![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 77 to 101 of 114. Go back in thread:
Posted by gromit on May 17, 2005, at 0:17:27
In reply to Re: Desipramine in neuropathic pain » ed_uk, posted by franco neuro on May 15, 2005, at 19:02:58
> Thanks Ed,
>
> I'd like to try and get some plain old dextromethorphan. I really don't feel like chugging cough syrup right now. :-)If you follow the link Ed posted http://www.erowid.org/chemicals/dxm/dxm_info2.shtml there are several brands of DXM gelcaps listed.
Posted by franco neuro on May 17, 2005, at 10:39:09
In reply to Re: Desipramine in neuropathic pain » franco neuro, posted by gromit on May 17, 2005, at 0:17:27
Hi,
I took another look and there is a prodcut that's called DexAlone. It comes in a gelcap and is available without a prescription. May be worth a try.
Thanks,
Franco
Posted by ed_uk on May 17, 2005, at 14:10:17
In reply to Re: Dextromethorphan, posted by franco neuro on May 17, 2005, at 10:39:09
I hope it helps!
Ed.
Posted by stephano on June 16, 2005, at 2:24:46
In reply to Anyone TIRED on Wellbutrin XL?, posted by islandangel on March 19, 2005, at 22:29:23
Hi all,
I'm new to the forum- just stumbled across some of the posts in this thread which I found particularly interesting. NeuroFranco- I too have CFS (have been ill for around a decade now) and have followed the work of Goldstein. I am in Australia but was saving up to go and see him when I found he had retired. I have little doubt that (my version of) CFS is exactly what he talks about with his lymbic hypothesis. A big "Yes" to chemical smells/sensitivity too for me!Until recently, I had never found any medication that helped me. SSRIs and anything else that focussed on boosting serotonin did nothing and often made me worse.
It was when I CAME OFF a drug (effexor) that I finally had a good drug response. (This happened in the second year of my illness but nobody could ever tell me why it might have happened or how to recreate it). I had been on it for around 5 months (225mg), realised it wasn't doing anything good, so decided to come off it and worked down to zero over the course of a couple of weeks (which is obviously faster than is recommended). I then had a period of maybe 10-12 days where I felt (miraculously) pretty close to normal. Interesting considering many people talk of negative experiences when withdrawing from venlafaxine. It actually helped me. I had a similar response when I ceased Zoloft.
That was many years ago, and I then went through a full range of expensive, time-wasting alternative therapies. Nothing helped and I was still very ill with a range of symptoms, including moderate to severe endogenous mood disturbance (depression+ anxiety)
At the start of this year I thought again about the 'coming off effexor' phenomenon, as it was the only time over the past decade that I had felt better.
I came to the conclusion that dopamine might be involved.(Too long to explain how I came to this conclusion!) Although there are no antidepressants that specifically target dopamine here in Australia (Wellbutrin is only here as 'Zyban' for quitting smoking and is very expensive) a pharmacologist I spoke to reckoned that the noradrenaline reuptake inhibitor Edronax (reboxetine) also had some effect on dopamine. I was sceptical, but this drug did indeed help. (I think you have a different snri in the U.S...Cymbalta maybe???)
I can relate to the counter-intuitive experience of being rendered sleepy/exhausted by a stimulant, because edronax does that to me sometimes. It waxes and wanes..sometimes it helps quite a lot, sometimes it puts me to sleep, sometimes it helps with physical symptoms but not mood. (Although anxiety has been pretty well reduced)
One of the stranger symptoms I have had with this illness is very flaccid muscle tone. It happened suddenly at the start of the condition, not as a result of deconditioning or anything. The edronax works to improve that significantly, and improves muscle tone back up to near what it should be in a 30 year old. (my age) No idea why, although I had previously found that pseudophedrine in big enough doses improved muscle tone too. (So suspect it's something to do with CNS stimulation)
Anyway, the point of this post is to say that Edronax has, overall, made me more functional, but things like mood and libido are still not too good. Am going to bite the bullet and borrow money to try Wellbutrin (called 'Zyban' here, but it's the same drug, Bupropion)
I must admit that life has been a veritable nightmare since I was twenty, but I am finally seeing the tiniest hint of a light at the end of the tunnel.
Anyway- I hope the wellbutrin helps...if not, I may have to revert to the edronax and work out how to boost dopamine with a separate agent. Has anyone ever used any of the Parkinson's drugs off-label for this purpose?
Any input about anything most appreciated. Best wishes all....this is a great forum.
