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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by Thereishope on February 26, 2004, at 19:03:21
Can anyone share there experience in weaning off Wellbutrin? What are the withdrawal effects? What's the best way to wean?
I went from 300mg. XL to 150mg. XL without any problems. Went from 150mg. XL, after about a month, to 75mg. SR an old anxiety symptoms appeared.
Any suggestions would be appreciated.
Posted by Chairman_MAO on February 27, 2004, at 13:38:06
In reply to Wellbutrin Withdrawal, posted by Thereishope on February 26, 2004, at 19:03:21
There is no withdrawl from Wellbutrin. This is simply your returning to your pre-bupropion state.
Posted by Althea8869 on February 27, 2004, at 19:19:53
In reply to Re: Wellbutrin Withdrawal » Thereishope, posted by Chairman_MAO on February 27, 2004, at 13:38:06
'There is no withdrawl from Wellbutrin.'
Is this fact or speculation. Just curious as I am at 300mg for ~1 month now, without response(or @150mg) and if there is no withdrawl, should I bother tapering or just stop all together?
Thanks in advance.
Posted by Thereishope on February 27, 2004, at 20:01:35
In reply to Re: Wellbutrin Withdrawal, posted by Althea8869 on February 27, 2004, at 19:19:53
After dropping from 150mg. to 75mg. I began feeling the anxiety and depression by the third day.
My pdoc wants me to remain at 150mg. and to wean extreeeeeeeemly slowly. I had decreased my dosage despite her protest. Hmmm...I won't be too quick to do that again! After what I've experienced the last couple of days I think that it will be awhile before I even attempt to come wean off Wellbutrin.
A good friend who has used Wellbutrin SR on and off for the last 7 years states that she has always experienced withdrawal symptoms. She said that they were nothing like the SSRI withdrawl, but still withdrawal.
We're all so different, but this has just been my own experience.
> 'There is no withdrawl from Wellbutrin.'
> Is this fact or speculation. Just curious as I am at 300mg for ~1 month now, without response(or @150mg) and if there is no withdrawl, should I bother tapering or just stop all together?
> Thanks in advance.
Posted by Althea8869 on February 27, 2004, at 20:09:40
In reply to Re: Wellbutrin Withdrawal » Althea8869, posted by Thereishope on February 27, 2004, at 20:01:35
Thanks for the info. I'll choose the safe route and taper - probably reasonably quickly as ive only been taking it for 2 months.
Posted by Chairman_MAO on February 29, 2004, at 9:41:17
In reply to Re: Wellbutrin Withdrawal, posted by Althea8869 on February 27, 2004, at 19:19:53
By "withdrawal", I meant a "withdrawal syndrome", i.e. a clearly identifiable cluster of symptoms that was not present before the bupropion and happens in nearly everyone that stops taking it without tapering. That said, ANY chronically administered substance will cause _some_ changes in the body, including vitamins, water, sugar, etc. We are beings in a constant state of flux. To expect to chronically administer a psychoactive drug and not expect to notice its withdrawal at all when it's removed is illogical. I expect people to think that it's logical these days with doctors, drug companies, and the media feeding people bald-faced lies concerning the nature of physical dependence, namely that only drugs that make you high cause habituation/dependence. Antidepressants are simply psychoactive drugs like all other psychoactive drugs when you understand them even a little bit; they're not correcting any sort of "imbalance". This assertion is bolstered by studies that show successful talk therapy producing the same changes on PET scans as successful antidepressant treatment outcomes. The change is the RESULT of feeling better, not the cause. More philosophically, one might argue that cause and effect here is moot, since we have no concrete idea how the brain produces consciousness in any way ...
"What goes up, must come down". This is especially true with antidepressants, all of which purportedly work after inducing physical, adaptive neurological CHANGES that take place over the course of several weeks.
It's reasonable to expect to feel "out of sorts" upon the withdrawal of bupropion--to some degree. However, the "withdrawal syndrome" of bupropion is milder than just about anything I can think of, including caffeine and certainly SSRIs, which are worse than opiates. Keep in mind, also, that "ye seek, and ye shall find." With all of the talk of withdrawal reactions on this message board, you may be prone to detect one where none exists.
