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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by merpmerp on January 3, 2011, at 10:24:35
The questions about TCAs are just because I'm curious about them; the questions about Wellbutrin are because I'm considering asking my doc about it.
I know very, very little about TCAs so please bear with me if the questions are ignorant :)
-Many TCAs work on both serotonin and norepinephrine. So how do they differ in mechanism from Effexor, Pristiq, Cymbalta, etc.?
-How do TCAs as a class differ in their subjective effects from SSRIs? (I mean I've read things like they are not often subject to 'poopout' and they work better for melancholic depression - which I have - than for atypical depression.)
-I keep reading conflicting things about Wellbutrin. Some sources say it works mainly on norepinephrine, other sources say it mainly works on dopamine. Which is it?
-If Wellbutrin affects dopamine, might it help with attention and motivation? (I'm struggling with this a lot but don't want to mess with Ritalin or Adderall.)
-Is Wellbutrin as often subject to nastiness like *s* ideation or 'poopout', which I've had with SSRIs?
Thank you.
Posted by Phillipa on January 3, 2011, at 11:07:31
In reply to A collection of random med questions, posted by merpmerp on January 3, 2011, at 10:24:35
TCA's can be very weight gain producing. Also can effect the conduction of the heart. Some find they do work well in a combo with an SSRI or SNRI. I personally can't and will not take them due to the heart as my family history is heart disease and strokes.
I once took wellbutrin 150mg and found it very stimulating too much so and had to go off it or was taken off by the pdoc. Some say it helps both with weight, and smoking also. Those are just a tip off the iceberg so to say on those two med classes. Phillipa
Posted by tensor on January 3, 2011, at 13:47:12
In reply to A collection of random med questions, posted by merpmerp on January 3, 2011, at 10:24:35
A couple of links for you :-)
http://en.wikipedia.org/wiki/Tricyclic_antidepressant#Pharmacology
http://www.dr-bob.org/babble/20040724/msgs/371048.html
/Mattias
Posted by merpmerp on January 3, 2011, at 13:52:24
In reply to Re: A collection of random med questions » merpmerp, posted by tensor on January 3, 2011, at 13:47:12
Thank you, that was good reading... I did not know that the TCAs differed so much with respect to each other!
Posted by merpmerp on January 3, 2011, at 14:10:24
In reply to Re: A collection of random med questions » merpmerp, posted by Phillipa on January 3, 2011, at 11:07:31
> I once took wellbutrin 150mg and found it very stimulating too much so and had to go off it or was taken off by the pdoc.
Did it make you too anxious? That's the thing I'm concerned about. My anxiety is currently well controlled and I don't want it getting out of hand again.
Posted by g_g_g_unit on January 3, 2011, at 19:32:05
In reply to A collection of random med questions, posted by merpmerp on January 3, 2011, at 10:24:35
Sorry, I'm still a pharmacological amateur, so I'm sure someone else could offer you more comprehensive replies . . but . .
> -Many TCAs work on both serotonin and norepinephrine. So how do they differ in mechanism from Effexor, Pristiq, Cymbalta, etc.?
TCA's are generally 'dirtier' and more scattershot in their binding affinities than the current class of SNRI's: so, in addition to their action at the serotonin and norepinephrine pumps, they also carry (sometimes unwanted) anti-histaminergic and anti-cholinergic effects, which may contribute to their therapeutic effects (i.e. sedation, lessening of rumination, etc.). Unlike SNRI's, they also have the additional property of being 5-HT2C and 5-HT2A antagonists.
>
> -How do TCAs as a class differ in their subjective effects from SSRIs? (I mean I've read things like they are not often subject to 'poopout' and they work better for melancholic depression - which I have - than for atypical depression.)According to studies, TCAs are more suited to melancholic depression, whereas SSRIs (Prozac being the exception) are favored in atypical depression. TCAs may enhance sleep quality and onset, whereas SSRIs will often cause insomnia and compromise sleep integrity. TCAs are supposedly more 'brightening' and less emotionally numbing than SSRIs.
>
> -I keep reading conflicting things about Wellbutrin. Some sources say it works mainly on norepinephrine, other sources say it mainly works on dopamine. Which is it?Wellbutrin is a norepinephrine releaser.
>
> -If Wellbutrin affects dopamine, might it help with attention and motivation? (I'm struggling with this a lot but don't want to mess with Ritalin or Adderall.)There are conflicting accounts re: Wellbutrin and attention. Some people find it works well for that purpose; some people find that they become intolerably foggy (most likely due to the Nicotinic receptor antagonism). You'd have to try it and find out.
>
> -Is Wellbutrin as often subject to nastiness like *s* ideation or 'poopout', which I've had with SSRIs?I'm not so sure about that, sorry.
>
> Thank you.
Posted by merpmerp on January 3, 2011, at 20:17:33
In reply to Re: A collection of random med questions » merpmerp, posted by g_g_g_unit on January 3, 2011, at 19:32:05
Thank you for your answer!
> Unlike SNRI's, they also have the additional property of being 5-HT2C and 5-HT2A antagonists.
Ah. This, I did not know.
> According to studies, TCAs are more suited to melancholic depression, whereas SSRIs (Prozac being the exception) are favored in atypical depression. TCAs may enhance sleep quality and onset, whereas SSRIs will often cause insomnia and compromise sleep integrity. TCAs are supposedly more 'brightening' and less emotionally numbing than SSRIs.
