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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 3 to 27 of 27. Go back in thread:
Posted by anony on January 3, 2006, at 12:32:56
In reply to Re: Questions about Wellbutrin ?anony, posted by Jasmine7718 on January 3, 2006, at 12:30:27
That's great. I'll give it a try.
Thank you for reponse :)
Posted by Phillipa on January 3, 2006, at 18:08:13
In reply to Re: Questions about Wellbutrin, posted by anony on January 3, 2006, at 12:32:56
If you're extremely anxious like I am it increased it dramatically. I only took it a week so there were no withdrawal symptoms. Fondly, Phillipa
Posted by anony on January 3, 2006, at 18:17:51
In reply to Re: Questions about Wellbutrin ?anony, posted by Phillipa on January 3, 2006, at 18:08:13
I don't understand what you are saying.
Are you saying that Wellbutrin increased your anxiety?
Posted by Phillipa on January 3, 2006, at 22:53:56
In reply to Re: Questions about Wellbutrin » anony, posted by Phillipa on January 3, 2006, at 18:08:13
Yes it incrased my anxiety dramatically. The pdoc thought I was hypomanic hence hospital off the med. Fondly,Phillipa
Posted by anony on January 3, 2006, at 23:15:30
In reply to Re: Questions about Wellbutrin ?Phillipa, posted by Phillipa on January 3, 2006, at 22:53:56
Oh, well....I thought Wellbutrin can decrease anxiety just as other anti-depressants do.
Now, I'm hesitating to try this med since I read some people saying that it rather induces anxiety.
I've tried most of SSRI's out there and Effexor, but none of them actually helped with anxiety associated with social activities themselves. Also, I didn't like their side effects (crazy withdrawal symptoms, sexual side effects, hair loss, etc.)
The only thing that's helping with my social anxiety is Clonezapam, but it's causing me less willing to go out and have fun(probably I'm slightly depressed by this drug).
Posted by Racer on January 3, 2006, at 23:33:58
In reply to Re: Questions about Wellbutrin, posted by anony on January 3, 2006, at 23:15:30
> Oh, well....I thought Wellbutrin can decrease anxiety just as other anti-depressants do.
Not really. While it's true that relieving depression will improve anxiety symptoms for most people, Wellbutrin does not affect serotonin, which is considered helpful for anxiety. Wellbutrin hits dopamine and norepinephrine -- also known as "noradrenaline." As in it's likely to trigger your adrenaline system if you're prone to that...
>
> Now, I'm hesitating to try this med since I read some people saying that it rather induces anxiety.Only if you're susceptible to it. And the only way to know if you are is to try it and see.
>
> I've tried most of SSRI's out there and Effexor, but none of them actually helped with anxiety associated with social activities themselves. Also, I didn't like their side effects (crazy withdrawal symptoms, sexual side effects, hair loss, etc.)Are antidepressants the only type of drugs you've tried for anxiety? It might be that you'd do better on one of the atypical antipsychotics -- don't cringe, they're not just for breakfast anymore -- or maybe one of the other anxiolytics. I, too, find benzos increase my depression, so I don't know that I'd look that way. Right now, I'm trying a drug called Buspar, which is an anxiolytic. I'm crossing my fingers.
I guess, if I were being honest with you, I'd recommend something like an SSRI -- side effects and all -- while going to therapy to work on the anxiety more directly. Learning self-calming methods, etc. Once you had an alternative in place, like those skills, you could either stop the SSRI altogether, or if you still needed an AD, you could try one of the others -- like Wellbutrin.
For what it's worth, I take Wellbutrin, I have been diagnosed with an eating disorder, and while I know that Wellbutrin isn't helping my anxiety, it really has helped me AND it's done it with very minimal side effects.
Good luck.
Posted by anony on January 3, 2006, at 23:54:14
In reply to Re: Questions about Wellbutrin ?anony, posted by Racer on January 3, 2006, at 23:33:58
Thanks for reply.
Well, since most SSRI's didn't do anything to social anxiety (tho they helped with generalized anxiety) I guess my fear in social situation won't go away despite with increased seretonin.
I'll give Wellbutrin a try. Clonezepam is really doing its job (have been taking only 0.25mg-0.5mg per day or zero for about 5 months) so what I really need is some motivation.