Ayn Rand took three Dexamyl Spansules (dextroamphetamine+amobarbital extended release capsules) per day. When her doctor told her to stop, she stopped, no problem. This is undoubtedly true for scores of people who used these supposedly "addictive" or "habit forming" products moderately. I am NOT asserting that this is true for all people who used them moderately, of course, and this is especially not true for the benzodiazepines. Then again, the SSRIs precipitate horrid withdrawal reactions in most people who cease them.
Perhaps withdrawal reactions are more a physiological expression of sudden, intense psychological pain than simply the lack of a drug ...
Posted by Althea8869 on February 29, 2004, at 10:48:59
In reply to Re: Wellbutrin Withdrawal » Althea8869, posted by Chairman_MAO on February 29, 2004, at 9:41:17
Chairman, I saw the same(similar) study results -ie on the comparison of psychotherapy vs. psychopharmacology and similarity in the PET scans of the brains of the patients. As I recall the AD they used was Serzone. I cant remember, but I'm not they were able to duplicate these results with other AD's. Needless to say, the best chances for remission occur with a combination of the two, that much we do know.
One of the most fascinating studies I ever read on the brain was a test to determine the efficacy of a new cancer drug. In it patients were either given this new drug or a placebo - all were told that the likelihood of hairloss with this med was very high. When the study was complete all but one of the patients given the med lost their hair, but the amazing thing was that 40-50% of those taking a placebo also lost their hair - only because they thought they were going to. Its a very powerful statement about either positive or negative thinking and their physiological consequences.
Anyway, as I mentioned in an earlier post, im going to err on the side of safety and taper, although given my short duration on this med, I will probably try to titrate down to zero in just over a week. If for no other reason than because I want to see if I will respond to a tricyclic. I've never responded to anything but effexor and I cant go back on that, so im going to push for clomipramine or Desipramine.
Thanks for the interesting tidbit on Rand, appreciate the trivia.
All the best.
Posted by Thereishope on February 29, 2004, at 15:22:50
In reply to Re: Wellbutrin Withdrawal » Chairman_MAO, posted by Althea8869 on February 29, 2004, at 10:48:59
>so im going to push for clomipramine or Desipramine.
Hello Althea. May I ask why you are chosing clomipramine or desipramine? I'm going to discuss switching to a tricyclic with my doctor on Friday. My choses are desipramine or pamelor. My first choice is desipramine because after research I've found that it is less likely to cause weight gain. I need something for the panic disorder which triggers the depression, then the ocd, although more "c" than "o" in my case.I've been dealing with that spacey unreal feeling that comes from anxiety since my panic attacks in 2002. It has been improved since starting on Wellbutrin, but lately I've suspected that the Wellbutrin XL might be the cause of my lightheaded spacey feeling, so I'm hoping to see some improvement by first switching to the SR. If this doesn't work the tricyclics are my next option.
Thanks for the information!
Posted by Althea8869 on February 29, 2004, at 18:15:06
In reply to Re: Wellbutrin Withdrawal » Althea8869, posted by Thereishope on February 29, 2004, at 15:22:50
The decision to choose clomipramine actually comes from a series of studies that show it to be far more effective than SSRI's in treating depression/dysthymia with melancholia/anhedonia.
Desipramine or Nortriptyline would be my second choices. These three seem to have the best side effect to efficacy ratios of the TCA's. I simply chose clomipramine because that was the one most of the studies chose to use. I still need to do some more research.Regarding your 'spaciness', im no doctor, but i'd probably put the wellbutrin at the top of the suspect list. Need to keep in mind, that of all the AD's out there, this is the one that has the medical community stumped it terms of how it works. I dont see many clinical studies with Wellbutrin in them, and I think its for precisely that reason. Ive been real lucky with side effects, other than some dry mouth for the first week, I havent noticed anything. We'll see what happens when I start tapering tomorrow.
Regarding your panic attacks, and I've had plenty - the real nasty ones too-, I dont know why you wouldnt just go with klonopin and use an AD as an AD. This stuff is an allstar. Most people can control anxiety/panic with as little as .5mg a day (once its had time to reach a 'true' steady state plasma concentration). Many criticize the use of klonopin, but I'll tell you what, I've had one panic attack in the last five years and I've never gone above .5mg/day and been as low as .25mg for more than a year. I think stories of getting off this stuff are a bit exaggerated. Though they may be taking much higher doses. Each time ive stopped for more than a few weeks, ive noticed some moderate withdrawl symptoms for the first 24-48 hours. After that, very minor.
