![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 18 of 18. This is the beginning of the thread.
Posted by MissThang on December 23, 2010, at 14:30:24
Hi Everyone -- I have been obsessively reading this board the past few months in an attempt to remedy my double depression (dysthemia with bouts of major depression). I had reached the conclusion that parnate was the cure for all my ails, but I've now been on it 6 weeks and nada...no initial stimulent effect, not an ounce of improvement in my major depression, nothing except constant hypertension. I'm only on 50 mg at this point because that's all my body will handle -- each dose sends my blood pressure up and even with the beta block I'm on (atenolol), my bp stays around 145/94 most of the time. (I didn't have hypertension prior to taking parnate.) I've been very careful with my diet and it doesn't seem to be a food-induced reaction, I just happen to be one of the lucky few who have responded with this side effect.
I was in touch with Dr. Gillman from Australia who said only about 2% of the 1000+ patients he's treated with parnate get this side effect and that it would wear off over time, but when you inlclude the 2-week washout I did after wellbutrin, I've basically been out of commission for 2 months and being self-employed, I'm going bankrupt so I can't just keep waiting and hoping my blood pressure's going eventually calm down enough for me to get to a therapeutic dose.
So...I'm wondering what I could do to make my old med work again. I was on 450mg wellbutrin xl with vyvanse and 15mg abilify, though I stopped the abilify about a month prior to going off the wellbutrin because I realized it was making me "flat" and I don't really want to take it again. I think all it was doing really was addressing the additional anxiety brought on by the vyvanse, which in hindsight, I realize didn't work as well as provigil with the wellbutrin.
I was determined to try parnate because I read so many wonderful things about it and my wellbutrin began pooping out on me several years ago. For the first year and a half or so, it worked very well all on its own, at which point it began pooping out. I thought maybe I'd gotten a bad batch or something, so I had the dr. write me a new script for that month's dose and went to a different drugstore to ensure I got another batch, but it still was less effective. I went from being treated with about 90% effectiveness to about 50% virtually overnight, and as the years wore on, it petered down to probably 15% effectiveness, despite our attempts to augment with lamictal, abilify, provigil and vyvanse. Before we switched, the dr. actually suggested that I try lithium as an augment, but I didn't like the idea of having to mess with the blood level business and the possibility of weight gain, but in hindsight, perhaps I should have tried it.
Right now, I'm on 50mg parnate and just yesterday I started autmenting with 600mg lithium, with the idea being that my dr. said I'd know within a week if the parnate/lithium combo was going to do me any good and by the time I see him at my scheduled appointment next week, we'd know whether we wanted to continue along that path or go in another direction. I've been on him to possibly autment the parnate with nortrip, but his concern there is that sometimes nortrip increases bp as well and I really don't have any wiggle room in my bp right now.
Some options I've thought of are either going ahead and taking 600mg of wellbutrin (probably along with the provigil) or augmenting wellbutrin with lithium if I do end up getting any benefits from it this week. I realize the increase in seizure risk between 450mg and 600mg increases from .4% to 2%, but with no family history of seizure, that still seems pretty low to me, especially when I think of the high likelihood of my haviing a hypertensive crisis on the parnate given my history of high blood pressure on it.
I forgot to mention that at one point (shortly after the wellbutrin started pooping out on me) I, on my own, went up to 600mg a day and felt great again. This only went on a few days before it was time for my regular apppointment with my pdoc and when I told him what I'd done, he had a near conniption fit talking about risk of seizures and so forth. So I dropped back down to 450mg and tried augmenting with a few things (I listed some here, but I think we tried a couple of others too and they didn't work.)
In the past, I've failed on every ssri I've tried and also on emsam (flat, unmotivated and eating all the time were the effects got from all of these -- along with sexual disfunction, which is unnaceptable to me). Before I started pushing for the parnate, I went through a 3-day period where I was adding 5htp along with another combined supplement that contained things to increase dopamine (velvet bean, aka, dopabean, was one of the primary componants), and for 3 days, I felt wonderful! Not down anymore, not pretending to smile anymore, actually enjoying people's company, etc. In short, my depression went totally into remission! Problem is, the effect stopped after 3 days and no matter what I did (increase the doses, take them on an empty stomach, whatever) I couldn't get the effect to last.
I mention that last scenario because that's what spurred me to want "more" -- more than a 15% response rate again...closer to a 100% response rate. I also mention it because since I responded both to an increase in seratonin and in dopamine, it's quite possible an increase in both with help me, though I do feel I'm primarily lacking in norpenephrine and dopamine, the two main chemicals wellbutrin addresses.
