![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by Joakim on January 15, 2016, at 20:06:23
On the third and fourth week on this drug i felt much better, excitement and pleasure in life came back.
Too bad it stopped working shortly after. I had a panic attack on the fifth week on Wellbutrin and broke down in tears, really intense emotions. After this i did not feel any of Wellbutrin's positive effects anymore. I tried giving it more time and tried all the doses (150 mg, 300 mg and 450 mg), i was on it for well over 3 months before i eventually gave up on it.
Now i am on the search of a replacement. Because i had a short lived good reaction to Wellbutrin, i'm trying to find something similar to it. Wellbutrin is a NDRI, and the list of other NDRI's are not antidepressants. But rather stimulants like Ritalin, and these aren't very good for long-term use.
After studying and research, i've learned how Wellbutrin works. It mostly acts on norepinephrine, and to a lesser extent dopamine. It is actually a weak antidepressant overall (which might explain why it's positive effects on me were so short lived) Because of this, i am looking for something stronger that works on either norepinephrine or dopamine. And what i ask myself is, did i have a good reaction to Wellbutrin because of it's action on norepinephrine? Or because of dopamine? This is what i'm currently on a quest about to find out.
I am taking the dopamine strategy first, i have not found many options for this one. Most prescription dopaminergics are psychostimulants, which aren't very good for long-term use. I have however, discovered an atypical antipsychotic named Amisulpride which i am currently trying. In lower doses, this drug releases dopamine. It has been reported as very useful for depression, dysthymia and emotional numbness.
If my dopamine strategy fails, then norepinephrine is next. I have found several options for this one, like NRI tricyclics such as Nortriptyline and Desipramine.
I'd like to hear some advice and recommendations from you guys. If you know of something that works similarly to Wellbutrin, and could be a good replacement for it. Please let me know.
Posted by rjlockhart37 on January 15, 2016, at 22:23:46
In reply to Wellbutrin was the closest to help my depression, posted by Joakim on January 15, 2016, at 20:06:23
wellbutrin is kinda like a cup of coffee, it's activating and can improve slowness from depression, but yes....bupropion is weak on dopamine, it does increase it but also i read that it blocks the reuptake of it, but it blocks the release of it too......i just rerember reading that somewhwere a long time ago.......
it's initial effects are mild euphoria, and then the stimulation can fade and then it equizles, i've been on wellbutrin first in 2004, then in 09, then short time in 12......
cogentin is sometimes what they give people who have TD from anti-psychosis meds, it does increase dopamine and is moderately well known amoung psychiatrist, you may ask about that but still it would be a more "off-label" medication to increase dopamine
too much dopamine = paranoia and irrtibility and some psychosis
too much norepinephrine = anxiety and agitation, hyper alertnessyou would have to level those to equal amounts to have a good effect, dexedrine is more for dopamine, on the other hand adderall releases a bit more NE than dexedrine due to the levo isomer on it
Posted by SLS on January 15, 2016, at 23:41:49
In reply to Wellbutrin was the closest to help my depression, posted by Joakim on January 15, 2016, at 20:06:23
Are you still taking Wellbutrin?
- Scott
Posted by Joakim on January 16, 2016, at 3:14:32
In reply to Re: Wellbutrin was the closest to help my depression » Joakim, posted by SLS on January 15, 2016, at 23:41:49
> Are you still taking Wellbutrin?
>
>
> - ScottYes i'm still taking it.
Posted by Christ_empowered on January 16, 2016, at 5:38:01
In reply to Re: Wellbutrin was the closest to help my depression, posted by Joakim on January 16, 2016, at 3:14:32
Maybe....add remeron, add an SSRI, add Ritalin, add Provigil...I do well with Abilify, Lamictal, and Wellbutrin...
thankfully, you have some options open to you.
Posted by linkadge on January 16, 2016, at 9:29:34
In reply to Re: Wellbutrin was the closest to help my depression, posted by Christ_empowered on January 16, 2016, at 5:38:01
Desipramine is more of a stimulant than nortrityline is. Emsam (selegiline) might also be something to look at.
