![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by kylenn on July 27, 2006, at 23:38:08
Ok, please, someone tell me if constant yawning--and I mean like 100 times a day (I can't count them)can be a side effect of high dose wellbutrin XL? I take alternating doses of 300 and 600 a day (I am supposed to be on 450, but can't find any 150s)
I am a physician,(I used to treat myself but not anymore) and believe me, I have researched this for many, many hours, and I cannot find out.
I know I didn't use to yawn like this. I think it started a few months ago, but my increased dose of Wellbutrin XL happened about 2 months ago.
I also take 30 of Lexapro.
It all started (here we go) a few years ago.
I had depression, I knew it, and I was treating myself. I used Paxil for years. Finally, it didn't work anymore, and I started upping the dose
FAST (I went from 20 to 80 inside 3 weeks, if I remember correctly.) That was an experience I won't soon forget. I think I had serotonin syndrome, or close to it.
I figured I had to switch antidepressants so I switched myself over to Zoloft.
Didn't work.
Then I think it was Effexor, didn't work as well as Paxil, but I was going to give it a fair chance
This was in like 1999 and I do not believe it was well known about Effexor Withdrawal Syndrome. I was probably patient ZERO! I forgot to grab some out of the sample closet one long weekend.
I thought I would die. I went to several other MDs in the next 3 or 4 weeks, because no one could figure out what was wrong with me.
I had intense symptoms:
Insomnia (like maybe 1-2 hours a night of sleep at first, but I also forgot my Ambien, but even on a night without Ambien I would get like 4 hours.
When I did fall asleep for 1 or 2 hours, I had
THE WORST NIGHTMARES OF MY LIFE!!! Very bloody,
and very colorful, and very terrifying.
As time progressed, I began to have back to back panic attacks (I had never had one before, but I found out fast they are legit) Like, I would have one triggered by like, a door closing (not slamming, just closing) or a phone ringing or someone asking me a question. They would last 15-30 minutes, I'd have a 5 minute recovery period, and off I'd go again. I couldn't work, and by day 3, I couldn't drive (Sunday morning).
The shock sensation started somewhere in my belly or chest and shot up to my brain like I'd been shocked by an electric fence. I could not describe it to anyone.
I was constantly anxious (when I wasn't having a panic attack, Hey, I'm serious here)
I was shivering, sweating, having abdominal cramps, diarrhea, tachycardia, and a dreamlike sense, like nothing was real or that I had somehow completely checked out.
After about 3 or 4 weeks, I finally started to feel better.
I didn't find out that it was Effexor withdrawal that caused me to be the sickest I had ever been in my life until a few months later, while researching the symptom cluster online, I came across this site (or another just like it) and finally, I saw my symptoms described, all together like I experienced, and I finally had a name for the indescribable electric sensation--Brain Shocks. I have seen them called Brain bounces lately, but for me it was definitely a shock.
Anyway, lesson learned.
During this time, I also suffered from extreme daytime sleepiness, and I was worked up for that.
It was discovered with a sleep study that I had OSA (obstructive sleep apnea), and I went thru the ringer trying to get fixed. I even had a UPP
(uvulo-palatoplasty). Didn't work. CPAP helped just a little bit.
Time passed, kept being my usual depressed self, I can't remember what I was on for it at this point, this period of my life is kind of a blur.
I went into a deep depression, and ended up in the hospital.
For any of you that might be unaware, Physicians are not supposed to get sick, and we are DEFINITELY not supposed to have a MENTAL illness.
They will tell you on TV that it is not a stigma to have that diagnosis. Even your own doctor might spout this propaganda. Well, the Medical Community (I mean physicians, and the Medical Boards, and lawyers involved, and Forensic Psychiatrists) are THE MOST prejudicial towards doctors who become mentally ill.
I lost my job, and I nearly lost my license, and for NO OTHER REASON than the fact that my secret diagnosis had been revealed. I was reported to the Medical Board while I was in the hospital for commiting the offence of depression.
Anyway, I fought for two years to keep my license, and I am back at work now, and I REALLY don't treat myself (but only because they held that against me as well). Let me tell you, the shrink that I was seeing right before my hospitalization stabbed me in the back and misdiagnosed me. He was unavailable and had cancelled and rescheduled 3 appointments I had with him prior to my admit, and when he sent his report to the board, he claimed I was "lost to follow up!!!" He misdiagnosed me with Bipolar Disorder. Not to knock the bipolars, but to get that diagnosis, you need to have suffered (or enjoyed, however you want to look at it) at LEAST one true episode of MANIA. I have never (fortunately or unfortunately) had any mania whatsoever. I was either down, or really down, my entire life. I think my true diagnosis, now, if you really want my opinion, is Major Depressive Disorder, severe, recurrent, currently in remission on medication and Dysthymia.
