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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 21 of 21. This is the beginning of the thread.
Posted by blackjack on February 27, 2001, at 21:50:35
I have been on Wellbutrin for about a year now. It is only the second antidepressant to keep me funtional over a long period of time--the other was Parnate. The problem is, I'm _just_ functional. My sleep is normal; I get up every day and go to work; my energy level is normal. However, I don't enjoy anything. I have no sex drive (I know, very odd for Wellbutrin). I get very little pleasure from anything I do, even things I used to enjoy. I've even stopped enjoying food, and after a lifetime of obesity, find myself havng to force myself to eat enough.
I don't know if this is a side effect of the Wellbutrin, or something the Wellbutrin has failed to do. I certainly experienced this kind of anhedonia during my depressive episodes, but it was always accompanied with dispair and fatigue and anxiety. My mood, really, is fine. I'm not suffering. I just don't want to do anything. I'd probably be parfectly content to stay this way, if it wasn't for the fact that it is afecting my relations with others. I don't want to spend time with my friends, and my girlfriend and I broke up because I wasn't able to show her any physical affection.
The problem is, I'm terrfied to change my meds, because as it is, I can work. I have lost 2 jobs because of my depression, and spent a lot of time unemplyed. I also accrued a huge debt. I simply can't afford to risk not being able to work. Also, I have had little success with other AD's, besides Parnate, which pooped out after 9 months both times I was on it, and withdrawl was so unpleasant I'm reluctant to try MAOI's again.
I have an appointment (after some HMO-wrestling) with my psychiatrist next week. I am wondering if there is anything that I might combine with the Wellbutrin that might alleviate the anhedonia, or if anyone has ever seen Wellbutin affect someone thus.
Background info:
28 years old, "atypical" depressive symptoms since childhood. No mania. Family history of mental illness on both sides. Mother is bipolar.
Medication history:
Paxil--partial response then relapse
Prozac--partial response then relapse
Zoloft--no resopnse
Effexor--partial response, overstimulation, then relapse
Remeron--stopped due to side effects: sedation
Paxil (2 seperate trials)--full response for 9 months, then relapse, accompanied by withdrawl symptoms, even with dose increased past max.
Celexa--partial response. Thyroid, then Dexedrine added to counteract sedative side-effects. Partial response for 4 months, then relapse.
As you can see, I haven't had much success with SSRI's alone, but I thought maybe adding an SSRI to Wellbutrin might come closer to the spectrum of neurtotransmitters affected by Parnate. But I fear my sexual side effect might get worse. Maybe Serzone + Wellbutrin?
Help? Anybody?
Posted by blackjack on February 27, 2001, at 22:02:18
In reply to Wellbutrin -- anhedonia (long), posted by blackjack on February 27, 2001, at 21:50:35
Sorry, I didn't mention my dosage. I'm on Wellbutrin-SR, 300mg (150mg x 2 daily)
Posted by kate9999 on February 27, 2001, at 23:36:46
In reply to Wellbutrin -- anhedonia (long), posted by blackjack on February 27, 2001, at 21:50:35
Just a thought - your mother's bipolar - ever think mood stabilizers? Could it be your meds are not just pooping out, but causing you to cycle?
Also, I had the kind of anhedonia you're talking about on SSRI's. Never took wellbutrin, but my doc actually recommending adding it to Zoloft to fight the apathy.
> I have been on Wellbutrin for about a year now. It is only the second antidepressant to keep me funtional over a long period of time--the other was Parnate. The problem is, I'm _just_ functional. My sleep is normal; I get up every day and go to work; my energy level is normal. However, I don't enjoy anything. I have no sex drive (I know, very odd for Wellbutrin). I get very little pleasure from anything I do, even things I used to enjoy. I've even stopped enjoying food, and after a lifetime of obesity, find myself havng to force myself to eat enough.
>
> I don't know if this is a side effect of the Wellbutrin, or something the Wellbutrin has failed to do. I certainly experienced this kind of anhedonia during my depressive episodes, but it was always accompanied with dispair and fatigue and anxiety. My mood, really, is fine. I'm not suffering. I just don't want to do anything. I'd probably be parfectly content to stay this way, if it wasn't for the fact that it is afecting my relations with others. I don't want to spend time with my friends, and my girlfriend and I broke up because I wasn't able to show her any physical affection.
>
> The problem is, I'm terrfied to change my meds, because as it is, I can work. I have lost 2 jobs because of my depression, and spent a lot of time unemplyed. I also accrued a huge debt. I simply can't afford to risk not being able to work. Also, I have had little success with other AD's, besides Parnate, which pooped out after 9 months both times I was on it, and withdrawl was so unpleasant I'm reluctant to try MAOI's again.
