![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 114. This is the beginning of the thread.
Posted by islandangel on March 19, 2005, at 22:29:23
I've been on Wellbutrin XL for 4 months or so now. I was taking very low dose of Elavil (amitryptaline)at night for poor sleep (10mg). I've taken low dose Elavil for about 4 years. However I thought the Wellbutrin XL may be enhancing the Elavil's sedative effect so I cut Elavil to 5mg at night. STILL got sleepy during the day after taking Wellbutrin XL so I stopped the Elavil completely. I was hoping I'd notice more energy from the Wellbutrin XL. I take it in the morning and within several hours I'm so tired I could put my head in my lap! Aside from being so tired on Wellbutrin XL it does help improve my mood and racing thoughts, I also deal better with stress. Some friends have told me Wellbutrin SR may work better for me. Think I should try SR instead of XL? I'd like to know if anyone else has this exhausted tired effect from Wellbutrin XL? I had GREAT energy from the XL the first 2 weeks I took it and after that I've been nothing but TIRED. Thanks for any input.
Posted by alivekickin on March 30, 2005, at 12:25:08
In reply to Anyone TIRED on Wellbutrin XL?, posted by islandangel on March 19, 2005, at 22:29:23
I wrote a huge message and I think I lost it. I will write again, but yes yes yes! I am exhausted on Wellbutrin XL. Pay attention to this. My therepist has seen clinical evidence of sleep problems with XL--specifically not getting deep REM sleep. She has seem improvement in patients who changed to Wellbutrin SR, as long as they took the dose or 2nd dose by late afternoon so that when it wears off in 8 or so hours when you are asleep--you have the chance to really sleep.
Posted by islandangel on March 30, 2005, at 14:18:18
In reply to Re: Anyone TIRED on Wellbutrin XL? » islandangel, posted by alivekickin on March 30, 2005, at 12:25:08
Hi: I'm really glad you mentioned this and wrote back. I decided to cut out the very low dose Elavil (amitryptaline) at night because I thought the Wellbutrin XL was enhancing or more than doubling the effects of the Elavil. SO... I'm STILL tired on XL! I take it first thing in the morning and by about 7:00pm at night I could just fall asleep standing up just about. This isn't like me. I usually don't go to sleep until after midnight. I will definitely ask my doc about trying the SR. Thank you so much for your input! It's SOoooo appreciated.
> I wrote a huge message and I think I lost it. I will write again, but yes yes yes! I am exhausted on Wellbutrin XL. Pay attention to this. My therepist has seen clinical evidence of sleep problems with XL--specifically not getting deep REM sleep. She has seem improvement in patients who changed to Wellbutrin SR, as long as they took the dose or 2nd dose by late afternoon so that when it wears off in 8 or so hours when you are asleep--you have the chance to really sleep.
Posted by franco neuro on April 1, 2005, at 12:44:54
In reply to Re: Anyone TIRED on Wellbutrin XL? » islandangel, posted by alivekickin on March 30, 2005, at 12:25:08
Hi,
How long have you been taking it? I'm only on my third day of 100mg SR, but it seems to be acting like a muscle relaxant! A couple of hours after I take it I feel like I need to lay down. Not sleep mind you, but just to lay down. I'm not complaining because my muscles could use some relaxing. It also seems to be helping some with chronic pain. I think both of these things have to do with it's norepinephrine reuptake inhibition. I'm just wondering when the dopamine "activation" kicks in. Guess I just have to wait and see...
Posted by islandangel on April 1, 2005, at 13:22:08
In reply to Re: Anyone TIRED on Wellbutrin XL? » alivekickin, posted by franco neuro on April 1, 2005, at 12:44:54
Hi: Your experience sounds very interesting. Double check all of your other medications to make sure that the Wellbutrin SR isn't increasing the effects to make you more tired. In my situation the first 3 weeks of taking Wellbutrin XL I had instant energy, almost too much. I went from peeling myself out of bed at 8:45am (my usual) to waking up at 5am bright eyed and bushy tailed! Now, I'm back to waking up later and I do not have the energy I had when I started. Next week I'll switch from XL to SR to see if it will help. I have fibromyalgia and have chronic pain too, THIS has really helped that pain. It also has allowed me to get off of Elavil which I think is amazing. The elavil I used to need to go to sleep at night but for me... by 8pm I'm exhausted and ready to put my head in my lap. I used to stay up until 2am beause I couldn't sleep (before wellbutrin). By the way I was up to the regular 300mg doseage but had to cut down to 150mg because the 300mg tended to make me very easily angered and aggro. And THAT is not me!