Posted by 4WD on June 17, 2005, at 21:49:45
In reply to Re: Anyone TIRED on Wellbutrin XL?, posted by stephano on June 16, 2005, at 2:24:46
Hi Stephano,
When I took Wellbutrin I had more physical energy but I had no inner motivation or enjoyment of it. I just needed to be active, moving around, working off nervous energy. It wasn't particularly pleasant. I also got insomnia. I could fall asleep okay but I would wake up half a dozen times and wouldn't be able to sleep long enough. OTOH I think I might have too much dopamine because zyprexa makes me feel much better (except I can't take it because I have an eating disorder that it wakes up).
Hope this helps.
Posted by SLS on June 18, 2005, at 7:48:06
In reply to Re: Anyone TIRED on Wellbutrin XL? » stephano, posted by 4WD on June 17, 2005, at 21:49:45
Hi.
> When I took Wellbutrin I had more physical energy but I had no inner motivation or enjoyment of it.
This is a common description of the nature of response to Wellbutrin. People who react this way to Wellbutrin often gain the motivation and enjoyment when a serotonergic is added to it (SSRIs, Effexor, Cymbalta). For a friend of mine, the addition of Effexor did the trick. The improvement in her depression and the attendant increases in functionality and enjoyment of life was marvelous to watch. She had spent most of her life in a state of moderate depression; fighting every day just to maintain a job and take out the garbage. She later switched the Effexor to Lexapro and now feels even better. I think the switch helped clear her mind, which had been left a bit foggy by the Effexor.Wellbutrin + SRI are complementary. That which one lacks, the other has and vice-versa. In addition, the Wellbutrin can act to reverse the apathy and sexual side effects of the SRI.
- Scott
Posted by TamaraJ on June 18, 2005, at 9:23:52
In reply to Re: Anyone TIRED on Wellbutrin XL?, posted by SLS on June 18, 2005, at 7:48:06
Scott,
I started Wellbutrin SR about 3 weeks ago, to augment the 75mg of nortrityline I have been taking. Would I be better off changing the nort for a SSRI like Lexapro, or does the Wellbutrin/nort combo have the potential to be a good one? It seems to be ok so far, and I am only at 100mg of Wellbutrin (which, I know, is not the therapeutic does). I went up to 150mg for 5 or 6 days, but ended up with really bad heads (almost migraine-like). I am going to try 100mg a.m. and 100mg p.m. (early afternoon) to see if that is more tolerable. The 150mg all at once seems to affect me badly for some reason :-(
Thanks.
Tamara
Posted by SLS on June 18, 2005, at 9:53:46
In reply to Re: Anyone TIRED on Wellbutrin XL? - ? for Scott » SLS, posted by TamaraJ on June 18, 2005, at 9:23:52
Hi Tamara.
How are you feeling right now?
> I started Wellbutrin SR about 3 weeks ago, to augment the 75mg of nortrityline I have been taking.
You might want to try moving up the dosage of nortriptyline to 100mg.
> Would I be better off changing the nort for a SSRI like Lexapro, or does the Wellbutrin/nort combo have the potential to be a good one?
Hmm. I wish I could answer this question for you. I know how much easier your decision-making process would be by having a definitive answer.
Do you think the Wellbutrin has helped at all?
> It seems to be ok so far, and I am only at 100mg of Wellbutrin (which, I know, is not the therapeutic does). I went up to 150mg for 5 or 6 days, but ended up with really bad heads (almost migraine-like). I am going to try 100mg a.m. and 100mg p.m. (early afternoon) to see if that is more tolerable. The 150mg all at once seems to affect me badly for some reason
:-(
I'm not a real big advocate of the XL once-a-day prescription. If I were taking Wellbutrin, I would take the SR version twice a day morning and evening.
Perhaps someone can provide some input as to the possibility that it is the nortriptyine that is acting as a catalyst to produce the headaches you get when you try to increase the dosage of Wellbutrin. It is conceiveable that you can take larger dosages of Wellbutrin in the absence of nortriptyline. I think I would proceed in the following sequence if I wanted to build a treatment around Wellbutrin:
1. Increase nortriptyline to 100mg; return to 75mg only if depression gets worse.
2. Switch to twice a day schedule of Wellbutrin of SR or XL: morning and evening.
3. Increase dosage of Wellbutrin gradually to 300mg.
4. If you cannot tolerate the higher dosages of Wellbutrin, discontinue nortriptyline. If tolerated, continue with the nortriptyline.
5. Attempt to increase the dosage of Wellbutrin to 300mg
6. Add to the Wellbutrin the SRI that you had the best response to in the past. These would include the SSRIs, Effexor, and Cymbalta. You can continue taking the nortriptyline.