>
> I have an appointment (after some HMO-wrestling) with my psychiatrist next week. I am wondering if there is anything that I might combine with the Wellbutrin that might alleviate the anhedonia, or if anyone has ever seen Wellbutin affect someone thus.
>
> Background info:
>
> 28 years old, "atypical" depressive symptoms since childhood. No mania. Family history of mental illness on both sides. Mother is bipolar.
>
> Medication history:
>
> Paxil--partial response then relapse
>
> Prozac--partial response then relapse
>
> Zoloft--no resopnse
>
> Effexor--partial response, overstimulation, then relapse
>
> Remeron--stopped due to side effects: sedation
>
> Paxil (2 seperate trials)--full response for 9 months, then relapse, accompanied by withdrawl symptoms, even with dose increased past max.
>
> Celexa--partial response. Thyroid, then Dexedrine added to counteract sedative side-effects. Partial response for 4 months, then relapse.
>
> As you can see, I haven't had much success with SSRI's alone, but I thought maybe adding an SSRI to Wellbutrin might come closer to the spectrum of neurtotransmitters affected by Parnate. But I fear my sexual side effect might get worse. Maybe Serzone + Wellbutrin?
>
> Help? Anybody?
Posted by Chris A. on February 27, 2001, at 23:59:31
In reply to Re: Wellbutrin -- anhedonia (long), posted by kate9999 on February 27, 2001, at 23:36:46
What about slowly adding some lamotrigene (Lamictal in the US)? It has mood stabilizing/antidepressant effects and is the only one that adds some pep to my step when I cannot otherwise get out of bed or lose complete interest and motivation. If there is any family history of bipolar it could be very dangerous to add another antipressant. Lamictal is pharmacologically an anticonvulsant and the side effect to be concerned with is a rash that can in extremly rare cases be very serious. It is generally avoided by adding the med in very slow increments. It is the med I have tolerated the best and it has helped me the most. No med is perfect and everyone responds differently.
Blessings,
Chris A.
Posted by ChrisK on February 28, 2001, at 6:19:40
In reply to Wellbutrin -- anhedonia (long), posted by blackjack on February 27, 2001, at 21:50:35
It's been a popular new topic around here for a month but Mirapex has worked great for me. It has gotten rid of the anhedonia/apathy in a short period of time. Do a little research on it and you may decide to try it.
Posted by Lorraine on February 28, 2001, at 13:08:42
In reply to Wellbutrin -- anhedonia (long), posted by blackjack on February 27, 2001, at 21:50:35
But I fear my sexual side effect might get worse. Maybe Serzone + Wellbutrin?
>
> Help? Anybody?I was on Serzone + Wellbutrin. It was a nice combo I thought. Took the Serzone at night. No weight gain or sexual side effects. I started losing my hair on the Wellbutrin so stopped.
Posted by dj on February 28, 2001, at 13:59:24
In reply to Re: Wellbutrin -- anhedonia (long), posted by Lorraine on February 28, 2001, at 13:08:42
>I started losing my hair on the Wellbutrin so >stopped.
How do you know it was the W. and not the Serzone?
Was it signficant amounts, clumps?Anyone else experience this?
Posted by blackjack on February 28, 2001, at 20:48:03
In reply to Wellbutrin -- anhedonia (long), posted by blackjack on February 27, 2001, at 21:50:35
I've been doing some reading, and here's what I think: my dopamine levels are shot. Dopamine plays a big role in pleasure. Parnate, the most effective med I've taken so far, is probably the most dopaminergic antidepressant availible. Tho Wellbutrin seems to block DA reuptake somewhat, it's not much except at high doses, and it may even suppress DA release. I'd bet that, knowing full well that drugs never work on me quite right, that Wellbutrin has either lowered my NA levels, or at least failed to boost them as effectively as the Parnate. The Wellbutrin does seem to have gotten my norepinephrine levels in order, thus accounting for my increased get-up-and-go...
So, the question is, what can I add to the Wellbutrin to give my dopamine levels a boost? Serzone's DA agonism is questionable. I know there are a lot of Parkinson's drugs out there, but I have no point of reference for them.
Thanks again.
Posted by Lorraine on February 28, 2001, at 22:37:28
In reply to Re: Hair?? » Lorraine, posted by dj on February 28, 2001, at 13:59:24
I didn't know at the time. But then I read that alpoecia (sp?) is a side effect of Wellbutrin. Just a patch up front on the right side where my part is. I'm off Wellbutrin and using some of that shampoo that's supposed to be good for hair loss and it's coming back now.
>
> How do you know it was the W. and not the Serzone?
> Was it signficant amounts, clumps?
>
Posted by JohnL on March 2, 2001, at 2:30:29
In reply to Wellbutrin -- anhedonia (long), posted by blackjack on February 27, 2001, at 21:50:35
Hi Blackjack,
Me and Ann Hedonia have known each other a long time. We go way back.In my experience there are two classes of drugs that seem particularly helpful in treating the 'blahs' you described. Stimulants, and antipsychotics.
