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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by moonman on May 28, 2001, at 20:58:59
Have had anxiety for over a year with a lot of facial flushing and some muscle weakness. My doctor has had me on all the SSRI's .. most recently Celexa. They all give me the creeps and don't help my anxiety (diazapam and beta blockers help). I asked for Wellbutrin and was told it's too stimulating. I argued and won and it appears to have helped some of my symptoms. Any theories?
Posted by Cam W. on May 28, 2001, at 23:16:50
In reply to Wellbutrin question for Cam W if you're out there, posted by moonman on May 28, 2001, at 20:58:59
Moonman - Sorry, usually Wellbutrin makes anxiety worse, unless maybe by treating your depression the anxiety subsides. Anxiety is thought to be caused by a serotonergic malfunction. I have heard elsewhere (in letters to the editor of a journal, I believe) that Wellbutrin has worked in anxiety, but I don't think that there was an explanation or I would have printed it off. - Cam
Posted by moonman on May 29, 2001, at 9:58:44
In reply to Re: Wellbutrin question for Cam W if you're out there » moonman, posted by Cam W. on May 28, 2001, at 23:16:50
Doesn't an SSRI increase the level and Buspar decrease the Level? I had such a large amount of serotonin win my blood while on Prozac the thought I had Carcinoid Syndrome. Would it follow that less serotonin in the blood for some people can ease anxiety? And perhaps the Wellbutrin (mini doses) is not affecting the too much serotonin issue?
Sorry for the convoluted question
Posted by Cam W. on May 29, 2001, at 17:21:18
In reply to Which way on Serotonin Cam?, posted by moonman on May 29, 2001, at 9:58:44
Moonman - An deficiency of serotonin is thought to cause anxiety (and depression and panic and OCD and PTSD, etc.). Each of these disorders is thought to be a deficiency in a particular serotonin pathway originating from the raphe nuclei (the body's main wake/sleep mechanism within the reticular activating system). This being said, the above is a very reductionist view of what is actually going on in the brain. You alter one neurotransmitter, you are altering them all, even ones we do not know of, yet. I am not saying that Wellbutrin will not help anxiety; it's "proposed" mechanism of action does not fit with the current "anxiety theory". Like I said, I have read of Wellbutrin alleviating anxiety, but this does go against the reductionist view. Obviously, the reductionist view is wrong (or the true mechanism of action of Wellbutrin is wrong - this is a definite possibily). Hey, if you've found something that works, stick with it. I'll keep an eye open to see if this can be explained by someone with a better grasp of depression than me.
Theorectially, your anxiety should be worse. It's not, and that is a hazard of proposing a theory, but remember, it is only a theory and is subject to revision. It is the "what ifs" and "not in this cases" that keep me in a job.
As an example, I will use the theory of the mechanism of action of atypical antipsychotics. For the past couple of years we have been told that it is the 5-HT2A receptor blockade that prevents EPS (except for Risperdal) and that D2 blockade is less important than previously thought. Then Phil Seemans (father of the receptor site theory) comes up with the "tweaking" of D2 receptors, rather than irreversible binding of an antipsychotic to D2 receptors that stops psychosis and prevents EPS and 5-HT2A really have little or no function. I was at the lecture where he proposed this (actually, he changed his whole lecture to integrate this theory - and showed why). At the time, I sat there with a respected psychiatrist and we said, "Bullshit!". Now that I have had time to integrate what Seemans said, I do see that he is probably right. I do realize that it is the "excepts" that kill you and your theories. This may be what is happening with Wellbutrin; it is an "except". God, I love this field; never a dull moment. Once we figure it out we will say, "How could it be any other way." As they say, it is not the end of the journey that is exciting, it is the getting there.