My new (and competent) psychiatrist and I have come to this conclusion together. (Some call it "double depression")
Oh, he's not really my NEW physician--I have been seeing him since 2003. He is the best shrink I have ever met. ANyWAy.
I still suffered from severe daily sleepiness.
No matter if I used my CPAP (which I did, faithfully) or how many hours of sleep I got, or how many cups of coffee I drank, taking the Lexapro at night, all that, I was still very sleepy.
Wellbutrin was added over a year ago, maybe two, for residual symptoms of inertia, anhedonia, decreased energy, and helped about 40%, and it improved my sex drive (thanks, doc!)
But I was still sleepy. Went thru the thyroid tests (again) adjusted my CPAP (again).
finally about one month or six weeks ago, my MD put me on Provigil (200/Q AM). It MAY have helped some...I think it helps me concentrate...but I am still sleepy! And, NOW I am YAWNING!!! I can deal with "sleepy", I always have (you learn that in medical school and residency) but this Yawning is really affecting my ability to functon.
I yawn as soon as I get up.
I yawn thru reading the paper and doing the crossword.
I yawn all the way to work.
I yawn at work.
And worse, much, much worse, I have startet to actually yawn while I am talking to patients, even if I am standing up!!
I yawn all thru the workday, all the way home, and the rest of the night (I'm yawning now)
until I go to sleep.
What is causing this!!!???
Please, if anyone has any ideas, I am exhausted.
Again, my meds are:
Lexapro 30mg/Q HS
WellbutrinXL 450mg/Q AM
Provigil 200mg Q AM
Cefazolin
and lots of coffee (no, I'm kidding, I never have time for more than one cup when I first get there)
THANKS in advance for any advice!
Posted by stargazer on July 28, 2006, at 6:41:55
In reply to YAWNING, posted by kylenn on July 27, 2006, at 23:38:08
Wellbutrin does not list yawning as a known side effect but many SE's are not included in the SE profile for drugs. It could be and if you want to know for sure you can consult the PDR or package insert. Usually Wellbutrin is an activating AD so you shouldn't be feeling like tired but it's possible.
SSRI's are better known for this SE and in my reference book almost all the SSRI's list this as a SE under the 'Other' classification.
Perhaps the Wellbutrin is potentiating the effects of the Lexapro (i think you said this is what you also take)and causing yawning.
Hard to tell which one is the culprit. You could decrease either med and see what happens over a few days.
Did you know doses of Wellbutrin above 450mg can lower the seizure threshold? Also you should take in 2 or 3 divided doses within the day.
You need to reference your pharmacology books and/or package inserts because the doctors don't always tell you. The seizure SE is the one I would worry about, not the yawning.
Good luck...............SG
Posted by mike lynch on July 28, 2006, at 10:04:38
In reply to Re: YAWNING/Wellbutrin dose too high, SE seizures, posted by stargazer on July 28, 2006, at 6:41:55
SSRI's definitely caused an increase in yawning for me, it may have been as severe as yours if I actually thought about it, but for me it was a minor thing that came and when.
Posted by Kay Vetter on July 28, 2006, at 11:51:56
In reply to Re: YAWNING/Wellbutrin dose too high, SE seizures, posted by stargazer on July 28, 2006, at 6:41:55
Yeah, I know about the lowered seizure threshhold, as I am a physician (not to be a smart alec, just reminding you). When I first started taking Wellbutrin (XL so it's once daily)
I started stuttering really bad and I had never stuttered before. I was treating myself at the time, I think it was in 2002, and I asked the drug rep if he knew about the stuttering, and he called someone at corporate, and they advised me to D/C the Wellbutrin. I did, and the stuttering stopped.
I told my shrink about this unusual (and not listed in the PDR or elsewhere) side effect,
and he wanted me to try it anyway, and see if I could tolerate the stuttering.
It did come back, and I still have it, but I have learned just to "slow my roll" with talking.
I usually speed talk.
Anyway, I tried holding the Lexapro to see if it made any difference, and no, it didn't
I held the Provigil, no effect
I held the WellbutrinXL, no difference
I upped my CPAP, things just got worse.
It is the Yawning I have a problem with.
I am starting to think I am just going to have to live with it.
Only thing I ever found related to possible causes of yawning were encephalitis, multiple sclerosis, epilepsy, brain tumor, and supranuclear palsy. None of those sound good, but I am quite sure I am not afflicted with those.
It probably is just what you say.
It is probably the mixture of the Lexapro and Wellbutrin that is causing it.
I don't think any of the SSRIs would be different, and I cannot d/c antidepressants, so I may just be stuck.
Of course, there is always that pesky little thing that always comes up when you talk about chronic fatigue. Get some exercise. Ugh, I hat it when I am told to do that.
But, I just might be getting desperate enough to try it!