So that's primarily what I feel like I need help with -- norpenephrine and dopamine, with maybe a touch of seratonin.
Do you really think 2% seizure risk is all that high? (Assuming my dr. does let me end up taking 600mg wellbutrin.) What can I take to augment the N and D primarily, with maybe only a touch of S?
I'm really desperate here and need your help...being self-employed, I really may go bankrupt if I don't get my butt in gear again soon and the way I feel now, I haven't bathed in 4 days and I just sit around watching tv all day. Hoping this lithium may kick in in time for Christmas with my family, but so far, nothing from it.
What would you suggest? (Sorry my post is so long.)
Posted by Phillipa on December 23, 2010, at 20:18:30
In reply to Going Off Parnate...Wellbutrin Poop Out Remedy?, posted by MissThang on December 23, 2010, at 14:30:24
I am going to ask you what do you feel would work the best for you? What is your least fear? Phillipa
Posted by MissThang on December 23, 2010, at 20:54:35
In reply to Re: Going Off Parnate...Wellbutrin Poop Out Remedy? » MissThang, posted by Phillipa on December 23, 2010, at 20:18:30
I'm not quite sure, Phillipa. I mean, I'd hate to have a seizure (quite obviously), but 2% seems like a pretty low incidence to contend with (with no family history of seizures). Then again, if I find the lithium does anything for me over the coming week, I wouldn't mind augmenting the 450mg wellbutrin with lithium to see how that works, as long as I had the option of increasing to 600mg of wellbutrin if that wasn't quite enough.
I'm also very curious about wellbutrin with a noradrenergic TCA like nortriptyline...it seems like it hits the same 2 main trainsmitters wellbutrin does but probably from a different angle, so that might be a good combo, but I can't seem to find any evidence of people taking wellbutrin and nortriptyline together. Also, I'm not really sure what the side of effects of nortrip are, other than dry mouth. I definitely don't want anymore weight gain or sexual disfunction as I'm single and have never been married and that's one of the main things I want out of life. (I gained almost 10 lbs during my 2-week washout after wellbutrin before parnate and so far, because of my bp issues with parnate, I can't really exercise or do much to get the weight off.) Anyway, I know if I were able to go back on the wellbutrin, I'd be able to resume my old eating habits, which kept me at the same size for years, so that's another reason I'm leaning towards trying harder to make wellbutrin work again than trying harder to get the parnate to work. I've also grown tired of monitoring my blood pressure 24/7 -- it's just way too high maintenance of a med for me, especially considering I'm getting NO benefit from it.
Anyone out there have any thoughts of combining wellbutrin with nortriptyline?
Posted by Phillipa on December 23, 2010, at 21:20:18
In reply to Re: Going Off Parnate...Wellbutrin Poop Out Remedy?, posted by MissThang on December 23, 2010, at 20:54:35
Only thing I've read is that TCA's can cause weight gain. Sounds like lithium wellbutrin is high on your list. No if parnate does nothing I'd also change. Cause of all the restrictions could not take an maoi. That's just me. Phillipa
Posted by MissThang on December 23, 2010, at 22:53:08
In reply to Re: Going Off Parnate...Wellbutrin Poop Out Remedy? » MissThang, posted by Phillipa on December 23, 2010, at 21:20:18
Well, apparently both lithium and TCA's can cause weight gain, though theoreticaly, since I'd just be using them to augment, I wouldn't be on that high of a dose of either one of them and wellbutrin has appetite-suppressing properties (which is one of the things I loved about it). And the truth it, if I actually got near 100% remission out of either combo (or by bringing up the wellbutrin to 600mg), I think I'd find it much easier to get back in the swing of exercising and eating more healthfully.
But you're right -- weight gain is a concern with both of those, though I managed to keep my weight in check pretty easily with the wellbutrin, vyvanse, abilify combo, despite the fact that abilify definitely caused cravings for sweets (especially at night). I think I'd have to be on a fairly high dose of wellbutrin and a stimulent to help keep my appetite at bay, though, if I were to go with either of those augments.
Posted by Phillipa on December 24, 2010, at 23:50:40
In reply to Re: Lithium Nortrip/Wellbutrin or 600mg Wellbutrin, posted by MissThang on December 23, 2010, at 22:53:08
Decision or still thinking? Phillipa
Posted by MissThang on December 25, 2010, at 9:04:01
In reply to Re: Lithium Nortrip/Wellbutrin or 600mg Wellbutrin » MissThang, posted by Phillipa on December 24, 2010, at 23:50:40
I've decided to go off the parnte and for the time being, stay on th lithium and add back the wellbutrin after my washout. At that point, I'll either take the wellbutrin up to 600mg, augment with either nortriptyline or desipramine or both increase the dose and augment. I'll stay on the lithium for the time being and see how it works with the wellbutrin (and just pray that wellbutrin works for me again now that I've been off of it for two months), and if it does, I'll keep it -- if not, I'll drop the lithium and just try the desip/nortrip options along with the 600mg of wellbutrin option. I'm also pondering a dopamine agonist like mirapex or requip with the wellbutrin to see how that works.
