Psycho-Babble Medication Thread 64282

Shown: posts 1 to 6 of 6. This is the beginning of the thread.

 

QUESTION FOR CAM!!

Posted by femenist on May 25, 2001, at 21:30:50

Cam maybe you can help me...I've been on Wellbutrin now for a week 75mg and Sarafem 20mg, 6 weeks and I still feel lightheaded can't focus, somewhat tired (brain fog). I read a post where you said you should not combine WB with any other SSRI's, can you tell me why? What do you think of this combo? I'm on Sarafem for PMS and WB for the side effects I feel on Sarafem. The WB does not seem to affect me (it makes feel up but I like that--should I increase the dose?) I still feel a little apathetic, can focus blah blah blah....How long do I have to be on these drugs to really get the effect? Cam, any information would be great...You have a great reputation here!! You come higly recommended!

Rose

 

Re: QUESTION FOR CAM!! » femenist

Posted by Cam W. on May 25, 2001, at 23:31:30

In reply to QUESTION FOR CAM!!, posted by femenist on May 25, 2001, at 21:30:50

Hi Rose -I aways say to stay on an antidepresant for 8 weeks before giving up on it. You may want to try staying on this combination for another couple weeks, but I think that you Wellbutrin dose is too low to be effective as an antidepressant.

If I said not to mix SSRIs with Wellbutrin™ (bupropion), it must have been at least a year ago. I probably said this with the evidence that SSRIs can decrease seizure threshold in susceptible people. As I gained experience with the use of Wellbutrin, I can to realize that this warning (which I believe I heard from a rep, when they first started detailing Wellbutrin) is very overblown. While I have seen seizures occur in people taking Wellbutrin with conventional antipsychotics (1 with chlorpromazine - Largactil™; and one with thioridazine - Mellaril™), I have never seen seen anyone seizure taking an SSRI-Wellbutrin combo.

Actually, adding Wellbutrin to an SSRI is one way to try to decrease the sexual dysfunction that can occur with SSRIs. Also, adding Wellbutrin to a regimen where somebody has partially responded to an SSRI sometimes works.

Sarafem™ (fluoxetine or Prozac™) can work well with Wellbutrin. It is sorta similar to taking Effexor XR at higher doses, but very little risk of withdrawl syndrome and not as much sedation or activation. The one thing that I have noticed is the thing that you mention; the "blah" feeling. It is sort of a euthymia, but with no emotion (don't feel like doing anything and little pleasure in anything. I would blame the Saraphem for this feeling.

I have seen this blah thing a few times. It usually happens when someone is taking Prozac 20mg daily and Wellbutrin SR 100mg or 150mg in the morning. We have tried a couple things, the most successful being adding another 100mg to 150mg of Wellbutrin in the afternoon (about 4:00pm). This works in about 50% of the cases we have tried.

We have tried to increase the Prozac, but this hasn't been very successful. Twice we have dropped the SSRI (both times it was Paxil™ - paroxetine, though; which is more sedating than Paxil) and increased the Wellbutrin and the persons were able to "feel" again.

The blah feeling and brain can happen when someone is taking an SSRI alone at too high a dose. I am not sure of the long-acting mechanism of Saraphem, but it could either be building up in your system, or your body is somehow releasing the Saraphem too quickly into your body, or the antidepressants aren't working.

I guess the first thing to do would be to ask your doc about increasing the Wellbutrin. He/she may not want to do this (seizure risk). Also, I would probably want to use the longer acting Wellbutrin SR, as it will cover you better, for more of the day. For you, and increase to Wellbutrin SR 100mg twice daily may be a viable option (ask your doc).

The other option is to switch to Prozac daily, at a lower dose (I wouldn't be in a hurry to do this, as the track record isn't that great, but I have seen it work). You could consider adding a stimulant, but where I work, this would a choice of very last resort. Most docs here would prefer a switch to Effexor XR (venlafaxine) and try to get the dose to 225mg to 300mg daily to increase energy in a person.


 

Re: QUESTION FOR CAM!!

Posted by femenist on May 26, 2001, at 19:54:38

In reply to Re: QUESTION FOR CAM!! » femenist, posted by Cam W. on May 25, 2001, at 23:31:30

Thank you very much! I will talk to my doctor about increasing the dose...are there any books that you recommend to read about Wellbutrin?

 

Re: QUESTION FOR CAM!! » femenist

Posted by Cam W. on May 27, 2001, at 22:32:59

In reply to Re: QUESTION FOR CAM!!, posted by femenist on May 26, 2001, at 19:54:38

> Thank you very much! I will talk to my doctor about increasing the dose...are there any books that you recommend to read about Wellbutrin?

Rose - I don't think there have been any books written on Wellbutrin and the journal articles are pretty dull. Ask your pharmacist for a print out on it. - Cam

 

Re: QUESTION FOR CAM!!

Posted by femenist on May 29, 2001, at 20:01:05

In reply to Re: QUESTION FOR CAM!! » femenist, posted by Cam W. on May 27, 2001, at 22:32:59

Cam: My pdoc raised the WB SR to 100mg. So we should see what happens--do you know anything about pregnancy and being on Sarafem/Wellbutrin? I can't find much; but I do find a lot on the Prozac...any suggestions?

 

Re: QUESTION FOR CAM!! » femenist

Posted by Cam W. on May 29, 2001, at 20:29:32

In reply to Re: QUESTION FOR CAM!!, posted by femenist on May 29, 2001, at 20:01:05

Rose - I have heard of a few uneventful pregnancies of mothers who were taking Wellbutrin when they became pregnant, but as far as I know, the mothers had stopped taking the drug once they realized they were pregnant. The drug is too new to have any good database information available. I am not sure if animal studies have shown any fetal abnormalities. Glaxo Wellcome, who make Wellbutrin, have a Birth Registry, but I do not think that it is open to the public. The company do not recommend taking Wellbutrin when pregnant, at this time (butt covering, really). I would not hazard a guess as to the safety of Wellbutrin in pregnancy. Sorry - Cam


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