![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by uncouth on August 17, 2009, at 14:13:26
Hi friends,
I'm not doing so well right now. The ups and downs of the past few months have worn on me significantly, and 10 days ago, while driving, I felt the mornings elevated mood and positive thoughts (a welcome respite from the negativity) go away, quickly and strongly. It was like a dark cloud coming over me, I had never felt it happen so quickly like that before. Over the next few days, things got significantly worse and I took to my bed in pain.
Then, last Monday, I saw someone driving that I didn't expect to see in town, and it has triggered an absolute torrent, an obsessional, regretful, extremely sad and angry set of emotions that I have struggled to contain the past week. I was suicidal before, and absolutely suicidal after, this event.
I had an emergency pdoc session and my doctor put me on Aplenzin (aka Wellbutrin 300) to replace 80mg of Strattera. It seems to have made things worse, or at least I haven't seen any improvement yet. My sleep is worse, I'm sweating at night, and my mind anxious and in pain. I'm also a bit agitated, while at the same time exhausted and taken to bed. What a combination.
Does anyone with experience with Wellbutrin know when the mood elevation kicks in, or at least when or if these side effects will moderate?
I am in a deep, dark pit of obsessive regrets, thoughts of "what could have been", a feeling like I'm in hell and have nothing to save me, and have been very close to suicide this past week. I can't escape my past or redo things, i know, and yet I cannot imagine living with my poor decisions and these regrets any longer (themselves a function of not fully treated depression!). Some of the words in this forum have helped me to get through the pain, and also a little book of sermons I found called "Spiritual Depression", which if you are Christian I suggest. But even still, I feel utterly empty and without any sense of emotional hope -- all i have left is that logical hope scott speaks of, and i question whether that is enough sometimes. I also picture in my head my mother, and how she'd feel for the rest of her life if I killed myself. My own life and prospects just isn't enough to pull me through this darkness. So I look at it like I'm suffering through this immense indescribable pain for something, for the absence of her pain over my death. So far that has been enough, it has kept me going through the tossing and turning at night, and the fatigue and boredom of the day.
This is so sick, it is just so sick to lose one's sense of self, one's belief in life itself. IT feels like life is over for me despite ample evidence to the contrary. And it's not just a 'feeling' anymore, it's beyond that, it's a full fledged belief and imprisoning sickly rationality that tells me this.
This is all over the place, i'm sorry, i'm just at my wits end. But I just wanted to share what is keeping me alive right now. 1) my mother's love and my reciprocal love of her 2) logical hope 3) Faith, a very weak faith however, that God loves me, knows my sufferings, and wants the best for me, and that in some unimaginable way, this is part of his plan.
I have to admit #3 is hard to accept.
That's it for now.
Luvox CR 200mg
Aplenzin 344mg
Namenda 5mg (tapering off)
Lithium 200mg
Rilutek 100mg
Deplin 7.5mg
Geodon 120mg
Posted by Phillipa on August 17, 2009, at 14:24:18
In reply to Not doing so well right now...but pushing, pushing, posted by uncouth on August 17, 2009, at 14:13:26
Uncouth at the beginning of your thread you mentioned that you'd been feeling better I think and then felt a cloud of doom decend on you. What meds were you on when felt good or better and how did the cloud feel? I know you expressed it already. And then seeing someone and made it worse. Is the wellbutrin helping at all. Only been a few day right. Hey Scott's right. And If I can't offer med advise I can offer my support and willingness to listen to everything you say as suicide isn't the answer. In your mind any idea what would help you feel better a tiny bit. Does your Mom know you feel so horrible. And I sure give you a lot of credit for being able to drive as that's a chore for me. Hang in my friend. We're here to listen and some will give excellent medical adivise. And you know to admit if needed for safety. Loving thoughts your way. Love Phillipa
Posted by Phillipa on August 17, 2009, at 14:26:01
In reply to Not doing so well right now...but pushing, pushing, posted by uncouth on August 17, 2009, at 14:13:26
Wanted to add that wellbutrin was agitating for me and couldn't take it but that me. Phillipa
Posted by uncouth on August 17, 2009, at 14:27:02
In reply to Re: Not doing so well right now...but pushing, pushing » uncouth, posted by Phillipa on August 17, 2009, at 14:24:18
thank you. no, meds were all the same except for strattera, which i dont think was doing much good to begin with. when the cloud came over me, it's not like i was really even in great shape, i was just comparatively better and not suicidal.
thank you for your support. yes, my mom knows most of what i'm going through.
