![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 22 of 22. This is the beginning of the thread.
Posted by lois on February 14, 2004, at 22:37:02
I am on Wellbutrin and strattera for depression/ADD. The strattera(?)- has pooped out after 7 months-up to 100mgs. I am only on 150 mgs of WB EX.If I went to 300,why I just might get tolerant to that. we'll see. However:
Has anyone tried the Wellbutrin + the *long acting* Ritalin together?
Short-acting ritalin made me feel myself years ago, but the downer when it wore off was intolerable. I am hoping, if we taper off the strattera and start ritalin SR with the WB it might not poop out.Then again, I'm used to that by now. Any thoughts?
Lois
Posted by Phil on February 15, 2004, at 0:39:39
In reply to wellbutrin,ADD,?add ritalin SR?, posted by lois on February 14, 2004, at 22:37:02
I don't think Wellbutrin has a high poop out rate.
Forget Ritalin SR, it sucks. It may last 3-4 hours and isn't as good as regular Ritalin. Generic Ritalin made by Barr(I think) is okay in immediate release form but all the other generic Rits are a waste of money.
I take Wellbutrin SR, actually XR now with Adderall XR. I highly recommend Adderall, it has been a great drug and lets me down much easier than Ritalin. I have a very slight queasy stomach with Adderall but it really isn't troublesome.
Dexadrine slow release is a generic and is also very good. Straterra didn't even register with me at all.
I also take Klonopin and Lexapro. I'm a bit treatment resistant.
Posted by sb417 on February 15, 2004, at 0:57:55
In reply to Re: wellbutrin,ADD,?add ritalin SR?, posted by Phil on February 15, 2004, at 0:39:39
Hi Phil. You take Wellbutrin and Adderall together? Wow! Those two together must really pack a punch! Do you sleep well?
Posted by Phil on February 15, 2004, at 1:37:20
In reply to Re: wellbutrin,ADD,?add ritalin SR? » Phil, posted by sb417 on February 15, 2004, at 0:57:55
Like a rock. I'm a fast metabolizer. At one time, I was on 300mg WellSR, 60mg Ritalin(later, 150mg Adderall SR w/ the same amt of WellSR), 20 mg of Lexapro and 3mg Klonopin. My doc said she wouldn't go to 150 on Adderall till after my physical with an EKG. I took my morning meds, had the EKG(completely normal) and she said,'You're checked out on 150.'
I've reduced Adderall to 60mg a day and am taking 150WellXL now but the other two are the same.
They call me treatment resistant.
When I took Amitriptyline, I was at 250mg a day. The PDR says 150mg outpatient, up to 300 inpatient.
I've never been hospitalized.
I have a physical yearly with blood work, including a liver panel done. So far so good and I've been on meds for 20 years. My BP is normal, pulse, normal.
Now, if I drink too much coffee, I'll get spun up pretty good. I'm up late because I took a long nap today.
My liver checks out but it probably doesn't enjoy the workload. It's either this or the alternative, which I can promise you is not pretty.
Posted by PsychoSage on February 15, 2004, at 3:48:10
In reply to Re: wellbutrin,ADD,?add ritalin SR?, posted by Phil on February 15, 2004, at 1:37:20
Can you tell me exactly what kind of tests you do to check how your body is doing on the stimulating meds? What should i say to the doctor?
I am on wellbutrin 300, and I started provigil this past week.
I had blood work for Trileptal done last week. I had an EKG done 2 years ago that was fine.
Posted by sb417 on February 15, 2004, at 7:01:19
In reply to Re: wellbutrin,ADD,?add ritalin SR?, posted by Phil on February 15, 2004, at 1:37:20
Posted by Phil on February 15, 2004, at 8:07:35
In reply to Re: wellbutrin,ADD,?add ritalin SR?, posted by PsychoSage on February 15, 2004, at 3:48:10
I've gotta say first, I'm no drug expert but I try to repeat what I've learned here and by my own history.
I'd say an EKG is fine but if you are worried about your heart, have a stress test done. That's where they wire you up and you walk progressively faster and higher on a treadmill as they monitor everything.
If there's heart disease in a family, I urge people to have one, meds or not. The author of running and other books, Jim Fixx was the wake up call. His father died very young of heart disease. Fixx was overweight and began running and turned himself into a guru of sorts for running and is why you see so many people doing it(to a large extent) He was a good marathoner and 100 mile a week type of guy. The famous heart surgeon in Dallas, Cooley was it, urged him to have a stress test but Fixx didn't listen. He went out for a run one morning and was dead before he hit the ground. A tragic loss that could have been prevented if he would have listened.
