Psycho-Babble Medication Thread 997996

Shown: posts 1 to 18 of 18. This is the beginning of the thread.

 

'Pulsing' Wellbutrin Dose

Posted by Chtorr281 on September 27, 2011, at 4:20:15

I'm curious if anyone here has experience with "pulsing" antidepressant dosage in order to keep it from pooping out. I'm currently taking Wellbutrin SR for chronic depression. Like all the different SSRIs I have tried, Wellbutrin worked very well for a few weeks then seemed to be way less effective. I started feeling emotionally flat and empty with periods of irritability and sadness. The emotional numbness or flatness was quite a bit worse with SSRIs though.

I seem to be able to get a positive response out of Wellbutrin again by pulsing the dose; I've tried different routines like 2 days off, 4 days on, etc. But what seems to work best is not taking it on Saturday, 300 mg on Sunday, and 150 mg the rest of the week. Strangely I feel best on Mondays and worst on Fridays. But if I keep taking it without interruption I get emotionally flat and irritable, and it does not improve.

Why would I feel the best the day after taking the higher dose? And worst after taking it continuously for a week?

I have tried different dosages and 300mg per day makes me feel much worse than 150mg. I've also tried going down to 75mg per day, but after a while even that had the same negative effects as when I continuously took the higher dosage with very few of the positive effects.

Do you think this has to do with building up tolerance or could it be something to do with circadian rhythms? When it is working its best and not causing anhedonia and irritation I sweat a lot when I sleep.

I have been on Zoloft, Paxil, Luvox, and Effexor, and they all had a short period where they were very effective, but then stopped working after a few weeks. Zoloft was the first one I ever tried and it probably worked the longest, for a couple of months, before I started feeling bland and irritable. Raising the dose made me exhausted all the time, more emotionally flat but with periods of extreme sadness or anger. I never tried "pulsing" the dose with any of the SSRIs.

I don't know if there is a better dosing strategy that I could be trying. Any ideas or experience in this area? My doctor claims that he has a few patients who do better by taking a med vacation for a day or two every so often, so he's not against my current strategy, but he also doesn't really have an explanation as to why just continually staying on a steady dose doesn't seem to work.

When taking no medications I have continuous atypical depression. Thanks for any ideas.

Chris

 

Re: 'Pulsing' Wellbutrin Dose

Posted by dragonblack on September 27, 2011, at 5:04:25

In reply to 'Pulsing' Wellbutrin Dose, posted by Chtorr281 on September 27, 2011, at 4:20:15

Hi,

I can't speak directly to your question regarding pulsing Wellbutrin, but I too struggle with it pooping out and it's the only thing that "sorta" works for me. I take the XL version, 300 mg, and I am looking into switching to the SR. I would be doing this for a number of reasons, but one of the main attractions to me is opening up dosage options not available on the XL. It frustrates me that 150, 300, and 450 are the only possible doses, like 100% or 50% increase (or decrease) of dosage might be just the micro-change I need. For me, 300 isn't enough, but 450 is too much, and the sides outweigh the benefits. On the SR, you have the option of 200, 250, 350, and 400 opened up. Granted, 2 of these require you to take 2 different strength pills, but I've searched the boards and there are plenty of people who have taken unusual doses of Wellbutrin. So, maybe you could experiment with several of these atypical doses, and see if these 150 mg jumps and dips they force us to make might be part of the problem. Just a thought. Good luck!

db

 

Re: 'Pulsing' Wellbutrin Dose dragonblack

Posted by Phillipa on September 27, 2011, at 10:25:45

In reply to Re: 'Pulsing' Wellbutrin Dose, posted by dragonblack on September 27, 2011, at 5:04:25

Different med but have found the same pulsing at times not all the time seems to work best. I've lowered in half and then doubled what are baby doses to begin with and sometimes feel better the day on lower dose then not so raise feel a bit better then back to same. Maybe it jars the brain? Phillipa

 

Re: 'Pulsing' Wellbutrin Dose

Posted by Chtorr281 on September 27, 2011, at 15:09:23

In reply to Re: 'Pulsing' Wellbutrin Dose, posted by dragonblack on September 27, 2011, at 5:04:25

> Hi,
>
> I can't speak directly to your question regarding pulsing Wellbutrin, but I too struggle with it pooping out and it's the only thing that "sorta" works for me. I take the XL version, 300 mg, and I am looking into switching to the SR. I would be doing this for a number of reasons, but one of the main attractions to me is opening up dosage options not available on the XL. It frustrates me that 150, 300, and 450 are the


only possible doses, like 100% or 50% increase (or decrease) of dosage might be just the micro-change I need. For me, 300 isn't enough, but 450 is too much, and the sides outweigh the benefits. On the SR, you have the option of
200, 250, 350, and 400 opened up. Granted, 2 of these require you to take 2 different strength pills, but I've searched
the boards and there are plenty of people who have taken
unusual doses of Wellbutrin. So, maybe you could
experiment with several of these atypical doses, and see if
these 150 mg jumps and dips they force us to make might be
part of the problem. Just a thought. Good luck!

