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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by jacquie on March 27, 2001, at 19:35:16
Hi Cam,
I hope you are well and it is nice to see you
back on the board. I wondered for some time
where you went to and am glad you are back.
I was wondering if you knew of any success stories
of people only on small doses of Wellbutrin, i.e.
150mg per day versus 300mg. I have often wondered
that therapeutic dose does not apply to me (300mg) and
I am going to visit the shrink in a few weeks and talk
again about Wellbutrin. I had some good effects and some
horrid ones and we just couldn't seem to get the dose
up there without my having major struggles (couldn't
think straight, sleep, was a mess really) So, I guess my
question is whether or not 150 is enough for a decent result
and also have you heard of it augmented with a touch of
celexa or such, like 5mg? Given that Wellbutrin does
nothing for serotonin. Gosh, I hope I have made some sense.
What is therapeutic dose based on? And last , but not least do
you have any thoughts on these nootropic drugs? I have
tried Adrafanil, or Olmifon, but it seems to fade away
within 2 weeks and you have to keep increasing it. Maybe
I have tough receptors, but nothing seems to combat the
depression and the periodic ADD. Any help is always
appreciated.
Be well,
Jacquie
Posted by Cam W. on March 27, 2001, at 20:56:31
In reply to Wellbutrin....message for CAM, posted by jacquie on March 27, 2001, at 19:35:16
Jacquie - Thanks for the welcome back.
Wellbutrin SR has a half-life of about 21 hours. This may give you adequate antidepressant blood levels, but the manufacturer says that the Wellbutrin SR should be taken twice daily. The SR version does come in a 100mg strength and I have seen people successfully take Wellbutrin SR 100mg twice daily. This may be enough to give you adequate antidepressant and anti-ADD activity. The doses need to be taken at least 8 hours apart. You could take 100mg when you first get up in the morning, or if you don't get up until later in the day, you could set your alarm for 6am, take your dose and go back to sleep. The next dose could be taken at 3pm or 4pm and this should not cause insomnia. I use to take 150mg at 5am and my next dose at 3pm (sometimes 4pm, but never later) and I had no problems with falling asleep at bedtime.
Even though 150mg of Wellbutrin SR once daily may give you adequate antidepressant blood levels, a twice daily dosing would give you a better steady state level of the drug. The people that I have seen take 150mg once daily and augmenting it with an SSRI didn't seem to have that great of antidepressant protection (but these people were treatment resistant to begin with).
If 100mg of the SR twice daily does not give you good enough antidepressant effect, your doctor could try adding a small dose of Celexa. This might help, but I still think that a twice daily dosing of Wellbutrin SR is needed. This can work for both the ADD and depression
As for the Adrafranil or Olmifon, I do not know anything about these drugs, so I could not give you any advice that I'd be comfortable with. They are not available in Canada and I haven't done much reading on them.
Ask your doc about 100mg of Wellbutrin SR twice daily, with the second dose at 3pm or 4pm and the first dose early in the morning. You should be able to tolerate this regimen and it can be augmented with a small dose of an SSRI if need be.
Let me know what your doc thinks about this. Some people can get away with less than 300mg per day.
I hope that this is of some help. - Cam
Posted by jacquie on March 28, 2001, at 6:01:41
In reply to Re: Wellbutrin....message for CAM » jacquie, posted by Cam W. on March 27, 2001, at 20:56:31
Hi Cam,
Thanks very much for your advice. I forgot about the
100mg SR and have taken those and stopped because
of the irritability factor ( I did not give it time)
I keep trying Wellbutrin because it doesn't seem to
have alot of strange side affects, although the last time it
did.You used to take Wellbutrin didn't you? I like the
motivation it gives and also the sense of focus, but i
get this at a small dose, when it is increased I
start getting the reverse.Enough said. Thank you for all your help and you are always
so helpful and welcome back again.Best,
Jacquie
Posted by Cam W. on March 28, 2001, at 6:43:01
In reply to Re: Wellbutrin....message for CAM, posted by jacquie on March 28, 2001, at 6:01:41
Jacquie - One of the start-up side effects of Wellbutrin is that sense of well being. This fades as your neurotransmitter and receptor mix "normalize". What I felt was that I was depression-free. I did go through a 2 week period where I was irritable at the drop of a hat and looked to find people to yell at in traffic. This passed after a couple weeks.
Again, for full antidepressant effect, with any antidepressant, takes 12 weeks or more. One should notice some symptom alleviation by 4 weeks (actually others around you notice this first) and should be more or less euthymic by 8 weeks. The antidepressant effect sometimes keeps adding to beyond 12 weeks.