Linkadge
Posted by SLS on January 16, 2016, at 10:34:14
In reply to Re: Wellbutrin was the closest to help my depression, posted by Joakim on January 16, 2016, at 3:14:32
> > Are you still taking Wellbutrin?
> >
> >
> > - Scott
>
> Yes i'm still taking it.You might want to continue the Wellbutrin and add Effexor or Pristiq to it. Also, adding Lamictal and Abilify can work well.
You have lots of options and excellent suggestions put forth by others.
- Scott
Posted by Joakim on January 16, 2016, at 10:41:08
In reply to Re: Wellbutrin was the closest to help my depression » Joakim, posted by SLS on January 16, 2016, at 10:34:14
> > > Are you still taking Wellbutrin?
> > >
> > >
> > > - Scott
> >
> > Yes i'm still taking it.
>
> You might want to continue the Wellbutrin and add Effexor or Pristiq to it. Also, adding Lamictal and Abilify can work well.
>
> You have lots of options and excellent suggestions put forth by others.
>
>
> - ScottI'm already on Lamictal and Abilify with the Wellbutrin, also including Amisulpride. Effexor, i've tried before. It did not go well for me.
Posted by SLS on January 16, 2016, at 13:39:23
In reply to Re: Wellbutrin was the closest to help my depression, posted by Joakim on January 16, 2016, at 10:41:08
> > > > Are you still taking Wellbutrin?
> > > Yes i'm still taking it.
> > You might want to continue the Wellbutrin and add Effexor or Pristiq to it. Also, adding Lamictal and Abilify can work well.
> >
> > You have lots of options and excellent suggestions put forth by others.> I'm already on Lamictal and Abilify with the Wellbutrin, also including Amisulpride. Effexor, i've tried before. It did not go well for me.
Sorry...
:-(
Linkadge is always good for a suggestion or two. Certainly, if you haven't tried a tricyclic antidepressant (TCA), it is something to look at seriously.
What happened with Effexor?
Is there any time of day when you consistently feel worse?
- Scott
Posted by Joakim on January 16, 2016, at 18:44:19
In reply to Re: Wellbutrin was the closest to help my depression, posted by linkadge on January 16, 2016, at 9:29:34
> Desipramine is more of a stimulant than nortrityline is. Emsam (selegiline) might also be something to look at.
>
> Linkadge
>
>What exactly do you mean by this? That Despiramine is more activating than Nortriptyline? I'm looking for something that can address my anhedonia. I'm trying that now with Amisulpride, but so far it hasn't done anything and i've been on it for almost 6 weeks.
I'm pretty much ready to start on either Nortriptyline or Desipramine soon. My current symptoms are anhedonia, lack of motivation and energy. Think Nortriptyline or Desipramine are effective on these symptoms?
Emsam is not available where I live.
Posted by Joakim on January 17, 2016, at 17:03:02
In reply to Re: Wellbutrin was the closest to help my depression » Joakim, posted by SLS on January 16, 2016, at 13:39:23
> > > > > Are you still taking Wellbutrin?
>
> > > > Yes i'm still taking it.
>
> > > You might want to continue the Wellbutrin and add Effexor or Pristiq to it. Also, adding Lamictal and Abilify can work well.
> > >
> > > You have lots of options and excellent suggestions put forth by others.
>
> > I'm already on Lamictal and Abilify with the Wellbutrin, also including Amisulpride. Effexor, i've tried before. It did not go well for me.
>
> Sorry...
>
> :-(
>
> Linkadge is always good for a suggestion or two. Certainly, if you haven't tried a tricyclic antidepressant (TCA), it is something to look at seriously.
>
> What happened with Effexor?
>
> Is there any time of day when you consistently feel worse?
>
>
> - Scott
>
>Effexor made me a lot worse. All i did was lay on the couch and cry when i was on it. And i feel pretty much the same the whole day, other than me being disappointed that i woke up in the first place.
