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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 20 of 20. This is the beginning of the thread.
Posted by Lisabet on December 5, 2000, at 20:15:26
I would like suggestions on meds to augment with Wellbutrin. I am a mild bipolar II with dysphoria (sp?) and hypomania. I also have generalized anxiety disorder with some obsessive tendencies (rumination).
The Wellbutrin is helping the depression somewhat, but I feel like I'm missing something. Not quite normal yet. Any suggestions on what will help the anxiety component to augment the Wellbutrin?
My doctor is pretty open, but I'd like to investigate the meds first before trying.
Thanks much.
Posted by JackD on December 5, 2000, at 22:09:30
In reply to Wellbutrin augmentation - suggestions?, posted by Lisabet on December 5, 2000, at 20:15:26
Have you considered Klonopin? Or maybe Remeron or Serzone?
I think Klonopin and Neurontin are known not only for being good anti-anxiety meds, but antipsychotics and mood stabilizers as well.
Posted by natg on December 6, 2000, at 1:23:44
In reply to Wellbutrin augmentation - suggestions?, posted by Lisabet on December 5, 2000, at 20:15:26
> I would like suggestions on meds to augment with Wellbutrin. I am a mild bipolar II with dysphoria (sp?) and hypomania. I also have generalized anxiety disorder with some obsessive tendencies (rumination).
>
> The Wellbutrin is helping the depression somewhat, but I feel like I'm missing something. Not quite normal yet. Any suggestions on what will help the anxiety component to augment the Wellbutrin?
>
> My doctor is pretty open, but I'd like to investigate the meds first before trying.
>
> Thanks much.Just a suggestion: Neurontin. It has heped me with anxiety and severe mood swings.
Good Luck.
Nat
Posted by JohnL on December 6, 2000, at 3:33:42
In reply to Wellbutrin augmentation - suggestions?, posted by Lisabet on December 5, 2000, at 20:15:26
Top choices that popped into my head right away:
Klonopin
Amisulpride
Risperdal
Zyprexa
Tegretol
Depakote
Nortriptyline
Effexor
I also thought of some secondary choices if the above drugs failed to help to you. But that's another bridge to cross another day. I think the above drugs, for various reasons, are top choices to sample.If your doctor is open, then ask for a two week sample of each. Many will turn out to be duds. They'll do nothing, give you untolerable side effects, or even make you worse. But you will discover in a short time that you really like one or two of them. You can then choose your favorites for longer trials, and put the duds on a backburner to be reconsidered for longer trials later if all else fails.
Keep in mind that with this strategy you aren't looking for a cure in a mere short two weeks. You are instead looking for superior drugs for you and weeding out inferior ones. Trial and error is the only way to do that. Superior drugs will usually make themselves obvious in less than two weeks. You probably won't be cured in two weeks, but you will probably be pleased that you feel surprisingly better. That's the superior drug you're looking for. Just have to begin an organized probing strategy to discover the superior drug.
John
Posted by ChrisK on December 6, 2000, at 5:31:06
In reply to Wellbutrin augmentation - suggestions?, posted by Lisabet on December 5, 2000, at 20:15:26
I have found Zyprexa to be excellent for the obsessive thoughts and Klonopin to be best for GAD. They are both somewhat sedating which may help soothe manic episodes.
Otherwise Neurontin may be worth a look for the bipolar.
Posted by Lisabet on December 6, 2000, at 17:25:25
In reply to Re: Wellbutrin augmentation - suggestions?, posted by JackD on December 5, 2000, at 22:09:30
> Have you considered Klonopin? Or maybe Remeron or Serzone?
>
> I think Klonopin and Neurontin are known not only for being good anti-anxiety meds, but antipsychotics and mood stabilizers as well.Jack, thank you for your response. Haven't tried Klonopin-isn't that a benzo? Also, I take Lorezapam (Ativan) as needed and that helps, but I want something to treat the imbalance, not the symptoms.
Tried Serzone, not good on first day! I just recently tried a really low dose of Neurontin and that did help with the anxiety and sleeping, but was really bad for concentration, memory problems and most of all sleepy and groggy all of the time! Even with taking the Wellbutrin!
Have not tried Remeron. What are your experiences with it? Isn't it close to Serzone? If I had a reaction to Serzone, wouldn't it be probable that I would on Remeron?