My doctor and I planned to have CBT in future when I move to a place close to the university hospital where they have good CBT program. For now, I'll stick to Clonezapam and try Wellbutrin.
I just hope Wellbutrin doesn't make my hair fall out.
Thank you again.
Posted by James K on January 5, 2006, at 18:03:55
In reply to Re: Questions about Wellbutrin, posted by anony on January 3, 2006, at 23:54:14
Hi, I take wellbutrin, and Clonazepam. Along with other things for other reasons. It's a good combo. XL is newer and you can take all of your dose at once it is not generic yet. SR you have to split your dose (I'm assuming you would take more than the lowest dose) you have to watch not to take it too late in the day for sleep reasons. SR is generic (this is United States, I don't know Canada - did you say Canada?).
for anxiety, I agree with I think Racer who said you just have to try. I've had less side effects than any ssri, but I haven't taken it long enough sober to give a realistic report on effectiveness.
Hair Loss? I've maintained the same amount of thinning hair for years. Really, if it happens it happens. Just keep it real short and it looks fine. Monoxidal sp? (rogaine) is messy and didn't help me. The only other proven hair cure messes with your male hormones, and I'm against it! I don't think any of my meds really affected my hair, but how could I know? I think it depends on your grandfathers.
Hope some of this is interesting,
James K
Posted by anony on January 6, 2006, at 4:31:01
In reply to Re: Questions about Wellbutrin ?anony, posted by James K on January 5, 2006, at 18:03:55
I've taken one 150mg dose of Wellbutrin SR yesterday, and it wasn't good!
I got really strange temper, some racing thoughts, and general anxiety. Are these symptoms that go away with time?
I read many reports from ppl who have taken Wellbutrin that that drug isn't really for anxiety.
Well, I'll have to talk to my doctor about this but do you people on this forum think I should see better effects with time, or this drug simply isn't for me?
Thank you very much for response. It always encourages me!
Posted by Racer on January 6, 2006, at 13:05:49
In reply to Re: Questions about Wellbutrin, posted by anony on January 6, 2006, at 4:31:01
Here's the thing: if you're worried that Wellbutrin will increase your anxiety -- that in and of itself will likely produce anxiety. That's a classic self-fulfilling prophecy, and the only way you'll know if it's the drug or the worry is to continue the drug until you've seen what sort of benefit it will have for your other symptoms. By that time, your anxiety over it increasing anxiety for you will likely have faded some, and you'll know whether or not it's worth it for you.
Again, I've got anxiety problems, I take Wellbutrin, and while I know it ain't calming, it's better than anything else I've taken so far.
Good luck, and I hope this is a little calming for you to read.
Posted by Tomatheus on January 6, 2006, at 18:23:24
In reply to Re: Questions about Wellbutrin, posted by anony on January 6, 2006, at 4:31:01
Anony,
I was on Wellbutrin monotherapy for several months (taking up to 400mg of Wellbutrin SR a day), and I can definitely relate to what you described as having a "really strange temper." I had this feeling that was really difficult to describe. It was like I felt somewhat energized, but without any drive; slightly less depressed than usual, but even more unhappy; somewhat angry and short-tempered, but not to the point that I was raging with anger. So, I think the "really strange temper" that you've been feeling describes how I felt on Wellbutrin pretty well, but then again, it's hard to say because that feeling is not the easiest thing to describe.
I personally ended up feeling slightly responsive to the Wellbutrin when I combined with lithium. But considering the fact that I had to load myself up with excessive amounts of caffeine and various supplements at least once or twice a day in order to get anything accomplished, I realize in retrospect how unsuccessful this combination actually was for me (I was originally diagnosed with dysthymia, then re-diagnosed as bipolar when I had some cycling on Paxil; since then, my symptoms have been mostly depressive in nature, perhaps with a bit of anxiety).
Anyway, I'm generally a big proponent of giving medications enough time to work, which would probably be at least three to four weeks in your case. For me, that feeling of having a "really strange temper" never really went away. So, while I'm inclined on one hand to say that your response might be similar to mine, it is also quite possible that your long-term experience with Wellbutrin might be very different from mine. If I were in your place, I would probably give the Wellbutrin at least another few weeks to see if your long-term response might be different from your short-term response. But at the same time, I don't know exactly how bad your temper, racing, thoughts, and anxiety symptoms are. If they become unbearable (and especially if they lead to a suicidal ideation), then I think it would be a good idea to take my rule of thumb (about giving meds enough time) and throw it out the window. And of course, you should get in contact with your doctor so he/she can authoritatively tell you how to proceed.
