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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by starflower on April 20, 2004, at 1:00:50
Hi there - I have been on Wellbutrin for almost 2 weeks - 4 days at 150mg XL and 9 days on 300mg XL.
I experienced no side effects on the 150mg but after 5 days on the 300mg I had the absolute worst PMS ever, with suicidal thoughts, feeling really weird, my head spinning.
At about 7 days I started to get a tight throat and chest at the same time every afternoon, this was really scary and, for some weird reason, relieved by Tylenol (which I discovered by accident when I was taking it for period pains).
From day 7 onwards, I have had a very bizarre reaction mood wise, whereby I feel horrible when I wake up (really depressed) then feel better an hour after I take my dose, only to find that at 6 or 7 every evening my mood drops so far that I feel like I'm falling off a cliff. It hits me out of nowhere.
This is worse than I felt before I started taking it - I was just flat, disconnected, not enjoying anything.
Spoke to the doc today and she said to reduce it down to 150mg XL for a week and see if I do any better.
I'm really scared - does anyone have any similar experiences of Wellbutrin?
BTW have run the full gamut of drugs - SSRIs seem to be more effective but leave me numb emotionally, except Paxil which took me 4 months to come off so am reluctant to start again.
Please help, I feel like I am going crazy, my moods are just all over the place.
Posted by King Vultan on April 20, 2004, at 8:10:03
In reply to Nuts on Wellbutrin - help!, posted by starflower on April 20, 2004, at 1:00:50
Your story reminds me of one I read regarding a psychiatrist who took Wellbutrin and experienced all sorts of negative effects. It sounds as though it may not be the best choice for you. I had somewhat better luck on 300 mg/day (of the SR formulation, which is taken twice a day because it is faster releasing); however, I experienced extreme irritability after a few months on this dosage and was forced to discontinue it. Like you, I found 150 mg/day to not do a whole lot. This drug has a fairly narrow therapeutic index, as you need to get over a certain threshold to experience any therapeutic benefit, and this winds up being closer to the tolerance limit than is the case for some other drugs.
Seeing as though you have tried so many drugs, you might consider a 3rd line treatment of an MAOI. I also experienced emotional numbness on SSRIs but am finding none of that on Nardil, which seems to have a very natural method of action. If you don't want to go to that extreme, you might also want to consider a tricyclic antidepressant such as desipramine, protriptyline (Vivactil), or nortriptyline. I found these also to be very good in the emotional/spirituality department, in stark contrast to the way SSRIs have affected me.
Todd
Posted by jaby on April 20, 2004, at 9:46:43
In reply to Nuts on Wellbutrin - help!, posted by starflower on April 20, 2004, at 1:00:50
Tight throat is likely acid reflux. I get it as well.
Posted by KathrynLex on April 20, 2004, at 12:10:31
In reply to Nuts on Wellbutrin - help!, posted by starflower on April 20, 2004, at 1:00:50
Hi Starflower,
One possibility is that your med just isn't as effective around the time of your period. I'm on 20 mgs of Lexapro and 150 mgs of Wellbutrin SR. But both seem to not work when my period hits. It's very frustrating because all of my old depression/anxiety symptoms return during the week of my period and that may be what's happening to you. (Oddly, I found that taking an Advil helps - for you Tylenol seems to work. My doc can't explain it.)
The lower dose may help, give it a few weeks and see how you feel. If your still not doing well...this probably isn't the right med for you. Keep an eye on it and see if the same thing happens when you get your period next month.
K.
Posted by starflower on April 20, 2004, at 12:15:58
In reply to Re: Nuts on Wellbutrin - help!, posted by KathrynLex on April 20, 2004, at 12:10:31
Thanks everyone for posts. I will try a week at 150mg and if I still don't feel better, I'm coming off this. I feel worse than when I started!
It's so exhausting going on and off so many meds.The only one that has worked for me without me feeling emotionally empty is Paxil, and the withdrawl from that was too much. But I may yet consider going back on it for life and just hope it keeps working.