In your case I would not stop the Wellbutrin. I would instead add the following to it:
Zyprexa 2.5mg to start, then up to 5mg or 10mg. Any daytime sedation disappears in about a week or so.
Risperdal .5 to 2mg.
Amisulpride 50mg to 100mg.
Adrafinil 300mg to 600mg.
Ritalin 5mg as needed.
Adderall.Of them all, the most helpful for my longstanding anhedonia have been Amisulpride, Zyprexa, Adrafinil. But any of them seem to work best with a little Prozac in the background.
Adding Prozac to your Wellbutrin is also an option. It is the least likely of all the SSRIs to cause emotional blunting, which you certainly don't want more of.
So you do have some choices. They all have strong potential in my opinion. In clinical studies Prozac+Zyprexa has been proving to be a powerful combination for anhedonia. The antipsychotics have strong potential, since part of schizophrenia is exactly like the blahness you described.
In your shoes I would try each of the above meds for 2 weeks each, and then choose the favorite(s) in that short time to continue for longer trials. The ones you don't like in two weeks--either due to intolerable side effects or worsening of mood--could be dumped or maybe return to some other day. I would put them on the back shelf though. Stick with the ones that you like in a short trial.
I think what makes the anhedonia situation confusing is that we often think of it as part of depression. It is part of depressin. BUT it can also be part of something else. AND it can be a separate thing altogether. So merely trying to treat depression in general can miss the whole anhedonia thing. For anhedonia, I have discovered in my own trials that meds other than antidepressants are by far the most helpful. You could try every antidepressant out there for the next 20 years and it would not surpise me if none of them helped your anhedonia.
John
Posted by sundog on March 2, 2001, at 8:20:46
In reply to Re: Hair?? » Lorraine, posted by dj on February 28, 2001, at 13:59:24
I started losing hair within maybe two weeks of starting Wellbutrin SR about nine months ago. At that time it was my only med, so I'm sure the WB was responsible. I haven't lost any clumps, just a steady allover shedding, very noticeable on the bathroom floor (and drains!) and in a thinner ponytail. It seems to have lessened somewhat since my dosage was reduced from 400 mg to 300, but hasn't stopped. I've been putting up with it because I had very thick hair to start with, so no one except me seems to notice it, and because WB has been good for me in other ways (though not entirely effective on its own). This has been my *only* negative side effect on WB. Been losing pounds along with the hair, too, so it's been an OK tradeoff so far.
> >I started losing my hair on the Wellbutrin so >stopped.
>
> How do you know it was the W. and not the Serzone?
> Was it signficant amounts, clumps?
>
> Anyone else experience this?
Posted by SalArmy4me on March 2, 2001, at 8:52:26
In reply to Re: Hair?? » dj, posted by sundog on March 2, 2001, at 8:20:46
Hair loss due to medications can be remedied with dietary zinc.
Posted by sundog on March 2, 2001, at 11:33:14
In reply to Re: Hair?? » sundog, posted by SalArmy4me on March 2, 2001, at 8:52:26
I had heard this elsewhere, but now I think I will try it. My multivitamin has 15 mg, but I suppose this might require more? I think the tabs I usually see in the store are something like 30 mg.
Thank you!
> Hair loss due to medications can be remedied with dietary zinc.
Posted by SalArmy4me on March 2, 2001, at 12:56:28
In reply to Re: Hair?? » SalArmy4me, posted by sundog on March 2, 2001, at 11:33:14
Don't take huge doses of vitamins or minerals, though. That plays hell on your liver and kidneys. Take just enough for perhaps a 200% Recommended Daily Allowance.
> I had heard this elsewhere, but now I think I will try it. My multivitamin has 15 mg, but I suppose this might require more? I think the tabs I usually see in the store are something like 30 mg.
>
> Thank you!
>
> > Hair loss due to medications can be remedied with dietary zinc.
Posted by JahL on March 2, 2001, at 14:40:50
In reply to Re: Hair?? » sundog, posted by SalArmy4me on March 2, 2001, at 8:52:26
> Hair loss due to medications can be remedied with dietary zinc.
Selenium (200ug daily) is also rumoured to help...
Oh & try & use zinc *picolinate*.Jah.
Posted by sundog on March 2, 2001, at 16:43:46
In reply to No Megavitamin Doses » sundog, posted by SalArmy4me on March 2, 2001, at 12:56:28
I agree with you about megadoses -- in general I look for supplements with modest dosages. The multi I take now lists 15 mg as 100% RDA for zinc, so that gives me a benchmark.
Thanks for replying.
> Don't take huge doses of vitamins or minerals, though. That plays hell on your liver and kidneys. Take just enough for perhaps a 200% Recommended Daily Allowance.
