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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 9 to 33 of 33. Go back in thread:
Posted by Yardena on September 1, 1999, at 18:56:26
In reply to Re: Wellbutrin, posted by JohnL on September 1, 1999, at 17:16:20
I tried Wellbutrin for a short time a couple of years ago, but it cause tinnitus and intestinal discomfort. I also wasn't thrilled with 3x day dosing, so I am glad to hear they have put out an SR since then. I have a friend who has been on it a while and loves it. Frankly, I think it adds to his anxiety/OCD symptoms, and I have read that it can be kind of agitating for some people. But he had such a bad experience on Prozac (made him very manic and agitated) and then such a profound improvement in his depression on Wellbutrin, that he is reluctant to rock the boat.
Posted by LD on September 3, 1999, at 8:58:45
In reply to Re: Wellbutrin, posted by Yardena on September 1, 1999, at 18:56:26
Does anyone know how long it takes for the antidepressant effects of Wellbutrin to kick in? I have now been on full strength (300 mg/day)
for 5 weeks now, with no improvement in my depression. I also have panic disorder and lots of anxiety all the time.
The wellbutrin has increased my anxiety (I think) and have been taking a small amount of klonopin for that. Is this not the drug
for me? My doc and I were waiting it out to see if it improved (been through Serzone and Paxil). She said if this didnt work
we were going to try Celexa. I'm getting very frustrated.Thanks, LMD
Posted by Pat on September 4, 1999, at 17:08:03
In reply to Re: Wellbutrin-how long does it take??, posted by LD on September 3, 1999, at 8:58:45
I think the small amount of Wellbutrin I'm on is helping my depression already (not yet a month), but I'm still having worse anxiety than I did when I started. What I want to know is did anyone have worsening anxiety for a month or more, and then had it get better? Will I always need a separate anxiety med with Wellbutrin? When the doc increases the dosage, will the anxiety increase as well? What have other users experienced?
Posted by Bob (not Dr.) on September 4, 1999, at 23:33:20
In reply to Experienced Wellbutrin Users Please Help, posted by Pat on September 4, 1999, at 17:08:03
LD-- I have depression and panic disorder as well. Some time ago, I switched to Wellbutrin from Paxil as the Paxil had turned me into a complete zombie. To make it worse, I had some pretty severe withdrawal symptoms from the Paxil, so my doc had me start on the WB without letting the Paxil washout a bit. That small overlap of those two meds, in retrospect, was one of my clearest, sanest times in the last four years. WB's effect on my withdrawal symptoms took about 20 minutes on the two or three occasions I forgot to take a dose. I imagine whatever it was doing may be related to how it can help smokers quit....
Once the Paxil had washed out, tho, I started getting pretty psychotic. Thankfully, I had one part of me that could recognize when things were getting too hot--it would send me into these unprovoked, uncontrollable rages--and I could walk away from whatever situation I was in to defuse things. My doc put me on Perphenazine at a really small dosage. That worked to control the rage, but WB never did anything for my depression.
(In case you're wondering: yes, I have thought about trying Paxil and WB together intentionally. Given other factors in my life right now, plus how stable my current cocktail has me and how nasty each one of those were to me on their own, it's too much to risk right now.)
Posted by fendel on September 5, 1999, at 22:59:50
In reply to Experienced Wellbutrin Users Please Help, posted by Pat on September 4, 1999, at 17:08:03
I've been on Wellbutrin for nearly four years now, currently taking 400 mg/day of Wellbutrin.
I felt a VERY fast response to it--about 12 hours from my first dose, which I think is unusual. It didn't help my anxiety, but my anxiety has been a spotty thing anyway--it comes and goes, mostly goes (luckily). I did have one panic attack after feeling stable on it for a while, but for the most part I've been calm, and for me the anxiety has not increased with the dosage.
But I have heard that Wellbutrin's not known for helping with anxiety.
Posted by dj on September 9, 1999, at 10:28:58
In reply to Re: Experienced Wellbutrin Users Please Help, posted by fendel on September 5, 1999, at 22:59:50
> > It didn't help my anxiety, but my anxiety has been a spotty thing anyway--it comes and goes, mostly goes (luckily). I did have one panic attack after feeling stable on it for a while, but for the most part I've been calm, and for me the anxiety has not increased with the dosage.