If you prefer to stay with nortriptyline or cannot tolerate a higher dosage of Wellbutrin in its absence, you can discontinue the Wellbutrin, restart the nortriptyline if necessary and add Parnate, Effexor, or Cymbalta.
- Scott
Posted by TamaraJ on June 18, 2005, at 10:20:59
In reply to Re: Anyone TIRED on Wellbutrin XL? - ? for Scott » TamaraJ, posted by SLS on June 18, 2005, at 9:53:46
> Hi Tamara.
>
> How are you feeling right now?
>
-- I am feeling not too bad, not too bad at all. I think I am almost there actually, which is a nice feeling.
>
> You might want to try moving up the dosage of nortriptyline to 100mg.
>
-- I tried to up the nort to 100mg a number of weeks ago, and it left me really sluggish and slow the next day. I tried the 100mg for a number of days, but it seemed to actually make me feel worse. Must be that therapeutic window thing. So, I went back to 75mg, and I was fine, but still lacking energy and motivation (I am, by nature, a somewhat hyper, high energy person, so my expectations may be too high really).
>
> Hmm. I wish I could answer this question for you. I know how much easier your decision-making process would be by having a definitive answer.
>
-- I know, it is so much a case of trial and error. I don't have any significant adverse effects with the Wellbutrin/nort combo, so I will stick with it for a while. Plus, my understanding is that nort works on serotonin as well, so I assume it is much like a SNRI?
>
> Do you think the Wellbutrin has helped at all?
>
-- Oh, yes, I have noticed a difference in my mood, my energy levels and my motivation, even at 100mg. Not an enormous difference, but enough that I am encouraged. So, I am going to try hard to tolerate a higher dose to get me over the last of the hump.
>
> I'm not a real big advocate of the XL once-a-day prescription. If I were taking Wellbutrin, I would take the SR version twice a day morning and evening.
>
-- I have heard negative things about the XL version. I am going to stick with the SR version. I think Minnie was saying that she also had a negative reaction to the 150mg tab, but when she takes 2, 100mg tabs, no negative reaction. Weird.
>
> Perhaps someone can provide some input as to the possibility that it is the nortriptyine that is acting as a catalyst to produce the headaches you get when you try to increase the dosage of Wellbutrin. It is conceiveable that you can take larger dosages of Wellbutrin in the absence of nortriptyline.-- I am wondering if the headaches were caused by my smoking. I have been trying to quit, and have cut down significantly since starting the Wellbutrin, but still have about 10 smokes a day. I wonder if the increased dose of Wellbutrin, combined with smoking, was producing migraine-like headaches. For some reason, that would make sense to me, and it was something that dawned on me this morning.
>
I think I would proceed in the following sequence if I wanted to build a treatment around Wellbutrin:
>
> 2. Switch to twice a day schedule of Wellbutrin of SR or XL: morning and evening.
>
-- I think you are right on here. I am going to try this, starting tomorrow, to see how I respond. Hopefully, there will be no problems. Actually, I have been quite fortunate with both the nort and the Wellbutrin. With the exception of some start-up side effects the first couple of weeks, I have not been troubled by much in terms of continuing side effects (knock on wood :-)).
>
> 3. Increase dosage of Wellbutrin gradually to 300mg.
>
-- Yes, depending on how I respond to the 200mg (in two doses), I would go up to 300mg if more antidepressant effect is needed. I am hoping that 200mg will do it for, since I really am almost there (yipes, I hope I have jinxed myself now).
>
> If you prefer to stay with nortriptyline or cannot tolerate a higher dosage of Wellbutrin in its absence, you can discontinue the Wellbutrin, restart the nortriptyline if necessary and add Parnate, Effexor, or Cymbalta.
>
-- I am a bit nervous of MAOIs, but I would certainly consider one if the nort/wellbutrin combo ends up proving disappointing. I have tried Effexor, and it was not good for me (had some continuing side effect problems that ended up causing even bigger problems). And, unfortunately, Cymbalta is not available in Canada yet :-(Thanks so much, Scott, for taking the time to respond to my questions. I really appreciate it. I was just curious to know if one of the newer ADs might work better with the Wellbutrin than the nort, but I am optimistic about the combo on am on now. So I hope things just continue to get better.
All the best, and take good care of yourself.
Tamara
Posted by ed_uk on June 18, 2005, at 10:38:58
In reply to Re: Anyone TIRED on Wellbutrin XL? - ? for Scott » SLS, posted by TamaraJ on June 18, 2005, at 10:20:59
Hi T!
