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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by West on June 17, 2009, at 11:19:26
Hello
I need some advice. I'm having trouble grappling with some tough breakthrough depression. Here's what I'm taking:
15mg Escitalopram
300mg Bupropion
10mg Selegiline
500mg L-Phenylalanine
2mg Clonazepam (for sleep but half in day if thing's are hellish)Every moment feels like a battle
I just took a second 5mg pill of selegiline.
Is this safe? Are there any risks besides hypertension and insomnia given selectivity is retained below 10mg?
It's this or something illegal to change my brain chemistry. I Get insomnia from everything though I know selegiline contributes significantly.
Thanks. You are all in my thoughts.
West
Posted by Phillipa on June 17, 2009, at 12:16:23
In reply to Esc + Bup + Selegiline, posted by West on June 17, 2009, at 11:19:26
West I get confused isn't seligline and maoi of sorts? Should that be taken with celexa SSRI? And the Bup you mean wellbutrin or the opiod antagonist? Hopefully someone with knowledge will answer soon. Phillipa
Posted by bleauberry on June 17, 2009, at 19:03:53
In reply to Esc + Bup + Selegiline, posted by West on June 17, 2009, at 11:19:26
> Hello
>
> I need some advice. I'm having trouble grappling with some tough breakthrough depression. Here's what I'm taking:
>
> 15mg Escitalopram
> 300mg Bupropion
> 10mg Selegiline
> 500mg L-Phenylalanine
> 2mg Clonazepam (for sleep but half in day if thing's are hellish)
>
> Every moment feels like a battle
>
> I just took a second 5mg pill of selegiline.
>
> Is this safe? Are there any risks besides hypertension and insomnia given selectivity is retained below 10mg?
>
> It's this or something illegal to change my brain chemistry. I Get insomnia from everything though I know selegiline contributes significantly.
>
> Thanks. You are all in my thoughts.
>
> West
>
Deprenyl is probably safe enough, though there might be some cardiac risk with the DLPA involved.Efficacy is a different story. The only times deprenyl has been proven effective is at high full MAOI doses monotherapy. You have to hunt far and wide to find anyone who finds it helpful longterm at low doses or augmentation doses. It just doesn't happen.
Has Lexapro been longer than 12 weeks? If yes, you have a choice of increasing the dose to 20mg-30mg range, or dumping it completely in favor of another ssri. Don't keep a loser on board.
The same with Wellbutrin. If it has been longer than 12 weeks, it has to go. Don't let a loser drag you down any longer.
Klonopin often causes or worsens depression. You gotta take a look at that. There are other options in that same family.
If you are looking for the norepinephrine/serotonin/dopamine approach, I think you will do a whole lot better with any of the following:
Zoloft+Nortriptyline
Savella
Prozac+Zyprexa
Nardil
ParnateSorry I don't have better things to say. When I see someone on a laundry list of meds and they feel like crap, I can't help but get pissed off at those meds and wonder why in the heck they are still on those meds, and why don't they go with combinations that actually have a huge body of evidence supporting their efficacy???
In the above list, Lexapro has a lot of credibility. Wellbutrin has a fair amount also. But that doesn't matter. If they aren't working, they aren't working, and it is simple as that. Throw the credibility out the window, and look at something else of equal or higher credibility that is different.
Posted by PetersKeys on June 18, 2009, at 8:01:56
In reply to Esc + Bup + Selegiline, posted by West on June 17, 2009, at 11:19:26
> Hello
>
> I need some advice. I'm having trouble grappling with some tough breakthrough depression. Here's what I'm taking:
>
> 15mg Escitalopram
> 300mg Bupropion
> 10mg Selegiline
> 500mg L-Phenylalanine
> 2mg Clonazepam (for sleep but half in day if thing's are hellish)
>
> Every moment feels like a battle
>
> I just took a second 5mg pill of selegiline.
>
> Is this safe? Are there any risks besides hypertension and insomnia given selectivity is retained below 10mg?
>
> It's this or something illegal to change my brain chemistry. I Get insomnia from everything though I know selegiline contributes significantly.
>
> Thanks. You are all in my thoughts.
>
> West
>Im on 150mg wellbutrin, 2.5 selegiline, and 20mg celexa. This combo seems to be helping me. doc said selegiline is a good add-on med when you stay under 10mg. I have treatmen resistance depression however, so im on more unconvential med combos.
Posted by West on June 18, 2009, at 16:36:47
In reply to Re: Esc + Bup + Selegiline, posted by PetersKeys on June 18, 2009, at 8:01:56
I am in a similar boat, though I perhaps have only partially treatment resistant depression. Are you prescribed selegiline by a doc in the UK? I'm wondering because it's not something I would expect from psychiatrists here. Overall combining bupropion with escitalopram has been the most effective for me. My references for drug comparison are:
prozac/escitalopram solo/duloxetine (nasty)/milnacipran (heart rate too high not so effective either)/moclobemide (complete write off)/dosulepin (another)/tianeptine
he combo has helped me before so it might be a blip.I'll begin a teva generic venlafaxine at 75mg XR tomorrow. The nhs don't pay for drugs whose patents have already expired, and generic is what you'll get 95% of the time.
I heard 'rodomel' (no seriously, what the hell is that? Who calls a venlafaxine generic >'rodomel'?, maybe it's a clever spin like 'remodel' <) has numerous complaints over increased side effects and lower efficacy from people who were switched to it from Effexor after the patent ran out last year.
If it really is the pits I'll see my psychiatrist about getting a private prescription for brand name. Hey ho, I should know soon enough if it's suitable or not.
How significant is klonopin at contributing to depression when taken at 1mg a day. Thing is, I actually find, at least the immediate effect, quite helpful.
But maybe it's being in my system all the time is in fact bringing me down overall, which could be the case, which is frustrating as if it is I'm not really clued in to it having that effect (unless i take a huge amount then i notice the next day when i experience som dullness/lethargy etc)
Officially, I get 2mg for sleep at night (unusual i think with uk psychs) with zopiclone as an alternative. On the rare occasions that I have taken that much at night I have actually noticed feeling quite good on waking up sometime - more up for doing things out and about than usual (effects on social anxiety seem quite potent).
So I really don't know but thank you for raising the issue. How many people have gotten worsening depression from it? I did develop a marked social anxiety with my depression, which is garden melancholic/unipolar with dysphoria
W
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