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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by MuseMemento on May 10, 2015, at 15:20:10
Hi, all. I just recently re-initiated a combo of wellbutrin and zoloft alongside existing medications abilify and memantine to attempt to treat severe depression and OCD. Not too surprisingly, although this wasn't the case in the past, the wellbutrin seems to have already started exacerbating my OCD. Would it make more sense to attempt to couple the zoloft with desipramine for a beneficial effect for depression without worsening OCD? I've tried high-dose zoloft with nortriptyline and tryptophan in the past to no avail. It seems like desipramine may be worth a shot. Or should I try to give the current regime longer? It's only been four days but the amount that my OCD has been worsened is startling to say the least. Thanks, all.
Posted by Bill82 on May 10, 2015, at 15:41:57
In reply to Desipramine + Zoloft for Depression, OCD, posted by MuseMemento on May 10, 2015, at 15:20:10
Possibility, or could try strattera(noephinephrine reuptake inhibitor) which may have less anticholinergic side effects. Have you found snris to be more benificiul for your depression than ssris? Just trying to see what made Wellbutrin help depression so much and wether or not it is dopamine or the notephineohrine aspect of it. Regardless, OCD is a bitch, hang in there it will get better
Posted by MuseMemento on May 10, 2015, at 16:01:19
In reply to Re: Desipramine + Zoloft for Depression, OCD, posted by Bill82 on May 10, 2015, at 15:41:57
Oooh. That's a good thought. I've read that desipramine has better antidepressant properties to it than strattera, though. Perhaps that only applies to its individual use, though. Honestly, Wellbutrin is the only thing that seems to have ever helped my depression and that was in combination with zoloft a few years ago. It's possible that it was increased anxiety helping me to have the energy to function rather than true relief, though. We shall see.
Posted by Bill82 on May 10, 2015, at 18:02:36
In reply to Re: Desipramine + Zoloft for Depression, OCD » Bill82, posted by MuseMemento on May 10, 2015, at 16:01:19
Other options could include trying any of the snri's at higher than normal doses to attempt to help the OCD better, or to perhaps prescribe adjunctive buspirone to the Wellbutrin to see if it helps with anxiety.
Finally, perhaps see what using lamictal would do, as it is a potent antidepressant in terms of bipolar disorder, and could perhaps alleviate your symptoms if the reason nothing is working is because of latent bipolar symptomology(or unipolar symptoms that are presented in the bipolar pathway rather than traditional depression).
Posted by MuseMemento on May 10, 2015, at 18:19:52
In reply to Re: Desipramine + Zoloft for Depression, OCD, posted by Bill82 on May 10, 2015, at 18:02:36
Thank you. I haven't tried Effexor in over a decade but I did try Pristiq at 100 mg, I believe, a few years ago with no noticeable benefit. I'm not sure if Lamictal helped but I know that I deteriorated when I discontinued it along with changing my primary medication. I'll see what the pdoc has to say about desipramine before anything else. Perhaps he'll want to see how I do on the zoloft, memantine and abilify first. Thanks again.
Posted by tom2228 on May 11, 2015, at 11:28:11
In reply to Re: Desipramine + Zoloft for Depression, OCD » Bill82, posted by MuseMemento on May 10, 2015, at 18:19:52
Hey Muse,
I don't know how you're currently feeling, but I would say give the Wellbutrin a chance. Psych meds can make us feel worse as we adjust before they make us feel better. Bear in mind that bupropion will raise your Abilify level, so you are adjusting to that too, and given its long half life it may take a little to even out.
That being said desipramine added to my Marplan has really helped my depression and anxiety personally. I take it at night but it definitely gives me energy, helps with melancholia and lack of interested, motivation, and keeps me focused whereas without or on lower doeses I space out into depression land. It has also helped me with meth cravings/ desire to use.
And although it is a tricyclic it has the least binding to muscarinic acetylcholine receptors, far lower than the rest. It does have "pseudo-anticholinergic" side effects due it's potent norepinephrine, but all NRIs including Strattera and Wellbutrin would have those.
Tom
Posted by MuseMemento on May 11, 2015, at 11:34:34
In reply to Re: Desipramine + Zoloft for Depression, OCD, posted by tom2228 on May 11, 2015, at 11:28:11
Thanks, Tom. I appreciate the message and reaching out. When I'd decided to return to zoloft and wellbutrin, I'd been in denial about how severe my OCD had been the entire which I'm only now recognizing. It can, and has for moments over the past couple days, been so bad that I thought I was going to experience a psychotic break and that was only on 150 mg. I'll discuss it with the doctor on Wednesday, though.
