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Dr. Bob is Robert Hsiung, MD,
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Posted by Sulpicia on June 20, 2001, at 21:37:19
I'd be grateful for everyone's wisdom here...
The particulars:
16 y/o BP II [nearly all depression, mania/hypomania NOT an issue]
stable on: lamictal 400, wellbutrin 450, adderall 20.
We need to stop the wellbutrin to address depression connected with
menstruation -- we know where we're going but ...
Wellbutrin decreased 450 -- 300 overnight w/ no problems.
300-150 attempted over 7 days -- not possible. Anger, rage etc.
No physical complaints.
Managed to hit 150 after 2 rough weeks -- missed school, angry, tearful.
Suggestions to finish the washout?
BP is stable, nothing weird is happening, but I'd like to make it as easy
as possible for her.
Pdoc suggested she could do the complete washout in 2 weeks but in view of
her difficulties told us to take our time and play it by ear...
Thanks,
S.
Posted by super on June 21, 2001, at 15:07:53
In reply to Wellbutrin washout suggestions for BP II?, posted by Sulpicia on June 20, 2001, at 21:37:19
I don't have any wisdom for you, but I'm very interested in why you are stopping the Wellbutrin? How would Wellbutrin be associated with PMS/PMDD? Is your plan to stop the Wellbutrin permanently and, if so, how will she avoid depression? And, finally, how would BPII be diagnosed without hypomania?
Sorry for prying--I'm just trying to get a handle on my own BPII/Wellbutrin situation. I have tried to stop Wellbutrin a couple times due to constipation that my p-doc attributes to Wellbutrin, but each time, I've gotten depressed and gone back on it. I can't take SSRIs, and tricyclics are known to make constipation worse, so I'm basically stuck with Wellbutrin...unless I can get by without an antidepressant.
> I'd be grateful for everyone's wisdom here...
> The particulars:
> 16 y/o BP II [nearly all depression, mania/hypomania NOT an issue]
> stable on: lamictal 400, wellbutrin 450, adderall 20.
> We need to stop the wellbutrin to address depression connected with
> menstruation -- we know where we're going but ...
> Wellbutrin decreased 450 -- 300 overnight w/ no problems.
> 300-150 attempted over 7 days -- not possible. Anger, rage etc.
> No physical complaints.
> Managed to hit 150 after 2 rough weeks -- missed school, angry, tearful.
> Suggestions to finish the washout?
> BP is stable, nothing weird is happening, but I'd like to make it as easy
> as possible for her.
> Pdoc suggested she could do the complete washout in 2 weeks but in view of
> her difficulties told us to take our time and play it by ear...
> Thanks,
> S.
Posted by Sulpicia on June 21, 2001, at 22:03:32
In reply to Re: Wellbutrin washout suggestions for BP II?, posted by super on June 21, 2001, at 15:07:53
> Hi--
we're stopping the Wellbutrin because it's not doing much: no response on the last 2 increases and
it doesn't touch those 3 or 4 days a month were she's totalled -- unable to get out of bed at all.
The lamictal has done a pretty good job of being an AD, for a MS, and the adderall helps out too.Pdoc is looking into using 1 of several possible AD meds in the same way as Sarafem is dispensed, tho
Sarafem itself is out -- dd had a rash once upon a time with an SSRI and we are *rigorous* with the lamictal,
having already done the rash thing. Ugh.Hypomania isn't an issue for her bcuz it was mild and short -- her *symptoms* are discussing Kierkegaard and explaining
why Budda got it all wrong...
As for you, perhaps you might read a bit about lamictal -- many find it has strong AD effect too, tho the risk/benefit
equation may be very different for you -- dd *had* to take it bcuz she didn't respond to anything else.
If you're doing well on Wellbutrin why not get the detailed manufacturer's info on and see what the pharmacology is -- with
some diligence, and help from pdoc, I'd bet you can figure out how it causes the constipation, and can probably find a way
around it. There are but so many ways Wellbutrin could be doing this, most if not all of which can be dealt with.Bipolar is a bear isn't it?
Thanks,
S.
Posted by super on June 22, 2001, at 7:50:17
In reply to Re: Wellbutrin washout suggestions for BP II? » super, posted by Sulpicia on June 21, 2001, at 22:03:32
Dear Sulpicia,
My p-doc has absolutely no ideas how to get rid of my constipation, other than lowering the dosage (tried that, get depressed) or switching to another AD (tried Paxil and Serezone with hypomanic response to each). I don't have a science background that would enable me to infer from the prescribing information for Wellbutrin; I'm not even sure what you are suggesting I look for. Do you know something that my p-doc and I don't know?Super
> > Hi--
> we're stopping the Wellbutrin because it's not doing much: no response on the last 2 increases and
> it doesn't touch those 3 or 4 days a month were she's totalled -- unable to get out of bed at all.
