![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 42 to 66 of 106. Go back in thread:
Posted by allisonm on October 23, 2000, at 21:59:53
In reply to Re: I'm a lab rat and kinda enjoy it!!!, posted by Athena on October 23, 2000, at 16:49:19
< < I guess my challenge to you guys is not to look outside of yourself for that answer. Our world is full of "quick fixes" and millions of illusions. > >
This is all well and good and true. However, I suspect that lectures on the subject will have little effect. The only way to learn such lessons is for one to experience the disappointment and find, define, and refine within themselves what is really meaningful. Some people never get there, and no one can make them go.
Posted by S. Howard on October 23, 2000, at 22:12:51
In reply to Re: I'm a lab rat and kinda enjoy it!!!, posted by allisonm on October 23, 2000, at 21:59:53
First: the medication I take (seroquel, depakote and paxil) is not mood-altering (damn!) so I wouldn't consider it "instant gratification".
Second: whoever suggested "getting married" as a way to allieviate depression was hopefully not serious. Even if it works for a short time, eventually you will drag your partner into your personal hell, along with any kids you might have. Before long, you will have created your very own dysfunctional family. Get help first please. -SGH
Posted by Athena on October 23, 2000, at 22:28:21
In reply to Re: I'm a lab rat and kinda enjoy it!!!, posted by S. Howard on October 23, 2000, at 22:12:51
> First: the medication I take (seroquel, depakote and paxil) is not mood-altering (damn!) so I wouldn't consider it "instant gratification".
Um, okay, I would definitely have to disagree with you here...seroquel, depakote, and paxil definitely ARE mood-altering drugs. But I know what you mean by "instant gratification"/mood-altering drugs...as in ecstasy, weed, etc.
So, SSRIs are not "instant gratification" but they do fit into the category of "quick fixes." You still have issues even though you are taking a pill.
> Second: whoever suggested "getting married" as a way to allieviate depression was hopefully not serious. Even if it works for a short time, eventually you will drag your partner into your personal hell, along with any kids you might have. Before long, you will have created your very own dysfunctional family. Get help first please. -SGH
Posted by Buffet on October 24, 2000, at 1:29:12
In reply to Re: I'm a lab rat and kinda enjoy it!!!, posted by S. Howard on October 23, 2000, at 22:12:51
> Second: whoever suggested "getting married" as a way to allieviate depression was hopefully not serious. Even if it works for a short time, eventually you will drag your partner into your personal hell, along with any kids you might have. Before long, you will have created your very own dysfunctional family. Get help first please. -SGH
Yup, that was me. And yes, I was kidding a little there. I just got married (about three months ago), and I'm still in the initial phase and must admit that it is fun. Definitely has its ups and downs and those will increase later on I know...Buffet
Posted by coral on October 24, 2000, at 5:46:26
In reply to Re: I'm a lab rat and kinda enjoy it!!!, posted by Athena on October 23, 2000, at 22:28:21
SSRI's are "quick fixes?" I don't think so . . . they're also not mood altering (in the way in which I THINK you mean it), they're mood correcting. If someone has disrupted blood chemistry due to a thyroid dysfunction, is taking Synthroid a mood-altering drug? Of course not. The same is true with the SSRI's, they correct the brain chemistry that's gone awry. IF a person is on the correct meds, the person is functioning normally, not in an altered state (it is difficult to make sure a person is on the right meds!!!)
There are some religious beliefs that disavow any medical intervention and that, of course, is a person's choice of beliefs.
I feel that we're evolving into a more holistic approach to healing in the west and have gained a great deal from Eastern teachings. It's insulting to hear a physician refer to a patient in a room as "The gall bladder in 214."
The US (and many other countries as well) has a history of medicating people who were "different" into submission, even to the point of lobotomies.
Athena, I don't know what your symptoms are and wouldn't presume to advise you in your methods of choice for healing, searching for Truth, etc. And, you're right that many people have had the experience of being a lab rat as new meds were tried, some successful, some not.
There's also little doubt about the incredible power of the mind that we're just beginning to understand. I don't speak for anyone else. I'm combating an endogenic depression. As I've said before, the answers are within me, and that includes how appropriately I evaluate potential help, what I do to correct and alleviate the problems, and what I can do to prevent them from happening. For me, it's a combo of meds and therapy.
Posted by Athena on October 24, 2000, at 16:01:52
In reply to Re: I'm a lab rat and kinda enjoy it!!!, posted by coral on October 24, 2000, at 5:46:26
the answers ARE within you, not outside of you.
