![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 33 to 57 of 106. Go back in thread:
Posted by Athena on October 22, 2000, at 14:18:24
In reply to Re: Ah a healthy discussion, i like it! » Athena, posted by KenB on October 22, 2000, at 13:49:33
> Athena,
>
> The "Hedonic range?" post below was inspired somewhat by your comments in this thread, but I started a new thread to avoid side tracking this one. This could probably fit as well on that social page, too, but it addresses the underlying philosophies that relate to the use of medications, and it relates to this "Are meds the answer?" discussion, so I put it here.
>
> Kendall
>
Hey Kendall, where's the "Hedonic Range?" new thread? I've looked everywhere, can't find...I would love to read it.
Athena
>
>
>
> > Oh contrare, people...
> >
> > actually, antidepressants HAVE done me a lot of good, as they have for most of you. By this I mean, I too have been at the bottom, seriously contemplating death, not wanting to take even one more intensely miserable breath in this world...and then I was put on Zoloft. For depression & anxiety (wouldn't wish that combination on anyone, even Hitler). Of course, Zoloft didn't work, and then I was put on Luvox, and it WORKED.
> >
> > And, yes I agree, ADs are NOT "happy pills." Luvox did not make me "happy." I guess the easiest way to describe it is I found each breath a little easier to take. That is all. The courage to breathe just a little longer...
> >
> > Two years later, here I am, coming off of these meds and all I am doing is offering my opinion, another opinion to make you guys think about your situation & choices. Are you doing the right thing for you? I truly hope so. Because no one told me the negative aspects to taking meds, nobody told me that withdrawing from them would be worse than my worst nightmare, so I want to tell YOU, so that at least you have heard of it before.
> >
> > And no, I do not know you, that is obvious. I do not know your personal pain more than you know mine. But I am human, and I know depression, and I know that dark abyss too. I just don't want anyone to go through what I have had to endure...w/o at least being warned beforehand.
> >
> > Do not think that I am here to attack anyone, anyone at all, because I am not. I am here to help you learn, as hopefully I can learn from you...
> >
> > So ...
> >
> > Are meds REALLY the answer?
> > Is exercise the answer?
> > Is a red flashy convertible the answer?
> > A palm pilot?
> > A new computer?
> > A new haircut?
> > New clothes?
> > and on and on....
> >
> > Well? IS IT?
> >
> > Tell me, is there ANYTHING outside of yourself that IS the answer?
> > I'd really like to know what you guys think.
> >
> > Oh the woes of Luvox withdrawals,
> > Athena
Posted by chdurie2 on October 22, 2000, at 14:43:13
In reply to Re: Ah a healthy discussion, i like it!, posted by Athena on October 22, 2000, at 14:18:24
> > Athena,
> >
> > The "Hedonic range?" post below was inspired somewhat by your comments in this thread, but I started a new thread to avoid side tracking this one. This could probably fit as well on that social page, too, but it addresses the underlying philosophies that relate to the use of medications, and it relates to this "Are meds the answer?" discussion, so I put it here.
> >
> > Kendall
> >
> Hey Kendall, where's the "Hedonic Range?" new thread? I've looked everywhere, can't find...I would love to read it.
> Athena
> >
> >
> >
> > > Oh contrare, people...
> > >
> > > actually, antidepressants HAVE done me a lot of good, as they have for most of you. By this I mean, I too have been at the bottom, seriously contemplating death, not wanting to take even one more intensely miserable breath in this world...and then I was put on Zoloft. For depression & anxiety (wouldn't wish that combination on anyone, even Hitler). Of course, Zoloft didn't work, and then I was put on Luvox, and it WORKED.
> > >
> > > And, yes I agree, ADs are NOT "happy pills." Luvox did not make me "happy." I guess the easiest way to describe it is I found each breath a little easier to take. That is all. The courage to breathe just a little longer...
> > >
> > > Two years later, here I am, coming off of these meds and all I am doing is offering my opinion, another opinion to make you guys think about your situation & choices. Are you doing the right thing for you? I truly hope so. Because no one told me the negative aspects to taking meds, nobody told me that withdrawing from them would be worse than my worst nightmare, so I want to tell YOU, so that at least you have heard of it before.