Will keep you updated, for now I am just getting through on a wing and a prayer. It's hard because I'm miles and miles away from home (I'm from England and am in Hawaii for 3 months) so everything is strange (including me).
Only 6 more days of this and if I feel no better, it's bye bye Wellbutrin.
Posted by zeugma on April 20, 2004, at 20:52:50
In reply to Re: Nuts on Wellbutrin - help!, posted by King Vultan on April 20, 2004, at 8:10:03
If you don't want to go to that extreme, you might also want to consider a tricyclic antidepressant such as desipramine, protriptyline (Vivactil), or nortriptyline. I found these also to be very good in the emotional/spirituality department, in stark contrast to the way SSRIs have affected me.
Todd,
Could you expand on this comment, please? This is a fascinating issue to me. I assume you mean that these TCA's don't have the deadening effect on the emotions as SSRI's?
Posted by MrSandman on April 20, 2004, at 23:58:15
In reply to Nuts on Wellbutrin - help!, posted by starflower on April 20, 2004, at 1:00:50
1. Your doctor originlly increased the your dosage by the greatest recommended amount in the shortest recommended interval of time. The adjustment to a longer interval, as your doc suggested, should provide you with a smoother, less agitated ride, though perhaps with a slower ascent of mood.
2.The peaks and valleys of mood you describe make perfect sense. Even with the XLs, it takes a while for the blood level to stabilize. Right now,
> "I feel horrible when I wake up (really depressed) then feel better an hour after I take my dose, only to find that at 6 or 7 every evening my mood drops so far that I feel like I'm falling off a cliff. It hits me out of nowhere."That sounds like the Wellbutrin begins to do its work after you take it, but that your system hasn't yet accumulated enough to carry you through the day. You describe some early therapeutic effect, the daytime mood lift. And it's come very early in the course of treatment. I take these as strong predictors of further, longer lasting benefits in the weeks ahead.
3. I am not minimizing the unpleasantness of the side effects you are experiencing. I've been where you are more than once. It's frightfully painful and confusing.
However, a tremendous number of patients feel an intensification of symptoms as a depression begins to lift, whether spontaneously or as a result of treatment. (This is why suicide rates soar in springtime as numb, vegetative depressives suffer the sharp pain and agitation that so often precede the therapeutic effects of sunnier days. ) This is an awfully perverse natural reality. But your very misery could well be a sign of healing that is under way.
4.Wellbutrin is known to energize, lift mood, and calm, often in that order. Right now it's a lot of energy a,little mood lift, and precious little peace to a brain that's been sad and anxious for a long spell. But better days are likely ahead as the effects begin to balance out.5. >"Please help, I feel like I am going crazy, my moods are just all over the place."
You may feel like you're going crazy, but there's less likelihood of psychosis with Wellbutrin than any other antidepressant. Wellbutrin tends to cause fewer long-term side effects than any other antidepressant,which is a good reason to see it through a fair trial- another 2 or three weeks.
6. Meanwhile, it might be a good idea to ask your doctor for something like Klonopin or Xanax , as needed (PRN), to reduce the tension,agitation and anxiety you are feeling.
Feel free to ask questions, tell of your progress, or just plain scream at me.
Best wishes.
Posted by starflower on April 21, 2004, at 0:20:00
In reply to Re: Nuts on Wellbutrin - help! » starflower, posted by MrSandman on April 20, 2004, at 23:58:15
Thank you for this, it's really helpful.
My only difficulty is my experience that if an a-d is effective for me, it levels me out after about 10 days, and that isn't what's happening yet with the Wellbutrin.
I will ride it out for another week (which will be three weeks on it) and then take stock again as I have a doctor's appointment then.
I don't know tho', since I came off the Paxil 2 years ago I've been on and off about 6 different meds ... In spite of the horrible withdrawals I'm thinking I might be better off on the Paxil. I don't know!!!!
This is a really tough time as I'm thousands of miles away from home, don't really know anybody and my doctor at home is on maternity leave (so I'm seeing a new one at the local clinic here).
