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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 7 to 31 of 31. Go back in thread:
Posted by wildcardII on May 9, 2006, at 12:38:24
In reply to Re: Wellbutrin - 600mg ??? » wildcardII, posted by SLS on May 9, 2006, at 11:22:47
for me, 20mg of prozac helped w/ the wellbutrin and the side effects were more tolerable than w/ zoloft; mainly less headaches. 75mg of effexor xr w/ wellbutrin xr worked well but caused me fatigue. odd i know, but it did. i've had good experiences w/ paxil but that's not an option rt. now. let me know what helps =)
Posted by Phillipa on May 9, 2006, at 12:43:12
In reply to Re: Wellbutrin - 600mg ??? » SLS, posted by wildcardII on May 9, 2006, at 12:38:24
I know a few people zoloft has worked wonders for my own Son with his PTSD took 200mg of zoloft. He also has lmg of ativan prn. Scott I hope and know that whatever decision you make it will be the right one for you. Love Phillipa
Posted by rjlockhart on May 9, 2006, at 12:55:43
In reply to Re: Wellbutrin - 600mg ???, posted by Phillipa on May 9, 2006, at 12:43:12
600mg for me made me really sit in my seat still. I was nervous and anxious.
I dont know if i should go back to wellbutrin.
I had siezure on it. One time when i took 600mg one day. I got off it immidatly.
Scared of it.
Rj
Posted by James K on May 9, 2006, at 13:20:56
In reply to Re: Wellbutrin - 600mg ???, posted by rjlockhart on May 9, 2006, at 12:55:43
I was under the impression that 450 was the maximum dose because of the increased seizure risk. And once you have a seizure on it, you should never take it again. But, what I think I know, and what the doctors and pharmaceuticals decide, are often very different.
James K
Posted by Catherine sheel on May 9, 2006, at 13:45:17
In reply to Wellbutrin - 600mg ???, posted by SLS on May 9, 2006, at 9:21:44
I'm on 300 mg. WB twice daily (for the past 4 years now). Plus they've put me on 125 mg Topamax twice daily to supplement my response to the WB. It's the only thing I'll respond to without side-effects to other meds. My psychiatrist hates it though bec. she wigs out about the risks of seizures. (On the other hand...topamax is an anti-sz. med -- so perhaps that helps? That's just my take on it. Not hers.) Clearly, if you have a seizure, there's the possibility of your driver's license being taken away...and that would really be rotten. I've just never been worried about it.
However, I have just recently joined this site because I've gotten pitting edema (20 lbs of water weight times 6 months), and I'm not sure why. I've heard WB could be the cause, so I stopped my WB cold-turkey last week. No resolution of the edema yet. Just wanted to add that in.
Have you tried the WB extended release? Sorry if that's an obvious question. But my insurance won't cover it. And it's supposed to be a better drug. So, maybe it might help your depression better at 450mg.
good luck.
-c
Posted by wildcardII on May 9, 2006, at 14:04:32
In reply to Re: Wellbutrin - 600mg ???, posted by Catherine sheel on May 9, 2006, at 13:45:17
the first few months i was on wellbutrin xr (300) and it was odd b/c the 1st time i was on wb i did not have the swelling. i still take the wb but drink 100oz of water daily and have very, very small if any amounts of sodium. it took awhile but all swelling is gone. good luck~i know how awful you can feel...
Posted by yxibow on May 9, 2006, at 14:34:03
In reply to had same problem » Catherine sheel, posted by wildcardII on May 9, 2006, at 14:04:32
Wellbutrin set my head on fire, literally.. I think it produced some sort of redness and my OCD was off the roof with nighttime ruminations, after about a few years. If one were to take 600mg of it, I would first only take SR or XR and then add at least 1 if not 2 or more mg of Klonopin or the equivalent of your favourite benzodiazepine with antiseizure properties. The seizure potential just sounds too great.
Posted by SLS on May 9, 2006, at 15:25:28
In reply to Re: had same problem, posted by yxibow on May 9, 2006, at 14:34:03
> Wellbutrin set my head on fire, literally.. I think it produced some sort of redness and my OCD was off the roof with nighttime ruminations, after about a few years. If one were to take 600mg of it, I would first only take SR or XR and then add at least 1 if not 2 or more mg of Klonopin or the equivalent of your favourite benzodiazepine with antiseizure properties. The seizure potential just sounds too great.
In 1983, I participated in an open label clinical trial of Wellbutrin. Back then, the dosage range used was 600-900mg. I can't remember how long I was on 900mg for, but there was never any mention of a risk of seizure. I think that became an issue some years later during a clinical trial of Wellbutrin to treat bulimia. These people were more at risk, presumbably because of abnormalities in electrolytes. I doubt that very much attention would have been paid to siezures had they never conducted that investigation.Although I doubt it would be very helpful to prevent a seizure, I am taking Lamictal 150mg.
