13 replies to this topic

[gerhard]

Hello, thanks for reading.

I've read a bit about both, on the forum as well as around on other websites, and still just haven't a clear idea of which route to go. Can anyone who has taken both compare their effects - and not only their positive effects, but the negative effects (if any) also? Mood, cognition, wakefulness, focus, productivity - anything at all?

I appreciate your help very much. Bye for now.

[gerhard]

Hi,

Just to add a little more information, basically I've been trying Wellbutrin for a while now, in addition to choline supplementation in CDP and Alpha GPC (concurrently) along with a Pir+Ani+oxi racetam stack (all low doses) and with chocamine powder and sulbutiamine to help with wakefulness and energy - but focus and mood still seem depressed.

So now I've taken a few weeks to wean myself off of the Wellbutrin, and want to replace it with either EMSAM or Mirapex in LOW DOSES.

Thanks very much.

[FunkOdyssey]

I ran into a potential deal breaker with pramipexole, I actually observed this phenomenon in action and only discovered this study a couple days ago:

Brain. 2009 May 4. [Epub ahead of print]
Reward-learning and the novelty-seeking personality: a between- and within-subjects study of the effects of dopamine agonists on young Parkinson's patients.
Bódi N, Kéri S, Nagy H, Moustafa A, Myers CE, Daw N, Dibó G, Takáts A, Bereczki D, Gluck MA.

1 Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary.

Parkinson's disease is characterized by the degeneration of dopaminergic pathways projecting to the striatum. These pathways are implicated in reward prediction. In this study, we investigated reward and punishment processing in young, never-medicated Parkinson's disease patients, recently medicated patients receiving the dopamine receptor agonists pramipexole and ropinirole and healthy controls. The never-medicated patients were also re-evaluated after 12 weeks of treatment with dopamine agonists. Reward and punishment processing was assessed by a feedback-based probabilistic classification task. Personality characteristics were measured by the temperament and character inventory. Results revealed that never-medicated patients with Parkinson's disease showed selective deficits on reward processing and novelty seeking, which were remediated by dopamine agonists. These medications disrupted punishment processing. In addition, dopamine agonists increased the correlation between reward processing and novelty seeking, whereas these drugs decreased the correlation between punishment processing and harm avoidance. Our finding that dopamine agonist administration in young patients with Parkinson's disease resulted in increased novelty seeking, enhanced reward processing, and decreased punishment processing may shed light on the cognitive and personality bases of the impulse control disorders, which arise as side-effects of dopamine agonist therapy in some Parkinson's disease patients.

PMID: 19416950

This inhibition of punishment processing manifests subtly as "bad decision making", apparent to those around you but not the medicated individual.

[gerhard]

That's an interesting study! I'm not sure if Wellbutrin falls into the same category, but judging by the objective measure of my productivity in terms of work and creative output, I definitely think that I was feeling more of a "reward drive" in relation to constructive tasks than I was before I began taking it.

I do have problems with getting sidetracked by petty whims and trivial interests, but, again, these distractions do seem to be mitigated by Wellbutrin rather than accentuated.

So I do think that dopamine supplementation in some form is helpful for me, but whether that should be in the form of a brute force agonist or something more akin to a precursor - I just don't know.

BPAP sounds like the best of all possible options, from what I've read here on the forum and elsewhere online, but of course it's not available on the internet.

[StrangeAeons]

I actually stopped pramipexole because I was wary of this type of detriment, and I carry an impulse control disorder diagnosis as is (though technically I've got a whole suticase full of diagnoses).
[I'm having a bit of a "come-down" syndrome, mostly being crappy mood and a periodic sniffle/shiver movement that I used to get after temper tantrums as a child. I really hope that goes away soon.]
I attribute the ICD to its selective agonism of dopamine receptors; it stimulates the limbic system (i.e. emotion, reward centers) dopamine pathways but not the prefrontal (i.e. learning, judgment) pathways. Unfortunately there's only one medication on the market that shows any D1 activity (D1 being the dopamine receptors most prominent in the prefrontal dopamine pathways) and it's been pulled from the market in the U.S., called Neupro.
I would actually say that if by "brute force" you mean lack of selectivity, reupatake inhibitors like Wellbutrin and MAO-B inhibitors like EMSAM are far less selective than Mirapex. The thing is, it might be selective for the wrong things. And a precursor, i.e. L-DOPA, is probably the most "brute force" method available, and I would strongly advise against using it. I know BPAP seems wonderful and flowery and amazing, but it's experimental and has very little data on bothersome details like safety. EMSAM is a great antidepressant, and I would definitely discuss the possibility of adding it or switching it out with your Wellbutrin. Mirapex also has some remarkable antidepressant properties when used as an augmentation strategy, but I'd try EMSAM first.

