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so as i have said they have me dx with treatment resistant depression. a new psychologist is toying with cyclothymia. i've tried a myriad of mood cocktails.

later i've been in stims, and without them in dead cant get out of bed, but i wasn't aloud to drink coffee in them.. but my depression is getting worse, and anxiety amount up.

i used to drink tons of coffee but quit to try the stim

i was in trintellex, buspar, adderall xr, klonopin at night to sleep

 

now we r doing wellbutrin, trintellix, buspar, klonopin day and night. no stim, can drink coffee....

 

this is jntil i get in to see my new pdoc. this one didn't feel comfortable starting mood stabializers when i'm gonna be going for a new doctor

any thiughs or similar luck with a similar combo??

 

 

 

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I find it interesting that you weren't  allowed to drink coffee with stims. I take Ritalin and was never told that.

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16 hours ago, looking for answers said:

later i've been in stims, and without them in dead cant get out of bed

I would bring this up for sure at your next appointment.

16 hours ago, looking for answers said:

but i wasn't aloud to drink coffee in them..

I've never been told not to drink coffee, just not to go overboard with it.

16 hours ago, looking for answers said:

but my depression is getting worse, and anxiety amount up.

Is that on your current cocktail or previous cocktail? Maybe your Trintellix dose needs to be increased (unless you're on 20 mg...).

16 hours ago, looking for answers said:

i used to drink tons of coffee but quit to try the stim

i was in trintellex, buspar, adderall xr, klonopin at night to sleep

 

now we r doing wellbutrin, trintellix, buspar, klonopin day and night. no stim, can drink coffee....

How important to you is it for you to be able to drink coffee? Have you given thought to trying other sources of caffeine? Like tea, yerba mate, or guarana extract that may not have as much caffeine in it as coffee? There's also a supplement you can order at nootropicsdepot.com called "Teacrine" that has theacrine in it which is similar to caffeine.

I'm very curious as to why you're on BuSpar AND Trintellix. They both act on the 5-HT1A receptor, with Trintellix working with much higher intrinsic activity than BuSpar, so it seems redundant to me to have both of them on board at the same time. BuSpar antagonizes the presynaptic dopamine autoreceptors and thus disinhibits dopamine release, but then again, Trintellix has some mechanisms of action for causing dopamine release too, like postsynaptic 5-HT1A partial agonism and 5-HT3 antagonism (according to Stahl).

So they replaced the Adderall XR with Wellbutrin and increased your Klonopin?

Do you think your anxiety was being driven up by the stimulant? In that case, do you think simply trying a lower dose of the stimulant would've helped? Or trying a methylphenidate-based stimulant like Ritalin, Metadate CD, Concerta, or Aptensio XR? Wellbutrin is just as likely to ramp up your anxiety as stimulants are because it, too, is a stimulant.

These are all things you could bring up with your gdoc/pdoc.

3 hours ago, looking for answers said:

curious what @mikl_pls thinks? you seem to know a ton!

I can't thank you enough for such a kind compliment! I'm quite humbled.

Edited by mikl_pls

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1 hour ago, mikl_pls said:

I would bring this up for sure at your next appointment.

my pdoc knows i'm exhausted and thinks it's from depression. i'm in the process of switching docs because current one feels like they can't help me anymore and i need more experienced clinician

Quote

I've never been told not to drink coffee, just not to go overboard with it.

Is that on your current cocktail or previous cocktail? Maybe your Trintellix dose needs to be increased (unless you're on 20 mg...).

 

this is my current cocktail. i am on 20mg trintellix. i have failed many many medications. i also was told that the trintellix needs decreased when placed with wellbutrin, because wellbutrin doubles its blood plasma levels.