- Scott
Posted by blueberry on May 9, 2006, at 18:27:51
In reply to Wellbutrin - 600mg ???, posted by SLS on May 9, 2006, at 9:21:44
Scott, why don't you try ritalin or adderall? Or have you already? I mean, you've had all the neuro boosting in the world already. Maybe tackle it from the other end, that is, where the neuros shoot out from rather than where they end up. Taken only during the day only, stimulants would prevent the receptor sensitization poopout thing too. I'm just basing the idea on the fact that wellbutrin did have a little spark for you at first...NE and DA seem in the right direction...the tolerance buildup poopout thing...conservative stimulant dosing could give you all that without the poopout.
But yeah, 600mg was common way back in the old days. You know about the seirzure thing. Zoloft in high doses is a serotonin-dopamine reuptake inhibitor.
I have followed your posts for so long I just get this strong gut feeling that the reuptake inhibition thing is never going to get you where you want to go. You're dealing with the final destination of where neuros go, but not where they originate from. If anything, where they originate from is just being continually squashed down by all the inhibiton.
I don't know. Just thinking out loud. Sorry. :-)
Posted by Sobriquet Style on May 10, 2006, at 7:30:38
In reply to Re: had same problem, posted by SLS on May 9, 2006, at 15:25:28
Firstly, this is something i'm finding very helpful in treating the illness, and which is working for me, so in no way can this predict whether it will work for you, and basically theres many reasons why it won't. That said, through reading your posts I think we have something in common with the treatment resistant factor and whereby when we take medications we possibly respond, if only for a few weeks to then be let down as the response wheres away into feeling nothing.
So, this is what I do. Firstly, I've come to the conclusion that thinking taking a drug that gives me relief - and hoping that it will continuously is a false hope based on experience with being somewhat treatment resistant. My psychology before would tell me, if only this will work, if only *this* will the *one* and i'll be okay, if only etc.. was to eventually let me down in the long run. Now I use the thinking process which tells me - the drug I take and gain relief, *is* 100% going to be short-lived and let me down without a shawdow of a doubt.
So my stratgy has been this. Use and have to hand drugs which you gain relief from. Use them in a kind of as - needed basis. I'm not so much talking just for one day, but perhaps for afew weeks - knowing that you will gain relief, then slowly discontinue the drug. Depending on how you feel, you may not need to add another drug replacement and get by day-to-day living okay.
If, however you can't, have another drug (hopefully) which which provide the symptoms you need to be addressed, and use this drug for the time period in which it will gain relief, and then like before, slowly discontinue the drug when you know it will be likely to stop. This also gives somewhat different flavours of remission, but you can use this to your advantage.
The key is the timing, knowing that you can get relief, and not taking the drug any longer whereby the drug stops working and the illness begins to re-emerge. It is a juggling act, and like juggling, takes practice.
Basically you're tricking the body, just as it tricks you, playing it at its own unpredictable game. Cyling your drug treatments just as the illness cycles itself. knowing that your illness will return, but having the tools to manipulate it in such a way that things do not get out of control.
This may sound ridiculus what i'm doing, and i'm not sure how long this will work for, but so far in the previous months I have gained much relief from this method.
I always use a base medication too, which I never stop, but occassionally vary the dosage.
Heres an example:
I take Neurontin daily (this is my base) [yours might be Lamictal for instance] I keep the dosage between 600mg - 900mg but this is irrelevant. The main thing is, this is taken consistently.
Then I have Lamictal. I can gain mood stabilizing effects from this drug and good anti depressants effects. The problem is, after 3 to 4 weeks it disappears and then starts to cause problems. Therefore at the moment, I dont need it, if I do in the future, (which I will no doubt) I'll take it for 2 - 3 weeks then stop. I'll gain relief, and just as the un-wanted effetcs kick in, I'll discontinue and gain relief again. (I find when a drug that works, then starts to not work and possibly create problems, when discontinued, I gain relief.)
For anxiety, and somewhat other symptoms related to the anxiety/depression chicken and egg syndrome, I've got Valium. As needed. Daily, or for afew days. Taken for a few days I get relief, soon after it'll make me feel slightly depressed, then I'll reduce the dosage, again then I'll gain relief from the depression it produced.
Phenibut - (it feels close to a drug for me) I'll take for mood enhancing, depression, sleep and anxiety. It will give me relief for a short while and then I'll stop.
Any other symptoms come in to play then, only if I absolutely need to, will I re-start another drug. It can and has been the case that inbetween I'll feel fine, and if I do, I'll just stick with my base medication, when the illness re-appears I'll fight back with the arsenal above (also including Provigil) to manipulate it once again depending on symtoms. Safe in the knowledge that because its been a while since I took the medication, when I restart it relief is more or less guaranteed to happen.