Posted by Maxime on August 17, 2009, at 14:58:59
In reply to Not doing so well right now...but pushing, pushing, posted by uncouth on August 17, 2009, at 14:13:26
I am really sorry that you are in such a dark place. A place I know all too well.
When I first started Wellbutrin I noticed a difference in my energy within a couple of days, as in I had much more of it. That's probably what is keeping you anxious at night. Which version are you taking?
I have no wise words for you right now. I just want you to know that I am here reading and that I care. Please keep posting if that helps.
I hope the storm passes soon.
Posted by SLS on August 17, 2009, at 15:57:15
In reply to Not doing so well right now...but pushing, pushing, posted by uncouth on August 17, 2009, at 14:13:26
Hi.
It is good that you have discontinued Strattera. I doesn't have a very good track record for treating depression. It really does work for ADD/ADHD, though.
It has been my observation that the majority of people who react to bupropion by exhibiting anxiety and agitation do not do well with it in the long run. However, I would still give it a few days to see if these things begin to abate. Trial-and-error is a methodical exploration of alternatives. I doubt anyone can be certain that you will not respond to this drug. Your best bet is to give the drug just a bit more time.
If you discontinued Strattera abruptly, perhaps some of what you are experiencing is withdrawal.
I hope things turn around for you quickly. At the very least, it would be nice not to be made worse by a drug.
3) Faith, a very weak faith however,> that God loves me
He does.> knows my sufferings
He does,> and wants the best for me
He wants what he wants. This is often left unknown.> and that in some unimaginable way, this is part of his plan.
Of course it is.
> Luvox CR 200mg
Interesting that you will be on an SSRI + bupropion. This is often a good combination. I am just not convinced that Luvox is the best choice unless the depression is secondary to OCD. I think excessive ruminations is depression and not OCD. Tricyclics are usually good for rumination. Luvox is probably the least effective SSRI for depression. If you can tolerate the bupropion, you might want to swap out the Luvox for Lexapro or Effexor.> Aplenzin 344mg
It can work well, but many people react to it with anxiety and agitation.> Namenda 5mg (tapering off)
I have never seen it work, but still think that it is potentially helpful. I have tried it twice. Both times, I felt better in the first week, and worse thereafter.> Lithium 200mg
Go to 300mg> Rilutek 100mg
Unless you need to take it for ALS, I don't see how this drug can benefit you. If it is not working - which it is clearly not - dump it.> Deplin 7.5mg
It seems to work early in treatment, than fades. I think 7.5 might actually be too high a dosage. It might be adding to your anxiety / agitation. If it were going to help, you wouldn't be feeling so bad.> Geodon 120mg
I would reduce the dosage to 40-80mg if you are using it for depression. One caveat: If you are going to go on an MAOI, you might have to discontinue Geodon so as to prevent serotonin syndrome. Geodon is a serotonin reuptake inhibitor.My doctor likes combining Lamictal with bupropion. If your doctor favors an antiglutamatergic approach, adding Lamictal is a reasonable choice. Riluzole and memantine are both antiglutamatergics. Also, a combination of Lamictal and lithium has shown good results in bipolar disorder to prevent both phases of the illness.
So... Are we having fun yet?
:-)
- Scott
Posted by bleauberry on August 17, 2009, at 18:35:27
In reply to Not doing so well right now...but pushing, pushing, posted by uncouth on August 17, 2009, at 14:13:26
>
> Luvox CR 200mg
> Aplenzin 344mg
> Namenda 5mg (tapering off)
> Lithium 200mg
> Rilutek 100mg
> Deplin 7.5mg
> Geodon 120mgI feel so badly about the place you are. I wish I had some pharmaceutical advice, but what could suggest would be "perceived" as drastic.