How important to you is it for you to be able to drink coffee? Have you given thought to trying other sources of caffeine? Like tea, yerba mate, or guarana extract that may not have as much caffeine in it as coffee? There's also a supplement you can order at nootropicsdepot.com called "Teacrine" that has theacrine in it which is similar to caffeine.

i just need something to perk me up. so coffee will work. i was told no caffeine period with the stim. but i was drinking like 80-120 oz of coffee per day prior, they thought it may be my adhd needed that jolt. but i just need to be careful and not drink as much

Quote

I'm very curious as to why you're on BuSpar AND Trintellix. They both act on the 5-HT1A receptor, with Trintellix working with much higher intrinsic activity than BuSpar, so it seems redundant to me to have both of them on board at the same time. BuSpar antagonizes the presynaptic dopamine autoreceptors and thus disinhibits dopamine release, but then again, Trintellix has some mechanisms of action for causing dopamine release too, like postsynaptic 5-HT1A partial agonism and 5-HT3 antagonism (according to Stahl).

cant say why both my crnp and pdoc agreed in trintellix. buspar i've been in forever and feel it's worthless

Quote

So they replaced the Adderall XR with Wellbutrin and increased your Klonopin?

yes that's exactly what they did. she just was trying to make me comfortable. i said i was calm on stim and benzo but if anxiety hit in stim i was screwed. and that my anxiety had been awful because i was switching doctors and therapists and it's this big waiting game n no one has answers or help for me and i feel hopeless . so she went with wellbutrin and increased benzo

 

Do you think your anxiety was being driven up by the stimulant? In that case, do you think simply trying a lower dose of the stimulant would've helped? Or trying a methylphenidate-based stimulant like Ritalin, Metadate CD, Concerta, or Aptensio XR? Wellbutrin is just as likely to ramp up your anxiety as stimulants are because it, too, is a stimulant.

no it's situational with work, changing doctors, and my mental condition sliding. the stim was actually giving me a nice personality boost. i have tried lower doses and ritalin they were simply ineffective.

Quote

These are all things you could bring up with your gdoc/pdoc.

I can't thank you enough for such a kind compliment! I'm quite humbled.

well you seem to be very insightful and thank you for the reply.

also my new psychologist is tossing around cyclothymia. but again this pdoc feels like my condition is out of her realm. she feels it's treatment resistant depression and is unsure where to go. my new psychologist is toying with cyclothymia vs anxiety and depression. she was uncomfortable starting a new mood stabilizer , and doing a stim and benzo at the same time. said she just doesn't have the knowledge that allows her to weigh the risks and directions. she's a new practitioner. i respect her for admitting that. her goal was to make m as comfortable as possible till i get to new pdoc. was much more comfortable

doing the combination therapy and increasing benzo for now. i've been in this benzo protocol like this before, the stim

just helped a lot as wel, and they think i may have some adhd. i tried lamictal but after 350-500mg my blood leeks were only at 0.9 and my genetrax test says i super metabolize that med so it was never useful therapeutically.

but she never did combo therapy....

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so they added 100mg wellbutrinsrfor 1month and i can up it to 200mg in 3-4 weeks if i geel

like i need more, but i see new pdoc in 19 days so i'll most likely wait.

 

current meds

trintellix 20mg

buspar 30mg 2xday

wellbutrin 100mg in am

klonopin 0.5-1mg day

klonopin 1mg with 6-9mg melatonin at night to sleep

what i don't get is she said take the sr in the

morning only, but isn't sr take twice daily if going over 100mg?

 

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2 hours ago, looking for answers said:

my pdoc knows i'm exhausted and thinks it's from depression. i'm in the process of switching docs because current one feels like they can't help me anymore and i need more experienced clinician

I'm sorry to hear that. I hope you can find someone who can help you.

2 hours ago, looking for answers said:

i also was told that the trintellix needs decreased when placed with wellbutrin, because wellbutrin doubles its blood plasma levels.

That's exactly what I was going to point out and you beat me to it. ;)

2 hours ago, looking for answers said:

i just need something to perk me up. so coffee will work. i was told no caffeine period with the stim. but i was drinking like 80-120 oz of coffee per day prior, they thought it may be my adhd needed that jolt. but i just need to be careful and not drink as much

Wow, that's quite a lot of coffee! Have you heard of Provigil (modafinil) or Nuvigil (armodafinil)? They're kinda like stimulants, but they're classified as eugeroics (wakefulness promoters) with vastly different mechanisms of action than traditional stimulants. It's nearly impossible to get a prescription for them since they want you to have narcolepsy or some sort of sleep disorder before they'll approve the PA required to get them, but if you can manage to get one (Nuvigil responded better to me, personally, but you can dose Provigil a little higher equivalently) it would probably be well worth the trouble and you might find that you won't need as much if any coffee. They're completely safe to take along with a stimulant like Adderall.

