![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by Hattree on May 1, 2003, at 9:43:02
On paper, Wellbutrin sounds like a great drug for me. In reality, on the first of second day taking it I plunge into a funk.
I ask this question from time to time about Wellbutrin or any AD--has anyone had the experience of a medication causing worse depression in the first few days, but ultimately working well?
Most people seem to say that if it starts out bad depression-wise, it stays bad. But since so many side-effects are transient, I wonder if this initial plunge could be as well.
Posted by SLS on May 1, 2003, at 11:59:41
In reply to initial depression on wellbutrin, others?, posted by Hattree on May 1, 2003, at 9:43:02
> On paper, Wellbutrin sounds like a great drug for me. In reality, on the first of second day taking it I plunge into a funk.
Hi.In the past, Wellbutrin has made my depression worse and very dysphoric. This effect did not diminish over time, even at 900mg. Nevertheless, I would not want to generalize my experience to yours. I hope everything works out for you.
- Scott
Posted by Ritch on May 1, 2003, at 13:28:55
In reply to initial depression on wellbutrin, others?, posted by Hattree on May 1, 2003, at 9:43:02
> On paper, Wellbutrin sounds like a great drug for me. In reality, on the first of second day taking it I plunge into a funk.
>
> I ask this question from time to time about Wellbutrin or any AD--has anyone had the experience of a medication causing worse depression in the first few days, but ultimately working well?
>
> Most people seem to say that if it starts out bad depression-wise, it stays bad. But since so many side-effects are transient, I wonder if this initial plunge could be as well.As far as my experience with AD's goes-SSRI's generally always had an immediate positive effect. Wellbutrin was just the opposite for me. I could start it and feel MUCH better for about a week or two and then start feeling agitated and crappy (probably related to cumulative sleep-deprivation). Never tried MAOI's. TCA's, however were like how you describe. They would make me feel crummy for about ten days or so and then my mind would quickly get brighter and sharper after the initial period. Remeron made me feel crummy from the onset and it never got any better, though.
Posted by Jack Smith on May 1, 2003, at 16:23:02
In reply to Re: initial depression on wellbutrin, others?, posted by SLS on May 1, 2003, at 11:59:41
> This effect did not diminish over time, even at 900mg.
Holy Sh**! I have never heard of such a high dose of WB--isn't there like a 10% seizure risk at that dose? DId you have a seizure? Scott, you always have interesting stories, if nothing else.
By the way, no one has ever been able to explain how WB works. THe one thing I do know is that above 600mg it becomes a significant dopamine reuptake inhibitor. Is that why you were going so high?
JACK
Posted by Snoozy on May 1, 2003, at 17:05:24
In reply to 900 mg of Wellbutrin!?! » SLS, posted by Jack Smith on May 1, 2003, at 16:23:02
Scott -
I'm with Jack on this one - 900mg? Whoa!
Did you work up to that dose? And what happened to you at that level?
I've been on 400mg for about 2 years and I have wished I could take more, but I've never heard of anyone taking 900mg. It was my understanding 400 was the upper limit.
Could you please enlighten us as to your experience?
Thanks!
> > This effect did not diminish over time, even at 900mg.
>
> Holy Sh**! I have never heard of such a high dose of WB--isn't there like a 10% seizure risk at that dose? DId you have a seizure? Scott, you always have interesting stories, if nothing else.
>
> By the way, no one has ever been able to explain how WB works. THe one thing I do know is that above 600mg it becomes a significant dopamine reuptake inhibitor. Is that why you were going so high?
>
> JACK
Posted by SLS on May 1, 2003, at 22:13:49
In reply to 900 mg of Wellbutrin!?! » SLS, posted by Jack Smith on May 1, 2003, at 16:23:02
> Holy Sh**! I have never heard of such a high dose of WB
Hi Jack.I participated in an open-label trial of Wellbutrin in 1983. I believe they were still doing dose-response studies, and hadn't yet arrived at an effective dosage range. Currently, I believe dosages higher than 450mg are considered to be associated with an increased risk of seizure. I think the seizure thing is a bit exaggerated when it comes to Wellbutrin. It didn't become an issue until the manufacturer decided to test it on bulemics. Electrolytes are often out of balance in bulemics such that it leaves them at increased risk of seizure. Had this particular study not been performed, it is likely that Wellbutrin would not have been considered any more liable to induce seizures than the tricyclics.
Depression sucks.
- Scott
Posted by Caleb462 on May 2, 2003, at 0:03:55
In reply to 900 mg of Wellbutrin!?! » SLS, posted by Jack Smith on May 1, 2003, at 16:23:02
It has been discovered how Wellbutrin works, actually, though it isn't well known. Some researcher did a study on it - I can't remember the link though.
Anyway... bupropion's (wellbutrin) strongest pharmacological action is that of a dopamine reuptake inhibitor. It also inhibits serotonin and norepinephrine reuptake, to a lesser degree. However, even it's dopamine action is very weak - even weaker than that of Zoloft. However - bupropion has several active metabolites that are also dopamine (and I guess norepinephrine/serotonin) reuptake inhibitors. Initially, the amounts of these metabolites in the body are very small - and thus have little effect. However, the blood levels of these metabolites continue to rise over a period of a few weeks, and in time, the blood levels of bupropion and it's metabolites are high enough that a strong inhibitory effect on the dopamine reuptake site is achieved. This is why Wellbutrin has a typical anti-depressant waiting period until full AD effects are felt.
Posted by jemma on May 2, 2003, at 11:35:52
In reply to initial depression on wellbutrin, others?, posted by Hattree on May 1, 2003, at 9:43:02
You could try adding 100 mg of modafinil to your wellbutrin. Wellbutrin did nothing for me when I tried it the first time, but with the modafinil it worked beautifully.
- jemma
Posted by BekkaH on May 3, 2003, at 11:53:57
In reply to Jack - Re: How wellbutrin works, posted by Caleb462 on May 2, 2003, at 0:03:55
> It has been discovered how Wellbutrin works, actually, though it isn't well known. Some researcher did a study on it - I can't remember the link though.
>Hello Caleb. If you do happen to remember the link for that research, I'd be interested to see it. Thanks!
Posted by BekkaH on May 3, 2003, at 12:20:38
In reply to initial depression on wellbutrin, others?, posted by Hattree on May 1, 2003, at 9:43:02
> > I ask this question from time to time about Wellbutrin or any AD--has anyone had the experience of a medication causing worse depression in the first few days, but ultimately working well?
************************************************
Hi Hattree. I haven't been keeping up on this board as much as I used to, so I can't remember whether you just got off of a stimulant, before starting on Wellbutrin. Remember that withdrawing from a stimulant can cause depression by itself, regardless of what medication you do or do not switch to. When you're used to stimulants, especially if you've been on them a long time, it is very difficult to keep in mind that antidepressants just don't "kick in" as fast as stimulants. Wellbutrin, Strattera and all the other AD's don't provide the immediate or nearly-immediate gratification that dexedrine, adderall or methylphenidate are known for. Although most AD's have some immediate effects, the full effects are not seen for weeks. I do think that at the outset, Wellbutrin, in particular, can worsen depression in some people. I think that might be because, unlike so many other AD's, it is activating. When you're still depressed and/or withdrawing from stimulants, that activation can be more like irritation and agitation in susceptible people. For example, if something is bothering you before you start on WB, then initially Wellbutrin might intensify those feelings. For many, Wellbutrin is NOT calming, and it may exacerbate pre-existing anxiety. Also, if Wellbutrin is interfering with your sleep, that can make you feel more depressed. Unless it is absolutely unbearable, I think you just have to wait a few more weeks to know for sure.
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.