The past few months have been going great using this system. Keeping the dosages low, keeping my body in balance not changing too quickly but just adapting the drugs to the illness my health has greatly improved. I'm now using reverse psychology too, saying to myself every once in a while "come on, i'm waiting for this to strike me, catch me if you can" But, like in other ways in life when you want something to happen, sometimes it never does! (Fortunately with manic depression this a good thing it hasn't!)
Sure, somedays are worse than others, but this strategy has been great for combating things and adapting my needs when they arise, socially, day to day things for example, and playing the cyling game at its own game. Its by no means perfect, but has it been a solution I'm having sucess with. If it ends tomorrow, (hope its does - reverse psychology! lol) then at least I can be pleased its lasted a good few months so far.
Like I say though, this may work, and although I havent described it in the best of ways, as this is a complex system, if you can get it to work, like practicing something, you'll get better and better over time and so will the illness. Because of our unique chemistry's, i'm unable to offer any more advice on which medications to use, you're the one who will know best at the end of the day, more importantly whether or not this may be of any use...
~
Posted by SLS on May 10, 2006, at 8:39:21
In reply to Scott, or anyone, this may work, it may not., posted by Sobriquet Style on May 10, 2006, at 7:30:38
Hi.
> So my stratgy has been this. Use and have to hand drugs which you gain relief from. Use them in a kind of as - needed basis. I'm not so much talking just for one day, but perhaps for afew weeks - knowing that you will gain relief, then slowly discontinue the drug. Depending on how you feel, you may not need to add another drug replacement and get by day-to-day living okay.
Thank you so much for your input.
Cycling between drugs has occured to me in the past. Your schedule for the timing of drug administration is interesting. I shall keep it in mind if I decide to try it.
- Scott
Posted by Larry Hoover on May 10, 2006, at 11:46:26
In reply to Scott, or anyone, this may work, it may not., posted by Sobriquet Style on May 10, 2006, at 7:30:38
> So my stratgy has been this. Use and have to hand drugs which you gain relief from. Use them in a kind of as - needed basis.
> This may sound ridiculus what i'm doing, and i'm not sure how long this will work for, but so far in the previous months I have gained much relief from this method.
I don't think it sounds ridiculous at all. It's very much the same thing as I have just discovered for my own self-care. I've been doing it that way for years, but I never stopped to look at it, until just recently, when I did some rather global reassessments.
I'm thinking of it in terms of pulses.
Short-term acute treatment.
Brief prophylaxis.
Very much what you have described, although my players are quite different.
Lar
Posted by blueberry on May 10, 2006, at 17:59:15
In reply to Scott, or anyone, this may work, it may not., posted by Sobriquet Style on May 10, 2006, at 7:30:38
That is a pretty cool method of cycling drugs. I might have to think about that. I certainly can relate to getting a few good days from a med that fades into nothingness, worseness, and side effects.
Posted by TJO on May 11, 2006, at 5:29:09
In reply to Re: Wellbutrin - 600mg ??? » B2chica, posted by SLS on May 9, 2006, at 11:20:52
Hi
How about a pill splitter???Tam
Posted by SLS on May 11, 2006, at 8:55:25
In reply to Re: Wellbutrin - 600mg ???, posted by TJO on May 11, 2006, at 5:29:09
I know that raising the dosage of Wellbutrin to 600mg is just a waste of time.
I started yesterday.
My doctor likes Lexapro for depression. I might end up adding it. I was thinking maybe Zoloft - Welloft.
- Scott
Posted by yxibow on May 11, 2006, at 20:21:21
In reply to Re: Wellbutrin - 600mg ???, posted by TJO on May 11, 2006, at 5:29:09
> Hi
> How about a pill splitter???
>
> TamI dont know if this applies to any comments on Wellbutrin SR or XR, but DO NOT split SR, you will get a instable and possibly dangerous dose of a drug that has an enteric coating to have time release.
Posted by TJO on May 12, 2006, at 5:14:00
In reply to Re: Wellbutrin - 600mg ??? » TJO, posted by yxibow on May 11, 2006, at 20:21:21
Thanks didn't know that ( and I take XL)
Tammy
Posted by patrickhh on May 12, 2006, at 12:03:11
In reply to Wellbutrin - 600mg ???, posted by SLS on May 9, 2006, at 9:21:44
I personally wouldn't try high doses of Wellbutrin like that. Although rare, the medication can cause seizures especially in higher doses. Chance of it producing seizures increases with increasing dosage. If you're not responding on 450, I'd consider something else.
> Has anyone responded well to Wellbutrin 600mg who had not responded adequately to lower dosages?
>
> I'm pretty sure my doctor will want to increase my dosage from 450mg to 600mg in an attempt to recapture my initial antidepressant response to it.
