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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by Seige on June 13, 2011, at 3:12:02
Hi guys,
This is my first post on the board, though I've been digging through for years, grabbing names of medications to give to my pdoc so I could try them out (yeah he was good, let me try practically anything).That said, I have tried practically everything legally prescribable (no stimulants) here in Australia, and hardly anything has put a dent in my depression of 4 years, the most bothering part of which is almost complete anhedonia. Parnate was the closest, but wore off fairly quickly.
Anyhow, I am currently on Valdoxan 50mg, which at 4 weeks hasn't done heaps, but I'm going to stick with it since it keeps my anxiety down, hasn't made things worse, like most other meds have, and helps me sleep.
What I am trying to figure out though, is that my last trial was of Wellbutrin (Zyban SR actually :D). Every time I went on it, after about a week my normally low mood would intensify, while the anhedonia didn't improve, so the only way to prop my mood up was intense amounts of caffeine. The first time I gave up after 4 weeks (2 weeks 150mg, 2 weeks 300mg). The weird thing is, 2 days after cutting the med, I woke up feeling pretty good, and the next week after that felt a little normal, anhedonia was a bit better, mood was good, etc.
I've experimented since then, and taking it for 4 days and stopping it once my mood begins to drop will give me a good week.
This confuses me a lot. But, I would like to know, what does it mean? Has anyone else had a similar experience on Buproprion?
Did I stop too early? Has anyone had it make them really depressed at 4 weeks before helping and alleviating anhedonia?Big post. Thanks guys.
Posted by SLS on June 13, 2011, at 3:55:23
In reply to Wellbutrin works, but while withdrawing?, posted by Seige on June 13, 2011, at 3:12:02
Bupropion affects me exactly the same way. Feeling better for a short time after discontinuing an antidepressant is not uncommon and is known as a withdrawal rebound improvement. I couldn't say what this says about your potential to respond to bupropion. That you felt worse while you were taking it leads me to believe that it is not a good match for you.
- Scott
Posted by phillipa on June 13, 2011, at 10:59:12
In reply to Re: Wellbutrin works, but while withdrawing? » Seige, posted by SLS on June 13, 2011, at 3:55:23
Wellbutrin I was stumbling around and what I thought in the past was a hypomanic response could have been depression. I agree doesn't sound like a good match. Think a few days off an ad is some drug is still in the body and when all gone it returns depression? Phillipa
Posted by desolationrower on June 13, 2011, at 17:54:24
In reply to Re: Wellbutrin works, but while withdrawing? » Seige, posted by SLS on June 13, 2011, at 3:55:23
i can't think how this would happen with bupropion, but there is the possibility that the immediate effects were negative, but long-term good. So upon cessation, the immediate effects end, and having only the long-term secondary effects results in improvement, that fades as you return to baseline.
-d/r
Posted by SLS on June 13, 2011, at 20:14:08
In reply to Re: Wellbutrin works, but while withdrawing?, posted by desolationrower on June 13, 2011, at 17:54:24
Hi d/r.
> i can't think how this would happen with bupropion,
Why would you deem bupropion any less capable of producing a withdrawal rebound improvement as is seen with other antidepressants, particularly the tricyclics?
> but there is the possibility that the immediate effects were negative
I didn't feel immediately better or worse with bupropion. Its negative effects on my mood emerged before two weeks had expired, and persisted for the entire time I took it. Much of the relief I experienced upon discontinuation I attribute to a withdrawal rebound improvement. I repeated this experiment several time - mostly out of desperation.
Regarding Parnate and watching for a spontaneous hypertensive crisis early in therapy, I may not have used the word "screen" properly. I was thinking that one could use a blood pressure measuring device and perhaps beware of hypertensive symptoms, although hypertension is often asymptomatic. Off the top of my head, I don't know if one could challenge the patient with a biological to determine sensitivity to Parnate.
- Scott
Posted by jono_in_adelaide on June 13, 2011, at 20:40:06
In reply to Wellbutrin works, but while withdrawing?, posted by Seige on June 13, 2011, at 3:12:02
Have you tried Bupropion (or Edronax) in combination with an SSRI (such as Zoloft)
Another usefull cocktail might be Avanza/Remeron plus Cymbalta
Last resort treatment might be Parnate plus nortriptyline
Posted by jono_in_adelaide on June 13, 2011, at 21:06:25
In reply to Re: Wellbutrin works, but while withdrawing?, posted by jono_in_adelaide on June 13, 2011, at 20:40:06
Oh, and given your condition, you might need to wait upto 12 weeks to get an effect, so dont give up too soon!
Posted by ralphrogers on June 13, 2011, at 21:17:00
In reply to Re: Wellbutrin works, but while withdrawing?, posted by jono_in_adelaide on June 13, 2011, at 20:40:06
I had a similar experience here. After reaching a certain dose (I went slowly up) and feeling the effects wane, by stopping the drug I'd feel the same initial effects come back. I recently added a small dose of Citalopram and this seems to have improved the Bupropion effects.
Zoloft (jono mentioned) is often the most combined SSRI with Bupropion, partly due to the low interaction of both. Citalopram is also "clean". May be that Zoloft is more stimulating than Citalopram in the combo.