I appreciate your feedback and intererest, Phillipa -- that's very sweet of you. It would really be nice, however, if some others who'd experienced wellbutrin poop-out would reply. I'm sure I'm not the only one who's experienced it and it sure would be helpful to know if anyone else had come up with a remedy for it.
I am very disappointed in the whole parnate thing...I was so worked up about trying it and was just sure it was going to be my saving grace, but my body just kept fighting it with hypertension and even after 6 weeks, it wasn't getting any better, so I think I just have to accept that parnate and I weren't meant to be:-(.
I have no desire to try nardil, given its reputation for causing sexual disfunction (and usually weight gain as well) and it doesn't seem like many people get relief from marplan, so I guess the maoi route isn't the one for me after all (already tried emasam).
So if anyone has any suggestions, please let me know. My pdoc is pretty decent -- he's willing to try a variety of things, even if I'm the one who has to come up with most of the suggestions, although admittedly, he was the one who wanted me to try lithium with wellbutrin before I took the parnate plunge and who knows? Wellbutrin and lithium may very well do the trick. (Trying to stay positive here and just pray that SOMETHING works -- I've had enough of staying on my sofa watching tv and researching antidepressants).
Posted by creepy on December 27, 2010, at 13:53:04
In reply to Going Off Parnate...Wellbutrin Poop Out Remedy?, posted by MissThang on December 23, 2010, at 14:30:24
Augmenting parnate with nortriptyline sounds really really risky. Since it messes with serotonin as well, AND it has some andrenergic effects that like you say can raise BP.
Also, beta blockers can cause depression in some folks.
If it was me, and I was self-employed, Id try something else pronto. Thats a really sucky position to be in there =(.I also have experienced the wellbutrin poop-out. I did a few re-trials on it and it did the same thing. I went on desipramine for awhile and that seemed to have some mild, lasting AD effect but I needed a SSRI to get benefit from it.
Posted by MissThang on December 27, 2010, at 14:42:14
In reply to Re: Going Off Parnate...Wellbutrin Poop Out Remedy?, posted by creepy on December 27, 2010, at 13:53:04
Creepy -- Well, my latest line of thought is to take Wellbutrin with lithium, since that's one of the few combos I didn't try when I was on Wellbutrin. I'm also giving serious consideration to trying the 600mg dose of wellbutrin xl, but it really seems like I'm going to have to find something to augment wellbutrin with if I want it to work for me long term. I'm definitely off the parnate as it has given me nothing but high blood pressure since I started it. Now it's just the torturous 2-week washout before I can try the wellbutrin again.
Sorry to hear you had the same problem with wellbutrin. Did you ever augment the wellbutrin with nortriptyline or desipramine? What about witht lithium?
Posted by creepy on December 31, 2010, at 12:24:24
In reply to Re: Going Off Parnate...Wellbutrin Poop Out Remedy?, posted by MissThang on December 27, 2010, at 14:42:14
Never augmented with those drugs.. theyre too similar in what they work on. The reason I went off wellbutrin was also anxiety. It was like the drug did nothing for depression but was pushing anxiety when it pooped out. If I added either of those Im not sure I could tolerate the extra NE.
I havent tried any of the serotonergic TCAs, only desipramine. I may try some of those if zoloft doesnt pan out.
Posted by roscopeeco on December 31, 2010, at 14:01:01
In reply to Re: Going Off Parnate...Wellbutrin Poop Out Remedy?, posted by creepy on December 27, 2010, at 13:53:04
> Augmenting parnate with nortriptyline sounds really really risky. Since it messes with serotonin as well, AND it has some andrenergic effects that like you say can raise BP.
> Also, beta blockers can cause depression in some folks.
> If it was me, and I was self-employed, Id try something else pronto. Thats a really sucky position to be in there =(.
>
> I also have experienced the wellbutrin poop-out. I did a few re-trials on it and it did the same thing. I went on desipramine for awhile and that seemed to have some mild, lasting AD effect but I needed a SSRI to get benefit from it.I wish you would get a MAO platelet level before you give up to see where you are at in regards to MAO inhibition. That number should obviously be as close to zero and definitely below 20%.
