Posted by SLS on August 4, 2009, at 8:25:45
In reply to Anafranil plus Reboxetine plus Wellbutrin - SLS, posted by Meltingpot on August 4, 2009, at 7:15:41
> > Hi,
> >
> > Well I don't think that the 4mg that's been added to my clomipramine (Anafranil) has been doing a lot and I've been on it for about 2 weeks. I know my psychiatrist will want me to give it 5 to 6 weeks but I'm impatient to try something else.
>
> >If you are talking about using reboxetine here, I don't understand the rationale for trying it. The metabolite of clomipramine, desmethylclomipramine, is a potent NE reuptake inhibitor. Perhaps the rationale is simply that you haven't tried it before.
>
> Hi Scott, I think my psychiatrist prescribed Reboxetine because of it's NE Reuptake. I know that Clomipramine does that too but doesn't it have more affinity for Serotonin?Again, the major metabolite of clomipramine, desmethylclomipramine, is a potent NE reuptake inhibitor and might be akin to desipramine in terms of selectivity. That said, it is the net effect on you that matters. I understand your doctor's desire to add reboxetine. It makes sense. It would be great if it works out. Some people respond to reboxetine monotherapy quite well, but I think they represent a minority. Perhaps reboxetine has more utility as an adjunct to other medications as you are using it currently.
> Also, I was finding that the higher dose Clomipramine was making me feel exhausted (although Depression does that too) and so she decided to take the dose back down and add the Reboxine. She did toy with the idea of adding Remeron but because that can also be sedating she decided against it. Also, as you say I was pleased to try a drug I haven't tried before.
It seems that you found a good doctor. I like her approach.
> I would like to try high dose Wellbutrin (450mg) with the Clomipramine (100mg) but then I'm a bit worried that the combination might induce seizures especially if I ever take Zyprexa on top.
Hmm. I didn't consider how Zyprexa lowered the seizure threshold.
You know your system very well. If you can get more relief from pulsing Zyprexa rather than chronic administration, then it would be hard to justify a change unless more concrete evidence were to emerge to substantiate its being counterproductive. I'm just reporting what I have been told by various doctors. There is anecdotal evidence that pulsing MAOIs is sometimes effective in combating poop-out. However, I am not sure the same holds true with reuptake inhibitors.
Never give up, no matter what they say. You deserve to live free, and not remain shackled and held in a dark, cold prison cell. You are certainly smart enough and motivated to find an answer to all of this.
Regarding lithium, it has not been an all-or-nothing experience for me. 300mg helped a little within 36 hours. 450mg helped even more. 600mg feels much better so far. If I need to go up, I will. The only side effect I have at this point is some tremulousness. The dosage range of 300-600mg is what is normally used for unipolar depression. In a situation where mood stabilization is necessary to prevent the recurrence of mania and depression, people usually end up between 900-1500mg. It depends upon blood levels as to what dosage is optimal.
Yesterday was a good day for me. This morning isn't as good, but I need to be patient and let the drug and my brain perform their dance together for awhile before evaluating the potential for the 600mg dosage to bring me to remission. I am not out of the woods quite yet. If things continue to improve over the course of two weeks, I will feel much more confident that I won't relapse.
You are more patient than I am. That will work in your favor.
Get well!
- Scott
poster:SLS
thread:909960
URL: http://www.dr-bob.org/babble/20090801/msgs/910198.html