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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 21 of 21. This is the beginning of the thread.
Posted by MHK on June 29, 2000, at 13:53:36
I've been on Wellbutrin SR for 2 1/2 months and already it seems to be losing its effectiveness. I was on it for about 4 months a little over a year ago (augmented with Prozac for a short time) and it seemed to have pooped out then as well.
It still does two things for me: helps me wake up in the morning (although not as well as it did initially) and it promotes weight loss (which is a big help to me -- I am 5'4" and about 150 lbs. overweight.)
I am already at the maximum dosage (200mg 2x/day), so increasing is not an option.
I've been dysthymic for decades and am an absolutely horrible procrastinator (or, I'm quite good at it -- depending on your perspective.) I REALLY need something that is going to help me get moving.
I know that most every med has some pros and cons in terms of side effects, but I can't/won't take anything that has weight gain and/or sexual dysfunction as common problems. I already have physical pain related to my weight (knees, ankles, back) which I don't want to exacerbate, and my sexual response is terribly low on its own.
Anybody out there with recommendations for augmenting the Wellbutrin or replacing it with something else?
I'd be grateful for any help you can offer.
Thanks so much,
Heidi
Posted by CarolAnn on June 29, 2000, at 15:34:41
In reply to Wellbutrin SR Poop-Out, posted by MHK on June 29, 2000, at 13:53:36
Heidi, I'm in the same boat with you. I've got to get my Pdoc working on some other meds. solution. Have you tried adding a stimulant to the Wellbutrin? I've been on Adderall with my Wellbutrin, but it seems to have pooped out as well. Still, It's worth a try if you haven't done a stimulant yet. I don't even know where to go from here. I feel like I go around in circles. My depression makes me tired and being tired makes me depressed and meanwhile, there's no energy for attempting weight loss. And, my procrastinating is so bad, that I can't even get myself to make an appt. with my Pdoc, when I know I won't get any better until I do!
Anyway, I think you should definitly talk to your Doctor about adding a stimulant, though I wouldn't talk about using it for weight loss. My Pdoc only resorted to stimulants when I told him (and it was true)that my fatigue was so bad, that I was seriously considering suicide just to end the tiredness! Best of wishes to you, let us know how it goes. CarolAnn
Posted by SLS on June 29, 2000, at 17:37:46
In reply to Re: Wellbutrin SR Poop-Out » MHK, posted by CarolAnn on June 29, 2000, at 15:34:41
Hi there.
Ritalin might be worth a try too.
It might be interesting to try adding Provigil (modafinil) to Wellbutrin (bupropion). A recent investigation studying the use of Provigil as an augmenting agent included two bipolar patients for whom it was combined with Wellbutrin. Bipolar depression shares many of the anergic (low energy) features you both describe. Both had also failed to respond to Prozac (fluoxetine). Of the ten patients treated with various Provigil + antidepressant combinations, the two taking Wellbutrin showed the most dramatic improvements. The dosages used were 100mg and 200mg. A trial of Provigil should extend for at least two weeks.
Have either of you ever tried Effexor?
- Scott
Posted by ksvt on June 29, 2000, at 22:05:29
In reply to Re: Wellbutrin SR Poop-Out - Heidi and CarolAnn, posted by SLS on June 29, 2000, at 17:37:46
> Hi there.
>
> Ritalin might be worth a try too.
>
> It might be interesting to try adding Provigil (modafinil) to Wellbutrin (bupropion). A recent investigation studying the use of Provigil as an augmenting agent included two bipolar patients for whom it was combined with Wellbutrin. Bipolar depression shares many of the anergic (low energy) features you both describe. Both had also failed to respond to Prozac (fluoxetine). Of the ten patients treated with various Provigil + antidepressant combinations, the two taking Wellbutrin showed the most dramatic improvements. The dosages used were 100mg and 200mg. A trial of Provigil should extend for at least two weeks.
>
> Have either of you ever tried Effexor?
>
>
> - Scott
I've been on WB for around 3 years at 400 mgs/day so there's no where else I can go with it. I've been able to tolerate it well and it has helped although in the last 6 months I really thought I was slipping badly. Recently my pdoc switched me to 300mg of Wellbutrin SR and 50 mg of Zoloft. I don't think I will stay on this very long because of the effect on my libido, so I too am looking for something to augment the Wellbutrin. Also, I really feel like I've reacted very differently to the time release dosages. I seem to feel very wired or totally washed out. Has anybody tried serzone to augment WB?