Posted by MissThang on January 2, 2011, at 8:19:10
In reply to Re: Going Off Parnate...Wellbutrin Poop Out Remedy, posted by roscopeeco on December 31, 2010, at 14:01:01
Roscopeeco -- I understand what you're saying, but I had just reached the point that I was "done" with parnate. It gave me constantly elevated blood pressure (something which doesn't seem to be going away much even now that I've been off of it for a week) and I was getting reactions to foods that were supposed to be "fine" in moderation (like 100% mozerella cheese pizza) -- I think, based on my horrible reaction to parnate, that it's just not the drug for me. I know it's done wonders for a lot of people (and that's why I was so excited to try it) but I just can't live my life tied to a bp monitor. Even now, I'm still experiencing spontaneous hypertensive events, although I've been off of it for a week now. I'm too scared to each much of anything except cereal at this point...I can't wait to finish getting this stuff out of my system!
Now that the parnate is mostly gone from my system, I'm now experiencing rebound anxiety, which is horrible -- complete with panic attacks! I can only pray this anxiety goes away as the parnate finished flushing itself from my system. Parnate and I just weren't meant to be friends.
Posted by Phillipa on January 2, 2011, at 19:30:43
In reply to Re: Going Off Parnate...Wellbutrin Poop Out Remedy, posted by MissThang on January 2, 2011, at 8:19:10
Wash out two weeks? Why hypertensive crisis if no more parnate? No the med wasn't meant for you. Phillipa
Posted by Ron Hill on January 5, 2011, at 1:27:17
In reply to Going Off Parnate...Wellbutrin Poop Out Remedy?, posted by MissThang on December 23, 2010, at 14:30:24
Miss Thang,
Have you ever added a low dose of a stimulant to Wellbutrin? For, example:
Adderal XL
http://pi.shirecontent.com/PI/PDFs/AdderallXR_USA_ENG.PDFDexedine SPANSULE sustain-release capsules
http://www.gsksource.com/gskprm/htdocs/documents/DEXEDRINE-PI-MG.PDFConcerta
http://www.concerta.net/index.htmlProvigil
http://www.provigil.com/media/PDFs/prescribing_info.pdfLamictal is an AED also used as a moodstablizer. It also has an antidepressant effect. Have you ever considered adding Lamictal to wellbutrin and lithium?
http://us.gsk.com/products/assets/us_lamictal.pdfAsk your p-doc to write a script for Deplin (L-methylfolate). It is well worth a try as an add-on:
http://www.deplin.com/At the same time that you take your Deplin, it is very important to take sublingual methylcobalamin (the endogenous from of B12) and pyridoxal-5-phosphate (P-5-P, the endogenous form of B6). This is absolutely true despite the fact that it is not mentioned on the Deplin website.
It is essential to take Methyl-B12 sublingually instead of orally down-the-hatch. When swallowed, about 1% is absorbed. When taken sublingually, about 99% is absorbed.
http://www.iherb.com/Jarrow-Formulas-Methyl-B-12-1000-mcg-100-Lozenges/129?at=0
http://www.iherb.com/Jarrow-Formulas-Methyl-B-12-1000-mcg-100-Lozenges/129?at=0
http://www.iherb.com/Source-Naturals-Coenzymated-B-6-25-mg-120-Sublingual-Tablets/1038?at=0Why take P-5-P instead of the type found in most multivitamin supplements:
Vitamin B6: How A Deficiency In One Essential Nutrient Could Quadruple Your Risk Of Stroke
<Start Text>
Date: 01/11/03
The benefits of vitamin B6 are wide ranging - from supporting protein metabolism and muscle growth to overcoming premenstrual symptoms and depression by encouraging the production of 'feel-good' chemicals, such as serotonin and dopamine, in the brain that help maintain emotional balance.
The benefits of vitamin B6 are wide ranging - from supporting protein metabolism and muscle growth to overcoming premenstrual symptoms and depression by encouraging the production of 'feel-good' chemicals, such as serotonin and dopamine, in the brain that help maintain emotional balance.It is important to be aware that vitamin B6 comes in different forms and the type found in most multivitamin supplements is an inactive and cheaper form called pyridoxine hydrochloride, rather than the active form: pyridoxal-5-phosphate (P5P). This doesn't necessarily pose a problem since pyridoxine is converted in your liver to the active form P5P - the only form your cells can use, which goes to work straight away in your blood stream.1
However, this transformation is not always successful and a lack of the mineral magnesium in the diet or an underactive liver (due to too much alcohol, antibiotics or a generally unhealthy lifestyle) can soon interfere with this process. If this happens then large amounts of pyridoxine can soon accumulate in the body that cannot be utilised, which can cause nerve damage over time.2
It also causes a deficiency of P5P, which can have negative consequences in terms of your health and result in depression, mood swings, muscle weakness, fatigue, hair loss, worsening of premenstrual symptoms, and poor appetite.