>
> But I have heard that Wellbutrin's not known for helping with anxiety.Anyone else have any experience on this front or anything to say about Wellbutrin & anxiety?
Posted by Bob on September 9, 1999, at 23:24:35
In reply to Re: Experienced Wellbutrin Users & anxiety???, posted by dj on September 9, 1999, at 10:28:58
> Anyone else have any experience on this front or anything to say about Wellbutrin & anxiety?
Just a quick recap -- it worked great with mine. It was essential in helping me get off Paxil; I don't know how I would have managed to leave my bedroom without it. After the Paxil washed out, it still did a good job keeping my anxiety level down.
If it wasn't for those psychotic rages I started experiencing (before adding some perphenazine to
the mix), I might have stuck with it. So, while it did help my anxiety, I can't say that I had a very typical response to it.Cheers,
Bob
Posted by dj on September 10, 1999, at 7:54:25
In reply to Glad to hear it works for so many..., posted by Bob (not Dr.) on September 4, 1999, at 23:33:20
Bob,
The Wellebutrin worked on your anxiety but not your depression but it also caused you to go into blind rages when used by itself. Anyone else have similar impact?
> LD-- I have depression and panic disorder as well. Some time ago, I switched to Wellbutrin from Paxil as the Paxil had turned me into a complete zombie.... That small overlap of those two meds, in retrospect, was one of my clearest, sanest times in the last four years.
> Once the Paxil had washed out, tho, I started getting pretty psychotic.... My doc put me on Perphenazine at a really small dosage. That worked to control the rage, but WB never did anything for my depression.
Posted by Pat on September 10, 1999, at 10:01:04
In reply to Re: Glad to hear it works for so many..., posted by dj on September 10, 1999, at 7:54:25
Funny that it worked on Bob's anxiety, but not his depression. It is definitely working for my depression, but I still have to take ativan for anxiety every day. If I don't take the ativan, I start to feel anxious and edgy by the late afternoon. I've been on the Wellbutrin for a month now. It may increase the anxiety when the doc ups the dosage or (as I'm hoping), it may decrease the anxiety. I'd like to start getting off ativan. But if I feel good with a little bit of Wellbutrin and a little bit (2 - 2 1/2 mg) of ativan every day, would this be an ok long term solution?
Posted by Jeff Silverstein on September 10, 1999, at 10:21:53
In reply to Experienced Wellbutrin Users Please Help, posted by Pat on September 4, 1999, at 17:08:03
I've taken Wellbutrin at various doses over a number of years. It is always mentioned as one of the few antidepressants that doesn't block panic attacks. (as did Imipramine and certain SSRIs) This is probably because its focus isn't on serotonin and it boosts dopamine and norepinephrine. It is, however considered a good choice for bipolars because it tends not to trigger manic swings. My experience has been that the higher the dosage, the more jittery. If you're sensitive to anxiety there's a point where it can trigger that. Benzodiazapines, like Ativan were the choice to smooth out the anxiety. At higher doses ((3-500mg) I found increased startle response and mild panicky feelings. However, if it's doing a really good job with the depression, and you're responding - the tranquilizer may be a good choice. People are hyper-afraid of tranqs because they fear addiction, and tend not to take as much as they need. Because of bad press we somehow feel that a tranquilizer is "bad" and should be avoided. Many anti-depressants have anxiety side effects, not just Wellbutrin - it all depends on your chemistry. If it's working well, Wellbutrin tends to be well tolerated because of low side effects - it's one of the very few antidepressants that has no sexual side effects for most - and the dopamine boost is said to even improve things in that department. I tolerated Wellbutrin well for years, usually with no more than .25 to 1mg of Ativan as needed - the more Wellbutrin, the more Ativan. Anxiety makes everything an emergency - make sure your doc is aware of what's going on. If a low dose of something quickly has intolerable side effects for you, he or she may not force it. You were wondering if the anxiety goes away - my experience is that there were times when it fluctuated, sometimes went away. But it's not a simple issue - for example the anxiety shows that the med is active - there were times when I found that a reduction in baseline anxiety meant the antidepressant fx were wearing off. Everybody's different. Some people get anxiety on rising - I found Wellbutrin anxiety kicked in late afternoon. I assume you're taking SR. A good choice might be cutting the tabs up and splitting the dosage over the day to reduce peaks - ask your doc. Good luck.