2 hours ago, looking for answers said:

cant say why both my crnp and pdoc agreed in trintellix. buspar i've been in forever and feel it's worthless

Trintellix is fine, it's a good drug for most people (I had a horrible experience with it lol). BuSpar is worthless for many people, unfortunately. Maybe next time you could tell them it's not doing anything because that's just one more extra medicine your liver is having to process, and there's no need for extraneous meds in your cocktail if it's not doing anything but being there, you know what I mean? That's just my suggestion, but I recommend that you go with whatever your doc says. But if you really feel it's not doing anything, you might have to get rather insistent, since sometimes doctors seem to forget they're treating a human being and instead throw pills at them because they look good on paper thinking they *should* work.

2 hours ago, looking for answers said:

yes that's exactly what they did. she just was trying to make me comfortable. i said i was calm on stim and benzo but if anxiety hit in stim i was screwed. and that my anxiety had been awful because i was switching doctors and therapists and it's this big waiting game n no one has answers or help for me and i feel hopeless . so she went with wellbutrin and increased benzo

Hmm. I don't see why she didn't just stick with the stimulant and increase the benzo. The interaction between stimulants and benzo and Wellbutrin and benzo are the same, really.

Do you think the Wellbutrin is helping? Do you like it better or worse than the stimulant?

2 hours ago, looking for answers said:

no it's situational with work, changing doctors, and my mental condition sliding. the stim was actually giving me a nice personality boost. i have tried lower doses and ritalin they were simply ineffective.

Yeah, methylphenidate is a placebo for me, even if I take up to 120 mg. Dexmethylphenidate is the same way. I have no idea why. I only respond to amphetamines.

It seems like you were doing better on the stimulant and just needed more Klonopin available to you. Maybe you could see a therapist too who could teach you coping mechanisms for when anxiety arises, then you'd know how to deal with them and not have to pop a Klonopin every time it happens (not saying not to use Klonopin, but maybe you wouldn't have to uses it as often.)

There's a first-generation antihistamine that you can by OTC called "chlorpheniramine." It has SNRI properties, antidepressant, and anti-anxiety properties. Some people use it as an antidepressant or for anxiety. I'm not advising you to go buy some and try it, but I've taken it before if I can catch an anxiety attack in the beginning stages before it gets really bad and need a benzo, and it has prevented me from needing to use a benzo. Of course there are those panic attacks that spring up out of nowhere or you don't see coming and you have no time to take any initiative. But I thought I might mention chlorpheniramine. It's a neat medicine. You can get a bottle of a bunch of them at Walmart; I believe they're called "Chlortabs" or something like that. Very inexpensive.

2 hours ago, looking for answers said:

also my new psychologist is tossing around cyclothymia. but again this pdoc feels like my condition is out of her realm. she feels it's treatment resistant depression and is unsure where to go. my new psychologist is toying with cyclothymia vs anxiety and depression.

1

If you were cyclothymic, your mood wouldn't be low enough for a major depressive episode. It would just be cycling between hypothymia and hyperthymia. No hypomania, mania, or major depressive episodes. Treatment resistant depression could be unipolar or bipolar, and diagnosis between the two is very important because they require different kinds of medications.

2 hours ago, looking for answers said:

she was uncomfortable starting a new mood stabilizer , and doing a stim and benzo at the same time.

So what? Plenty of people take stimulants, benzos, and mood stabilizers. I take 2 mood stabilizers, a benzo, and a stimulant. lol. Sounds like your doctor is just really unsure of what to do. I was going to say something about Lamictal but then I read what you said about it. That's very unfortunate. Zonegran is being used more and more for bipolar depression—I like Zonegran a lot. Sometimes, Topamax can have an antidepressant effect. Tegretol can have an antidepressant effect in some people but it has quite a lot of side effects.

