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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 Angelina Jolie on May 7, 2005, at 6:42:45
My best friend was really depressed and was smoking a lot. To help her quit smoking, I gave her some of my Wellbutrin. That was a huge mistake. I found out that she hasn't eaten in a week. She has lied to me about it. I found out through a mutual friend. I approached her about it and she just ignored me. She is going to her doctor to get a prescription of her own. What do I do?
Posted by Racer on May 7, 2005, at 12:42:57
In reply to Wellbutrin and anorexia in best friend, posted by Angelina Jolie on May 7, 2005, at 6:42:45
First you learn from it: never give your prescription drugs to anyone else. There may be a reason that your friend's doctor didn't write that scrip for her in the first place.
And then you sit back and say that the only thing you can do for your friend is be her friend. It's up to her when, how, and if she gets treatment. If you can't be her friend without trying to "fix" her, then you're not being her friend. You can encourage her to seek help, but you can't make her do it.
Good luck.
Posted by Chairman_MAO on May 7, 2005, at 13:18:01
In reply to Wellbutrin and anorexia in best friend, posted by Angelina Jolie on May 7, 2005, at 6:42:45
The reason they say it's contraindicated in those with eating disorders is that their body mass is so low that the rise to peak concentrations of the drug in the body could cause a seizure. (I'm pretty sure, anyway)
The best thing you can do is to tell your friend about this fact. Presumably she won't want to have a seizure. Best wishes for your friend's health, BTW: every time I hear about or see someone with an eating disorder I get slightly teary (and I'm on two "big-gun" mood boosters, haha). It's just such a horrible misunderstanding about life that those people have, you just want to tell them that everything is really FINE, you know?
Posted by Angelina Jolie on May 7, 2005, at 14:40:09
In reply to Re: Wellbutrin and anorexia in best friend » Angelina Jolie, posted by Chairman_MAO on May 7, 2005, at 13:18:01
> The reason they say it's contraindicated in those with eating disorders is that their body mass is so low that the rise to peak concentrations of the drug in the body could cause a seizure. (I'm pretty sure, anyway)
>
> The best thing you can do is to tell your friend about this fact. Presumably she won't want to have a seizure.Are you sure that she won't have a seizure? I would like to read some literature on that topic. I have heard of it before, but not yet from a doctor.
Thank you for your input. I really appreciate evey bit of support.
Posted by Phillipa on May 7, 2005, at 18:39:04
In reply to Re: Wellbutrin and anorexia in best friend, posted by Angelina Jolie on May 7, 2005, at 14:40:09
What I don't understand is how the hospital I worked for could have a stop smoking campaign and give wellbutrin to everyone. I left before they began. I wonder what the results were. Fondly, Phillipa
Posted by Racer on May 7, 2005, at 21:37:57
In reply to Re: Wellbutrin and anorexia in best friend » Angelina Jolie, posted by Chairman_MAO on May 7, 2005, at 13:18:01
> The reason they say it's contraindicated in those with eating disorders is that their body mass is so low that the rise to peak concentrations of the drug in the body could cause a seizure. (I'm pretty sure, anyway)
>Nope. The seizure risk have nothing to do with BMI. In fact, the risk is much higher for bulimia than anorexia, despite the fact that bulimics tend to be heavier. The risk is related to electrolyte imbalances, which are common in those who purge.
> BTW: every time I hear about or see someone with an eating disorder I get slightly teary (and I'm on two "big-gun" mood boosters, haha). It's just such a horrible misunderstanding about life that those people have, you just want to tell them that everything is really FINE, you know?I have to ask: what is the misunderstanding you're referring to? I don't get it?
Now, this is coming from someone who is most likely older than you are, who has a long history of anorexia. While I will admit that being thin is very nice, and I enjoy that part, it's not the main motivating factor, when you come right down to it. For whatever reason, I feel better when I'm actively restricting what I eat. I feel clearer, more able to focus, with more energy, etc. Thus, it is a self-sustaining cycle.
There has to be some mechanism involved, because most people who diet do not develop eating disorders. (Which is not to say that their eating is not disordered, but that's a different story...) While yes, there is a lot of pressure to be thin these days, that's not enough to trigger an eating disorder.
If I'm reading your comment wrong, please let me know. And -- because print can't show any of the non-verbal clues to mood, intent, etc -- I don't mean to come off here as though I was offended. I wanted to correct the seizure thing, and I really am curious. I am interested in what others have to say about EDs, probably because of my own -- um -- knowledge of them.