Thanks again.
Posted by Lisabet on December 6, 2000, at 17:29:09
In reply to Re: Wellbutrin augmentation - suggestions?, posted by natg on December 6, 2000, at 1:23:44
Thank you for your response.
Tried Neurontin for about 6 weeks. A very low dose. Helped with sleeping at night and did help anxiety.
Did not help with moodiness and irritability. The cons outweighed the pros when it came to memory problems and concentration. It made me tired all the time, too. Didn't like that-low motivation.
Any other suggestions?
Posted by Lisabet on December 6, 2000, at 17:40:39
In reply to Re: Wellbutrin augmentation - suggestions?, posted by JohnL on December 6, 2000, at 3:33:42
JohnL, thank you for the suggestions. I think we should get straight to the secondary choices. I tried various mood stabilizers and I really don't do well with them. Tried Effexor, Depakote, Neurontin, and Tegretol. They are too sedating for me and zap my motivation, which depresses me more. I really don't want to try Lithium, either., because of the weight gain. Don't do well on SSRI's either.
Haven't tried Klonopin, Amisulpride, Risperdal, or Zyprexa. What can you tell me about those? I guess you could categorize me as a "treatment resistant" case. I'm very sensitive to meds. And I happen to be one of the few people on Wellbutrin that makes me tired.
I have tried over a few years, with remission in between, pretty many meds. I know there are a lot more. It is very frustrating, but what other choice is there? You gotta do what you gotta do.
Thank you for your suggestions, John.
Lisa
Posted by Lisabet on December 6, 2000, at 17:49:41
In reply to Re: Wellbutrin augmentation - suggestions?, posted by ChrisK on December 6, 2000, at 5:31:06
Chris, thank you for your suggestions. Tried Neurontin. Didn't work out for me. Made me too tired ALL of the time. And concentration and short term memory problems.
What can you tell me about your experiences with Zyprexa and Klonopin? And what doses? Did you take Wellbutrin? I don't like to be too sedated. Takes away my motivation, which gets me down.
I don't really get "manic" or the euphoria that some talk about. I am hypomanic. Obsessive, racing thoughts, driven. I get irritable or dysphoric.
Thanks again,
Lisa
Posted by JackD on December 6, 2000, at 23:41:27
In reply to Re: Wellbutrin augmentation - suggestions?-Jack, posted by Lisabet on December 6, 2000, at 17:25:25
Klonopin is different than other benzos (Yes, it is a benzo). It's actually classified as an anti-convulsant and used a lot for treating epilepsy. I just suggest trying it cause you have bipolar, and it has mood-stabilizing properties. You also said you have anxiety, and it is great for that. If you read posts about Klonopin, you'll see most people have quite different experiences with it as opposed to other benzos.
I've tried Remeron, and it helped VERY quickly, which is what I like about it. It is great for depression, and pretty good for anxiety. It is known for it's quick action, and its very good side effect profile. However, it WILL cause drowsiness for a while. This is a given. If you have sleeping problems, this can be a great bonus. I'll put it this way: After 20-30 min of taking just a 15mg pill of Remeron, your eyes will get so heavy you won't be able to keep them open. But, you'll sleep like the baby Jesus himself (Remeron has proven to actually improve sleep architecture).
Posted by ChrisK on December 7, 2000, at 5:30:54
In reply to Re: Wellbutrin augmentation - suggestions?, posted by Lisabet on December 6, 2000, at 17:49:41
Lisa,
I had very obsessive suicidal thoughts for a long period of time. Nothing seemed to help until I found Zyprexa. It really cleared up my thinking. I still take it a couple of years later and can notice a change in my thoughts if I stop for more than 2 days. I take it in addition to Nortriptyline which is my main AD (although I have taken it with Wellbutrin and Effexor at different times). I take 7.5 mg at night and really don't have a problem the next day with feeling sedated. Most people start with low dose of 2.5 mg. If you are going to see some results it will be within a few days of starting.
There is some initial sedation but I found it went away after about 2 weeks. If you try Zyprexa try to give it a couple of weeks before making a decision to stop. The one bad side effect is the weight gain. I don't know exactly why it happens but it does seem to happen to almost everyone. Pfizer is supposed to come out with a new med called Zeldox which is like Zyprexa but without some of the major side effects. It's scheduled to be released in the first quarter of 2001.
