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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 4 of 4. This is the beginning of the thread.
Posted by petters on October 31, 2001, at 15:31:00
Hi Scott...
I have some experience, that are similar yours. I had an trial on Bupropion, as an add on to: Venlaflaxine + Mirazepine + Litium, because anergia. The first four days on 150mg I was eutymic and felt pleasure, witch I havenīt felt for years. On day five the effect was lost. I couldenīt raise the dosage because of raised bloodpreasure. I probably go back to Ziprasidone.
I have had trial on Bromcriptin, Mirapex, Amantadin. On Amantadin I had the same effect that you describes. The first tre hour very energic, and after that sedation. If I only could have the states, that I had the first four days on Bupropion.
What about you, Scott? I really hope you are not to bad. What about the Citalopram strategi, to your current regim - I hope you donīt mind Iīm asking. By the Way have you tried Clomipramin infusion? We use it here in Sweden in refractary cases. Unfortunately I couldnīt tolerate it. What about Yohimbin?
I hope you can stand my sometimes horrible spelling.
Sincerely
Petters
Posted by SLS on November 1, 2001, at 15:26:55
In reply to Bupropion poop out Scott, posted by petters on October 31, 2001, at 15:31:00
Hi Petters.
I am sorry that I haven't been responding regularly. I do appreciate your concern for me.
> I have some experience, that are similar yours. I had an trial on Bupropion, as an add on to: Venlaflaxine + Mirazepine + Litium, because anergia. The first four days on 150mg I was eutymic and felt pleasure, witch I havenīt felt for years. On day five the effect was lost.
I know. It is like a cruel joke.
Many people have the same 3-4 day response to amphetamine, methylphenidate, and dopamine agonists (bromocriptine and pergolide). Methylphenidate did not help me at all when I added it to tranylcypromine and desipramine.
> I couldenīt raise the dosage because of raised bloodpreasure. I probably go back to Ziprasidone.
A friend of mine is doing well with a combination of venlafaxine 150mg + bupropion 300mg. How much venlafaxine are you taking? Do you think bupropion would raise your blood pressure without venlafaxine?
If you respond partially to venlafaxine, maybe you would respond well to an MAOI like tranylcypromine or phenelzine. I know you have tried moclobemide, but these two drugs are much more effective.
Why did you stop taking ziprasidone? Have you ever tried sulpiride or amisulpride?
> I have had trial on Bromcriptin, Mirapex, Amantadin. On Amantadin I had the same effect that you describes. The first tre hour very energic, and after that sedation. If I only could have the states, that I had the first four days on Bupropion.
It is good that you can remember. You now have something to hope for. You know how good life will be when you find a treatment that works for you.
> What about you, Scott? I really hope you are not to bad.
Things are not too bad today. I am having trouble finding a dosage of nortriptyline that will keep me stable. I am going to ask my doctor to switch to imipramine. A small percentage of people who are partially responsive to nortriptyline do not have a therapeutic window for it. No single dosage works consistently.
> What about the Citalopram strategy, to your current regime - I hope you donīt mind Iīm asking.
I don't mind. I am happy that you ask.
My doctor seems to like citalopram. However, I want to try phenelzine first because I know I respond partially to it. I have never combined phenelzine with imipramine, lamotrigine, and an atypical neuroleptic (olanzapine or ziprasidone).
I reduced my dosage of lamotrigine from 300mg to 100mg to prevent cognitive side effects. I am going to wait a month to allow my system to stabilize. Next, my doctor wants to try adding mirtazepine again. I think mirtazepine will make me feel worse again, but he wants to see to be sure.
> By the Way have you tried Clomipramin infusion? We use it here in Sweden in refractary cases. Unfortunately I couldnīt tolerate it.
No, but I have heard of it being done. It is an old strategy that I don't think ever became popular in the US. Maybe I should read more about it.
Thanks.
> What about Yohimbin?
Right now, I am afraid to try yohimbine because I think it will make my depression worse like mirtazepine. Both drugs are NE alpha-2 antagonists. Dr. Andrew Nierenberg had recommended that I try yohimbine when I saw him in 1992. However, when I asked him about it again last year, he didn't think it was a good idea.
> I hope you can stand my sometimes horrible spelling.
You write English very well. I wish I could speak and write another language as well as you do. I sometimes feel very selfish that I don't.
- Scott
Posted by petters on November 2, 2001, at 12:39:49
In reply to Re: Bupropion poop out Scott ŧ petters, posted by SLS on November 1, 2001, at 15:26:55
> Hi Petters.
>
> I am sorry that I haven't been responding regularly. I do appreciate your concern for me.
>
> > I have some experience, that are similar yours. I had an trial on Bupropion, as an add on to: Venlaflaxine + Mirazepine + Litium, because anergia. The first four days on 150mg I was eutymic and felt pleasure, witch I havenīt felt for years. On day five the effect was lost.
>
> I know. It is like a cruel joke.