>Wellbutrin
Perhaps you won't need to increase your Well dose any further. Maybe, after a couple more weeks on your current dose, you'll be feeling much better...
Ed xx
Posted by TamaraJ on June 18, 2005, at 12:42:56
In reply to Re: Anyone TIRED on Wellbutrin XL? - ? for Scott » TamaraJ, posted by ed_uk on June 18, 2005, at 10:38:58
> Hi T!
>
> >Wellbutrin
>
> Perhaps you won't need to increase your Well dose any further. Maybe, after a couple more weeks on your current dose, you'll be feeling much better...
>
-- I wonder. Oh, no, decisions, decisions. I think I am going to try 200mg (in two doses) tomorrow or Monday just to see if I can tolerate it and to see if it makes me feel even better. What the heck, it's still not a high dose. I have also been taking Pregnenolone and DHEA (in very small doses) for a couple of weeks. I think they have helped in some way as well. My hormones were totally screwed up from the Depo months ago, so perhaps the Pregnenolone and DHEA are helping to bring them back into balance. Who knows. All I know is that I want to be me again, and I think (and hope and pray) that I am almost there.
Tamara
xoxo
Posted by ed_uk on June 18, 2005, at 14:27:30
In reply to Re: Anyone TIRED on Wellbutrin XL? - ? for Scott » ed_uk, posted by TamaraJ on June 18, 2005, at 12:42:56
Hi T!
>I think I am going to try 200mg (in two doses) tomorrow or Monday just to see if I can tolerate it and to see if it makes me feel even better.
I hope it helps :-) .......and it doesn't make you irritable :-O
Ed xxx
Posted by 4WD on June 18, 2005, at 15:45:19
In reply to Re: Anyone TIRED on Wellbutrin XL?, posted by SLS on June 18, 2005, at 7:48:06
> Hi.
>
> > When I took Wellbutrin I had more physical energy but I had no inner motivation or enjoyment of it.
>
>
> This is a common description of the nature of response to Wellbutrin. People who react this way to Wellbutrin often gain the motivation and enjoyment when a serotonergic is added to it (SSRIs, Effexor, Cymbalta). For a friend of mine, the addition of Effexor did the trick. The improvement in her depression and the attendant increases in functionality and enjoyment of life was marvelous to watch. She had spent most of her life in a state of moderate depression; fighting every day just to maintain a job and take out the garbage. She later switched the Effexor to Lexapro and now feels even better. I think the switch helped clear her mind, which had been left a bit foggy by the Effexor.
>
> Wellbutrin + SRI are complementary. That which one lacks, the other has and vice-versa. In addition, the Wellbutrin can act to reverse the apathy and sexual side effects of the SRI.
>
>
> - Scott
>Unfortunately the Wellbutrin also increased anxiety for me. And the insomnia was a big problem. I know I could add more Klonopin to counteract the anxiety and a sleeping med to counteract the insomnia but I get to the point of thinking okay I'm taking one med for this and another to counteract the effects of the first med and so on. I remember your post about if you want to play you've gotta pay but I guess I'm just stubborn and not quite miserable enough to be willing to put up with four sets of side effects.
In my heart I want to be med free or conquer this with a minimum of medication plus supplements and exercise. I don't know if this will work but I've never tried it before so I might as well give it at least as long of a shot as I have given specific meds. And I keep hoping that my former abuse of pain meds was a large part of the cause of my depression and that now that I'm free of that, I can get better depression wise (with time).
Marsha
>
Posted by TamaraJ on June 18, 2005, at 16:00:58
In reply to Re: Anyone TIRED on Wellbutrin XL?, posted by 4WD on June 18, 2005, at 15:45:19
Marsha,
Have you tried Paxil? Paxil was the first AD I was prescribed, at a time when I was experiencing my first ever depression. It was an agitated depression, which meant LOTS of anxiety. Within 3 weeks of starting Paxil my anxiety had subsided significantly, and the depression had started to lift. It was a great med for me for about 7 years, and I regret having stopped taking the low maintenance dose I was on because, when I experienced a second depressive episode, the Paxil didn't work again. Some people say it is very sedating, but I never had a problem with sedation, and I took it early in the morning. You could also look at taking Paxil and nortriptyline together. It might be a good combo. The nort seems to be quite effective for anxiety and panic attacks, not mention being sedating so it could help in the sleep area.
Hope you find a combo that works for you with as few side effects as possible. Good luck, and take care.
