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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by WhiteTiger on April 24, 2009, at 20:31:57
Ok so my GP prescribed 225 mg Wellbutrin and lowered my dose of Zoloft to 100. She did this to help me quit smoking.
I called my pdoc just to check to see if this was "kosher."
She called back and left a message (I was on the other line and didn't know it was her beeping in) that I should stay at 150 on the Zoloft and only take 150 mg of the Wellbutrin.
Well, that would not be enough to decrease my drive to smoke!
She said there was danger of manic cycling that I need to monitor and she needs to monitor.
Strange thing is, on this stuff, I slept until 2 pm today. Granted, I had a sleep study done last night and it was NOT a restful night's sleep. I probably have apnea.
I'm listening to my GP and not my pdoc. I see the pdoc on Tuesday though. I hope she isn't pissed at me. I called and left a message with the weekend after hours service that I plan to continue following GP's prescription.
Added Note: I had already taken my 225 mgs for the day when she called. So, I decided that since I'm tolerating it well, to continue the trial my GP intended.. unless I hear differently on Tuesday from pdoc.. and I will listen to her then.
I just googled Wellbutrin and mania and found that Wellbutrin is the least likely to cause mania of the SSRI's. My BF calls my psychiatrist "Dr.Ditz" because she's screwed up my prescriptions twice. I don't switch because I can tolerate her okay.But to call me and request an immediate appointment over this seems rather strange to me.
I'll follow whatever advice she gives on Tues, but until then, I'm listening to my GP's prescription.
Other meds I'm on: Lamictal, Klonopin, Abilify, Propranolol
Posted by Phillipa on April 24, 2009, at 23:14:10
In reply to Too Many Cooks in my Medication Kitchen!, posted by WhiteTiger on April 24, 2009, at 20:31:57
Wellbutrin isn't an SSRI. Not to sound like I know a lot as don't but they do act differently. I think wellbutrin effects dopamine. Love Phillipa ps I do know it's stimulating took it once at 150 and ended up in hospital. Heard it's also good for bipolar.
Posted by Ceres on April 25, 2009, at 3:16:26
In reply to Too Many Cooks in my Medication Kitchen!, posted by WhiteTiger on April 24, 2009, at 20:31:57
Hi, White Tiger~
It's messy for one doctor to alter another specialist's concurrent treatment. I'm surprised that the GP didn't regard the importance of coordinating treatment changes w/ your psychiatrist. Does she know your diagnosis?
So quitting cigarettes is important for health, but preventing a potential suicidal depression or manic state might be a more immediate issue.The p-MD's wanting to find a solution in person makes sense to me. ..And, it's good that she's fitting you in soon --so many psychiatrists are overbooked now. Maybe she'll want you to sign a release-of-info (is that what it's called?) so that she can coordinate w/ your GP.
re: Mixing up Rx's
I don't know how bad the mix-ups were. Does it feel like she takes you seriously?
For me, if a doctor tries to be conscientious, I try to cut them some slack. Some of my doctors also struggled w/ illness & medication side effects that caused problems w/ short-term memory, --& I can so relateWelbutrin: --in my experience caused heavy sedation at first & w/ dose increase, became stimulating --I have friends who used it to quit smoking, though a few have retained the patch & nicotine gum, still a big improvement
Good luck w/ your apt, working treatment out btwn the 3 of you
Posted by Zana on April 25, 2009, at 10:23:32
In reply to Re: Too Many Cooks in my Medication Kitchen!, posted by Ceres on April 25, 2009, at 3:16:26
Welcome. Wellbutrin and zoloft can be an over-stimulating combination. I would stick with one doc, probably your pdoc for exactly the reasons you gave. Your title is right. There are too many cooks in your med kitchen. I'd wait until you've seen your pdoc to make any changes. If you don't really trust her jugdement, maybe you need a new doc. I'm sure the sleep study through a wrench in the works. Hard to know how you'll feel after a few days on a regular schedule.
Hope things settle down.Zana
Posted by WhiteTiger on April 25, 2009, at 11:58:04
In reply to Re: Too Many Cooks in my Medication Kitchen!, posted by Zana on April 25, 2009, at 10:23:32
Thanks. I can now see why my pdoc has been so cautious. There's really no excuse why my GP didn't coordinate care with my pdoc, since they are in the same health network and my records are in a central computer that they share.
Still, I'm giving the wellbutrin 225 mg a chance for now. If I get manic, I'll take klonopin and take the dose down, like the pdoc said. I'll have my BF watch me to see if I'm getting manic.
The thing is, this is day 2. I'm still just sleepy on it. It's not the reaction one would expect, is it?