Tomatheus
> I've taken one 150mg dose of Wellbutrin SR yesterday, and it wasn't good!
>
> I got really strange temper, some racing thoughts, and general anxiety. Are these symptoms that go away with time?
>
> I read many reports from ppl who have taken Wellbutrin that that drug isn't really for anxiety.
>
> Well, I'll have to talk to my doctor about this but do you people on this forum think I should see better effects with time, or this drug simply isn't for me?
>
> Thank you very much for response. It always encourages me!
Posted by Jasmine7718 on January 7, 2006, at 0:31:06
In reply to Re: Questions about Wellbutrin, posted by anony on January 6, 2006, at 4:31:01
I agree with Racer. The more you focus on the Wellbutrin causing anxiety, the more likely that will make it worse for you. In addition to my social anxiety, I have severe generalized anxiety and even used to have panic attacks. Wellbutrin did cause a little bit of anxiety in the beginning, and I definitely had a short fuse. I just hung in there, and I think all of the negative side effects had passed by six weeks in. Try to hang in for a couple of weeks and see if things get better. If not, it's time to move to something different. Good luck.
Jasmine
Posted by elkat on January 7, 2006, at 23:32:21
In reply to Re: Questions about Wellbutrin » anony, posted by Tomatheus on January 6, 2006, at 18:23:24
I had a strange experience with Wellbutrin. I think your description of how I generally felt on that med was very close, with the engerized not motivated feeling etc. I did a combo with Remeron and I was on the high end of Wellbutrin XL at 450 and 45mg of Remeron, with 1.5 mg of klonopin. I was on that mix for about 5-6 months I got tired of the "strange temper" agitation feeling and lowered my dose to 300 the first part of December.
Then after about two weeks, I rethought that and upped it back to 450 and had a manic reaction. They had me lower it to 150, I went and my PDoc suggested adding in some Lithium. I just freaked out and quit everything except the klonopin.
I'm about 10 days into no ADs and I'm getting depressed and feel physically ill. But, I'm not real sure about going on yet another med to cancel out the side effect of something that wasn't working that great anyway, or was quitting on me. It just doesn't make sense.
Posted by Tomatheus on January 8, 2006, at 0:54:44
In reply to Re: Questions about Wellbutrin » Tomatheus, posted by elkat on January 7, 2006, at 23:32:21
> I'm about 10 days into no ADs and I'm getting depressed and feel physically ill. But, I'm not real sure about going on yet another med to cancel out the side effect of something that wasn't working that great anyway, or was quitting on me. It just doesn't make sense.
Elkat,
I definitely don't blame you for feeling the way that you do. The only reason that I stayed on Wellbutrin for as long as I did was because it was superior to the only two other meds that I had tried up to that point (Paxil, which temporarily induced rapid cycling; and Zyprexa, which basically turned me into a zombie). So, I ended up adding lithium to it, which resulted in me taking a combo that was superior to Wellbutrin alone but (as you can probably tell from my previous message on this thread) ended up getting me nowhere. In retrospect, I think I would have been better off switching from Wellbutrin to another medication instead of trying to augment something that was doing me little good to begin with. So, I think that your approach makes sense. Hopefully your pdoc will understand why you did what you did and won't get too upset.
Tomatheus
Posted by elkat on January 8, 2006, at 11:36:28
In reply to Re: Questions about Wellbutrin » elkat, posted by Tomatheus on January 8, 2006, at 0:54:44
What did you end up doing? I'm not sure what to do at this point...
>So, I ended up adding lithium to it, which resulted in me taking a combo that was superior to Wellbutrin alone but (as you can probably tell from my previous message on this thread) ended up getting me nowhere. In retrospect, I think I would have been better off switching from Wellbutrin to another medication instead of trying to augment something that was doing me little good to begin with. So, I think that your approach makes sense. Hopefully your pdoc will understand why you did what you did and won't get too upset.
