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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 linkadge on November 12, 2007, at 19:01:51
Has anyone taken both bupropion and an NRI? Can anyone compare bupropion to say nortryptaline or desipramine?
Thanks
Linkadge
Posted by tecknohed on November 12, 2007, at 19:20:10
In reply to bupropion compared to NRI's, posted by linkadge on November 12, 2007, at 19:01:51
> Has anyone taken both bupropion and an NRI? Can anyone compare bupropion to say nortryptaline or desipramine?
>
> Thanks
>
> LinkadgeLofepramine, which metabolizes to desipramine was a great drug for me. Motivation, concentration & stamina. Slightly irritated whilst out of my 'comfort zone'. I found it best on it's own. With buspirone it was YUCK! (but then so was buspirone)
Bupropion, although giving me more energy made me more irritable & obsessive. Even aggressive at times. I've only taken bupropion with Nardil, not on it's own.
Posted by Astounder on November 15, 2007, at 23:37:52
In reply to bupropion compared to NRI's, posted by linkadge on November 12, 2007, at 19:01:51
> Has anyone taken both bupropion and an NRI? Can anyone compare bupropion to say nortryptaline or desipramine?
>
> Thanks
>
> LinkadgeWellbutrin had immediately an effect at an acute 900 mg XL dosing, made me giddly and alert. Weakly psychostimulant-like. Since I've read there is tolerance to its DAergic effects (eventual DAT upregulation), I went for desipramine instead. I also don't like the idea of DAergic metabolites floating around when I'm trying to sleep.
Desipramine 100 mg did nothing for me, even chronically, except cure my heartburn and cause some awesome hallucinations.
Both of them cause plastic NET downregulation after a few weeks, like all other NAergic antidepessants. An effect that remains after treatment ends.
Posted by tecknohed on November 16, 2007, at 4:25:32
In reply to Re: bupropion compared to NRI's » linkadge, posted by Astounder on November 15, 2007, at 23:37:52
What is 'plastic NET downregulation'? I dont believe I have any unwanted lasting negative effects from using NRIs.
Posted by Astounder on November 16, 2007, at 8:39:58
In reply to Re: bupropion compared to NRI's » Astounder, posted by tecknohed on November 16, 2007, at 4:25:32
> What is 'plastic NET downregulation'? I dont believe I have any unwanted lasting negative effects from using NRIs.
It's a positive effect of long term treatment. You end up actually decreasing the number of NE uptake pumps by chronic blockade. This means the effect of NRIs can be maintained even after the NRIs are removed.
Posted by linkadge on November 16, 2007, at 9:33:09
In reply to Re: bupropion compared to NRI's » linkadge, posted by Astounder on November 15, 2007, at 23:37:52
>Wellbutrin had immediately an effect at an acute >900 mg XL dosing, made me giddly and alert.
Geez, I hope you weren't just taking 900mg without working up to it. You could have seized.
>Weakly psychostimulant-like. Since I've read >there is tolerance to its DAergic effects
>(eventual DAT upregulation), I went for >desipramine instead.Thats a strange reason to choose a drug switch. I had read that DAT upregulation occured in the neucleus accumbens but not in other brain regions. Burpropion is also supposedly has higher affinity for NET in humans than DAT.
>I also don't like the idea of DAergic >metabolites floating around when I'm trying to >sleep.
So it gave you insomnia?
>Both of them cause plastic NET downregulation >after a few weeks, like all other NAergic >antidepessants. An effect that remains after >treatment ends
I'm confused by this statement. Are you suggesting that norepinephrine transport does not return to baseline uptake after NRI discontinuation? Or do you only mean shortly after?
Linkadge
Posted by Astounder on November 16, 2007, at 10:43:22
In reply to Re: bupropion compared to NRI's » Astounder, posted by linkadge on November 16, 2007, at 9:33:09
The seizure risk is way overblown, I think. The original clinical trials using instant release Wellbutrin used up to 900 mg/d, and only causes seizure in those with already lowered seizure thresholds (bulimics).
>>I also don't like the idea of DAergic >metabolites floating around when I'm trying to >sleep.
DA&NAergics are known to typically decrease both slow wave and REM sleep, while NAergics themselves just decrease REM. Plus constant D2 receptor stimulation (not breaking while sleeping), is going to cause postsynaptic downregulation. I don't care about their effects on attention, just mood & reward, so the mesolimibic area is most important to me.
