Psycho-Babble Medication Thread 358766

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strattera AND effexor AND wellbutrin?

Posted by lisaj32 on June 21, 2004, at 19:29:21

I've been on effexor and wellbutrin for quite some time and they helped my mood a lot, but I got tired of getting fired from jobs due to my ADD. Two weeks ago we added strattera to the mix. The past few days I've felt PSYCHO. Jittery, tremor-y, sweaty, anxious and depressed. Ride it out? or WHAT WERE YOU THINKING, THAT'S A BAD MIX?

 

Re: strattera AND effexor AND wellbutrin? » lisaj32

Posted by psychosage on June 21, 2004, at 19:45:29

In reply to strattera AND effexor AND wellbutrin?, posted by lisaj32 on June 21, 2004, at 19:29:21

what are your doses?

That is odd. No doctor I have known would put someone on all of them at once. is this a psychiatrist? Does this person specialize in ADD?

that is a lot of norepinephrine effect.

wellbutrin and strattera, though quite different, both have very similar effects on NE according to my pdoc and combining them would not be smart with most people.

Effexor works on NE at higher doses at 150mg+

your pdoc should cross taper you on your meds, and he or she needs to be able to know how a med is doing on its own roughly each time you try something new.

for most people, when something does not work they get off it instead of leaving it there.

are you taking WB or Efex for anything else?

You should check out Dr. Amen's website to see what kind of ADD you have because some meds are better than others for certain types that coexist with depression or epilepsy, etc.

Good luck!

 

Re: strattera AND effexor AND wellbutrin?

Posted by lisaj32 on June 21, 2004, at 19:56:02

In reply to Re: strattera AND effexor AND wellbutrin? » lisaj32, posted by psychosage on June 21, 2004, at 19:45:29

> what are your doses?
>
> That is odd. No doctor I have known would put someone on all of them at once. is this a psychiatrist? Does this person specialize in ADD?
>
> that is a lot of norepinephrine effect.
>
> wellbutrin and strattera, though quite different, both have very similar effects on NE according to my pdoc and combining them would not be smart with most people.
>
> Effexor works on NE at higher doses at 150mg+
>
> your pdoc should cross taper you on your meds, and he or she needs to be able to know how a med is doing on its own roughly each time you try something new.
>
> for most people, when something does not work they get off it instead of leaving it there.
>
> are you taking WB or Efex for anything else?
>
> You should check out Dr. Amen's website to see what kind of ADD you have because some meds are better than others for certain types that coexist with depression or epilepsy, etc.
>
> Good luck!
>
>

Thanks. The doses are
Effexor SR = 300mg
Wellbutrin SR = 100mg
Strattera = 80mg

The Effexor was just for depression, but the doc chose it knowing I was having trouble concentrating and focusing. They added the Wellbutrin while I was in rehab to help with cravings, which it did, and my mood seemed to be doing really well so we just left it there.

This is a new doc, yah, a psychiatrist. When we talked about adding the Strattera she was a little worried about putting it with Effexor but she looked in a leeetle book and said it was ok.

I don't like feeling this way but if the side effects are apt to pass I'm willing to ride it out. I have predominantly inattentive ADD, just diagnosed after I screwed up another job.

Thanks for your reply.

 

Re: strattera AND effexor AND wellbutrin? » lisaj32

Posted by King Vultan on June 22, 2004, at 8:06:26

In reply to Re: strattera AND effexor AND wellbutrin?, posted by lisaj32 on June 21, 2004, at 19:56:02


> >
> >
>
> Thanks. The doses are
> Effexor SR = 300mg
> Wellbutrin SR = 100mg
> Strattera = 80mg
>
> The Effexor was just for depression, but the doc chose it knowing I was having trouble concentrating and focusing. They added the Wellbutrin while I was in rehab to help with cravings, which it did, and my mood seemed to be doing really well so we just left it there.
>
> This is a new doc, yah, a psychiatrist. When we talked about adding the Strattera she was a little worried about putting it with Effexor but she looked in a leeetle book and said it was ok.
>
> I don't like feeling this way but if the side effects are apt to pass I'm willing to ride it out. I have predominantly inattentive ADD, just diagnosed after I screwed up another job.
>
> Thanks for your reply.
>


Maybe because I've done so much reading at Dr. Preskorn's site (www.preskorn.com), my concern in combinations like this is always the CYP-450 enzyme interactions, particularly, the ones involving the 2D6 enzyme. Now, unfortunately, all of these drugs are metabolized by 2D6, and one of them (Wellbutrin) is a strong inhibitor of this enzyme, while another (Effexor) is a moderate inhibitor, if I remember correctly.