Sorry for rambling - Cam
Posted by paulk on May 29, 2001, at 22:35:43
In reply to Re: Which way on Serotonin Cam? » moonman, posted by Cam W. on May 29, 2001, at 17:21:18
Well said – if only it was as simple as running a blood test to figure out which med would help. I talked to a University professor involved in Psychopharmacology drug research – he says it is amazing that we have any drugs that work at all considering our poor understanding of what is going on. He thinks history will see the medicines of this time as “extremely crude”.
Posted by terra miller on May 30, 2001, at 11:51:26
In reply to Re: Which way on Serotonin Cam? » moonman, posted by Cam W. on May 29, 2001, at 17:21:18
I'm on wellbutrin. After riding through that initial phase (which seems lightyears ago) of increased agitation(diff than anxiety)and rage, things leveled off. I have recently increased my dose to total 300mg/day and here's the deal: I have more cognitive ability to make choices over what my chemicals are causing me to feel. That is the major aid. I also appreciate the benefit of additional concentration and energy, but it's the added ability to calm internally that is very helpful.
I don't know that wellbutrin has increased my anxiety or decreased it. I have too much other stuff going on right now (PTSD) to run an appropriate scientific method on myself.
I couldn't go anywhere on the SSRI's either. And I, too, wonder if too much serotonin might be a culprit. (In fact, I got so suicidal on Zoloft it was extreme. Dropped it and it was gone. I went the total other direction.)
So I wanted to add that I've got this internal calming thing going on as well. I still have to use Ativan on the shortterm, but the wellbutrin acts like a consistent undercurrent that's extremely helpful.
More for you to chew on. :-)
Terra
> Moonman - An deficiency of serotonin is thought to cause anxiety (and depression and panic and OCD and PTSD, etc.). Each of these disorders is thought to be a deficiency in a particular serotonin pathway originating from the raphe nuclei (the body's main wake/sleep mechanism within the reticular activating system). This being said, the above is a very reductionist view of what is actually going on in the brain. You alter one neurotransmitter, you are altering them all, even ones we do not know of, yet. I am not saying that Wellbutrin will not help anxiety; it's "proposed" mechanism of action does not fit with the current "anxiety theory". Like I said, I have read of Wellbutrin alleviating anxiety, but this does go against the reductionist view. Obviously, the reductionist view is wrong (or the true mechanism of action of Wellbutrin is wrong - this is a definite possibily). Hey, if you've found something that works, stick with it. I'll keep an eye open to see if this can be explained by someone with a better grasp of depression than me.
>
> Theorectially, your anxiety should be worse. It's not, and that is a hazard of proposing a theory, but remember, it is only a theory and is subject to revision. It is the "what ifs" and "not in this cases" that keep me in a job.
>
> As an example, I will use the theory of the mechanism of action of atypical antipsychotics. For the past couple of years we have been told that it is the 5-HT2A receptor blockade that prevents EPS (except for Risperdal) and that D2 blockade is less important than previously thought. Then Phil Seemans (father of the receptor site theory) comes up with the "tweaking" of D2 receptors, rather than irreversible binding of an antipsychotic to D2 receptors that stops psychosis and prevents EPS and 5-HT2A really have little or no function. I was at the lecture where he proposed this (actually, he changed his whole lecture to integrate this theory - and showed why). At the time, I sat there with a respected psychiatrist and we said, "Bullshit!". Now that I have had time to integrate what Seemans said, I do see that he is probably right. I do realize that it is the "excepts" that kill you and your theories. This may be what is happening with Wellbutrin; it is an "except". God, I love this field; never a dull moment. Once we figure it out we will say, "How could it be any other way." As they say, it is not the end of the journey that is exciting, it is the getting there.
>
> Sorry for rambling - Cam
Posted by Shirley 2 on June 2, 2001, at 11:28:40
In reply to Re: Which way on Serotonin Cam? » Cam W., posted by terra miller on May 30, 2001, at 11:51:26
Terra,
After starting St. John's Wort, which ironically is supposed to be similar in chemical nature to Wellbutrin, I have similar feelings. In tandem with Adderall, I have more mental energy but feel completely calm. I can plan in my head what needs to be done without writing it down which truly is amazing. Previously, I was very short tempered when traffic didn't move fast enough for me but now I don't get upset at all.