>
> Tomatheus
Posted by Tomatheus on January 8, 2006, at 12:49:51
In reply to Re: Questions about Wellbutrin, posted by elkat on January 8, 2006, at 11:36:28
> What did you end up doing? I'm not sure what to do at this point...
Elkat,
I've taken the MAOI route. Like most meds, the MAOIs have been rather limited in terms of the antidepressant effects that they've had on me, but I'm currently on Nardil and achieving some success. The problem that I'm having is that I tend to get a halfway decent antidepressant response for approximately two weeks after starting at a new dose (sometimes longer, sometimes shorter), but the effect doesn't seem to last. So, I'm not sure how much longer I'm going to be on Nardil, considering that its "true" effect (i.e., the effect that it produces after the first few weeks at a certain dose) makes me feel rather depressed. But we'll see...
With respect to your situation, I'm wondering how you've responded to the other meds you've taken, particularly the SSRIs (assuming that you've taken them). What's your current diagnosis, and what have you been diagnosed with in the past? I will say that treatment-resistant depressives (particularly patients with "atypical depression" and those who experience mixed depression and anxiety) tend to respond favorably to the MAOIs, but then again, they're not for everybody. So, as far as deciding on a new medication or med combo to take, it really depends on your diagnosis and primary symptoms, as well your response patterns to other meds. Considering that you became somewhat agitated (or felt that hard-to-describe "strange temper") on the Wellbutrin, it might be best to aim for something serotogenic. But at the same time, I'm guessing that you've already tried at least one SSRI, so it's hard to really say whether or not something like a tricyclic, for example, might be in your best interests.
Tomatheus
Posted by elkat on January 8, 2006, at 13:37:25
In reply to Re: Questions about Wellbutrin » elkat, posted by Tomatheus on January 8, 2006, at 12:49:51
Last go round was with Lexapro, and I had an akathisia reaction from what I think was a dopamine shutdown that was really nasty. We added the Wellbutrin for help with the dopamine, and that did the trick. But, I quit the Lexapro and moved to Remeron due to gasto side effects. Last time I saw doctor I mentioned the dopamine situation. I thought maybe either Provigil, an ADD med like Adderall, or a dopamine drug like Mirapex, but I don't think she agrees with my experimental approach to drug therapy. So she suggests Lithium. She gave me a mood chart to see if I have bipolar. So far it's all on the down side. Are the MAOI's good for dopamine?
Posted by Tomatheus on January 8, 2006, at 20:18:35
In reply to Re: Questions about Wellbutrin, posted by elkat on January 8, 2006, at 13:37:25
Elkat,
See below for my responses...
> Last time I saw doctor I mentioned the dopamine situation. I thought maybe either Provigil, an ADD med like Adderall, or a dopamine drug like Mirapex, but I don't think she agrees with my experimental approach to drug therapy. So she suggests Lithium.
Did she tell you why she suggested lithium?
> She gave me a mood chart to see if I have bipolar. So far it's all on the down side.
With respect to treatment-induced hypomanic symptoms, the current prevailing theory among researchers and psychiatrists is that patients who experience any kind of hypomania from taking any antidepressant have some type of bipolar disorder - usually the prototypical "bipolar III." The implication, of course, is that these patients do not stand to benefit from antidepressant therapy alone, but from either mood stabilizer monotherapy or some combination of mood stabilizers and antidepressants. Even though I do think that *some* patients with treatment-induced (hypo)mania might require a mood stabilizer to control any breakthrough (hypo)manic symptoms that might emerge from antidepressant therapy alone, I don't think that enough is known about the etiologies of mood disorders to justify the position that *all* patients with any kind of treatment-induced (hypo)mania must take a mood stabilizer to achieve the best results. Some patients, for example, may develop (hypo)manic symptoms from taking one antidepressant but may be able to achieve remission from their depressive symptoms without feeling any (hypo)manic symptoms on another antidepressant. And remember that in your case, it took 450 mg of Wellbutrin combined with 45 mg of Remeron and 1.5 mg of Klonopin to trigger manic symptoms - and this didn't even happen until you tried going onto this combination for a second time. There's really no way to say for sure that the med combo that you were taking wouldn't have triggered the same manic symptoms in the typical unipolar patient because no researcher has ever tested your specific combo for its tendency to induce (hypo)mania.