My experriences with Klonopin have been very good. It helped relieve me of bad panic attacks which have since subsided. I still take Klonopin as needed prior to going into a stressful situation like a large family gathering. If I know that I'm getting into something stressful I take 1 mg about 2-3 hours ahead of time and it relives the anxiety to the point where I can be sociable with people and not want to withdraw from the room.
Hope this helps a little
Chris
> Chris, thank you for your suggestions. Tried Neurontin. Didn't work out for me. Made me too tired ALL of the time. And concentration and short term memory problems.
>
> What can you tell me about your experiences with Zyprexa and Klonopin? And what doses? Did you take Wellbutrin? I don't like to be too sedated. Takes away my motivation, which gets me down.
>
> I don't really get "manic" or the euphoria that some talk about. I am hypomanic. Obsessive, racing thoughts, driven. I get irritable or dysphoric.
>
> Thanks again,
> Lisa
Posted by natg on December 7, 2000, at 18:37:31
In reply to Re: Wellbutrin augmentation - suggestions? » Lisabet, posted by ChrisK on December 7, 2000, at 5:30:54
> Dear Lisa:
I agree with Chris as far as Zyprexa is concerned. I take Risperdal but I have also taken Zyprexa ( I could not handle the weight gain as I had already put on a huge amount on Paxil).
I think it would be worth trying if the weight gain part is not an issue. Otherwise, you could also consider Risperdal or Amisulpride.
Klonopin or Xanax are good for panic.
Other alternatives would be : Desipramine or Nortryptyline.Best of Luck,
Nat
Posted by Lisabet on December 8, 2000, at 18:09:13
In reply to Re: Wellbutrin augmentation - suggestions?-Jack, posted by JackD on December 6, 2000, at 23:41:27
Jack, thank you again.
What is the composition of Remeron? How long will Remeron cause drowsiness approx.? What are other side effects? What about weight gain history?
I wouldn't mind taking it before bed: any funky dreams? Would I be able to wake up for a 2 1/2 year old in the night? Although, a good night's rest sounds great!
-Lisa
Posted by Lisabet on December 8, 2000, at 18:10:07
In reply to Re: Wellbutrin augmentation - suggestions? » Lisabet, posted by ChrisK on December 7, 2000, at 5:30:54
Chris, thanks again. It is helpful. Saves some of the actual pain of learning the hard way. My obsessiveness is driven. Gotta do this, gotta be on top of this, I need this and that... and I worry about EVERYTHING!
I don't think I could deal with Zyprexa because of the weight gain. I lost 22 lbs. recently and need to lose about 40 more. That would definetely put me back into depression!
Tell me about Nortriptyline. Can you take it with Wellbutrin?
I take Lorezapam for when I can feel like my anxiety is building, a "low resistance" day, or if I might be in a "situation." I guess what I fear most of anything is being embarassed (loss of control). Lorezapam works fine for this. And it's not really sedating at all. Can you compare Klonopin to Lorezapam? I know Lorezepam helps with the symptoms of anxiety, but does Klonopin help to correct the imbalance?
I really appreciate the feedback.
-Lisa
Posted by JackD on December 8, 2000, at 18:54:36
In reply to Re: Wellbutrin augmentation - suggestions?-Jack, posted by Lisabet on December 8, 2000, at 18:09:13
> What is the composition of Remeron?
What do you mean by this? Here's some basic info on Remeron. Remeron is a tetracyclic. It's a new class of medicine I believe is a build on the older tricyclics. It's strong point, like I said, is its great side-effect profile (besides drowsiness) and quick onset of Antidepressant action. It is an antagonist of 5-HT2 and 5HT-3 (Seratonin receptors), Hi (Histamine receptor; this is why it makes you drowsy), and A1 (Alpha-adrenergic; increase Norepinephrine function).
I don't know how specific you want me to get, but if you want to know more go to WWW.RXLIST.COM .
>How long will Remeron cause drowsiness approx.?
>What are other side effects? What about weight gain history?
>
> I wouldn't mind taking it before bed: any funky >dreams? Would I be able to wake up for a 2 1/2 >year old in the night? Although, a good night's >rest sounds great!