Posted by Phillipa on May 7, 2005, at 22:24:20
In reply to Re: Wellbutrin and anorexia in best friend » Chairman_MAO, posted by Racer on May 7, 2005, at 21:37:57
Okay Racer you asked for it! I lost my sense of taste a year ago. The last taste to go was chocolate. Now before it started to go I never ate chocolate. I was very consciencious about what I ate. It had to be healthy. A lot of yogurt, salad with low fat dressing, chicken, no snack food, a little bit of ice cream each day. But i excercised excessively because i couldn't be in the house alone. But now, I sit before dinner and eat chocolate truffles, chocolate covered raisins, anything to try and taste something. I am never hungry. I don't feel full. They did a full day work=up at Wake Forest Medical Centers Taste and Smell Center and told me i had had a virus that destroyed the neurons in my nose. My only chance to taste again was to take theophylline 400mg for 4-6months. I haven't done it. It seems like witch craft to me. I looked it up on the internet and in Washington DC at their Taste and Smell Center they use it too. I think it's psychological. Years ago when going through a divorce I purged for about 2 weeks and then jogged to relieve the guilt. So I stopped. So, have I created a new eating disorder? You can Babble me. No I'm not nuts. Fondly, Phillipa
Posted by Chairman_MAO on May 8, 2005, at 19:33:05
In reply to Re: Wellbutrin and anorexia in best friend » Chairman_MAO, posted by Racer on May 7, 2005, at 21:37:57
You completely misinterpreted my comment, both in meaning and spirit, I think.
The misunderstanding is that one has to be that on top of things, that in control; that the world is such a scary place; that you aren't adequate as you are without restricting/purging (this does not necessarily have to have anything to do with actual physical appearance/weight, and as I understand it usually doesn't).
I'm not sure if I'm even expressing it right, but it's kinda ineffable. I believe, anyway, that the psychological mechanism behind an eating disorder is the same as that behind any addiction: Fulfillment gained through an activity, engagement, enmeshment, etc. that the one invovled doesn't think they can get or is not able to get any other way in the world [that is less [self-]destructive. I have 3 1/2 years of rather severe drug addiction (which was for those 3 1/2 years the way I learned to cope with the dysthymia which was there for a lifetime)
in my past, and have spoken at length with three bulimics and two anorexics (at least) while in and out of institutions. My academic advisor at one of my colleges also was a former bulimic. She and I used to talk sometimes, trading experiences and sentiments about our mental illness, and I am thoroughly convinced that what underlies drug addiction and what underlies eating disorders--psychologically and probably neurologically--is the same. It's some kind of inability to feel satisfied with oneself, this strnage feeling of perpetual emptiness, a constant problem that always needs fixing that always metamorphoses into something else whenever you think you've got it under control. The misunderstanding is that there is no "it" to get under countrol, no group of "normals" judging you, etc. I may fail to explain it in a way that makes any sense to you, but I'd like to think that's because "it" is actually a really intense, complex, and baffling bundle of emotions.I took a philosophy seminar in "self-deception and weakness of will", and read some good literature (Susan Bordo) on the subject. So again, I hope I am not a complete moron in my understanding of it.
The involvement of the opioid system in eating disorders, drug addiction, etc. also makes a strong case that they have similar substrates. The number one addiction/involvement of the sort we're talking about here, of course are dysfunctional, codependent love relationships, the sort of relationships where each participant cannot ever be without the other, etc. I'm a big fan of Stanton Peele's (www.peele.net) taken on addiction, although I don't agree with everything he says.
Additionally, I did some digging and thinking, and I remembered the thing about wellbutrin is simply what I read @ www.preskorn.com a long time ago:
http://www.preskorn.com/columns/0001.html
"Patients with anorexia or bulimia nervosa, who have
lean body mass and the potential for rapid drug
absorption have an increased risk of seizures."Given that the SR formulation was developed to even out the pharmacokinetics to lower the seizure risk, I came to the perhaps spurious conclusion that the reason those with eating disorders are at risk is the lower BMI / quicker rise to peak plasma. If this isn't the case, I'm sorry and hope I didn't offend you or anything.
Posted by Chairman_MAO on May 8, 2005, at 19:47:30
In reply to Re: Wellbutrin and anorexia in best friend, posted by Angelina Jolie on May 7, 2005, at 14:40:09
I'm saying that, given the available data, the risk of seizure for her is higher, given that she has an eating disorder. You can read about it at http://www.preskorn.com/columns/0001.html
and other places, although Racer says it's about the electrolytes. While I don't want to get into an argument about the cause of this, i don't understand how an electrolyte imbalance could increase the seizure risk SOLELY with bupropion. Wouldn't an electrolyte imbalance increase the propensity to have a seizure in general and thus, by virtue of simplicity, not be a concern unique to bupropion printed in its monograph but rather something known by doctors and not printed in monographs, which are designed to be read by doctors?Really, most ADs lower it just as much as bupropion does. It's my belief that, in general, the seizure risk is way overblown given a dose of 450mg/day or less (especially 300mg/day or less). Having an electrolyte imbalance, it seems to me, would be a risk factor apart from a low BMI.