The meds we take aren't great for the heart but it's not like we're shooting speed either.
Have blood work done and ask your pdoc to request a liver panel and EKG.
The best thing any of us can do is walk 30 minutes a day and drink lots of water. Am I doing it? No.... but when I did, it was incredibly helpful. Matter of fact, I can't walk distance well because of developing anterior compartment syndrome. The outside muscle on my calves(sp?) seizes up and says stop. It's a condition where your muscle outgrows the sheath around it, which doesn't stretch. An operation where they slit the sheath can fix it but I can't afford it but I could be swimming or biking.
I heard Magic Johnson say, when he was on all the drugs for HIV, that he still worked out hard to 'sweat out those meds.' I think he must be the most optimistic person I've ever seen.
I don't know when it happened, PsychoSage, but if you ask me what time it is, I'll tell you how to build a clock. Sorry for this long response.
My mothers' last words to me were take care of yourself and, of course, I love you. I could have just said that.
Phil
Posted by lois on February 15, 2004, at 14:57:11
In reply to Re: wellbutrin,ADD,?add ritalin SR?, posted by Phil on February 15, 2004, at 0:39:39
I also take at night:lexapro 50mgs, clonipin 0.5mgs,topamax 100mgs,and remeron 7.5 mgs. Lamictal 200mgs 2X a day with the others.I have to hit all the transmitters to varying degrees and have stablizers too. Many things before this have not worked, or worked [or placebo type response(which is which? Who knows.)] And then I got tolerant. Short acting Ritalin definitely does not hold me, maybe SR won't.Also my liver is sensitive, but was OK last week, except for alk. phos. slightly high at 107.
So, as far as Adderal, we have to watch out for which ones would be less hepatotoxic to certain liver pathways,as well as which "sub transmitters"work for me.
Posted by action on February 16, 2004, at 7:41:43
In reply to wellbutrin,ADD,?add ritalin SR?, posted by lois on February 14, 2004, at 22:37:02
Hey Guys,
I just started taking Klonopin but it really makes me tired. I sleep 14 hours a day.
Does Wellbutrin act immediately like Ridalin or does it have to build up in your system for a few weeks before it starts to work?
Aslo I read on this board that Wellbutrin does not increase Dopamine levels, may even decrease them? I would like a drug that works similiar to Nardil. Unfortunately after some time Nardil has pooped out on me.
Have you guys tried Provigil - What do you guys think of Provigil?
Thanks,
Mark
Posted by Chairman_MAO on February 16, 2004, at 12:33:33
In reply to Wellbutrin fast acting or build up?, posted by action on February 16, 2004, at 7:41:43
Wellbutrin undergoes extensive metabolism, and its three active metabolites accumulate over time. As this accumulation takes place, the effect becomes more robust. The "antidepressant" effect takes place after at least a month of chronic treatment, like all antidepressants--except "classic" stimulants and opioids, heh.
In regard to its effect on dopamine, I believe the jury is still out. From a psychopharmacological perspective, it probably has SOME weak dopaminergic effects, direct or indirect, given that it makes some people horny, can induce hallucinations, and because some people report muscle twitches that are much like those reported with dopaminergic agents. The study below shows that chronic administration produces a blockade of the dopamine uptake transporter of 26%--a value I am not sure means much at all. Anyone else care to comment on this?
Honestly, I've learned that from a clinial perspective, whether it has any effect on doapmine or not is really not relevant; just pay attention to whether it works or not. :)IMHO, Wellbutrin is simply a stimulant weak enough to evade scheduling (that means WEAK). It is structurally similar to the diet drug diethylpropion and the illegal drug cathinone. Draw your own conclusions.
Provigil has been shown completely ineffective for ADD. Wellbutrin has spotty efficacy, but better than Provigil. If you want energy, Provigil is better.
I started Wellbutrin for ADD because, due to my history, no doctor--except a private one--would ever give me amphetamine, which is the only thing that helps worth a damn. Thusfar I notice no beneficial effects, though I am only at 150mg of the XL. I am not optimistic. Let me know how your journey goes!
Biol Psychiatry. 2003 Oct 15;54(8):800-5.
