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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by greywolf on April 25, 2004, at 18:10:08
This question was triggered by a question Psychosage posed about splitting Wellbutrin tabs. In offering my simplistic and probably not very helpful response, it occurred to me to ask you folks for some advice about Wellbutrin myself.
As I have explained in prior posts (mostly several weeks ago), I am BPII with a severe depressive component, and OCD. I had given up on pharmaceutical treatment a few years ago after a couple years of seemingly trying every med on the market at the time. After going it on my own proved not to be the smartest decision I've ever made, I started over with SSRIs last year.
Long story short, the SSRIs had the same intolerable SEs (primarily extreme fatigue and sexual) that had caused me to give up on them before after long-term trials. Same with Effexor. I then tried trazodone and eliminated the sexual SEs, but at the cost of being asleep for a good part of the work day. Since my doctor is not comfortable prescribing stimulants, he asked me to try Wellbutrin again.
The Wellbutrin has been very tolerable after I got over some enhanced anxiety during the first week. I started out at 150/day and now I'm at 300 (150x2/day).
Unfortunately, I have not experienced any therapeutic benefit at all during the last 5 weeks. I've only been at 300/day for a little over 2 weeks, but I see no difference in mood. This is not much different from the lack of therapeutic benefit I've experienced with the SSRIs, but I never bothered addressing that question while I was taking the SSRIs because the SE problems kind of overwhelmed any other consideration.
I have been very depressed for weeks now, but without the expected hypomanic punctuation. Honestly, I think I'm too tired to even find the energy for it, and not having come out of the low for even a couple days of productivity is distressing. Worse, the visible tics associated with my OCD have become much more difficult to control.
Because my doctor has been pretty responsive to switching meds several times over the past few months, but has asked me to give Wellbutrin more of a chance, I've been hanging out with this misery for company longer than I otherwise might. I am not taking lithium this time at my request because of a couple bad incidents while I was on it before, so the focus has been on getting this worsening depression under control.
So, my question for anyone who's listening is this: has anyone had a similar experience with Wellbutrin (tolerating it well, but finding no noticeable benefit)? I've read that you can go with higher dosages, but I'm wondering what the point in that is when I've had absolutely no response thus far.
I'd appreciate your thoughts on this. Anything would be helpful.
Posted by SLS on April 25, 2004, at 19:45:16
In reply to Therapeutic kick-in for Wellbutrin?, posted by greywolf on April 25, 2004, at 18:10:08
> I'd appreciate your thoughts on this. Anything would be helpful.
I would not presume to forecast your clinical response to Wellbutrin based on your current condition, but you really cannot come to a conclusion about its value after only two to three weeks. Sorry. I guess that's about what you expected hear.Given that you are tolerating Wellbutrin so well, and that you have been intolerant of so many other medications, it makes a great deal of sense to continue to explore it. That will involve testing 300mg for 3-4 more weeks and perhaps pushing the dosage up to 450mg. I did not do well with Wellbutrin, so I cannot offer any personal experience as to what to look for in the way of early signs of response. Hopefully, someone else can.
- Scott
Posted by greywolf on April 25, 2004, at 21:12:29
In reply to Re: Therapeutic kick-in for Wellbutrin?, posted by SLS on April 25, 2004, at 19:45:16
Thanks for the response, Scott. My concern is that it's been more than just a couple weeks. While I've been at 300/day for two weeks, I was at 150 for 3 weeks before that. And the thing that has me troubled is the absolute lack of any benefit. In fact, there are no effects at all, positive or negative. Once I got over an increase in anxiety the first few days, there's been nothing in terms of effect.
It would be no big deal to just continue this way for a few more weeks if it weren't for the unremittant depression I've been experiencing. It's been a long time since I've been this bad, and I don't know if it's worth the misery to continue with a med that has shown nothing so far.
I'm wondering if anyone else has gotten to this point with no benefit, but has finally experienced something positive at the max dosage. If not, I really am at a loss as to what I can try next. I've been through a ton of meds over the years, and nothing has helped.
Posted by visionmachine on April 26, 2004, at 4:51:38
In reply to Therapeutic kick-in for Wellbutrin?, posted by greywolf on April 25, 2004, at 18:10:08
howdy,
i thought i would post my experiences with wellbutrin. i've been on wellbutrin sr for approx 5 months now for depressive disorder, initially at 300 mg (150mg bid) for about 8 to 10 weeks, with some slight improvement in mood. it wasnt until my dosage was increased to 450 mg (150mg tid) that i noticed a real, sudden marked improvement in mood, energy and cognitive clarity. i have since continued to remain at that dosage. from what i understand 450mg/day is at the high end of the recommended therapeutic range.
what might be of interest to you is that i did note a few side effects throughout the duration of this treatment, the most troubling of which was the development of strange, involuntary, "myclonic jolt"-like muscle tics and spasms. i only experienced a few of these a day, although they since seem to have subsided somewhat. but given that i had never experienced problems with tics or spasms, i do find them a disturbing side effect. in light of what you mentioned in your post about your worsening tics, this may be something you might want to consider bringing to the attention of your physician.
Posted by Sebastian on April 27, 2004, at 12:27:37
In reply to Therapeutic kick-in for Wellbutrin?, posted by greywolf on April 25, 2004, at 18:10:08
Try adding a SSRI with the wellbutrin. The SSRI will have the good anti-depressing effect, while the wellbutrin hopfully will ease the SE of SSRI.
I take 300 wellbutrin with 60 celexa and 7.5 zyprexa. The wellbutrin seems to ease off the side-effects from the other two.
Posted by greywolf on April 28, 2004, at 9:07:00
In reply to Re: Therapeutic kick-in for Wellbutrin?, posted by Sebastian on April 27, 2004, at 12:27:37
Thanks for the advice. I'm not sure adding an SSRI will help. I've tried every SSRI on the market over the last 5 years, and none of them have had any real therapeutic effect. Serzone had some, but that faded away after a short time. Everything else has failed. Effexor didn't work and had the same intolerable SEs that I found with the SSRIs. Trazodone was somewhat more tolerable in terms of SEs because I took it at night, but at the higher dosages I need it turned me into a zombie for a good part of the next day.Yesterday my doctor upped the Wb to 400/day. He's hoping that a beneficial response will be seen at this level, but I wonder. If I've had absolutely no response at 300, how would 400 be significantly different? I'm going to give it a try for another month, but given the downward spiral I've been on over the last month and a half, I'm not looking forward to the next few weeks.
Any, thanks to all for taking the time to give me your thoughts on the matter.
This is the end of the thread.
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