My doctor said that there is Paxil CR now - does anyone know if there are fewer withdrawals with this?
Starflower xx
> 1. Your doctor originlly increased the your dosage by the greatest recommended amount in the shortest recommended interval of time. The adjustment to a longer interval, as your doc suggested, should provide you with a smoother, less agitated ride, though perhaps with a slower ascent of mood.
>
> 2.The peaks and valleys of mood you describe make perfect sense. Even with the XLs, it takes a while for the blood level to stabilize. Right now,
> > "I feel horrible when I wake up (really depressed) then feel better an hour after I take my dose, only to find that at 6 or 7 every evening my mood drops so far that I feel like I'm falling off a cliff. It hits me out of nowhere."
>
> That sounds like the Wellbutrin begins to do its work after you take it, but that your system hasn't yet accumulated enough to carry you through the day. You describe some early therapeutic effect, the daytime mood lift. And it's come very early in the course of treatment. I take these as strong predictors of further, longer lasting benefits in the weeks ahead.
>
> 3. I am not minimizing the unpleasantness of the side effects you are experiencing. I've been where you are more than once. It's frightfully painful and confusing.
>
> However, a tremendous number of patients feel an intensification of symptoms as a depression begins to lift, whether spontaneously or as a result of treatment. (This is why suicide rates soar in springtime as numb, vegetative depressives suffer the sharp pain and agitation that so often precede the therapeutic effects of sunnier days. ) This is an awfully perverse natural reality. But your very misery could well be a sign of healing that is under way.
>
> 4.Wellbutrin is known to energize, lift mood, and calm, often in that order. Right now it's a lot of energy a,little mood lift, and precious little peace to a brain that's been sad and anxious for a long spell. But better days are likely ahead as the effects begin to balance out.
>
> 5. >"Please help, I feel like I am going crazy, my moods are just all over the place."
>
> You may feel like you're going crazy, but there's less likelihood of psychosis with Wellbutrin than any other antidepressant. Wellbutrin tends to cause fewer long-term side effects than any other antidepressant,which is a good reason to see it through a fair trial- another 2 or three weeks.
>
> 6. Meanwhile, it might be a good idea to ask your doctor for something like Klonopin or Xanax , as needed (PRN), to reduce the tension,agitation and anxiety you are feeling.
>
> Feel free to ask questions, tell of your progress, or just plain scream at me.
>
> Best wishes.
>
Posted by MrSandman on April 21, 2004, at 10:15:13
In reply to Re: Nuts on Wellbutrin - help! » MrSandman, posted by starflower on April 21, 2004, at 0:20:00
Starflower:
The unknown can cause us plenty of fear. With a new doctor, a new medicine, and half a world from home, no wonder you're upset.
But try to stay calm, occupy your mind, and work off the stress as best you can. Some of the unpleasant symptoms (tension, constriction of throat, dizziness) you described in a previous post are much like anxiety and will only be exacerbated by undue fear.You've got a lot of things going for you, including a doctor who is making sound decisions and is responsive to you, access to the latest version of a safe, effective medication known for minimal side effects; your intelligence; and your ability to access information and support via computer .
By the way, Wellbutrin is not chemically akin to any other antidepressant. This may explain why you haven't yet felt the "leveling off" you've experienced with other ADs.
Hang in there.
Posted by King Vultan on April 21, 2004, at 13:01:28
In reply to Re: Nuts on Wellbutrin - help! » King Vultan, posted by zeugma on April 20, 2004, at 20:52:50
> If you don't want to go to that extreme, you might also want to consider a tricyclic antidepressant such as desipramine, protriptyline (Vivactil), or nortriptyline. I found these also to be very good in the emotional/spirituality department, in stark contrast to the way SSRIs have affected me.
>
> Todd,
>
> Could you expand on this comment, please? This is a fascinating issue to me. I assume you mean that these TCA's don't have the deadening effect on the emotions as SSRI's?