Posted by CarolAnn on June 30, 2000, at 8:00:37
In reply to Re: Wellbutrin SR Poop-Out - Heidi and CarolAnn, posted by SLS on June 29, 2000, at 17:37:46
Scott, I tried Ritalin and found it too addictive, actually I have already been thinking about trying Provigil, just have to get up the gumption to ask my Pdoc about it!
Also, I did try effexor and even at the highest dose, it did nothing for me. Thank you so much for the message Scott, I hope you have been feeling better. CarolAnn
--
To ksvt, I have tried Serzone with Wellbutrin and the Serzone made me closer to suicide then I have ever been! But remember, most everything is different for most everyone. So, you never know, what harms some can help others! Good luck! CarolAnn
Posted by Johnturner77 on June 30, 2000, at 12:41:55
In reply to Re: to SLS and ksvt..., posted by CarolAnn on June 30, 2000, at 8:00:37
> Scott, I tried Ritalin and found it too addictive,
Specifically what do you mean too addictive? It worked too well? Or all you could think about was taking more? Maybe it was just right and you felt normal and though this is too good to be true. Maybe the dose was just too high.
Posted by MHK on June 30, 2000, at 13:12:10
In reply to Re: Wellbutrin SR Poop-Out » MHK, posted by CarolAnn on June 29, 2000, at 15:34:41
Thanks to everyone for the information. Things have been so lousy this week that I called my Pdoc and I'm going in to see her in a few minutes. Hopefully, we can find something that will help.
Unfortunately, I really don't like her. Very stiff, very formal (insists on calling me by my last name, etc.) and condescending. I've got to find somebody new.
Anybody with recommendations in the Chicago area?
Thanks again,
Heidi
Posted by CarolAnn on July 1, 2000, at 15:06:09
In reply to Re: CarolAnn...too addicting??, posted by Johnturner77 on June 30, 2000, at 12:41:55
Hey, sorry it took so long to respond, haven't had a chance to get online in a while.
Anyway, by "specifically too addicting", I meant that even though I was on the highest dose prescribed, I wanted more and more. I was supposed to be on 20mgs. three times/day. Which is 90 pills in a month. The last prescription I allowed myself to get filled, I took all 90 pills in just over a week! I knew I was in trouble there, but didn't want to admit to pdoc, so I just said, I didn't want to take it anymore. I have a different pdoc now, and am on Adderall, which was very helpful in the beginning, but not much help after seven months. So, back to the 'seeking energy and motivation' drawing board! CarolAnn
Posted by Dr. Bob on July 2, 2000, at 15:44:13
In reply to Thanks (and one more question), posted by MHK on June 30, 2000, at 13:12:10
> Anybody with recommendations in the Chicago area?
There's always our own Affective Disorders Clinic:
http://psychiatry.uchicago.edu/services/adc.html
Bob
Posted by ksvt on July 3, 2000, at 16:42:10
In reply to Re: to SLS and ksvt..., posted by CarolAnn on June 30, 2000, at 8:00:37
> Scott, I tried Ritalin and found it too addictive, actually I have already been thinking about trying Provigil, just have to get up the gumption to ask my Pdoc about it!
> Also, I did try effexor and even at the highest dose, it did nothing for me. Thank you so much for the message Scott, I hope you have been feeling better. CarolAnn
> --
> To ksvt, I have tried Serzone with Wellbutrin and the Serzone made me closer to suicide then I have ever been! But remember, most everything is different for most everyone. So, you never know, what harms some can help others! Good luck! CarolAnnTo CarolAnn - have you ever used an SSRI with Wellbutrin, and if so, which one and why did you stop?
Posted by Anna P. on July 4, 2000, at 0:14:27
In reply to Re: one more question, posted by Dr. Bob on July 2, 2000, at 15:44:13
> > Dr Bob,
Whom can you reccomend at the University for the treatment resistant
atypical bipolar II with no mania, just lethargy,
and SAD at the top of that. Please help.Anna P.
Posted by Dr. Bob on July 4, 2000, at 1:42:23
In reply to Re: Dr Bob reccomendations please, posted by Anna P. on July 4, 2000, at 0:14:27
> Whom can you reccomend at the University for the treatment resistant
> atypical bipolar II with no mania, just lethargy,
> and SAD at the top of that.I'd refer you to our Affective Disorders Clinic, too...