Posted by pullmarine on October 24, 2000, at 16:05:29
In reply to Ah a healthy discussion, i like it!, posted by Athena on October 22, 2000, at 8:20:18
>
> So ...
>
> Are meds REALLY the answer?
> Is exercise the answer?
> Is a red flashy convertible the answer?
> A palm pilot?
> A new computer?
> A new haircut?
> New clothes?
> and on and on....
>
> Well? IS IT?
>
> Tell me, is there ANYTHING outside of yourself that IS the answer?I think I'd feel a lot better if I could spend my whole life smoking opium, but my doc won't prescribe any.
JOHN
> I'd really like to know what you guys think.
>
> Oh the woes of Luvox withdrawals,
> Athena
Posted by Mary Beth on October 24, 2000, at 16:11:58
In reply to I absolutely agree..., posted by Athena on October 24, 2000, at 16:01:52
I think that withdrawl was the intial topic of this thread and I am going to stick with it. I have noticed since I stopped taking meds that I have become slightly detached from my life, I am not as concerned about my impact on others. (OHHH did I hurt there feelings? I feel freedom from this detachment as I am not held back as much as I used to be held back. However, I have noticed that I am a little bitcher. I am also much more aware of my feelings. I actually have feelings whether good or bad I have them and for two years I have had very few poistive or negative feelings. Has anyone else noticed this type of feeling after going of there meds? Do you have any pointers.
Posted by Athena on October 25, 2000, at 21:29:41
In reply to withdrawl, posted by Mary Beth on October 24, 2000, at 16:11:58
well...perhaps these feelings are normal "life" feelings? Personally, I don't think that feelings in "normal life" are really supposed to be so baseline, as in NOT extremes. I agree, after coming off my meds, I too have extremes, but somehow this makes me feel more alive. Is this odd? Or is this normal and the meds are what's NOT normal.
? just thoughts.
And in my opinion, I AM sticking to the topic. Everything we've talked about so far is related to this topic, and the issues involved.
Posted by Buffet on October 26, 2000, at 3:05:06
In reply to Re: withdrawl, posted by Athena on October 25, 2000, at 21:29:41
> well...perhaps these feelings are normal "life" feelings? Personally, I don't think that feelings in "normal life" are really supposed to be so baseline, as in NOT extremes. I agree, after coming off my meds, I too have extremes, but somehow this makes me feel more alive. Is this odd? Or is this normal and the meds are what's NOT normal.
>
> ? just thoughts.You know, I was just talking to my wife about this exact subject but in reverse. I have been off the ssri's for about three months and mentioned that I have noticed that my moods swings have been acting up much more lately. She told me that she has noticed a huge difference in my moods, mood swings, and anxiety but was afraid to tell me. She noted several examples of these swings in mood that I had overlooked as 'just being my normal self'. I now look back at these examples and in hindsite I can see how these swings have affected various events in the last couple months (negatively). I have made the decision to go back on an ssri, either prozac, or maybe celexa which I haven't tried. I have made the decision that the chemical imbalances or whatever it is that I have, affect my life negatively and when I was on the medication I was much more stable. They have helped me become more 'normal' and able to deal with the ups and downs in life on a much more rational level. My moods are what is making life have innapropriate extremes. Am I making any sense here? I agree that most people don't need meds, but I definitely think I do as proven by the quality of my life when on them and the decay of quality life when not on them.
Posted by S. Howard on October 26, 2000, at 13:55:07
In reply to Hindsite-why I vote for meds... » Athena, posted by Buffet on October 26, 2000, at 3:05:06
It's understandable that most people don't want to rely on lifetime medication - it seems unnatural and unhealthy. I was horrified to find out that I'm hypertensive and would need a drug to control my blood pressure for the rest of my life. But I think most people would agree that taking a daily pill beats the hell out of being paralyzed by a stroke.
It's senseless to spend your life suffering from depression or mood disorders because you believe
"drugs are bad", or that depending on them for your mental well-being is somehow shameful. Taking medication to improve your quality of life is better than ending up with your head in the oven. Even if you don't think so, your loved ones do.-SGH
Posted by R.Anne on October 26, 2000, at 14:44:12
In reply to I absolutely agree..., posted by Athena on October 24, 2000, at 16:01:52
> the answers ARE within you, not outside of you.
*****
And then some of the answers that ARE within you are outside of you.
