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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by Laney on December 28, 2009, at 18:50:54
Any ideas would be helpful!
Don't really want to take an SSRI because of side effects.Laney
Posted by bleauberry on December 28, 2009, at 19:14:42
In reply to An AD that affects serotonin besides an SSRI, posted by Laney on December 28, 2009, at 18:50:54
Tryptophan with B6 and Niacin will increase serotonin. I got heavy SSRI sexual side effects from 5HTP, but most people do not get any side effects at all. I'm weird. Tryptophan however had no sexual side effects, but from the feel of it definitely make a lot of serotonin.
St Johns Wort, ususally does not have the sexual side effects of SSRIs.
Remeron is supposedly serotonergic but since it can be combined with MAOIs, it probably really doesn't do much to increase serotonin.
Posted by inanimate peanut on December 28, 2009, at 22:15:33
In reply to An AD that affects serotonin besides an SSRI, posted by Laney on December 28, 2009, at 18:50:54
Wellbutrin must do something to serotonin because they won't let me take it with my MAOI due to serotonin syndrome. It isn't supposed to have the sexual, weight gain, or other side effects of SSRIs. I know some people on this board got agitated when they took it, but I did really well on it as long as I stuck with the brand name XL formulation.
Posted by willey on December 29, 2009, at 1:23:38
In reply to Re: An AD that affects serotonin besides an SSRI, posted by inanimate peanut on December 28, 2009, at 22:15:33
> Wellbutrin must do something to serotonin because they won't let me take it with my MAOI due to serotonin syndrome. It isn't supposed to have the sexual, weight gain, or other side effects of SSRIs. I know some people on this board got agitated when they took it, but I did really well on it as long as I stuck with the brand name XL formulation.
They are wrong,i was just reading in depth on wellbutrin for a friend today,and its method of action are due to its affect on ne/dopamine.It does not have strong or to my reading any impact on serotonin.
Also in a famous study of parnate augmentation thats often posted here,wellbutrin addition to parnate was infact one strategy.
I have tried it with no ill effect,and that should be an option for you.
However hearing that a doc wont agree with you to do this even disregarding the misinfo why is to no surprise,you will find unless you have a open doc,you can expect little help with a doc allowing additions to parnate.
In the article which is easly found,parnate augments included
Parnate + Nortriplyine
Parnate + low dose ritalin
Parnate + Wellbutrin
Parnate + high dose treatment
Posted by inanimate peanut on December 29, 2009, at 11:14:42
In reply to Re: An AD that affects serotonin besides an SSRI, posted by willey on December 29, 2009, at 1:23:38
OK, willey. Your easy to find and my easy to find are 2 separate things. Do you happen to have the link?
Posted by bleauberry on December 29, 2009, at 16:43:15
In reply to An AD that affects serotonin besides an SSRI, posted by Laney on December 28, 2009, at 18:50:54
Two comments.
Fisrt, slightly off topic, I wanted to chime in on the Wellbutrin discussion. It should be respected that Wellbutrin's mechanism is unknown. We have some basic science that tells us a few things it may do...weak NE reuptake inhibitor, weak DA reuptake inhibitor...and some hunches it is somehow tied into the nicotinic and/or nitric oxide pathways. Most of its mechanisms are mystery, as is clearly stated on the manufacturer's label.
I can say from my own personal experinece, with varying mileage respected, that I had more profound SSRI side effects on Wellbutrin than I did on SSRIs...the sexual stuff, the numbness stuff, all of that. Worse on Wellbutrin. Maybe whether it crosses over to the serotonin circuits depends on each person's genes and unique wiring.
Probably one of the better ways to avoid ssri side effects, or at least keep them minimal, may be to keep the dose low by combining it with a TCA such as Nortriptyline or Desipramine. The overall potential effect on depression is much more powerful and rapid, with less side effects than either alone. Mileage varies. I speak in general terms. I don't know. But for anyone to claim (anyone equals doctor, pdoc, friend, forum, whatever) that Wellbutrin is universally sex friendly, stimulating, non SSRI-like, is false.
Parnate was rather friendly to me, at a low dose, with none of the SSRI side effects except for light sleep structure. Nortriptyline alone doesn't feel to me like it has any of the SSRI side effects, but then, it is rather worthless to me without an SSRI. In that situation, SSRI side effects are greatly reduced. Nortriptyline must have some other of its unknown dirty mechanisms that partially block or reverse SSRI side effect mechanisms. Don't know.
Another approach to reverse SSRI side effects when taking an SSRI, besides a TCA, are stimulants such as Modafinil or Ritalin or Adderall. Sometimes Remeron is helpful, and sometimes antipsychotics are helpful.
But to set out to find a drug that does not have SSRI side effects is going to be a personal trial and error process, because nothing is universally one way or another for everyone.
Not much useful I realize, but two cents is two cents.
Posted by West on December 30, 2009, at 12:40:34
In reply to Re: An AD that affects serotonin besides an SSRI, posted by bleauberry on December 29, 2009, at 16:43:15
Can you substantiate this claim?..."(adding a tricyclic to an SSRI) The overall potential effect on depression is much more powerful and rapid, with less side effects than either alone. Mileage varies. I speak in general terms. I don't know."
Posted by SLS on December 30, 2009, at 13:13:25
In reply to Re: An AD that affects serotonin besides an SSRI » bleauberry, posted by West on December 30, 2009, at 12:40:34
> Can you substantiate this claim?..."(adding a tricyclic to an SSRI)
I don't know about the side effect thing, but for me, I find that a combination of Effexor and nortriptyline produces a more robust antidepressant effect than either drug alone.
I found that I needed full therapeutic dosages of both drugs when they were combined. The presence of one drug did not reduce the minimum effective dosage of the other.
- Scott
Posted by bleauberry on December 30, 2009, at 17:06:26
In reply to Re: An AD that affects serotonin besides an SSRI » bleauberry, posted by West on December 30, 2009, at 12:40:34
I think others can do that better than I can. Pubmed has some case studies and small studies that support what I have shared.
The best source I am aware of is Dr Gillman at psychotropical.com. A very good site to surf around and read some fascinating stuff. If you haven't been there, you gotta spend some time there.
Other than that I am recalling cases here and at other forums where the combination seemed to work more robustly and usually showing benefits even before the first week was done.
Back to the orginal question, nobody can substantiate anything in psychiatry. Nothing is solidly proven, nothing is duplicatable, nothing has advanced from theory to fact, and everything is experimental. The best we can do is go on experience, gut instincts, and creative guesses.
> Can you substantiate this claim?..."(adding a tricyclic to an SSRI) The overall potential effect on depression is much more powerful and rapid, with less side effects than either alone. Mileage varies. I speak in general terms. I don't know."
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Posted by mtdewcmu on January 2, 2010, at 13:23:05
In reply to Re: An AD that affects serotonin besides an SSRI » West, posted by SLS on December 30, 2009, at 13:13:25
> > Can you substantiate this claim?..."(adding a tricyclic to an SSRI)
>
> I don't know about the side effect thing, but for me, I find that a combination of Effexor and nortriptyline produces a more robust antidepressant effect than either drug alone.
>
> I found that I needed full therapeutic dosages of both drugs when they were combined. The presence of one drug did not reduce the minimum effective dosage of the other.
>
>
> - ScottThe more the merrier. It seems to me that a tricyclic could be a useful way to add a norepinephrine effect. I may wind up adding one to my own regimen.
I also wonder if the central anticholinergic property has a slight mood-elevating effect. Apparently Artane is a drug of abuse in some parts of the world.
This is the end of the thread.
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