Posted by Jeff Silverstein on September 10, 1999, at 10:43:27
In reply to Still Need More Wellbutrin Info , posted by Pat on September 10, 1999, at 10:01:04
Pat, you sound like you're doing fine. We neurochemically-challenged have gotten it into our heads that if we take benzodiazapines we're going to end up like Marilyn Monroe - or addicted. The amounts of Ativan you're taking aren't "abuser" amounts and you're not washing them down with Vodka are you? You don't have to get off Ativan so fast - particularly if it's helping you tolerate an antidepressant which is helping your more major symptoms. But this is a common conflict - I'd fight myself when I needed the tranqulizer, and then I'd stay anxious. I used to have to tell myself "take the Ativan, stupid." Ivan Goldberg told me that these low dosages of Ativan are what he calls "pediatric" and it's far mor important to get the right antidepressant working. Of course he didn't want me taking Ativan if I didn't need it - but made sure I recognized that it was necessary when I did. I also have a theory that our increased self-hate, paranoia, and depressed thought may add to our beating ourselves up about taking the benzodiazapine - we've "picked" something "bad" to accuse ourselves of - and we've gotten into a double bind because if we took the Ativan appropriately, we wouldn't be so agitated about it.
Posted by Pat on September 10, 1999, at 13:01:18
In reply to Re: Still Need More Wellbutrin Info , posted by Jeff Silverstein on September 10, 1999, at 10:43:27
Thanks for your posts, Jeff. I find your thoughts pretty comforting. I have had a lot of the same experiences that you have. My anxiety on the Wellbutrin also kicks in in late afternoon. I have also been at war with myself many times over taking the ativan. Sometimes I feel like a failure because I now have to take this addictive medicine (after having kicked all the drug abuse of my youth) just to keep myself from freaking out. But then I tell myself, like you, just take the ativan stupid. I only need 1/2 mg in the afternoon for anxiety, but I also take 1 to 1 1/2 mg at bedtime for insomnia. In a perfect world, Wellbutrin would handle the anxiety for me too. It is doing a really good job with the depression. I'm surprised at how much better I feel on a dose (only 100mg SR daily) my pdoc considers a "baby dose". I'm making a note to ask him on my next visit about splitting up the dose somehow to avoid the afternoon anxiety. Anyway, I'm "babbling". Thanks again.
Posted by Jim on March 3, 2000, at 10:59:04
In reply to Experienced Wellbutrin Users Please Help, posted by Pat on September 4, 1999, at 17:08:03
> I think the small amount of Wellbutrin I'm on is helping my depression already (not yet a month), but I'm still having worse anxiety than I did when I started. What I want to know is did anyone have worsening anxiety for a month or more, and then had it get better? Will I always need a separate anxiety med with Wellbutrin? When the doc increases the dosage, will the anxiety increase as well? What have other users experienced?
I was on Wellbutrin(150 mg/day) for about 8 months last year. It worked fine, but I discontinued it without any trouble. After a 7 month layoff, I started back on it last week at 300 mg/day without starting at a lower dose as recommended. Now, 6 days after being back on it at 300 mg, I have experienced a couple nights of pretty bad insomnia with one moderate panic attack during my insomnia. I have had only one panic attack in my life and it was in a moment of severe stress a couple of years ago. This one was simply because I couldn't sleep. I want to believe that my error in not starting out at a lower dose, as recommended, caused this anxiety and panic, and not that I'm developing a panic disorder. I have discontinued Wellbutrin as a result. Has anyone experienced this or has anyone's physician commented on this? Please help.
