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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by tecknohed on December 11, 2006, at 15:01:27
Hi people. Special Hi to those who remember me (& who I didn't p*ss off in some way).
Haven't posted here for nearly a year. Things have got worse than ever since then.
Main symptoms are still Social Phobia/APD, up & down severe depression plus a fatigue LIKE I NEVER THOUGHT POSSIBLE. Dont know WHAT the fatigue is all about. I'm hoping it's a side effect of long term modafinil use & not something worse, though I have my suspicions. I've always had energy problems but this really worries me & is hell to live with.
Still on Nardil - have been for 3 years. On very low dose of Clonazepam, not cause it helps but rather because I 'need' it. Without it I feel hectic inside. And I just come to end of modafinil - I've concluded that it aint no long term solution, not for me. But I have to stop it anyway as my pdoc has just gone ahead & issued me a script of Zyban (UK Bupropion - recently licenced here as an antidepressant, incidently). Not even I would mix the 2.
Anyway, its what I've asked for for ages & all I've ever got is refusals with some sort of explination of how it would be too dangerous with Nardil. In fact My pdoc has told me in the past he'd never even heard of such a combo. Funny how today he said he'd tried it on a few patients combined with MAOIs. Said it may be worth a try, like it was all his idea (I plan to change my doc again soon!).
So who's got any comments on this combo of Nardil & Zyban/Wellbutrin? Whos tried it, knows someone who has, read something about it, etc etc etc...? I can't find any info anywhere.
I've taken my 1st quarter pill but no problems so far...
All responces appreciated.
Posted by tecknohed on December 11, 2006, at 15:33:29
In reply to Nardil+Bupropion Guinea pig, posted by tecknohed on December 11, 2006, at 15:01:27
Just thought I'd add, it's been 2 hours since I took the 1/4 Zyban (=37.5mg) & no major increase in blood pressure. Diastolic up from 62 to 74 mmHg, Solstolic same, Pulse dropped slightly.
But they are sustained release tabs. Anyone know how breaking a tab effects the sustained release?
Posted by Tomatheus on December 15, 2006, at 1:26:34
In reply to Nardil+Bupropion Guinea pig, posted by tecknohed on December 11, 2006, at 15:01:27
Hi Tecknohed,
I'm sorry to hear that your condition has worsened since you posted here last. The optimist in me was hoping that you were still responding favorably to the Nardil-pregnenolone combo that you tried taking around this time last year, but I somehow had the feeling that your response to pregnenolone would unfortunately turn out to be similar to mine (a few days of relief, followed by a return to my baseline state of severe depression).
It's good to hear from you, though, despite the circumstances. And it's encoraging to hear that you're trying different medication combos. I hope that combining Wellbutrin with Nardil will give you the lift that you need to begin functioning somewhat normally again. I can certainly relate to not having the energy to do much of anything, despite trying one treatment strategy after another, and despite making every effort to try to get out of bed and accomplish all (or even a few) of the things that I want to accomplish. So, unfortunately, I know that you're not exaggerating when you say that the extreme fatigue that you've been feeling is hell to live with. And I know that it's generally not recommended to take phenelzine (Nardil) in combination with bupropion (Wellbutrin, Zyban). In fact, as you probably know, the two meds are technically contraindicated. But some cases of depression are more disabling and treatment-resistant than others, and I wouldn't rule out the possibility that you might have a sort of double depression that *requires* the use of an antidepressant combo that might be considered to be "dangerous" in some individuals.
I haven't personally tried taking Nardil in combination with Wellbutrin (or Zyban or generic bupropion), and I'm not sure whether or not anybody who's posted on this board recently is currently on the combo. I know that Ace was thinking about adding Wellbutrin to his medication cocktail (which of course includes Nardil, considering that he's the "Nardil champ"), but I'm don't know for sure whether or not he ultimately ended up taking the Wellbutrin.
Finally, I am not aware of any reports describing the successful combination of phenelzine and bupropion in the peer-reviewed medical/scientific literature. However, I do have one case report in my possession (Pierre & Gitlin, 2000) that summarizes one woman's "gradual return to euthymia with resolution of her long-standing depressive symptoms" following the administration of a bupropion-tranylcypromine (Wellbutrin-Parnate) combo -- 300 mg/day of bupropion and 60 mg/day of tranylcypromine. Attempts to discontinue either the bupropion or the tranylcypromine resulted in a return of the woman's depressive symptoms. The report's authors emphasized the potential benefits of the cautiously prescribing a bupropion-tranylcypromine combo to individuals with treatment-resistant depression. Considering that Parnate (tranylcypromine) is both an MAOI and a monoamine reuptake inhibitor whereas Nardil (phenelzine) is not known to possess any reuptake inhibitory properties, it would be my guess that a Wellbutrin-Nardil combo should be at least as safe as a Wellbutrin-Parnate combo. Whether or not a Wellbutrin-Nardil combo would be as effective as a Wellbutrin-Parnate combo is difficult to determine.