Posted by Ami on October 27, 2000, at 0:09:42
In reply to Re: prozac withdrawl-for Dohotay, posted by Dorothee Teboul on June 24, 2000, at 2:04:54
I just have a question. I have been on Prozac for about 4 years and have been very happy with it. I have tried to go off of it a few times with out success. I have very bad withdraws, a lot of crying, irrational thoughts, bad dreams and my brain feels funny, like it is tingling. The withdraws are worse than the depression that caused me to go on it. Anyway, I always go running back to the Prozac. Our new insurance company is refusing to cover Prozac and gave my Dr. a whole list of "cheaper" drugs to try. We decided to try Wellbutrin. Now I am having a lot of anxiety (never a problem before). My question is does anyone have experience with Wellbutrin? Does this sound like it's Prozac withdraw or could it be the new med? I have been off Prozac for 7 days and usually feel withdraw by the 3rd day, and have been on Wellbutrin for 3 days. Help!
Posted by JackieJ on October 27, 2000, at 13:14:49
In reply to Re: prozac withdrawl-for Dohotay, posted by Ami on October 27, 2000, at 0:09:42
> I just have a question. I have been on Prozac for about 4 years and have been very happy with it. I have tried to go off of it a few times with out success. I have very bad withdraws, a lot of crying, irrational thoughts, bad dreams and my brain feels funny, like it is tingling. The withdraws are worse than the depression that caused me to go on it. Anyway, I always go running back to the Prozac. Our new insurance company is refusing to cover Prozac and gave my Dr. a whole list of "cheaper" drugs to try. We decided to try Wellbutrin. Now I am having a lot of anxiety (never a problem before). My question is does anyone have experience with Wellbutrin? Does this sound like it's Prozac withdraw or could it be the new med? I have been off Prozac for 7 days and usually feel withdraw by the 3rd day, and have been on Wellbutrin for 3 days. Help!
To Ami and All:I have been on prozac for 5 years. I am currently taking 40 mg per day in addition to 400 mg of wellbutrin. My doctor just yesterday dropped my dose of prozac from 40 to 30 mg. In 2 more weeks I will go from 30 to 20, in another 2 weeks, down to 10, and in 2 more weeks, no more prozac. Then he will INCREASE my wellbutrin from 400 mg per day to 600 mg per day. (He told me that just recently it is safe to go as high as 600 mg whereas 400 mg USED to be the max. I'm very scared of withdrawal symptoms from prozac and increased intake of wellbutrin. I can NOT live the way I did without the prozac. However, I'm sick of the sexual side effects after 5 years. And I am sick of the weight gain! Any input from all is appreciated. Please respond to my email address as well in case I can't find this site again. JackieJeckyl@aol.com
Posted by Emmanuela on October 29, 2000, at 1:24:04
In reply to Re: prozac withdrawl-for Ami » Ami, posted by JackieJ on October 27, 2000, at 13:14:49
Hi Jackie -
I've been on Wellbutrin for quite some time, and it's been a great
medication for me. I just talked to my pdoc yesterday, and as far as he
knows, and he's quite the psychopharmacologist, 450 mg. is the top of
the range for Wellbutrin, as more than that runs the risk of seizures.
Can you give me the new info source that your doc has on the upper range
of Wellbutrin?
The only anxiety I experience has nothing to do with the Wellbutrin,
but just anxiety itself that shows up once in a while, and then I take
tiny dose of xanax for that.
Let me know how you do on the Wellbutrin. When I began it, I had a
small hand tremor that slowly dissipated with time. Good luck, and keep
in touch.Emmanuela
Posted by Sunnely on October 29, 2000, at 18:59:21
In reply to Re: prozac withdrawl-for Ami » Ami, posted by JackieJ on October 27, 2000, at 13:14:49
> To Ami and All:
>
> I have been on prozac for 5 years. I am currently taking 40 mg per day in addition to 400 mg of wellbutrin. My doctor just yesterday dropped my dose of prozac from 40 to 30 mg. In 2 more weeks I will go from 30 to 20, in another 2 weeks, down to 10, and in 2 more weeks, no more prozac. Then he will INCREASE my wellbutrin from 400 mg per day to 600 mg per day. (He told me that just recently it is safe to go as high as 600 mg whereas 400 mg USED to be the max. I'm very scared of withdrawal symptoms from prozac and increased intake of wellbutrin. I can NOT live the way I did without the prozac. However, I'm sick of the sexual side effects after 5 years. And I am sick of the weight gain! Any input from all is appreciated. Please respond to my email address as well in case I can't find this site again. JackieJeckyl@aol.comHi JackieJ,
Could you ask your doctor where he got the information (reference) that it is "safe" to go as high as 600 mg/day with Wellbutrin? Would you be kind enough to post it here? I will be concerned about going up to 600 mg/day of Wellbutrin as this puts you on a really high risk for seizures (even with the use of the sustained-release or SR formulation). Not only that the use of higher doses of Wellbutrin i.e., greater than 450 mg/day, puts one at higher risk for seizures, in your case, the combined use of Prozac + Wellbutrin raises that risk even higher.
