I think that I may have been unlucky in my choice of neurologists.
The last one that I saw told me that he sees thousands of patients. He said that I should be optimistic, and that I should trust him, but he didn't respond to messages that I left on his portal.
My current neurologist prescribed an MAO inhibitor, Rasagiline, while I was taking Bupropion, an anti-depressant. When this was flagged by my pharmacist as posing a serious drug interaction warning, the neurologist dismissed it. When considering whether to go off of Rasagiline, my neurologist advised that it was fine to do so without tapering, which also contradicts what I've read about it. This new neurologist doesn't respond to portal messages either.
This is all very confusing and disheartening, because I'm taking so many different medications right now that I often feel pretty unhealthy, which my acupuncturist commented might be because of complex interactions of all or some of them, a problem about which little is known, though it may be very common. I don't know which meds to keep and which to drop, or whether to stick with my current neurologist.
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Required Reading Book List for Advocates of their own health.
Number One:
“The New Parkinson’s Disease Treatment Book” Second Edition, 2015
Dr. Eric Ahlskog,
Chair of Movement Disorders Mayo Clinic.
Thirty years experience.
Number Two:
Title: What Your Doctor May Not Tell You About(TM): Parkinson's Disease..
Author: Marjama-Lyons Jill M MD
Number Three:
Managing Parkinson's Mid-Stride: A Treatment Guide to Parkinson's
If managing your Parkinson’s has become more challenging than it used to be, the book Managing Parkinson’s Mid-Stride: A Treatment Guide to Parkinson’s is for you. This book explains why symptoms may get better and worse throughout the day and how to treat and cope with them. Find answers and read tips and stories that can help.
Medications. A Treatment Guide to Parkinson’s Disease
In 1988, the U.S. Food and Drug Administration (FDA) recommended that the daily dose of Sinemet should not exceed 800 mg per day, and as of 2013, this recommendation has not been revised. In 2018 the labeling of Sinemet recommends not exceeding a levodopa total daily dose of 2,000 mg per day. As movement disorder specialists, general neurologists and primary care doctors have learned, many people with Parkinson’s can easily tolerate the higher doses used to minimize symptoms. Some people
with PD encounter problems with insurance reimbursement of higher daily doses because of the FDA regulation. An insurance decision can be appealed if necessary.
If I had a choice between going to your neurologist or your acupuncturist for medical care, based on what I know about your neurologist, I'd go to the acupuncturist.
When I got atrial fibrillation back in 2017 my randomly assigned cardiologist told me it would never go away and was going to prescribe some nasty medicine. I left his office and found a great cardiologist. Within 3 months my AFIB was gone (they zapped me!).
"Using buPROPion together with monoamine oxidase inhibitors (MAOIs) like rasagiline is not recommended. Combining these medications can cause blood pressure to get dangerously high, which may be a medical emergency. Other side effects of buPROPion may also be increased, such as headache, sleep disturbances, tremor, restlessness, nervousness, anxiety, palpitation, and rapid heartbeat. Serious and potentially life-threatening problems can occur."
On the other hand, an industry sponsored retrospective study of use of MAO-B inhibitors plus antidepressants, including bupropion, claimed there are no cases of hospitalizations due to serotonin toxicity syndrome:
With all that said, I am not satisfied with your neurologist's unavailability and casual dismissal of the interaction issue. At the very least they owed the foregoing explanation to you, including a discussion of what to watch out for. Personally I would look for another.
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Be aware that some psych meds can cause tremors. I know of one case where this seems to have been misdiagnosed as Parkinson's. What all are you taking? What are your main Parkinson's symptoms?
Thanks for the info. I don't have Bupropion-induced Pseudo-Parkinsonism, because I have not just tremors, but also the minor trouble swallowing and constipation.
There is a list of neurologists specializing in Parkinson's on the Michael J. Fox Foundation website: michaeljfox.org/news/moveme...
I'm also looking for a new neurologist. I used the Michael J. Fox database to get names for my area, checked them against my insurance provider's approved doctors, and then evaluated their bios (especially videos/interviews) and patient reviews as best as I could. I now have notes on the 'most promising' from that list, and I'll be asking for recommendations from my other healthcare providers too.
Dr. Ahlskog,s book, as recommended, by RoyProp, is a great help! Knowledge is power! Also, crimsonclover’s recommendation, concerning the Michael J. Fox website list of neurologists, is excellent! I trust this, being in a clinical study group, with the Michael J. Fox, foundation, for a number of years, as a PWP! Good luck in finding the right neurologist for your needs!
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Important question: Reduction of B1 over time is inevitable, but how far does this go?
Standard Neurologist 
Husband's neurologist is weaning him off levadopa carbadopa to put him completely on pramipexol. 
Neurologist says probably Parkinsons, no medication as yet, what to do now!!
Swapping Rasagiline for Safinamide - Hobson’s Choice or out of the frying pan and into the fire? 