Thanks for posting again. I hope that you might find my response to be of some help.
Tomatheus
==
REFERENCE
Pierre, J. M., & Gitlin, M. J. (2000). Bupropion-tranylcypromine combination for treatment-refractory depression. Journal of Clinical Psychiatry, 61, 450-451.
==
> Hi people. Special Hi to those who remember me (& who I didn't p*ss off in some way).
>
> Haven't posted here for nearly a year. Things have got worse than ever since then.
>
> Main symptoms are still Social Phobia/APD, up & down severe depression plus a fatigue LIKE I NEVER THOUGHT POSSIBLE. Dont know WHAT the fatigue is all about. I'm hoping it's a side effect of long term modafinil use & not something worse, though I have my suspicions. I've always had energy problems but this really worries me & is hell to live with.
>
> Still on Nardil - have been for 3 years. On very low dose of Clonazepam, not cause it helps but rather because I 'need' it. Without it I feel hectic inside. And I just come to end of modafinil - I've concluded that it aint no long term solution, not for me. But I have to stop it anyway as my pdoc has just gone ahead & issued me a script of Zyban (UK Bupropion - recently licenced here as an antidepressant, incidently). Not even I would mix the 2.
>
> Anyway, its what I've asked for for ages & all I've ever got is refusals with some sort of explination of how it would be too dangerous with Nardil. In fact My pdoc has told me in the past he'd never even heard of such a combo. Funny how today he said he'd tried it on a few patients combined with MAOIs. Said it may be worth a try, like it was all his idea (I plan to change my doc again soon!).
>
> So who's got any comments on this combo of Nardil & Zyban/Wellbutrin? Whos tried it, knows someone who has, read something about it, etc etc etc...? I can't find any info anywhere.
>
> I've taken my 1st quarter pill but no problems so far...
>
> All responces appreciated.
Posted by tecknohed on December 16, 2006, at 15:48:02
In reply to Re: Nardil+Bupropion Guinea pig » tecknohed, posted by Tomatheus on December 15, 2006, at 1:26:34
Thanks Thomatheus. Everything you mentioned is spot on. Especially the pregnenolone - waste of time that turned out to be.
I'm already on 150mg/day bupropion now. If I weren't so messed I would have increased much slower. Yet things seem to have got worse. I'm now in solid depression - no ups at all, just constant hatefull thinking, inward disgust, etc...
Its hard to know exactly why this is. Is it caused by bupropion? I'm aware that noradrenergic drugs can do this, its happened with reboxetine before. I doubt the sudden withdrawal of 500mg/day modafinil is helping either. I really want to stop the clonazepam completely, but have read that this can increase the likelyhood of siezures when just starting bupropion.
Funny thing (not really) also is that I am actually more 'awake' in my head now, which is exactly what I wanted, but feeling depressed every moment I am awake certainly isn't what I wanted. The only thing I have to turn to is caffein when things get unbareable. Works, but the rebound is a bad trade-off.
I'm gonna up my Nardil to 90mg, stay on 150mg bupropion & halve clonazepam to 0.25mg/day - try that for a week. Fingers crossed.
Worst time of year for all this too - hey, maybe Santa will give me a new brain!
Posted by tecknohed on December 16, 2006, at 16:01:29
In reply to Re: Nardil+Bupropion Guinea pig » Tomatheus, posted by tecknohed on December 16, 2006, at 15:48:02
My mood involves much anger & irritibility too. Is this just depression?
Posted by Tomatheus on December 18, 2006, at 0:46:29
In reply to Re: Nardil+Bupropion Guinea pig » Tomatheus, posted by tecknohed on December 16, 2006, at 15:48:02
> I'm gonna up my Nardil to 90mg, stay on 150mg bupropion & halve clonazepam to 0.25mg/day - try that for a week. Fingers crossed.
I'll keep my fingers crossed for you, as well. And I'll get back to you with a lengthier and hopefully more helpful response soon (probably within the next day or two).
Tomatheus
Posted by jedi on December 24, 2006, at 2:37:42
In reply to Re: Nardil+Bupropion » tecknohed, posted by tecknohed on December 16, 2006, at 16:01:29
> My mood involves much anger & irritibility too. Is this just depression?