Posted by anne on March 3, 2000, at 14:05:57
In reply to Re: Experienced Wellbutrin Users Please Help, posted by Jim on March 3, 2000, at 10:59:04
for a little reassurance, it sounds like you are
having a reaction to the Wellbutrin. Unfortunately,
even if your body responded well to it the first
time that is not predictive of future responses.However, you should not abruptly discontinue it,
either! Try taking 150 mg SR in the morning, every
other day for the next few days. If you are
feeling better, then you can decide whether to
discontinue use. I think it is very unlikely that you
are developing a concomitant anxiety disorder,
although not ruled out. Hope this helps, hang in
there.
Posted by bob (hi folks, I'm back) on March 3, 2000, at 20:30:11
In reply to Re: Experienced Wellbutrin Users Please Help, posted by anne on March 3, 2000, at 14:05:57
Anne's advice about tapering off a med is good for just about any of the stuff we take.
I doubt, too, that Wellbutrin could GIVE you an anxiety disorder, but it may be helping an exisitng one express itself a bit more obviously. Depression and anxiety disorders go hand-in-hand for a lot of people, and at times the symptoms of one can mask any sign of the other.
I'm a good example of that. I started seeing my therapist due to some rather severe daily panic attacks. I've been observably depressed since I was 8, but I'd never really shown any signs of panic disorder until I was 34, just before I started treatment. By the time we decided I needed medication, we were back working on depression issues during our sessions. Over the next two years and something like 11 different combinations of meds, I'd present either more depressed or more panicked depending on which med wasn't working for me at the time. It all taught me not to take the panic disorder side of my condition lightly, and to thank my stars for finding klonopin when I did -- it's managed my panic wonderfully for 18 months or so now.
As for Wellbutrin -- I started right off at 300mgSR/d in reaction to severe withdrawal from Paxil. While both were in my system, things were fine. After the paxil washed out of me, tho, my Welbutrin demons started popping up. It lost its efficacy as an AD at 300/d, so I went up to 450. For me, it wasn't anxiety so much as it was irritability and, eventually, uncontrollable rages. Nothing a little perphenazine (an antipsychotic) couldn't handle, tho. Still didn't have any efficacy as an AD on its own or with Prozac for me, and these three together eventually put me in the ER due to a nasty interaction between the prozac and perphenazine ... but the story ends happily, because this chain of events brought klonopin into my mix.
16 months after that, I tried wellbutrin again, at 75mg (nonSR) 2xd to augment the nortriptyline I'm on now. All it did was bring back the irritability.
Oh, and my otherwise non-existent allergy to cats. Off wellbutrin, I'm fine. On wellbutrin ... contact with a cat will swell my eyes shut in ten minutes or less. And I've never shown any allergic reactions to anything else EVER. Weird science.
... maybe it's just me, but over the last year (or so) checking in on this board, it seems like wellbutrin triggers more love-it or hate-it reactions than any other med, with the possible exception of paxil.
cheers,
bob
Posted by micahael on March 4, 2000, at 14:52:18
In reply to Re: Glad to hear it works for so many..., posted by dj on September 10, 1999, at 7:54:25
> Bob,
>
> The Wellebutrin worked on your anxiety but not your depression but it also caused you to go into blind rages when used by itself. Anyone else have similar impact?
>
> > LD-- I have depression and panic disorder as well. Some time ago, I switched to Wellbutrin from Paxil as the Paxil had turned me into a complete zombie.... That small overlap of those two meds, in retrospect, was one of my clearest, sanest times in the last four years.
> > Once the Paxil had washed out, tho, I started getting pretty psychotic.... My doc put me on Perphenazine at a really small dosage. That worked to control the rage, but WB never did anything for my depression.why did you not stay on the welllbutrin and start the paxil again?
why did you not stay on the wellbutrin and start the paxil again?