Tamara
Posted by 4WD on June 18, 2005, at 16:12:51
In reply to Re: Anyone TIRED on Wellbutrin XL? - ? for Scott » SLS, posted by TamaraJ on June 18, 2005, at 10:20:59
I just don't get it. It's just unfathomable to me how people can manage these doses without crippling side effects. At 25mg of nortriptyline my mouth was so dry I couldn't speak half the time. And at 150mg Wellbutrin, I couldn't sleep more than a couple hours at a time. I think my problem isn't so much that I'm med resistant it's that I just can't tolerate a therapeutic dose of anything.
Yes, I'm a whiny baby.
Marsha
Posted by TamaraJ on June 18, 2005, at 16:19:14
In reply to Re: Anyone TIRED on Wellbutrin XL? - ? for Scott, posted by 4WD on June 18, 2005, at 16:12:51
Were you taking the nort during the day? I only take it at night, so the only time I have dry mouth is early in the morning. And, did you know you can get Wellbutrin SR in 100mg tablets? If you can't tolerate 150mg, ask your doc for 100mg and see how you do on that dose. I seem to recall Minnie saying a while ago that she had some problems on the 150mg tablet, but when she went to 200mg (one dose of 2x100mg), she was fine. I, too, experienced irritability on 150mg. I am going to try 200mg (in 2 doses though) tomorrow.
Tamara
> I just don't get it. It's just unfathomable to me how people can manage these doses without crippling side effects. At 25mg of nortriptyline my mouth was so dry I couldn't speak half the time. And at 150mg Wellbutrin, I couldn't sleep more than a couple hours at a time. I think my problem isn't so much that I'm med resistant it's that I just can't tolerate a therapeutic dose of anything.
>
> Yes, I'm a whiny baby.
>
> Marsha
Posted by 4WD on June 18, 2005, at 16:19:42
In reply to Re: Anyone TIRED on Wellbutrin XL? » 4WD, posted by TamaraJ on June 18, 2005, at 16:00:58
> Marsha,
>
> Have you tried Paxil? Paxil was the first AD I was prescribed, at a time when I was experiencing my first ever depression. It was an agitated depression, which meant LOTS of anxiety. Within 3 weeks of starting Paxil my anxiety had subsided significantly, and the depression had started to lift. It was a great med for me for about 7 years, and I regret having stopped taking the low maintenance dose I was on because, when I experienced a second depressive episode, the Paxil didn't work again. Some people say it is very sedating, but I never had a problem with sedation, and I took it early in the morning. You could also look at taking Paxil and nortriptyline together. It might be a good combo. The nort seems to be quite effective for anxiety and panic attacks, not mention being sedating so it could help in the sleep area.
>
> Hope you find a combo that works for you with as few side effects as possible. Good luck, and take care.
>
> Tamara
Hi Tamara,Thanks for the suggestion but I think I must have pretty much an opposite chemistry from yours. When I tried switching from Effexor to Paxil last summer, I started getting panicky within a week or two. And nortriptyline made me more anxious also.
OTOH, the Paxil panickyness might just have been from going off Effexor too rapidly. It might be worth trying again once the anxiety I'm having right now gets better. I'm still only off Effexor for about three months and I'm hoping that's part of the source of the anxiety.
Then on the Other other hand, I have paradoxical reactions to a lot of meds. Who knows?
Marsha
Posted by TamaraJ on June 18, 2005, at 16:27:00
In reply to Re: Anyone TIRED on Wellbutrin XL? » TamaraJ, posted by 4WD on June 18, 2005, at 16:19:42
Hi Marsha,
I experienced the same thing when I started Paxil - increased anxiety and panic - for about the first 3 weeks or so. At first I was freaking out. The last thing I wanted was more freaking anxiety. I spoke to my doctor and she told me that it was likely just start-up side effects, and it would subside after 2 to 3 weeks. She also gave me a small script for Xanax to use during the adjustment phase. And, after about 3 weeks, the anxiety subsided (was pretty much gone, actually), and I didn't really need the Xanax anymore (or too often). But, as you say, we are all different, so Paxil may not have been the right med for you. Or, between the withdrawal from Effexor and the start-up side effects of Paxil, you experienced really severe anxiety and panic. It's so hard to tell.
How long did you try the nort for? Again, the incredible anxiety could have been start-up side effects. I was a bit more agitated when I started nort, but that went away as my body adjusted to the med.
Tamara
> Hi Tamara,
>
> Thanks for the suggestion but I think I must have pretty much an opposite chemistry from yours. When I tried switching from Effexor to Paxil last summer, I started getting panicky within a week or two. And nortriptyline made me more anxious also.