Let me know how it goes!
Posted by franco neuro on April 1, 2005, at 21:34:33
In reply to Re: Anyone TIRED on Wellbutrin XL?, posted by islandangel on April 1, 2005, at 13:22:08
Hello again,
Actually it's the only med I'm on right now. I stopped Zoloft and Klonopin about a month ago, although I have popped 0.25 of the Klonopin on a couple of really bad insomnia nights. I really was hoping that the Wellbutrin would be energizing for me, but what can you do. I too have chronic fatigue and chronic pain. I also took Elavil for quite a while to help with poor sleep and pain. Maybe I need to add a stimulant to the Wellbutrin to get the energy/motivation boost. You wouldn't think one wouldn't have to, but I'm definitely having a paradoxical response to this med. Can't complain though. Does help with the pain. Maybe I'll just try taking it in the evening. Boy is my biochemistry messed up.
By the way, did you post a chronic fatique link once before? If so can you post it again. I'd like to see if anyone knows of a doc that uses Dr. Jay Goldstein's protocol. I have his latest book "Tuning the Brain" and I think if anyone could help me he's the guy. Unfortunately, he retired last year. But maybe there are a few docs out there that are following in his shoes...
Posted by islandangel on April 2, 2005, at 5:32:07
In reply to Re: Anyone TIRED on Wellbutrin XL? » islandangel, posted by franco neuro on April 1, 2005, at 21:34:33
Hi: Yes, there is something about the Wellbutrin that helps the pain doesn't it. And the mood as well, even when I don't feel good physically I do feel good mentally which helps. I went from 50mg of Elavil down to 10 and then 5. Now no Elavil. Because I was so darn zapped and tired when taking it with Wellbutrin XL. I've been told Wellbutrin enhances the effects of the relaxant type drugs like Elavil. Thus, I've stopped the Elavil all together for the first time in about 5 years. You might need a while for the other RX's you've been taking to get out of your system. I'm still tired on the Wellbutrin XL but not as wiped out as I felt while taking the Elavil at the same time. Still, I plan to make the switch to Wellbutrin SR late next week. From what I understand, some people tend to hold on to the "XL" and don't metabolize it like others do, thus the tired effect. I'm hoping the SR will have better results as some folks have said. I love the Wellbutrin, I just don't like being dog tired already at 8pm. :)
Sorry I haven't heard of your chronic fatigue doctor. But there is a guaifennesin treatment commonly used for CFS and fibromyalgia. I'm not a candidate unfortunately because it requires you to be salicylate free. I can't do that because I am on aspirin therapy (a salycilate).
Take care and let me know how you do with everything!
> Hello again,
>
> Actually it's the only med I'm on right now. I stopped Zoloft and Klonopin about a month ago, although I have popped 0.25 of the Klonopin on a couple of really bad insomnia nights. I really was hoping that the Wellbutrin would be energizing for me, but what can you do. I too have chronic fatigue and chronic pain. I also took Elavil for quite a while to help with poor sleep and pain. Maybe I need to add a stimulant to the Wellbutrin to get the energy/motivation boost. You wouldn't think one wouldn't have to, but I'm definitely having a paradoxical response to this med. Can't complain though. Does help with the pain. Maybe I'll just try taking it in the evening. Boy is my biochemistry messed up.
>
> By the way, did you post a chronic fatique link once before? If so can you post it again. I'd like to see if anyone knows of a doc that uses Dr. Jay Goldstein's protocol. I have his latest book "Tuning the Brain" and I think if anyone could help me he's the guy. Unfortunately, he retired last year. But maybe there are a few docs out there that are following in his shoes...
Posted by franco neuro on April 2, 2005, at 11:12:05
In reply to Re: Anyone TIRED on Wellbutrin XL?, posted by islandangel on April 2, 2005, at 5:32:07
Hi. You made the right move in starting Wellbutrin before stopping the Elavil. I only wish I had done the same. I started at 10mg of Elavil and ended up going up to 100mg during the four years that I was on it. I felt like it was starting to prematurely age me. I became frustrated and decided to stop it. Unfortunately, I did it too quickly and without a backup med. I really hit the skids after that. If only I had known that Wellbutrin could help with pain. Oh well you live and you learn. Hopefully...