Having said what I've said about bipolarity, I don't think patients should necessarily dismiss the possibility that they might benefit from a mood stabilizer, either. Lamictal, for example, tends to be a better antidepressant agent than it is an antimanic agent, and it's sometimes even prescribed to patients who are completely unipolar. So, I guess what I'm saying is that you should trust your "instincts" (or perhaps more accurately, your knowledge about how you respond to meds based on past experiences) to a certain extent. But at the same time, consider the merits of what your doctor recommends, and do your best to try to understand your doctor's rationale for prescribing you a certain medication or med combo.
> Are the MAOI's good for dopamine?
In short, yes. All of the MAOIs increase the amount of dopamine being released into the synapses by inhibiting MAO-A, MAO-B, or both. MAO-A breaks down serotonin and norepinephrine in their respective neurons by converting the neurotransmitters into inactive metabolites. MAO-B, on the other hand is selective in its metabolism of benzylamine and phenylethylamine (Lotufo-Neto et al., 1999). Both MAO enzymes break down dopamine, so inhibiting either MAO-A or MAO-B (or obviously both) makes more dopamine available to be released from dopaminergic neurons. So, to summarize, the inhibition of MAO-A potentiates the release of serotonin, norepinephrine, and dopamine; the inhibition of MAO-B allows for a greater release of benzylamine, phenylethylamine, and dopamine; and the inhibition of both MAO enzymes makes more serotonin, norepinephrine, benzylamine, phenylethylamine, and dopamine (X2) available to be released from neurons.
In most Western countries, moclobemide is the only commercially available MAO inhibitor that is nearly completely selective in its inhibition of MAO-A. But unlike most commercially available MAOIs, moclobemide is reversible, which means that the drug's inhibition of the MAO enzymes is not permanent. So after a certain amount of time (a few hours, I believe), moclobemide "lets go" of the MAO-A enzyme so it can once again perform its functions. In terms of its ability to allow for more dopamine to be released, moclobemide is believed to be somewhat less potent than the older irreversible inhibitors.
Because Nardil, Parnate, Marplan, and selegiline all inhibit both MAO-A and MAO-B to some extent, they are all relatively potent in their abilities to potentiate dopamine release. Nardil is generally believed to slightly less potent in terms of its effects on dopamine than the other irreversible MAOIs, in part because of its ability to increase GABA levels (which tends to reduce the firing of dopaminergic neurons). I don't really have a whole lot to say about Marplan because I'm not the least bit familiar with its clinical and pharmacokinetic properties. Parnate tends to be more activating (and consequently, more dopaminergic) in most patients than Nardil, which may be at least partially due to Parnate's structural similarity to that of amphetamine. Selegiline, which also possesses strong dopaminergic properties, is highly preferential to MAO-B at low doses (i.e., 5 to 10 mg/day or less) but loses some of this selectivity at higher doses (Thase et al., 1995). Selegiline is currently available in pill form and is expected to become available as a transdermal patch soon (I believe on Feb. 26).
So, that pretty much sums up your MAOI options, assuming that you live in the United States. Considering that you're looking for something relatively dopaminergic, it might be a good idea to try Emsam (the selegiline patch) when it becomes available because it has a much lower tendency to potentiate a hypertensive crisis than Nardil, Parnate, or even oral selegiline. Of course, if you do decide that it might be a good idea to try an MAOI, the biggest challenge that you'll probably have to face will be convincing your doctor that an MAOI is right for you. Most doctors are at least somewhat hesitant to prescribe MAOIs - especially doctors who don't like to take experimental approaches to drug therapy.
Having said that, I do wish you luck in whatever you decide to do.
Tomatheus
==
Lotufo-Neto, F., Trivedi, M., & Thase, M. E. (1999). Meta-analysis of the reversible inhibitors of monoamine oxidase type A moclobemide and brofaromine for the treatment of depression. Neuropsychopharmacology, 20, 226-47.
Thase, M. E., Trivedi, M. H., & Rush, A. J. (1995). MAOIs in the contemporary treatment of depression. Neuropsychopharmacology, 12, 185-219.
