# Heroic combo's



## crayzyMed (Nov 2, 2006)

This are some antidepressant combinations definatly worth looking into.

Essential psychopharmacology: neuroscientific basis and practical applications
Stephen M. Stahl has singled out 13 successful drug combinations (Heroic combos).

The point is to use safe and rational drug combinations that exploit expected
pharmacological and molecular synergies while even promoting mutual tolerabilities (Stahl).

Heroic combos

1: High dose venlaxafine + mirtazapine =California rocket fuel 
2: High dose venlaxafine + NDRI (bupropion)
3: High dose venlaxafine + NRI (selective reboxetine or a nonselective TCA)
4: High dose venlaxafine + stimulant
5: Venlaxafine + nefazodone
6: Mirtazapine + SSRI 
7: Mirtazapine + NRI (reboxetine)
8: Mirtazapine + NDRI (bupropion)
9: Mirtazapine + stimulant
10: SSRI + NRI (selective reboxetine)
11: SSRI + NDRI (bupropion)
12: SSRI + stimulant
13: Nefazodone + NDRI (bupropion)

3: nonselective TCA such as desipramine, maprotilene, nortriptyline, or protriptyline
4: stimulants: d-amphetamine, methylphenidate, phentermine, or diethylpropion
4: could also include direct-acting dopamine agonists such as pramipexole
9: stimulants: d-amphetamine, methylphenidate, phentermine, or diethylpropion
9: could also include direct-acting dopamine agonists such as pramipexole
12: stimulants: d-amphetamine, methylphenidate, phentermine, or diethylpropion
12: could also include direct-acting dopamine agonists such as pramipexole

This is copied from:
http://www.dr-bob.org/babble/20091117/msgs/927038.html


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## jim_morrison (Aug 17, 2008)

Interesting, in the book of his that I own, only the first 4 combos are mentioned in it as "heroic combos", guess he expanded on it.


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## Vini Vidi Vici (Jul 4, 2009)

Dude, !! i was just about to make a new thread, with a collection of synergistic combos that are uncommonly used together, but comprised of currently available/attainable treatment options. But u made the thread so i lose


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## crayzyMed (Nov 2, 2006)

Vini Vidi Vici said:


> Dude, !! i was just about to make a new thread, with a collection of synergistic combos that are uncommonly used together, but comprised of currently available/attainable treatment options. But u made the thread so i lose


Youll always lose from me vini heheheheheh


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## Dav779 (Feb 21, 2010)

is it hepful to add buspirone (5-HT1A receptor partial agonisthttp://en.wikipedia.org/wiki/Partial_agonist) in the california rocket fuel ?


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## crayzyMed (Nov 2, 2006)

Dav779 said:


> is it hepful to add buspirone (5-HT1A receptor partial agonisthttp://en.wikipedia.org/wiki/Partial_agonist) in the california rocket fuel ?


Yes, as buspar would further increase serotogenic neurotransmission.


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## fredericmoreau (Dec 1, 2009)

How about my current drug regimen?

Parnate 60mg tid, nortriptyline 50mg qd, dextroamphetamine 10mg bid and lorazepam prn.

Parnate synergizes nicely with amphetamine for increased DA, and the nortriptyline helps prevent orthostatic hypotension and the tyramine effect through NE reuptake inhibition (not to mention it helps me sleep soundly). I rarely even take lorazepam, but it's there in case of breakthrough anxiety or even for sleep.

I think this combo is the gold standard for treatment resistant mood disorders, or at least it is for me anyway. I think it's also telling that this combination could have been prescribed 50 years ago and we've yet to really come up with anything better. The funny thing is MAOIs are legally contraindicated with both TCAs and stimulants, and the pharmacy freaks out every time I fill my scripts at the same time. I always end up explaining that only the highly serotonergic TCAs are dangerous to take with an MAOI, and that stimulants have been used successfully in tandem with MAOIs for decades.


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## korey (Apr 25, 2006)

Jeez, how many people here are on the Parnate + Dexedrine combo? I realize it's relatively safe when taken responsibly and under the care of a doctor, but it's still something I would've thought to be more scarce.


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## crayzyMed (Nov 2, 2006)

korey said:


> Jeez, how many people here are on the Parnate + Dexedrine combo? I realize it's relatively safe when taken responsibly and under the care of a doctor, but it's still something I would've thought to be more scarce.