>I'm confused by this statement. Are you suggesting that norepinephrine transport does not return to baseline uptake after NRI discontinuation? Or do you only mean shortly after?
I thought so, but I can't find any data on how long the changes last, unfortunately.
Posted by linkadge on November 17, 2007, at 19:51:35
In reply to Re: bupropion compared to NRI's, posted by Astounder on November 16, 2007, at 10:43:22
>The seizure risk is way overblown, I think. The >original clinical trials using instant release >Wellbutrin used up to 900 mg/d, and only causes >seizure in those with already lowered seizure >thresholds (bulimics).
I would still be carefull. I know of two individuals who developed seizure disorders after bupropion induced seizures.
>DA&NAergics are known to typically decrease both >slow wave and REM sleep, while NAergics >themselves just decrease REM. Plus constant D2 >receptor stimulation (not breaking while >sleeping), is going to cause postsynaptic >downregulation. I don't care about their effects >on attention, just mood & reward, so the >mesolimibic area is most important to me.
Well, you'll never outsmart the mesolimbic system. Its always one step ahead.
Linkadge
Posted by anonymoose on November 20, 2007, at 22:26:28
In reply to Re: bupropion compared to NRI's, posted by Astounder on November 16, 2007, at 10:43:22
Hi Astounder,
Thanks for your informative posts. Sorry to hijack this thread, but was wondering if I could ask a couple questions...
>Plus constant D2 receptor stimulation (not breaking while sleeping), is going to cause postsynaptic downregulation.
Would a dopamine agonist (e.g. Mirapex) also cause this postsynaptic downregulation? Also, you're referring to downregulation of DA transporter activity, right?
Which would cause more DAT downregulation, MAO-B inhibition (e.g. deprenyl) or D3 agonism (e.g. Mirapex)?
I think my dopamine system has been getting more and more screwed up over time (possible contributing factors: stress, chronic depression-induced stress, SSRIs, ritalin/adderall use). I've completely lost all sensitivity/response to caffeine, nicotine, alcohol, ritalin/adderall. Even orgasm no longer causes that rush of "pleasure chemicals" that you feel in your brain. Couple this with complete flattening of emotional response to formerly pleasureable stimuli (music, good conversation, art/beauty, etc.) and ever-worsening dysthymia/anhedonia/apathy... am I right in thinking this is a dopaminergic problem?
Thanks in advance. Any and all input is sincerely appreciated.
-John
Posted by linkadge on November 20, 2007, at 23:37:03
In reply to Re: bupropion compared to NRI's » Astounder, posted by anonymoose on November 20, 2007, at 22:26:28
>Would a dopamine agonist (e.g. Mirapex) also >cause this postsynaptic downregulation?
Probably to some degree, just as neuroleptics DA antagonists cause a degree of upregulation.
>Which would cause more DAT downregulation, MAO-B >inhibition (e.g. deprenyl) or D3 agonism (e.g. >Mirapex)?
MAO-B inhibition would likely cause DAT upregulation. Ie more dopamine transporter would be produced to compensate for decreases metabolsim via MAO-B. I don't think direct agonists like mirapex affect the transporter either way, but I could be wrong. It may depend on dopamine release in that case.
>and ever-worsening dysthymia/anhedonia/apathy... >am I right in thinking this is a dopaminergic >problem?
Possibly. The best remedy in your case would probably be a minimization of stimulant use, coupled with stress reduction and a high protein diet. You could pop some sort of dopamine mimicking drug, or mess with metabolism but the system will work a lot better if you have the dopamine stores to make it work.
Dopamine by itself isn't the magic pleasure chemical. It interacts with opiates, serotonin, norepinephrine etc. Stress can throw the whole thing out of whack, as can excessive drug use.
Start from the bottom up. Build a strong base with stress reduction, good nutrition and drug minimization, then use drugs as necessary to go from there.
I know I am not astounder, sorry for replying. If he wants to reply too that's cool.
Linkadge
Posted by anonymoose on November 21, 2007, at 1:04:10
In reply to Re: bupropion compared to NRI's, posted by linkadge on November 20, 2007, at 23:37:03
Linkadge,
Thanks for the info/tips.
> Possibly. The best remedy in your case would probably be a minimization of stimulant use, coupled with stress reduction and a high protein diet. You could pop some sort of dopamine mimicking drug, or mess with metabolism but the system will work a lot better if you have the dopamine stores to make it work.
