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 Question on Wellbutrin, *and* switch from Aricept? 
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Post Question on Wellbutrin, *and* switch from Aricept?
Hi,
It's WifeLiz, and I'm sure this info is somewhere incl. at the sticky post w/ poll on meds.
Still trying to read everything.

My Husband, early stages LBD w/ Parkinsonism, had 1) (by his Psychiatrist specializing in Geriatrics) (Husband 52)Well butrin, small amount, added to his Lexapro, to add anti depressant effect, and to help, (secondary purpose) w/ dopamine. Has anyone had bad or good experience w/ this? Or heard of this reasoning on dopamine re Parkinsonism?

2) Had suggested by local Neuro. (And we make no changes w/o Mayo O.K.) that he might switch from Aricept to the R. version of this class: Remizyn or something similar? (NOT risperadol)
I asked why not Exelon, and local Neuro said "too many G.I. problems," which my Husband does have.

Does anyone have opinions or experiences w/ the "R" drug (pls forgive my memory at moment; I always remember, read about Aricept and Exelon, but not usually the third. I also do not recall hearing/ reading about this third type, or GI probs from Exelon.

My LBDA support group suggested I might want to ask here. Thank you so very much.

WifeLiz


Thu Feb 15, 2007 6:31 pm
Post 
Hi Liz,
Lack of dopamine is what causes the Parkinson's Symtoms ie: stiffness, shuffling, tremors....So many of the meds are to replace the Dopamine or at least try to mimic them........
Exelon is a drug that is very hard on the stomach, it took my Husband many months to get to correct dose (12mg)and in our case I seen no difference as I have said before it is possible for us it was started to late in the illness.
I am glad you went to the support group, what did you think of it?


Thu Feb 15, 2007 7:39 pm

Joined: Mon Feb 05, 2007 3:43 am
Posts: 215
Location: Seattle, WA
Post 
Used to be called Reminyl, now called Razadyne. I think it gets less marketing support than Aricept, and I believe it also has to be taken twice a day.

Both Razadyne and Exelon block both acetylcholinesterase and butylcholinesterase, two different paths that destroy acetylcholine. I'm working from memory, but I think that acetylcholinesterase primarily happens in the central nervous system, butylcholinesterase out in the periphery. There's not clear consensus that blocking butylcholinesterase is going to help more with the cognitive problems, but there does seem to mildly convincing evidence that Exelon is more poorly tolerated in terms of GI side effects.

Wellbutrin works by inhibiting reuptake of dopamine and norepinephrine, and is structurally unrelated to other currently-marketed antidepressants. It's useful in that it doesn't tend to sedate, has no anticholinergic side-effects and there's evidence that it's particularly good at resolving the slowed cognition that can be present in depression. For both men and women, there are positive effects in the bedroom, with no *ahem* decline in performance as seen with many SSRIs in men.

I'm not sure how the dopamine reuptake inhibition is going to play in PD-like syndromes. I think you're right on track to get this checked out by a DLB specialist before implementing it.

There's been a lot of research around low folate levels and depression. The thing is, it seems to be somewhat unrelated to folic acid consumption from food....it may have more to do with genetic differences in how we convert folic acid into bioactive l-methylfolate. Merck KGaA (AKA Merck Darmstadt, a distant relative of Merck in the US) has a partnership with a US company to market l-methylfolate as an adjunctive treatment for depression (meaning it's approved to use with an SSRI, for example, not as monotherapy, the only thing you take for depression. There's information on their product at:
http://www.pamlab.com/Products,Deplin

I'm a huge fan of high-dose folate supplements - Cal has taken one for years, other people with LBD are taking it (search for "Cerefolin") and it's routinely given to pregnant women in the US, which is pretty much synonymous with "incredibly safe". The Deplin is about $20/month if you pay cash, and is available on many Rx drug plans. I might be more inclined, personally, to try the folate rather than adding another antidepressant, but I'm just a passionate amateur.

Eric

_________________
Cal is not the real name of a real 84 year old with DLB. I don't speak for LBDA, nor do I have clever initials behind my name, so information is provided without warranty. Caveat everybody. I blog at http://PragmaticCaregiver.blogspot.com


Thu Feb 15, 2007 10:13 pm
Profile WWW
Post Thank you Irene, EricS
Many thanks to both of you. (I am still apologizing for not catching up on reading, then, what's only right, thanks for replies, etc. Trying!)
I appreciate the personal experiences and the "passionate" medical info, even cost info.
I have been on Wellbutrin myself since this began, as SSRIs exacerbate hyponatremia, (low sodium, condition associated w/ Addison's and other problems, an F.Y.I. for you Eric); so I knew some of this. I've also been a fan forever of B Complex (my Chem./Phys. Professor Brother believes best "drug" for Depression, anxiety, etc.). If taken sublinguilly (sp.?) the B-12 is best absorbed, but one also gets Folic Acid (Folate, I believe?) But thanks for extra info. I've been "picking up" here on Folate.
Irene, the local LBDA Support Group Mtg. was just great, both for me, and surprisingly, my DH, in early stages. He found comraderie w/ another LBD/Parkinsonism patient; all spouses, children, survivors received help, some kinds unexpected. I am unsure what I am allowed to discuss here, but happy to PM anything, re unexpected "help," etc. if desired and w/ permission of other attendees. I wouldn't miss it for the world, let's say. And the "professionalism brought to it, along w/ the personal quality of it, I wish I could share w/ all, around country. Hope this dream becomes reality sooner rather than later.
Thanks for asking.
Please be well, to you both, to All.
WifeLiz


Fri Feb 16, 2007 3:03 pm
Post Thank you Irene, EricS
Many thanks to both of you. (I am still apologizing for not catching up on reading, then, what's only right, thanks for replies, etc. Trying!)
I appreciate the personal experiences and the "passionate" medical info, even cost info.
I have been on Wellbutrin myself since this began, as SSRIs exacerbate hyponatremia, (low sodium, condition associated w/ Addison's and other problems, an F.Y.I. for you Eric); so I knew some of this. I've also been a fan forever of B Complex (my Chem./Phys. Professor Brother believes best "drug" for Depression, anxiety, etc.). If taken sublinguilly (sp.?) the B-12 is best absorbed, but one also gets Folic Acid (Folate, I believe?) But thanks for extra info. I've been "picking up" here on Folate.
Irene, the local LBDA Support Group Mtg. was just great, both for me, and surprisingly, my DH, in early stages. He found comraderie w/ another LBD/Parkinsonism patient; all spouses, children, survivors received help, some kinds unexpected. I am unsure what I am allowed to discuss here, but happy to PM anything, re unexpected "help," etc. if desired and w/ permission of other attendees. I wouldn't miss it for the world, let's say. And the "professionalism brought to it, along w/ the personal quality of it, I wish I could share w/ all, around country. Hope this dream becomes reality sooner rather than later.
Thanks for asking.
Please be well, to you both, to All.
WifeLiz


Fri Feb 16, 2007 3:12 pm
Post 
Hi Liz,
I am glad that you found the support group helpful and that your Husband is also finding peace with it too, it makes you feel not so alone on this Lewy path, For the most part this is an open forum to anything having to do with LBD, so there should be no problem sharing here , so dicussions are open here.


Fri Feb 16, 2007 3:44 pm
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