![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 4 of 4. This is the beginning of the thread.
Posted by raisinb on August 6, 2008, at 16:43:08
I've been taking zoloft 50 mg and wellbutrin xl 300 mg for about two months to treat major depression. They've really worked for my moods. I feel better than I have in years.
However, I am still losing weight--lost about 7lb from depression, 5 more from wellbutrin alone, then 5 more on the combo--and counting. My dr suggested zoloft would help me gain back what I had lost but all it's done is slow down the loss. It's getting to a crisis point because I was thin to begin with.
I also still have insomnia trouble. 3 mg Lunesta usually does the trick, but I need it every night, and some nights it just doesn't give me more than 5 hours or so.
I haven't seen a pdoc before, but my dr suggested I get one, so I went to see her today. She said that if I wanted to treat my depression, insomnia, weight loss, and anxiety with one pill, we should really take me off of what I'm on and put me on Remeron. She also said that sometimes, when people got "jacked up" from Wellbutrin like I did, and had long-term insomnia problems, what was going on was undiagnosed bipolar disorder. In that case, she said, the plan B would be trying Lamictal.
I really don't think I am bipolar, but maybe she could have a point? I can't remember experiencing any mania. Can you be bipolar and not know it? I thought everyone got jacked up on Wellbutrin. And is it a good idea to get off something that is working right now? What have people's experiences with Remeron been?
For now, we decided to do the conservative thing, reduce the WB and double the Zoloft. I did like her very much. I was just wondering what everyone thought of her opinions.
Posted by bleauberry on August 6, 2008, at 17:25:50
In reply to my new pdoc's recommendations, posted by raisinb on August 6, 2008, at 16:43:08
The plan to raise zoloft and lower wellbutrin sounds decent. Honestly though I don't think it is wise to mess with something that works. Don't change dose, time of day for a dose, or anything. Other than that, I would maybe consider adding low dose remeron or low dose zyprexa. Both will help with the sleep thing, but zyprexa more likely to help the weight thing. It is also indicated for bipolar. So if the pdoc wants to cover that base, then it makes sense to add a bipolar med that also improves sleep and helps weight gain. That would be zyprexa in a dose range of 2.5mg to 5mg.
Like you I am thin. On 5mg zyprexa I went from 138 to 145-148. Many people gain excessive weight. But for us thin ones, that is not such a concern. I had awesome sleep for years on zyprexa, after enduring prozac insomnia as long as I could and got tired of lunesta and stuff.
I do not like the idea of messing with something that is working. If someone were to study the archives of this site, probably hundreds of cases would be found of people who messed with a good thing and never got it back. Remember, treating these diseases is like shooting at a moving target. Say for example you abandon zoloft+wellbutrin now and try remeron. Assume it goes poorly. Then you want back on zoloft+wellbutrin, only to find they feel different and aren't working like they did. The remeron changed things.
Posted by SLS on August 6, 2008, at 18:32:38
In reply to Re: my new pdoc's recommendations, posted by bleauberry on August 6, 2008, at 17:25:50
> The plan to raise zoloft and lower wellbutrin sounds decent. Honestly though I don't think it is wise to mess with something that works. Don't change dose, time of day for a dose, or anything. Other than that, I would maybe consider adding low dose remeron or low dose zyprexa. Both will help with the sleep thing, but zyprexa more likely to help the weight thing. It is also indicated for bipolar. So if the pdoc wants to cover that base, then it makes sense to add a bipolar med that also improves sleep and helps weight gain. That would be zyprexa in a dose range of 2.5mg to 5mg.
>
> Like you I am thin. On 5mg zyprexa I went from 138 to 145-148. Many people gain excessive weight. But for us thin ones, that is not such a concern. I had awesome sleep for years on zyprexa, after enduring prozac insomnia as long as I could and got tired of lunesta and stuff.
>
> I do not like the idea of messing with something that is working. If someone were to study the archives of this site, probably hundreds of cases would be found of people who messed with a good thing and never got it back. Remember, treating these diseases is like shooting at a moving target. Say for example you abandon zoloft+wellbutrin now and try remeron. Assume it goes poorly. Then you want back on zoloft+wellbutrin, only to find they feel different and aren't working like they did. The remeron changed things.Good advice.
If your depression has been melancholic or agitated, you might be predisposed to losing weight to begin with. If this is true, raising the Zoloft to 200mg might be a good place to start. Sometimes, partial responses bring on an exaggeration of the symptoms portrayed by the illness. You might find yourself experiencing an increase in:
dizziness
heart rate
dry mouth
constipation
nervousness
heart palpitations
tremulous hands
sweating
teeth clenchingIf this is true, then raising the dosage of Zoloft might make these things go away, even without having to reduce the Wellbutrin.
How has your sleep changed since beginning drug therapy?
- Scott
Posted by raisinb on August 7, 2008, at 9:53:18
In reply to Re: my new pdoc's recommendations, posted by SLS on August 6, 2008, at 18:32:38
Hi Scott--
I do have dry mouth and occasional twitches; these aren't bothersome, however.I do think I'm predisposed to losing weight, as depression caused me to lose a good deal.
My sleep has gotten marginally better on the Zoloft/WB combo. At first I was on WB alone, and I didn't sleep at all--I might have gotten 2-3 hours a night after I took 3x what I was supposed to take of Lunesta. Now I still need the max dose of Lunesta, but it works better. And about once a month, I sleep 7 hours on my own. It's always a big day ;)
The main thing I'm worried about with reducing Wellbutrin is sexual side effects. Right now the WB is keeping those mostly at bay.
This is the end of the 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.