So, instead of relying on ordinary vitamin B6 (pyridoxine) being converted properly to P5P in your body, it is best to take pure P5P in the first place. Better still, P5P possesses even more health-related benefits compared to the inactive form of vitamin B6. In addition to helping the conditions outlined above, it has also been shown to improve carpal tunnel syndrome (compression of the nerves in the wrist causing numbness and pain in the hand), and helps control homocysteine levels that in turn helps prevent cardiovascular disease, stroke and arthritis.
P5P helps keep homocysteine levels in check - reducing the risk of heart disease and stroke
P5P appears to be able to help disperse and inactivate a substance called homocysteine. If you're a long-time HSI member or reader of the daily health email alerts you'll know why this is so vital, as homocysteine promotes the build-up of plaque on blood vessel walls, which increases coagulation (clotting).So it's no surprise then that a high homocysteine level can significantly increase your risk of suffering a heart attack or stroke. Recent research has revealed that homocysteine may be one of the biggest culprits responsible for causing these conditions - possibly more so than cholesterol. If you'd like to receive the FREE daily health email alerts for more updates like this, then simply click on the Register link, above left.
Scientists from the Department of Neurology, Massachusetts General Hospital in the US, have found that levels of P5P in stroke patients is about half that of healthy individuals. Having these low P5P levels has been shown to increase the risk of stroke by up to four-fold.3
The US scientists believe that the increased risk of stroke is due to high homocysteine levels that deficient supplies of P5P are unable to lower. It follows that supplementing with P5P, therefore boosting the body's own levels of this nutrient, helps lower homocysteine and reduces the risk of stroke.
Low P5P levels also implicated in Parkinson's disease and rheumatoid arthritis
Homocysteine levels have also been found to be high in Parkinson's disease patients who are taking the drug L-dopa. This is a commonly prescribed drug for treating the disease but it has one serious drawback - it causes homocysteine levels to rise. So it is vital to keep homocysteine levels low in these patients, in order to prevent an additional illness like cardiovascular problems from developing.Dr J. Miller and co-workers from the Vitamin Bioavailability Laboratory, Human Nutrition Research Centre on Ageing, Tufts University in the US, studied 40 Parkinson's disease patients and found that those who had high homocysteine levels also had low concentrations of P5P in their blood. This tallies with the research findings already mentioned and confirms that when levels of P5P are low homocysteine rises.
Dr Miller concluded: 'The vitamin B requirements necessary to maintain normal homocysteine concentrations are higher in patients who are on L-dopa. Vitamin B (P5P) supplements may be warranted for Parkinson's disease patients'.4
In another clinical trial, US scientists from the Cooper Institute for Aerobics Research in Dallas, Texas, studied 150 volunteers who agreed to take a daily vitamin preparation containing P5P (25 mg), folic acid (5mg) and vitamin B12 (50 micrograms). They found that after 12 weeks of treatment, concentrations of P5P in the blood were significantly increased and that homocysteine levels plummeted by up to 25 per cent.5
Patients with rheumatoid arthritis also tend to have low levels of P5P in their blood. Researchers from the Human Nutrition Research Centre, Tufts University, Boston, in the US, studied 33 patients with the disease. They measured P5P concentrations in the patients' urine, blood and red blood cells. They found that low levels of P5P are significantly implicated in cases of rheumatoid arthritis.6
What to take for best results
The recommended dosage amount for the maintenance of overall health is 20-25mg of P5P daily. For the treatment of specific diseases, the dosage can be increased to 50mg three times a day - this amount should only be taken under proper medical supervision. Pregnant and breast-feeding women should only take P5P following medical advice. As always it is extremely important that you consult your doctor before taking P5P if you are currently on any medication.1. Bor MV et al. Clin Chem 2003, 49(1):155-161
2. Wang H, Kuo M, Brain Res Bull 2002, 58(6):541
3. Kelly PJ et al. Stroke 2003, 34(6):e51-54
4. Miller JW et al. Neurology 2003, 60(7):1125-1129
5. Earnest C, Cooper KH, et al Nutrition 2002, 18(9):738-742
6. Chiang EP et al. J Nutr 2003,133(4):1056-1059
<End Text>I have taken lithium a few times in the past. If I were you, I would not take more than 600 mg/day due to adverse side effects at high dosages.