>
Yes, this was my experience; although, as with everything, you can find people who say the opposite. There are a lot of theories as to what effects are associated with the different neurotransmitters, but as Stahl states in "Essential Psychopharmacology" in a diagram on page 165, "The noradrenergic projection from the locus coeruleus to limbic cortex may mediate emotions, as well as energy, fatigue, and psychomotor agitation or psychomotor retardation." My experience with the three tricyclics I tried, which are all selective norepinephrine reuptake inhibitors, as well as my experience so far on my current med, the MAOI Nardil, is yes, these drugs don't cause the emotional deadening/aloofness/loss of spirituality that I've people heard say so often about SSRIs. I actually decided to believe in God about 10 days after starting desipramine, this after a lifetime of being either anti- or nonreligious.I guess my theory for the problem with SSRIs lies in their very nature: they are so selective for serotonin that norepinephrine transmission gets left behind in the dust and winds up atrophying to some extent (obviously, SSRIs have negative effects on dopamine transmission as well, as evidenced by some of the sexual problems they can cause). Stahl talks about the interrelation between norepinephrine and serotonin extensively, and what I find striking is that norepinephrine naturally boosts serotonin, and there is an intimate relationship between the two that the action of SSRIs is somewhat at odds with, IMO. As he also mentions, they may be a synergistic advantage in working on multiple neurotransmitters rather than just one as SSRIs do.
Todd
Posted by starflower on April 21, 2004, at 14:20:37
In reply to Re: Nuts on Wellbutrin - help! » starflower, posted by MrSandman on April 21, 2004, at 10:15:13
This really sucks. I have 6 days until I see the doc and I feel much more depressed than when I started the WB.
It seems so counter intuitive to keep on putting this stuff into my body which is making me feel worse than before, I hate it.
I read that one of the side effects of bupropion is depression and it seems to be true for me, it's really messing up my mind.
I don't feel anxious any more just really really low.
I tried ringing my doctor just now and she's not in until Monday so I don't know what to do. I feel like stopping this whole thing, binning the Wellbutrin and just seeing how I am. It drives me crazy that a drug that is meant to be helping me is making me feel so bad. At least off the drugs, I know that what I'm feeling is 'me' even if it's horrible. It's so much worse when it is drug induced.
I don't know, I'm very far from home and I really don't know what to do.
I spose if I continued with the 150mg for another week at least I would know for sure that it doesn't work but it seems like a lot to put myself through for that little piece of knowledge. I mean, how much do I need to suffer to prove a point.
I really don't get a sense that this is going to work for me. I usually respond to meds after a maximum of 10 days if I'm going to respond to them, this has been two weeks now and I'm feeling worse.
> Starflower:
>
> The unknown can cause us plenty of fear. With a new doctor, a new medicine, and half a world from home, no wonder you're upset.
>
> But try to stay calm, occupy your mind, and work off the stress as best you can. Some of the unpleasant symptoms (tension, constriction of throat, dizziness) you described in a previous post are much like anxiety and will only be exacerbated by undue fear.
>
> You've got a lot of things going for you, including a doctor who is making sound decisions and is responsive to you, access to the latest version of a safe, effective medication known for minimal side effects; your intelligence; and your ability to access information and support via computer .
>
> By the way, Wellbutrin is not chemically akin to any other antidepressant. This may explain why you haven't yet felt the "leveling off" you've experienced with other ADs.
>
> Hang in there.
>
Posted by KathrynLex on April 21, 2004, at 15:28:33
In reply to Re: Nuts on Wellbutrin - help! » MrSandman, posted by starflower on April 21, 2004, at 14:20:37
Hi Starflower,
I'm sorry you're not doing very well. Tuck yourself into bed and rest, or do something else relaxing. You've been through a lot.
If you think you can stand it, stay on the Wellbutrin. If you've reached the end of your rope, stop taking it. There are a lot of medications out there, and Wellbutrin just might not be the right one for you.
I stopped taking Wellbutrin yesterday and haven't gone through any withdrawl and I'm feeling a little more alert that I have in the past several weeks. It's been nice.