It is interesting that some people get tired on a med that should act as somewhat of a stimulant by boosting dopamine. In his book Dr. Goldstein says that this is common among many people with neurosomatic disorders (i.e. CFS, FMS, IBS, pelvic inflammatory disease, etc.) I'm currently trying to figure out why this is and what can be done about it. His book is pretty complex. Why did he have to retire?! I was ready to drive across the country from New Jersey to California to see him. The guy basically went into hiding. People were coming from around the world to see him. A lot of people would show up at his house and hound him. I guess he just got tired of it all. But thank God he's still writing books. He's supposed to have another one coming out soon called "Brain Static: Case Studies in Neurosomatic Medicine." I can't wait.
By the way, I also have the book by Dr. St. Amand, the guy who came up with the guaifenesin therapy. The funny thing is, he had no clue as to why it was helping some people. The reason he came up with was all wrong. It turns out that guaifenesin is a NMDA (N-methyl-D-aspartate) antagonist. They're finding out that in a lot of people with CFS and FMS there is over activity of the excititory neurotransmitters glutamate and aspartate. Initially, this causes over secretion of dopamine and neurepinephrine. But, over time it causes DA and NE to become suppressed. Either because they have become depleted, or there is synaptic failure, or the DA and NE recepter cells have become down regulated. This is why meds that boost dopamine and norepinephrine are so helpful. Many of the newer anti-convulsants (i.e. Neurontin, Lamictal, etc.) are also helpful in CFS and FMS because they suppress NMDA and glutamate. Dr. St. Amand also had to come up with a reason why it didn't help some of his patients so he came up with the salicylate theory. Which, apparently, is also wrong. Hey I'm not knocking the guy. He meant well and helped some people so he's alright with me. Should have worked on the science behind his treatment a little more though. Anyway sorry for rambling. Researching this stuff has pretty much been my whole life this past year...
Posted by islandangel on April 2, 2005, at 14:19:28
In reply to Re: Anyone TIRED on Wellbutrin XL? » islandangel, posted by franco neuro on April 2, 2005, at 11:12:05
HI Wow! You really have done your homework and I can see it because I have a medical background. Yes I've tried to give up Elavil many times in the past thinking I'm getting better with pain and sleeplesness. I always thought someday maybe I'll get better and wont have to take it anymore. But then I'd end up in my Dr.'s office complaining of pain and exhaustion and he tells me Elavil is probably forever. I remember it has given me a weird type of withdrawl whenever I stopped taking it; where my upper arms would itch severely and I'd get headaches. I didn't have such a bad problem with it this time thankfully with the Wellbutrin. I just had to stop the Elavil with the Wellbutrin because of the intensification of the sleepiness.
By the way for a couple of days when I first started WellbutrinXL made me VERY itchy, especially on my hands and my palms of my hands but it stopped after a few days.
You may have something with your theory on why some folks metabolize Wellbutrin differently. When I take drugs that are supposed to relax me it makes me hyper. Whenever I have to take Benadryl or whenever I'm in the hospital for something and they give me a strong pain medication that is supposed to put me asleep... I end up being wide awake for HOURS! Some people may disagree but I think you are on target with your theory. Metabolizing meds I think is sorta like people and metabolizing food. Certain foods give people indigestion while the same food doesn't affect another person. I believe for those who get tired on Wellbutrin XL--- we do have a problem metabolizing it in that it stays in our body longer has a higher effect and thus the tireness instead of energy.
By the way, I do know Dr. St. Amand personally. I've met him a couple of times. You are right about his need for more scientific research to prove his protocol. He's getting a little better at following the scientific data. Some Fibro groups are now following his guaifenessen treatment without the hoopla over the salycilates. Salicilates are in everything from toothpaste, to toilet paper. The ones following his protocol without following the salicilate theory seem to be doing well. Anyway, it's good discussing this with someone since people tend to raise their eyebrows when I say WellbutrinXL makes me TIRED!
I can't wait until next Friday when I'll make the switch to SR!!!
Keep me posted on how you are doing.
Sincere THANKS for the info!!!