FYI, Wellbutrin (bupropion) and one of its active metabolites or daughter compounds (hydroxybupropion) are metabolized (broken down) by at least 3 liver enzymes namely CYP2B6, CYP3A4, and CYP2D6. More specifically, the parent compound (bupropion) is metabolized mainly by CYP2B6 and partly by CYP3A4, while the active metabolite (hydroxybupropion) is metabolized by CYP2D6. Prozac does not affect the action of CYP2B6 and modestly inhibits the action of CYP3A4. Therefore, it has a weak effect on the metabolism of the parent compound (bupropion). However, Prozac markedly inhibits the action of CYP2D6. Prozac's inhibiting action on this liver enzyme will then significantly inhibits the metabolism of the active metabolite (hydroxybupropion) causing an increase in its blood level. Since the metabolite, hydroxybupropion, has equal propensity to cause seizures as its parent compound, the rise in its blood level consequently raises one's risk for seizures. Even though your dose of Prozac is being gradually reduced, its inhibiting effect on the liver enzyme CYP2D6 will continue (although diminishing) for at least another 5-8 weeks after it is completely dicontinued. This is due to Prozac's very long half-life (the combined half-life of fluoxetine and norfluoxetine). I believe I read somewhere that the increase in blood level of hydroxybupropion can also cause a decrease in Wellbutrin's antidepressant effect. I am not certain about this, however.
Withdrawal symptoms from Prozac (if they ever occur) are usually milder than the other SSRIs with shorter half-lives. As mentioned above, Prozac has a very long half-life which acts as a "protective" mechanism from the occurrence of withdrawal. This is not to say that withdrawal symptoms will never occur if Prozac is abruptly discontinued.
The following is a general guideline to minimize the risk of seizures with the use of Wellbutrin as an antidepressant:
1. The dose should be carefully titrated (increased) to achieve the lowest effective dose.
2. Daily doses (if greater than 150 mg/day) are to be divided into at least every 6 to 8 hours interval.
3. The dose should not exceed 450 mg/day.
4. Any SINGLE dose should not exceed 150 mg.
5. The doses should not be given closer than every 6 hours.
6. Further dose increases should not occur any more frequently than every 3 days, and for no more than 100 mg.
7. Preferably, use the SR (Sustained Release) than the IR (Immediate Release) formulation.
8. The combined use of Wellbutrin (antidepressant) and Zyban (smoking cessation) is contraindicated. The generic name for both drugs is bupropion, manufactured by the same company.
References:
1. Benefits of new sustained-release bupropion: less-frequent dosing, fewer side effects. In: Psychoparmacology Update, November 1997.
2. Preskorn SH: Bupropion. Journal of Psychiatric Practice, January 2000.
Posted by Athena on October 29, 2000, at 20:19:26
In reply to Re: prozac withdrawl-for Ami » JackieJ, posted by Sunnely on October 29, 2000, at 18:59:21
Hey everyone,
I am still having problems with withdrawing from this *@#*#)@* Luvox!! :) I am down to a 50mg pill every Monday, Thursday, and Saturday. I cannot put any more days in between doses as I will become nauseous again and have that funny "brain/dizzy" thing again. I wonder if I will ever get off this horrible drug. Curiously, and a lot of you will say "I told you so, Athena", lol, my fiance mentioned that I have been more moody lately, and anxious. But I am trying to stick to my goal of getting my brain off this addicting drug and deal with my issues/problems/mental health in more naturalistic ways. I have taken up meditation & yoga, and I don't think I've ever read so many books in my life. (note: I'm currently devouring the "Road Less Traveled" by Scott Peck, MD..and it has made me cry more than once...you might wanna flip thru it!)
Also, I wanted to ask, have any of you tried St. John's Wort, or Sam-e, or even GABA? If so, I'd like to hear your experiences.
In response to one of you guys' earlier post, if meds truly truly make you feel more normal, and not just "numb", then by all means be happy! But meds are not for me, been there done that.