Posted by elkat on January 9, 2006, at 9:17:33
In reply to Re: Questions about Wellbutrin » elkat, posted by Tomatheus on January 8, 2006, at 20:18:35
I'm giving the Wellbutrin another try...I've been off both it and the Remeron for over a week and I'm wondering if it was the Remeron that was bothering me. I have to rule that out.
Posted by Tomatheus on January 9, 2006, at 9:46:01
In reply to Re: Questions about Wellbutrin, posted by elkat on January 9, 2006, at 9:17:33
> I'm giving the Wellbutrin another try...I've been off both it and the Remeron for over a week and I'm wondering if it was the Remeron that was bothering me.
That is certainly possible.
I hope things work out for you.
Tomatheus
Posted by ed_uk on January 9, 2006, at 14:22:44
In reply to Re: Questions about Wellbutrin » elkat, posted by Tomatheus on January 8, 2006, at 20:18:35
Hi T
Rasagiline (Azilect) was recently approved in the UK. Are you interested in this drug?
Ed
Posted by Tomatheus on January 10, 2006, at 19:09:49
In reply to Re: Questions about Wellbutrin » Tomatheus, posted by ed_uk on January 9, 2006, at 14:22:44
> Rasagiline (Azilect) was recently approved in the UK. Are you interested in this drug?
Ed,
I may be interested in it at some point, but I think I'd prefer to try Parnate (again) and Emsam (assuming that it becomes available relatively soon) first before considering rasagiline. I took Parnate for about two weeks and ended up discontinuing it because the afternoon sedation was just interfering with my ability to attend university classes too much. So, I never really gave it much of a chance, and I certainly didn't allow myself to try different dosing schedules to see if I could prevent some of that afternoon sedation. If things don't work out with Nardil, I'll probably try Parnate next and then Emsam. What interests me most about Emsam (as opposed to oral selegiline) is that it actually allows the selegiline to stay at an almost perfectly steady level in the bloodstream over a 24-hour period. As I've mentioned in other posts, I suspect that an MAOI's ability to inhibit the MAO enzymes consistenty over time has a lot to do with its therapeutic benefits. Even though Emsam doesn't inhibit MAO-A to a huge extent, at least it will inhibit both enzymes in a manner that is consistent over time. I still have my doubts about Emsam because I still think it's too selective to MAO-B to help me much, but I may try it, especially if my current Nardil trial and a Parnate trial both prove to be unsuccessful.
And so, if Emsam fails, I'm not sure if I'll still be interested in a drug that's primarily an MAO-B inhibitor, but I might consider it. I know of a source where I could obtain it from if need be.
Thanks for the suggestion.
Tomatheus
Posted by elkat on January 10, 2006, at 19:25:30
In reply to Re: Questions about Wellbutrin » ed_uk, posted by Tomatheus on January 10, 2006, at 19:09:49
I went back on the Wellbutrin XL at 300 mg, and I feel fine! I even slept a lot better last night. I guess it was the Remeron. Maybe I got a bad generic batch, or it was probably too much noradrenline with the two med mixed. Maybe my neurotransmittal system needed a break.
Posted by Tomatheus on January 10, 2006, at 19:30:26
In reply to Re: Questions about Wellbutrin » ed_uk, posted by Tomatheus on January 10, 2006, at 19:09:49
Hi Babblers,
I made a post in Social, but I guess I just wanted to link to it somewhere here so that those of you who primarily just check out the meds board will be aware of it.
Here's the link:
http://www.dr-bob.org/babble/social/20060108/msgs/597697.htmlMeanwhile, please feel free to continue discussing Wellbutrin on this thread. It's not my hope to create too much a divergence from the topic of this thread.
Thanks,
Tomatheus
Posted by Tomatheus on January 10, 2006, at 20:02:19
In reply to Re: Questions about Wellbutrin, posted by elkat on January 10, 2006, at 19:25:30
> I went back on the Wellbutrin XL at 300 mg, and I feel fine! I even slept a lot better last night. I guess it was the Remeron. Maybe I got a bad generic batch, or it was probably too much noradrenline with the two med mixed. Maybe my neurotransmittal system needed a break.
Elkat,
That's great to hear. It sounds like this is a success story so far, and hopefully things will stay that way!
Tomatheus
This is the end of the thread.
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