Hi,
I've been off the board for a while also. Just saw your thread and I have taken the combination of 90mg Nardil, 300mg bupropion and 1mg clonazepam. The bupropion did help with my fatigue and weight gain from the Nardil. If you have anger issues, chances are the bupropion will add to these. Every time I've been on the medication it has created a lot of anger in my usual kicked back personality. Other side effects from the combination were minimal. I do remember being a little scatter-brained on the combo. As I remember, the newer XL version is a lot smoother and more expensive than the SR version or plain bupropion. I have read that you can't split the SR and maintain a sustained release. The release mechanism is something in the caplet itself.I know it is officially contraindicated, but I really don't know why. It was a fairly good augmentor of Nardil for me. Eventually the PDOC who had me on it retired; the next doctor was too chicken to continue it. I have tried to get my current Doc to add Provigil but he would not go for it. Now I am augmenting 75mg of Nardil with 80mg of Geodon; it seems to be working quite well. I think it is the effect on 5-HT2A that makes this atypical antipsychotic a good augmentor.
Good Luck,
Jedi
Posted by Tomatheus on December 24, 2006, at 18:17:13
In reply to Re: Nardil+Bupropion » tecknohed, posted by tecknohed on December 16, 2006, at 16:01:29
> My mood involves much anger & irritibility too. Is this just depression?
Tecknohed,
It's possible that the anger and irritability that you've been experiencing could be a component of your depressive disorder itself or a symptom of a comorbid anxiety disorder. If I recall correctly, I think I remember you saying that you had social anxiety disorder, so the anger and irritability could conceivably be a manifestation of either the social anxiety, depression, or both. Some researchers have also suggested that comorbid depression and anxiety can be an indication of possible bipolarity, and that patients who experience irritability along with their depressive symptoms might respond to a mood stabilizer.
Personally, nothing has ever made me more irritable than lithium did. I experienced an extreme amount of akathisia on that "mood stabilizer," as well as some other extrapyramidal side effects (most notably, the hand tremor) that are still with me today more than a year and a half after stopping the stuff. I've also read a few posts here suggesting that Lamictal could induce some irritability, but of course, responses could vary significantly from one indiviual to the next. The main point that I'm trying to make is that certain types of affective disorders may appear to resemble bipolar I and bipolar II as they're defined in the DSM, but that doesn't necessarily mean that they're going to respond to the same kind of treatment. But then again, I don't think that mood stabilizers should be completely shunned as a potential option, either.
Another thing that you might want to consider is the possibility that the Nardil that you've been taking might be contributing to the anger and irritability that you've been experiencing. Were your symptoms of anger and irritability as bad as they are now (or even present at all) before you started on your current regimen of Nardil? If not, the Nardil might be either causing these symptoms or making them worse. In general, irritability is not typically associated with Nardil use, but I have read a few reports on this board of Nardil-induced akathisia, and I know that I certainly felt irritable at times on various versions of the film-coated Nardil. So, I do think that it's possible that the Nardil *might* be playing a role in the irritability and anger that you've been experiencing.
And of course, it's also quite likely that the bupropion might be contributing to the worsening of these symptoms, especially if they've worsened since you started the drug. I'm guessing that you're probably already well aware of this possibility, but I just wanted to make sure that I covered all of my bases.
Well, I hope this helps some. Please let me know if you have any questions, and have a happy holidays.
Tomatheus
P.S. I (finally) responded the Babblemail that you sent me the other day.
Posted by tecknohed on December 25, 2006, at 9:35:36
In reply to Re: Nardil+Bupropion » tecknohed, posted by jedi on December 24, 2006, at 2:37:42
Thanks guys.
I started Nardil over 3 years ago now & when it first took effect it seemed almost impossible to be angry - I felt that good. However, one thing it has also done since then is make me alot bolder, like not being afraid to say whats on my mind and certainly not hiding my anger. Before this, having Social Phobia I would of course hide most of it, or simply be unable to express it. Not any more. So yes, maybe Nardil does make me 'act' on anger sometimes, though I feel that the anger is always there in the background anyway.Another thing I forgot to mention is I have gradually devoloped OCD over a long period of time since childhood. I remember as a child feeling overly disgusted & dirty about the 'thought' of germs, now of course it gets out of hand - I cant use a knife and fork unless 'I' washed it up myself, or at least watched it being washed up! I now use a dish washer which has solved that problem! (its not just a germ thing, but more to do with 'other peoples' germs. Wierd huh?). Anyway, one thing which feels a big part of my OCD is anger. When I'm angry my OCD is also bad & vice versa.
The good news however is that I'm now doing very well on my Nardil 90mg & Bupropion 75mg combo (yes thats right - just 75mg/day!) Like Jedi I too am supposed to slowly increase to 300mg/day but I dare not go beyond 75. Thing is, that seems enough. Not only that I've also developed (from day one) a 'tic', an odd involuntary movement in my neck accompanied by impulsive neck strain. so I dont want to push it at the moment. It's not a big problem, just damn annoying! The jolly mood the Bupropion has put me in seems worth it though. In fact its augmented the Nardil pretty well. AT LAST! I'm nearly off the clonazepam too which is helping but which may of course add to the anger too.