Posted by KaraS on April 2, 2005, at 15:21:53
In reply to Re: Anyone TIRED on Wellbutrin XL? » islandangel, posted by franco neuro on April 2, 2005, at 11:12:05
Hi Franco,
Have you ever tried taking stimulants or selegiline? I've tried Ritalin and selegiline. They both put me to sleep. You may know all of this already since you have been reading a lot by Dr. Goldstein but if not... According to Dr. Goldstein, this paradoxical reaction may be caused by hypersensitive dopamine autoreceptors. He claims to have seen this quite frequently in his CFS patients. (I have also been diagnosed with CFS.) Apparently the "cure" is to downregulate these autoreceptors. The drugs Amisulpride and Sulpiride can do this. They are atypical antipsychotics that are not available in the U.S. King Vultan, who used to post regularly on this board thought that he also had this condition and that Parnate was able to downregulate these autoreceptors for him. Selegiline might also work. I don't know how Wellbutrin fits into all of this.Also, here are a couple of sites on CFS and Fibromyalgia:
http://www.fibromyalgiasupport.com/
Within this last site is an article by Dr. Goldstein on stimulants and those with paradoxical responses to them:
http://www.ncf-net.org/forum/Stimulants.html
K
Posted by KaraS on April 2, 2005, at 15:54:49
In reply to Re: Anyone TIRED on Wellbutrin XL? » islandangel, posted by franco neuro on April 2, 2005, at 11:12:05
I just read your post to Ed below in another thread and you are already thinking about the hypersensitive dopamine autoreceptors theory. I just wanted to add that when King Vultan was building up on Parnate, he claimed to feel awful at each dosage increase. Then he would start feeling better after about a week. He thought that might be the downregulation taking place. When I first tried selegiline (5 mgs.) it made me sleepy. After I took it a few times (I always took it in the late morning) one evening about 8-9 hours after I took it, I felt stimulated (like I was expecting to feel from this all along). I think this may have been a result of downregulation. I'm not sure why Dr. Goldstein thinks or thought that only amisulpride/sulpiride could address this problem. As Todd posited (King Vultan) why wouldn't medications like Parnate, selegiline, Ritalin downregulate dopamine autoreceptors in the same way that SSRIs downregulate serotonin autoreceptors? Anyway, he was doing so well on Parnate that he is no longer posting anymore. :-(
Kara
Posted by ed_uk on April 2, 2005, at 18:01:40
In reply to Re: Read this before answering my previous post » franco neuro, posted by KaraS on April 2, 2005, at 15:54:49
Hi Kara!
>Anyway, he was doing so well on Parnate that he is no longer posting anymore. :-(
I honestly don't know why he's not posting anymore, perhaps he's just very busy with work. I think he was doing well but he did still have a few problems. I do hate it when regular posters just disappear, it makes me wonder whether something bad has happened. I think he's probably doing well though!
Ed xxx
Posted by KaraS on April 2, 2005, at 20:49:25
In reply to Re: King Vultan » KaraS, posted by ed_uk on April 2, 2005, at 18:01:40
> Hi Kara!
>
> >Anyway, he was doing so well on Parnate that he is no longer posting anymore. :-(
>
> I honestly don't know why he's not posting anymore, perhaps he's just very busy with work. I think he was doing well but he did still have a few problems. I do hate it when regular posters just disappear, it makes me wonder whether something bad has happened. I think he's probably doing well though!
>
> Ed xxx
Hi Ed,I think he's probably doing well since he had made a lot of improvement on the Parnate (though as you say he did have some issues to work on still). I don't think that posters should be allowed to stop posting! Don't they know we worry about them? ;-)
Kara
Posted by ed_uk on April 3, 2005, at 11:01:05
In reply to Re: King Vultan » ed_uk, posted by KaraS on April 2, 2005, at 20:49:25
Hi Kara!
>I don't think that posters should be allowed to stop posting!
It would be nice if people weren't allowed to turn their babblemail off!!!
Ed xxx
Posted by KaraS on April 3, 2005, at 13:38:38
In reply to Re: King Vultan » KaraS, posted by ed_uk on April 3, 2005, at 11:01:05
> Hi Kara!
>
> >I don't think that posters should be allowed to stop posting!
>
> It would be nice if people weren't allowed to turn their babblemail off!!!
