Posted by europerep on January 25, 2010, at 14:43:09
In reply to Re: switching from venlafaxine/mirtazap to moclobe, posted by West on January 25, 2010, at 7:18:01
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> She is wrong about this. Venlafaxine doesn't appear to have any siginificant interaction with the cytochrome P450, in which the metabolism of so many drugs are involved, including bupropion (a CYP2D6 inhibitor). As I mentioned I have taken both and survived. The two have been combined safely in cases of refractory depression in at least two (admittedly anecdotal) documented cases in medical literature. The STAR*D algorithm also mentions it - you and your doctor should be looking at this right now - it was designed to address patients in exactly your current situation.1) yes i know, i did also find a psychopharmacology manual advising the combo, so I am definitely going to try it out.. I think my doc won't have none of that, since, quite frankly, she believes to be the ultimate source of pharmacological knowledge, but that is not the problem.. I did already obtain a box of bupropion by consulting a different doctor and telling her I was regularly taking it, so she give me a prescription for it.. if necessary, I'll just do that again.. I did not take it yet, because, as I mentioned earlier, when reducing mirtazapine I had sleeping troubles.. so far (yesterday was the first day w/o mirtazapine, the days before 15mg) I haven't had any problem sleeping, maybe because I shifted the venlafaxine from 300-150-150 to 375-150-75.. I'm such a genius ;)
at any rate, I will certainly not let these options "untouched", I just have to say that slowly I am wondering what for, because, unless the medication I am taking and I have taken did not produce its pharmcological effect (i.e., raising neurotransmitter concentration), then different meds doing effectively the same thing won't do the trick.. also, I read that reserpine, which depletes neurotransmitters, did only induce depression in a small group of individuals, so there has to be more to depression than just the monoamine hypothesis.. well, I'll see..>
> This, among others is one option. Please do consider the others outlined in STAR*D.2) I will, but, you know, if I lose another eight weeks now, that is just a drop in the ocean..
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> This is something to be concerned about I agree. It depends on how serious the situation is. Like anything, it will be a study in risk vs benefit.
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> I would venture to say that adding drugs with opposing mechanisms of action might have a greater outcome both in tolerability and efficacy. But it sounds as if, since you're suggesting it, you might benefit from a stronger serotonergic action. If this is the case, consider whether the bottom of venlafaxine, primarily an SSRI, has simply fallen out altogether. In which case you should be looking at switching to escitalopram or sertraline, perhaps augmenting a second drug as per the STAR*D algorythm3) well, I don't know whether it's serotonin, or NE, or DA, that is missing, or maybe all three.. I just found the extraordinary response to venlafaxine+SSRI quite impressing, especially after ECT..
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> > oh btw, west, I thought you were a doctor who gave his advice to people on the board :) , but now I see you are "only" a patient too, right?..
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> You flatter me :) I am my own doctor...we all are here!4)yeah, true.. unfortunately :(
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poster:europerep
thread:930533
URL: http://www.dr-bob.org/babble/20100122/msgs/934963.html