As for mood stabilizers, I try to avoid them. I've tried one (forgot which one) & it just dampened my mood. I cant live like that.
Overall much more positive - great!
teck.
Oh, Merry Christmas to all!
Posted by Tomatheus on December 25, 2006, at 15:43:10
In reply to Re: Nardil+Bupropion, posted by tecknohed on December 25, 2006, at 9:35:36
Tecknohed,
Thank you for your detailed reply and for the update on your trial with Nardil and bupropion. It's wonderful to hear that your response has continued to improve, and I hope that the improvement continues.
See below for my responses to specific portions of your post...
> As for mood stabilizers, I try to avoid them. I've tried one (forgot which one) & it just dampened my mood. I cant live like that.
Personally, I tend to avoid mood stabilizers these days, as well. I probably shouldn't keep repeating the details of my experience with lithium because others certainly have more positive experiences with it, but as you know, lithium monotherapy had an extremely disturbing effect on me -- an effect that still has not completely gone away. I also took Zyprexa at one point for its "mood stabilizing" effects and basically lost what little capacity that I had to think clearly and coherently prior to taking it. I pretty much felt like a complete zombie. Fortunately, it was obvious that I wasn't responding favorably to Zyprexa and wasn't going to experience any kind of therapeutic benefit from it at any point, so I didn't stay on it for too long. At least Zyprexa's effects went away after I stopped taking it, unlike the effects of lithium.
I still haven't ruled out the possibility of trying Lamictal at some point in the future if I don't end up getting a sustained response out of the combo that I'm on now. At the same time, I'm not big on the idea of taking any sodium channel-blocking drugs -- even something like Lamictal that also seems to have some antidepressant properties (which probably result from its ability to reduce the release of glutamate).
But generally speaking, I too have tended to avoid mood stabilizers as of late. I suspect that my affective disorder is essentially a double depression of sorts that needs to be treated with two different types of antidepressants in order to go into anything that even remotely resembles a sustained period of remission. The antimanic effects of most of the so-called mood stabilizing drugs on the market today are the last thing that I need to help restore and maintain my functionality.
> Overall much more positive - great!
That's definitely good news. It couldn't come at a better time, either. I'll continue to keep my fingers crossed in hopes that you continue to receive sustained benefits from the Nardil-bupropion combo.
> Oh, Merry Christmas to all!
Same to you (and to all)!
Tomatheus
Posted by tecknohed on December 26, 2006, at 18:09:05
In reply to Re: Nardil+Bupropion, posted by tecknohed on December 25, 2006, at 9:35:36
Tomatheus - Lamictal was the mood stabiliser which I tried - twice. Both times it made me pretty tired, though I was complaining of tiredness at the time. Didn't give it much of a chance either. I might consider it again now though, especially as my tiredness is much (not completely) better.
Others that made me tired in the past but which I may try again are Gabapentin or Gabitril (Tiagabine) both of which might not only help my SP but also help prevent siezures whilst on bupropion.
I also may ask my pdoc about adding a small dose of tryptophan (Optimax in UK) at bedtime. Tomatheus - I read with great interest your babblemail & your theory on Nardil's relation with nitric oxide & agree that a serotonergic med could be worth a look.
Luckily I'm with a doc who will allow me to pretty much try anything, as long as its sensible & makes sense. I just have to agree to take full responsibility should anything go wrong. I think thats fair enough!
Posted by tecknohed on December 26, 2006, at 18:09:40
In reply to Re: Nardil+Bupropion, posted by tecknohed on December 25, 2006, at 9:35:36
Tomatheus - Lamictal was the mood stabiliser which I tried - twice. Both times it made me pretty tired, though I was complaining of tiredness at the time. Didn't give it much of a chance either. I might consider it again now though, especially as my tiredness is much (not completely) better.
Others that made me tired in the past but which I may try again are Gabapentin or Gabitril (Tiagabine) both of which might not only help my SP but also help prevent siezures whilst on bupropion.
I also may ask my pdoc about adding a small dose of tryptophan (Optimax in UK) at bedtime. Tomatheus - I read with great interest your babblemail & your theory on Nardil's relation with nitric oxide & agree that a serotonergic med could be worth a look.
Luckily I'm with a doc who will allow me to pretty much try anything, as long as its sensible & makes sense. I just have to agree to take full responsibility should anything go wrong. I think thats fair enough!
This is the end of the thread.
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