Still wallowing in withdrawals,
Athena
Posted by SLS on October 29, 2000, at 21:55:26
In reply to Re: prozac withdrawl-for Ami » JackieJ, posted by Sunnely on October 29, 2000, at 18:59:21
> Hi JackieJ,
>
> Could you ask your doctor where he got the information (reference) that it is "safe" to go as high as 600 mg/day with Wellbutrin? Would you be kind enough to post it here? I will be concerned about going up to 600 mg/day of Wellbutrin as this puts you on a really high risk for seizures (even with the use of the sustained-release or SR formulation). Not only that the use of higher doses of Wellbutrin i.e., greater than 450 mg/day, puts one at higher risk for seizures, in your case, the combined use of Prozac + Wellbutrin raises that risk even higher.
>
> FYI, Wellbutrin (bupropion) and one of its active metabolites or daughter compounds (hydroxybupropion) are metabolized (broken down) by at least 3 liver enzymes namely CYP2B6, CYP3A4, and CYP2D6. More specifically, the parent compound (bupropion) is metabolized mainly by CYP2B6 and partly by CYP3A4, while the active metabolite (hydroxybupropion) is metabolized by CYP2D6. Prozac does not affect the action of CYP2B6 and modestly inhibits the action of CYP3A4. Therefore, it has a weak effect on the metabolism of the parent compound (bupropion). However, Prozac markedly inhibits the action of CYP2D6. Prozac's inhibiting action on this liver enzyme will then significantly inhibits the metabolism of the active metabolite (hydroxybupropion) causing an increase in its blood level. Since the metabolite, hydroxybupropion, has equal propensity to cause seizures as its parent compound, the rise in its blood level consequently raises one's risk for seizures. Even though your dose of Prozac is being gradually reduced, its inhibiting effect on the liver enzyme CYP2D6 will continue (although diminishing) for at least another 5-8 weeks after it is completely dicontinued. This is due to Prozac's very long half-life (the combined half-life of fluoxetine and norfluoxetine). I believe I read somewhere that the increase in blood level of hydroxybupropion can also cause a decrease in Wellbutrin's antidepressant effect. I am not certain about this, however.
>
> Withdrawal symptoms from Prozac (if they ever occur) are usually milder than the other SSRIs with shorter half-lives. As mentioned above, Prozac has a very long half-life which acts as a "protective" mechanism from the occurrence of withdrawal. This is not to say that withdrawal symptoms will never occur if Prozac is abruptly discontinued.
>
> The following is a general guideline to minimize the risk of seizures with the use of Wellbutrin as an antidepressant:
>
> 1. The dose should be carefully titrated (increased) to achieve the lowest effective dose.
>
> 2. Daily doses (if greater than 150 mg/day) are to be divided into at least every 6 to 8 hours interval.
>
> 3. The dose should not exceed 450 mg/day.
>
> 4. Any SINGLE dose should not exceed 150 mg.
>
> 5. The doses should not be given closer than every 6 hours.
>
> 6. Further dose increases should not occur any more frequently than every 3 days, and for no more than 100 mg.
>
> 7. Preferably, use the SR (Sustained Release) than the IR (Immediate Release) formulation.
>
> 8. The combined use of Wellbutrin (antidepressant) and Zyban (smoking cessation) is contraindicated. The generic name for both drugs is bupropion, manufactured by the same company.
>
> References:
>
> 1. Benefits of new sustained-release bupropion: less-frequent dosing, fewer side effects. In: Psychoparmacology Update, November 1997.
>
> 2. Preskorn SH: Bupropion. Journal of Psychiatric Practice, January 2000.
Hi Jackie and Sunnely,I took part in one of the phase III investigations of Wellbutrin. I don't know if I was part of one of the dosage-finding type studies, but I had taken 900mg without any adverse reactions and almost no side effects. The only one I can remember was some mild disturbance of visual accomodation.
- Scott
Posted by R.Anne on October 29, 2000, at 22:00:29
In reply to More meds withdrawal talk, posted by Athena on October 29, 2000, at 20:19:26
Sorry to hear you're feeling so badly. I, too, had to withdraw from what I call the worst drug I ever took-Luvox. I hope Luvox helped someone on this earth but surely not me or you. My pdoc told me to just quit taking it like that. No instructions. I suffered for a few days and I had been on about 250 mg. a day. That drug made me hallucinate and that is NOT normal for me. Made me more nervous than a long tailed cat in a room full of rocking chairs! Thought I'd add that for humor! I tried St. John's Wort and made ice tea out of it. Wasn't bad but along with my other drugs I was groggy. By the way, Luvox is not an addicting drug. Best wishes that you will feel better. Have you tried hot baths and chamomile tea? That's relaxing. I don't know about the other herbal drugs you mentioned. They are known as drugs, too, by pharmacists. They are made up of chemicals, too, even if they are called natural. If you buy any of that stuff at the drugstore the pharmacist often will give you advice on it if you ask. They are usually real nice, too. Best wishes that you feel better soon!!