>
> Many people have the same 3-4 day response to amphetamine, methylphenidate, and dopamine agonists (bromocriptine and pergolide). Methylphenidate did not help me at all when I added it to tranylcypromine and desipramine.
>
> > I couldenīt raise the dosage because of raised bloodpreasure. I probably go back to Ziprasidone.
>
> A friend of mine is doing well with a combination of venlafaxine 150mg + bupropion 300mg. How much venlafaxine are you taking? Do you think bupropion would raise your blood pressure without venlafaxine?
>
> If you respond partially to venlafaxine, maybe you would respond well to an MAOI like tranylcypromine or phenelzine. I know you have tried moclobemide, but these two drugs are much more effective.
>
> Why did you stop taking ziprasidone? Have you ever tried sulpiride or amisulpride?
>
> > I have had trial on Bromcriptin, Mirapex, Amantadin. On Amantadin I had the same effect that you describes. The first tre hour very energic, and after that sedation. If I only could have the states, that I had the first four days on Bupropion.
>
> It is good that you can remember. You now have something to hope for. You know how good life will be when you find a treatment that works for you.
>
> > What about you, Scott? I really hope you are not to bad.
>
> Things are not too bad today. I am having trouble finding a dosage of nortriptyline that will keep me stable. I am going to ask my doctor to switch to imipramine. A small percentage of people who are partially responsive to nortriptyline do not have a therapeutic window for it. No single dosage works consistently.
>
> > What about the Citalopram strategy, to your current regime - I hope you donīt mind Iīm asking.
>
> I don't mind. I am happy that you ask.
>
> My doctor seems to like citalopram. However, I want to try phenelzine first because I know I respond partially to it. I have never combined phenelzine with imipramine, lamotrigine, and an atypical neuroleptic (olanzapine or ziprasidone).
>
> I reduced my dosage of lamotrigine from 300mg to 100mg to prevent cognitive side effects. I am going to wait a month to allow my system to stabilize. Next, my doctor wants to try adding mirtazepine again. I think mirtazepine will make me feel worse again, but he wants to see to be sure.
>
> > By the Way have you tried Clomipramin infusion? We use it here in Sweden in refractary cases. Unfortunately I couldnīt tolerate it.
>
> No, but I have heard of it being done. It is an old strategy that I don't think ever became popular in the US. Maybe I should read more about it.
>
> Thanks.
>
> > What about Yohimbin?
>
> Right now, I am afraid to try yohimbine because I think it will make my depression worse like mirtazepine. Both drugs are NE alpha-2 antagonists. Dr. Andrew Nierenberg had recommended that I try yohimbine when I saw him in 1992. However, when I asked him about it again last year, he didn't think it was a good idea.
>
> > I hope you can stand my sometimes horrible spelling.
>
> You write English very well. I wish I could speak and write another language as well as you do. I sometimes feel very selfish that I don't.
>
>
> - Scott
Hi Scott...To be frank honest, I am very imperessed of your farmakological knowleged. I Will take your tips under consideration, and talk it over with my doc.
I went off Ziprasidone because of a little feeling of numbless. But I will start it again because of the fail trial on Bupropion. I didnīt know that one could fell so great that I did the first four days on it. Specially the feeling sensation of pleasure, I mean realy plesure, and this was not a form of hypomanic states. Iīm sure about that. But what can one do. Just keep on struggle. Itīs dammed that the dopaminergic receptors so fast changes.I know you somwere write that you have a form of bipolar depression. Iīm think that I am bipolar 2. But you see, in my country, we donīt have bipolar 2, and not 3. only bipolar 1 disorders.
Have you tried combination therapies with Venlafaxine , to a tricycklic ( where therapeutic blood levels can be followed and used to advantage)? You can recruit different receptors with different meds, and What I have seen sometimes as many as 3-4 different antidepresants.
Have you tried Topipramate. I know there is not mutch data on it yet. I have seen one bipolar depression, witch was consider to be refractary. But When they made a trial on Lamotrigine + Topamax she had a great response. Of cours this is on case.
Have you tried the more convention treatment of Sodium divalporoex) Litium + Carbamazepine. Superb data of those, compered to poor data on Lamotrigin, Gabapentin... What about Nefazodone, or risperdone.
We have had Citalopram in my contry for 8 years. And its great for anxiety, and some depression. But keep in mind. The maximal recommeded dosage is 60 mg. I know severel cases that go as high as 100 - 120 mg, even in combination. without any server side effect, more than sexual side effect.I donīt remember if you have tried tryptofan. In my country some clinical treat refractary depression with clomipramin infusion + Tryptofan. They say it has the same potential that ECT.
By the way. Do you have Maprotilin in US? tricycklic. An risk in this meds are that it can trigger an manic states.
Another strategi I have seen in extreme serve refractary bipolar depression is: Amitryptilin + Clomipramin + Tryptofan + Litium.
Stay Well
Sincerely
Petters
Posted by SLS on November 6, 2001, at 10:30:55
In reply to Re: Bupropion poop out To - Scott, posted by petters on November 4, 2001, at 1:36:21
> To be frank honest, I am very imperessed of your farmakological knowleged.