Prozac is not favored for atypical depression? Is it more favored for melancholic depression then?
I felt better on Prozac (when it was working for me) than I ever have on Lexapro. On Prozac I felt "cured" instead of "drugged and sort of okay."
> There are conflicting accounts re: Wellbutrin and attention. Some people find it works well for that purpose; some people find that they become intolerably foggy (most likely due to the Nicotinic receptor antagonism). You'd have to try it and find out.
I may be doing just that sometime soon. :)
Thank you much!
Posted by Phillipa on January 3, 2011, at 20:22:02
In reply to Re: A collection of random med questions » g_g_g_unit, posted by merpmerp on January 3, 2011, at 20:17:33
Actually did the opposite and pdoc thought was hypomanic. Off the med fine returned immediately to baseline anxiety. Phillipa
Posted by g_g_g_unit on January 3, 2011, at 22:13:19
In reply to Re: A collection of random med questions » g_g_g_unit, posted by merpmerp on January 3, 2011, at 20:17:33
> Thank you for your answer!
Don't sweat it!
>
> Prozac is not favored for atypical depression? Is it more favored for melancholic depression then?No, I think Prozac works in both cases of atypical and melancholic dep., which is why it's often a first-line agent.
>
> I felt better on Prozac (when it was working for me) than I ever have on Lexapro. On Prozac I felt "cured" instead of "drugged and sort of okay."
>
> > There are conflicting accounts re: Wellbutrin and attention. Some people find it works well for that purpose; some people find that they become intolerably foggy (most likely due to the Nicotinic receptor antagonism). You'd have to try it and find out.
>
> I may be doing just that sometime soon. :)Good luck :)
>
> Thank you much!
>
Posted by merpmerp on January 4, 2011, at 8:56:16
In reply to Re: A collection of random med questions, posted by g_g_g_unit on January 3, 2011, at 22:13:19
One further random question I had...
-Why is Wellbutrin the only one in its class (as far as I know of)? After the success of Prozac, companies were rushing out their own SSRIs to compete. Why has that not been the case with Wellbutrin?
Posted by tensor on January 4, 2011, at 10:59:13
In reply to Re: A collection of random med questions, posted by merpmerp on January 4, 2011, at 8:56:16
> One further random question I had...
>
> -Why is Wellbutrin the only one in its class (as far as I know of)? After the success of Prozac, companies were rushing out their own SSRIs to compete. Why has that not been the case with Wellbutrin?Probably because it's difficult to hit the sweet spot with DAT occupancy. Too little and you won't notice it. Too much and it will produce (God forbid! :)) euphoria and be abusable.
Actually there are substances with similar mechanisms but are stronger; methylphenidate and amphetamines and derivatives./Mattias
Posted by merpmerp on January 4, 2011, at 11:39:23
In reply to Re: A collection of random med questions » merpmerp, posted by tensor on January 4, 2011, at 10:59:13
> Actually there are substances with similar mechanisms but are stronger; methylphenidate and amphetamines and derivatives.
>
> /MattiasYup, I knew about those, but I am somewhat curious why we don't have a glut of Wellbutrin-clones on the market. Your answer about DAT occupancy answers that :)
Posted by MissThang on January 12, 2011, at 8:50:56
In reply to A collection of random med questions, posted by merpmerp on January 3, 2011, at 10:24:35
Wellbutrin does seem, in my experience, to be less likely to lead to ideation and other nasty side effects such as weight gain and sexual dysfunction.
I just stopped it a couple of months ago because its effects had waned for me, but I've recently restarted it and it seems to be working for me again, so while poop-out is obviously possible, it also seems possible to regain the positive effects of the drug after a break from it. I had been on it for about 6 years and the benefits from it lessened after about 1.5 yrs, but if I had to do it over again, I would have simply taken a mini-med vacation from it and restarted it along with perhaps supplementing it with SAM-e. If I can continue getting it to work for me with a few mini-breaks thrown in here and there, I'll stay on this drug for life -- it's made that much of a difference for me and it's very safe -- it's one of the few drugs I actually feel safe enough on to try various nutritional supplements as augmentors, whereas with the ssri's, maoi's and even with the tca's, that can be pretty risky.
I'm a big fan of wellbutrin since it's the only med that's really worked for me...ssri's made me apathetic, fat and asexual and my recent trial of parnate was a nightmare.
If you haven't tried wellbutrin, I'd definitely say give it a try -- I also have primarily melancholic depression and it's been a great drug for me -- better mood, more motivation and enhanced sexual function.
From condensing all the reading I've done, I've come to the conclusion that it assists with both noripenephrine and dopamine.
Posted by merpmerp on January 15, 2011, at 13:49:10
In reply to Re: A collection of random med questions, posted by MissThang on January 12, 2011, at 8:50:56
Hi there,
Well so far I've been playing around with very low dose Lexapro and supplementing with tyrosine and exercise, and I'm very happy with how this is working. But if this stops working and I slide into depression again, Wellbutrin is definitely what I will look into. I think dopamine is a problem with me, hence the tyrosine, but if I were to take Wellbutrin I'd stop taking the tyrosine.
Thanks for sharing your experience with it. I really hope it keeps working for you. It's good to know that it can potentially work again after a mini-break from it!
This is the end of the thread.
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