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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 21 of 21. This is the beginning of the thread.
Posted by sdb on April 10, 2005, at 3:47:35
It is said that Wellbutrin can increase anxiety, nervousness and panic attacks. It seems to be activating (biological effects interestingly similar but not equal (!) to cocaine).
Somebody has experience with Wellbutrin and anxiety?
Thanks
Posted by NeilKramer on April 10, 2005, at 9:02:49
In reply to Wellbutrin XL and Anxiety, posted by sdb on April 10, 2005, at 3:47:35
I found that Wellbutrin was very good for depression and sex drive, but increased my anxiety and insomnia. I think it is a very good drug for a lot of people, but unfortunately it has that anxiety potential. I would suspect that Provigil is the same way too, but you could give that a try. I think it might be a lot like Wellbutrin.
Posted by bluebird125 on April 10, 2005, at 11:50:02
In reply to Wellbutrin XL and Anxiety, posted by sdb on April 10, 2005, at 3:47:35
at one time i had only a wellbutrin prescription. i felt extremely anxious so i stopped taking it. later my psychiatrist added it to my other antidepressant prescription to lessen the sexual side effects. to my surprise, i didn't have any of the anxiety/jitteriness. it lessened the sexual side effects and helped me concentrate better. your doctor might consider a combination if you don't find something else that works.
Posted by Neil Kramer on April 10, 2005, at 11:56:42
In reply to Wellbutrin XL and Anxiety, posted by sdb on April 10, 2005, at 3:47:35
Effexor might be a good combo with Wellbutrin.
Posted by mattw84 on April 10, 2005, at 15:47:48
In reply to Re: Wellbutrin XL and Anxiety, posted by Neil Kramer on April 10, 2005, at 11:56:42
I would tend to disagree -- Effexor has some effect on norepinephrine (AKA noradrenaline) which would likely only increase the agitation caused by bupropion.
Though I am strongly apprehensive to make a recommendation in this case, namely as it is impossible to dx symptoms via an impersonal medium... Regardless, if you insist on taking Wellbutrin XL and want to just control the negative side effects, here is a short list of possible solutions incumbent on the side-effect:
Anxiety w/panic attacks: Add clonazepam .25mg twice daily
Tremor/Hypertension: Add Atenolol 25mg twice daily
Agitation: Discontinue use of Wellbutrin - Antipsychotics which would be used to control agitation would further decrease one's seizure threshold...In general those taking wellbutrin should avoid any stimulants such as caffeine or prescription stimulants. (Amphetamines, etc...) These will only increase the unwanted anxiety.
Regards,
Matt
Posted by Phillipa on April 10, 2005, at 17:01:03
In reply to Re: Wellbutrin XL and Anxiety, posted by mattw84 on April 10, 2005, at 15:47:48
I lasted a week on it and the anxiety was so bad my old pdoc thought I was manic. Fondly, Phillipa
Posted by Spriggy on April 10, 2005, at 17:01:47
In reply to Re: Wellbutrin XL and Anxiety, posted by mattw84 on April 10, 2005, at 15:47:48
Wellbutrin caused me to not sleep or eat for four entire days. It was the worst anxiety I have yet to experience.
I think if you are just depressed, it is probably a good fit- I have two friends that it has helped tremendously with depression.. but if you are anxiety prone, I'd stay clear of it.
The pdoc told me "Wellbutrin is not the drug of choice if someone has anxiety."
From my experience, I think he's correct.
Posted by sdb on April 10, 2005, at 17:08:39
In reply to Re: Wellbutrin XL and Anxiety, posted by Spriggy on April 10, 2005, at 17:01:47
Matt, i give you a hint:
Nadolol or oxprenolol (slow) for longterm
and pindolol for shorterm is much more effective than atenolol.Atenolol is a good exercise tachycardia blocker but it does not effectively block adrenaline/noradrenaline from the adrenal medulla or intravenous isoprenaline.
Posted by NeilKramer on April 10, 2005, at 18:05:58
In reply to Re: Wellbutrin XL and Anxiety, posted by mattw84 on April 10, 2005, at 15:47:48
I'm not a pdoc, but I know someone with mixed anxiety/depression whose done very well with that combination. But, yes, the norepinephrine of Effexor might not be what you want. And the sexual side effects...
