on February 27, 2004, at 20:06:28
In reply to Re: Some TCA/Wellbutrin Questions - Concerns » Althea8869, posted by zeugma on February 27, 2004, at 19:38:31
Really appreciate the info Zeugma. I've always been lucky with regard to side effects. Never seem to get them as bad as others(knock on wood) so im going to try to get my doc to try either Clomipramine or Nortriptyline. With desipramine as my third choice.
Thanks again Zeugma.
Posted by zeugma on February 28, 2004, at 10:18:39
In reply to Re: Some TCA/Wellbutrin Questions - Concerns » zeugma, posted by Althea8869 on February 27, 2004, at 20:06:28
> Really appreciate the info Zeugma. I've always been lucky with regard to side effects. Never seem to get them as bad as others(knock on wood) so im going to try to get my doc to try either Clomipramine or Nortriptyline. With desipramine as my third choice.
> Thanks again Zeugma.Althea, that makes a lot of sense. I hope that one of those drugs works out for you.
keep us updated.
z
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