> The lamictal has done a pretty good job of being an AD, for a MS, and the adderall helps out too.
>
> Pdoc is looking into using 1 of several possible AD meds in the same way as Sarafem is dispensed, tho
> Sarafem itself is out -- dd had a rash once upon a time with an SSRI and we are *rigorous* with the lamictal,
> having already done the rash thing. Ugh.
>
> Hypomania isn't an issue for her bcuz it was mild and short -- her *symptoms* are discussing Kierkegaard and explaining
> why Budda got it all wrong...
> As for you, perhaps you might read a bit about lamictal -- many find it has strong AD effect too, tho the risk/benefit
> equation may be very different for you -- dd *had* to take it bcuz she didn't respond to anything else.
> If you're doing well on Wellbutrin why not get the detailed manufacturer's info on and see what the pharmacology is -- with
> some diligence, and help from pdoc, I'd bet you can figure out how it causes the constipation, and can probably find a way
> around it. There are but so many ways Wellbutrin could be doing this, most if not all of which can be dealt with.
>
> Bipolar is a bear isn't it?
> Thanks,
> S.
Posted by Wendy B. on June 22, 2001, at 18:17:34
In reply to Re: Wellbutrin washout suggestions for BP II?, posted by super on June 22, 2001, at 7:50:17
> Dear Sulpicia,
> My p-doc has absolutely no ideas how to get rid of my constipation, other than lowering the dosage (tried that, get depressed) or switching to another AD (tried Paxil and Serezone with hypomanic response to each). I don't have a science background that would enable me to infer from the prescribing information for Wellbutrin; I'm not even sure what you are suggesting I look for. Do you know something that my p-doc and I don't know?
>
> Super
Hi Super & Sulpicia,I, too, suffer fr bipolar II, soft, or depressed end of the stick, hardly any hypomania, etc. like your daughter, but maybe not as bad as she is, I can't tell. I'm on wellbutrin (300) and neurontin (2400), and that keeps me on a pretty even keel, tho the down moods do come around, just for not as long and not as deep. I wish I knew more about the tapering off, sorry.
Regarding the constipation, these drugs and a lot of ADs, are known to affect the digestive tract in this way (they are anti-choleringenics, how is that spelled??), which means they dry you out. This is also why a lot of people suffer from dry-mouth from these drugs, which sometimes leads to problems with teeth and gums, etc. Do a search on these topics and you'll find a lot of people suffer from the same effects.
I really suffer from the constipation, like you, Super, and it's a pain in the a__ (sorry!). What I've found very helpful are natural remedies. Try one or all or a combo of the following:1) Drink lots and lots of water all day long, as much as you can hold, 6-8 8-oz glasses a day, at least. The best thing is drinking it warm first thing in the morning, with a slice of lemon squeezed into it. Lemon is a natural diuretic (spelling?), which helps the body eliminate more completely. I drink warm water with lemon in it all day when I can, and take lemon slices with me when I go to work. It's very helpful for my system, maybe yours too, and it's not bad for you, and just might help.
2) Find a natural foods store or co-op with a knowledgeable herbal specialist. They can help you find digestive clean-out remedies, otherwise known as "internal cleansing" products. The brand I like is Yerba Prima. The most important ingredient in it is an herb called senna. It is very powerful, but in the Yerba Prima product, it is very well-balanced with a lot of other good cleansing herbs. You can buy senna alone in leaf form, people make teas, or more correctly, herbal infusions, from it, and it really works. So if you buy it that way, put a quarter-teaspoon of it in a tea-ball, steep it in hot water, and drink. It is not exactly the best tasting stuff in the world, but when you're severely constipated, you'll do almost anything to relieve it. Go slowly, and take mini-amounts until you get the right dosage for your system.
There is also a senna tea already in bag form (Traditional Medicinals brand, I think), that, too, tastes god-awful, but a few sips of that stuff, man, and you're on your way!
So like I say, take small doses of it at first, or you will have a lot of gastric pain, and you will have to rush to the bathroom, and that means you've taken too much, ease off on it. Try it (the tea) twice a day.3) Try to lower your intake of all foods except fruit and vegetables for a few days, drinking lots of lemon-water and juices, too. It'll just make you feel lighter, and help you poop (sorry, I can't help it...)