Posted by stresser on April 10, 2005, at 20:22:03
In reply to Re: Wellbutrin XL and Anxiety, posted by Spriggy on April 10, 2005, at 17:01:47
Wellbutrin caused me extreme anxiety, and drove me into depression as well. I will never take it again. My daughter takes it and does just fine with it, for now. Everyone is different. -L
Posted by mattw84 on April 10, 2005, at 23:34:08
In reply to Re: Hint for betablockers, posted by sdb on April 10, 2005, at 17:08:39
Sdb,
I appreciate that =)
The only reason I prefer Atenolol is because it is what I see used most effectively in emergency settings. It is probably the most effective beta-blocker I have seen in action. A dose of 100mg combined with a 12.5mg of HCT can convert an A-Fib patient in less than 5 minutes.
Combined with that it is also, in my opinion, the most sedating of it's class -- just sort of the "golden standard" if your will...
Frankly though, if the use of Wellbutrin induces hypertension severe enough to warrant use of beta-blockers I would just assume discontinue the use of the Wellbutrin.
Alike, it is not a drug I would recommend to patients with anxiety disorders unless the anxiety is already being treated or you desire to combine the Wellbutrin with an anxiolytic.
If anxiety is a serious concern or you are cycling frequently -- I have heard good reviews of Symbyax.
Regards,
Matt
Posted by ed_uk on April 11, 2005, at 10:23:42
In reply to Re: Hint for betablockers, posted by mattw84 on April 10, 2005, at 23:34:08
Hi!
>The only reason I prefer Atenolol is because it is what I see used most effectively in emergency settings.
Since atenolol is relatively beta-1 selective, standard doses are unlikely to be effective in the treatment of anxiety-related tremor and other symptoms which appear to be mediated by the beta-2 receptor. Propranolol is often used to treat anxiety because it's not beta-1 selective. Nadolol or oxprenolol may be prefered by some pdocs because they may be better tolerated. Atenolol is a useful drug in cardiology but I don't think it's a particularly useful drug in psychiatry.
Regards,
Ed.
Posted by mattw84 on April 11, 2005, at 10:54:56
In reply to Re: Hint for betablockers » mattw84, posted by ed_uk on April 11, 2005, at 10:23:42
Precisely...
I suggested clonazepam .25mg bid for anxiolytic purposes -- and atenolol for tremor/hypertension. Great thread, but beta-blockers are generally never used to control anxiety... Perhaps situational or performance anxiety pro re nata, but otherwise it is pretty much unheard of. Thanks for the input ed...
Posted by ed_uk on April 11, 2005, at 13:25:20
In reply to Re: Hint for betablockers, posted by mattw84 on April 11, 2005, at 10:54:56
Hi,
>I suggested clonazepam .25mg bid for anxiolytic purposes -- and atenolol for tremor/hypertension.
Sorry, I misinterpreted your last post. As I said, atenolol can control hypertension but it's not a logical choice for the treatment of tremor.
>Great thread, but beta-blockers are generally never used to control anxiety... Perhaps situational or performance anxiety pro re nata, but otherwise it is pretty much unheard of.
Propranolol is, as you say, used to treat certain types of anxiety- particularly in the UK where pdocs avoid benzos like the plague! I don't find propranolol helpful personally but some people do succesfully use it to control anxiety symptoms such as tremor and palpitations. It hasn't performed well in trials (for anxiety) but I have encountered many people who like it.
Regards,
Ed.
Posted by sdb on April 11, 2005, at 16:29:41
In reply to Re: Hint for betablockers » mattw84, posted by ed_uk on April 11, 2005, at 13:25:20
Betablockers have influence on electrophysiological conduction and they also block beta1/beta2 or even alpha1 receptors on the cardiac tissue. Beta1/beta2 receptors play a role in the forwarding of electrical signals and there are more beta2 receptors on the heart tissue than it is often written in literature. Betablockers with
good beta2/beta1 blocking properties are the most effective to block the blunt adrenaline released by adrenal medulla. Electical conduction by nerves in the heart plays also a role in inotropie and chronotropie but this is more when you go swimming or jogging. Adrenaline is much more the trigger for inotropie and chronotropie in fight and flee situations.Interestingly betablocker molecules ressembles to adrenaline and as a consequence they block and stimulate at the same time (and this could cause beta downregulation, a positive effect of some betablockers in longterm use to combat fight and flight response).
Betablockers can also have membrane stabilizing actions (MSA), which could be an advantage for fight and flight responses (only in higher dosages). They modulate for example influx of fast Na channels.
Unfortunately it is true that beta1 blockers have less side effects than b1/2 blockers (beta2 receptores on blood vessels for example).
I would say that atenolol is a beta1/beta2 blocker with some more affinity to beta1-receptores and additional modulating properties in electrical conduction. Thus there is some efficacy in higher dosages for fight and flight situations. Unfortunately there is documented beta-receptor upregulation with time and this is a disadvantage for longterm use to combat anxiety response.
