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Dr. Bob is Robert Hsiung, MD,
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Posted by KellyD on November 28, 2003, at 19:49:10
I am begining week 4 of a Wellbutrin XL trial. I am at a loss as to of it's really helping. I do feel a small bit better, but the extra anxiety it has brought is a very unwelcomed friend. My dose of Klonopin hasn't seem to help much. Some of the side effects I expected did not come true, but the anxiety is very disturbing and has caused the agoraphobic symptoms to reemerge.
I see Dr. on Monday - I don't think at this point the anxiety will decrease and I can't tolerate it at this level.
My primary problem started out with awful anxiety and the depression happened after 1 1/2 years use of Klonopin at a low dose.
I would like some info as to if Xanax is a "less depressing" anti-anxiety med. I have avoided it as the abuse potential seems to be higher, but I haven't had problems on Klonopin ---- so.
I don't want to try another AD, as it doesn't appear to suit me.
Advice appreciated.
Posted by zeugma on November 28, 2003, at 21:34:22
In reply to Fair Trial or Trudge On, posted by KellyD on November 28, 2003, at 19:49:10
I've heard a lot lately about the depressogenic effects of benzos. CALEB96 appears to be an expert on benzodiazepine pharmacology (or at least highly knowledgeable), and in his comment on a thread I contributed to (a ways up called "Benzo Blabber") he said they basically ALL induce depression after a while.
However, I have read studies suggesting that Xanax actually works as an AD in certain people.
Have you tried any other AD's besides WB? WB is probably one of the more anxiogenic AD's, so I would think it is not an ideal choice for someone who has bad anxiety to begin with.Best of luck,
z
Posted by KellyD on November 28, 2003, at 23:38:09
In reply to Re: Fair Trial or Trudge On, posted by zeugma on November 28, 2003, at 21:34:22
Thanks for your response. Yes, I have been the SSRI's route. Zoloft was the worst, with Paxil running a close second. From there, it was Buspar. I just don't tolerate "stuff" really well. The Klonopin was a godsend for quite a while. I'm really not a benzophobe. I was able to function really well, on a low dose. The depressive symptoms began about two months ago.
I knew going into it,Wellbutrin was not a REALLY good choice, but options were somewhat limited. I thought the Klonopin would take care of the "excess" anxiety.
Thethought of a TCA or MAOI is not one I care to entertain.
I guess I'm picky and may want what I'm not willing to put up with to get there. I just don't like that this journey to be well has to include weeks of feeling "hellish".
The promise of these meds is wonderful. The reality is a bit more hollow.
Thanks again.
Posted by Dinah on November 29, 2003, at 10:39:09
In reply to Re: Fair Trial or Trudge On » zeugma, posted by KellyD on November 28, 2003, at 23:38:09
> The promise of these meds is wonderful. The reality is a bit more hollow.
>
> Thanks again.
>Isn't it the unfortunate truth? I take it that you, like me, have problems with agitation from antidepressants? I found nortriptyline to be an awful lot like Effexor in that regard.
On the other hand, I was able to tolerate Luvox fairly well. I think it's one of the least activating SSRI's. No orgasms for the four years I was on it of course. And an apathy that was hard to shake. Of course, everyone is different.
How long has your pdoc asked you to give Wellbutrin to let the start up side effects wear off? And has he tried adding mood stabilizers to any of the antidepressants?
I'm faced with a similar decision right now. My brand new migraine specialist doubled my Depakote to a still low 250 mg., and I find myself definitely more depressed in an extremely crabby and irritable sort of way. It's getting in the way of my family life. And I don't think I'm imagining that my hair is falling out. As much as I want to be compliant with the new doc's recommendations, I'm going to skip it for a few days and see if I become human again.
Posted by KellyD on November 29, 2003, at 11:22:55
In reply to Re: Fair Trial or Trudge On, posted by Dinah on November 29, 2003, at 10:39:09
Thanks for writing Dinah. I'm sorry for your problems, too.I honestly have times I feel this is making me feel better. I know I'm smoking less (yes, awful habit and isn't helping the issues at all).
My Dr. wanted me to give it 'til I returned on Monday appt.
I think I might discuss changing the the benzo to Xanax and maybe that will make a difference.
We'll see.
Hope you work it out, too.
Posted by Dinah on November 29, 2003, at 12:30:28
In reply to Re: Fair Trial or Trudge On » Dinah, posted by KellyD on November 29, 2003, at 11:22:55
If it's helping you and you can get the side effects under control, that would be great. Good luck Monday!
Posted by Emme on November 29, 2003, at 21:35:16
In reply to Fair Trial or Trudge On, posted by KellyD on November 28, 2003, at 19:49:10
The Serzone is sedating and should counteract the anxiety from Wellbutrin. That combo was very good for me for a while. I think there were some liver issues associated with Serzone, but I don't know what the incidence of problems is and whether it's scared a lot of doctors off of it. Maybe see what your doctor thinks about it.