> > >
> > > And no, I do not know you, that is obvious. I do not know your personal pain more than you know mine. But I am human, and I know depression, and I know that dark abyss too. I just don't want anyone to go through what I have had to endure...w/o at least being warned beforehand.
> > >
> > > Do not think that I am here to attack anyone, anyone at all, because I am not. I am here to help you learn, as hopefully I can learn from you...
> > >
> > > So ...
> > >
> > > Are meds REALLY the answer?
> > > Is exercise the answer?
> > > Is a red flashy convertible the answer?
> > > A palm pilot?
> > > A new computer?
> > > A new haircut?
> > > New clothes?
> > > and on and on....
> > >
> > > Well? IS IT?
> > >
> > > Tell me, is there ANYTHING outside of yourself that IS the answer?
> > > I'd really like to know what you guys think.
> > >
> > > Oh the woes of Luvox withdrawals,
> > > AthenaAthena-Ken's reply is new thread called "hedonic...?" listed after "The Visit" below.
Caroline H.
Posted by KenB on October 22, 2000, at 14:43:45
In reply to Re: Ah a healthy discussion, i like it!, posted by Athena on October 22, 2000, at 14:18:24
> Hey Kendall, where's the "Hedonic Range?" new thread? I've looked everywhere, can't find...I would love to read it.
> AthenaMaybe you have refreshed your window with this thread, but not the main board. I suspect you have found the "Hedonic range?" post by now, but here is the direct URL:
Posted by Buffet on October 22, 2000, at 16:44:17
In reply to Ah a healthy discussion, i like it!, posted by Athena on October 22, 2000, at 8:20:18
Athena said...
> Are meds REALLY the answer?
> Is exercise the answer?
> Is a red flashy convertible the answer?
> A palm pilot?
> A new computer?
> A new haircut?
> New clothes?
> and on and on....
>
> Well? IS IT?My answer is join a Gym, get excercise, get some goals, get a haircut, go get a tan, go rock climbing, get married (or a relationship), maybe some religion, and hell- try the drugs out if you think they might help you. Prozac did help me for about a year and faded. Zoloft helped for about 4 months and faded. I enjoy being a lab rat because my knowledge base of what works and what doesn't slowly increases to the point that I finally start to narrow my drug choices down to ones that work. When they stop working, the imput from the drug users help in some way to create better drugs down the pipe. I'm looking for the day when a GABA increasing drug comes out, and I'll be the first to try it! The drugs will eventually get better, and if the present ones work for you then use 'em.
Posted by Athena on October 22, 2000, at 16:55:22
In reply to I'm a lab rat and kinda enjoy it!!! » Athena, posted by Buffet on October 22, 2000, at 16:44:17
My answer is join a Gym, get excercise, get some goals, get a haircut, go get a tan, go rock climbing, get married (or a relationship), maybe some religion, and hell- try the drugs out if you think they might help you. Prozac did help me for about a year and faded. Zoloft helped for about 4 months and faded. I enjoy being a lab rat because my knowledge base of what works and what doesn't slowly increases to the point that I finally start to narrow my drug choices down to ones that work. When they stop working, the imput from the drug users help in some way to create better drugs down the pipe. I'm looking for the day when a GABA increasing drug comes out, and I'll be the first to try it! The drugs will eventually get better, and if the present ones work for you then use 'em.
Buffet: of course if being argumentative makes you happy, by all means proceed. Personally, I definitely don't see the point in continually searching through drugs and more drugs and whatever else. But if you are HAPPY trying things that continually fail, then by god more power to you. What EVER makes YOU happy.
But I know that Instant Gratification is not the answer for me. I need things that I can depend on.
Posted by coral on October 22, 2000, at 21:00:25
In reply to Re: I'm a lab rat and kinda enjoy it!!!, posted by Athena on October 22, 2000, at 16:55:22
Dear Athena,
Zoloft worked like an absolute charm for me, after a ton of trial and error. But, I also coupled therapy with the meds.
