Posted by Ame Sans Vie on October 17, 2003, at 10:12:23
In reply to Re: Some advice and non-serotonergic ideas for you..., posted by MamaB on October 17, 2003, at 6:54:07
> Hi,
> A couple of warnings from personal experience:
>
> 1) It is not a good idea to combine high doses of Wellbutrin (over 300mgm a day) with CNS stimulants (Ritalin, Dexadrine, Adderall etc.)Well, this is not a problem at least 99% of the time. I'd be wary of adding a CNS stimulant to a dose above 400mg bupropion, but it's still *very* commonly done. Analogous to taking pstims with MAOIs, it's safest to start low with the stim and titrate up slowly. Many people (especially on this board) tend to be medication resistant and require doses (of Wellbutrin for example) which are a bit higher than the 400mg dose that any GP would be afraid to exceed. But these people need such high doses often because their bodies don't seem to respond terribly well to the drug, and thus a 400mg dose of bupropion for some people on this board may only have the effect of a dose 25% that size or less. Thus, a quite powerful antidepressant-augmenting agent such as a stimulant or opioid, may be many peoples' only hopes at living even partly normal lives... thank the gods on high that my psychiatrist understands my need for narcotic painkillers to treat depression since nothing else worse.
Also, just for example's sake, I've personally met several people in the real world (and many online as well) who take high dose Wellbutrin plus a stimulant for ADD/ADHD. If I recall correctly, seven of the people I've met in person have been on 400mg/day of bupropion plus above maximum doses of amphetamines or methylphenidate. Don't get me wrong though, I'm not saying this combination is safe for everyone. Just that, when one is working with a knowledgeable psychiatrist, many "rules" can be broken. I mean, I mentioned MAOI + stimulant above, and to many, many doctors, the idea is proposterous and they'd never consider it. This is certainly a more dangerous combination than stim + bupropion IMHO. Hell, some doctors are even combining tricyclics with MAOIs -- the key is start low(er than usual) and go slow. Perhaps, for example, 1.25-2.5mg of some form of amphetamine to begin with, raising the dose slowly only if no adverse effects are experienced. It actually is a very safe approach.
> 2) The same thing can happen with the combination of an SSRI and a high dose of Wellbutrin (especially Prozac)There is a certain population of caucasians, 10-20% I believe, who cannot metabolize this combination properly due to a lack of a liver enzyme.Right, P450 CYP2D6 is the enzyme -- the same enzyme responsible for endogenous conversion of codeine into morphine. Those who are deficient in the enzyme will find that codeine has no effect -- it doesn't do much of anything, if anything at all, until the body transforms it into morphine.
As far as combining an SSRI and bupropion however, it's an *extremely* common practice. And for those CYP2D6 deficient, there are tons of other options for reversing SSRI side effects -- buspirone, gingko biloba, bethanechol, ciproheptadine, pramipexole, ropinirole, amantadine, cabergoline, bromocriptine, methylphenidate, amphetamine, methamphetamine, magnesium pemoline........
There's no question about it though -- a CYP2D6 deficiency should be tested for following one's first appointment, and most drugs should be withheld until results come back negative. There's just no excuse not to have that lab work done (especially if the patient is white), and of course it is ultimately the doctor's fault if he/she were to administer medications that affect the CYP2D6 pathway in any way (i.e. substrates, inhibitors, inducers) before testing for this if it results in discomfort for the patient (which is usually the worst case scenario when these deficients are prescribed substrates of this enzyme -- moderate discomfort that doesn't tend to last long at all in most).
> 3) Before you take ANY "natural" substance CHECK WITH YOUR PSYCHISTRIST. Do not trust the word of the person selling it to you!!
~~>WARNING: angry, frustrated words below, but not at all aimed toward you, MamaB. Guess it's just been quite some time since I've really expressed my views about this topic...... lots of stuff I needed to get out.