Don't put yourself through this if you don't want to. Listen to your body...if it's had enough, quit taking it. It sounds like you're unhappy with it. Stop taking it and ask your doctor about other alternatives when you see her in another few days.
We're all here for you, take care.
K.
Posted by zeugma on April 21, 2004, at 21:12:42
In reply to Re: Nuts on Wellbutrin - help! » zeugma, posted by King Vultan on April 21, 2004, at 13:01:28
I guess my theory for the problem with SSRIs lies in their very nature: they are so selective for serotonin that norepinephrine transmission gets left behind in the dust and winds up atrophying to some extent (obviously, SSRIs have negative effects on dopamine transmission as well, as evidenced by some of the sexual problems they can cause). Stahl talks about the interrelation between norepinephrine and serotonin extensively, and what I find striking is that norepinephrine naturally boosts serotonin, and there is an intimate relationship between the two that the action of SSRIs is somewhat at odds with, IMO. As he also mentions, they may be a synergistic advantage in working on multiple neurotransmitters rather than just one as SSRIs do.
Todd
This meshes well with the experience I have had on the NE reuptake inhibitors, nortriptyline and atomoxetine (Strattera). What I find curious is the fact that increase in NE also creates a rise in 5-HT: it must be a modest rise, since NRI's don't cause the same level of sexual dysfunction, nor (and I think this would be more significant, as the relative lack of sexual s/e could be explained by NE's relationship to dopamine) are they very effective for OCD. In any case, I haven't felt the 'serotonergetic' effect of decreased rejection sensitivity, or any real impact on my social anxiety at all.I have experienced a clearing effect, from the nortriptyline and especially from the Strattera, on my thought process. In fact Strattera can be downright frustrating in this regard: I become perfectly aware of the reasons for my anxiety as it occurs, but experience no diminishment of the anxiety at all. I thought Strattera would be the perfect drug to use during CBT, as CBT is all about making rational analyses of situations that cause the anxiety: but I found myself reflecting clearly on the causes of my anxiety even as it escalated to panic-attack proportions (I decided to ditch CBT at that point and start Klonopin, despite my pdoc's evident displeasure at this switch: Strattera made me much more determined to get my way! I suppose that is NE's connection to reversal of 'behavioral despair' in the animal models of depression, in which NRI's are so much more active than SSRI's.)
I also have ADD, as my 'brain fog' symptoms suggest. Do you find Nardil to have an anti-ADD effect? Theoretically, it should be very effective. I appreciate your insights-
z
Posted by T_R_D on April 22, 2004, at 12:00:18
In reply to Re: Nuts on Wellbutrin - help!, posted by KathrynLex on April 20, 2004, at 12:10:31
Hi, just to add my voice...my moods/meds seem to fluctuate with my monthly cycle as well. My doc just said it's unfortunate but part of the deal. Makes me wonder what on earth menopause will be like?!?!
Posted by King Vultan on April 22, 2004, at 12:48:07
In reply to Re: emotions and norepinephrine » King Vultan, posted by zeugma on April 21, 2004, at 21:12:42
>
> I also have ADD, as my 'brain fog' symptoms suggest. Do you find Nardil to have an anti-ADD effect? Theoretically, it should be very effective. I appreciate your insights-
>
> z
>
>
>I don't have primary ADD but do have some ADD symptoms related to my depression. I'm finding Nardil is very good at treating those symptoms, and my work performance has improved drastically, as I'm more conscientious, focused and motivated--I would say more so than I've ever experienced. I was having tremendous difficulty concentrating before the Nardil kicked in, having problems such as making simple math mistakes and having to redo calculations over and over before I was sure I had the correct result. Those problems have pretty much disappeared.
Todd
Posted by Rix on April 24, 2004, at 17:27:24
In reply to Re: Nuts on Wellbutrin - help!, posted by jaby on April 20, 2004, at 9:46:43
I get the tightness as well....in throat and chest....has anyone taken anything that has helped this..is it acid reflux...????Please help as this tightness feels alot like anxiety
This is the end of the thread.
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