Posted by SLS on April 13, 2006, at 16:20:18
In reply to question for SLS, posted by linkadge on April 13, 2006, at 14:51:24
Hi Linkadge.
> Hey, hows the Wellbutrin going?
Today was a tough one. Monday was significantly better. However, there is still a residual improvement. I have to expect peaks and valleys along the way, but hopefully the trend will be towards improvement. It will probably take a good 6 months before I near euthymia - maybe even a year. I should get a better idea as to which direction this thing is going during the next two months.
> I saw a different doctor today who mentioned giving it a try since I've been on the SSRI's multiple times.
I had tried Wellbutrin immediate release two or three times previously, but not in combination with nortriptyline or Lamictal. My doctor thought it was worth another try because he has had success with Wellbutrin + Lamictal. Also, he speculated that there would be less initial dysphoria using an extended release preparation.
If Wellbutrin gives you more mental and physical energy, but a lack of mood brightening, it might be worth taking the SRI you like best along with it. Effexor and Lexapro might be good choices. Of course, adding a TCA is an option. I find nortriptyline to be more of a mood brightener than desipramine. Most people respond to 75 - 100mg. It has a genuine therapeutic window. If you go too high with it, you lose the antidepressant effect. Weird.
> Some people seem to like it, but I guess some people have a hard time tollerating it.
I had headaches and a significant amount of background anxiety when I first started Wellbutrin. They have lessened quite a bit. I am in my fourth week of treatment. Some people use BZDs during the first few weeks to mitigate the anxiety. I didn't want to complicate things, so I decided not to add any more drugs. For me, the anxiety was mild to moderate, so I found it tolerable.
> How would you compare it to say, a noradrenergic TCA ?
I am tempted to say that Wellbutrin feels like a TCA, but I am having a difficult time being able to distinguish it from nortriptyline. I think they are working synergistically to produce an effect that reminds me of when I combined Parnate + desipramine. There is no apathy or amotivation. I don't know the extent to which Lamictal or Abilify are contributing to the overall antidepressant effect. If things go well, I will probably attempt to discontinue the Abilify.
As I improve and gain sufficient energy, I intend to begin an exercise program. I doubt I will be performing any vigorous aerobic exercises, but I should get a nice GH and testosterone kick from the resistance training. I might keep the intensity down to start off with. I don't want to stress the body in a way that would be counterproductive for recovery. One of my doctors said that intense anaerobic exercise depletes the brain of catecholamines. I don't know. I just don't want to endanger the antidepressant response. I should start out slowly anyway. It has been a long time since I've worked out.
I hope your new doctor is a source of fresh ideas.
I know it is difficult for you to contemplate returning to pharmacotherapy. I think Wellbutrin is a cleaner drug than the SRIs with respect to side effects. Perhaps you won't have to be as concerned with the long-term detrimental changes that you feel SSRIs have caused you.
Currently:
nortriptyline 100mg
Wellbutrin XL 300mg
Lamictal 100mg
Abilify 10mgI really hope something good happens for you soon. You have certainly done your part in trying to get well. You deserve that all of your hard work should pay off with a resolution of your condition.
I wish you the best of luck with your new doctor and hope that the two of you can find an effective treatment that you are happy with. If you do find one, I would recommend staying on it for at least 18 months and taper very gradually to help prevent a relapse. As for me, I'm a lifer. My case history pretty much mandates it.
- Scott
poster:SLS
thread:632693
URL: http://www.dr-bob.org/babble/20060412/msgs/632743.html