Posted by bleauberry on April 26, 2009, at 18:13:20
In reply to Too Many Cooks in my Medication Kitchen!, posted by WhiteTiger on April 24, 2009, at 20:31:57
Too many cooks in the medication kitchen? Yeah, I know how that is.
Well, just for grins to lighten up the discussion, how about if we add yet one more cook? I just wanted to say that if the goal is to take something to help reduce the urge to smoke, and at the same time it has to be something that goes very well with Zoloft, I would have recommended Nortriptyline instead of Wellbutrin.
Posted by jane d on April 27, 2009, at 1:32:22
In reply to Re: Too Many Cooks in my Medication Kitchen!, posted by WhiteTiger on April 25, 2009, at 11:58:04
>
> The thing is, this is day 2. I'm still just sleepy on it. It's not the reaction one would expect, is it?WhiteTiger,
If your sleep study was anything like mine you basically lost a full nights sleep 2 nights ago. If you're still tired after a couple more days than I might wonder if it was the meds.
I'm with Zana that you should be letting your psychiatrist handle the meds and if you don't trust her than you should replace her. You're on Zoloft, Lamictal, Klonopin, Abilify, Propranolol and now you've added Wellbutrin. Oh yeah. Don't forget that you're currently on nicotine as well. This is not the kind of combination GP's get enough experience with.
I used Wellbutrin successfully to quit smoking years ago. I took 300 mg. I was taking it as an antidepressant but I'm positive it was what made it possible for me to finally quit. It still wasn't easy. It took months, lots of nicotine gum, and multiple relapses but I've now been an ex smoker for years. Keep in mind that once you aren't smoking you may need to adjust your other medications again. Nicotine is a powerful (and I think helpful) psychiatric drug. Also, if you do have apnea, treating it may help.
jane
Posted by manic666 on April 27, 2009, at 13:24:48
In reply to Too Many Cooks in my Medication Kitchen!, posted by WhiteTiger on April 24, 2009, at 20:31:57
you mean people in america an places take mental issue meds to stop smokeing . thats unbelievable,you could finish up with more addictions ,docs in england would show you the door sraight away. you may get free patchs,but i dont believe what im reading thats crazy. i would sooner take my chances with the cigs than meds. i dont smoke but i used to , i would swap my mental illness to smoke 50 cigs a day with anyone.
Posted by manic666 on April 27, 2009, at 13:28:43
In reply to i dont get this at all, posted by manic666 on April 27, 2009, at 13:24:48
i think i misunderstood the tread ,well i least i hope i did sorry.
Posted by sowhysosad on April 27, 2009, at 14:13:29
In reply to i dont get this at all, posted by manic666 on April 27, 2009, at 13:24:48
> you mean people in america an places take mental issue meds to stop smokeing . thats unbelievable,you could finish up with more addictions ,docs in england would show you the door sraight away.
Well, only about a quarter would according to this study. The rest regularly write scrips for bupropion for smoking at the rate of around 2 per month:
Posted by jane d on April 28, 2009, at 23:15:55
In reply to i dont get this at all, posted by manic666 on April 27, 2009, at 13:24:48
> you mean people in america an places take mental issue meds to stop smokeing . thats unbelievable,you could finish up with more addictions ,docs in england would show you the door sraight away. you may get free patchs,but i dont believe what im reading thats crazy. i would sooner take my chances with the cigs than meds. i dont smoke but i used to , i would swap my mental illness to smoke 50 cigs a day with anyone.
Manic,
Yup. Wellbutrin is even marketed under another name, Xyban, just for smokers. I haven't heard of Wellbutrin being particularly addictive or dangerous but then it's been a long time since I've done any reading on medication so maybe I'm wrong about that. I do agree that any psych med has risks and should be used only when necessary. Personally I think people should try other ways to quit first. But cigarettes are dangerous too So if they can't quit than I think it's worth taking a small risk IF wellbutrin really does help people quit smoking. And while I tend to distrust most of the claims made by the drug manufacturers I do believe that it did help me to quit. It's hard to describe exactly what it did. I still had cravings - just not as severe. Maybe a small monkey on my back, not a hyperactive orangutan.jane
Posted by manic 666 on April 29, 2009, at 12:55:05
In reply to Too Many Cooks in my Medication Kitchen!, posted by WhiteTiger on April 24, 2009, at 20:31:57
talking about smokeing i havent smoked for years ,an i went fishing an sparked up a cigar you no those little ones with a filter. i was on my own in this beutiful lake an it felt cool.i bet i do it again , i dont hammer them but there is a couple in my fishing bag.
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