![[dr. bob]](/dr-bob-sm.gif)
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 Meltingpot on August 3, 2009, at 2:17:28
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.
I plan to stay on the clomipraine (Anafranil) and Reboxetine for 5 weeks because I want to give it a good try but in the meantime I have wellbutrin in my drawer and was wondering if it would be safe to take 300mg of that a day. I was thinking of maybe taking it for a week to see how it affects me.
Has anybody else had any experience with this combination?
Thanks.......Denise
Posted by SLS on August 3, 2009, at 6:34:30
In reply to Anafranil plus Reboxetine plus Wellbutrin, posted by Meltingpot on August 3, 2009, at 2:17:28
> 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.
> I plan to stay on the clomipraine (Anafranil) and Reboxetine for 5 weeks because I want to give it a good try but in the meantime I have wellbutrin in my drawer and was wondering if it would be safe to take 300mg of that a day. I was thinking of maybe taking it for a week to see how it affects me.
I would dump the reboxetine first and then add the Wellbutrin to clomipramine.
I have a personal bias against reboxetine. It made me far more depressed with anxiety and suicidality. I don't see very many people singing its praises. I don't think the drug is effective in as large a percentage of the population as are most other antidepressants.
Give consideration to using Zyprexa or Geodon every day instead of "pulsing" it ever few days. You want the brain to reset itself to a new equilibrium. Pulsing Zyprexa might be preventing that from happening. Geodon represents an alternative to Zyprexa. It can act as a potent potentiator of antidepressants. If it doesn't work within a week or two at 40-80mg, it probably won't. If it produces undesirable effects, you just switch back to Zyprexa the next day. You get your answer pretty quick.
- Scott
Posted by Phillipa on August 3, 2009, at 11:31:26
In reply to Anafranil plus Reboxetine plus Wellbutrin, posted by Meltingpot on August 3, 2009, at 2:17:28
Denise are you still on the zyprexa as thought it worked well for you. Good luck. Phillipa
Posted by Meltingpot on August 4, 2009, at 7:15:41
In reply to Re: Anafranil plus Reboxetine plus Wellbutrin, posted by SLS on August 3, 2009, at 6:34:30
> 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? 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.
I am sort of tippy toeing around this psychiatrst and don't want to question her because she is all I have now when it comes to my mental health. She seems to consider everything I tell her very carefully, is a good psychiatrist (compared to the NHS ones) and applies some logic and foreward planning when treating me. The NHS have pretty much said that they will not treat me any longer and that I should just try accepting my condition instead of fighting against it. So I think they have given up on me.
> I plan to stay on the clomipraine (Anafranil) and Reboxetine for 5 weeks because I want to give it a good try but in the meantime I have wellbutrin in my drawer and was wondering if it would be safe to take 300mg of that a day. I was thinking of maybe taking it for a week to see how it affects me.
>I would dump the reboxetine first and then add the Wellbutrin to clomipramine.
I would like to dump the reboxetine but also am loathe to give up on it before exploring a higher dose. Having said that I don't want to see the full five weeks out and then for her to tell me to increase the dose for another 5 weeks. I guess I could just double the dose of reboxetine for a week and then quit altogether. 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.
>I have a personal bias against reboxetine. It made me far more depressed with anxiety and suicidality. I don't see very many people singing its praises. I don't think the drug is effective in as large a percentage of the population as are most other antidepressants.>Give consideration to using Zyprexa or Geodon every day instead of "pulsing" it ever few days. You want the brain to reset itself to a new equilibrium. Pulsing Zyprexa might be preventing that from happening. Geodon represents an alternative to Zyprexa. It can act as a potent potentiator of antidepressants. If it doesn't work within a week or two at 40-80mg, it probably won't. If it produces undesirable effects, you just switch back to Zyprexa the next day. You get your answer pretty quick.
I really do understand what you are saying about Zyprexa and I have deliberated over this so many times. The thing is when I've tried taking a low dose every day for a week I feel a bit better energy wise but I have little motivation. It's like I suddenly have the energy to do things but just don't feel like doing it. I've found that when I take 10mg I get a really good rebound effect from it so that for about 4 or 5 days after taking it I have more energy and motivation. I don't know why, I think it kind of resets my brain and clears out all of the clutter. It's like having a little holiday. Also, although I thank God for Zyprexa it still doesn't make me feel like I felt when antidepressants worked, you've described the feeling yourself, colours seem more vivid, I feel like I see things more in 3D rather than flat and gray, music sounds a lot better etc etc. Is it wrong of me to want to feel like that again?
I have been conducting my own little experiments whilst on the clomipramine, I tried adding Effexor for about a week but didn't feel much different and I even tried adding 400mg of lithium per day for a week but didn't feel any different on that either. I see that you have responded to 600mg did it take 600mg in order for you to respond? Not that I can compare myself to you at all because you have Bipolar and I don't.
I'm curious to know how you feel when just taking the nortryptaline without the Parnate and vice versa? What would you say each one gives you on it's own. I know that I have asked you a similiar question before but I can't find the thread.
Thanks again for your suggestions......Denise
Posted by Meltingpot on August 4, 2009, at 7:18:41
In reply to Re: Anafranil plus Reboxetine plus Wellbutrin » Meltingpot, posted by Phillipa on August 3, 2009, at 11:31:26
Hi Phillipa,
The zyprexa does seem to provide relief but I'm loathe to take it every day.
Denise
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
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.