You mentioned "something you can depend on," and I'd like to know where you can TRULY find that in this world, outside of basics, such as the earth turning on its axis. Ultimately, it comes down to depending on me since it is my life. That brings me to the most frustrating part of the depression for me. I failed me. After four decades of successes and failures, losses, grief, joys, being able to work through problems, always depending on my mind, my own mind turned against me and threw me into the darkest abyss. I still haven't come to terms with that betrayal.
Crawling out of the hole of hell required meds and therapy. I don't believe either one alone would've worked. So, your question is a good one. The answers and solutions are within me; providing my brain so that its chemistry is property balanced and therapy to deal with crucial issues that negatively impact my life.
Posted by stjames on October 22, 2000, at 21:54:47
In reply to Re: I'm a lab rat and kinda enjoy it!!!, posted by Athena on October 22, 2000, at 16:55:22
> But I know that Instant Gratification is not the answer for me. I need things that I can depend on.James here.....
I've never found meds to be much of an instant gratification as they
take months to reach full effect.james
Posted by Buffet on October 23, 2000, at 0:53:10
In reply to Re: I'm a lab rat and kinda enjoy it!!!, posted by Athena on October 22, 2000, at 16:55:22
-------------------------------------------------
> Buffet: of course if being argumentative makes you happy, by all means proceed. Personally, I definitely don't see the point in continually searching through drugs and more drugs and whatever else. But if you are HAPPY trying things that continually fail, then by god more power to you. What EVER makes YOU happy.
> But I know that Instant Gratification is not the answer for me. I need things that I can depend on.
---------------------------------------------------
I'm sorry Athena, but I wasn't being argumentative. I agree with your frustrations and do see your point. When I said join a gym, blah blah blah... I meant it! These have been things that have pulled me out of depressive episodes on occasion. I was trying to say that any change of pace will sometimes change your mental outlook. I was saying that taking the meds for me has been a good thing, and when one med doesn't work (or poops out) I look forward to trying out a new one in hopes that it helps (changing meds is another change of pace thing for me).When I find myself trapped in my apartment because of low energy levels and depression, there comes a point where I just jump up and drive somewhere in attempts to just do something. Sometimes it works, other times it doesn't. There is no "answer", but there are things that one can do in attempt to combat depresion and other mental illness, and taking the drugs has helped me more than hindered me. I don't see it as instant gratification. For me, instant gratification is going out and using a street drug or alcohol for an immediate change in mood, which is something I absolutely CANNOT do anymore because I'm prone to abuse. Taking an AD is definitely not instant grat, but I don't think that was what you were getting at, right?
Hope this clarifies what I was getting at.
Buffet
Posted by Athena on October 23, 2000, at 16:49:19
In reply to Re: I'm a lab rat and kinda enjoy it!!! » Athena, posted by Buffet on October 23, 2000, at 0:53:10
> So I've been thinking of what I mean by instant gratification...and the answer the keeps popping up in my mind is anything that is outside of yourself. Well almost anything. Working hard at things for a long time to find results surely doesn't qualify as "instant gratification."
I guess I mean that, especially in the American society, we are almost programmed, encouraged, to look OUTSIDE of ourselves for our happiness. Like I said before...a new haircut, new clothes, cars, money, the ultimate diet, and yes, drugs. And in my mind, I do group ADs into this category as well. Obviously I know that you guys may not agree, we have different experiences/perspectives, and that's perfectly cool. That's why it's so interesting to be on a board and challenge each other's intellect & viewpoints. Learning.
I guess my challenge to you guys is not to look outside of yourself for that answer. Our world is full of "quick fixes" and millions of illusions.
So what can we depend on, one of you asked? What can we know is solid and true and will never betray us?
Knowing that there is something greater than ourselves...that none of the bullshit of this world means a damn thing....illusions, all of it. "Change is the only constant." And that's what I can depend on.
I don't even depend on my "image" of myself, because that is fleeting as well. My mind also will send my into the depths of despair, anxiety, suicidal thoughts...So I do not rely on myself, in the sense of this "self-image" as this is yet another illusion.
I seek Truth, and I will until I die...through the depths of hell, despair, even bliss, I seek it, and I want to learn as much as possible...and one of the best places to learn to from other people.
"The more you know the less you need."