That is, start over. That means ditch them all, one by one, with carefully managed tapering over a period of 3 to 6 months. Find out who the real person is hidden under all those meds. Find out what the real depression is versus the med induced state of mind.A lot of people would probably scream at me for even thinking such a strategy. That's ok. I've seen it work a lot more often than the one you are pursuing...that is, changing one med or adding yet another.
If there is a med future for you, it should be ones completely different than anything you are on now. No more reuptake inhibitors. No more bizarre meds that no one even knows what they do...aka, wellbutrin, mood stabilizers, antipsychotics.
The low dose Lithium would be the only keeper, as that is actually...generally speaking...a rather healthy thing for the brain and body...at that dose.
Nardil and Parnate are keepers. As are a handful of life-style changes involving a food-choice overhaul with specific goals in mind, and a handful of specific targeted supplements or herbs, and a handful of "challenge" tests easily done with OTC products to see if you have something identifiable that has depression as a top symptom.
I don't preach what I don't do myself, and my history is longer and worse than yours. Just for reference. ECT failure here.
So I'm sorry I don't have much advice other than get off this bad ride and hitch a ride on a new one.
As a general observation of the last 15 years I've been here, I have witnessed that the people in the worst shape are usually the ones on the longest lists of meds. The odd thing is, they weren't that bad before the meds, but they don't see that. Spend a few dozen hours searching the archives here and this trend is quite pronounced.
There is something else causing your depression. It aint serotonin, norepinephrine, or dopamine. Biological, almost certainly. It is probably easier and cheaper than one knows to find out what it is and improve it. But that's a different topic.
If you are seeking spiritual connection with Jesus and God, that is awesome. I have heard of miraculous healing, but never seen it. I have felt unhuman strength to go forward, followed by wisdom to figure things out, but only when one turns to Him first, not to cures first. After all, one of the sins is to have other gods. We become so entrenched in our psychiatric world we view our meds as gods. If not gods, they are what occupies most of our thoughts and plans and feelings. That makes it hard to have a spiritual connection. He must come before all other things, and it is then He shows Himself. I believe the connection between us and Him is much stronger when the fewest things are standing in the way.
Posted by floatingbridge on August 17, 2009, at 19:06:56
In reply to Not doing so well right now...but pushing, pushing, posted by uncouth on August 17, 2009, at 14:13:26
Hi Uncouth,
I don't have any advice, or words of wisdom--others here have said it better than I could. I wish you relief from pain, and that your meds come together quickly for you.
keep posting,
fb
Posted by uncouth on August 17, 2009, at 19:09:32
In reply to Re: Not doing so well right now...but pushing, pushing » uncouth, posted by SLS on August 17, 2009, at 15:57:15
> Hi.
>
> It is good that you have discontinued Strattera. I doesn't have a very good track record for treating depression. It really does work for ADD/ADHD, though.
>
> It has been my observation that the majority of people who react to bupropion by exhibiting anxiety and agitation do not do well with it in the long run. However, I would still give it a few days to see if these things begin to abate. Trial-and-error is a methodical exploration of alternatives. I doubt anyone can be certain that you will not respond to this drug. Your best bet is to give the drug just a bit more time.
>
> If you discontinued Strattera abruptly, perhaps some of what you are experiencing is withdrawal.
>
> I hope things turn around for you quickly. At the very least, it would be nice not to be made worse by a drug.
>
> 3) Faith, a very weak faith however,
>
> > that God loves me
> He does.
>
> > knows my sufferings
> He does,
>
> > and wants the best for me
> He wants what he wants. This is often left unknown.
>
> > and that in some unimaginable way, this is part of his plan.
> Of course it is.
>
>Thank you scott for taking the time to write these words, I appreciate it immensely.
>
>
> > Luvox CR 200mg
> Interesting that you will be on an SSRI + bupropion. This is often a good combination. I am just not convinced that Luvox is the best choice unless the depression is secondary to OCD. I think excessive ruminations is depression and not OCD. Tricyclics are usually good for rumination. Luvox is probably the least effective SSRI for depression. If you can tolerate the bupropion, you might want to swap out the Luvox for Lexapro or Effexor.
