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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by lars1 on January 8, 2005, at 12:05:55
Have you taken both bupropion (Wellbutrin, Zyban) and methylphenidate (Ritalin, Concerta, Metadate), not necessarily at the same time? If so, how would you compare the effects? I ask because I currently take bupropion (for ADD and depression) and am wondering whether methylphenidate might work better for me.
Both bupropion and methylphenidate are dopamine/norepinephrine uptake inhibitors. Both are sometimes used to treat ADD. Both have mood-elevating properties. Bupropion has a long (21 hr) elimination half-life, while methylphenidate has a short (3 hr) one. Therefore, bupropion might be expected to have a smoother effect, with less tendency toward stimulant "crashing" as a dose wears off. On the other hand, the long half-life also means that bupropion remains in the body at high levels through the night, not just during the day. Therefore bupropion might be more likely to cause insomnia and more likely to "poop out" over time. Does any of this match your experience?
Lars
Posted by lars1 on January 10, 2005, at 2:14:46
In reply to Wellbutrin vs. Ritalin, posted by lars1 on January 8, 2005, at 12:05:55
Posted by ed_uk on January 10, 2005, at 2:37:05
In reply to Wellbutrin vs. Ritalin, posted by lars1 on January 8, 2005, at 12:05:55
Oh dear, I wish I had the opportunity to try even one of them :-(
Ed.
Posted by lars1 on January 10, 2005, at 8:42:49
In reply to Re: Wellbutrin vs. Ritalin » lars1, posted by ed_uk on January 10, 2005, at 2:37:05
> Oh dear, I wish I had the opportunity to try even one of them :-(
>
> Ed.Is Wellbutrin not available in the UK? If not, there must be *some* dopaminergic that you could get prescribed?
Posted by Ritch on January 10, 2005, at 10:20:07
In reply to Wellbutrin vs. Ritalin, posted by lars1 on January 8, 2005, at 12:05:55
> Have you taken both bupropion (Wellbutrin, Zyban) and methylphenidate (Ritalin, Concerta, Metadate), not necessarily at the same time? If so, how would you compare the effects? I ask because I currently take bupropion (for ADD and depression) and am wondering whether methylphenidate might work better for me.
>
> Both bupropion and methylphenidate are dopamine/norepinephrine uptake inhibitors. Both are sometimes used to treat ADD. Both have mood-elevating properties. Bupropion has a long (21 hr) elimination half-life, while methylphenidate has a short (3 hr) one. Therefore, bupropion might be expected to have a smoother effect, with less tendency toward stimulant "crashing" as a dose wears off. On the other hand, the long half-life also means that bupropion remains in the body at high levels through the night, not just during the day. Therefore bupropion might be more likely to cause insomnia and more likely to "poop out" over time. Does any of this match your experience?
>
> LarsI've taken both, separately and together. The buproprion actually would be less likely to poop out than the stim, but it definitely caused me a lot of insomnia and I can't take the stuff (one of the reasons). Bupropion also has metaboites that last longer than the parent drug and those metaboites are also active. OTOH, I could take MPH 3 hours before bedtime and then crash and sleep like a rock all night. I wouldn't bother with MPH unless you are taking something like Concerta that will level out all of the crashing. If you've got depressive problems along with ADD, the bupropion should work a lot better. If you have trouble with insomnia from the buproprion, you might do better with a TCA instead.
Posted by ed_uk on January 10, 2005, at 12:17:40
In reply to Re: Wellbutrin vs. Ritalin » lars1, posted by Ritch on January 10, 2005, at 10:20:07
Hi,
Bupropion is available in the UK in the form of Zyban. It is approved for smoking cessation but not depression. Psychiatrists do not use it, it is generally considered to be a very dangerous drug in the UK. It has recieved a LOT of bad press. Only a very small minority of UK pdocs ever prescribe stims. There is this dumb idea that they are only safe in children.
If, like me, you suffer from hypersomnia, poor concentration, poor attention, fatigue, low motivation etc. They want to give you an SSRI! They don't even accept that SSRIs can worsen/cause drowsiness and amotivation.
My life is a mess.
Regards,
Ed.
Posted by lars1 on January 11, 2005, at 10:42:04
In reply to Re: Wellbutrin vs. Ritalin » lars1, posted by Ritch on January 10, 2005, at 10:20:07
> I've taken both, separately and together. The buproprion actually would be less likely to poop out than the stim, but it definitely caused me a lot of insomnia and I can't take the stuff (one of the reasons). Bupropion also has metaboites that last longer than the parent drug and those metaboites are also active. OTOH, I could take MPH 3 hours before bedtime and then crash and sleep like a rock all night. I wouldn't bother with MPH unless you are taking something like Concerta that will level out all of the crashing. If you've got depressive problems along with ADD, the bupropion should work a lot better. If you have trouble with insomnia from the buproprion, you might do better with a TCA instead.