****
> Hey everyone,
>
> I am still having problems with withdrawing from this *@#*#)@* Luvox!! :) I am down to a 50mg pill every Monday, Thursday, and Saturday. I cannot put any more days in between doses as I will become nauseous again and have that funny "brain/dizzy" thing again. I wonder if I will ever get off this horrible drug. Curiously, and a lot of you will say "I told you so, Athena", lol, my fiance mentioned that I have been more moody lately, and anxious. But I am trying to stick to my goal of getting my brain off this addicting drug and deal with my issues/problems/mental health in more naturalistic ways. I have taken up meditation & yoga, and I don't think I've ever read so many books in my life. (note: I'm currently devouring the "Road Less Traveled" by Scott Peck, MD..and it has made me cry more than once...you might wanna flip thru it!)
>
> Also, I wanted to ask, have any of you tried St. John's Wort, or Sam-e, or even GABA? If so, I'd like to hear your experiences.
>
> In response to one of you guys' earlier post, if meds truly truly make you feel more normal, and not just "numb", then by all means be happy! But meds are not for me, been there done that.
>
> Still wallowing in withdrawals,
> Athena
Posted by JackieJ on October 30, 2000, at 8:12:53
In reply to Re: prozac withdrawl-for Ami » JackieJ, posted by Sunnely on October 29, 2000, at 18:59:21
> > To Ami and All:
> >
> > I have been on prozac for 5 years. I am currently taking 40 mg per day in addition to 400 mg of wellbutrin. My doctor just yesterday dropped my dose of prozac from 40 to 30 mg. In 2 more weeks I will go from 30 to 20, in another 2 weeks, down to 10, and in 2 more weeks, no more prozac. Then he will INCREASE my wellbutrin from 400 mg per day to 600 mg per day. (He told me that just recently it is safe to go as high as 600 mg whereas 400 mg USED to be the max. I'm very scared of withdrawal symptoms from prozac and increased intake of wellbutrin. I can NOT live the way I did without the prozac. However, I'm sick of the sexual side effects after 5 years. And I am sick of the weight gain! Any input from all is appreciated. Please respond to my email address as well in case I can't find this site again. JackieJeckyl@aol.com
>
> Hi JackieJ,
>
> Could you ask your doctor where he got the information (reference) that it is "safe" to go as high as 600 mg/day with Wellbutrin? Would you be kind enough to post it here? I will be concerned about going up to 600 mg/day of Wellbutrin as this puts you on a really high risk for seizures (even with the use of the sustained-release or SR formulation). Not only that the use of higher doses of Wellbutrin i.e., greater than 450 mg/day, puts one at higher risk for seizures, in your case, the combined use of Prozac + Wellbutrin raises that risk even higher.
>
> FYI, Wellbutrin (bupropion) and one of its active metabolites or daughter compounds (hydroxybupropion) are metabolized (broken down) by at least 3 liver enzymes namely CYP2B6, CYP3A4, and CYP2D6. More specifically, the parent compound (bupropion) is metabolized mainly by CYP2B6 and partly by CYP3A4, while the active metabolite (hydroxybupropion) is metabolized by CYP2D6. Prozac does not affect the action of CYP2B6 and modestly inhibits the action of CYP3A4. Therefore, it has a weak effect on the metabolism of the parent compound (bupropion). However, Prozac markedly inhibits the action of CYP2D6. Prozac's inhibiting action on this liver enzyme will then significantly inhibits the metabolism of the active metabolite (hydroxybupropion) causing an increase in its blood level. Since the metabolite, hydroxybupropion, has equal propensity to cause seizures as its parent compound, the rise in its blood level consequently raises one's risk for seizures. Even though your dose of Prozac is being gradually reduced, its inhibiting effect on the liver enzyme CYP2D6 will continue (although diminishing) for at least another 5-8 weeks after it is completely dicontinued. This is due to Prozac's very long half-life (the combined half-life of fluoxetine and norfluoxetine). I believe I read somewhere that the increase in blood level of hydroxybupropion can also cause a decrease in Wellbutrin's antidepressant effect. I am not certain about this, however.
