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pristiq is a norepinephrine reuptake inhibitor, as is wellbutrin, so that combination would need to be discussed with your doctor.

I'm in Canada too, tried all of these drugs you've mentioned (except pristiq, but that's nearly identical to effexor, which I have tried and it was hell.) Cipralex and Zoloft are both generally considered to be the superior drugs (according to side-by-side studies and meta-analyses) compared to all the other available SSRIs and SNRIs, including Pristiq/Effexor. But you're right, genetics play a huge role in psychiatric drug response.

Cipralex is a very effective first line treatment. It takes care of the serotonin reuptake inhibition with amazing selectivity. I know they're both under patent but I also imagine it's cheaper than Pristiq. The Wellbutrin would then take care of both norepinephrine and dopamine reuptake inhibition, keeping all your bases covered with regards to reuptake inhibition.

These drugs can be activating though and sometimes cause insomnia, which makes remeron an even wiser choice to throw in the mix, especially if you're not concerned about weight gain. SSRIs and other antidepressants can cause activation of certain 5-HT2 receptors, working against the antidepressant effect. Remeron is a very strong antagonist at these same sites, and so it works to boost the effectiveness of the entire combination.

My only other problem with it, aside from the weight gain, is that it is a very potent antihistamine. This is what causes the sedation, aids in sleep, and why it should be taken before bedtime. But in my experience, it makes me wake up feeling extremely groggy. Your mileage may vary though, and it is DEFINITELY worth a try. Cipralex + Wellbutrin + Remeron is, in my opinion, the IDEAL first-line treatment combo.
 

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My only other problem with it, aside from the weight gain, is that it is a very potent antihistamine. This is what causes the sedation, aids in sleep, and why it should be taken before bedtime. But in my experience, it makes me wake up feeling extremely groggy.
I think half the problem with remeron and next day grogginess is it's long half life, which pretty much ensures that you have a potent antihistamine in your system 24/7, I'm not sure if an antihistamine with say an 8 hour half life would cause as much next day grogginess, but perhaps somebody in this forum whos taken a shorter acting one (eg benadryl, doxylamine.) could better answer that.
 

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Alright yeah. the pristiq for me wasn't bad. I felt a little nausea, but mostly just felt incredibly stupid for a few days. I also had to stop it suddenly, which I imagine isn't bad after only three weeks, but i was moody, very moody. so far (5 days) into the cipralex and i haven't felt a thing in terms of side effects. And luckily im still on my dads health care, so prescriptions aren't a problem cost-wise. but I'll take these combinations to my doc in 3weeks and see what he says.
 

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I'd also suggest to try and get effexor instead of pristiq, as it doesnt seem to look that great, it seems to be less succesfull then effexor and duolexetine.
I think it's pretty much accepted in the medical community that Effexor xr is a more effective SNRI than pristiq and cymbalta.
 

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I think it's pretty much accepted in the medical community that Effexor xr is a more effective SNRI than pristiq and cymbalta.
Duolexetine is almost a joke in terms of efficacy, and Effexor tends to rank slightly below zoloft/lexapro, while being associated with far more severe side effects. I really don't think Effexor should be considered until at least ONE good SSRI is tried.
 

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The Power Of Nature
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pristiq is a norepinephrine reuptake inhibitor, as is wellbutrin, so that combination would need to be discussed with your doctor.

I'm in Canada too, tried all of these drugs you've mentioned (except pristiq, but that's nearly identical to effexor, which I have tried and it was hell.) Cipralex and Zoloft are both generally considered to be the superior drugs (according to side-by-side studies and meta-analyses) compared to all the other available SSRIs and SNRIs, including Pristiq/Effexor. But you're right, genetics play a huge role in psychiatric drug response.

Cipralex is a very effective first line treatment. It takes care of the serotonin reuptake inhibition with amazing selectivity. I know they're both under patent but I also imagine it's cheaper than Pristiq. The Wellbutrin would then take care of both norepinephrine and dopamine reuptake inhibition, keeping all your bases covered with regards to reuptake inhibition.

These drugs can be activating though and sometimes cause insomnia, which makes remeron an even wiser choice to throw in the mix, especially if you're not concerned about weight gain. SSRIs and other antidepressants can cause activation of certain 5-HT2 receptors, working against the antidepressant effect. Remeron is a very strong antagonist at these same sites, and so it works to boost the effectiveness of the entire combination.