I wish you the best of luck with whatever you try. Let me know which TCA you go with and how its working.
Take care.
Posted by Thereishope on February 29, 2004, at 21:56:21
In reply to Re: Wellbutrin Withdrawal » Thereishope, posted by Althea8869 on February 29, 2004, at 18:15:06
Thanks so much for this information.
I've tried Klonopin for months and I didn't experience any withdrawal when I stopped. Klonopin is good, but it made me depressed. I thought this was unusual until I read a couple of posts on this site stating the same. I've read that after awhile this would have subsided. It probably would have if I had been prescribed the correct AD.
Please keep me posted on your success with clomipramine, an I'll do the same!
> The decision to choose clomipramine actually comes from a series of studies that show it to be far more effective than SSRI's in treating depression/dysthymia with melancholia/anhedonia.
> Desipramine or Nortriptyline would be my second choices. These three seem to have the best side effect to efficacy ratios of the TCA's. I simply chose clomipramine because that was the one most of the studies chose to use. I still need to do some more research.
>
> Regarding your 'spaciness', im no doctor, but i'd probably put the wellbutrin at the top of the suspect list. Need to keep in mind, that of all the AD's out there, this is the one that has the medical community stumped it terms of how it works. I dont see many clinical studies with Wellbutrin in them, and I think its for precisely that reason. Ive been real lucky with side effects, other than some dry mouth for the first week, I havent noticed anything. We'll see what happens when I start tapering tomorrow.
>
> Regarding your panic attacks, and I've had plenty - the real nasty ones too-, I dont know why you wouldnt just go with klonopin and use an AD as an AD. This stuff is an allstar. Most people can control anxiety/panic with as little as .5mg a day (once its had time to reach a 'true' steady state plasma concentration). Many criticize the use of klonopin, but I'll tell you what, I've had one panic attack in the last five years and I've never gone above .5mg/day and been as low as .25mg for more than a year. I think stories of getting off this stuff are a bit exaggerated. Though they may be taking much higher doses. Each time ive stopped for more than a few weeks, ive noticed some moderate withdrawl symptoms for the first 24-48 hours. After that, very minor.
>
> I wish you the best of luck with whatever you try. Let me know which TCA you go with and how its working.
>
> Take care.
>
>
Posted by Althea8869 on February 29, 2004, at 22:50:26
In reply to Re: Wellbutrin Withdrawal » Althea8869, posted by Thereishope on February 29, 2004, at 21:56:21
Thereishope - happy if i helped. Youre right about klonopin, in the begininning it can cause mild depression. Thats seen a lot with anti-anxiety meds. Im at .25mg/day right now - been at this dose for 7-8 months. I think my body has adjusted to it, so I dont believe its directly responsible for the pit i've been stuck in. Oh for want of a miracle.
Anyway - you chose your screenname well. I believe there is. I'll post on how things go.
Take care...
Posted by Questionmark on March 3, 2004, at 10:01:22
In reply to Re: Wellbutrin Withdrawal » Chairman_MAO, posted by Althea8869 on February 29, 2004, at 10:48:59
Chairman, great points. Such a good point about the "bald-faced" b.s. from media, pharm companies, and doctors about physical dependence. So freaking true. And really good point regarding the PET scans and what they were supposed to show.
That's neat that Wellbutrin has such a mild withdrawal reaction. That makes sense though considering i've never heard or even read about anyone complaining about it.
It was also interesting to see you write that SSRI withdrawal is worse than that of opiates. i've been wondering about that a long time (since Paxil withdrawal was a never-ending nightmare, more or less, and i've never experience opiate w/drawal). i definitely believe it though (esp also since SSRIs exert their effects round the clock pretty much as opposed to the 4 or so hours of opiates). Knowing that infuriates me to think of how the SSRIs have become the freaking gold standard of antidepressant (and even antianxiety [?]) medication, and how everyone including doctors think they're so dam* safe and bad-side-effect free, and such an improvement to the drugs of old, and so on. Ridiculous. i wonder how many people have to try other SSRIs after having a definitely inadequate first trial of SSRI, before being able to try something else-- let alone a TCA or , God forbid, an MAOI. Ah it makes me sick.