2 hours ago, looking for answers said:

i respect her for admitting that. her goal was to make m as comfortable as possible till i get to new pdoc. was much more comfortable

Okay, that I definitely agree with, and I respect her as well. Any doctor or clinician that will tell you "I don't know," or "I don't have experience with prescribing that," etc., is a great doctor and says a lot about them. They are definitely worth keeping as a regular doctor and clinician for any other maladies that might come your way. It shows that their ego is in check and that they aren't too proud to admit that they don't have knowledge in a certain area.

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2 minutes ago, BrianOCD said:

Hey I was wondering why you're taking Klonopin and Buspar combined?

been doing it for a long time? i have no idea, i think they added buspar for more anti anxiety effects and to augment the AD, but i am not sure!

 

why do u ask

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3 hours ago, mikl_pls said:

I'm sorry to hear that. I hope you can find someone who can help you.

I am going to a much more experienced PDOC, looking forward to it after years of no help and going downhill, but thank you!

3 hours ago, mikl_pls said:

That's exactly what I was going to point out and you beat me to it. ;)

Wow, that's quite a lot of coffee! Have you heard of Provigil (modafinil) or Nuvigil (armodafinil)? They're kinda like stimulants, but they're classified as eugeroics (wakefulness promoters) with vastly different mechanisms of action than traditional stimulants. It's nearly impossible to get a prescription for them since they want you to have narcolepsy or some sort of sleep disorder before they'll approve the PA required to get them, but if you can manage to get one (Nuvigil responded better to me, personally, but you can dose Provigil a little higher equivalently) it would probably be well worth the trouble and you might find that you won't need as much if any coffee. They're completely safe to take along with a stimulant like Adderall.

THey told me no to provigil, maybe new pdoc will ok it, she told me it was a stim

3 hours ago, mikl_pls said:

Trintellix is fine, it's a good drug for most people (I had a horrible experience with it lol). BuSpar is worthless for many people, unfortunately. Maybe next time you could tell them it's not doing anything because that's just one more extra medicine your liver is having to process, and there's no need for extraneous meds in your cocktail if it's not doing anything but being there, you know what I mean? That's just my suggestion, but I recommend that you go with whatever your doc says. But if you really feel it's not doing anything, you might have to get rather insistent, since sometimes doctors seem to forget they're treating a human being and instead throw pills at them because they look good on paper thinking they *should* work.

I will bring it up with the new doc. Its just kinda hanging out htere now

Hmm. I don't see why she didn't just stick with the stimulant and increase the benzo. The interaction between stimulants and benzo and Wellbutrin and benzo are the same, really.

Do you think the Wellbutrin is helping? Do you like it better or worse than the stimulant?

Just started wellbutrin today , so i have no idea, we havent tried combo AD's yet, so its a shot in the dark

Yeah, methylphenidate is a placebo for me, even if I take up to 120 mg. Dexmethylphenidate is the same way. I have no idea why. I only respond to amphetamines.

It seems like you were doing better on the stimulant and just needed more Klonopin available to you. Maybe you could see a therapist too who could teach you coping mechanisms for when anxiety arises, then you'd know how to deal with them and not have to pop a Klonopin every time it happens (not saying not to use Klonopin, but maybe you wouldn't have to uses it as often.)

I do good on stims and benzos, but the anxiety is better on benzos, but the mood is better on stims! Ive also been in therapy for almost 4 years trying coping mechanics, CBT, EMDR, and many many things........not helping, for now its benzoss

There's a first-generation antihistamine that you can by OTC called "chlorpheniramine." It has SNRI properties, antidepressant, and anti-anxiety properties. Some people use it as an antidepressant or for anxiety. I'm not advising you to go buy some and try it, but I've taken it before if I can catch an anxiety attack in the beginning stages before it gets really bad and need a benzo, and it has prevented me from needing to use a benzo. Of course there are those panic attacks that spring up out of nowhere or you don't see coming and you have no time to take any initiative. But I thought I might mention chlorpheniramine. It's a neat medicine. You can get a bottle of a bunch of them at Walmart; I believe they're called "Chlortabs" or something like that. Very inexpensive.