>
> Withdrawal symptoms from Prozac (if they ever occur) are usually milder than the other SSRIs with shorter half-lives. As mentioned above, Prozac has a very long half-life which acts as a "protective" mechanism from the occurrence of withdrawal. This is not to say that withdrawal symptoms will never occur if Prozac is abruptly discontinued.
>
> The following is a general guideline to minimize the risk of seizures with the use of Wellbutrin as an antidepressant:
>
> 1. The dose should be carefully titrated (increased) to achieve the lowest effective dose.
>
> 2. Daily doses (if greater than 150 mg/day) are to be divided into at least every 6 to 8 hours interval.
>
> 3. The dose should not exceed 450 mg/day.
>
> 4. Any SINGLE dose should not exceed 150 mg.
>
> 5. The doses should not be given closer than every 6 hours.
>
> 6. Further dose increases should not occur any more frequently than every 3 days, and for no more than 100 mg.
>
> 7. Preferably, use the SR (Sustained Release) than the IR (Immediate Release) formulation.
>
> 8. The combined use of Wellbutrin (antidepressant) and Zyban (smoking cessation) is contraindicated. The generic name for both drugs is bupropion, manufactured by the same company.
>
> References:
>
> 1. Benefits of new sustained-release bupropion: less-frequent dosing, fewer side effects. In: Psychoparmacology Update, November 1997.
>
> 2. Preskorn SH: Bupropion. Journal of Psychiatric Practice, January 2000.
Hi Emanuella and SunnelyFrom what you two have responded back to me, thank you very much. Now I REALLY have serious conerns for increasing my wellbutrin to 600 mg. This increase will only be done after I am completely off of prozac for several weeks (according to my pdoc). I don't see him again for another week so I cannot ask him his particular source of information in which it is ok to go as high as 600 mg of wellbutrin SR. I am expecting a phone call from him however, and will ask then. I'll get back with y'all as soon as possible. Thanks again.
JackieJ
Posted by Sunnely on October 30, 2000, at 20:30:15
In reply to Re: prozac withdrawl-for Ami, posted by SLS on October 29, 2000, at 21:55:26
> I took part in one of the phase III investigations of Wellbutrin. I don't know if I was part of one of the dosage-finding type studies, but I had taken 900mg without any adverse reactions and almost no side effects. The only one I can remember was some mild disturbance of visual accomodation.
>
>
> - ScottHi Scott,
WOW! You must be one of the (few) lucky ones. So, how did you take it? I mean, was it 900 mg once a day, 450 mg twice a day, or 300 mg three times a day? Was the formulation used the "SR"? Did you know you were taking 900 mg per day during the clinical trial? Was this clinical trial done in the US or outside? Just curious.
Posted by Mary Beth on October 30, 2000, at 21:44:58
In reply to Re: prozac withdrawl-for Ami » SLS, posted by Sunnely on October 30, 2000, at 20:30:15
I have noticed and increase in feelings of failure the last week. I have been off prozac for about three weeks now. Is this a phase or is this what I should come to expect. I am ok part of the day but I notice that when an idea of mine is not accepted or someone appears to cut me down. I quickly feel a sense of failure, no one likes me, I am so stupid, I am an idiot. Does anyone have any suggestions, the whole exercising at 10:30 at night when I feel this way won't work. It may also have some realtionship to being tired, bedtime. Any advice?
Posted by SLS on October 31, 2000, at 18:10:36
In reply to Re: prozac withdrawl-for Ami » SLS, posted by Sunnely on October 30, 2000, at 20:30:15
Hi guys.
I took Wellbutrin in 1983 as open-label trial in the US. I don't know if that is technically considered a phase III trial, but that is the phase of investigation that Wellbutrin was in at that time.
Sunnely, are open-label administrations of an investigational drug still considered phase III?
Wellbutrin was dispensed as red 150mg tablets. I took two tablets (150mg) three times a day. The investigative physician was Baron Shopsin. He used to send me home with a letter envelope filled with red pills.
During this period of time, the dosage range being targeted by Burroughs Wellcome was between 300mg and 600mg. It was thought that 450mg would be the average effective dosage. Wellbutrin was supposed to be released for marketing later that year. However, a number of studies using bulimics yielded a significant number of seizures. This was probably due to the electrolytic imbalances that can occur in bulimia. The drug company decided not to release it at that point. If I recall correctly, it wasn't until 1990 until it became available.