Just a thought but you can use a pill splitter to cut the SR in half and it still releases slowly. So it would be possible to fine tune the dose even further.
>
> db

 

Re: 'Pulsing' Wellbutrin Dose

Posted by dragonblack on September 27, 2011, at 16:21:53

In reply to Re: 'Pulsing' Wellbutrin Dose, posted by Chtorr281 on September 27, 2011, at 15:09:23

> > Hi,
> >
> > I can't speak directly to your question regarding pulsing Wellbutrin, but I too struggle with it pooping out and it's the only thing that "sorta" works for me. I take the XL version, 300 mg, and I am looking into switching to the SR. I would be doing this for a number of reasons, but one of the main attractions to me is opening up dosage options not available on the XL. It frustrates me that 150, 300, and 450 are the
>
>
> only possible doses, like 100% or 50% increase (or decrease) of dosage might be just the micro-change I need. For me, 300 isn't enough, but 450 is too much, and the sides outweigh the benefits. On the SR, you have the option of
> 200, 250, 350, and 400 opened up. Granted, 2 of these require you to take 2 different strength pills, but I've searched
> the boards and there are plenty of people who have taken
> unusual doses of Wellbutrin. So, maybe you could
> experiment with several of these atypical doses, and see if
> these 150 mg jumps and dips they force us to make might be
> part of the problem. Just a thought. Good luck!
>
>
>
> Just a thought but you can use a pill splitter to cut the SR in half and it still releases slowly. So it would be possible to fine tune the dose even further.
> >
> > db
>
>

Interesting. I've never heard of splitting the SR's, though I have heard of splitting the XL's. Some do it to try to turn it into an IR, but apparently the coating on the XL is a self-healing polymer, like that dude from Terminator 2, so if you split it you get some instant release but then it reverts to being XL. Pretty weird, yet cool.

 

Re: 'Pulsing' Wellbutrin Dose

Posted by creepy on September 27, 2011, at 17:02:27

In reply to Re: 'Pulsing' Wellbutrin Dose, posted by dragonblack on September 27, 2011, at 5:04:25

Ive had about five trials of this drug at different doses. It works for awhile then it poops out.
I think it is because its so much like a traditional stimulant, that dose escalation is the only thing that keeps those initial benefits going.
Unfortunately you cant go past 450mg without risk of seizure.
You could investigate memantine.. there are some claims that it helps keep tolerance from building.
Otherwise Id look at something like emsam / selegilene.

 

Re: 'Pulsing' Wellbutrin Dose

Posted by Chtorr281 on September 27, 2011, at 19:21:29

In reply to Re: 'Pulsing' Wellbutrin Dose, posted by dragonblack on September 27, 2011, at 16:21:53

> > > Hi,
> > >
> > > I can't speak directly to your question regarding pulsing Wellbutrin, but I too struggle with it pooping out and it's the only thing that "sorta" works for me. I take the XL version, 300 mg, and I am looking into switching to the SR. I would be doing this for a number of reasons, but one of the main attractions to me is opening up dosage options not available on the XL. It frustrates me that 150, 300, and 450 are the
> >
> >
> > only possible doses, like 100% or 50% increase (or decrease) of dosage might be just the micro-change I need. For me, 300 isn't enough, but 450 is too much, and the sides outweigh the benefits. On the SR, you have the option of
> > 200, 250, 350, and 400 opened up. Granted, 2 of these require you to take 2 different strength pills, but I've searched
> > the boards and there are plenty of people who have taken
> > unusual doses of Wellbutrin. So, maybe you could
> > experiment with several of these atypical doses, and see if
> > these 150 mg jumps and dips they force us to make might be
> > part of the problem. Just a thought. Good luck!
> >
> >
> >
> > Just a thought but you can use a pill splitter to cut the SR in half and it still releases slowly. So it would be possible to fine tune the dose even further.
> > >
> > > db
> >
> >
>
> Interesting. I've never heard of splitting the SR's, though I have heard of splitting the XL's. Some do it to try to turn it into an IR, but apparently the coating on the XL is a self-healing polymer, like that dude from Terminator 2, so if you split it you get some instant release but then it reverts to being XL. Pretty weird, yet cool.