>
> OTOH, the Paxil panickyness might just have been from going off Effexor too rapidly. It might be worth trying again once the anxiety I'm having right now gets better. I'm still only off Effexor for about three months and I'm hoping that's part of the source of the anxiety.
>
> Then on the Other other hand, I have paradoxical reactions to a lot of meds. Who knows?
>
> Marsha
>
Posted by ed_uk on June 18, 2005, at 18:29:48
In reply to Re: Anyone TIRED on Wellbutrin XL? - ? for Scott, posted by 4WD on June 18, 2005, at 16:12:51
>At 25mg of nortriptyline my mouth was so dry I couldn't speak half the time.
Perhaps you're a slow metaboliser of TCAs. You might benefit from a very low dose eg. 10mg nort.
~Ed
Posted by SLS on June 18, 2005, at 19:33:21
In reply to Re: Anyone TIRED on Wellbutrin XL?, posted by 4WD on June 18, 2005, at 15:45:19
Hi.
> Unfortunately the Wellbutrin also increased anxiety for me.
This might be an unappealing idea, but the addition of an SSRI, Effexor, or Cymbalta might take care of the anxiety quite nicely.
Do you experience any body aches or pains?
> And the insomnia was a big problem.
I hate to do this to you, but one hell of a potent combination would be an SRI + Wellbutrin + Remeron. The Remeron would treat the insomnia and add quite a punch to the other drugs to treat the depression and anxiety. You might not need any benzodiazepines at all.
> I know I could add more Klonopin to counteract the anxiety and a sleeping med to counteract the insomnia but I get to the point of thinking okay I'm taking one med for this and another to counteract the effects of the first med and so on.
I know. Things can become quite a mess, especially when they don't work. When they do work, someone becomes a genius.
> I remember your post about if you want to play you've gotta pay but I guess I'm just stubborn and not quite miserable enough to be willing to put up with four sets of side effects.
Again, you might need only two drugs total.
> In my heart I want to be med free or conquer this with a minimum of medication plus supplements and exercise.
Go for it. The drugs will always be there to come back to if you need them.
> I don't know if this will work but I've never tried it before so I might as well give it at least as long of a shot as I have given specific meds. And I keep hoping that my former abuse of pain meds was a large part of the cause of my depression and that now that I'm free of that, I can get better depression wise (with time).
Stranger things have happened. I think the combination of pregnenelone + DHEA sounds interesting. I guess the DHEA acts as a guarantee that enough androgen will become available should much of the pregnenelone be converted to progesterone. From what I understand, women tend to profit more from the addition of DHEA than men do, and it acts as both an antidepressant and anxiolytic.
Supplements are not my forte, so I'll leave the rest to the "Alternative" board. I wish I had the energy to read more. I would love to become more familiar with alternative treatments.
Good luck!
- Scott
Posted by SLS on June 18, 2005, at 20:13:08
In reply to Re: Anyone TIRED on Wellbutrin XL? - ? for Scott, posted by 4WD on June 18, 2005, at 16:12:51
Hi.
> I just don't get it. It's just unfathomable to me how people can manage these doses without crippling side effects.
Slower titrations? Many of the side effects lessen greatly with time.
> At 25mg of nortriptyline my mouth was so dry I couldn't speak half the time.
The first time I took a TCA, I experienced dry mouth along with profuse sweating, blurred vision, constipation, abnormal orgasms, intense itching, elevated heart rate, and a few other things. This stuff appeared after the first dose. Within a few weeks, I was not so emotionally reactive to the side effects, especially because they had dissipated somewhat.
25mg of nortriptyline is probably equal to 50mg of imipramine with regard to side effects and somewhere between 50-75mg of imipramine with regard to therapeutic effect. That's a pretty high dosage to start at if you tend to be sensitive to side effects or are a poor-metabolizer of tricyclics. Most people need 75mg of nortriptyline. If in doubt, taking a blood test is often helpful in serving as a guide to dosing. If you are a poor metabolizer (P450 2D6) of TCAs, you will need substantially less drug to reach a therapeutic level as well as less drug to precipitate side effects.
> And at 150mg Wellbutrin, I couldn't sleep more than a couple hours at a time.
Insomnia has always been a good sign for me that I will respond to a medication. It is imperative that you not let insomnia prevent you from fully exploring the therapeutic potential of a drug. It should be treated as aggressively as the depression itself. You can't stop Wellbutrin until you get to 300mg. If I were to let insomnia cause me to abort my first trial of Parnate + desipramine, I would never have attained remission. I took both Ativan and Halcion to treat the antidepressant-induced insomnia. It worked well. There are several strategies to cope with insomnia besides warm milk. Don't be afraid to use them.