The concern in this case is that even though the dosage of Wellbutrin is thankfully rather low, there is likely still at least some increase in blood plasma level of the other drugs. I don't know how significant this might be, but the dosage of Strattera is already pretty high to begin with. Refer your doctor to the drug insert packet that comes with Wellbutrin and the example given involving 300 mg Wellbutrin SR and 50 mg desipramine, which is a classic 2D6 substrate. My own experience was that 150 mg Wellbutrin SR/day increased the blood plasma levels of desipramine by a factor of about 3 times more than they would have been taking the desipramine by itself. Applying this same reasoning to your situation, the 100 mg of Wellbutrin might possibly be doubling the effect of the Strattera, as well as increasing the effect of the Effexor, for that matter.

As mentioned, you do seem to be taking a lot of stuff. I question the wisdom of combining these three drugs and would perhaps consider some other combination. A fellow I work with takes 2 x 200 Wellbutrin SR and 2 x 15 mg Ritalin/day for ADD, and this seems to be a good combination for him, but he does not have your depression issues. Whatever you do, just keep in mind that there are med interactions that can alter the effectiveness of a particular dose of a drug, and the more drugs in a cocktail, the more of a concern this is.

Todd

 

Re: strattera AND effexor AND wellbutrin? » King Vultan

Posted by lisaj32 on June 22, 2004, at 10:17:55

In reply to Re: strattera AND effexor AND wellbutrin? » lisaj32, posted by King Vultan on June 22, 2004, at 8:06:26

Thanks,Todd. I don't understand all the biochemistry stuff--psychopharmacology was the one course I should have taken in grad school that I didn't. But clearly my pdoc made a hasty decision on this one and didn't consider interaction effects beyond the question of would she get sued for doing something the books say not to.

Whatever her limitations, she's all I've got right now in terms of available pdocs. I'm going to call her today and see what she suggests. It's very hard for me to give up on Strattera, as I so much NEED something that will help me focus. I've avoided stimulants because I was addicted to a stimulant--cocaine--though I've been clean for 3 1/2 years.

I'm really struggling, but today I feel that I can function and I don't have suicidal thoughts, which is a big improvement over yesterday. Which I spent playing computer solitaire and telling myself this too, my friend, shall pass.

--Lisa

 

Re: provigil - cocaine? » lisaj32

Posted by psychosage on June 22, 2004, at 15:17:03

In reply to Re: strattera AND effexor AND wellbutrin? » King Vultan, posted by lisaj32 on June 22, 2004, at 10:17:55

> Thanks,Todd. I don't understand all the biochemistry stuff--psychopharmacology was the one course I should have taken in grad school that I didn't. But clearly my pdoc made a hasty decision on this one and didn't consider interaction effects beyond the question of would she get sued for doing something the books say not to.
>
> Whatever her limitations, she's all I've got right now in terms of available pdocs. I'm going to call her today and see what she suggests. It's very hard for me to give up on Strattera, as I so much NEED something that will help me focus. I've avoided stimulants because I was addicted to a stimulant--cocaine--though I've been clean for 3 1/2 years.
>
> I'm really struggling, but today I feel that I can function and I don't have suicidal thoughts, which is a big improvement over yesterday. Which I spent playing computer solitaire and telling myself this too, my friend, shall pass.
>
> --Lisa


i've had stimulant issues myself, and I've been clean from booze and drugs for 2.5 years and haven't done speed in over 3.

Provigil {modafinil} might interest you since it is also used for ADD, and there is research being conducted with it for stimulant abuse.

I do have to warn you that it does have some euphoric effects. I take 100mg a day, but I am also on a mood stabilizer. Are you bipolar?

Good luck.


http://www.pennhealth.com/phys_forum/pto/jan_feb04/glutamate.html

Glutamate Enhancing Agent Found to Blunt Cocaine High


In a controlled study, PENN Behavioral Health psychiatrists demonstrated that a glutamate-enhancing agent blunts the cocaine high experienced by cocaine addicts. A subsequent open-label study also indicated that the drug promotes cocaine abstinence and reduces craving. “About 16 percent of people who try cocaine become addicted and this addiction is driven by a cycle of euphoria and craving which often leads to a binge pattern of use,” says Charles A. Dackis, MD, addiction specialist and chief of psychiatry at the University of Pennsylvania Medical Center-Presbyterian.