I have a hunch that you would do well on Nardil (phenelzine). It is a very good antidepressant and it treats social anxiety and other types of anxiety disorders. In addition to the increases in dopamine, norepinephrine, serotonin, and trace neurotransmitters due to the mao inhibition, Nardil has a GABA effect that, for me, causes a peaceful less anxious feeling throughout my body.
The problem with Nardil is very problematic weight gain and, for some like me, erectile dysfunction and delayed orgasm are side effects. The ED can usually be treated adequately with Viagra, or a similar brand. For a male, the delayed orgasm can be a good thing for his partner. But, obviously, delayed or anorgasmia is problematic for a female.
I've been taking Nardil for 4 1/2 years and it is a very good med for me except for the side effects discussed above. If I had it to do over again, I would be almost obsessive about weight monitoring and control right from the beginning. It is hard to loss the weight once it's on. I encourage anyone going on Nardil to be rigorous about weight control right from the day you start taking the medication.
Because of my weight gain, I switched to Parnate for a trial. I gave Parnate four months to work, but it never provided any antidepressant action for me. As soon as I went back to my beloved Nardil the antidepressant effect immediately returned.
Parnate is more likely to cause a hypertensive crisis than Nardil.
In 1996, my first p-doc misdiagnosed me as ADHD and prescribed Ritalin and Paxil. Due to the fact that I am actually bipolar II and NOT ADHD, the stimulant and SSRI pushed me into a full blown mania and caused me to start ultra rapid cycling. My cycle was 15 days; six days of debilitating depression followed by nine days depression free. The 15 day cycle never stopped; when one ended the next one immediately started. This occurred over and over and over, for 14 1/2 years. As you can imagine, I went through an enormous number of med trials over the years of trying to treat my ultra rapid cycling.
I wrote the previous paragraph in order to share with you the fact that four months ago I started a medication called Valdoxan (agomelatine). I immediately stopped ultra rapid cycling and, thereby, all of my depression stopped. My 14 1/2 years of hell are over. Valdoxan is another antidepressant that you might consider as an add-on. I realize that you are not rapid cycling nor are you bipolar. However, Valdoxan works, in part, by resychronizing the circadian clock. Recent research indicates that the circadian clock may play a role in some, or most, depressive disorders.
Valdoxan is an M1 and M2 agonist and a 5ht2c antagonist. M1 and M2 are melatonin receptors. As an agonist of M1 and M2, Valdoxan is thought to reset the circadian clock. When 5ht2c is antagonized, dopamine and norepinephrine are released in the frontal cortex.
Valdoxan is not U.S. FDA approved and, therefore, it is not sold in the U.S. But, it is available on the internet. Insurance companies in the U.S. do not pay for it since it is not FDA approved. So, if you order it, you have to pay full price which is currently about $100 per one month supply.
Below is the URL to an extensive Valdoxan website by Servier, the pharmacutical company. Click all of the links that you can find inside the document. Since Valdoxan is a rather new medication, released in Europe in 2009, you might want to give your p-doc a copy of the URL. If e-mails are not accepted by your p-doc, then either put the URL on a thumb drive and have him copy the URL onto his/her computer, or just hand-copy the URL and give it to your p-doc. Here is the link; click on the Doctor link:
http://www.valdoxan.co.uk/landing.aspx?redirect=/Default.aspxFinally, please look at my list of vitamins and supplements. If I do not take them for two or three days in a row, I become noticeably depressed. My point is they work. I have spent a lot of time researching vitamins and supplements that are known to treat depression. Do your homework on these vitamins and supplements and give each of them a trial. Phosphatidylserene is a little expensive but well worth it. Please do not exclude it due to price.
-- Ron
dx: Bipolar II and mild OCPD
600 mg/day Trileptal (oxcarbazepine)
200 mg/day Lamictal (lamotrigine)
500 mg/day Keppra (levetiracetam)
90 mg/day Nardil (phenelzine)
12.5 mg at betime Valdoxan (agomelatine)
3.75 mg/day Deplin (taken with 2500 mcg/day of sublingual methyl B-12, and 12.5mg/day of sublingual P-5-P)
2.5 mg/day Adderal XR45 ml/day of Carlsons Bottled Fish Oil
100 mg/day phosphatidylserene
One Multi-vitamin/day; Only 100% of all the usual vitamins; Look for good chelations. NO VANADIUM!!