Bob
Posted by CarolAnn on July 4, 2000, at 8:34:29
In reply to Re: to SLS and ksvt..., posted by ksvt on July 3, 2000, at 16:42:10
>>>
>> To CarolAnn - have you ever used an SSRI with Wellbutrin, and if so, which one and why did you stop?>>>To ksvt,
Actually, I am currently on Celexa with the Wellbutrin. I think Celexa is an SSRI, fairly certain, actually. Anyway, When I got off the Serzone, the pdoc added 20mgs.Celexa to my 400mgs.Wellbutrin (per day). It didn't do anything until we (slowly) got the dose up to 40mgs.Celexa. Now, my mood has improved, and oddly enough, my sexual response is better at 40mgs. then it was at 20mgs.(just FYI, my *drive* is still non-existant, but if I 'force' myself, for hubby's sake, the payoff is pretty darn good!). The only problem I still battle is intense fatigue, for which the pdoc gives me Adderall at 10mgs. 3x/day. The Adderall is not helping as much as it did in the beginning, but I think that is my fault. Because, I continue to eat too much junk and I don't exercise, which I really think would help all the meds. do their jobs better! Oh geez! Here I go again, giving my life story, in answer, to one little question!
Best of luck to you! CarolAnn
Posted by ksvt on July 4, 2000, at 16:01:13
In reply to Re: to ksvt..., posted by CarolAnn on July 4, 2000, at 8:34:29
> >>>
> >> To CarolAnn - have you ever used an SSRI with Wellbutrin, and if so, which one and why did you stop?>>>
>
> To ksvt,
> Actually, I am currently on Celexa with the Wellbutrin. I think Celexa is an SSRI, fairly certain, actually. Anyway, When I got off the Serzone, the pdoc added 20mgs.Celexa to my 400mgs.Wellbutrin (per day). It didn't do anything until we (slowly) got the dose up to 40mgs.Celexa. Now, my mood has improved, and oddly enough, my sexual response is better at 40mgs. then it was at 20mgs.(just FYI, my *drive* is still non-existant, but if I 'force' myself, for hubby's sake, the payoff is pretty darn good!). The only problem I still battle is intense fatigue, for which the pdoc gives me Adderall at 10mgs. 3x/day. The Adderall is not helping as much as it did in the beginning, but I think that is my fault. Because, I continue to eat too much junk and I don't exercise, which I really think would help all the meds. do their jobs better! Oh geez! Here I go again, giving my life story, in answer, to one little question!
> Best of luck to you! CarolAnnTo CarolAnn - please excuse me for being so nosey about this and feel free to tell me to get lost at any time, but I don't really have anyone I can discuss these things with who has any personal experience with these drugs. How long have you been on medication? Were you just on 400 mgs of WB for awhile before your doctor added the Serzone. Does he or she think the fatigue is related to Celexa? Was this something you experienced with Serzone also? How long have you been on Celexa? Have some of the more unpleasant side effects lessened. Was lack of "drive" an issue only with Celexa or also with Serzone and/or WB? I've been on 400 mgs of Wellbutrin for quite awhile and the notion of augmenting it is a relatively recent one - perhaps because unlike most people on this board, I see my pdoc very infrequently. I'm so accustomed to only partially responding to meds, that I was rather slow to pick up on the fact that maybe I didn't have to feel as awful as I did this winter. Anyway, I'm on this WB/Zoloft combination now and I think I have to quit it or increase it. I'm feeling some better now so the notion of trying something else doesn't hold great appeal, particularly when I have alot else going on in my life. However, I'm likely to have to be on meds for the forsseable future (and the not foreseeable future also), so staying on a drug that diminishes my sex drive as much as Zoloft does, seems intolerable. Thanks for all your info. Ksvt
Posted by CarolAnn on July 4, 2000, at 17:46:04
In reply to Re: to ksvt... » CarolAnn, posted by ksvt on July 4, 2000, at 16:01:13
Hey ksvt,
ask as much as you want, as often as you need to! I'm happy to help, anywhere I can!
Now, re: Wellbutrin - once I had gotten to the highest dose(200mgs. 2x/day), I was on it for 12wks before my pdoc decided to augment. He believes in a 6 to 8 wk trial period, and then I wanted to wait one more month to augment.
re: Serzone - at 12wks of Wellbutrin, I was getting no help at all, it was not even "activating" which is supposed to be a main side-effect. So, we started Serzone, can't remember doses, but after the first increase, I got more depressed and tired then I've ever been(my closest ever to suicide). So, Serzone was stopped immediately. At this time, Adderall(a stimulant-10mgs. 3x/day) was added, because one of my primary depression 'symptoms' is excessive fatigue. This was near xmas, and my inability to "get anything done", was(I explained to my Pdoc) contributing to the suicidal thoughts(as well as increased stress).
re: Celexa - The addition of Adderall was helping my fatigue, but not really augmenting the Wellbutrin. Since I had already tried most of the SSRI's with no improvement, the pdoc felt that it was best to stay on Wellbutrin and use something to try and give it a kick. We started with 20mgs., which I felt made me 'less' depressed, but certainly not 'well'. I had no adverse side-effects, except that orgasm became more difficult, my "drive" has been pretty consistently low(some variation from med. to med.,ie: 'low or lower'), except for about the first two wks on Wellbutrin, it went up(don't know why, maybe placebo effect?). When the Celexa was upped to 40mgs. per day, I noticed that while I still had no "drive", the orgasms came back(even better then they were, actually).