I would prefer to know nothing and never be depressed.
I want to complement you too. I think that you have extraordinary clinical instincts. They parallel the best doctors in the US. You are also very well balanced in your approach. Are you a medical professional?
> I went off Ziprasidone because of a little feeling of numbless.I experience numbness with Risperdal 1.5mg, Zyprexa 5.0mg, and Geodon 60mg. My doctor says that it is possible to experience this, but it is not common. The numbness with Risperdal did not disappear, even after two weeks. Two years ago, I don't remember feeling numb at Zyprexa 10mg. But I was taking lamotrigine 200mg, not 300mg. This is why I tried to decrease lamotrigine. Unfortunately, it seems that I need 300mg. for it to help. It only helps a little, but it is better than nothing. It is enough to allow me to be on Psycho-Babble. Without lamotrigine, I am too vegetative and can't read at all.
> But I will start it again because of the fail trial on Bupropion. I didnīt know that one could fell so great that I did the first four days on it. Specially the feeling sensation of pleasure, I mean realy plesure, and this was not a form of hypomanic states. Iīm sure about that. But what can one do. Just keep on struggle. Itīs dammed that the dopaminergic receptors so fast changes.
Yes. Me too. This happened to me with bromocriptine, a selective dopamine D2 receptor agonist. It helped for only 3 days. Amphetamine affected me exactly the same way.
With tricyclics and MAOIs, I experience something similar. Two weeks after starting a drug, I have a very strong antidepressant response. But it only lasts for 3 days. Never 4 days! I am interested in memantine, an uncompetitive NMDA antagonist. It is supposed to reduce neuroadaptive changes (plasticity) affecting receptor sensitivity in response to amphetamine, cocaine, and opioids like morphine. It also prevents neurotoxicity and might increase neurotrophin production. I am hoping that memantine would prevent the adaptive processes that occur during the 3 days of normal functioning that lead to relapse. I know these thoughts are too simplistic. Memantine is available in Germany under the brand name Akatinol.
Are you still taking venlafaxine? How much?
> I know you somwere write that you have a form of bipolar depression. Iīm think that I am bipolar 2. But you see, in my country, we donīt have bipolar 2, and not 3. only bipolar 1 disorders.
I believe that there really is a bipolar II. The two most important features of bipolar II are:
1. There is never full mania, only hypomania.
2. It responds less to lithium, and more to valproate.This is why it is important to have two diagnostic entities.
> Have you tried combination therapies with Venlafaxine , to a tricycklic ( where therapeutic blood levels can be followed and used to advantage)?
Yes. I am doing that right now. But I think I am having trouble with nortriptyline. I like the way it feels when it is working, but it seems that I have no therapeutic window. 25mg. is too little and 50mg. is too much. Maybe I have to try in the middle. Before adding venlafaxine, nortriptyline 100mg. was pretty good for a few months. 100mg was still not very stable, though. 125mg. was too much and 75mg. was too little. My doctor commented that this is a problem with as much as 25% of people using nortriptyline. After adding venlafaxine, this problem got worse. I might switch to imipramine.
> You can recruit different receptors with different meds, and What I have seen sometimes as many as 3-4 different antidepresants.
I think you are right. My doctor wants me to try adding mirtazepine again. This would be: tricyclic + venlafaxine + mirtazepine + lamotrigine.
> Have you tried Topipramate.
No. But my doctor mentioned it.
> I know there is not mutch data on it yet. I have seen one bipolar depression, witch was consider to be refractary. But When they made a trial on Lamotrigine + Topamax she had a great response. Of cours this is on case.
Thanks!!! This is good news.
> Have you tried the more convention treatment of Sodium divalporoex) Litium + Carbamazepine. Superb data of those, compered to poor data on Lamotrigin, Gabapentin... What about Nefazodone, or risperdone.
I have not tried nefazodone.
> We have had Citalopram in my contry for 8 years. And its great for anxiety, and some depression. But keep in mind. The maximal recommeded dosage is 60 mg. I know severel cases that go as high as 100 - 120 mg, even in combination. without any server side effect, more than sexual side effect.
> I donīt remember if you have tried tryptofan. In my country some clinical treat refractary depression with clomipramin infusion + Tryptofan. They say it has the same potential that ECT.
Wow.
France, Sweden, Denmark, and Germany are more progressive and have more drugs to work with than the US.
Do you have VNS (vagus nerve stimulation) or rTMS (repetitive transcranial magnetic stimulation)?
> By the way. Do you have Maprotilin in US? tricycklic. An risk in this meds are that it can trigger an manic states.
Yes, we have maprotiline. The brand name is Ludiomil. I might try it some time. I see that your country often uses combination infusions of clomipramine + maprotiline. Do you know the theory why infusions work?
> Another strategi I have seen in extreme serve refractary bipolar depression is: Amitryptilin + Clomipramin + Tryptofan + Litium.
Very interesting.
Thank you, Petters. Again!
Sincerely,
Scott
This is the end of the thread.
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