4) Get regular, aerobic exercise.
This all may sound too wacky for a lot of people, but some combination of the above 4 things will help you a lot, I can pretty much guarantee you...
> > Bipolar is a bear isn't it?
> > Thanks,
> > S.Yeah, it sucks! Hope your daughter feels better soon...
Wendy
Posted by Sulpicia on June 22, 2001, at 20:18:05
In reply to Re: Wellbutrin washout suggestions for BP II? » super, posted by Wendy B. on June 22, 2001, at 18:17:34
> > Dear Sulpicia,
> > My p-doc has absolutely no ideas how to get rid of my constipation, other than lowering the dosage (tried that, get depressed) or switching to another AD (tried Paxil and Serezone with hypomanic response to each). I don't have a science background that would enable me to infer from the prescribing information for Wellbutrin; I'm not even sure what you are suggesting I look for. Do you know something that my p-doc and I don't know?
> >
> > Super
>
>
> Hi Super & Sulpicia,
>
> I, too, suffer fr bipolar II, soft, or depressed end of the stick, hardly any hypomania, etc. like your daughter, but maybe not as bad as she is, I can't tell. I'm on wellbutrin (300) and neurontin (2400), and that keeps me on a pretty even keel, tho the down moods do come around, just for not as long and not as deep. I wish I knew more about the tapering off, sorry.
>
> Regarding the constipation, these drugs and a lot of ADs, are known to affect the digestive tract in this way (they are anti-choleringenics, how is that spelled??), which means they dry you out. This is also why a lot of people suffer from dry-mouth from these drugs, which sometimes leads to problems with teeth and gums, etc. Do a search on these topics and you'll find a lot of people suffer from the same effects.
> I really suffer from the constipation, like you, Super, and it's a pain in the a__ (sorry!). What I've found very helpful are natural remedies. Try one or all or a combo of the following:
>
> 1) Drink lots and lots of water all day long, as much as you can hold, 6-8 8-oz glasses a day, at least. The best thing is drinking it warm first thing in the morning, with a slice of lemon squeezed into it. Lemon is a natural diuretic (spelling?), which helps the body eliminate more completely. I drink warm water with lemon in it all day when I can, and take lemon slices with me when I go to work. It's very helpful for my system, maybe yours too, and it's not bad for you, and just might help.
>
> 2) Find a natural foods store or co-op with a knowledgeable herbal specialist. They can help you find digestive clean-out remedies, otherwise known as "internal cleansing" products. The brand I like is Yerba Prima. The most important ingredient in it is an herb called senna. It is very powerful, but in the Yerba Prima product, it is very well-balanced with a lot of other good cleansing herbs. You can buy senna alone in leaf form, people make teas, or more correctly, herbal infusions, from it, and it really works. So if you buy it that way, put a quarter-teaspoon of it in a tea-ball, steep it in hot water, and drink. It is not exactly the best tasting stuff in the world, but when you're severely constipated, you'll do almost anything to relieve it. Go slowly, and take mini-amounts until you get the right dosage for your system.
> There is also a senna tea already in bag form (Traditional Medicinals brand, I think), that, too, tastes god-awful, but a few sips of that stuff, man, and you're on your way!
> So like I say, take small doses of it at first, or you will have a lot of gastric pain, and you will have to rush to the bathroom, and that means you've taken too much, ease off on it. Try it (the tea) twice a day.
>
> 3) Try to lower your intake of all foods except fruit and vegetables for a few days, drinking lots of lemon-water and juices, too. It'll just make you feel lighter, and help you poop (sorry, I can't help it...)
>
> 4) Get regular, aerobic exercise.
>
> This all may sound too wacky for a lot of people, but some combination of the above 4 things will help you a lot, I can pretty much guarantee you...
>
>
> > > Bipolar is a bear isn't it?
> > > Thanks,
> > > S.
>
> Yeah, it sucks! Hope your daughter feels better soon...
>
> WendyThanks Wendy both for your good wishes and for your GI help.
This was precisely what I meant for Super -- her pdoc *should* have
known that it was an anti-cholinergic and what the hell that meant.In addition to the water [all you can stand]prune juice, dried apricots,
and Sennakot are possible too.
If you use an herbal product MAKE DAMN SURE of its ingredients and try to
buy a single substance product.
Docusate [sp?] is an OTC stool softener that works by increasing water
in the stool -- ask the pdoc or check a medchecker to make sure it's safe.
S. :)
This is the end of the thread.
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