Hi Ritch,Thanks for the info. I would definitely want one of the sustained-release forms if I took methylphenidate. Could you compare how bupropion and MPH actually feel, aside from the different duration of action?
Lars
Posted by lars1 on January 11, 2005, at 12:58:41
In reply to Re: Dopamine is taboo in the UK... to lars, posted by ed_uk on January 10, 2005, at 12:17:40
> Bupropion is available in the UK in the form of Zyban. It is approved for smoking cessation but not depression. Psychiatrists do not use it, it is generally considered to be a very dangerous drug in the UK. It has recieved a LOT of bad press.
This is really unfortunate. As I just mentioned in another thread, its bad reputation appears to be undeserved. There is an article at http://bupropion.com/wonderwell/ that talks about some of the history. Wellbutrin XL is getting a big marketing push in the U.S. right now, with ads on prime-time TV.
> Only a very small minority of UK pdocs ever prescribe stims. There is this dumb idea that they are only safe in children.
It probably doesn't help that the ICD doesn't make the same distinction between "Predominantly Inattentive Type" and "Predominantly Hyperactive-Impulsive Type" of ADD that the DSM makes. From what I hear, hyperactivity often improves as kids grow up, while inattention often persists. The ICD mostly focuses on the hyperactivity aspect, so it tends to miss the ADD problems of adults. You do use ICD in the UK, don't you?
>
> If, like me, you suffer from hypersomnia, poor concentration, poor attention, fatigue, low motivation etc. They want to give you an SSRI! They don't even accept that SSRIs can worsen/cause drowsiness and amotivation.
>
> My life is a mess.You sound like the perfect candidate for dopaminergics. Not only do your symptoms match up, but the severity is such that you aren't able to proceed with your education. The only way they could be more severe is if you were actively suicidal. It's hard to understand why your pdoc won't take a more aggressive approach in treating you. (By the way, this is in no way meant as a criticism of you, only of your pdoc.)
All of the symptoms you mention can be symptoms of depression. I wonder if you would get anywhere with the argument that you have depression which is clearly not being adequately treated by the meds you are on and therefore you need to switch to or augment with something new, such as Wellbutrin or a MAO inhibitor. (MAOI's do boost dopamine, don't they?) Actually, anything that improved your depression would probably help with those symptoms, so maybe the new drug wouldn't even need to be directly dopaminergic.
Lars
Posted by Ritch on January 11, 2005, at 13:41:07
In reply to Re: Wellbutrin vs. Ritalin, posted by lars1 on January 11, 2005, at 10:42:04
> > I've taken both, separately and together. The buproprion actually would be less likely to poop out than the stim, but it definitely caused me a lot of insomnia and I can't take the stuff (one of the reasons). Bupropion also has metaboites that last longer than the parent drug and those metaboites are also active. OTOH, I could take MPH 3 hours before bedtime and then crash and sleep like a rock all night. I wouldn't bother with MPH unless you are taking something like Concerta that will level out all of the crashing. If you've got depressive problems along with ADD, the bupropion should work a lot better. If you have trouble with insomnia from the buproprion, you might do better with a TCA instead.
>
>
> Hi Ritch,
>
> Thanks for the info. I would definitely want one of the sustained-release forms if I took methylphenidate. Could you compare how bupropion and MPH actually feel, aside from the different duration of action?
>
> Lars
>
>The "kickin" is very different for me. Bupropion actually makes me feel a little tired for the first few hours after I take it. I get some mild nystagmus (eye jiggles) from it. AFter about six hours or so that's when the "stimulating" effect of it starts to happen. I also get this "time dilation" effect from bupropion. It's the ONLY med that I've ever noticed this with---time goes by VERY slowly and I feel very impatient with many things that I have to wait on. It makes me feel more DRIVEN and I find it kind of hard to sit still. It's somewhat agitating. MPH, kicks in very very fast, my attention immediately gets very focused and there is a cardiovascular component to it that's hard to miss. However, I don't get the restlessness and I don't get the time dilation thing with MPH. There is one thing that both of them seem to share--I have this breathing tic that tends to happen where I feel like I have to voluntarily take breaths it doesn't seem to happen on its own. I didn't like that. Also on MPH if I took a higher dose (i.e. 20mg), I would get another annoying tic of needing to repetitively swallow. Didn't like that. Dexedrine was the only stim that was tic free for me. Adderall.. I got an occasional tic where I felt I needed to sip water all the time.
