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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by CarolAnn on March 24, 2000, at 7:35:41
Well, it's that time again. It's been almost 8 weeks on Celexa(20 mgs), which was added to the Wellbutrin(400mgs.), which I've been on for 4 months. I really don't think this mix is doing much for me. The only time I really feel improved is when I take my Adderall. I have my Pdoc appt. a week from Monday, so...any suggestions for where to go next? I don't think that I want to stop the Wellbutrin, although I don't even know if it is effecting me at all. The thing is, I just can't handle anything that will increase fatigue and from what I've read, Wellbutrin is the most "activating" AD. I'm considering switching the Celexa to Prozac. I was on Prozac when I first started Wellbutrin, but at the time the Pdoc didn't want to mix ADs in case the Wellbutrin would be effective on it's own. At this point, I'm almost ready to try a MAOI, but...I don't know, I'm just so tired of being tired and having no motivation, but aren't we all? Sorry to ramble...any and all suggestions, advice, ect., are welcomed! Thanks! CarolAnn
Posted by bob on March 24, 2000, at 23:38:19
In reply to what to try next...anyone???, posted by CarolAnn on March 24, 2000, at 7:35:41
How much experience have you had with SSRIs? They may all be in the same class of meds, but they can have very different effects. That certainly was true for me.
While either of these two meds, on their own, were quite atrociously awful for me, for a brief time when I was on Paxil (washing out of it) and Wellbutrin (helping me cope with paxil withdrawal) the two worked together marvelously. [and no, I won't try it again -- either on its own is a nightmare for me, and I rarely get any effect out of a med the second trial or later that I have of it.]
You may want to consider a TCA with the wellbutrin as well.
good luck!
bob
Posted by JB on March 28, 2000, at 23:47:08
In reply to what to try next...anyone???, posted by CarolAnn on March 24, 2000, at 7:35:41
CarolAnn-I could have written your message. See
my message under "L-Tyrosine? 5-HTP?
L-Tryptophane?"
Posted by JohnL on March 29, 2000, at 3:29:29
In reply to what to try next...anyone???, posted by CarolAnn on March 24, 2000, at 7:35:41
> Well, it's that time again. It's been almost 8 weeks on Celexa(20 mgs), which was added to the Wellbutrin(400mgs.), which I've been on for 4 months. I really don't think this mix is doing much for me. The only time I really feel improved is when I take my Adderall. I have my Pdoc appt. a week from Monday, so...any suggestions for where to go next? I don't think that I want to stop the Wellbutrin, although I don't even know if it is effecting me at all. The thing is, I just can't handle anything that will increase fatigue and from what I've read, Wellbutrin is the most "activating" AD. I'm considering switching the Celexa to Prozac. I was on Prozac when I first started Wellbutrin, but at the time the Pdoc didn't want to mix ADs in case the Wellbutrin would be effective on it's own. At this point, I'm almost ready to try a MAOI, but...I don't know, I'm just so tired of being tired and having no motivation, but aren't we all? Sorry to ramble...any and all suggestions, advice, ect., are welcomed! Thanks! CarolAnn
CarolAnn,
Sorry to hear about your difficulties. I wish there was an easy answer. Here's a suggestion or two to think about though.First, just to see if a serotonin deficiency is really involved or not, maybe increase the Celexa to 40mg or 60mg quickly for about a week or two just to see what happens. The answer might be that simple. If there is either no response with increased side effects, or a negative response with increased side effects, that will be a pretty good clue that focusing on serotonin may not be the way to go. It's likely for you that any of the other SSRIs--except Prozac--will be too sluggish. Prozac has the best chance of providing some activation. Could always try it for a month just to see how it goes.
How about tricyclics? When the SSRIs just don't cut it, the tricyclics often can. Wellbutrin+tricyclic is a very powerful combo for hard to treat depression. The same goes for a tricyclic+stimulant. The two concerns would be dry mouth and constipation. But those won't be too hard to accept and deal with if you're feeling a lot better. If you notice a decent response to a tricyclic, you may be able to drop the Wellbutrin partially or completely.
I saw a research study that suggested a positive mood response to Ritalin predicts a positive response to Desipramine. A negative mood response to Ritalin predicts a postive response to Nortriptyline. That helps put the odds in your favor when choosing which tricyclic to try.
So, suggestions to consider would be:
1. Increase Celexa to the maximum tolerated dose for two weeks to see what happens.
2. Compare Prozac for a couple weeks to a month.
3. Try either Desipramine or Nortriptyline. Possibly drop the Wellbutrin after identifying a better response to something else.Just my thoughts. There are still plenty of other angles to try, such as Lamictal or Zyprexa (which will target chemistries that you haven't touched upon yet). But for someone in need of activation, I think the above suggestions would be reasonable places to experiment and compare. Wishing you the best.
JohnL
Posted by CarolAnn on March 29, 2000, at 16:54:01
In reply to Re: what to try next...anyone???, posted by JohnL on March 29, 2000, at 3:29:29
Thank you both for the suggestions.
JB, I have tried both 5htp and tyrosine in the past with no results, but will keep them in mind to try again if I get no results with Celexa increase.JohnL, Boy do you give good advice! Increasing the Celexa is exactly what my Pdoc did at my appt. today, although he only wants to go up 10mgs. at a time, so that we will know what is the lowest dose that will work. I'm feeling fairly positive about taking this route, because though I haven't felt "undepressed"(a term I made up), I have felt some improvement on my current regiman. Hopefully, I will see more improvement with the extra Celexa. Hope you are well, are you still trying stimulants? How are your current meds. doing? take care! CarolAnn
Posted by Trucn on June 19, 2001, at 13:48:25
In reply to Re: To JB and JohnL, posted by CarolAnn on March 29, 2000, at 16:54:01
> Thank you both for the suggestions.
> JB, I have tried both 5htp and tyrosine in the past with no results, but will keep them in mind to try again if I get no results with Celexa increase.
>
> JohnL, Boy do you give good advice! Increasing the Celexa is exactly what my Pdoc did at my appt. today, although he only wants to go up 10mgs. at a time, so that we will know what is the lowest dose that will work. I'm feeling fairly positive about taking this route, because though I haven't felt "undepressed"(a term I made up), I have felt some improvement on my current regiman. Hopefully, I will see more improvement with the extra Celexa. Hope you are well, are you still trying stimulants? How are your current meds. doing? take care! CarolAnnI got to this thread by searching for T-tryptophane and read with interest each of your entries/responses to CarolAnn's initial thread.
Background; I have been a Parkinsons patient for about 8 years and am currently taking, daily, Simemet CR - 200/800mg + Tasmar - 300mg (in 3 doses). In the past I took Zoloft and I believe desipramine (poor memory) until they became ineffective and then was partially successful with Prozac for 3 years. I relocated a few years ago and a new neurologist switched me to Paxil of which I currently take 40mg daily.
My problem? Paxil has become almost totally ineffective to the point that I don't care if the sun comes up each day. I feel no suicidal tendencies, so things have not progressed that far as yet, if ever.
My question; In 2 weeks I have an appointment with my neurologist and am interested to know if approaching him about taking L-tryptophane has any merit. I do not have a good rapport with him and he tends to make me feel "dumb' about medical things, in general.
I have read quite a few articles about L-tryptophane and know something of its background, but being an engineer I don't always interpret medical jargon properly. Any advice would be appreciated.
This is the end of the thread.
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