{i spent a week in the dual diagnosis ward at presbyterian while at school}

In addition to regular craving, cocaine addicts experience cue craving, an intense craving that occurs when they see something that reminds them of their addiction, such as a person, place or thing. Studies at the University of Pennsylvania Medical Center demonstrated that when shown videos of cocaine paraphernalia, participants who were addicted to cocaine underwent tremendous metabolic changes in the brain. “Although cocaine acutely stimulates the brain, over time a chronically exposed person will experience dysregulation of the pleasure centers in the brain, which appears to include the depletion of two neurotransmitters, glutamate and dopamine,” adds Dr. Dackis, who also works in the University of Pennsylvania Center for Studies on Addiction. “Chronic exposure to cocaine puts cocaine addicts in a negative mood state, termed ‘hedonic dysregulation,’ that involves malfunctioning pleasure circuitry, and they complain that they can’t enjoy life or anything without cocaine.”


Cocaine addicts also have markedly reduced activity in the frontal lobe of the brain, which is largely comprised of glutamate-containing pyramidal cells. Neuropsychological tests that examine frontal lobe function find deficits in cocaine addicts who have impaired executive function, decision-making, ability to weigh risks against benefits, and ability to suppress impulses.


Despite 20 years of intensive research, no drug has been identified with proven ability in cocaine addiction. However, modafinil is the first glutamate enhancing agent to be tested. “The preliminary open-label results are very promising and we are currently testing modafinil in a controlled study. Modafinil is a novel, awakening drug that enhances executive function and concentration. Since it reaches the pleasure centers of the brain, we believe it may reverse some of the long-term affects of cocaine,” explains Dr. Dackis. “And, even more importantly, it has demonstrated an ability to block the cocaine high.”


In the open-label study, 17 cocaine-dependent individuals (with severe cocaine withdrawal) were randomized to receive either 200 or 400 mg/day of modafinil for a period of eight weeks. When compared to a group of placebo-treated subjects from another study, those who received modafinil had significantly higher abstinence (47 percent vs. 6.5 percent) and treatment retention. Both dosages were well tolerated and the four participants who used cocaine in combination with modafinil reported absent or diminished euphoria.


PENN psychiatrists are currently conducting a double blind placebo controlled clinical trial studying modafinil and its affect on cocaine dependence. In addition, the National Institute on Drug Abuse is soon launching a multi-center study (which will likely include PENN as a site) on modafinil and cocaine.


 

 

Re: strattera AND effexor AND wellbutrin? » lisaj32

Posted by King Vultan on June 22, 2004, at 17:12:16

In reply to Re: strattera AND effexor AND wellbutrin? » King Vultan, posted by lisaj32 on June 22, 2004, at 10:17:55

> Thanks,Todd. I don't understand all the biochemistry stuff--psychopharmacology was the one course I should have taken in grad school that I didn't. But clearly my pdoc made a hasty decision on this one and didn't consider interaction effects beyond the question of would she get sued for doing something the books say not to.
>
> Whatever her limitations, she's all I've got right now in terms of available pdocs. I'm going to call her today and see what she suggests. It's very hard for me to give up on Strattera, as I so much NEED something that will help me focus. I've avoided stimulants because I was addicted to a stimulant--cocaine--though I've been clean for 3 1/2 years.
>
> I'm really struggling, but today I feel that I can function and I don't have suicidal thoughts, which is a big improvement over yesterday. Which I spent playing computer solitaire and telling myself this too, my friend, shall pass.
>
> --Lisa


Your pdoc doesn't sound all that bad and seems to at least be trying. I believe that most doctors would not be as familiar as to the nitty gritty of what I'm talking about as I am, and perhaps it really isn't that important. None of the drugs you are taking are particularly dangerous, and I mainly just wanted to suggest that the effective dosage of a drug may be magnified by other drugs in a cocktail. Where this really becomes important is when combining tricyclic antidepressants, which are lethal in overdose, with SSRIs such as Prozac, but I believe even most GPs are aware that this kind of combination is generally supposed to be avoided.

Todd

 

Re: provigil - cocaine?

Posted by lisaj32 on June 24, 2004, at 8:02:14

In reply to Re: provigil - cocaine? » lisaj32, posted by psychosage on June 22, 2004, at 15:17:03

psychosage, that's really good information to have. I've never heard of that medication and will do some more reading on it. I'm not bipolar, just depressive and inattentive.

my pdoc had the audacity to suggest that I'd become depressed because messing up a job is depressing! how dare she! :)

she suggested going back down to 40mg of Strattera and said I could discontinue the Wellbutrin if it made me feel better about things, but she didn't think it was problematic taking them together. she said "go ahead and try them all again and see if it happens again, then we'll know it was a reaction." Easy for HER to say!

I just want to be able to make a living. I have a doctorate and am becoming increasingly unemployable after messing up job after job. Always for not being able to keep up with the paperwork. The quality of my work is great, I just don't get it done.

thanks for your help with this. It really helps just talking about it.

--Lisa


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