Posted by lars1 on January 11, 2005, at 14:41:13
In reply to Re: Wellbutrin vs. Ritalin » lars1, posted by Ritch on January 11, 2005, at 13:41:07
Thanks! Your description is very vivid. I haven't tried MPH, but I do take Wellbutrin, and I also feel impatient on it sometimes. For me, this is a good thing, since I can be way too patient otherwise and can take a long time even to do simple things like eat a meal.
Lars
Posted by CareBear04 on January 12, 2005, at 2:09:05
In reply to Re: Wellbutrin vs. Ritalin » Ritch, posted by lars1 on January 11, 2005, at 14:41:13
hey, i've taken both. my first stimulant-like drug (intended to have that effect, anyway) was wellbutrin. i started on a low-dose of 75-150mg, and then went all the way up to 450mg. i tried the SR and XL forms, but the XL was pretty ineffective for me, and the SR had this really rank smell, like rotten eggs. made it unpleasant to take. i don't know if wellbutrin worked for me. it definitely did seem to take care of some tiredness and maybe helped with my concentration, but maybe part of my impression was a placebo-effect more than actual helping. in the end, taking immediate release wellbrutin 3x a day was too much, and i went on to strattera and provigil before trying adderall and ritalin and then ritalin in the form of concerta.
i definitely recommend concereta over wellbutrin. it is slightly appetite suppressing, it definitely gives you a kick, and it helped me with concentration. comparing it to adderall, i much prefer adderall, but concerta is a good second choice for me. i was on 27mg x 3... maybe you're better at math than i am. and i supplemented with some immediate release adderall in the afternoons. i'm not sure what a standard dose is. the pills come in wacky doses. good luck!
Posted by ed_uk on January 12, 2005, at 3:03:43
In reply to Re: Dopamine is taboo in the UK » ed_uk, posted by lars1 on January 11, 2005, at 12:58:41
Hi!
Thank you for the link to the article- it was very interesting :-)
>It probably doesn't help that the ICD doesn't make the same distinction between "Predominantly Inattentive Type" and "Predominantly Hyperactive-Impulsive Type" of ADD that the DSM makes.
You're absolutely right! I think my pdoc would laugh if I suggested that I might have ADD.
>The ICD mostly focuses on the hyperactivity aspect, so it tends to miss the ADD problems of adults. You do use ICD in the UK, don't you?
The DSM and the ICD are both used. I get the impression that there is much more emphasis on diagnosis in the US, partly for insurance reasons.
>You sound like the perfect candidate for dopaminergics.
I know!
Things my pdoc never prescribes.....
Nardil, Parnate, Selegiline, Provigil, Ritalin, Dexedrine, Concerta, any TCAs apart from lofepramine, Wellbutrin..... the list goes on.
>All of the symptoms you mention can be symptoms of depression.
I don't feel depressed though. I'd like to try Parnate but I would have to hold a gun to my pdocs head!
Best Regards,
Ed.
Posted by lars1 on January 12, 2005, at 9:31:16
In reply to Re: Wellbutrin vs. Ritalin » lars1, posted by CareBear04 on January 12, 2005, at 2:09:05
> hey, i've taken both. my first stimulant-like drug (intended to have that effect, anyway) was wellbutrin. i started on a low-dose of 75-150mg, and then went all the way up to 450mg. i tried the SR and XL forms, but the XL was pretty ineffective for me, and the SR had this really rank smell, like rotten eggs. made it unpleasant to take. i don't know if wellbutrin worked for me. it definitely did seem to take care of some tiredness and maybe helped with my concentration, but maybe part of my impression was a placebo-effect more than actual helping. in the end, taking immediate release wellbrutin 3x a day was too much, and i went on to strattera and provigil before trying adderall and ritalin and then ritalin in the form of concerta.
> i definitely recommend concereta over wellbutrin. it is slightly appetite suppressing, it definitely gives you a kick, and it helped me with concentration. comparing it to adderall, i much prefer adderall, but concerta is a good second choice for me. i was on 27mg x 3... maybe you're better at math than i am. and i supplemented with some immediate release adderall in the afternoons. i'm not sure what a standard dose is. the pills come in wacky doses. good luck!Thanks! I have to agree that Wellbutrin feels kind of weak compared to "real" psychostimulants. But it does seem to boost the effect of the Adderall that I take.
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