Posted by allisonm on October 23, 2000, at 21:59:53
In reply to Re: I'm a lab rat and kinda enjoy it!!!, posted by Athena on October 23, 2000, at 16:49:19
< < I guess my challenge to you guys is not to look outside of yourself for that answer. Our world is full of "quick fixes" and millions of illusions. > >
This is all well and good and true. However, I suspect that lectures on the subject will have little effect. The only way to learn such lessons is for one to experience the disappointment and find, define, and refine within themselves what is really meaningful. Some people never get there, and no one can make them go.
Posted by S. Howard on October 23, 2000, at 22:12:51
In reply to Re: I'm a lab rat and kinda enjoy it!!!, posted by allisonm on October 23, 2000, at 21:59:53
First: the medication I take (seroquel, depakote and paxil) is not mood-altering (damn!) so I wouldn't consider it "instant gratification".
Second: whoever suggested "getting married" as a way to allieviate depression was hopefully not serious. Even if it works for a short time, eventually you will drag your partner into your personal hell, along with any kids you might have. Before long, you will have created your very own dysfunctional family. Get help first please. -SGH
Posted by Athena on October 23, 2000, at 22:28:21
In reply to Re: I'm a lab rat and kinda enjoy it!!!, posted by S. Howard on October 23, 2000, at 22:12:51
> First: the medication I take (seroquel, depakote and paxil) is not mood-altering (damn!) so I wouldn't consider it "instant gratification".
Um, okay, I would definitely have to disagree with you here...seroquel, depakote, and paxil definitely ARE mood-altering drugs. But I know what you mean by "instant gratification"/mood-altering drugs...as in ecstasy, weed, etc.
So, SSRIs are not "instant gratification" but they do fit into the category of "quick fixes." You still have issues even though you are taking a pill.
> Second: whoever suggested "getting married" as a way to allieviate depression was hopefully not serious. Even if it works for a short time, eventually you will drag your partner into your personal hell, along with any kids you might have. Before long, you will have created your very own dysfunctional family. Get help first please. -SGH
Posted by Buffet on October 24, 2000, at 1:29:12
In reply to Re: I'm a lab rat and kinda enjoy it!!!, posted by S. Howard on October 23, 2000, at 22:12:51
> Second: whoever suggested "getting married" as a way to allieviate depression was hopefully not serious. Even if it works for a short time, eventually you will drag your partner into your personal hell, along with any kids you might have. Before long, you will have created your very own dysfunctional family. Get help first please. -SGH
Yup, that was me. And yes, I was kidding a little there. I just got married (about three months ago), and I'm still in the initial phase and must admit that it is fun. Definitely has its ups and downs and those will increase later on I know...Buffet
Posted by coral on October 24, 2000, at 5:46:26
In reply to Re: I'm a lab rat and kinda enjoy it!!!, posted by Athena on October 23, 2000, at 22:28:21
SSRI's are "quick fixes?" I don't think so . . . they're also not mood altering (in the way in which I THINK you mean it), they're mood correcting. If someone has disrupted blood chemistry due to a thyroid dysfunction, is taking Synthroid a mood-altering drug? Of course not. The same is true with the SSRI's, they correct the brain chemistry that's gone awry. IF a person is on the correct meds, the person is functioning normally, not in an altered state (it is difficult to make sure a person is on the right meds!!!)
There are some religious beliefs that disavow any medical intervention and that, of course, is a person's choice of beliefs.
I feel that we're evolving into a more holistic approach to healing in the west and have gained a great deal from Eastern teachings. It's insulting to hear a physician refer to a patient in a room as "The gall bladder in 214."
The US (and many other countries as well) has a history of medicating people who were "different" into submission, even to the point of lobotomies.
Athena, I don't know what your symptoms are and wouldn't presume to advise you in your methods of choice for healing, searching for Truth, etc. And, you're right that many people have had the experience of being a lab rat as new meds were tried, some successful, some not.
There's also little doubt about the incredible power of the mind that we're just beginning to understand. I don't speak for anyone else. I'm combating an endogenic depression. As I've said before, the answers are within me, and that includes how appropriately I evaluate potential help, what I do to correct and alleviate the problems, and what I can do to prevent them from happening. For me, it's a combo of meds and therapy.