My only other problem with it, aside from the weight gain, is that it is a very potent antihistamine. This is what causes the sedation, aids in sleep, and why it should be taken before bedtime. But in my experience, it makes me wake up feeling extremely groggy. Your mileage may vary though, and it is DEFINITELY worth a try. Cipralex + Wellbutrin + Remeron is, in my opinion, the IDEAL first-line treatment combo.
I agree:yes As for sedation i did read a few times the effexor takes good care of remerons sedation, thats why i suggested such a combination, but your combo could also very well be very effective and looks like a great first line of treatment.

@jim
Yes i did know cymbalta is pretty worthless but didnt know anything about pristiq, i assumed it could be as effective as effexor but it doesnt look like it.
 

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Duolexetine is almost a joke in terms of efficacy, and Effexor tends to rank slightly below zoloft/lexapro, while being associated with far more severe side effects. I really don't think Effexor should be considered until at least ONE good SSRI is tried.
I think the official ranking for those 3 is 1. Lexapro 2. Effexor 3. Zoloft, but I agree that if lexapro or zoloft can work for you then it's crazy to take effexor.
Also different subtypes of depression will respond better to one of the 3 aforementioned meds more than the other, so the list is generalization at best, still it can be of some use.

http://www.wellsphere.com/depression-article/scientists-rate-the-top-antidepressants/596658
 

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As for sedation i did read a few times the effexor takes good care of remerons sedation
Thats true, as a combo their pretty optimal in that way that effexor can cause insomnia, nausea, loss of appetite, sexual dysfunction etc, whilst remeron can prevent insomnia, nausea, loss of appetite and sexual dysfunction, so that either means that if the combo works, it works great, and if it doesnt, then you get double the side effects.

I actually find the antihistaminergic and hence CNS depressant effects of remeron to have a DEPRESSING effect though, which is somewhat ironic for an antidepressant.
 

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The Power Of Nature
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Thats true, as a combo their pretty optimal in that way that effexor can cause insomnia, nausea, loss of appetite, sexual dysfunction etc, whilst remeron can prevent insomnia, nausea, loss of appetite and sexual dysfunction, so that either means that if the combo works, it works great, and if it doesnt, then you get double the side effects.

I actually find the antihistaminergic and hence CNS depressant effects of remeron to have a DEPRESSING effect though, which is somewhat ironic for an antidepressant.
Yes, its still trial and error, some things work for other some things dont, altough i definatly agree that treatment should be started with some of the most effective combo's to get a treatment response as fast as possible.
 

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Cipralex + Wellbutrin + Remeron is, in my opinion, the IDEAL first-line treatment combo.
Yes, its still trial and error, some things work for other some things dont, altough i definatly agree that treatment should be started with some of the most effective combo's to get a treatment response as fast as possible.
Treatment should be started with monotherapy using a first line agent (eg. an SSRI like Escitalopram/Sertraline) not with combinations of drugs.
 

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The Power Of Nature
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Treatment should be started with monotherapy using a first line agent (eg. an SSRI like Escitalopram/Sertraline) not with combinations of drugs.
But dont you agree that after a while a new drug should be added instead just stopping that particular SSRI and start up another one?

This progress of trialing each SSRI takes months, in my opinion its better then to potentiate the SSRI.
 

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But dont you agree that after a while a new drug should be added instead just stopping that particular SSRI and start up another one?

This progress of trialing each SSRI takes months, in my opinion its better then to potentiate the SSRI.
I fully agree that trying SSRI after SSRI after SSRI... is a very time consuming process and IMHO not a very good strategy. But drug combos are not first-line treatment for social anxiety disorder.
 

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I fully agree that trying SSRI after SSRI after SSRI... is a very time consuming process and IMHO not a very good strategy. But drug combos are not first-line treatment for social anxiety disorder.
Medline, how many SSRI's do you think it's wise to try before moving on to another class of AD's? I've tried 2 myself, Paxil and Lexapro, neither worked for me at all, and although my doctor has suggested zoloft and prozac, I feel like it would just be a waste of time to try every SSRI on the market, and want to try something else.
 

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Medline, how many SSRI's do you think it's wise to try before moving on to another class of AD's? I've tried 2 myself, Paxil and Lexapro, neither worked for me at all, and although my doctor has suggested zoloft and prozac, I feel like it would just be a waste of time to try every SSRI on the market, and want to try something else.
I think after having tried two different SSRIs for a long enough time at a high enough dose, an AD with a different method of action should be tried.
 

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Augmentation with a 2nd drug is typically only indicated when the patient has at least a PARTIAL response to the first drug.
 

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Augmentation with a 2nd drug is typically only indicated when the patient has at least a PARTIAL response to the first drug.
Right, that's also an important point.
 
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