For most people, euthymia is the goal. To get to a place where you can function and contribute to society and have a little fun. Focus snd acuity come from practice. Studying and learning new thinks will bring back your focus much better than a pill. The reversal that you experienced at higher doses were probably start-up side effects (which occur at dose increases, as well) and should go away in a week or two.
Hope this helps - Cam.
Posted by jacquie on March 28, 2001, at 12:34:10
In reply to Re: Wellbutrin....message for CAM » jacquie, posted by Cam W. on March 28, 2001, at 6:43:01
Hi Cam,
Your advice always helps. Thank you.I did feel great on the start up with Wellbutrin
and irritability is a mild term for what i felt...
I never felt depressed, however, while on it and it
kept me from an interest in smoking as well. This
was at a very low dose 100mg. Then we started to increase
and the sleep problem started again. Klonopin did
nothing, trazadone - nothing, we tried and tried.
Finally I got off Wellbutrin, but depression returned,
as did smoking and low motivation.I would concur that focus would be better solved by
learning. You are very right, but I find myself
really struggling sometimes to understand people,
almost as if there is a real barrier in the logic area
for me. I get frustrated when things get too technical
or difficult and then I give up. It has gotten
worse as I have gotten older (the big 40 in another month)
and maybe it is the Klonopin. I have been on it for
a whole year now and I wonder if it is time to
reconsider its value. It helps my anxiety and my sleep
problems, but maybe it is contributing to this other
problem.I know so many people who take Wellbutrin at 300mg
per day and do great! I am so jealous that they can
take it and not get what I got, hand tremor, shortness
of breath, insomnia, couldn't focus my mind, and was
forgetful, I guess my concern is always will these
side effects subside or am I stuck with hand tremors
and memory problems indefinately. I tried Celexa and
really liked it (3 months I tried it, fairly fair shot
at it) but bad insomnia and then bruising ..low platelets
so I got off it immed., pronto per doc as I was getting the
rare side effects.So I am struggling to find the best one for me and
research like crazy, but have found nothing yet
that might be the one. I have tried the Adrafanil and it works
for awhile, but it seems to wear off, or maybe I am
adjusting, so now I am looking at Modafinil or Provigil (sp)
along with thoughts of grin and bear it with wellbutrin and see if
it wears off (the bad side effects).I hope the shrink can help me figure this out. There
must be people like me who are hypersensitive to drugs.
Even 10mg of Celexa the first night gave me night
sweats. It's crazy, but then I feel a little loo-loo
after awhile I can assure you.Well, there's more of my banter!
You've been a great help, Cam. You have a gift and you
use it well. Thanks.
Best,
Jacquie
Posted by terra miller on April 1, 2001, at 17:44:37
In reply to Re: Wellbutrin....message for CAM » jacquie, posted by Cam W. on March 27, 2001, at 20:56:31
please forgive me for jumping into your conversation.
cam, you mentioned the SR version being out at 21 hours. do you know what the rate is for the immediate release version?
specific issue: taking 75mg immediate release, 3 times a day (7am, 1pm, 6pm... roughly) i need to take at about 5 hours. thing is, this means i go all night without one until 7am again. sometimes i wake up at 5am and take it!, but then that pushes it all back blablabla. i wake up and feel chemically needy and spend the morning adjusting back. rest of the day doing well.
thoughts?
thanks for letting me barge in. again, my apologies. thanks for any thoughts of help you could give.
terra
Posted by Cam W. on April 1, 2001, at 20:29:24
In reply to Re: Wellbutrin....message for CAM » Cam W., posted by terra miller on April 1, 2001, at 17:44:37
Terra - Actually, we don't have the regular Wellbutrin in Canada, so I am not actually sure what the half-life is (ie I have no books telling me this). Other from the U.S. may have this at their fingertips, but I don't. I believe that the regular Wellbutrin needs to be taken 3 times daily, so I would guess that, on average, the half-life would be 8 to 10 hours (just a guess).
Once you have adjusted to the dose you are on (ie 2 or 3 months of taking the drug), you could try slowing adjusting your nighttime dose closer to bedtime. You could try taking it 1/2 an hour later for 3 or 4 nights and keep doing this as long as you have no problem falling asleep. This may stop some of the morning low blood levels. If at any point you have problems sleeping, bump the dose back that 1/2 hour and try again in a few days.
The other option is to switch to the Wellbutrin SR version. You should be able to switch from the regular to the long acting without any washout. You can just switch from the regular (75mg 3 times daily) one day to the SR (150mg twice daily) the next. The only problem here is that you are going from a total daily dose of 225mg to 300mg. This may or may not be a problem, but the SR version may give you more adequate and sustained blood levels than the regular version. This is something to discuss with your doc. Tell him/her that you are not being covered for the full 24 hours with the regular version and see what the doc has to say.
Hope this is of some help - Cam
This is the end of the thread.
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