By the way, I loved your statement about having more cognitive ability to make choices over what your chemicals are causing you to feel. You hit the nail on the head.
Like you, I have been on several SSRI's and actually Zoloft permanently stopped my suicidal urges unlike what it did to you. But after a year and a half, it stopped being effective, and I have struck out with Prozac and Celexa.
My psychiatrist didn't think Wellbutrin would be good for me because of my anxiety and prescribed Luvox. I was tired of SSRI's and decided on a whim to give St. John's Wort a shot. Not expecting a darned thing, it's been nothing short of miraculous.
I wish you continued success on Wellbutrin and just wanted to let you know how much I related to what you said.
Shirley
Posted by terra miller on June 2, 2001, at 22:01:51
In reply to Re: Which way on Serotonin Cam? » terra miller, posted by Shirley 2 on June 2, 2001, at 11:28:40
Shirley,
you know, i read recently that st.johns.wort didn't do much for major depression at all and that now they were even questioning it's effectiveness on minor depression.but i'm trying to treat anxiety. i understand that some consider anxiety to be a symptom of depression. they can think what they want. *grin* i'm not depressed. i'm just dealing with shell-shock a bit these days.
all that is to say, wondering if s.j.w. would be just great for anxiety sufferers???????
how much did you end up taking? did your pdoc know? what did s/he say? curious.
terra.
Posted by Shirley 2 on June 3, 2001, at 6:22:39
In reply to Re:St.John's Wort » Shirley 2, posted by terra miller on June 2, 2001, at 22:01:51
Terra,
I have anxiety and depression and it worked instantaneously for both. Of course, YMMV.
I started off with 150mg due to my sensitivity to meds and that was great for two days. However, yesterday, I definately needed some more, so I took another 150mg in the afternoon and felt fine instantly. The only drawback - I didn't sleep well last night but hopefully by taking the entire dose in the morning, that side effect will disappear.
The typical dose is 900mg a day so I am nowhere near that yet. I'll keep letting my body tell me what it needs.
I saved the best for last:)) Does my p-doc know? Not yet but I'll leave a message with him tomorrow
so he doesn't feel blindsided when I see him next week.During my last visit, he had prescribed Luvox, which I really didn't want to take so I can imagine he'll be pissed at first. Then I'm sure he'll remind me that St. John's Wort interacts with certain drugs but I have done my homework in that area and as far as I can tell, I'm ok with Adderall and Remeron.
But in spite of the complaints I have about him, one good thing I do like is if something works as the result of my experimentation,no matter how unconvential it may be, he will go with it as long as it's medically safe. However, it's frustrating to me that I have to take matters into my own hand because he won't move off of SSRI land.
I'm curious, where did you read that it's not effective for minor depression? I thought that it's effectiveness in treating minor to moderate depression wasn't in dispute.
As far as whether it's effective for major depression, I just don't understand how a study co-sponsored by Phizer can be considered credible.
When I was reading about SJW, if I remember correctly, a study on its effectiveness made it into a British Medical Journal, where it's hard to get published. I can't remember if the study indicated that it worked for major depression but it definately was effective for minor and moderate situations.Terra, do you think your p-doc would be willing to let you try SJW? Normally, I would say try it on your own but I am not sure how it would interact with Wellbutrin. Therefore I don't want to say anything irresponsible.
Prozac, which I know definately interacts with it, has been completely out of my body since May 17, according to my P-Doc so I knew I was on safe grounds there. I have checked several sites and didn't see any negative interactions with Remeron and Adderall although I can't be 100% sure since I am not a doctor.
I have probably said way more than you wanted to know:)) But I hope that helps and if you have more questions, fire away. Let me know if you eventually decide to try SJW.
Shirley
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