Posted by SLS on May 11, 2015, at 16:52:51
In reply to Re: Desipramine + Zoloft for Depression, OCD, posted by Bill82 on May 10, 2015, at 18:02:36
Has clomipramine (Anafranil) been mentioned yet? Although its anticholinergic side effects are unpleasant, it can be potent as both an antidepressant and an anti-OCD.
Combining Luvox with nortriptyline might be an interesting treatment to investigate. Nortriptyline metabolism is not normally affected by Luvox. However, if one is already known to be as slow metabolizer via P450 2D6 enzyme, the dosage of nortriptyline would need to be reduced.
- Sorry.
Posted by MuseMemento on May 11, 2015, at 19:11:09
In reply to Re: Desipramine + Zoloft for Depression, OCD, posted by SLS on May 11, 2015, at 16:52:51
Clomipramine was intolerably sedating for me during the initial titration. I suppose I could try it again at some later date but I'd given up on it for the time being. It may be worth another look. I'm actually beginning to think that it's the zoloft that's causing the most difficulty as I didn't take wellbutrin today but the ocd has been worse still today. Perhaps I should be looking at pairing wellbutrin with another ssri.
Posted by Horse on June 3, 2015, at 20:34:37
In reply to Re: Desipramine + Zoloft for Depression, OCD » SLS, posted by MuseMemento on May 11, 2015, at 19:11:09
I'm doing ok on Lexapro. I'm treating a lot of anxiety including OCD. Zoloft wasn't quite right...I had panic attacks and felt very spacey. I think of Lexapro as a workhorse. Have you considered it?
Posted by MuseMemento on June 3, 2015, at 21:58:14
In reply to Re: Desipramine + Zoloft for Depression, OCD » MuseMemento, posted by Horse on June 3, 2015, at 20:34:37
What dose are you taking? I tried it at 20 mg and noticed something but it wasn't enough and we didn't try going any higher. Afterwards, I learned that with a clean EKG and in cases of OCD, we could have gone as high as 50 mg. Perhaps that's something to think about in the future. I'm presently trying clomipramine and it's the most sedating med I've ever touched. I hope that changes once the therapeutic effect kicks in.
Posted by Horse on June 4, 2015, at 22:47:04
In reply to Re: Desipramine + Zoloft for Depression, OCD » Horse, posted by MuseMemento on June 3, 2015, at 21:58:14
I hope your trial is successful...and the fatigue subsides. I take 20 mg daily. My doc wanted to push it, but I didn't tolerate it. He told me the same about doses up to 60 mg. I respond well enough at 20 mg.... Hey, best of luck!
Posted by MuseMemento on June 4, 2015, at 22:51:18
In reply to Re: Desipramine + Zoloft for Depression, OCD » MuseMemento, posted by Horse on June 4, 2015, at 22:47:04
Thanks for the reminder that there are other possibilities if this fails!
Posted by phidippus on June 8, 2015, at 22:12:51
In reply to Desipramine + Zoloft for Depression, OCD, posted by MuseMemento on May 10, 2015, at 15:20:10
There's an algorithm for treating OCD that the APA endorses. Here are all the medications you should worry about using to treat your OCD:
SSRIs
SNRIs
Mirtazapine
Clomipramine
Lyrica
Riluzole
Keppra
Zonegran
MAOI
dextroamphetamine
Tramadol
TopemaxAll of these drugs have been studied as treatments for OCD.
Eric
Posted by MuseMemento on June 13, 2015, at 18:04:26
In reply to Re: Desipramine + Zoloft for Depression, OCD » MuseMemento, posted by phidippus on June 8, 2015, at 22:12:51
Thanks, Eric. That seems quite comprehensive. I'm trialling clomipramine for a second time now and not doing well on it but I've yet to try luvox of the ssris, escitalopram above 20 mg/day and either cymbalta or milnacipran of the snris. I suppose the trick is that I need something that really does double duty insofar as it treats both depression and OCD.
Posted by phidippus on June 14, 2015, at 17:00:04
In reply to Re: Desipramine + Zoloft for Depression, OCD » phidippus, posted by MuseMemento on June 13, 2015, at 18:04:26
Luvox works well for OCD-it is most notable as sigma receptor agonist and does this moreso thann any other ssri. Sigma agonist have displayed antidepressant and anxiolytic properties.
If one AD is not working to treat both, then couple it with another AD that does. For instance, Mirtazapine with Luvox.
Eric
This is the end of the thread.
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