I only know of 3 ppl, that isnt that much. But yeah its safe and effective.


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## crayzyMed (Nov 2, 2006)

fredericmoreau said:


> How about my current drug regimen?
> 
> Parnate 60mg tid, nortriptyline 50mg qd, dextroamphetamine 10mg bid and lorazepam prn.
> 
> ...


Looks like a very effective combo. I agree that we have had one of the most effective things for depressiong for ages!


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## fredericmoreau (Dec 1, 2009)

korey said:


> Jeez, how many people here are on the Parnate + Dexedrine combo? I realize it's relatively safe when taken responsibly and under the care of a doctor, but it's still something I would've thought to be more scarce.


It definitely takes finding the right pdoc. In another thread I outlined how I found my current psychiatrist. In short: look through the research done in the departments of psychiatry at the medical schools in your area and contact the md's who seem amenable to atypical treatment regimens explaining your history and asking if they would be willing to treat you or refer you to a psychiatrist open to prescribing an MAOI w/ stimulant augmentation.


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## jim_morrison (Aug 17, 2008)

fredericmoreau said:


> How about my current drug regimen?
> 
> Parnate 60mg tid, nortriptyline 50mg qd, dextroamphetamine 10mg bid and lorazepam prn.
> 
> Parnate synergizes nicely with amphetamine for increased DA, and the nortriptyline helps prevent orthostatic hypotension and the tyramine effect through NE reuptake inhibition (not to mention it helps me sleep soundly). I rarely even take lorazepam, but it's there in case of breakthrough anxiety or even for sleep.


Good to finally hear an actual case of someone being on Parnate + Nortriptyline, so do you find it actually helps with the orthostatic hypotension and food reactions to a significant degree?


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## dreadnaught (Apr 14, 2010)

*A lil bit of HELP?*

Hello all,

Very interesting and informative stuff here. Quick question: A combo of Wellbutrin XL 300mg (brand) and Adderall 60mg daily. Good combo? Does either one inhibit the other? I know the combo is rx'd frequently. I was very recently started on Wellbutrin XL 300mg daily along with the adderall and as soon as I started the WB, ALL effects of the adderall are GONE! Meanwhile, the day before just taking Adderall, everything was fine.

Does anyone have any similar experiences or can possibly explain this?


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## mark555666 (May 1, 2008)

dreadnaught said:


> Hello all,
> 
> Very interesting and informative stuff here. Quick question: A combo of Wellbutrin XL 300mg (brand) and Adderall 60mg daily. Good combo? Does either one inhibit the other? I know the combo is rx'd frequently. I was very recently started on Wellbutrin XL 300mg daily along with the adderall and as soon as I started the WB, ALL effects of the adderall are GONE! Meanwhile, the day before just taking Adderall, everything was fine.
> 
> Does anyone have any similar experiences or can possibly explain this?


I believe wellbutrin blocks the reuptake of dopamine. It's better to take a higher dose of adderall and stop the wellbutrin or vice versa imho (I prefer adderall though)..


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## crayzyMed (Nov 2, 2006)

dreadnaught said:


> Hello all,
> 
> Very interesting and informative stuff here. Quick question: A combo of Wellbutrin XL 300mg (brand) and Adderall 60mg daily. Good combo? Does either one inhibit the other? I know the combo is rx'd frequently. I was very recently started on Wellbutrin XL 300mg daily along with the adderall and as soon as I started the WB, ALL effects of the adderall are GONE! Meanwhile, the day before just taking Adderall, everything was fine.
> 
> Does anyone have any similar experiences or can possibly explain this?


Wellbutrin inhibits the reuptake of NE and DA to some extend, it can counteract adderall that way.

That combo seems a bit wierd tough, dont get the point of 2 dopaminergics?


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## dreadnaught (Apr 14, 2010)

Well the reason is this: Adderall for ADD as well as off label use for motivation/depression. The Wellbutrin XL recently added for depression/lack of motivation. 

I have read from so many places that the WB/AMP combo was working really well. And occassionally I'd see someone say exactly what I am experiencing, the almost complete cancellation of the AMP effects. 

I mean, if the Wellbutrin from a chemical standpoint blocks the effects of AMP, then how is it that so many people say differently? That they don't have any problems at all with not feeling the AMP doing its job?

And just to make sure I understand this correctly from what you guys replied with, Wellbutrin WILL BLOCK the effects of AMPs correct? 

Thanks alot!


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