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Originally Posted by earthdog  I have been on 300mg Wellbutrin and 75mg of Effexor (down from 225mg since starting TRT about one year ago under Swale's care) per day, and I don't feel that combo is doing its job. About 9 years ago I was on Prozac and I feel I did better on that. I was taken off if it because of sexual side effects - which were more likely due to low T than the Prozac - and put on Celexa and Wellbutrin. Then I was taken off Celexa and put on Effexor because of weight gain and general lethargy (also probably due in part to low T).
One problem I have that I think is due to the Effexor is faulty memory.
What are your feelings on this combo I'm on (300mg Wellbutrin and 75mg Effexor)?
While I solicit everyone's response, I'm really hoping Marianco will see this and take a shot at it. |
I have been diagnosed with SEVERE major depression for the past ten years. I have taken literally every modern class antidepressant as well as some of the older tricyclic antidepressants. Ive also taken the MAOI Parnate and tried oral selegiline. Ive tried lithium augmentation of antidepressants, lamictal, depakote for headaches, low dose atypical anti-psychotics for augmentation of antidepressants.
I could go on and on and on...Ive taken all of them.
Some people here want to know what the best antidepressants are. I will tell you based upon my extensive experiences.
Overall, the MAOI Parnate was the best antidepressant Ive ever taken. It hits all three of the major monoamines, serotonin, norephinephrine AND STRONGLY, dopamine. It also increases MAO-B monoamines, obscure neurotransmitters like PEA, the "love" neurotransmitter you get in your brain when you eat expensive European chocolates.
Parnate kicked the shit out of all other antidepressants Ive ever taken. Period. There was not even any close comparison. Parnate also sharply increased my libido and my ability to get erections...so I can assume it increased my testosterone levels. Off Parnate and on SSRIs or Effexor, I barely thought about sex. On Parnate, I thought about sex a lot.
The problem with MAOIs is they are extremely dangerous. I found the MAOI diet very problematic and had two MAOI hypertensive crisises, one which landed me in a psychiatric hospital for nine days. That is the only psychiatric hospitalization Ive ever had and it wasnt a fun experience. All cause of MAOIs.
There is a new "transdermal" MAOI out, it uses the MAOI selegiline. I took oral selegiline for a short period and it felt very similar to Parnate to me. Since it is transdermal and bypasses the gut, in the lowest dose, the MAOI diet is not needed. This increases its safety...and usefulness...by a huge amount.
I am 100% positive there are many men out there with the secondary (central) form of hypogonadism who would respond better to transdermal selegiline than traditional TRT. With no estrogen spikes...none of that crap.
As far as modern class antidepressants, I found high dose Effexor to be the most potent. I totally disagree with Dr. Marianco (sp?) that 150 mg Effexor is approximately the same as 10 mg Lexapro or Celexa. 150 mg Effexor, you are strongly hitting two neurotransmitters, serotonin and norephinephrine. With both Lexapro and Celexa (wimpy SSRIs), you are mainly getting serotonin.
Effexor is a much more powerful antidepressant compared to any SSRI. I have never taken Cymbalta, but since its similar to high dose Effexor (hits all three of the major monoamines), I would suspect its effect is similar.
I also found plain old amphetamines (Ritalin) relieved anhedonia way better than serotoninergic meds like SSRIs. SSRIs are mainly for mild to moderate depressions and a recent MAJOR study conducted by psychiatry called STAR*D showed that SSRIs create a remission in major depression only one third of the time. That is a dismal recovery rate for medications so hyped as SSRIs.
I have found sleep apnea treatment (CPAP) to be an extremely effective augmentation approach for antidepressants. CPAP helped my mood disorder greatly.
Ive also read that shock treatment, or ECT, increases ALL the monoamines in the brain, including dopamine. I would strongly suspect that a session of ECT would reverse, at least temporarily, many cases of secondary or central hypogonadism. ECT could best be described as a "super MAOI." It causes massive release of all brain neurotransmitters, many hormones, improves sleep architecture, etc. Renowned ECT expert Dr. Max Fink, MD claims ECT's mechanism of action largely has to do with stimulating neuroendocrine effects on the pituitary gland and the hypothalamus...the same exact "master" glands in the brain associated with secondary hypogonadism. Fink claims the seizure induced by ECT creates massive neuro-endocrine changes in the nervous system no drug or hormone could even come close to duplicating.
Fred
Re: Antidepressants 