>I had a mood elevation in June about 3 weeks into starting Luvox...but I was on many other meds at the same time, and two weeks later it went away. But it was a definite hypomania (bought a car and a motorcycle, selling both now). I don't know what to ascribe it to, but I agree that the Luvox may not be effective and could be hurting me, causing some fatigue. However my doctor wants to keep it on for my obsessional/ruminative thinking. Interesting about tricyclics for rumination, I didn't know that. I have had varying response to effexor in the past, and my longest state of stability was on Effexor + Lamictal, years ago.
> > Aplenzin 344mg
> It can work well, but many people react to it with anxiety and agitation.
>
> > Namenda 5mg (tapering off)
> I have never seen it work, but still think that it is potentially helpful. I have tried it twice. Both times, I felt better in the first week, and worse thereafter.
>I asked to be put on it to help out with ECT (22 treatments in the spring) related memory disfunction, but I think i've regained all I'm going to regain at this point, and i can't say it's done anything positive for my mood, and my doctor isn't convinced it's a great med for mood either.
> > Lithium 200mg
> Go to 300mg
>
will do.
> > Rilutek 100mg
> Unless you need to take it for ALS, I don't see how this drug can benefit you. If it is not working - which it is clearly not - dump it.
>
I was about 4 weeks into my riluzole trial when I had that mood elevation, so it could be something. I am guilty of being romanticized by the scientific literature with regards to riluzole, and it looks like a lithium-style neurotrophic agent. but i don't know if i should be experimenting with myself at this point. even still, i have this vision of neurons atrophying in my brain, and riluzole going in and protecting them, bringing them back to life. like i said, romantic attraction to drugs. :-/> > Deplin 7.5mg
> It seems to work early in treatment, than fades. I think 7.5 might actually be too high a dosage. It might be adding to your anxiety / agitation. If it were going to help, you wouldn't be feeling so bad.
>
> > Geodon 120mg
> I would reduce the dosage to 40-80mg if you are using it for depression. One caveat: If you are going to go on an MAOI, you might have to discontinue Geodon so as to prevent serotonin syndrome. Geodon is a serotonin reuptake inhibitor.
>well its supposed to be for depression/mood stabilizer as i'm BP2. but at 120mg it didn't protect me from hypomania, and i'm still deep in the pits, so i dont know what good its doing me. i'd like to reduce it too, but doctor says one thing at a time.
> My doctor likes combining Lamictal with bupropion. If your doctor favors an antiglutamatergic approach, adding Lamictal is a reasonable choice. Riluzole and memantine are both antiglutamatergics. Also, a combination of Lamictal and lithium has shown good results in bipolar disorder to prevent both phases of the illness.
>
> So... Are we having fun yet?
>
> :-)
>
> - ScottThanks for your wisdom scott.
Posted by uncouth on August 17, 2009, at 19:18:50
In reply to Re: Not doing so well right now...but pushing, pushing, posted by bleauberry on August 17, 2009, at 18:35:27
bleuberry thanks once again for your insightful post. i'm not against going off meds...but what got me into trouble in the first place was a slow taper off effexor and lamictal I did 4 years ago. i've never been able to replicate my success on that combination.
for what its worth, i've had ECT, rTMS (i'd consider both of them failures), so i too wonder where the real depression is coming from, and if it's simply not something that can be treated.
i did well on parnate last year. i shouldn't have gone off. silly me wanted to be on a stimulant for my adhd symptoms, and going off parnate led to the severe depression that necessitated ECT. i do think about going back on parnate, but am giving my doctor one more try with this SSRI/bupropion combo. i think there is something about withdrawing from an MAOI that is far more dangerous than any other sort of med switch, and doctors don't appreciate how significantly it throws off the brain. you cant just replace parnate with effexor+adderall, as I unfortunately now know firsthand.
you're right. absolutely right. medication has become my idol, and something has to change. i spend too much time on pubmed. i pray that somehow or another it does, by the grace of God.
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.