> Dopamine by itself isn't the magic pleasure chemical. It interacts with opiates, serotonin, norepinephrine etc. Stress can throw the whole thing out of whack, as can excessive drug use.Got that. But I think the original cause of my problems is endogenous in nature. Looking back in my case, my symptoms started 3 years before I began to realize I was suffering from some sort of dysthymic depression, and I hadn't taken any sort of drugs before then. I'm not a regular smoker or drinker, and I limit my caffeine intake to 100mg/day, on average.
For a while I thought I had a sleep disorder, because I started falling asleep in class with increasing regularity (had a sleep test done, which turned up no sleep irregularities). Then I started falling asleep every time I tried to read something. I'd been a straight-A student, but my grades tanked and I think this precipitated full-blown depression.
It was only then that I was put on Zoloft (my first psychiatric med). The first day gave me an incredible, almost euphoric response - I felt emotion, energy, and motivation again. But this quickly wore off by the 2nd week. I tried augmenting with adderall 10-20mg/day, but the therapeutic effect pooped out after a few months.
Over the next five years, I tried numerous antidepressants, none of which worked. Also, I'd go a few months on ritalin/adderall (10-20mg/day) until it pooped out and then go off a few months before trying again.
My symptoms had been getting worse and worse over the past few months despite being off regular ritalin/adderall. And it wasn't until starting Selegiline yesterday that I got any sort of relief. So I'm pretty sure that I need something, either the Selegiline or the Mirapex, to keep my depressive symptoms at bay.
So yeah, I'm pretty sure I've got some endogenous problem that normal measures (stress reduction, good nutrition, etc.) can't fix by itself.
> Start from the bottom up. Build a strong base with stress reduction, good nutrition and drug minimization, then use drugs as necessary to go from there.
>
> I know I am not astounder, sorry for replying. If he wants to reply too that's cool.
>
> Linkadge
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>
>
>
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Posted by linkadge on November 22, 2007, at 12:04:36
In reply to Re: bupropion compared to NRI's » linkadge, posted by anonymoose on November 21, 2007, at 1:04:10
>I'm not a regular smoker or drinker, and I limit >my caffeine intake to 100mg/day, on average.
Thats good. I understand though, I often resort to using certain substances simply because I want to feel better, and because prescription antidepressants rarely work (for me).
>For a while I thought I had a sleep disorder, >because I started falling asleep in class with >increasing regularity (had a sleep test done, >which turned up no sleep irregularities). Then I >started falling asleep every time I tried to >read something. I'd been a straight-A student, >but my grades tanked and I think this >precipitated full-blown depression.
>It was only then that I was put on Zoloft (my >first psychiatric med). The first day gave me an >incredible, almost euphoric response - I felt >emotion, energy, and motivation again. But this >quickly wore off by the 2nd week. I tried >augmenting with adderall 10-20mg/day, but the >therapeutic effect pooped out after a few >months.
Same here. I had a good response to zoloft, and to a lesser extent celexa. But the brain adapts quickly.
>Over the next five years, I tried numerous >antidepressants, none of which worked. Also, I'd >go a few months on ritalin/adderall (10->20mg/day) until it pooped out and then go off a >few months before trying again.
Yeah, the stimulants can poop out quickly. If you are dealing with pure AD/HD without mood issues, they can sometimes work for a long time.
>My symptoms had been getting worse and worse >over the past few months despite being off >regular ritalin/adderall. And it wasn't until >starting Selegiline yesterday that I got any >sort of relief. So I'm pretty sure that I need >something, either the Selegiline or the Mirapex, >to keep my depressive symptoms at bay.
If you find something that helps, thats the main thing. Somtimes with these drugs there is a yin-yang theory of poop out. Ie taking an SSRI too long will throw dopamine out of whack, or taking a dopaminergic too long could throw serotonin out of whack.
>So yeah, I'm pretty sure I've got some >endogenous problem that normal measures (stress >reduction, good nutrition, etc.) can't fix by >itself.
There are some pretty helpful supplements. Ie SAMe, omega-3, and SJW are of the strongest. Many suffers get a degree of relif by augmenting with certain supplements.
You might try a tryptophan/selegiline combination, if selegiline alone poops out.
Linkadge
This is the end of the thread.
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