Posted by collegeguy on April 16, 2004, at 22:39:27
In reply to WellbutrinSR causing panic attacks, posted by josephinejones on April 16, 2004, at 6:06:36
Wellbutrin is an NDRI, meaning it results in higher levels of the neurotransmitters norepinephrine and, to a lesser degree, dopamine by inhibiting their synaptic reuptake. The panicky symptoms you are experiencing sound like the Wellbutrin is too stimulating for you. These side effects could just be temporary, as antidepressant side effects often are, though they could just as well indicate you are on too high a dose of Wellbutrin SR (or on the wrong medication altogether). If your doctor feels strongly that the side effects will subside if given time, he/she should give you something to help manage the side effects--in your case, the ideal treatment addition would be a benzodiazepine like Ativan or Klonopin. Ativan (lorazepam) taken in small doses several times a day (3x usually) tends to be most useful because it is a medium acting benzo drug--it does not enter and leave your system very quickly like Xanax or wallow in your system for days like Valium does. It is important that you are given a drug that has a short enough acting life so that you can take it only for as long as needed for the Wellbutrin effects to subside. Benzodiazepines can be unintentionally addicting because of their propensity to cause dependence in the user if taken for long periods of time and thus should be used only when needed.
That being said, don't be scared of the benzodiazepine drugs just because they are Schedule III controlled substances or may to you have a bad rep--they have been around for decades and their theraputic effects are numerous and well documented. Generally, staying within the mid level dose per day limit for no greater than a month will not produce any dependance. You should talk to your pdoc about this though.
Also, your Wellbutrin might be too high a dose or even the wrong wellbutrin for you. While the SR (sustained release) tabs can be especially useful in those depressives who need a "wellbutrin boost" more than once a day, having to deal with oscillating medication levels can cause anxiety in others. As such, Wellbutrin XL (extended release) 24-hour once a day tabs might be better for you. You could start at 150 mg (the lowest XL dose) for a week or two, then move up to 300 mg. If you receive no greater antidepressant effect on the 300 mg / increased side effects, titrate back down to 150 mg (though don't split SR or XL tabs, they are specially formulated and cannot be divided). Wellbutrin XL has a more steady blood level curve than SR does. It is also cheaper per daily treatment dose than SR (though SR is soon being released in generic form by a manufacturer awaiting approval).
Regardless, panic attacks are serious side effects, especially if you did not experience them off the medication, and you should talk to your doctor if they continue.
poster:collegeguy
thread:336829
URL: http://www.dr-bob.org/babble/20040412/msgs/337055.html