Posted by Athena on October 24, 2000, at 16:01:52
In reply to Re: I'm a lab rat and kinda enjoy it!!!, posted by coral on October 24, 2000, at 5:46:26
the answers ARE within you, not outside of you.
Posted by pullmarine on October 24, 2000, at 16:05:29
In reply to Ah a healthy discussion, i like it!, posted by Athena on October 22, 2000, at 8:20:18
>
> So ...
>
> Are meds REALLY the answer?
> Is exercise the answer?
> Is a red flashy convertible the answer?
> A palm pilot?
> A new computer?
> A new haircut?
> New clothes?
> and on and on....
>
> Well? IS IT?
>
> Tell me, is there ANYTHING outside of yourself that IS the answer?I think I'd feel a lot better if I could spend my whole life smoking opium, but my doc won't prescribe any.
JOHN
> I'd really like to know what you guys think.
>
> Oh the woes of Luvox withdrawals,
> Athena
Posted by Mary Beth on October 24, 2000, at 16:11:58
In reply to I absolutely agree..., posted by Athena on October 24, 2000, at 16:01:52
I think that withdrawl was the intial topic of this thread and I am going to stick with it. I have noticed since I stopped taking meds that I have become slightly detached from my life, I am not as concerned about my impact on others. (OHHH did I hurt there feelings? I feel freedom from this detachment as I am not held back as much as I used to be held back. However, I have noticed that I am a little bitcher. I am also much more aware of my feelings. I actually have feelings whether good or bad I have them and for two years I have had very few poistive or negative feelings. Has anyone else noticed this type of feeling after going of there meds? Do you have any pointers.
Posted by Athena on October 25, 2000, at 21:29:41
In reply to withdrawl, posted by Mary Beth on October 24, 2000, at 16:11:58
well...perhaps these feelings are normal "life" feelings? Personally, I don't think that feelings in "normal life" are really supposed to be so baseline, as in NOT extremes. I agree, after coming off my meds, I too have extremes, but somehow this makes me feel more alive. Is this odd? Or is this normal and the meds are what's NOT normal.
? just thoughts.
And in my opinion, I AM sticking to the topic. Everything we've talked about so far is related to this topic, and the issues involved.
Posted by Buffet on October 26, 2000, at 3:05:06
In reply to Re: withdrawl, posted by Athena on October 25, 2000, at 21:29:41
> well...perhaps these feelings are normal "life" feelings? Personally, I don't think that feelings in "normal life" are really supposed to be so baseline, as in NOT extremes. I agree, after coming off my meds, I too have extremes, but somehow this makes me feel more alive. Is this odd? Or is this normal and the meds are what's NOT normal.
>
> ? just thoughts.You know, I was just talking to my wife about this exact subject but in reverse. I have been off the ssri's for about three months and mentioned that I have noticed that my moods swings have been acting up much more lately. She told me that she has noticed a huge difference in my moods, mood swings, and anxiety but was afraid to tell me. She noted several examples of these swings in mood that I had overlooked as 'just being my normal self'. I now look back at these examples and in hindsite I can see how these swings have affected various events in the last couple months (negatively). I have made the decision to go back on an ssri, either prozac, or maybe celexa which I haven't tried. I have made the decision that the chemical imbalances or whatever it is that I have, affect my life negatively and when I was on the medication I was much more stable. They have helped me become more 'normal' and able to deal with the ups and downs in life on a much more rational level. My moods are what is making life have innapropriate extremes. Am I making any sense here? I agree that most people don't need meds, but I definitely think I do as proven by the quality of my life when on them and the decay of quality life when not on them.
Posted by S. Howard on October 26, 2000, at 13:55:07
In reply to Hindsite-why I vote for meds... » Athena, posted by Buffet on October 26, 2000, at 3:05:06
It's understandable that most people don't want to rely on lifetime medication - it seems unnatural and unhealthy. I was horrified to find out that I'm hypertensive and would need a drug to control my blood pressure for the rest of my life. But I think most people would agree that taking a daily pill beats the hell out of being paralyzed by a stroke.