>
> Ed xxx
Absolutely! It's so rude! ;-)k
Posted by franco neuro on April 3, 2005, at 20:51:37
In reply to Re: Anyone TIRED on Wellbutrin XL? » franco neuro, posted by islandangel on April 2, 2005, at 14:19:28
Hi IG,
Boy I really wish I could reach the point where I didn't have to do any more of this homework. It's really hard. Especially when you're already as messed up as I am. Your experiences with Elavil. as well as antihistamines, really got me thinking. I started at 10mgs but over time I had to keep upping it until I was taking over 125mgs a night to get to sleep. I always thought it was the antihistamine effect that knocked me out, which is the common wisdom. But I've been experimenting with whatever I could get my hands on lately, (thanks to "Tuning the Brain) so I tried some Benedryl. I had never tried it before. As it turned out, of course, it didn't make me sleepy at all. It was mildly analgesic, however. I have to look back through Dr. Goldstein's book but I'm pretty sure he mentioned that histamine may stimulate the NMDA receptor, which is why they help with pain in some neurosomatic patients. So, it wasn't Elavil's antihistamine action that knocked me out when I took it. After being an antihistamine, it hits the acetylcholine, NA, 5ht-2, and NA alpha-1. Yes it is a very messy drug. It has pretty strong anticholinergic activity, which is scary because we really need our acetylcholine! Especially if we don't want to end up with Alzheimer's. No SSRI ever knocked me out so i doubt it was the 5-ht2 effect. So it had to be the anticholingergic or norepinephrine interaction. Because I had to keep bumping it up I must have been becoming more and more depleted in chatecholamines. When I stopped it I think the bottom must have dropped out, because I really felt like I was dying. I felt week and had this strange tingly/sizzling like feeling down my left leg and in my pelvis and on the left side of my chest and torso. I swear to God I felt like my muscles were melting away. I think my brain/nervous system were in such a panic to get amino acids to make DA and NA that it was breaking down muscle tissue (protein) to get them. I tell you I still haven't recovered from it. I think I may have had something akin to a mild form of "neuroleptic malignant syndrome" of which Goldstein says,
"Although I encounter it only about once every ten years, neuroleptic malignant syndrome, a disorder of autonomic hypereactivity, fever, muscle breakdown, and apparent catatonia, is caused by standard neuroleptics and possibly by rapid cessation of IV amantadine infusion."
Elavil isn't a neuroleptic, but neither is amantadine. And I have read that it has been found to cause NMS and parkinsonism with chronic use. I really screwed myself!
By the way I'm not surprised that you've seen Dr. St. Amand. We CFS types get around. I've been to 50+ docs, including Majid "The Canary and Chronic Fatigue" Ali and have had my fillings replaced and have tried cholestyramine, and have taken nystatin for nonexistant yeast infection, etc., etc., etc. I only wish I had gotten around to seeing Dr. Jay Goldstein... :-(
Posted by franco neuro on April 3, 2005, at 21:18:35
In reply to Re: Read this before answering my previous post » franco neuro, posted by KaraS on April 2, 2005, at 15:54:49
Hi Kara,
All hail King Vultan! He makes sense...
Thanks for the links. That Goldstein one is in the book almost word for word. He does cover those to meds in the book. I must say I'm a bit wary of taking an antipsychotic, because I fear my DA levels are so low it may give me extrapyramidal symptoms or tardive dyskinesia. Amisulpride, however, is supposed to be a dopamine stabilizer. Lowering DA when it's high, and raising it when it's low. Would be interesting if it's true.> As Todd posited (King Vultan) why wouldn't medications like Parnate, selegiline, Ritalin downregulate dopamine autoreceptors in the same way that SSRIs downregulate serotonin autoreceptors? [Hydergine may also be a good med to try. It's reputed to be "neuroprotective" in chronic low doses. Golstein says, "Ergoloid mesylates, or Hydergine, is another diamond in the rough. It is a DA and Ach (mainly DA) agonist, is well tolerated, and two 1 mg tablets either work or not in 30 minutes."]
This is an excellent question and one that I've been pondering too. Why wouldn't chronically flooding the synapse downregulate the autoreceptor as it most likely would the post synaptic receptors? I wish I knew. This may be the million dollar question.
By the way I found a story on a CFS site posted by a guy who's trying to use Dr. Goldstein's protocol with his own doctor. His doctor has no clue what he's trying to accomplish but is willing to give him the meds. I guess this is what I have to do. I emailed him and it turns out he is in Florida. I emailed him asking for details and am waiting for his reply.
I need to make up a battle plan...
Posted by franco neuro on April 3, 2005, at 22:20:51
In reply to Re: Anyone TIRED on Wellbutrin XL? » franco neuro, posted by islandangel on April 2, 2005, at 14:19:28
Hi IA, (I have no idea why I put IG on the last one.)