2000 IU/day Vitamin D-3
850 mg/day of Mg 212% of RDA (as 5 grams of Mg Malate)
200 mcg/day GTF Chromium
600 mcg/day Chromium Picolinate
200 mg/day Co-Q10
1000 mg/day Cinnamon
480 mg/day Milk Thistle
2 g Vitamin C
Whats next to add?:
NAC, + 8 to 10 glasses of water, + Acetyl-L-Carnitine, + Alpha-Lipoic Acid
----------------------> Hi Everyone -- I have been obsessively reading this board the past few months in an attempt to remedy my double depression (dysthemia with bouts of major depression). I had reached the conclusion that parnate was the cure for all my ails, but I've now been on it 6 weeks and nada...no initial stimulent effect, not an ounce of improvement in my major depression, nothing except constant hypertension. I'm only on 50 mg at this point because that's all my body will handle -- each dose sends my blood pressure up and even with the beta block I'm on (atenolol), my bp stays around 145/94 most of the time. (I didn't have hypertension prior to taking parnate.) I've been very careful with my diet and it doesn't seem to be a food-induced reaction, I just happen to be one of the lucky few who have responded with this side effect.
>
> I was in touch with Dr. Gillman from Australia who said only about 2% of the 1000+ patients he's treated with parnate get this side effect and that it would wear off over time, but when you inlclude the 2-week washout I did after wellbutrin, I've basically been out of commission for 2 months and being self-employed, I'm going bankrupt so I can't just keep waiting and hoping my blood pressure's going eventually calm down enough for me to get to a therapeutic dose.
>
> So...I'm wondering what I could do to make my old med work again. I was on 450mg wellbutrin xl with vyvanse and 15mg abilify, though I stopped the abilify about a month prior to going off the wellbutrin because I realized it was making me "flat" and I don't really want to take it again. I think all it was doing really was addressing the additional anxiety brought on by the vyvanse, which in hindsight, I realize didn't work as well as provigil with the wellbutrin.
>
> I was determined to try parnate because I read so many wonderful things about it and my wellbutrin began pooping out on me several years ago. For the first year and a half or so, it worked very well all on its own, at which point it began pooping out. I thought maybe I'd gotten a bad batch or something, so I had the dr. write me a new script for that month's dose and went to a different drugstore to ensure I got another batch, but it still was less effective. I went from being treated with about 90% effectiveness to about 50% virtually overnight, and as the years wore on, it petered down to probably 15% effectiveness, despite our attempts to augment with lamictal, abilify, provigil and vyvanse. Before we switched, the dr. actually suggested that I try lithium as an augment, but I didn't like the idea of having to mess with the blood level business and the possibility of weight gain, but in hindsight, perhaps I should have tried it.
>
> Right now, I'm on 50mg parnate and just yesterday I started autmenting with 600mg lithium, with the idea being that my dr. said I'd know within a week if the parnate/lithium combo was going to do me any good and by the time I see him at my scheduled appointment next week, we'd know whether we wanted to continue along that path or go in another direction. I've been on him to possibly autment the parnate with nortrip, but his concern there is that sometimes nortrip increases bp as well and I really don't have any wiggle room in my bp right now.
>
> Some options I've thought of are either going ahead and taking 600mg of wellbutrin (probably along with the provigil) or augmenting wellbutrin with lithium if I do end up getting any benefits from it this week. I realize the increase in seizure risk between 450mg and 600mg increases from .4% to 2%, but with no family history of seizure, that still seems pretty low to me, especially when I think of the high likelihood of my haviing a hypertensive crisis on the parnate given my history of high blood pressure on it.
>
> I forgot to mention that at one point (shortly after the wellbutrin started pooping out on me) I, on my own, went up to 600mg a day and felt great again. This only went on a few days before it was time for my regular apppointment with my pdoc and when I told him what I'd done, he had a near conniption fit talking about risk of seizures and so forth. So I dropped back down to 450mg and tried augmenting with a few things (I listed some here, but I think we tried a couple of others too and they didn't work.)
>
> In the past, I've failed on every ssri I've tried and also on emsam (flat, unmotivated and eating all the time were the effects got from all of these -- along with sexual disfunction, which is unnaceptable to me). Before I started pushing for the parnate, I went through a 3-day period where I was adding 5htp along with another combined supplement that contained things to increase dopamine (velvet bean, aka, dopabean, was one of the primary componants), and for 3 days, I felt wonderful! Not down anymore, not pretending to smile anymore, actually enjoying people's company, etc. In short, my depression went totally into remission! Problem is, the effect stopped after 3 days and no matter what I did (increase the doses, take them on an empty stomach, whatever) I couldn't get the effect to last.
>
> I mention that last scenario because that's what spurred me to want "more" -- more than a 15% response rate again...closer to a 100% response rate. I also mention it because since I responded both to an increase in seratonin and in dopamine, it's quite possible an increase in both with help me, though I do feel I'm primarily lacking in norpenephrine and dopamine, the two main chemicals wellbutrin addresses.