> Have you tried Bupropion (or Edronax) in combination with an SSRI (such as Zoloft)
>
> Another usefull cocktail might be Avanza/Remeron plus Cymbalta
>
> Last resort treatment might be Parnate plus nortriptyline
Posted by Seige on June 13, 2011, at 21:46:28
In reply to Re: Wellbutrin works, but while withdrawing?, posted by jono_in_adelaide on June 13, 2011, at 20:40:06
> Have you tried Bupropion (or Edronax) in combination with an SSRI (such as Zoloft)
>
> Another usefull cocktail might be Avanza/Remeron plus Cymbalta
>
> Last resort treatment might be Parnate plus nortriptylineI don't know if I'd want to try Bupropion and Zoloft, given they both made me feel worse. Edronax up to 24mg by itself didn't do anything. Cymbalta was also nasty, but haven't tried Remeron, I was thinking it might be worth trying as an augment to the Valdoxan, since they're both 5ht2c antagonists.
Actually I'm starting to have a bit of hope that Valdoxan might be The One, I had a good day on Friday then drunk myself silly that night. Had a bad Saturday, Sunday, got drunk again, Had a bad Monday, but feel ok today, good like I haven't felt since my last WB withdrawal.
I think maybe drinking myself silly on Friday and Sunday might have reversed some progress that the Valdoxan had made. I'll hold out on the drinking, and if it continues to improve, yay, and might revisit my pdoc about adding a small amount of Prozac or Remeron?
Posted by jono_in_adelaide on June 13, 2011, at 22:26:25
In reply to Re: Wellbutrin works, but while withdrawing?, posted by Seige on June 13, 2011, at 21:46:28
Is Valdoxan on the market here in Australia, or are you getting it from overseas?
Given that Parnate was about the best you've tried, it might be worthtrying that plus nortriptyline.
Posted by jono_in_adelaide on June 13, 2011, at 22:28:57
In reply to Re: Wellbutrin works, but while withdrawing?, posted by Seige on June 13, 2011, at 21:46:28
I would also strongly suggest you try Remeron, starting at 15mg/day and increasing to atleast 45mg/day - you have nothing to lose, and everything to gain!
Posted by sigismund on June 14, 2011, at 2:08:09
In reply to Re: Wellbutrin works, but while withdrawing?, posted by jono_in_adelaide on June 13, 2011, at 22:26:25
>Is Valdoxan on the market here in Australia,
Yep
Posted by phillipa on June 14, 2011, at 19:00:57
In reply to Re: Wellbutrin works, but while withdrawing? » jono_in_adelaide, posted by sigismund on June 14, 2011, at 2:08:09
Sigi what do you think of it? Is this why a certain site isn't active anymore? PJ
Posted by desolationrower on June 14, 2011, at 20:01:22
In reply to Re: Wellbutrin works, but while withdrawing? » desolationrower, posted by SLS on June 13, 2011, at 20:14:08
> Hi d/r.
>
> > i can't think how this would happen with bupropion,
>
> Why would you deem bupropion any less capable of producing a withdrawal rebound improvement as is seen with other antidepressants, particularly the tricyclics?sorry, i wrote that literally, not how it sounds now that i look at it. I meant, i cannot remember a mechanism. I have come across a few things on norepinephrine reuptake generally, but i can't remember it the way i can remember the 5ht story of "reuptake overloads presynaptic autoreceptors within hours, causing lowered 5ht release and firing rates until the autoreceptors desensitize and recede over the course of 1-3 weeks".
> > but there is the possibility that the immediate effects were negative
>
> I didn't feel immediately better or worse with bupropion. Its negative effects on my mood emerged before two weeks had expired, and persisted for the entire time I took it. Much of the relief I experienced upon discontinuation I attribute to a withdrawal rebound improvement. I repeated this experiment several time - mostly out of desperation.The other thing i remember about bupropion is the reduction of tnf-alpha levels. Usually that is good for energy, chronic disease, etc. perhaps for you, more tnf-alpha is good?
It is also somewhat active at some nicotinic receptor, but i didn't find much info on what it does when i looked into it. Have you monkeyed around much with ACHEis, nicotine, acetylcholine precursors?
> Regarding Parnate and watching for a spontaneous hypertensive crisis early in therapy, I may not have used the word "screen" properly. I was thinking that one could use a blood pressure measuring device and perhaps beware of hypertensive symptoms, although hypertension is often asymptomatic. Off the top of my head, I don't know if one could challenge the patient with a biological to determine sensitivity to Parnate.
>
>
> - Scotti just remember reading a CME or something about selegiline patch, and they did some sort of meals (probably just a juice or somehting) with specific amounts of tyramine, and looked for maybe 5 or 10 mm jump in bp.
it hasn't really ever been proven that spontaneous crisis involve tyramine though. i had a bp incrase eating an apple and having some tea about 5 hours before.
-d/r
Posted by SLS on June 18, 2011, at 4:36:10
In reply to Re: Wellbutrin works, but while withdrawing?, posted by desolationrower on June 14, 2011, at 20:01:22
Hi again.
> I have come across a few things on norepinephrine reuptake generally,
You might be right. I have never experienced a withdrawal rebound improvement with a SSRI or SNRI.
> but i can't remember it the way i can remember the 5ht story of "reuptake overloads presynaptic autoreceptors within hours,
Yup!
:-)
> causing lowered 5ht release and firing rates until the autoreceptors desensitize and recede over the course of 1-3 weeks".
Yup!
This is why pindolol, a 5-HT1a somatodendritic autoreceptor antagonist, has been observed to "hasten" or accelerate an antidepressant response to SRIs. It buffers the effects of reuptake inhibition while receptors are reregulating themselves.
Thanks for posting this.
- Scott
This is the end of the thread.
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