Posted by Noa on March 4, 2000, at 15:28:48
In reply to Re: Glad to hear it works for so many..., posted by micahael on March 4, 2000, at 14:52:18
Am I grasping at straws to want to try wellbutrin again? I was on it such a short time a few years ago, with some diarrhea. Now I think maybe I should try it again. Is this ludicrous? I am feeling frustrated with the effexor at this point. Each time I read about another medicine on the board, I think, well maybe that one will work for me. then I hear about them all pooping out on people and plateauing in their helpfullness. So getting of the effexor supermarket line just to get into another stuck line doesn't seem very appealing. But neither does staying in this line simply because I don't know where else to go. Today I had the fantasy, for the first tiem in years, of just going off of all my meds. I am pissed off that they aren't working. Don't worry, I won't actually go off my meds. My wish is that I could and be ok, but I know it ain't so.
Posted by Brenda on March 4, 2000, at 17:01:44
In reply to Re: Glad to hear it works for so many..., posted by Noa on March 4, 2000, at 15:28:48
> Am I grasping at straws to want to try wellbutrin again? I was on it such a short time a few years ago, with some diarrhea. Now I think maybe I should try it again. Is this ludicrous? I am feeling frustrated with the effexor at this point. Each time I read about another medicine on the board, I think, well maybe that one will work for me. then I hear about them all pooping out on people and plateauing in their helpfullness. So getting of the effexor supermarket line just to get into another stuck line doesn't seem very appealing. But neither does staying in this line simply because I don't know where else to go. Today I had the fantasy, for the first tiem in years, of just going off of all my meds. I am pissed off that they aren't working. Don't worry, I won't actually go off my meds. My wish is that I could and be ok, but I know it ain't so.
Noa - It doesn't sound like grasping at straws to me. It sounds like wanting to feel better. Also, the medication merry-go-round is very stressful in and of itself. I grew frustrated with it only after 3 months and quit taking everything but the Zoloft and a little benadryl for sleep at night. So far okay - but it's only been 4 weeks.
I hope you feel better soon.
Posted by Phil on March 4, 2000, at 17:09:01
In reply to Re: Glad to hear it works for so many..., posted by Noa on March 4, 2000, at 15:28:48
Noa, Know exactly how you feel. I've actually stopped the Reboxetine and have cut way back on Ritalin and Klonopin. My new job is really chaotic and I felt I was about to explode..too much adrenaline.
Right now, I'm very tired of meds and am going to try medicinal minimalism. If and when life greys down again...I'll be back. Ritalin and K act quick and may be enough, at least for today.
I'm always slowed down on meds, heavier. Even though they have kept me from sinking, they've never made me want to swim.
Phil
Posted by bob (I hate server back-ups) on March 4, 2000, at 21:34:30
In reply to Re: Glad to hear it works for so many..., posted by Phil on March 4, 2000, at 17:09:01
You know, of all the times for me to get back on Babble, I pick five minutes before they must have backed up the server last night, since all of a sudden NONE of my posts were going thru ... anyway...
Noa, I got something I'm going to post for you that I saved from last night down on your thread.
Michael -- good question about why didn't I get back on paxil and wellbutrin together. The bottom line is I've had numerous bad experiences the second time around on a gave a fair trial to in the past. It was more in retrospect than a realization at the time that the wellbutrin/paxil combo was actually working well for me ... really, it was months after that time had passed and I was in a much worse place before I could see how well things had been working out. But...
-- just how much paxil was left in my system? At "therapeutic" dosage levels, that drug was a nightmare for me. I felt like an extra left over from Night of the Living Dead Part Whatever.
-- On its own or in combo with another AD, twice now, wellbutrin has been a disaster as well.For some short time, two wrongs made a right for me. But right now, the meds I'm on have me stable, clear, and on a slight but noticable upward trajectory. I don't have the time or the energy to give those two disasters the chance to work again -- given the mess they make of me individually, if a second "trial" of the two together failed I don't think I could stand the consequences. The risk of failure is just too great. If the first "trial" had been a true trial, rather than an overlap between starting one and washing the other out, then I might be able to get a better feel on whether they'd work together ... but with the info I have, calling it a crapshoot would be overly optimistic.
As for the minimalism, for me it came in my recent addition of ritalin to my nortriptyline/klonopin mix. My pdoc wanted to push my dosage even higher on the nortrip instead of augmenting. Hell! I'm at 150mg/d right now ... he wanted to take it up to 175. I don't understand the logic behind working on one med and pushing til you're red-lining on the dosage limits and THEN trying something else.