It's senseless to spend your life suffering from depression or mood disorders because you believe
"drugs are bad", or that depending on them for your mental well-being is somehow shameful. Taking medication to improve your quality of life is better than ending up with your head in the oven. Even if you don't think so, your loved ones do.-SGH
Posted by R.Anne on October 26, 2000, at 14:44:12
In reply to I absolutely agree..., posted by Athena on October 24, 2000, at 16:01:52
> the answers ARE within you, not outside of you.
*****
And then some of the answers that ARE within you are outside of you.
Posted by Ami on October 27, 2000, at 0:09:42
In reply to Re: prozac withdrawl-for Dohotay, posted by Dorothee Teboul on June 24, 2000, at 2:04:54
I just have a question. I have been on Prozac for about 4 years and have been very happy with it. I have tried to go off of it a few times with out success. I have very bad withdraws, a lot of crying, irrational thoughts, bad dreams and my brain feels funny, like it is tingling. The withdraws are worse than the depression that caused me to go on it. Anyway, I always go running back to the Prozac. Our new insurance company is refusing to cover Prozac and gave my Dr. a whole list of "cheaper" drugs to try. We decided to try Wellbutrin. Now I am having a lot of anxiety (never a problem before). My question is does anyone have experience with Wellbutrin? Does this sound like it's Prozac withdraw or could it be the new med? I have been off Prozac for 7 days and usually feel withdraw by the 3rd day, and have been on Wellbutrin for 3 days. Help!
Posted by JackieJ on October 27, 2000, at 13:14:49
In reply to Re: prozac withdrawl-for Dohotay, posted by Ami on October 27, 2000, at 0:09:42
> I just have a question. I have been on Prozac for about 4 years and have been very happy with it. I have tried to go off of it a few times with out success. I have very bad withdraws, a lot of crying, irrational thoughts, bad dreams and my brain feels funny, like it is tingling. The withdraws are worse than the depression that caused me to go on it. Anyway, I always go running back to the Prozac. Our new insurance company is refusing to cover Prozac and gave my Dr. a whole list of "cheaper" drugs to try. We decided to try Wellbutrin. Now I am having a lot of anxiety (never a problem before). My question is does anyone have experience with Wellbutrin? Does this sound like it's Prozac withdraw or could it be the new med? I have been off Prozac for 7 days and usually feel withdraw by the 3rd day, and have been on Wellbutrin for 3 days. Help!
To Ami and All:I have been on prozac for 5 years. I am currently taking 40 mg per day in addition to 400 mg of wellbutrin. My doctor just yesterday dropped my dose of prozac from 40 to 30 mg. In 2 more weeks I will go from 30 to 20, in another 2 weeks, down to 10, and in 2 more weeks, no more prozac. Then he will INCREASE my wellbutrin from 400 mg per day to 600 mg per day. (He told me that just recently it is safe to go as high as 600 mg whereas 400 mg USED to be the max. I'm very scared of withdrawal symptoms from prozac and increased intake of wellbutrin. I can NOT live the way I did without the prozac. However, I'm sick of the sexual side effects after 5 years. And I am sick of the weight gain! Any input from all is appreciated. Please respond to my email address as well in case I can't find this site again. JackieJeckyl@aol.com
Posted by Emmanuela on October 29, 2000, at 1:24:04
In reply to Re: prozac withdrawl-for Ami » Ami, posted by JackieJ on October 27, 2000, at 13:14:49
Hi Jackie -
I've been on Wellbutrin for quite some time, and it's been a great
medication for me. I just talked to my pdoc yesterday, and as far as he
knows, and he's quite the psychopharmacologist, 450 mg. is the top of
the range for Wellbutrin, as more than that runs the risk of seizures.
Can you give me the new info source that your doc has on the upper range
of Wellbutrin?
The only anxiety I experience has nothing to do with the Wellbutrin,
but just anxiety itself that shows up once in a while, and then I take
tiny dose of xanax for that.