I have tried a lot of meds. and a lot of med. combos, and what I am on has been the best so far. I still feel room for improvement with mood, and especially with energy. But, I am afraid to "rock the boat", so have been putting off talking changes with my Pdoc.
Well, I hope I got all your questions, but if I missed any, or you come up with anymore, feel free to ask! As far as a suggestion, my thought(which could well be wrong) is that, if you can go higher on the Zoloft(are you at 50 or 100mgs?), you may want to try that before giving it up all together. My basis for this advice is only the fact that: Celexa is an SSRI too, and my 'improvement'(sexually speaking), happened after the dose was doubled, oddly enough.
Anyway, I'm sorry I don't have anything more concrete to help you make a decision. It's hard for all of us, when you consider how many different reactions there are to the same or similar medications.
Best of luck to you, and again, ask anything, anytime! CarolAnn
>
Posted by Anna P. on July 7, 2000, at 15:15:18
In reply to Re: Dr Bob reccomendations please, posted by Dr. Bob on July 4, 2000, at 1:42:23
> >
>
> I'd refer you to our Affective Disorders Clinic, too...
>
> BobDr. Bob, what are the names of the most experienced doctors at the clinic?
I'm looking for refferals. Thank you.Anna P.
Posted by Dr. Bob on July 8, 2000, at 10:29:19
In reply to Re: Dr Bob, one more question, posted by Anna P. on July 7, 2000, at 15:15:18
> Dr. Bob, what are the names of the most experienced doctors at the clinic?
> I'm looking for refferals.The most experienced are:
Elliot Gershon, MD
Professor and Chairman
World renowned for his research in the genetics of bipolar disorders, Dr. Gershon's special interests include genetic counseling and the psychopharmacology of clients with bipolar disorders.
Posted by Anna P. on July 11, 2000, at 15:02:00
In reply to Re: U. of Chicago Affective Disorders Clinic, posted by Dr. Bob on July 8, 2000, at 10:29:19
> > Dr. Bob, what are the names of the most experienced doctors at the clinic?
> > I'm looking for refferals.
>
> The most experienced are:
>
> Elliot Gershon, MD
> Professor and Chairman
> World renowned for his research in the genetics of bipolar disorders, Dr. Gershon's special interests include genetic counseling and the psychopharmacology of clients with bipolar disorders.
>
Posted by dls on July 11, 2000, at 15:48:49
In reply to Re: Dr Bob reccomendations please, posted by Dr. Bob on July 4, 2000, at 1:42:23
Dear Dr. Bob,
Don't mean to impose, but am frustrated. I'm trying to find someone who professes to have a working knowledge of the emotional aspects of pituitary disease, especially when disruption (disturbance) of the hypothalmic-pituitary axis is a consideration (post surgery + radiation - with a little Lupron thrown into the disruption).
Any suggestions?
Don
Posted by Dr. Bob on July 14, 2000, at 14:05:43
In reply to Re: Dr Bob reccomendations please - AGAIN, posted by dls on July 11, 2000, at 15:48:49
> I'm trying to find someone who professes to have a working knowledge of the emotional aspects of pituitary disease, especially when disruption (disturbance) of the hypothalmic-pituitary axis is a consideration (post surgery + radiation - with a little Lupron thrown into the disruption).
Maybe try our endocrinology section? Their home page is at:
http://endocrinology.uchicago.edu
And if you click on Faculty Research Interests up at the top, you'll see that a few of them list "pituitary". Good luck,
Bob
Posted by dls on July 15, 2000, at 20:05:23
In reply to Re: U. of Chicago Endocrinology, posted by Dr. Bob on July 14, 2000, at 14:05:43
> > I'm trying to find someone who professes to have a working knowledge of the emotional aspects of pituitary disease, especially when disruption (disturbance) of the hypothalmic-pituitary axis is a consideration (post surgery + radiation - with a little Lupron thrown into the disruption).
>
> Maybe try our endocrinology section? Their home page is at:
>
> http://endocrinology.uchicago.edu
>
> And if you click on Faculty Research Interests up at the top, you'll see that a few of them list "pituitary". Good luck,
>
> Bob
Thank you, kind sir.Don
This is the end of the thread.
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