If you were cyclothymic, your mood wouldn't be low enough for a major depressive episode. It would just be cycling between hypothymia and hyperthymia. No hypomania, mania, or major depressive episodes. Treatment resistant depression could be unipolar or bipolar, and diagnosis between the two is very important because they require different kinds of medications.

Thats what i said but both the psychologist and PDOC disagree, that it can manifest in many differnt ways, no one is sold on it yet thought

3 hours ago, mikl_pls said:

So what? Plenty of people take stimulants, benzos, and mood stabilizers. I take 2 mood stabilizers, a benzo, and a stimulant. lol. Sounds like your doctor is just really unsure of what to do. I was going to say something about Lamictal but then I read what you said about it. That's very unfortunate. Zonegran is being used more and more for bipolar depression—I like Zonegran a lot. Sometimes, Topamax can have an antidepressant effect. Tegretol can have an antidepressant effect in some people but it has quite a lot of side effects.

She is unsure, shes a DNP, and a newer one, i love her, great rapport, but she admits not having the expereince with a difficult case and doesnt wanna just do things shes not comfortable with

Okay, that I definitely agree with, and I respect her as well. Any doctor or clinician that will tell you "I don't know," or "I don't have experience with prescribing that," etc., is a great doctor and says a lot about them. They are definitely worth keeping as a regular doctor and clinician for any other maladies that might come your way. It shows that their ego is in check and that they aren't too proud to admit that they don't have knowledge in a certain area.

SHes great id rec her to anyone with not as complicated as a case. great rapport and patient skills. BTW thanks for the lengthy replies they mean alot 

 

 

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3 hours ago, looking for answers said:

THey told me no to provigil, maybe new pdoc will ok it, she told me it was a stim

I guess they're being conservative. Plenty of people take Provigil/Nuvigil with a stimulant.

3 hours ago, looking for answers said:

Just started wellbutrin today , so i have no idea, we havent tried combo AD's yet, so its a shot in the dark

Hope it works for you!

3 hours ago, looking for answers said:

I do good on stims and benzos, but the anxiety is better on benzos, but the mood is better on stims! Ive also been in therapy for almost 4 years trying coping mechanics, CBT, EMDR, and many many things........not helping, for now its benzoss

What exactly are the stimulants for? For people with ADHD, stimulants actually decrease anxiety. But if one doesn't have ADHD, stimulants will likely increase anxiety; however, it's still possible for them to increase anxiety for folks with ADHD though. Maybe if you just tried Provigil/Nuvigil instead of a stimulant along with the rest of your meds, maybe it wouldn't ramp up your anxiety like traditional stimulants?

3 hours ago, looking for answers said:

Thats what i said but both the psychologist and PDOC disagree, that it can manifest in many differnt ways, no one is sold on it yet thought

Well, hopefully when you see the more experienced pdoc, you'll get a proper diagnosis.

 

3 hours ago, looking for answers said:

She is unsure, shes a DNP, and a newer one, i love her, great rapport, but she admits not having the expereince with a difficult case and doesnt wanna just do things shes not comfortable with

That's much better than a doctor who's too proud to admit they don't know something about your condition or what to do about it.

3 hours ago, looking for answers said:

SHes great id rec her to anyone with not as complicated as a case. great rapport and patient skills. BTW thanks for the lengthy replies they mean alot

You're more than welcome! I'm glad to help as long as I'm actually helping... lol.

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6 hours ago, mikl_pls said:

I guess they're being conservative. Plenty of people take Provigil/Nuvigil with a stimulant.

THey told me no coffee, or benzos with the provigil, that was the issue. It wasnt taking provigil with a stim. I asked what about provigil then i could take something again to calm me down, she said no its still a stimulant!

Hope it works for you!

What exactly are the stimulants for? For people with ADHD, stimulants actually decrease anxiety. But if one doesn't have ADHD, stimulants will likely increase anxiety; however, it's still possible for them to increase anxiety for folks with ADHD though. Maybe if you just tried Provigil/Nuvigil instead of a stimulant along with the rest of your meds, maybe it wouldn't ramp up your anxiety like traditional stimulants?