I am not a good representative of the effects of stimulating or anxiogenic drugs. I sleep just fine taking 15mg of Dexedrine, regardless what time of day I take it. For some reason, Dr. Shopsin liked to tell me about the drugs he was working with. He was perhaps the first one to recognize that there was a reduced liability for Wellbutrin to induce mania. He thought that it might even afford some prophylaxis against mania. The guy really was brilliant. Anyway, he never mentioned a tendency for Wellbutrin to produce adverse reactions at the dosages he was working with. Wellbutrin produces a moderate exacerbation of my depression.
- Scott> > I took part in one of the phase III investigations of Wellbutrin. I don't know if I was part of one of the dosage-finding type studies, but I had taken 900mg without any adverse reactions and almost no side effects. The only one I can remember was some mild disturbance of visual accomodation.
> >
> >
> > - Scott
>
> Hi Scott,
>
> WOW! You must be one of the (few) lucky ones. So, how did you take it? I mean, was it 900 mg once a day, 450 mg twice a day, or 300 mg three times a day? Was the formulation used the "SR"? Did you know you were taking 900 mg per day during the clinical trial? Was this clinical trial done in the US or outside? Just curious.
Posted by R.Anne on October 31, 2000, at 22:01:06
In reply to prozac withdrawl and feelings of failure, posted by Mary Beth on October 30, 2000, at 21:44:58
>*****
> I have noticed and increase in feelings of failure the last week. I have been off prozac for about three weeks now. Is this a phase or is this what I should come to expect. I am ok part of the day but I notice that when an idea of mine is not accepted or someone appears to cut me down. I quickly feel a sense of failure, no one likes me, I am so stupid, I am an idiot. Does anyone have any suggestions, the whole exercising at 10:30 at night when I feel this way won't work. It may also have some realtionship to being tired, bedtime. Any advice?
***Marybeth,
I experience myself doing the same thing and what helps for me is to initiate a dialogue with myself. When I call myself a name or a failure, I talk back to myself and say "no, I'm not" and then I tell myself not to talk to myself that way because it doesn't help my mental state. Then I try to look for good things about myself, look in the mirror and smile at myself and tell myself good things. You could try telling yourself of your successes in life and the good you've done. Something like affirmations. This helps me a lot! Hope it will help you. Remember, you are not a failure or stupid-you're a wonderful person!
Posted by S. Howard on November 1, 2000, at 17:35:24
In reply to prozac withdrawl and feelings of failure, posted by Mary Beth on October 30, 2000, at 21:44:58
>
> I have noticed and increase in feelings of failure the last week. I have been off prozac for about three weeks now. Is this a phase or is this what I should come to expect. I am ok part of the day but I notice that when an idea of mine is not accepted or someone appears to cut me down. I quickly feel a sense of failure, no one likes me, I am so stupid, I am an idiot. Does anyone have any suggestions, the whole exercising at 10:30 at night when I feel this way won't work. It may also have some realtionship to being tired, bedtime. Any advice?Maybe it's paxil time. Your self-esteem seems really unsteady and I can relate. If you're determined to stay away from medication (or not), I recommend the best self-help book I've ever read- "How to Stop Worrying and Start Living" by Dale Carnigie. It's a classic because it works.
Occasionally I re-read it to put my life back in perspective.
My second suggestion is to do something that changes your life so completely, you don't have time to focus on your misery. In my late teens, I was consumed by depression and anger. I was so combative and destructive that my parents threw me out. Not having anywhere to go, I joined the Army and left for basic training almost immediately (if I wasn't a good daughter, at least I was a recruiter's dream). Voila - all the earth-shaking problems I'd been having with my parents, my friends, my boyfriend, my school, my life - became trivial in the terrible heat at Fort Jackson, South Carolina. I was not athletic, I had never made my bed, I wasn't good at following orders and I didn't care for guns. Sorry...weapons. It was the hardest thing I've ever done, particularly since I was singled out for my "attitude", but I graduated with my company. My parents didn't attend the ceremony and I didn't expect them to, although they could have easily afforded the plane trip. Just the same I was really proud of myself, maybe for the first time in my life. I was a different person.I'm not suggesting that you join the Army (join the Air Force if you must), I'm simply giving an example of a drastic life change. You don't have to be especially young to do this. My husband went through the Fire Academy in his mid-30s and although he endured some teasing about being the "old man", he now loves his job. His previous job was torture for him and he was so unhappy, it was hard to be around him. He's a different person.
Good luck with your search - SGH
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