On this I really do have to disagree -- psychiatrists (and at least 95% of all other allopathic practictioners) essentially know squat about holistic medicine -- very bad road for them to take if they plan on being around half a century from now. So, the vast majority of physicians will tell you to avoid them simply out of ignorance and the desire to make a buck -- of course allopathic medicine practitioners don't want their patients taking safer remedies which lack side effects, cost many, many times less in most cases and are extremely effective for so many. That's money right out of their wallet. I'd certainly never suggest ephedrine/ephedra/ma huang to anyone, but I guess until I start seeing horror stories on the news about *vitamins* and *minerals* (lol), I'll just stick with what's working -- and working QUITE well. And then thinking about all 50 or so prescriptions I've been on over the past three years that have made my life miserable and copmletely secluded for years... comparing those with the natural supplements I take? That's like comparing Adölf Hitler and Mother Theresa.
For a while, I was the in-store "expert" on herbal, vitamin, mineral, homeopathic, and many other remedies in a large chain health food store. Adverse interactions between prescription drugs and OTC remedies are rather few and far between. Side effects with most supplements are usually non-existant, and when they do occur, they are, in my experience suggesting remedies to folks and consequently getting feedback shortly thereafter, they light years away from being as debilitating as those brought on by most prescription drugs available. No addictive potential, high quality materials contained within them with study after study after study to support their use, tons of walking, talking testimonies of the riches of healthy self-medication (and you can find many examples in these forums, especially in Psycho-Babble Alternative)... and on top of it all, doctors who are occasionally unable, but much more often *unwilling* to help.
Besides -- these nutrients and other supplements we take are correcting a horrible imbalance caused by the disgusting American fast-food, couch potato way of living. The majority of these supplements are things that our bodies *SHOULD* have in them, but don't (or have grossly insufficient amounts of). DL-phenylalanine, methyl donors, vitamins, minerals, super green foods, activated coenzymes, neurotransmitter precursors capable of actual bodily utilization in the full... no reason to talk to your doctor about taking this stuff. Sure, DL-phenylalanine can't be taken with MAOIs -- those taking MAOIs should have been informed of this by their prescribing physician. L-tryptophan shouldn't be taken with most antidepressants -- but there is a quite clear warning on the label which tells you that. But TMG, DMG, DMAE, pregnenolone, ALA, fish oil...... no danger there unless there's an allergy. And everyone should certainly be taking fish oil -- if someone could actually get a doctor to sit down long enough to review the evidence which is ****HIGHLY**** in favor of it, I couldn't trust a doctor who told me not to take it. But get a doctor to spend even five minutes scanning over the research? Not unless someone owes you a Christmas miracle. But I've recently been blessed with great physicians who all realize the absolute importance of a two-way approach -- allopathic and holistic -- in medicine.
It's the internet age -- doctors and other professionals may not want educated patients/consumers/etc., but that's their own problem. A dying breed of professionals straining for their last breaths... the intelligent consumer will have most Snooty-You-look-like-a-drug-seeker-to-me-kid doctors extinguished sooner than we know. I just hope it can be in my lifetime. I've known more about allopathic and holistic medicine than any psychiatrist I've ever seen. I've been responsible for my own treatment for years because of around 8-10 psychiatrists, not one of them would get off their butts and research a bit to help their patients. It was myself who had to search the web endlessly, finding clinical abstracts, case studies, etc. to bring to my doctor to have him try my on a new medicine. No one should have to endure that, no one's live-in family should have to endure the terror of living with a mentally unstable human being. To me, and many many others with whom I've spoken, with very few exceptions, the money-grubbers' only utility lies in that they possess the almighty prescripion pads.
If humans really are the intelligent apes we so arrogantly think we are, then it shouldn't be long before all drugs -- Schedules I-V and everything left over -- become readily available to adults. Though I know that argument has been beaten to death, and no one's ever presented anything remotely resembling a rational reason that this should not happen.
> I have seen the results of all three of the above and it is not pretty. (med induced psychosis, seizures, sensory deficits) just to name a few) Granted, every individual is unique, but the above are only cautions. I will attempt to pass along some more technical info. shortly.
I know we all appreciate you're words of warning. Many of us at this board are old pros at this game though. Every aspect of it. So when the opportunity does come up, I always take a very strong stance toward more holistic approaches to therapy and less doctor interference, since any serious psychiatrist patient should strive to know much more about their (our) conditions than our doctor's do. And many of us here do -- goes with the territory.
poster:Ame Sans Vie
thread:269769
URL: http://www.dr-bob.org/babble/20031015/msgs/270192.html