Posted by sundog on March 2, 2001, at 16:46:47
In reply to Re: Hair??, posted by JahL on March 2, 2001, at 14:40:50
I've heard this too, and have been taking 200 mcg selenium for a while, but not really consistently. I'm going to try to make it more habitual and see what happens.
Thanks for the tip on type of zinc!
> Selenium (200ug daily) is also rumoured to help...
> Oh & try & use zinc *picolinate*.
>
> Jah.
Posted by Sunnely on March 2, 2001, at 19:38:10
In reply to Re: Hair??, posted by sundog on March 2, 2001, at 16:46:47
Use the combination of selenium and zinc (200 mcg selenium and 100 mg zinc), daily. Works well for Depakote-induced hair loss. Worth a try for other psychotropic hair loss.
FYI, the recommended daily allowance (RDA) for selenium is 70 mcg daily while the RDA for zinc is 15 mg. Those who are already taking a multivitamin could change to a brand called "One Source" from WalMart, which already contains 200 mcg of selenium. However, it only has the RDA for zinc, so it would still be necessary to take an additional zinc supplement.
+++++++++++++++++++++++++++++++++++
> I've heard this too, and have been taking 200 mcg selenium for a while, but not really consistently. I'm going to try to make it more habitual and see what happens.
>
> Thanks for the tip on type of zinc!
>
> > Selenium (200ug daily) is also rumoured to help...
> > Oh & try & use zinc *picolinate*.
> >
> > Jah.
Posted by sundog on March 3, 2001, at 8:42:20
In reply to Re: Hair?? » sundog, posted by Sunnely on March 2, 2001, at 19:38:10
The multi I've been taking (a NatureMade brand) has 50 mcg selenium and 15 mg zinc, so I'll work upwards from that. I just checked the selenium supplement I've been taking on and off, and it's 100 mcg, not 200 as I'd been thinking. I've seen upper limits for selenium given as 400 - 1000 mcg in various sources, so am assuming 250 won't cause problems (50 in current multi plus two 100 tablets).
I had been kind of unhappily semi-resigned to this hair thing, but now I'm going to try this regimen. Thanks very much, Sunnely!
sundog
> Use the combination of selenium and zinc (200 mcg selenium and 100 mg zinc), daily. Works well for Depakote-induced hair loss. Worth a try for other psychotropic hair loss.
>
> FYI, the recommended daily allowance (RDA) for selenium is 70 mcg daily while the RDA for zinc is 15 mg. Those who are already taking a multivitamin could change to a brand called "One Source" from WalMart, which already contains 200 mcg of selenium. However, it only has the RDA for zinc, so it would still be necessary to take an additional zinc supplement.
Posted by josey on March 27, 2002, at 23:28:53
In reply to Wellbutrin -- anhedonia (long), posted by blackjack on February 27, 2001, at 21:50:35
> I am a female and have been taking Zoloft(50mg)a day for 4 months and notice a decreased sex drive- any recommedations from others who have switched to other anti-depressants and regained the sex drive but not lost the mood equalization?
jo
Posted by RhainyC on March 28, 2002, at 9:08:35
In reply to Wellbutrin -- anhedonia (long), posted by blackjack on February 27, 2001, at 21:50:35
> I have been on Wellbutrin for about a year now. It is only the second antidepressant to keep me funtional over a long period of time--the other was Parnate. The problem is, I'm _just_ functional. My sleep is normal; I get up every day and go to work; my energy level is normal. However, I don't enjoy anything. I have no sex drive (I know, very odd for Wellbutrin). I get very little pleasure from anything I do, even things I used to enjoy. I've even stopped enjoying food, and after a lifetime of obesity, find myself havng to force myself to eat enough.
<Snippage of long informative part>
Maybe Serzone + Wellbutrin?
>
> Help? Anybody?
I think that the combo of Serzone/Wellbutrin may work. I hope you ask about it with the pdoc. I was on wellbutrin twice before, once for quitting smoking <didnt work for me but my mood was much better> and the second time for depression, which while it worked for a bit, after about 8 weeks, I went on a long crying jag and had to stop taking it.Presently, I am on Serzone, 100mg in am, and 200mg at bedtime. I also take 600mg Neurontin at bedtime to help with my back and sleeping through the night.
With this combo, I have not had any decrease in orgasms, which was one of the main reasons I tried the Serzone. It is not supposed to give sexual side affects. With all the other meds I was on _Except_ wellbutrin, I had Anorgasmia, which in case you are not familiar with the term means, inability to achieve orgasm. I had a very loving husband, and we have a good sex life, I am totally unwilling to give that up.
So far the meds I am taking, have stabilized my mood, though I do not have a lot of energy per say. I have only been on them since the 13th of this month, but feel pretty confident in the combination.
Hope this helps.
Blessings,
RhainyC
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