Posted by SLS on January 17, 2016, at 18:58:49
In reply to Re: Wellbutrin was the closest to help my depression, posted by Joakim on January 17, 2016, at 17:03:02
> Effexor made me a lot worse. All i did was lay on the couch and cry when i was on it. And i feel pretty much the same the whole day, other than me being disappointed that i woke up in the first place.
I'm sorry that you should have to suffer so much.
Does it help at all to know that you are not alone in your suffering? I hope it does, but it may not. This is such a hideous disease.
Have you considered giving Parnate a try? MAO inhibitors seem scary at first, but I have been taking them on and off for 35 years. I had only one tyramine reaction from accidentally eating pepperoni.
- Scott
Posted by Joakim on January 17, 2016, at 19:22:54
In reply to Re: Wellbutrin was the closest to help my depression » Joakim, posted by SLS on January 17, 2016, at 18:58:49
> > Effexor made me a lot worse. All i did was lay on the couch and cry when i was on it. And i feel pretty much the same the whole day, other than me being disappointed that i woke up in the first place.
>
> I'm sorry that you should have to suffer so much.
>
> Does it help at all to know that you are not alone in your suffering? I hope it does, but it may not. This is such a hideous disease.
>
> Have you considered giving Parnate a try? MAO inhibitors seem scary at first, but I have been taking them on and off for 35 years. I had only one tyramine reaction from accidentally eating pepperoni.
>
>
> - ScottParnate will be my very, very last resort. If nothing else i try works. If only there weren't any dietry restrictions with MAOI's... i'd gladly try them out.
Posted by baseball55 on January 18, 2016, at 21:20:12
In reply to Re: Wellbutrin was the closest to help my depression, posted by Joakim on January 17, 2016, at 19:22:54
> Parnate will be my very, very last resort. If nothing else i try works. If only there weren't any dietry restrictions with MAOI's... i'd gladly try them out.
>Obviously, you need to do what is comfortable for you at this time. But I find that people way overestimate the impact of MAOI dietary restrictions. No-nos are:
aged cheeses (mozzarella and American, cream cheese are all fine) I have eaten aged cheeses in small amounts without a problem however - parmesan, cheddar, feta. Generally, you would need to eat an ounce or so to cause a reaction, though there's no hard and fast rule. I kind of push the envelope. I could give all this up with little impact on my normal diet.
aged meats. Salami, pepperoni, other hard deli meats (am not familiar with any others). Spoiled meats are dangerous too, but then spoiled meats are dangerous in many ways. Probably beef jerky is no good. So how often do you eat these things? You can switch from pepperoni to sausage pizza. I like sausage better anyway. Other meats, including deli meats, are fine.
Marmite - Huh? Some British food. Never had it
Sauerkraut - something I've eaten maybe twice in my life. If you like reubens, switch to cole slaw.
Fava beans - never had them in my life. Don't miss them. All other beans are fine.
Soy sauce in large quantities. Use sparingly with sushi. Be careful what you order at a Chinese restaurant. I have read that up to 1/4 cup is fine.
Draft beer - lines can have tyramine buildup. Bottled beer is fine.
Chianti is a no-no. Other red wines not mentioned anywhere, but I avoid all red wine. I don't like red wine anyway. White wine is fine, as are spirits, though one should avoid alcohol when depressed, in general.
Other things? I've seen things like no more than one orange a day, but you see a lot of stuff that's alarmist and not replicated anywhere else. And I never eat more than one orange a day. I usually don't eat oranges at all (probably I should). I do eat a lot a grapefruit.So that's pretty much it. Most American diets don't include most of the restricted foods anyway. Might be harder if you live in Italy or France.
Another argument I've heard friends use against MAOIs is that they don't want to do the washout. But really, if your current drug isn't helping you, why not take two weeks off and start an MAOI? You won't make anything worse.
People also worry about drug interactions besides SSRIs. There are some dangerous one - demeral and tramadol come to mind. But these drugs have many substitutes and aren't used all that much anyway. If you are having surgery, no problem. I had two surgeries on parnate and just told the anesthesiologist beforehand. If you're worried about an accident leaving you unconscious, so you can't tell the anesthesiologist, get a medical alert bracelet.
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.