In vivo activity of bupropion at the human dopamine transporter as measured by positron emission tomography.Learned-Coughlin SM, Bergstrom M, Savitcheva I, Ascher J, Schmith VD, Langstrom B.
GlaxoSmithKline, Five Moore Drive, Research Triangle Park, NC 27709, USA.
BACKGROUND: Converging lines of evidence are consistent with an inhibitory effect of the antidepressant and smoking-cessation aid bupropion on dopamine and norepinephrine reuptake, but the in vivo effects of the drug at the human dopamine transporter (DAT) have not been studied to date. This study employed positron emission tomography (PET) to assess the extent and duration of DAT receptor occupancy by bupropion and its metabolites under conditions of steady-state oral dosing with bupropion sustained-release (SR) in healthy volunteers. METHODS: Six healthy male volunteers received bupropion SR 150 mg daily on days 1 through 3 and 150 mg every 12 hours on day 4 through the morning of day 11. PET investigations were performed between 1 and 7 days before initiation of bupropion SR dosing, as well as 3, 12, and 24 hours after the last dose of bupropion SR on day 11. RESULTS: Bupropion and its metabolites inhibited striatal uptake of the selective DAT-binding radioligand (11)C-betaCIT-FE in vivo. Three hours after the last dose of bupropion SR, average DAT occupancy by bupropion and its metabolites was 26%-a level that was maintained through the last PET assessment at 24 hours after dosing. CONCLUSIONS: Bupropion and its metabolites induced a low occupancy of the striatal DAT over 24 hours under conditions of steady-state oral dosing with therapeutic doses of bupropion SR. These data are consistent with the hypothesis that dopamine reuptake inhibition may be responsible in part for the therapeutic effects of the drug.
Posted by KimberlyDi on February 17, 2004, at 13:01:10
In reply to Wellbutrin fast acting or build up?, posted by action on February 16, 2004, at 7:41:43
Wellbutrin for depression is definately a build up. For ADD, I'm not sure.
> Hey Guys,
>
> I just started taking Klonopin but it really makes me tired. I sleep 14 hours a day.
>
> Does Wellbutrin act immediately like Ridalin or does it have to build up in your system for a few weeks before it starts to work?
>
> Aslo I read on this board that Wellbutrin does not increase Dopamine levels, may even decrease them? I would like a drug that works similiar to Nardil. Unfortunately after some time Nardil has pooped out on me.
>
> Have you guys tried Provigil - What do you guys think of Provigil?
>
> Thanks,
> Mark
Posted by PsychoSage on February 18, 2004, at 3:50:59
In reply to Re: Wellbutrin fast acting or build up? » action, posted by Chairman_MAO on February 16, 2004, at 12:33:33
> Wellbutrin undergoes extensive metabolism, and its three active metabolites accumulate over time. As this accumulation takes place, the effect becomes more robust. The "antidepressant" effect takes place after at least a month of chronic treatment, like all antidepressants--except "classic" stimulants and opioids, heh.
>
> In regard to its effect on dopamine, I believe the jury is still out. From a psychopharmacological perspective, it probably has SOME weak dopaminergic effects, direct or indirect, given that it makes some people horny, can induce hallucinations, and because some people report muscle twitches that are much like those reported with dopaminergic agents. The study below shows that chronic administration produces a blockade of the dopamine uptake transporter of 26%--a value I am not sure means much at all. Anyone else care to comment on this?
>
>
> Honestly, I've learned that from a clinial perspective, whether it has any effect on doapmine or not is really not relevant; just pay attention to whether it works or not. :)
>
> IMHO, Wellbutrin is simply a stimulant weak enough to evade scheduling (that means WEAK). It is structurally similar to the diet drug diethylpropion and the illegal drug cathinone. Draw your own conclusions.
>
> Provigil has been shown completely ineffective for ADD. Wellbutrin has spotty efficacy, but better than Provigil. If you want energy, Provigil is better.
>
> I started Wellbutrin for ADD because, due to my history, no doctor--except a private one--would ever give me amphetamine, which is the only thing that helps worth a damn. Thusfar I notice no beneficial effects, though I am only at 150mg of the XL. I am not optimistic. Let me know how your journey goes!
>
I have been taking wellbutrin again since last may or so. I started out on 150 for 4 months then up to 300. I was at 300 before, but it felt like I was taking nothing, and in a few weeks I was in the psych ward for psychotic depression, but that had little to do wtih wellbutrin and its efficacy.