[FunkOdyssey]

I am now a proponent of the increasingly popular memantine + vyvanse combination for the purposes described by the OP (mood, cognition, wakefulness, productivity, focus).

[gerhard]

Hi, thanks for the replies!

What about DL-Phenylalanine?

I don't think I'll be able to get a prescription for Memantine, and Vyvanse would be quite a stretch too.

In any case, I will give EMSAM a try instead of going back on Wellbutrin - or, more accurately, I'll give Seleligine a try, since I can't seem to find EMSAM online and haven't succeeded in getting a prescription for it.

Okay, thanks again, take care, bye.

[StrangeAeons]

EMAM is superior to selegiline if you have depressive symptoms: you bypass first-pass effect, and reduce the risk of certain interactions at MAO-A inhibiting doses by not having it in your gut. Consistent plasma concentrations also help to avoid mood swings.
Since you don't seem to be doing any of this through a psychiatrist, though, it seems like you this is more of an experiment than a necessity. Vyvanse is just sustained-release Ritalin (methylphenidate). If you're capable of observing a very frequent dosing schedule with Ritalin you can get the same effect. You can definitely get a prescription for either if you have true ADD symptoms, and if you have a clinically-significant impulse control disorder you might be able to persuade a doc to give you those as well... er, maybe not.
I just looked up ICD and evidently the psychiatrists I've seen who use this diagnosis do so in a much different context than they way it's actually defined. I think they're using it in place of what should technically be referred to as ADHD-Hyperactive.

[FunkOdyssey]

Vyvanse is lisdexamfetamine which is a prodrug that is metabolized into dextroamphetamine, you are thinking of Concerta.

Edited by FunkOdyssey, 24 July 2009 - 03:37 AM.

[StrangeAeons]

so I am. I don't know my stims as well as I should; it appears that Vyvanse:Dextroamphetamine::Concerta:Methylphenidate. I suppose here is as good a place as any to explain why you prefer a dextroamphetamine-based drug to a Ritalin-based one-- Is this a personal preference thing or is it something more specific?

[gerhard]

I'd be glad to go through a psychiatrist, except all of those on my insurance like to refer to - instead of recent research, studies and breakthroughs - a list presumably handed to them by some pharmaceutical corporation that has lines drawn from Symptom A to Pill B; hence they'll only write me prescriptions for whatever's been advertised on TV recently. It's very frustrating. I've been through two pschyiatrists and three GP's and none will write me even a trial prescription for Provigil. When I discussed EMSAM with my current doctor, he flipped open a curious device - some kind of palm pilot, I guess - and within seconds informed by that EMSAM was for Alzheimer's patients only, not for me. My protestations were met by silence.

None of you have had these same problems, I suppose, because you live in more enlightened corners of the world than I do: the swampiest little nook of the Deep South.

If anyone would be gracious and charitable enough to contact me through PM and help me understand how better to interact with doctors in these endeavors, or any other topics related to my predicament, I'd appreciate your help very much.

Anyhow, back to the topic: Thanks again for the suggestions, I'll definitely follow them to the furthest extent I can manage in my circumstances.

Funk - what are your dosages and cycling schedule like on Memantine and Vyvanse?

Edited by gerhard, 24 July 2009 - 02:25 PM.

[FunkOdyssey]

20mg of vyvanse, sometimes 5mg IR adderall later in the day, with 20mg of memantine. I take either Saturday or Sunday off.

I have a prescription for 40mg of vyvanse but I haven't felt like I needed to use that much yet, a little goes a long way when you do everything correctly.

[gerhard]

Woah -

I started Wellbutrin again three days ago, after a break of nearly two months, and while I can't know for certain if it's responsible, it is certain that I have had a sudden onset of moderate depression.

Concurrence does not prove causation - but is it possible? Should I hold off on trying EMSAM as a result of this?

[StrangeAeons]

Three days? The antidepressant aspects of psychotropic drugs are usually only evident after several weeks.

Sometimes those several weeks... well, they suck.

In my case they never stopped sucking, or at the best only got to a point where they sucked less; but even for people who benefit from antidepressants, there's an adjustment period. Things might get worse before they get better. Of course, if you start having suicidal ideation... then the risk isn't worth the benefit. Of course if you aren't taking the drug for the antidepressant effect, then it's probably not worth it to begin with.

Wellbutrin and EMSAM may both be "dopaminergic", but they work very, very differently. Don't read too much into their MOA's, look at the data and their indications. Tricyclics and MAOI's both act on the same neurotransmitter systems, and yet they have very different profiles that often lead to one drug succeeding where another one failed, or one being tolerable where the other isn't. Again, if you're euthymic then maybe psychostimulants are a better route to go if concentration is your main goal.

Edited by StrangeAeons, 26 July 2009 - 11:25 PM.