Allow three weeks for any one dosage to demonstrate its efficacy and side effect profile.
> I think my problem isn't so much that I'm med resistant it's that I just can't tolerate a therapeutic dose of anything.
Whatever can go wrong does go wrong? I know the feeling. Perhaps you need to titrate dosages of medication at a rate half of that of the average person. I am unwilling to accept that you cannot tolerate the medications that will give you your life back.
> Yes, I'm a whiny baby.I am also unwilling to accept this statement. Things have been hard for you. You are not responsible for the way these drugs affect you. In addition, you might not have been adequately prepared by your physician to have a full appreciation of the potential side effects of these drugs before beginning to take them.
Who cares? Whine all you want. Something good may come of it.
- Scott
Posted by 4WD on June 18, 2005, at 22:06:54
In reply to Re: Anyone TIRED on Wellbutrin XL? » 4WD, posted by TamaraJ on June 18, 2005, at 16:27:00
> Hi Marsha,
>
> I experienced the same thing when I started Paxil - increased anxiety and panic - for about the first 3 weeks or so. At first I was freaking out. The last thing I wanted was more freaking anxiety. I spoke to my doctor and she told me that it was likely just start-up side effects, and it would subside after 2 to 3 weeks. She also gave me a small script for Xanax to use during the adjustment phase. And, after about 3 weeks, the anxiety subsided (was pretty much gone, actually), and I didn't really need the Xanax anymore (or too often). But, as you say, we are all different, so Paxil may not have been the right med for you. Or, between the withdrawal from Effexor and the start-up side effects of Paxil, you experienced really severe anxiety and panic. It's so hard to tell.
>
> How long did you try the nort for? Again, the incredible anxiety could have been start-up side effects. I was a bit more agitated when I started nort, but that went away as my body adjusted to the med.
>
> Tamara
>
> > Hi Tamara,
> >
> > Thanks for the suggestion but I think I must have pretty much an opposite chemistry from yours. When I tried switching from Effexor to Paxil last summer, I started getting panicky within a week or two. And nortriptyline made me more anxious also.
> >
> > OTOH, the Paxil panickyness might just have been from going off Effexor too rapidly. It might be worth trying again once the anxiety I'm having right now gets better. I'm still only off Effexor for about three months and I'm hoping that's part of the source of the anxiety.
> >
> > Then on the Other other hand, I have paradoxical reactions to a lot of meds. Who knows?
> >
> > Marsha
> >
>
>I think I tried both of them for about three weeks. Maybe I'm just too impatient. Maybe it was withdrawal from Effexor. As you say, it's just so hard to tell. I do remember getting really bad restless legs on the Paxil by the second or third day so I wasn't too motivated to stick it out. And Klonopin also gives me restless legs if I take it in the afternoon or at night so adding more of it would have compounded that problem.
I'm so glad you've found a combo that seems to be working for you. AT first I was ticked off cause somebody was getting well and it wasn't me. You know? But it gives me hope that it is possible to find a good treatment. Mine is out there somewhere. And right now I'm not deeply depressed; just apathetic and lethargic and anhedonic. ANd the anxiety has gotten some better and I'm not suicidal anymore. So that's a lot.
Marsha
Posted by 4WD on June 18, 2005, at 22:24:04
In reply to Re: Anyone TIRED on Wellbutrin XL? - ? for Scott » 4WD, posted by ed_uk on June 18, 2005, at 18:29:48
> >At 25mg of nortriptyline my mouth was so dry I couldn't speak half the time.
>
> Perhaps you're a slow metaboliser of TCAs. You might benefit from a very low dose eg. 10mg nort.
>
> ~Ed
I think I'm a slow metabolizer in general. I could never take more than about 50mg of Effexor, my Celexa maximum dose is 10-15mg, on Prozac I took 20mg 2-3 times a week and .5 mg of Klonopin controls anxiety fairly well. I also get drunk on two beers. OTOH I could gulp down 30mg of hydrocodone and feel just fine.You know it's upsetting that there are specific protocols for treatment of every possible kind and variation of cancer but no treatment protocol for various symptoms/type of depression beyond simply SSRIs or SNRIs for MDD and mood stabilizers for bipolar. It makes me want to get in the boat with Linkadge and either use my own power to row like hell (quit all drugs and let my brain rebalance itself) or just sink the d*** thing.