Most effective b1/b2 blockers are
Bopindolol, pindolol, timolol (mostly used by oculists), nadolol, oxprenolol, propranololkind regards
sdb
Posted by Phillipa on April 11, 2005, at 16:38:24
In reply to Re: Hint for betablockers, posted by sdb on April 11, 2005, at 16:29:41
Why do suppose my first pdoc prescribed 25mg of lopressor before he put me on l0mg of paxil. I was already on xanax, but he said it "would prepare my body for the AD". All I know is that it made me sooooo tired and when I ran on the treadmill my HR wouldn't go up which I have since been told is dangerous. BTW this pdoc is now under investigation for insurance fraud and illegal distribution of controlled substances. And this was the only pdoc the hospital I worked at would send me to under employee assistance, during national depression week. Fondly, Phillipa
Posted by sdb on April 11, 2005, at 16:50:27
In reply to Re: Hint for betablockers, posted by Phillipa on April 11, 2005, at 16:38:24
Lopressor can go (cross the blood brain barrier) in to the brain and this cause fatigue. Also slowed heart rate is a reason for fatigue.
And you are right, (you are a very understanding person) lopressor is very effective to block exercise tachycardia. There are better alternatives for betablockers.I dont know why your pdoc gave it to you. I have never heard of "preparing the body with lopressor for an ad). Perhaps lopressor could slow down first the response to paxil but this is...i dont know. Its good you have changed your pdoc.
Kind regards
sdb
Posted by Colleen D. on April 11, 2005, at 20:52:30
In reply to Wellbutrin XL and Anxiety, posted by sdb on April 10, 2005, at 3:47:35
and I'm currently on 300mg of Wellbutrin, a low dose of Effexor (75mg) which works more like an SSRI at this dose and 1.25mg clonazepam daily. I'm doing very well on this combo.
Good luck!
Colleen
Posted by Bill LL on April 13, 2005, at 8:49:51
In reply to Re: Hint for betablockers, posted by Phillipa on April 11, 2005, at 16:38:24
Phillipa- My cardiologist put me on lopressor (aka Toprol) 3 weeks a go for blood pressure. This is after I told him about my anxiety. He is in a very reputable practice of about 12 cardiologists.
I now feel better than I ever have in my life! My Cymbalta (duloxetine) took care of depression and worrying, but not my lifelong chest discomfort which I always attributed to anxiety. The Toprol took away the chest discomfort. I am now so glad that I had high blood pressure since the bp pill cured my agonizing life long discomfort.
Fortunately, for me, the Toprol does not make me tired at all.
> Why do suppose my first pdoc prescribed 25mg of lopressor before he put me on l0mg of paxil. I was already on xanax, but he said it "would prepare my body for the AD". All I know is that it made me sooooo tired and when I ran on the treadmill my HR wouldn't go up which I have since been told is dangerous. BTW this pdoc is now under investigation for insurance fraud and illegal distribution of controlled substances. And this was the only pdoc the hospital I worked at would send me to under employee assistance, during national depression week. Fondly, Phillipa
Posted by sdb on April 13, 2005, at 15:56:24
In reply to Re: Hint for betablockers - Phillipa, posted by Bill LL on April 13, 2005, at 8:49:51
For specific anxiety (performance, panic) betablocker are usefull and some of them do not have much side effects. The betablockers reduce negative physical symptoms. In other anxieties like Generalized Anxiety Disorder, Social Phobia and often repeated panic attacks for example the betablockers can be used in a combination with other "anxiolitic" drugs.
Regards
sdb
Posted by sdb on April 13, 2005, at 16:17:22
In reply to Re: Hint for betablockers - Phillipa, posted by Bill LL on April 13, 2005, at 8:49:51
Bye the way, I have taken almost every betablocker available and made some exercise and adrenaline experiments.
Everybody reacts different, but I can personally recommendNadolol (instead of Propranolol)
Oxprenolol (Slow Trasicor), unfortunately unavailable in US
Pindolol (only for shortterm use)Beta1-selective Blockers have mostly less sideffects but they are <useless> to combat anxiety response. Metoprolol and Atenolol are truly beta1-selective with some beta2 blocking properties. Strong beta1 selective like bisoprolol
and nebivolol <do not> have any effect of anxiety response.Full articels I read and I have found interesting: (search in http://www.ncbi.nlm.nih.gov/)
A dose-ranging study to evaluate the beta 1-adrenoceptor selectivity of bisoprolol.
Lipworth BJ, Irvine NA, McDevitt DG.Oxprenolol in the treatment of examination stress.
Krishnan G.Beneficial effect of nadolol on anxiety-induced disturbances of performance in musicians: a comparison with diazepam and placebo.
James I, Savage I.
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