I mean, for a lot of us, maybe most of us ... particularly those who get that "refractory" tag added to their depression ... the simple, straight forward approaces have failed. So how will more of the same approach make things any better?
If, on the other hand, what is going on is some subtle mix of imbalances between several different systems -- not seratonin alone, not norepinephrine alone, not thyroid or opiates or dopamine alone -- then maybe what we need is a more subtle cocktail of a few meds rather than maximum dose of A, then add B and push it to its maximum dose, then add C ad infinitum ad absurdum.
Anyway, for me, my klonopin is at a fairly low level andits working fine on my panic. My nortrip is moving me along to a better place than I've been for a long time, but not fast enough and not in all areas. Four days on ritalin, again at a low level, and it's working very well with the other two, but very subtlely.
bob
Posted by Linda on March 5, 2000, at 9:59:01
In reply to Re: Experienced Wellbutrin Users Please Help, posted by Jim on March 3, 2000, at 10:59:04
I have been taking Wellbutrin-SR for several years & it works beautifully. Initially, an increase in anxiety is not unusual, but should subside in apx. 2 weeks - it sounds like this might not be the best med for you. There are many antidepressants out there that include an indication for anxiety as well (Effexor XR [has similar side-effect profile], Paxil [better choice if you also suffer from insomnia], & Zoloft [well tolerated]). This list does not include those anxiolytics that are habit-forming. Wellbutrin should always be started at a lower does to allow your body time to adjust & decrease initial side effects; although, at six weeks, this is not the issue. You should talk with your health care provider regarding a new med for your condition.
Posted by Mariaz on June 14, 2001, at 10:15:01
In reply to Re: Experienced Wellbutrin Users Please Help, posted by Linda on March 5, 2000, at 9:59:01
I have been taking wellbtrin for about 2 weeks and have had headaches since I started, they are a little less now. Has anyone else experienced this and what did you do to resolve this?
Posted by Cam W. on June 14, 2001, at 20:43:30
In reply to new wellbutrin user, posted by Mariaz on June 14, 2001, at 10:15:01
Mariaz - Yes, headache is a start-up side effect of Wellbutrin and should go away in another week or so. The headache may come back for awhile if the doc increases your dose. - Cam
Posted by miriam18 on June 15, 2001, at 7:22:31
In reply to Re: new wellbutrin user » Mariaz, posted by Cam W. on June 14, 2001, at 20:43:30
I have been taking Welbutrin for about a month. Initially, I began with 150 mgs, 75 mgs, twice a day, then proceed to 300 mgs. after about 10 days, 150 mgs, twice a day. I feel good on Welbutrin, more energy, less desire to eat (I was previously on Prozac for 12 years, with good success), however in the last week I have developed a severe "yawning" problem. I have an impetus to yawn, I begin to yawn and can't "complete" the yawn. Seems as if I can't get in the air I need to complete the yawn. This happens several times an hour throughout the day. I called my psychiatrist to see if this was a side-effect, since Welbutrin is the only new substance I've recently added. He said he has not heard of this as a Welbutrin side-effect. Any information will be appreciated. Miriam18
Posted by Cam W. on June 15, 2001, at 7:42:08
In reply to Re: new wellbutrin user, posted by miriam18 on June 15, 2001, at 7:22:31
Miriam - Yes, I had a similar problem with Wellbutrin SR, but I would almost always finish my yawns. I would get these big yawns that would sometimes end in a full body shudder. These did lessen with time, but never went totally away. I did not find them to be too disturbing though and sometimes they felt rather good. When you feel like one is coming on, take a deep breath in through your nose (breathe with your belly by pulling down your diaphragm, rather than just filling up your chest with air) and let it out through your mouth. This may encourage you to complete your yawn.
I found them to occur especially first thing in the morning, usually before my first coffee of the day, but they could occur at any time during the day. I do not think that they are dangerous and as long as I covered my mouth when I yawned, they didn't bother other people. - Cam
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