Marsha
Posted by 4WD on June 18, 2005, at 22:33:12
In reply to Re: Anyone TIRED on Wellbutrin XL? » 4WD, posted by SLS on June 18, 2005, at 19:33:21
> Stranger things have happened. I think the combination of pregnenelone + DHEA sounds interesting. I guess the DHEA acts as a guarantee that enough androgen will become available should much of the pregnenelone be converted to progesterone. From what I understand, women tend to profit more from the addition of DHEA than men do, and it acts as both an antidepressant and anxiolytic.
>Thanks, Scott. I am switching to a new Pdoc (first appt is June 30). He's a two hour drive away but one of the clinics where he works is called Mental Health and Natural Medicine and he's considered a holistic practitioner. The DHEA sounds like a great idea. That's one I hadn't considered. I don't know much about supplements either but I'm learning. And you make a really good point - the drugs will still be there to come back to. I'm not quitting my Celexa/Klonopin yet though. And maybe I'll try adding Lamictal to that. And I still have one ace in the hole. I responded well to imipramine back in 1987 before I was taken off it and put on Prozac so I can always try that again. Maybe it's been long enough that my body would think it was a whole new drug.
Marsha
Posted by 4WD on June 18, 2005, at 22:47:56
In reply to Re: Anyone TIRED on Wellbutrin XL? - ? for Scott » 4WD, posted by SLS on June 18, 2005, at 20:13:08
> Hi.
>
> > I just don't get it. It's just unfathomable to me how people can manage these doses without crippling side effects.
>
> Slower titrations? Many of the side effects lessen greatly with time.
>
> > At 25mg of nortriptyline my mouth was so dry I couldn't speak half the time.
>
> The first time I took a TCA, I experienced dry mouth along with profuse sweating, blurred vision, constipation, abnormal orgasms, intense itching, elevated heart rate, and a few other things. This stuff appeared after the first dose. Within a few weeks, I was not so emotionally reactive to the side effects, especially because they had dissipated somewhat.
>
> 25mg of nortriptyline is probably equal to 50mg of imipramine with regard to side effects and somewhere between 50-75mg of imipramine with regard to therapeutic effect. That's a pretty high dosage to start at if you tend to be sensitive to side effects or are a poor-metabolizer of tricyclics. Most people need 75mg of nortriptyline. If in doubt, taking a blood test is often helpful in serving as a guide to dosing. If you are a poor metabolizer (P450 2D6) of TCAs, you will need substantially less drug to reach a therapeutic level as well as less drug to precipitate side effects.
>
> > And at 150mg Wellbutrin, I couldn't sleep more than a couple hours at a time.
>
> Insomnia has always been a good sign for me that I will respond to a medication. It is imperative that you not let insomnia prevent you from fully exploring the therapeutic potential of a drug. It should be treated as aggressively as the depression itself. You can't stop Wellbutrin until you get to 300mg. If I were to let insomnia cause me to abort my first trial of Parnate + desipramine, I would never have attained remission. I took both Ativan and Halcion to treat the antidepressant-induced insomnia. It worked well. There are several strategies to cope with insomnia besides warm milk. Don't be afraid to use them.
>
> Allow three weeks for any one dosage to demonstrate its efficacy and side effect profile.
>
> > I think my problem isn't so much that I'm med resistant it's that I just can't tolerate a therapeutic dose of anything.
>
> Whatever can go wrong does go wrong? I know the feeling. Perhaps you need to titrate dosages of medication at a rate half of that of the average person. I am unwilling to accept that you cannot tolerate the medications that will give you your life back.
>
> > Yes, I'm a whiny baby.
>
> I am also unwilling to accept this statement. Things have been hard for you. You are not responsible for the way these drugs affect you. In addition, you might not have been adequately prepared by your physician to have a full appreciation of the potential side effects of these drugs before beginning to take them.
>
> Who cares? Whine all you want. Something good may come of it.
>
>
> - Scott
>
Scott, you are incredibly good to spend so much time responding to posts like this. I can't imagine how you can be so compassionate and so involved while you are so depressed yourself. It's just amazing. I think I'd be better off if I spent more time trying to help other people instead of spending so much time focusing on what's wrong with me and how to fix it. You are a truly good person and you deserve to get well. Thank you again for your help and caring. And you know, you're right. I'd be willing to tolerate almost any side effect --if it came with remission. It's when you get the full side effects without remission (or with only a slight improvement)that it's so frustrating. But your stoicism makes me more willing to tolerate it myself next time around.Marsha
Go forward in thread:
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.