>
> Are you sure that she won't have a seizure? I would like to read some literature on that topic. I have heard of it before, but not yet from a doctor.
>
> Thank you for your input. I really appreciate evey bit of support.
Posted by Racer on May 8, 2005, at 22:18:55
In reply to Re: Wellbutrin and anorexia in best friend » Racer, posted by Chairman_MAO on May 8, 2005, at 19:33:05
I wasn't offended -- just very curious.
What you've said about addiction is pretty much accurate from my own experience, but it actually has a lot more in common with OCD. I never realized how obsessive I get, just normally, and that gets ratchetted up by a factor of, oh, about a thousand when it comes to actively anorexic periods of my life. And I think my AN serves the same sort of purpose that OCD behaviors do. Reduces anxiety, for a while.
So, not offended, just curious. Thank you for your answer.
And, having read a lot of the articles there, read Preskorn with a grain of salt, 'K?
Posted by Phillipa on May 8, 2005, at 22:55:31
In reply to Re: Wellbutrin and anorexia in best friend » Chairman_MAO, posted by Racer on May 8, 2005, at 22:18:55
Racer you're right. I believe a lot of the things I do are related to OCD also. I was bulemic for about 2 weeks once. I count and add numbers, the rule to drink after 8pm and five or six beers with a cigarette for each beer. This is OCD, don't you think? Fondly, Phillipa
Posted by mworkman on May 9, 2005, at 18:10:58
In reply to Re: Wellbutrin and anorexia in best friend » Racer, posted by Phillipa on May 8, 2005, at 22:55:31
I think forced throwing up causes an increase of chemicals and activity in the brain. This is why bulimics get a post purge high. Wellbutrin can cause a seizure in anyone, but this increase in activity from purging really increases the chances of a seizure.
To the first poster. Has it only been one week that your friend has had disordered eating. If it is then I think you should do talk to her and try and get her to stop, if that doesn't work, talk to her doctor(how old is she, if she is underage the doctor will probably report it to her parents), after that talk to the parents. I think this is the right thing to do because she doesn't have an eating disorder yet. And while people that have eating disorders really have to make the decision on thier own, she hasn't gone that far yet and you helping her could keep her from going over the edge to full fledged eating disorder. Of course, tell her you are doing this because you care about her. And I would uggest going to the parents last because they can often be over-reactive and make things worse.
Posted by Chairman_MAO on May 11, 2005, at 20:23:50
In reply to Re: Wellbutrin and anorexia in best friend » Chairman_MAO, posted by Racer on May 8, 2005, at 22:18:55
I don't agree with everything preskorn says, but he WAS a principal investigator during the initial bupropion trials, so I figured he might know SOMETHING. ;)
What, in particular, do you feel is in error on his site? I am curious.
Posted by Chairman_MAO on May 11, 2005, at 20:26:31
In reply to Re: Wellbutrin and anorexia in best friend, posted by mworkman on May 9, 2005, at 18:10:58
I seriously doubt this "increase in activity" is what is responsible for the seizure. What you are referring to I think is an "endorphin rush" following purging, which is why naltrexone seems to help bulimics. I don't know why they just don't give buprenorphine to "normalize" the endorphin system, though, as naltrexone can cause despair, dysphoria, etc. Oh, wait, I _DO_ know why, it's just absurdly sadistic reasoning ...
Posted by tygereyes on May 11, 2005, at 20:34:50
In reply to Re: Wellbutrin and anorexia in best friend » mworkman, posted by Chairman_MAO on May 11, 2005, at 20:26:31
> I seriously doubt this "increase in activity" is what is responsible for the seizure. What you are referring to I think is an "endorphin rush" following purging, which is why naltrexone seems to help bulimics. I don't know why they just don't give buprenorphine to "normalize" the endorphin system, though, as naltrexone can cause despair, dysphoria, etc. Oh, wait, I _DO_ know why, it's just absurdly sadistic reasoning ...
I thought that Naltrexone was often prescribed as an adjunct to antidepressant pharmacotherapy? What is the mechanism by which it would BOTH cause despair/dysphoria AND boost antidepressant response? I'm curious!
Posted by Chairman_MAO on May 12, 2005, at 8:21:37
In reply to Re: Wellbutrin and anorexia in best friend, posted by tygereyes on May 11, 2005, at 20:34:50
In very low doses (on the order of micrograms), naltrexone actually induces some degree of analgesia as well as potentiates other opiates and reduces tolerance/dependence. I suppose it could be used as an antidepressant like this.
As far as using 50mg naltrexone or the like, I don't know why that would be helpful to depression. Anyone else know?
This is the end of the thread.
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