Posted by bleauberry on December 29, 2009, at 16:43:15
In reply to An AD that affects serotonin besides an SSRI, posted by Laney on December 28, 2009, at 18:50:54
Two comments.
Fisrt, slightly off topic, I wanted to chime in on the Wellbutrin discussion. It should be respected that Wellbutrin's mechanism is unknown. We have some basic science that tells us a few things it may do...weak NE reuptake inhibitor, weak DA reuptake inhibitor...and some hunches it is somehow tied into the nicotinic and/or nitric oxide pathways. Most of its mechanisms are mystery, as is clearly stated on the manufacturer's label.
I can say from my own personal experinece, with varying mileage respected, that I had more profound SSRI side effects on Wellbutrin than I did on SSRIs...the sexual stuff, the numbness stuff, all of that. Worse on Wellbutrin. Maybe whether it crosses over to the serotonin circuits depends on each person's genes and unique wiring.
Probably one of the better ways to avoid ssri side effects, or at least keep them minimal, may be to keep the dose low by combining it with a TCA such as Nortriptyline or Desipramine. The overall potential effect on depression is much more powerful and rapid, with less side effects than either alone. Mileage varies. I speak in general terms. I don't know. But for anyone to claim (anyone equals doctor, pdoc, friend, forum, whatever) that Wellbutrin is universally sex friendly, stimulating, non SSRI-like, is false.
Parnate was rather friendly to me, at a low dose, with none of the SSRI side effects except for light sleep structure. Nortriptyline alone doesn't feel to me like it has any of the SSRI side effects, but then, it is rather worthless to me without an SSRI. In that situation, SSRI side effects are greatly reduced. Nortriptyline must have some other of its unknown dirty mechanisms that partially block or reverse SSRI side effect mechanisms. Don't know.
Another approach to reverse SSRI side effects when taking an SSRI, besides a TCA, are stimulants such as Modafinil or Ritalin or Adderall. Sometimes Remeron is helpful, and sometimes antipsychotics are helpful.
But to set out to find a drug that does not have SSRI side effects is going to be a personal trial and error process, because nothing is universally one way or another for everyone.
Not much useful I realize, but two cents is two cents.
poster:bleauberry
thread:931322
URL: http://www.dr-bob.org/babble/20091227/msgs/931473.html