Posted by noelle on July 28, 2006, at 19:59:26
In reply to Re: YAWNING/Wellbutrin dose too high, SE seizures, posted by Kay Vetter on July 28, 2006, at 11:51:56
I yawn all day too and always have on AD, I've kind of gotten used to it but it is embarrasing when I'm doing it infront of other people
Posted by kylenn on July 28, 2006, at 22:01:08
In reply to YAWNING, posted by kylenn on July 27, 2006, at 23:38:08
I think I may have made a connection this afternoon between the yawning and Wellbutrin's propensity to lower the seizure threshhold.
I did see on one of the sites I went to while looking for answers about yawning that it can be due to those weird diseases, and epilepsy was one.
Does that mean that yawning due to Wellbutrin is being triggered by the same receptors Wellbutrin lands on to cause the lowered seizure threshhold?
And, if so, does the yawning mean that you are closer to the threshhold? Or perhaps, have already crossed it?
Just wondering.
Don't get too technical if you know the answer.
Kylenn
Posted by llrrrpp on July 29, 2006, at 0:23:00
In reply to Re: YAWNING, posted by kylenn on July 28, 2006, at 22:01:08
Hi,
I was yawning a lot until I started provigil 2.5 weeks ago. now my fatigue is under control. occasionally I still have sleepy attacks. I believe these may be attributed to low blood sugar.I take 90 mg cymbalta & 12.5 or 25 mg of seroquel in the pm. 200 mg provigil in am.
Have you tried eating 5 small meals a day, and trying to keep your blood sugar pretty even (enough fat & protein, few refined carbs?)
this may help with yawning. Sorry it's so annoying. Another thing that's funny about yawning is that it truly is contagious. Observing a yawn is often sufficient to trigger a full-blown yawning reflex, suggesting that there may be a psychological trigger to yawning, even in the absence of fatigue. Have you ever noticed a pattern between a situation/thought and a yawn? If so, maybe there's a way to inhibit this response and replace it with something else. Just a wild suggestion.
best of luck to you,
-ll
Posted by wacky on July 31, 2006, at 15:59:48
In reply to Re: YAWNING/Wellbutrin dose too high, SE seizures, posted by Kay Vetter on July 28, 2006, at 11:51:56
Back in 91-2 I was hospitalized and had a very hard time disconnecting from my "professional" image to one of a patient. At the time I was working for the child abuse unit representing social workers in dependency cases. Then I became their patient in a psych ward - and it was VERY hard to overcome my own image problem - switching hats like that.
I too experienced a backlash from my employer due to the stigma associated not only with mental illness, but being "locked up." This competent attorney had a glich - and wasn't stable. Eventually I just left the office - and launched a private practice career. Fortunately for me - I was successful. But I can certainly see where others might not be so lucky.
Just thought I'd share that.
Posted by Dr. Bob on August 1, 2006, at 8:20:05
In reply to Re: YAWNING/Wellbutrin dose too high, SE seizures, posted by wacky on July 31, 2006, at 15:59:48
> Back in 91-2 I was hospitalized and had a very hard time disconnecting from my "professional" image to one of a patient.
Sorry to interrupt, but I'd like to redirect follow-ups regarding "professional" image to Psycho-Babble Work. Here's a link:
http://www.dr-bob.org/babble/work/20060706/msgs/672524.html
Thanks,
Bob
Posted by tiredmommy on August 1, 2006, at 23:55:54
In reply to YAWNING, posted by kylenn on July 27, 2006, at 23:38:08
I have had problems with yawning for the last few weeks as well. I've been on Wellbutrin 300 mg for a while, but I needed something more. So my doc added Cylexa but I wasn't willing to give up orgasms, so I switched to Cymbalta to supplement the Wellbutrin.
Anyway, I have noticed that when I started the Cylexa and since I've been on Cymbalta I have been yawning A LOT. It's embarassing since I've just started a new job and doesn't make the best impression with my new boss.
But my question is this: Back in the day when I did such things regularly, every time I was coming on to Ecstasy, I would yawn uncontrollable for a half hour or so. It feels similar when I have the yawning issues recently. Is there some connection? Some brain issue that I'm unaware of? Or am I just crazy? Which I'm also willing to accept. . . .
Posted by tizza on August 2, 2006, at 1:05:47
In reply to Re: YAWNING, posted by kylenn on July 28, 2006, at 22:01:08
SSRI's were by far the worst culprit for yawning I have ever experienced. Cipramil,(citalopram) was by far the YAWNING WINNER!!!!!!!!! After every yawn and or jaw chatter/wobble I would then clench my teeth so hard that I cracked several right down to the gum line. Prozac did this too and so did Luvox and Efexor XR to a lesser extent. It's not a good look at work when you're driving people around all day. I had never experienced this before and as soon as I stopped taking SSRI's it never came back. Have you raised your SSRI intake recently, that always made it heaps worse for me. I was going for 50+ big ones a day, so embarrassing. And I would just love to add that hearing a physician acknowledging Efexor withdrawal hell is just music to my ears. Thankyou so much for sharing that. Paul
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.