Let me know how you do on the Wellbutrin. When I began it, I had a
small hand tremor that slowly dissipated with time. Good luck, and keep
in touch.Emmanuela
Posted by Sunnely on October 29, 2000, at 18:59:21
In reply to Re: prozac withdrawl-for Ami » Ami, posted by JackieJ on October 27, 2000, at 13:14:49
> To Ami and All:
>
> I have been on prozac for 5 years. I am currently taking 40 mg per day in addition to 400 mg of wellbutrin. My doctor just yesterday dropped my dose of prozac from 40 to 30 mg. In 2 more weeks I will go from 30 to 20, in another 2 weeks, down to 10, and in 2 more weeks, no more prozac. Then he will INCREASE my wellbutrin from 400 mg per day to 600 mg per day. (He told me that just recently it is safe to go as high as 600 mg whereas 400 mg USED to be the max. I'm very scared of withdrawal symptoms from prozac and increased intake of wellbutrin. I can NOT live the way I did without the prozac. However, I'm sick of the sexual side effects after 5 years. And I am sick of the weight gain! Any input from all is appreciated. Please respond to my email address as well in case I can't find this site again. JackieJeckyl@aol.comHi JackieJ,
Could you ask your doctor where he got the information (reference) that it is "safe" to go as high as 600 mg/day with Wellbutrin? Would you be kind enough to post it here? I will be concerned about going up to 600 mg/day of Wellbutrin as this puts you on a really high risk for seizures (even with the use of the sustained-release or SR formulation). Not only that the use of higher doses of Wellbutrin i.e., greater than 450 mg/day, puts one at higher risk for seizures, in your case, the combined use of Prozac + Wellbutrin raises that risk even higher.
FYI, Wellbutrin (bupropion) and one of its active metabolites or daughter compounds (hydroxybupropion) are metabolized (broken down) by at least 3 liver enzymes namely CYP2B6, CYP3A4, and CYP2D6. More specifically, the parent compound (bupropion) is metabolized mainly by CYP2B6 and partly by CYP3A4, while the active metabolite (hydroxybupropion) is metabolized by CYP2D6. Prozac does not affect the action of CYP2B6 and modestly inhibits the action of CYP3A4. Therefore, it has a weak effect on the metabolism of the parent compound (bupropion). However, Prozac markedly inhibits the action of CYP2D6. Prozac's inhibiting action on this liver enzyme will then significantly inhibits the metabolism of the active metabolite (hydroxybupropion) causing an increase in its blood level. Since the metabolite, hydroxybupropion, has equal propensity to cause seizures as its parent compound, the rise in its blood level consequently raises one's risk for seizures. Even though your dose of Prozac is being gradually reduced, its inhibiting effect on the liver enzyme CYP2D6 will continue (although diminishing) for at least another 5-8 weeks after it is completely dicontinued. This is due to Prozac's very long half-life (the combined half-life of fluoxetine and norfluoxetine). I believe I read somewhere that the increase in blood level of hydroxybupropion can also cause a decrease in Wellbutrin's antidepressant effect. I am not certain about this, however.
Withdrawal symptoms from Prozac (if they ever occur) are usually milder than the other SSRIs with shorter half-lives. As mentioned above, Prozac has a very long half-life which acts as a "protective" mechanism from the occurrence of withdrawal. This is not to say that withdrawal symptoms will never occur if Prozac is abruptly discontinued.
The following is a general guideline to minimize the risk of seizures with the use of Wellbutrin as an antidepressant:
1. The dose should be carefully titrated (increased) to achieve the lowest effective dose.
2. Daily doses (if greater than 150 mg/day) are to be divided into at least every 6 to 8 hours interval.
3. The dose should not exceed 450 mg/day.
4. Any SINGLE dose should not exceed 150 mg.
5. The doses should not be given closer than every 6 hours.
6. Further dose increases should not occur any more frequently than every 3 days, and for no more than 100 mg.
7. Preferably, use the SR (Sustained Release) than the IR (Immediate Release) formulation.
8. The combined use of Wellbutrin (antidepressant) and Zyban (smoking cessation) is contraindicated. The generic name for both drugs is bupropion, manufactured by the same company.
References:
1. Benefits of new sustained-release bupropion: less-frequent dosing, fewer side effects. In: Psychoparmacology Update, November 1997.
2. Preskorn SH: Bupropion. Journal of Psychiatric Practice, January 2000.
Go forward in 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.