Just wanted to add that I have been getting some transient slight itching, but mostly in the areas where I tend to get nerve pain. Except my hands, where I don't get any pain but do have very dry skin. The itching on my hands is oh so slight. No problem at all. I think it must have something to do with NE's effect on the tiny arterioles and capillaries that provide blood flow to the skin. Just a guess...
Posted by Steen on April 5, 2005, at 18:17:50
In reply to Re: Anyone TIRED on Wellbutrin XL? » islandangel, posted by franco neuro on April 3, 2005, at 22:20:51
I am starting on Wellbutrin XL tomorrow in hopes of helping me with menopause. I had a total hysterectomy 3 years ago and I am not able to take hormones due to a family history of breast cancer. Being without hormones has been awful, no energy, no sex drive and I did not want to take an SSRI d/t the problems with weight gain and sexual desire issues. Have any of you ever heard of taking Wellbutrin for something like this? I am currently on no medications (except for a low dose of blood pressure medication-after the hysterectomy problem), nor have I ever been, fortunately. I'm a little nervous about taking it d/t the problems people have cited with the anxiety and nervousness, but I start tomorrow. I like the idea of having a place to talk about this, though, so I hope it's OK that I responded to the posting. I hope it doesn't make me tired, because I'm battling feeling tired anyway, either from a little depression or lack of hormones or AGE!!!!
Thanks for listening!
Chris
Posted by KaraS on April 5, 2005, at 18:34:03
In reply to Re: Read this before answering my previous post » KaraS, posted by franco neuro on April 3, 2005, at 21:18:35
Hi Franco,
> All hail King Vultan! He makes sense...
>
> Thanks for the links. That Goldstein one is in the book almost word for word. He does cover those to meds in the book. I must say I'm a bit wary of taking an antipsychotic, because I fear my DA levels are so low it may give me extrapyramidal symptoms or tardive dyskinesia. Amisulpride, however, is supposed to be a dopamine stabilizer. Lowering DA when it's high, and raising it when it's low. Would be interesting if it's true.
I am also afraid of the APs (but then I'm becoming afraid of most meds these days). I didn't know that amisulpride is a dopamine stabilizer. I've also heard that it can have some less than desirable side effects.
> > As Todd posited (King Vultan) why wouldn't medications like Parnate, selegiline, Ritalin downregulate dopamine autoreceptors in the same way that SSRIs downregulate serotonin autoreceptors? [Hydergine may also be a good med to try. It's reputed to be "neuroprotective" in chronic low doses. Golstein says, "Ergoloid mesylates, or Hydergine, is another diamond in the rough. It is a DA and Ach (mainly DA) agonist, is well tolerated, and two 1 mg tablets either work or not in 30 minutes."]I also didn't know that about hydergine. I have always thought of it in terms of Ach only. Have you tried it?
> This is an excellent question and one that I've been pondering too. Why wouldn't chronically flooding the synapse downregulate the autoreceptor as it most likely would the post synaptic receptors? I wish I knew. This may be the million dollar question.Same here. Dr. Goldstein doesn't address that, does he?
> By the way I found a story on a CFS site posted by a guy who's trying to use Dr. Goldstein's protocol with his own doctor. His doctor has no clue what he's trying to accomplish but is willing to give him the meds. I guess this is what I have to do. I emailed him and it turns out he is in Florida. I emailed him asking for details and am waiting for his reply.
>
> I need to make up a battle plan...
I know what you mean but doesn't Dr. Braverman have a battle plan for you? Have you heard anything back from the guy on the CFS site?How's the Wellbutrin now? Any more energy from it? You might still get an antidepressant effect from it that will provide motivation without the overt early sense of stimulation, no?
K
Posted by franco neuro on April 5, 2005, at 20:45:21
In reply to Re: Anyone TIRED on Wellbutrin XL?, posted by Steen on April 5, 2005, at 18:17:50
Hi Steen...Welcome aboard!
Sorry to hear you're having some problems. You're not alone. I'm not too crazy about the SSRI's. I've been on Paxil and Zoloft and have pretty much had it with them. I don't see how killing someone's libido is going to help their depression. Having said that, they do appear to help some people. My sister being one of them.
If you're worried about fatigue and libido than Wellbutrin is probably a good medication to start with. For most people it is energy and libido enhancing. As a matter of fact, it is often prescribed to those already taking SSRI's to reverse SSRI induced sexual dysfunction and SSRI induced apathy. This is why I wanted to give it a try. Unfortunately I appear to be having a paradoxical response. I've been taking the SR version for a week and it's really knocking me out. However, it is helping with chronic pain. Go figure? Don't go by my experience though, because I have very odd brain chemistry. I plan on sticking with it for at least another week and then discuss with my doctor what to do next.