Right now I have not been in the psych ward or really depressed since I have been on wellbutrin for the third time. I guess it is a good thing if I don't notice it or expect the mild euphoria that occurs at the beginning of using it.I've also been kind of a basketcase since Zyprexa sandbagged me a little more than a year ago, and I got off it. Therefore, I am not sure how profound the effect of Wellbutrin is because it is not particularly helpful with concentration which was why i swtiched to it from zoloft.
My moods cycle still even though I am on trileptal, so i am not sure what that is all about.
I also have to admit that wellbutrin doesn't provide anymore motivation or well-being feelings the way provigil has for the last week at 50mg.
I love the side effect profile of wellbutrin except that I suspect it may cause irritability.
Any drug that doesn't make me tired or stupidly dull is a winner in my book.
I enjoy the XL dosing.
I also am not allowed near amphetamine.
Posted by Tony P on February 19, 2004, at 2:38:06
In reply to Wellbutrin fast acting or build up?, posted by action on February 16, 2004, at 7:41:43
> Hey Guys,
> [...]
> Does Wellbutrin act immediately like Ridalin or does it have to build up in your system for a few weeks before it starts to work?
> [...]My personal experience was that the activating effect cut in predictably after 3 days - very fast for an A/D. As a previous poster said, the full benefits may take a month or more. I couldn't continue with it as it made me too anxious and insomniac -even hypomanic at the "usual" full dose. My MD had to add benzos and sleeping pills (Imovane/zopiclone) which I am still on.
It sure FEELS like a dopamine booster to me, but maybe I wasn't on it long enough (2 months if I remember correctly) for the dopamine deactivating effect to start.
Tony P
Posted by action on March 12, 2004, at 3:50:38
In reply to Re: Wellbutrin fast acting or build up? » action, posted by Tony P on February 19, 2004, at 2:38:06
> > Hey Guys,
> > [...]
> > Does Wellbutrin act immediately like Ridalin or does it have to build up in your system for a few weeks before it starts to work?
> > [...]
>
> My personal experience was that the activating effect cut in predictably after 3 days - very fast for an A/D. As a previous poster said, the full benefits may take a month or more. I couldn't continue with it as it made me too anxious and insomniac -even hypomanic at the "usual" full dose. My MD had to add benzos and sleeping pills (Imovane/zopiclone) which I am still on.
>
> It sure FEELS like a dopamine booster to me, but maybe I wasn't on it long enough (2 months if I remember correctly) for the dopamine deactivating effect to start.
>
> Tony PIt appears that Wellbutrin is a (big?) dopamine booster...
This post and related articles are very convincing...
http://www.dr-bob.org/babble/20040304/msgs/321714.htmThanks
Action
Posted by SandyWeb on March 13, 2004, at 12:25:35
In reply to Re: Wellbutrin fast acting or build up? » Tony P, posted by action on March 12, 2004, at 3:50:38
I'm curious. Does anyone know if 300mg SR can be taken at once? Our Formulary only allows for 150mg SR pills, and if I want to go to 450mg then I'd either have to take the pills three times per day (ugh!) or take 300mg and 150mg per day.
Does anyone take 300mg SR at once?
Posted by green hornet on March 16, 2004, at 9:16:48
In reply to Re: Wellbutrin fast acting or build up?, posted by SandyWeb on March 13, 2004, at 12:25:35
> I'm curious. Does anyone know if 300mg SR can be taken at once? Our Formulary only allows for 150mg SR pills, and if I want to go to 450mg then I'd either have to take the pills three times per day (ugh!) or take 300mg and 150mg per day.
>
> Does anyone take 300mg SR at once?
>
I have taken 300SR of Wellbutrin at one time with no adverse effects. However, I think that this is only advisable after one has been on a lower dose for sometime first. One doc tried to start me on 300qd and I got really weird. I take 400mgm total a day and it works fine, better on an empty stomach. Any questions let me know.
