Posted by Libby Bonine on March 14, 2002, at 17:15:27
In reply to Re: Wellbutrin Ritalin » Charlotte, posted by TSA West on March 14, 2002, at 2:00:26
I've been dealing with this for awhile and have tried some of these solutions, as well as a couple of others. Here's my experience with them. My diagnosis is ADD and chronic major depression with agitation. Prior to starting any of the measures below, I was taking:
Wellbutrin SR 300 mg/day
Ritalin 60 mg/dayAt these doses, I was experiencing extreme daytime sleepiness, extreme lethargy, & occasional agitation (crying).
I was tested for hypothyroid disorder and was told my thyroid was normal - if anything, a bit hyperactive. Still, my doc recommended trying a "subclinical" dose of thyroid hormone. That stimulated me enough so that I wasn't sleepy during the day and felt good - for awhile. In time, however, I began to have a lot of difficulty waking in the morning - so much difficulty that most days I couldn't muster enough energy to take my meds off the nightstand. When I also began experiencing heart palpitations, I was taken off the thyroid medication.
Since then...
> Some possible solutions:
>
> 1) Add a stimulating antidepressant like fluoxetine, reboxetine, or protriptyline.This seems to be the best fix so far. I am currently taking fluoxetine 20 mg/day and it has made a noticable difference. I have more energy; the agitation has disappeared; & my mood has improved slightly. I still experience daytime sleepiness, though. I think I will eventually end up having to take more than 20mg/day, but since the heart palpitations, I have to be careful about taking more energizing drugs.
I'm starting to realize that daytime sleepiness may just be something I have to live with. I've found that exercise, even when I can only muster the energy & motivation for a few minutes each day, helps a great deal. A couple of short walks during the day and a few minutes of stationary cycling after dinner help keep me awake & functioning. However, exercise is tricky with my meds. I have to monitor my heart rate closely.
> 2) Add a stimulant like Modafinil or Adrafinil.
I didn't try another stimulant, but did try increasing my dose of Ritalin up to 80 mg/day. The extra 20 mg/day made me so sleepy that most afternoons I fell asleep sitting at my desk. Yet, in spite of the extra sleepiness, my problems with muscle rigidity & migranes grew. So the extra stimulant didn't help.
Reducing my dose did seem to help a bit. I now take 40 mg/day most days, but have permission from my doc to take up to 60 mg on days when I'm forced to work overtime. My preference is to take as little as I have to take in order to sustain concentration while I'm at work.
> 3) Raise your dose to 450 mg of Wellbutrin.
For me, this was worse than increasing Ritalin. 450 mg/day left me barely functional. Stupor would be a good descriptor. Also, my migraines got stronger, lasted longer, & the constant nausea was unbearable.
I experienced a little less daytime sleepiness when we lowered my dose to 150 mg/day from 300, but my mood became much more depressed, so I returned to my original dose of 300 mg/day.
My current meds:
Wellbutrin SR 300 mg/day
Fluoxetine 20 mg/day
Ritalin 40-60 mg/dayI feel good and function well. I still get sleepy during the day, but I expect my doc will tweak my fluoxetine dose a bit to see if I can tolerate more. My doc & I have discussed the possibility that in time I will end up on fluoxetine and Ritalin, with no Wellbutrin but for now, things are manageable, so I'm not rocking the boat.
poster:Libby Bonine
thread:97835
URL: http://www.dr-bob.org/babble/20020313/msgs/98010.html