>
> So that's primarily what I feel like I need help with -- norpenephrine and dopamine, with maybe a touch of seratonin.
>
> Do you really think 2% seizure risk is all that high? (Assuming my dr. does let me end up taking 600mg wellbutrin.) What can I take to augment the N and D primarily, with maybe only a touch of S?
>
> I'm really desperate here and need your help...being self-employed, I really may go bankrupt if I don't get my butt in gear again soon and the way I feel now, I haven't bathed in 4 days and I just sit around watching tv all day. Hoping this lithium may kick in in time for Christmas with my family, but so far, nothing from it.
>
> What would you suggest? (Sorry my post is so long.)
Posted by MissThang on January 5, 2011, at 7:33:13
In reply to Re: Going Off Parnate...Wellbutrin Poop Out Remedy? » MissThang, posted by Ron Hill on January 5, 2011, at 1:27:17
Hi Ron -- Thanks for your suggestions.
I have been studying supplements off and on for years and after the wellbutrin stopped working as effectively, the only thing that sent me into a true remission again was the addition of some supploements that boosted both serotonin and dopamine, though th effect only lasted 3 days.
My latest angle of attack (once I finish washing out from parnate) is to go back on the wellbutrin, augmented by up to 1600mg SAM-e, and if it helps, I'll also add the other supplements that boosted my mood so much before. I've read good things about SAM-e and am keeping my fingers tightly crossed that it works for me as well as those other supplements did.
I did try augmenting with stimulents -- provigil, nuvigil and vyvanse. In hindsight, provigil was the best of these, helping my mood and alertness without adding much anxiety, whereas the nuvigil and vyvanse both gave me added anxiety. However, I've just started on Armour Thyroid, and I'm hoping that will take the place of a stimulent, though I'd certainly be willing to go back on the provigil if necessary.
After the horrible experience I had with Parnate, I'm just not in the mood to try an MAOI again. Virtualy everything in my typical diet has some forbidden substance in it and I'm just not willing to put up with the weight gain and anorgasma from Nardil -- both would make me even more depressed.
I have also been taking care to take fish oil and krill oil, along with a b-complex that contains the p5p form of b6 and a sublingual preparation of the correct form of b12. I also take 10,000 iu of vitamin D each day, along with a liquid multivitamin that's more easily absorbed into my system.
I take a good amount of folic acid as well, so I'm wondering how much deplin would actuallly help the wellbutrin work. Know anyone with any experience with deplin?
Posted by MissThang on January 5, 2011, at 8:31:51
In reply to Re: Going Off Parnate...Wellbutrin Poop Out Remedy? » MissThang, posted by Ron Hill on January 5, 2011, at 1:27:17
Ron -- Btw, I also did try adding lamictal to Wellbutrin at one point as well...didn't get the rash or anything, but also got no AD benefits.
I wrote my last post really late at night and was really too tired to be writing, so forgive me if it seems a bit jumbled.
I see that you're saying you actually have tried deplin -- do you think it's actually helped you at all?
Posted by Phillipa on January 5, 2011, at 19:54:27
In reply to Re: Going Off Parnate...Wellbutrin Poop Out Remedy?, posted by MissThang on January 5, 2011, at 8:31:51
I also took it when first out. Took for a month no side effects no improvement either. Expensive so stopped. I remember one poster who took full dose of Deplin and did very well. Some have done well on lesser doses than recommended. Phillipa
Posted by creepy on January 14, 2011, at 13:12:46
In reply to Going Off Parnate...Wellbutrin Poop Out Remedy?, posted by MissThang on December 23, 2010, at 14:30:24
Thats a rough spot to be in.
I dont know if I would raise wellbutrin that high. Sure the seizure risk is small. I would worry that it would just poop out again at 600mg.
I have taken it in several trials at various doses and eventually no matter how I tried it pooped out on me. Im taking it now again, in fact and its doing the same thing and I cant chase higher doses due to anxiety.
There is a very mild AD effect that hangs around.. but the big relief it gives at first just never lasts. It feels like taking traditional stimulants.. you cant get lasting depression relief from those because of tolerance. Not sure if the mechanism is the same, or if its just me.
There are other drugs you can use in place of wellbutrin. But depending on which part of it helps you, it may be difficult.
Desipramine is a good NRI but it is also big on BP / cardiac effects, being a TCA. So I would not take it with an MAOI. Its an option if you switch to something else though.
As for the dopamine, you could try traditional stimulants or dopamine agonists like mirapex, etc. Some of these have cardiac implications too. They are serious medications.
I hope you find something that helps.
This is the end of the thread.
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