THe stim is for an ADHD diagnosis, and for refractory depression, more for the depression at this point, they will treat the adhd more once the depression is under control. BUt more as a mood booster IMHO

6 hours ago, mikl_pls said:

Well, hopefully when you see the more experienced pdoc, you'll get a proper diagnosis.

 

That's much better than a doctor who's too proud to admit they don't know something about your condition or what to do about it.

You're more than welcome! I'm glad to help as long as I'm actually helping... lol.

Hey anyone willing to listen or try to help at this point is great and appreciated! IM so over trying, fighting, med changes, doc changes, fighting with insurance, and having no answers and feeling like crap

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2 hours ago, looking for answers said:

THey told me no coffee, or benzos with the provigil, that was the issue. It wasnt taking provigil with a stim. I asked what about provigil then i could take something again to calm me down, she said no its still a stimulant!

Wow... I... don't know how to respond to this except I'm sorry that you're dealing with such a conservative pdoc...

2 hours ago, looking for answers said:

THe stim is for an ADHD diagnosis, and for refractory depression, more for the depression at this point, they will treat the adhd more once the depression is under control. BUt more as a mood booster IMHO

I see. My mom took Metadate CD and now Concerta for that very same purpose. It was like night and day for her. Honestly it's gotten to where it's like that for me too. Like I said, I hope the Wellbutrin works for you, and if it doesn't, I hope you can get back on a stimulant.

2 hours ago, looking for answers said:

Hey anyone willing to listen or try to help at this point is great and appreciated! IM so over trying, fighting, med changes, doc changes, fighting with insurance, and having no answers and feeling like crap

I know exactly how you feel!!

1 hour ago, looking for answers said:

only starting me in 100 mg wellbutrin sr

wonder how long till i feel the stim effects from it, if it all.

Wellbutrin SR 100 mg?! Jeez! My GP started me on 150 mg! Once or twice a day? (I have a hunch that it's once a day...)

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I started on 75 mg of Wellbutrin and went up to 150 mg in two weeks and then up to 300 mg. At 100 mg, it really isn't going to do much.

Also, I have to say that Provigil is technically not a stimulant. It basically works to keep you awake. I don't even think that it has been shown effective in clinical trials for ADHD.

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Provigil (and nuvigil its cousin) are 

more background "stims" meaning they don't have the PUNCH adderall_ Or methylphenidate Can. Good Choice for round the clock fatigued. 

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5 hours ago, Iceberg said:

Provigil (and nuvigil its cousin) are 

more background "stims" meaning they don't have the PUNCH adderall_ Or methylphenidate Can. Good Choice for round the clock fatigued. 

depression sure is making me tired!

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we'll get this trintellix is name brand no generic. so i was in 20 mg and getting a copay reduction from my insurance company due to so many failed meds. so it took it down from like 178 for 30 pills to 68. then with trintellix own discount program i could get the script for 10 bucks.

 

now that they added the wellbutrin and the trintellix dose has to go to 10mg. the co pay is 170 again. the insurance said the 10 mg difference changes the tier of the medication and they will not do a copay reduction. the doctor said we'll take it for now. because i'm going to a new dr in three weeks because this dr cant handle my case. so i'm essentially taking a med i know i can never afford , and hoping it works????? wtf is wrong with this.......

 

just more hopelessness 

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18 minutes ago, looking for answers said:

the insurance said the 10 mg difference changes the tier of the medication and they will not do a copay reduction.

That is utter and complete BS... Insurance companies are all a bunch of horses' asses.

20 minutes ago, looking for answers said:

now that they added the wellbutrin and the trintellix dose has to go to 10mg. the co pay is 170 again.

Is that with the Trintellix copay coupon??

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it's 78 with the coupon which is still to

much i take too many meds

i'm pretty pissed because ya pointless to even augment with the wellbutrin bc i will be coming off the trintellix no matter what..... do this is wasted meds , wasted time, and more things i will hve to taper when i get to new pdoc ...

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