The only way you'll ever know if it's right for you is to give it a shot. Good luck! And feel free to post as often as you'd like... :-)
Posted by Steen on April 5, 2005, at 22:05:53
In reply to Re: Anyone TIRED on Wellbutrin XL? » Steen, posted by franco neuro on April 5, 2005, at 20:45:21
> Hi Steen...Welcome aboard!
>
> Sorry to hear you're having some problems. You're not alone. I'm not too crazy about the SSRI's. I've been on Paxil and Zoloft and have pretty much had it with them. I don't see how killing someone's libido is going to help their depression. Having said that, they do appear to help some people. My sister being one of them.
>
> If you're worried about fatigue and libido than Wellbutrin is probably a good medication to start with. For most people it is energy and libido enhancing. As a matter of fact, it is often prescribed to those already taking SSRI's to reverse SSRI induced sexual dysfunction and SSRI induced apathy. This is why I wanted to give it a try. Unfortunately I appear to be having a paradoxical response. I've been taking the SR version for a week and it's really knocking me out. However, it is helping with chronic pain. Go figure? Don't go by my experience though, because I have very odd brain chemistry. I plan on sticking with it for at least another week and then discuss with my doctor what to do next.
>
> The only way you'll ever know if it's right for you is to give it a shot. Good luck! And feel free to post as often as you'd like... :-)
franco neuro,
Thanks for answering. Did you have the side effects of being nervous, anxious and agitated? If so, how long did it last? I think if I know that it is only for a week or so, I can stand it. I'm worried because of other posts that I have read (I am not even sure it was on this website) about people having such long-lasting horrible effects. I wondered if they had significant problems prior to taking Wellbutrin and that's why the stories were so bad. Ah, but you're right. The only way I can tell is to try. I'll start tomorrow and we'll see. I'll check in.I hope your sedation problem is resolved. Maybe this too shall pass? I hope so. I imagine it is difficult to know that somewhere there is a halfway decent solution, but you can't quite find it. Good luck to you, too.
Steen
Posted by franco neuro on April 5, 2005, at 22:16:14
In reply to Re: Read this before answering my previous post » franco neuro, posted by KaraS on April 5, 2005, at 18:34:03
Hi Kara,
I was beginning to worry that everyone abandoned this thread. :-) The fatigue seemed to lesson yesterday but reappeared with a vengeance today. I had been taking 1/4 grain of Dr. Braverman's thyroid formula, but I stopped a couple of days ago. I decided to take it this morning and am wondering if that contributed to the fatigue, because I called his office today and they told me my thyroid antibodies came back high. So maybe the thyroid hormone is causing an immune reaction. I doubt it. I think it's the dopamine paradox and/or the double edged sword that is norepinephrine. I'll keep taking it for a while and see what happens.
> I am also afraid of the APs (but then I'm becoming afraid of most meds these days).
I know the feeling. I'm always afraid that I'll do more harm to my already messed up brain/body. But what I'm more afraid of is never feeling healthy again and having the rest of my life pass me by like the last few years have. Having said that, the AP's will probably be my medications of last resort.
> I didn't know that amisulpride is a dopamine stabilizer.
Here's what it says in Stephen M. Stahl's "Essential Psychopharmacology: The Prescriber's Guide", amisulpride:
-Is possibly a dopamine stabilizer and dopamine agonist.
-Theoretically blocks presynaptic DA 2 receptors at low doses.
-Theoretically blocks postsynaptic DA 2 receptors at high doses.
-May be a partial agonist at DA 2 receptors, which would theoretically reduce DA output when DA concentrations are high and increase output when DA concentrations are low.
-Blocks DA 3 receptor, which may contribute to it's clinical action.
-Unlike other atypical AP's, amisulpride does not have potent actions at serotonin receptors.> I've also heard that it can have some less than desirable side effects.
Amen. Any drug that blocks DA can have some scary side effects.
> I also didn't know that about hydergine. I have always thought of it in terms of Ach only. Have you tried it?You might be thinking of Galantamine, which is a cholinesterase inhibitor.
The million dollar question?
