Posted by MissThang on December 23, 2010, at 14:30:24
Hi Everyone -- I have been obsessively reading this board the past few months in an attempt to remedy my double depression (dysthemia with bouts of major depression). I had reached the conclusion that parnate was the cure for all my ails, but I've now been on it 6 weeks and nada...no initial stimulent effect, not an ounce of improvement in my major depression, nothing except constant hypertension. I'm only on 50 mg at this point because that's all my body will handle -- each dose sends my blood pressure up and even with the beta block I'm on (atenolol), my bp stays around 145/94 most of the time. (I didn't have hypertension prior to taking parnate.) I've been very careful with my diet and it doesn't seem to be a food-induced reaction, I just happen to be one of the lucky few who have responded with this side effect.
I was in touch with Dr. Gillman from Australia who said only about 2% of the 1000+ patients he's treated with parnate get this side effect and that it would wear off over time, but when you inlclude the 2-week washout I did after wellbutrin, I've basically been out of commission for 2 months and being self-employed, I'm going bankrupt so I can't just keep waiting and hoping my blood pressure's going eventually calm down enough for me to get to a therapeutic dose.
So...I'm wondering what I could do to make my old med work again. I was on 450mg wellbutrin xl with vyvanse and 15mg abilify, though I stopped the abilify about a month prior to going off the wellbutrin because I realized it was making me "flat" and I don't really want to take it again. I think all it was doing really was addressing the additional anxiety brought on by the vyvanse, which in hindsight, I realize didn't work as well as provigil with the wellbutrin.
I was determined to try parnate because I read so many wonderful things about it and my wellbutrin began pooping out on me several years ago. For the first year and a half or so, it worked very well all on its own, at which point it began pooping out. I thought maybe I'd gotten a bad batch or something, so I had the dr. write me a new script for that month's dose and went to a different drugstore to ensure I got another batch, but it still was less effective. I went from being treated with about 90% effectiveness to about 50% virtually overnight, and as the years wore on, it petered down to probably 15% effectiveness, despite our attempts to augment with lamictal, abilify, provigil and vyvanse. Before we switched, the dr. actually suggested that I try lithium as an augment, but I didn't like the idea of having to mess with the blood level business and the possibility of weight gain, but in hindsight, perhaps I should have tried it.
Right now, I'm on 50mg parnate and just yesterday I started autmenting with 600mg lithium, with the idea being that my dr. said I'd know within a week if the parnate/lithium combo was going to do me any good and by the time I see him at my scheduled appointment next week, we'd know whether we wanted to continue along that path or go in another direction. I've been on him to possibly autment the parnate with nortrip, but his concern there is that sometimes nortrip increases bp as well and I really don't have any wiggle room in my bp right now.
Some options I've thought of are either going ahead and taking 600mg of wellbutrin (probably along with the provigil) or augmenting wellbutrin with lithium if I do end up getting any benefits from it this week. I realize the increase in seizure risk between 450mg and 600mg increases from .4% to 2%, but with no family history of seizure, that still seems pretty low to me, especially when I think of the high likelihood of my haviing a hypertensive crisis on the parnate given my history of high blood pressure on it.
I forgot to mention that at one point (shortly after the wellbutrin started pooping out on me) I, on my own, went up to 600mg a day and felt great again. This only went on a few days before it was time for my regular apppointment with my pdoc and when I told him what I'd done, he had a near conniption fit talking about risk of seizures and so forth. So I dropped back down to 450mg and tried augmenting with a few things (I listed some here, but I think we tried a couple of others too and they didn't work.)
In the past, I've failed on every ssri I've tried and also on emsam (flat, unmotivated and eating all the time were the effects got from all of these -- along with sexual disfunction, which is unnaceptable to me). Before I started pushing for the parnate, I went through a 3-day period where I was adding 5htp along with another combined supplement that contained things to increase dopamine (velvet bean, aka, dopabean, was one of the primary componants), and for 3 days, I felt wonderful! Not down anymore, not pretending to smile anymore, actually enjoying people's company, etc. In short, my depression went totally into remission! Problem is, the effect stopped after 3 days and no matter what I did (increase the doses, take them on an empty stomach, whatever) I couldn't get the effect to last.
I mention that last scenario because that's what spurred me to want "more" -- more than a 15% response rate again...closer to a 100% response rate. I also mention it because since I responded both to an increase in seratonin and in dopamine, it's quite possible an increase in both with help me, though I do feel I'm primarily lacking in norpenephrine and dopamine, the two main chemicals wellbutrin addresses.
So that's primarily what I feel like I need help with -- norpenephrine and dopamine, with maybe a touch of seratonin.
Do you really think 2% seizure risk is all that high? (Assuming my dr. does let me end up taking 600mg wellbutrin.) What can I take to augment the N and D primarily, with maybe only a touch of S?
I'm really desperate here and need your help...being self-employed, I really may go bankrupt if I don't get my butt in gear again soon and the way I feel now, I haven't bathed in 4 days and I just sit around watching tv all day. Hoping this lithium may kick in in time for Christmas with my family, but so far, nothing from it.
What would you suggest? (Sorry my post is so long.)
poster:MissThang
thread:974433
URL: http://www.dr-bob.org/babble/20101218/msgs/974433.html