Oh there never seems to be any consensus on this, but also, which do you think generally result in a worse withdrawal syndrome: benzodiazepines or SSRIs? (This includes variety and severity of withdrawal symptoms, as well as duration of withdrawal).Althea, the study you mentioned about the cancer drug, placebo, and hair loss is amazing. It's so weird though. i always feel that i could never be thAT susceptible to a placebo effect. For instance, it always used to tick me off so much when my one pdoc would just say or insinuate that certain effects from some drug i was on were basically just in my head, so to speak. And i'm so sure that i would easily be able to determine which drug i was taking (of those that i've taken) if given some kind of blind test (not within classes though, except Nardil vs. Parnate [MAOIs]). And yet this kind of strong placebo effect has been substantiated in a number of, if not many studies. So... i don't know, i'm not sure what i'm asking. It's just strange.
Oh and that was interesting about Ayn Rand.
Posted by zeugma on March 3, 2004, at 18:59:46
In reply to Some thoughts, posted by Questionmark on March 3, 2004, at 10:01:22
>Knowing that infuriates me to think of how the SSRIs have become the freaking gold standard of antidepressant (and even antianxiety [?]) medication, and how everyone including doctors think they're so dam* safe and bad-side-effect free, and such an improvement to the drugs of old, and so on. Ridiculous. i wonder how many people have to try other SSRIs after having a definitely inadequate first trial of SSRI, before being able to try something else-- let alone a TCA or , God forbid, an MAOI. Ah it makes me sick.>
Makes me sick too. I remember how doctors would confidently tell me how "you wouldn't believe how good the medications we have now are," etcetera etcetera. After a couple of disatrous trials, what I couldn't believe was how far treatment standards seemed to have regressed. The roots of the illusion, I think, are twofold:
1) the illusion of specificity, 'rational design,' whatever. That somehow SSRI's targeted only the system that was causing the depression and left the other systems alone (I'm paraphrasing loosely but you know what I mean). This illusion is hubristic because we know barely anything about the normal brain, much less the depressed one (and I am almost sure that depressions are heterogeneous and not a natural kind).
2) the illusion that because a treatment has a wide 'therapeutic index,' then you can afford to be cavalier with what you do with it. Since you can't OD on an SSRI a doctor could diagnose 'depression' in less time than it takes to write a script. And since the treatment was so 'safe', then ANY effects the drug had on people could be taken less seriously. I mean, prescribing someone a TCA or MAOI is serious business. A narrow 'therapeutic index' means that the treatment had better be therapeutic, since the consequences of ineffective treatment are greater, in prescribers' minds. And there is a subliminal transition from 'safe' to effective' in doctors' minds, a transition encouraged by the illusion of specificity in 1).
Posted by Althea8869 on March 3, 2004, at 19:01:11
In reply to Some thoughts, posted by Questionmark on March 3, 2004, at 10:01:22
It really is an amazing thing isnt it? The absolute power the mind can have over the body. You are right, incidentally, there have been other studies where similar results were seen by those taking a placebo. Another one I read about involves a medication that had a very high probability of causing a rash around nose/face, similar to lupus. And patients were told that if they saw this rash that they should immediately cease the medication. Once again, something like 40% of the placebo takers got this exact rash. Its quite amazing.
Its also one of the most compelling reasons behind the American Psychiatric Assoc's statement that psychotherapy ALONE is more efficacious in the treatment of almost all forms of depression than ANY medication(s) alone. And further that long term remission rates are far higher for psychotherapy treated patients than for patients treated with medication alone. Interestingly, they have just as much clinical data(if not more) to support their statements as pharm's have supporting their drugs.
Most psych's agree, however, that the best long term success rates are achieved by a combination of medication and a particular psychotherapy treatment suited to your situation. Cognitive Behavioral Therapy, for example, seems to be broadly efficacious for some forms of depression.
Anyway - yeah! Its interesting stuff. It seems like there must be a way of combining the two on a purer basis. Who knows.
This is the end of the thread.
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