[Bob from Canada]

I am currently taking medication for Parkinsons (Sinemet) and Depression (Wellbutrin) and have read on another site recently that these 2 medications can interact with each other. Has anyone experienced this?
Also, I have recently read that a recent study showed that some of the older antidepressants actually work better in cases where the depression is related to PD. These older antidepressants (tricyclics) target 2 receptors in the brain (Serotonin and Norepinephram) where as the newer meds target only Serotonin. One potential drawback that I can forsee switching to an older med is that the side effects are likely stronger.

Any input that can be provided regarding these points would be most appreciated.

Cheers

[hiptothat]

I don't think Wellbutrin and Sinemet are contraindicated together, but there may need to be dosage adjustments. Wellbutrin targets both dopamine and norepinephrine neurotransmitters, so it can raise the level of dopamine in the brain in theory enough that the sinemet dosage may need to be lowered to avoid dopaminergic side effects, like hallucination. It makes sense to me that a Parkinson's pt. would benefit from Wellbutrin because of the target pathways, although I am not a psychiatrist and have no experience with monitoring pts on these drugs. My Neuro said that sometimes the older psych drugs benefit the depression associated with Parkinson's better than the SSRI's which mainly target serotonin. He also said that increasing the dose of Selegeline could help with depression by gaining both MAO-A and B inhibition rather than the B that is targeted with lower dosages. But then you have to watch the tyramine/Hypertension risk with the wine, aged cheese etc. So complicated!

Interestingly, I struggled with depression about 10-12 yrs prior to my PD dx and found that Wellbutrin was the only treatment that helped me. In retrospect, it probably was raising the dopamine levels in my brain that was making less and less of it. SSRI's like Prozac made me feel awful, since raising serotonin gave me too much of what I had plenty of.

It really feels like brain chemistry is the last frontier of medicine, doesn't it?
So much trial and error...

[Stitcher]

The The Drug Interactions component at Drugs.com simply suggests a titration method to start Wellbutrin.

Yes, some of the older antidepressants do work better with/for PD. I take nortriptyline and it has made a difference for me.

See: Tricyclic antidepressants best for depression in Parkinson's
17. December 2008 19:48
http://www.news-medical.net/news/2008/12/17/44349.aspx
Excerpt: In the study, scientists gave 52 people diagnosed with Parkinson's disease and depression either nortriptyline, a tricyclic antidepressant (TCA), paroxetine CR, a selective serotonin reuptake inhibitor (SSRI) or a placebo pill. Tricyclics affect both norepinephrine and serotonin, two different receptors in the brain. The people were tested for improvement of depression symptoms at two, four and eight weeks after starting treatment.

Drug.com: Interactions between your selected drugs:

Wellbutrin (buPROPion) and levodopa (Ingredient of Sinemet) (Moderate Drug-Drug)

ADJUST DOSE: According to the product labeling for bupropion [Wellbutrin], limited clinical data suggest a higher incidence of adverse experiences in patients receiving bupropion concurrently with either levodopa or amantadine. Neither the mechanism of interaction nor specific adverse effects are cited. According to a published case report, neurotoxic effects including ataxia, dizziness, vertigo, agitation, tremors, and gait abnormalities occurred in 3 elderly patients following addition of amantadine to bupropion therapy. The symptoms resolved within 72 hours after discontinuation of both drugs. The authors theorize that additive central dopaminergic effects of the drugs may have caused the apparent interaction.

MANAGEMENT: Caution is advised if bupropion is used with levodopa or amantadine. The manufacturer recommends a lower initial dosage of bupropion and gradual dosage increments in patients receiving the drugs concurrently.

Side Effects of nortriptyline:

"In fact, most people tolerate the medication well. When people do develop nortriptyline side effects, in many cases they are minor, meaning they require no treatment or are easily treated by you or your healthcare provider."

Interactions between Sinemet and nortriptyline, per Drugs.com: "Anecdotal reports also suggest that coadministration of tricyclic antidepressants and levodopa or carbidopa may occasionally result in hypertensive episodes; however, causality was not clearly established. The mechanism is unknown. Until more information is available, it may be prudent to monitor patients for altered efficacy and safety."

[Bob from Canada]

Originally Posted by hiptothat

I don't think Wellbutrin and Sinemet are contraindicated together, but there may need to be dosage adjustments. Wellbutrin targets both dopamine and norepinephrine neurotransmitters, so it can raise the level of dopamine in the brain in theory enough that the sinemet dosage may need to be lowered to avoid dopaminergic side effects, like hallucination. It makes sense to me that a Parkinson's pt. would benefit from Wellbutrin because of the target pathways, although I am not a psychiatrist and have no experience with monitoring pts on these drugs. My Neuro said that sometimes the older psych drugs benefit the depression associated with Parkinson's better than the SSRI's which mainly target serotonin. He also said that increasing the dose of Selegeline could help with depression by gaining both MAO-A and B inhibition rather than the B that is targeted with lower dosages. But then you have to watch the tyramine/Hypertension risk with the wine, aged cheese etc. So complicated!

Interestingly, I struggled with depression about 10-12 yrs prior to my PD dx and found that Wellbutrin was the only treatment that helped me. In retrospect, it probably was raising the dopamine levels in my brain that was making less and less of it. SSRI's like Prozac made me feel awful, since raising serotonin gave me too much of what I had plenty of.

It really feels like brain chemistry is the last frontier of medicine, doesn't it?
So much trial and error...

Thanks, can you clarify 1 point - you say that Wellbutrin helped in the 10 - 12 yrs prior to PD dx. What about after the PD dx - any changes?

[hiptothat]

Hi Bob
I have not tried it again yet. I have been doing pretty well just having my motor sxs relieved and being able to feel less clumsy and inept. But as I feel my mood slide downward I have begun to think of trying it again. I tried it a couple of yrs before my dx for a while with not as much benefit; but now I theorize that I had much less dopamine produced in my brain to "boost" by then. I couldn't understand why it had worked so well a decade before and then not, but in hindsight it makes more sense.
I hope you get good results from whatever you try!

[Bob from Canada]

Originally Posted by hiptothat

Hi Bob
I have not tried it again yet. I have been doing pretty well just having my motor sxs relieved and being able to feel less clumsy and inept. But as I feel my mood slide downward I have begun to think of trying it again. I tried it a couple of yrs before my dx for a while with not as much benefit; but now I theorize that I had much less dopamine produced in my brain to "boost" by then. I couldn't understand why it had worked so well a decade before and then not, but in hindsight it makes more sense.
I hope you get good results from whatever you try!

Hi, it does make sense that closer to your PD diagnosis, the dopamine level had already started to decline which is why it was not as effective. Perhaps this supports my original posting that Wellbutrin may not be that effective where PD is involved.

Thanks again for your input

Bob