> Dr. Goldstein doesn't address that, does he?As a matter of fact, I started flipping through the nearly 500 pages of "Tuning the Brain" and managed to find this tasty tidbit...[] are my additions...
"I am being drawn to the conclusion that fatigue is, at least in part, related to NAc [nucleus accumbens] DA release, or the insufficiency thereof. PFC [prefrontal cortex], even mPFC [medial prefrontal cortex] , hypoactivity is common in neurosomatic disorders."
He continues...
"If the mPFC DA is insufficient, there will be hyperglutamatergic input to presynaptic D2 autoreceptors [BINGO!] on mesoaccumbens DA neurons, which is the apparent situation in neurosomatic disorders."
I new it had to do with the EAA's glutamate and/or NMDA. As a matter of fact this is pretty much the thrust of his whole theory. Earlier in the book he says...
"The ultimate goal increasingly appears to be (for most patients) to reduce the sensitivity of the NMDA receptor, one of the primary receptors for the excititory amino acid (EAA) glutamate."
Also,
"...it would make sense to decrease glutamate neurotransmission in a patient who has a disorder of synaptic gating, those who do poorly in high-stimulus environments, such as malls, and those who are overly sensitive to many sensory inputs as is frequently seen in CFS, FMS, IBS, multiple chemical sensitivities (MCS), PMS, and too many other 'esses' than I care to mention."
Oh man do car exhaust and chemical smells kill me. I can smell someone spraying perfume on half a block away! Everyone's always telling me "what are you talking about I don't smell anything." And sure enough someone will come around the corner with a perfume bottle in their hand.
This is turning into the mother of all posts. But that guy in Florida did get back to me and seems pretty real. I believe he may have consulted Dr. Goldstein on the phone but never saw him in person. He said he was lucky to have an alternative type doctor who, although she wasn't too keen on meds., was willing to help him out. As far as Dr. Braverman goes, he did give me the Wellbutrin but I'm not sure he's the guy to try out Goldstein's protocol with. You have to understand it's hard to see the guy in person. You're lucky to get a minute with him. My freind gave him "Tuning the Brain" a few months ago and now he acts like he doesn't remember it. And on his radio show a few weeks back he was virtually quoting from it. It's the ego thing again. But we'll see. If you read my post on the other thread below you'll see my argument as to why a paradoxical response to a stimulant almost has to be due to the autoreceptor. (I'm still waiting patiently for someone to respond to it. Any input will help.) Of course I'm no scientist and Dr. Goldstein does mention a possible problem with the DA transporter (but only in passing). But I doubt I'll ever boost my DA without first using a glutamate/NMDA antagonist. I should pummel my postsynaptic receptors with a stimulant just to make sure they're not just really downregulated. But I doubt this is the case. Ok I'll end this post now before I pass out...
Posted by Harlock on April 6, 2005, at 9:31:15
In reply to Re: Anyone TIRED on Wellbutrin XL?, posted by Steen on April 5, 2005, at 18:17:50
I've been on WB XL for many months and have been on some form of it (non-XL) etc, for years
It doesn't seem to help my depression at all, but it does give me energy. It can make you eat less too, and thus loose wieght. At least that's what it does for me.
I'm now gaining weight thanks to Symbiax (the zyprexxa part of it, I think).
I gained 8 pounds in 1.5 weeks! 160->168 in no time. Bad news.
Posted by islandangel on April 6, 2005, at 10:59:38
In reply to Re: Anyone TIRED on Wellbutrin XL?, posted by Harlock on April 6, 2005, at 9:31:15
Hi Harlock: Interesting about your experience with Wellbutrin. I gained at least 10 pounds or more while on Prozac a little over a year ago. Prozac made me even more of a zombie than the tiredness I feel with Wellbutrin XL so I actually feel lucky. Wellbutrin in the beginning made me a little nauseas and I didn't notice stomach growling when I hadn't eaten. BUT that was in the beginning, maybe the first 2 weeks. After the first 2 weeks that stopped. I hadn't lost anything on Wellbutrin but because my weight had already creeped up at an uncomfortable level with Prozac, I decided to diet by cutting carbohydrates, mostly sugars. Wellbutrin makes it EASIER to control your eating when you need to. It feels great to have complete control and not fall off the "wagon". One thing Wellbutrin hasn't helped me with is my terrible procrastination. As for the weight control, I've been able to lose about 7 pounds in the last month. And I have great control over what I eat. Before... with Prozac, I was hungry all the time! Good luck on your new med.
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