>
> I'm thinking of asking him to add a SRI if that doesn't work. I am leaning towards Zoloft.
>
> Thanks.
>
>
> - Scott
Posted by Larry Hoover on May 12, 2006, at 22:58:56
In reply to Re: Wellbutrin - 600mg ??? » SLS, posted by patrickhh on May 12, 2006, at 12:03:11
> I personally wouldn't try high doses of Wellbutrin like that. Although rare, the medication can cause seizures especially in higher doses. Chance of it producing seizures increases with increasing dosage. If you're not responding on 450, I'd consider something else.
Good point. The risk of seizure rises exponentially with dose, for bupropion.
Lar
Posted by SLS on May 13, 2006, at 7:23:28
In reply to Re: Wellbutrin - 600mg ??? » patrickhh, posted by Larry Hoover on May 12, 2006, at 22:58:56
> > I personally wouldn't try high doses of Wellbutrin like that. Although rare, the medication can cause seizures especially in higher doses. Chance of it producing seizures increases with increasing dosage. If you're not responding on 450, I'd consider something else.
>
> Good point. The risk of seizure rises exponentially with dose, for bupropion.I was once on 900mg of Wellbutrin when they were still investigating the dosage range prior to its approval. Given my many treatment failures, I am willing to take the risk. Although I'm not sure they would prevent a seizure, I am taking Lamictal and Keppra as mood stabilizers.
- Scott
Posted by Larry Hoover on May 13, 2006, at 8:46:04
In reply to Re: Wellbutrin - 600mg ???, posted by SLS on May 13, 2006, at 7:23:28
> > Good point. The risk of seizure rises exponentially with dose, for bupropion.
>
> I was once on 900mg of Wellbutrin when they were still investigating the dosage range prior to its approval. Given my many treatment failures, I am willing to take the risk. Although I'm not sure they would prevent a seizure, I am taking Lamictal and Keppra as mood stabilizers.
>
>
> - ScottWell then. Hard data over-rides statistical risk estimates, I should think.
I do pray for your remission, my friend.
Lar
Posted by ed_uk on May 13, 2006, at 11:23:58
In reply to Re: Wellbutrin - 600mg ???, posted by SLS on May 13, 2006, at 7:23:28
Hi Scott
I really hope 600mg helps you. How will you take it? 300mg XL twice a day? It sometimes seems to reduce side effects when controlled release meds are taken twice a day, even ones which are *supposed* to last 24 hours.
Ed
Posted by SLS on May 13, 2006, at 11:34:23
In reply to Re: Wellbutrin - 600mg ??? » SLS, posted by ed_uk on May 13, 2006, at 11:23:58
Hi Ed.
> I really hope 600mg helps you.
I'm not expecting it to.
:-(
> How will you take it? 300mg XL twice a day?
Yes. I guess that makes the most sense.
If I get nowhere over these next two weeks, I might reduce the dosage back to 300mg and add a SRI. Maybe I can twist my doctor's arm and add Nardil if the SRI doesn't work. I don't anticipate any problems mixing it with nortriptyline and Wellbutrin. I would, of course, discontinue the SRI and wait a week or two before starting the Nardil.
- Scott
Posted by patrickhh on May 16, 2006, at 14:56:04
In reply to Re: Wellbutrin - 600mg ???, posted by SLS on May 13, 2006, at 7:23:28
> I was once on 900mg of Wellbutrin when they were still investigating the dosage range prior to its approval. Given my many treatment failures, I am willing to take the risk. Although I'm not sure they would prevent a seizure, I am taking Lamictal and Keppra as mood stabilizers.
>
>
> - ScottI hpe it works for you.
My only concern would be that seizures can lead to immediate death. I don't know if it's worth losing your life over. If the max dose is not helping you, it may simply be time to try something else. Statistics show that increasing the dose doesn't lead to improved rate in response/remission.
You may need to adjust your mood stabilizers. Or possibly add another.
Posted by SLS on May 16, 2006, at 20:02:11
In reply to Re: Wellbutrin - 600mg ??? » SLS, posted by patrickhh on May 16, 2006, at 14:56:04
Hi.
> > I was once on 900mg of Wellbutrin when they were still investigating the dosage range prior to its approval. Given my many treatment failures, I am willing to take the risk. Although I'm not sure they would prevent a seizure, I am taking Lamictal and Keppra as mood stabilizers.
> I hpe it works for you.
>
> My only concern would be that seizures can lead to immediate death. I don't know if it's worth losing your life over. If the max dose is not helping you, it may simply be time to try something else. Statistics show that increasing the dose doesn't lead to improved rate in response/remission.
>
> You may need to adjust your mood stabilizers. Or possibly add another.
Thanks for your concern.I'm going to give this thing another week or so. I can't afford to leave any stones unturned. I can pretty much tell already that it is going nowhere, though.
- Scott
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