Re: Bupropion + modafinil alternatives

"Yes, a generic version of Cymbalta is available. The patent for brand-name Cymbalta expired in 2013, allowing other companies to produce and market duloxetine, the Cymbalta generic name. Various manufacturers, including Sun Pharma, Teva, Lupin, and Aurobindo, began to produce the generic version after the original patent expired. The introduction of duloxetine as a generic has provided more options for patients needing this type of medication".

If you don't live in the U.S., you can import it with a regular doctor's prescription. Better yet, use Google to find generic duloxetine in your country.

> I've tried Effexor and for me it's a washout, I get intolerable anxiety. Cymbalta, which gives a different ratio of NE & 5HT iirc, is much better, but not ideal, for reasons I think I mentioned in my original post. I've come to believe that my 5HT levels are likely adequate; just about any A/D that targets 5HT makes me unpleasantly anxious

I think you are right in looking towards dopamine, especially if there is a lack of energy, motivation, and anhedonia as prominent symptoms.

That is certainly not a common complaint, but I don't doubt that it is possible. Lamotrigine can be energizing. What dosage did you work up to? How quickly did you increase the dosage? Lamotrigine seems to be better for people with bipolar depression than it is for unipolar depression. Did you ever have a hypomanic /manic reaction to a drug? Family history?

Using lithium at low dosages (150-450 mg/day) can work for both unipolar and bipolar depression.

> In fact, years ago I had the unpleasant experience of serotonin syndrome from an unexpected interaction between Serzone and Wellbutrin.

That's worth thinking about. As I'm sure you know, nefazodone is both a serotonin reuptaker and 5-HT2a antagonist. The latter mechanism can increase serotonin release. One must always take into consideration that there might be more mechanisms to yet be discovered.

>One idea I was reminded of earlier tonight by a video that YouTube helpfully algorithmically served up to me is that DA can be boosted by some activities.

A long time ago, I found a study that reported that when one "acts" manic, dopamine metabolites found in the blood-stream or urine were increased. I actually used this as a strategy to mitigate my depression. In fact, I used it when I was in the waiting room for my NIH screening. Things were so bad at first, that I wanted to turn around and go home. I couldn't let this happen, so I decided to try it. It worked, and I was able to complete the screening process. I was amused when the NIH doctor called my parents to be sure that I wasn't manic. I tend to engage with people, and this animates me. After two weeks after intake, my depression settled back to my baseline severity. At this point, they saw how severe my depression was. The invesitator later said that my staying alive was nothing short of "heroic". Similarly, at the end of my first visit with a doctor at NYU (New York University), he called my depression "horrendous". After he said that, I cried. I felt that this doctor understood. I felt vindicated.

I don't have much capacity for exercise these days, as I have peripheral arterial disease and can't even walk far without pain. But I _can_ walk, and I can start progressively doing more, also getting back to a set of exercises a physio recommended to me -- if I can break my lifelong sedentary habit and resistance to most exercise.

Were you more active as a child before your depression began? Your lack of motivation and energy are classic symptoms of an anergic depression. A handful of years ago, triple reuptake inhibitors were in the antidepressant pipeline. These drugs inhibit all three amine neurotransmitters (actually, they act more like modulators). DA + 5-HT + NE. I would like to have seen how you reacted to nomifensine (Merital). It is a potent DA reuptake inhibitor. It was sold around the world. However, there were reports of hemolytic anemia coming out of the Europe. The drug company voluntarily withdrew worldwide. It was FDA approved in 1984 and recalled in 1986. This is one of the few drugs that I had a great response to, but for less than a week. My doctor at the time (Baron Shopsin) said that he had never seen me so well. This is the same pattern of response I had to every other antipressants. It was only when I combined a MAOI + TCA + lamotrigine that I found success with.

For what it's worth, in 1983, after performing some research in a medical school library, that dopamine might be a crucial contributor in *my* case. I was laughed at by my research clinician at Columbia Presbyterian / New York Psychiatric. When I asked for bupropion - not available at the time - on a compassionate use basis, they said "no". I left and found someone who was working with it open-label. It made me moderately worse. Previously, in a phone call to Donald Sweeny, MD, he told me that bupropion didn't work the way I thought it did. It was not a potent DA reuptake inhibitor. He said that no one knows how bupropion works. It was true then. It is true now.

I still think that dopamine hypoactivity is involved in my case. This is probably most true for bipolar disorder.

> Another physical DA booster I've heard suggested a couple of times is a cold shower (just 1-2 minutes). I'm a bit shower-shy lately, partly because I don't have an en suite shower, but really it's just a matter of making my mind up to it. I have a health worker coming once a week who will help me shower if I just ask him!
>
> As you can see, I'm posting at length to try and talk myself into doing some of these things. I'm a lifelong pill popper, though, so I really want an NDRI to give me a chemical kick-in-the-pants to get going!
>
> Thank you for the MAOI suggestion. The last time I saw the pdoc I'm going to in a couple of weeks, he mentioned them, but I demurred on account of my favourite lunch or snack is often salami or aged cheese.

Priorities. I am sure that if Nardil or Parnate brings you to remission (or something close), you will be very happy to give those foods up.

I wouldn't overlook playing with a DA receptor agonist. Pramepixole (Mirapex) would be my first choice, but only as an augmenter. I have only rarely see it work, thought.

Some see things as they are and ask why.
I dream of things that never were and ask why not.

The only thing necessary for the triumph of evil is that good men do nothing.

Re: Bupropion + modafinil alternatives

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