Posted by TamaraJ on June 18, 2005, at 10:20:59
In reply to Re: Anyone TIRED on Wellbutrin XL? - ? for Scott » TamaraJ, posted by SLS on June 18, 2005, at 9:53:46
> Hi Tamara.
>
> How are you feeling right now?
>
-- I am feeling not too bad, not too bad at all. I think I am almost there actually, which is a nice feeling.
>
> You might want to try moving up the dosage of nortriptyline to 100mg.
>
-- I tried to up the nort to 100mg a number of weeks ago, and it left me really sluggish and slow the next day. I tried the 100mg for a number of days, but it seemed to actually make me feel worse. Must be that therapeutic window thing. So, I went back to 75mg, and I was fine, but still lacking energy and motivation (I am, by nature, a somewhat hyper, high energy person, so my expectations may be too high really).
>
> Hmm. I wish I could answer this question for you. I know how much easier your decision-making process would be by having a definitive answer.
>
-- I know, it is so much a case of trial and error. I don't have any significant adverse effects with the Wellbutrin/nort combo, so I will stick with it for a while. Plus, my understanding is that nort works on serotonin as well, so I assume it is much like a SNRI?
>
> Do you think the Wellbutrin has helped at all?
>
-- Oh, yes, I have noticed a difference in my mood, my energy levels and my motivation, even at 100mg. Not an enormous difference, but enough that I am encouraged. So, I am going to try hard to tolerate a higher dose to get me over the last of the hump.
>
> I'm not a real big advocate of the XL once-a-day prescription. If I were taking Wellbutrin, I would take the SR version twice a day morning and evening.
>
-- I have heard negative things about the XL version. I am going to stick with the SR version. I think Minnie was saying that she also had a negative reaction to the 150mg tab, but when she takes 2, 100mg tabs, no negative reaction. Weird.
>
> Perhaps someone can provide some input as to the possibility that it is the nortriptyine that is acting as a catalyst to produce the headaches you get when you try to increase the dosage of Wellbutrin. It is conceiveable that you can take larger dosages of Wellbutrin in the absence of nortriptyline.-- I am wondering if the headaches were caused by my smoking. I have been trying to quit, and have cut down significantly since starting the Wellbutrin, but still have about 10 smokes a day. I wonder if the increased dose of Wellbutrin, combined with smoking, was producing migraine-like headaches. For some reason, that would make sense to me, and it was something that dawned on me this morning.
>
I think I would proceed in the following sequence if I wanted to build a treatment around Wellbutrin:
>
> 2. Switch to twice a day schedule of Wellbutrin of SR or XL: morning and evening.
>
-- I think you are right on here. I am going to try this, starting tomorrow, to see how I respond. Hopefully, there will be no problems. Actually, I have been quite fortunate with both the nort and the Wellbutrin. With the exception of some start-up side effects the first couple of weeks, I have not been troubled by much in terms of continuing side effects (knock on wood :-)).
>
> 3. Increase dosage of Wellbutrin gradually to 300mg.
>
-- Yes, depending on how I respond to the 200mg (in two doses), I would go up to 300mg if more antidepressant effect is needed. I am hoping that 200mg will do it for, since I really am almost there (yipes, I hope I have jinxed myself now).
>
> If you prefer to stay with nortriptyline or cannot tolerate a higher dosage of Wellbutrin in its absence, you can discontinue the Wellbutrin, restart the nortriptyline if necessary and add Parnate, Effexor, or Cymbalta.
>
-- I am a bit nervous of MAOIs, but I would certainly consider one if the nort/wellbutrin combo ends up proving disappointing. I have tried Effexor, and it was not good for me (had some continuing side effect problems that ended up causing even bigger problems). And, unfortunately, Cymbalta is not available in Canada yet :-(Thanks so much, Scott, for taking the time to respond to my questions. I really appreciate it. I was just curious to know if one of the newer ADs might work better with the Wellbutrin than the nort, but I am optimistic about the combo on am on now. So I hope things just continue to get better.
All the best, and take good care of yourself.
Tamara
poster:TamaraJ
thread:473033
URL: http://www.dr-bob.org/babble/20050617/msgs/514876.html