Some of these questions I really can't answer for you. You may just have to experiment to find out.From posts I've read in the past, some individuals only experience the drowsiness for a month or two. I only took it for a few weeks, and by the last week I was already much less drowsy.
You really have to see how drowsy it makes YOU. At first I don't think you will likely wake up very easily. It's like drinking a bottle of nyquil.
I haven't had any particularly weird dreams on it, but many people report strange dreams (nightmares, vivid dreams) on Remeron as well as other antidepressants.
I think there is a definite weight gain potential on this med; it may make you more sluggish.
P.S. Interestingly enough, many people have reported LESS drowsiness at higher doses than at lower ones.
Posted by Lisabet on December 8, 2000, at 19:21:09
In reply to Re: Wellbutrin augmentation - suggestions?-Jack, posted by JackD on December 8, 2000, at 18:54:36
Jack, thanks. I saw a post from a while back that you endorsed taking buspar with Wellbutrin.
I took buspar when I had more anxiety/panic problems than the dysphoria that I have now. The buspar really helped me then!
However, after having to get off meds because of pregnancy, I had to quit buspar for two years. I went back on buspar and I had side effects that I hadn't before and stopped taking it.
I have this nagging feeling that buspar might be what I need to augment Wellbutrin with.
What are your thoughts on this?
Sorry if I'm taking a lot of your time. :)
Posted by JackD on December 8, 2000, at 23:53:38
In reply to Re: Wellbutrin augmentation - suggestions?-Jack, posted by Lisabet on December 8, 2000, at 19:21:09
Sorry, but that wasn't me. I've never endorsed buspar, and I really know very little about it. If it helped you before though, then hey, why not augment the wellbutrin with it.
Posted by ChrisK on December 10, 2000, at 5:41:06
In reply to Re: Wellbutrin augmentation - suggestions? Chris, posted by Lisabet on December 8, 2000, at 18:10:07
Zyprexa is still the best thing I have found to help with the obsessive or racing thoughts. Lorazepam and Klonopin are both Benzo's with slightly diffferent half lives. I've taken both in the past and prefer the Klonopin as it seems to have a "smoother" release. Now I only take it when I know I'm going into a situation that will cause great anxiety. If you need a fast response then Xanax is much quicker.
I have taken Nortriptyline along with Wellbutrin and they do compliment each other. Like a lot of people I am trying to minimize the number of meds I need to take. In the past it has been as high as 6 but now I'm back down to 3 (Nortrip, Zyprexa and Naltrexone).
Good Luck with the direction you choose to go.
Chris
Posted by SLS on December 10, 2000, at 14:38:54
In reply to Re: Wellbutrin augmentation - suggestions? Chris, posted by ChrisK on December 10, 2000, at 5:41:06
> I have taken Nortriptyline along with Wellbutrin and they do compliment each other. Like a lot of people I am trying to minimize the number of meds I need to take. In the past it has been as high as 6 but now I'm back down to 3 (Nortrip, Zyprexa and Naltrexone).
Hi Chris.When you first added naltrexone, what else were you taking? How would describe your response to it?
Thanks.
- Scott
Posted by ChrisK on December 11, 2000, at 5:53:09
In reply to Re: Wellbutrin augmentation - suggestions? Chris » ChrisK, posted by SLS on December 10, 2000, at 14:38:54
If I remember it right (so many meds over the last couple of years), I was taking Effexor XR 225 mg when I added Naltrexone. First I noticed that it did what was advertised and I didn't have the strong alcohol cravings and if I did drink I never felt like I was drunk or getting the old feelings that alcohol gave me. After a couple of weeks I also felt a mild improvement in my depression.
I wouldn't say it was a life-saving type of change but it was a mild augmentation to the Effexor. I think if you look back in the archives there are posts by Wayne R. describing his experiences with it. I know I have seen that there have been studies done to quantify the AD value of Naltrexone but can't remember right now where I saw one.
I was taking Effexor for about 4 months before trying Remeron and then moving on to my current Nortriptyline but during that time I kept the Naltrexone and never had a problem with meds conflicting.
Hope this helps,
Chris
> Hi Chris.
>
> When you first added naltrexone, what else were you taking? How would describe your response to it?
>
> Thanks.
>
>
> - Scott
This is the end of the thread.
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