Emme
Posted by Viridis on November 29, 2003, at 22:00:48
In reply to Fair Trial or Trudge On, posted by KellyD on November 28, 2003, at 19:49:10
I haven't had depression problems with Klonopin, which I take every day, but I do take Adderall as well for ADD, and it has a substantial AD effect. Even before I started Adderall, though, I found that Klonopin decreased my depression by reducing my anxiety -- I think that a lot depends on the cause of your depression, and if it's anxiety-based, then benzos can be a big help.
Xanax does appear to have AD effects for some people, and I always find myself in a good mood the day after taking it (I use it occasionally for additional anxiety relief).
What worried me with Xanax is that, unlike Klonopin, I developed definite tolerance to it even with occasional use, so now it takes several times as much to achieve the same results. I never had any other problems with it, but wouldn't want to use it regularly for anxiety relief (although maybe my tolerance would reach a plateau?). My pdoc says he's seen this before, and is much more cautious with Xanax than Klonopin. He'll give me enough Xanax for the occasional flare-up but (especially given my development of tolerance) prefers that I use it sparingly, whereas he's fine with daily use of Klonopin.
Wellbutrin has a reputation for causing severe anxiety in some people, and I had a terrible time with it even after 8 weeks. It's great for some people, but my pdoc avoids it for anxiety-prone patients. I also can't tolerate SSRIs, but WB was the worst for anxiety.
One med that you might find helpful is Strattera. It's prescribed mainly for ADD but can also have antidepressant effects. I found it helpful mood-wise for quite a while, although its positive effects for me seem to have waned lately. The main thing with Strattera is to increase the dose fairly slowly, or you may experience side effects like nausea and dry mouth. These disappeared quickly for me when I tapered the dose up in increments, starting at 25 mg and moving to 80 over a few weeks. Although Strattera is supposed to be a norepinephrine reuptake inhibitor like Wellbutrin, I actually found it calming (Wellbutrin made me a nervous wreck and had all sorts of weird side effects).
Good luck!
Posted by KellyD on November 29, 2003, at 22:59:34
In reply to Re: Fair Trial or Trudge On » KellyD, posted by Viridis on November 29, 2003, at 22:00:48
Thank you all for your input. I don't know really what I'll do. There will be a long discussion on Monday.
Klonopin has been good to me. The depressive symptoms could have certainly been life factor related.
I have avoided Xanax, but I'm wondering.... my Klonopin dose was low and I'm trying to be postive that mayhaps I wouldn't have a tolerance issue. I guess I won't know unless I try... famous words - used that in the WB trial.
Thanks again to you all.
Posted by femlite on December 1, 2003, at 11:18:30
In reply to Re: Fair Trial or Trudge On, posted by KellyD on November 29, 2003, at 22:59:34
Hi Kelly
Ive probably missed you before your pdoc apointment.
Have you considered BP?
It could be that you need a mood stabilizer. Could be a better long term solution than benzos (and Im not a benzophile either)
The WB sounds like its not working out, as I think you would have some idea by now.
Let us know how it goes okay
Warmest regards
> Thank you all for your input. I don't know really what I'll do. There will be a long discussion on Monday.
> Klonopin has been good to me. The depressive symptoms could have certainly been life factor related.
> I have avoided Xanax, but I'm wondering.... my Klonopin dose was low and I'm trying to be postive that mayhaps I wouldn't have a tolerance issue. I guess I won't know unless I try... famous words - used that in the WB trial.
> Thanks again to you all.
Posted by KellyD on December 1, 2003, at 11:53:07
In reply to Re: Fair Trial or Trudge On » KellyD, posted by femlite on December 1, 2003, at 11:18:30
femlite,
Thanks so much for your support. This is the second day without Wellbutrin and I feel good. I feel like my Klonopin is working.... which is something I did not feel was happening on WB. Or, at the very least, it wasn't taking care of the possible WB induced anxiety. I'm more positive and actually am going on errands prior to my appt. this afternoon. (good for an agoraphobe)
The holiday and the two days after were AWFUL and I felt horrible.
I do feel a bit like the kid who has to tell a parent, I failed a test. My Dr. is good and we do have open communication - although, I'm quite frustrating at times.
I don't really met the criteria for BP. I've never been manic and my depression seems to "slide" in. I don't equate it with cycling and swings. I guess it's not totally out of the realm of possibility.
I truly think my PRIMARY issue is with anxiety and whether the depressive symptoms are, just that - in and of themselves, or due to poor anxiety control, or the benzo use - I guess I can't say really. Most docs don't accept an anxiety disorder as a free standing diagnosis, in particular, when depressive symptoms are involved also.
I've tried three different AD's and I'm shellshocked at this point on meds.
Fish Oil is looking real good these days to me and some "alternative" ideas.Anyway, thanks for your kind words. I hope you are working your stuff out.
I'm just thankful today is a good day. One day at a time... it ain't easy to do, but I gotta be thankful for the good days.... it's the first one in a while, actually.
My Best Wishes to you, too - hang in there,
Kelly
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