Green Hornet
Posted by sl on March 16, 2004, at 19:04:51
In reply to Re: Wellbutrin fast acting or build up?, posted by SandyWeb on March 13, 2004, at 12:25:35
I'd recommend trying to do it 3 times/day (you can get an old Palm Pilot for about $20 and use the alarms, that's how I rememember 2x/day), and THEN if you can't then go for the 300+150 method. :)
Posted by SandyWeb on March 16, 2004, at 20:13:41
In reply to Re: Wellbutrin fast acting or build up?, posted by sl on March 16, 2004, at 19:04:51
I've been taking the 150mg 3x a day. It really isn't hard for me. I take one when I get up in the morning, one at lunch, and one at supper. But all it does is still make me tired.
Posted by HappyGirl on March 16, 2004, at 23:45:37
In reply to Re: Wellbutrin fast acting or build up? Yes but..., posted by green hornet on March 16, 2004, at 9:16:48
Hi green honet:
I just wonder whether you get any 'stomach problem' or any other 'GI' problem due to WB dosage, 400 mg.?
Because, for me, 300 mg. WB sr is 'absolute limit,' otherwise I get 'diet/appetite suppresant effect'from WB sr. Some day, I just need to eat just a couple of hambergers for all day long meal that sounds like NOT health way to live under today's world.
Normally, without WB sr, I am able to eat three meals with decent appetite along with tidbit snacks in the afternoon.
So then, your WB sr dosage, 400 mg. is a 'complete shock' to me. However, I know that everyone reacts differently on different medications.
However, if there is/are any good clues in regard to decent appetite or food intake while on WB sr, I would be truly appreciated.
H.G.
Posted by Pamela Lynn on March 17, 2004, at 1:56:45
In reply to Wellbutrin fast acting or build up?, posted by action on February 16, 2004, at 7:41:43
> Hey Guys,
>
> I just started taking Klonopin but it really makes me tired. I sleep 14 hours a day.
>
> Does Wellbutrin act immediately like Ridalin or does it have to build up in your system for a few weeks before it starts to work?
>
> Aslo I read on this board that Wellbutrin does not increase Dopamine levels, may even decrease them? I would like a drug that works similiar to Nardil. Unfortunately after some time Nardil has pooped out on me.
>
> Have you guys tried Provigil - What do you guys think of Provigil?
>
> Thanks,
> MarkHiya Mark. I thought I would put my Wellbutrin story in here for you too.
I've been on WB for about 7 mos. now. I started at 150 mgs the first 2 weeks and MAN did I feel some way wild energy...REAL fast, as in the 2nd day on the WB! However I also got real, REAL irritable too. So much so that I had to sit my children down w/my husband and explain that I was on a new medication and it was making me a bit grouchy! After the 2 weeks I went up to another 150 mgs...one in the AM and one in the PM...around 2 weeks both the extreme energy and irritability started to go away. I was calmer but more focused. I am now on the most one should take (as far as my shrink says anyway)...150 in the AM, 100 at noon and 150 in the PM....It's working well for me. Over the years i've been on just about every med. for my bi-polar, depression and BPD. Sad thing is that alot of them worked out well...for a year or so and then I had to switch to another. Meds. seem to "poop out" on me quickly.
Hope this has helped.
P.L.
Posted by lois on March 17, 2004, at 19:25:15
In reply to Re: Wellbutrin and appetite/green honet ., posted by HappyGirl on March 16, 2004, at 23:45:37
I think Wellbutrin helps with dopamine and norepinephrine. Might be wrong. I'm on it, and also on an SSRI for depression, ADD, and BPI.
Am tapering off the Strattera as it pooped out. But starting out on the Strattera(ADD), I was able to *start* Wellbutrin.
I was not able to tolerate Wellbutrin before without the strattera-an ADD drug. I am tapering Up on the Wellbutrin at the same time as decreasing the Strattera. Just started this. So far I feel good.
As far as *appetite*, I found Remeron made me too ravenous! I think Remeron, part SSRI(?), helps with serotonin,if you need it. And helps with something else I can't remember.
MY SSRI is Lexapro. With a smige,(7.5mgs) of Remeron and a pinch of a few other meds,Remeron helps me have a restful *sleep*. At that low dose it doesn't affect my appetite.
Posted by sl on March 17, 2004, at 19:28:34
In reply to Re: Wellbutrin and appetite/green honet . » HappyGirl, posted by lois on March 17, 2004, at 19:25:15
> I think Wellbutrin helps with dopamine and norepinephrine. Might be wrong.
No, I'm pretty sure you're right.
Cuz SSRIs do nothing for me except make me tired. So Wb has to work on something else other than Seratonin.
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.