Some more info about dosage "pulsing" that I didn't mention. The first time I decided to try a different dosage strategy than taking the same dose every day (since I know from long experience that that doesn't work for me) I stopped taking Wellbutrin for 3 days in order to reset myself. This is after being on 150mg a day for a long time (300mg being worse as far as side effects and effectiveness). By the 3rd morning of not taking it, I was feeling fantastic, even better than I felt during my original 4th or 5th week on it which when it was at its best. I resumed taking it the next day and have tried "pulsing" it since then.

So it apparently lowers something essential while doing its job. And that essential something seems to recover while being off the drug. Strange that I would feel almost hypomanic after *not* taking it for a few days.

Also, I wanted to mention again that the day after I take a higher dose I feel better, but not on that particular day if the high dose. On the days I feel it working I feel great. I seem to get about 4 very good days per week, 1 fair day, and 2 rather poor days. I think this is the best I can do which is a clear improvement for me over just taking the same dose day after day and feeling emotionally flat and irritable. Like most Tuesdays on this current schedule, i feel very good. My wife and family have been shocked at how much better Wellbutrin has made me, but I know for a fact that the only way I am able to keep it working is with this method.

Whether this would have worked with other ADs I just don't know.

For anyone who has stopped responding to it, I would be fascinated to see if this would work for them. Clearly something in my brain is recovering by stopping and/or lowering the dose. With continuous same dosage that recovery never takes place and I no longer get an antidepressant response.


 

Re: 'Pulsing' Wellbutrin Dose

Posted by bleauberry on September 29, 2011, at 6:26:07

In reply to 'Pulsing' Wellbutrin Dose, posted by Chtorr281 on September 27, 2011, at 4:20:15

Well personally I am in favor of whtatever dosing schedule works. No matter how small, ultra small, pulsed, whatever. None of it matters. All that matters is how you feel.

There have been other people here that commented on doing better with "as needed" or "pulsing" versus daily schedule. I've done better with pulsing some things, while others are better daily. Whatever works.

So if I'm in real bad shape I can rescue myself by taking half a vicadin. But it won't help me that day. I hardly feel it actually. But the next day....I'm saved, much better day. Why does it work like that the day after, when it's only a 3 hour med? I don't know. It just does.

 

Re: 'Pulsing' Wellbutrin Dose

Posted by SLS on September 29, 2011, at 17:21:43

In reply to Re: 'Pulsing' Wellbutrin Dose, posted by bleauberry on September 29, 2011, at 6:26:07

> Well personally I am in favor of whtatever dosing schedule works. No matter how small, ultra small, pulsed, whatever.

Throughout my treatment history, it was recommended by doctors that I NOT pulse antidepressants. I am not sure of all their reasons why, but I think treatment resistance was a concern.


- Scott

 

Re: 'Pulsing' Wellbutrin Dose

Posted by torrid on September 29, 2011, at 20:43:52

In reply to 'Pulsing' Wellbutrin Dose, posted by Chtorr281 on September 27, 2011, at 4:20:15

everything poops out on me about 6-12 months. I switch AD's when needed and nothing works like wellbutrin so I guess I pulse, I take it for a week or so and stop it for as much as a week and resrt it. I think the cymbalta maybe starting to poopout on me, maybe just a little but that is how poopout starts for me, slow decline until steep fall. I'm bracing myself for it.

 

Re: 'Pulsing' Wellbutrin Dose

Posted by Chtorr281 on September 30, 2011, at 16:24:44

In reply to Re: 'Pulsing' Wellbutrin Dose, posted by torrid on September 29, 2011, at 20:43:52

> everything poops out on me about 6-12 months. I switch AD's when needed and nothing works like wellbutrin so I guess I pulse, I take it for a week or so and stop it for as much as a week and resrt it. I think the cymbalta maybe starting to poopout on me, maybe just a little but that is how poopout starts for me, slow decline until steep fall. I'm bracing myself for it.


So wellbutrin remains effective for you when taking it one week on/ one week off? I would love to read more about people who take ADs on as as-needed basis. For some of us this may be the only route to go.

I know I simply can't take the same thing every day and have it keep working. I wish I could because it is much simpler.

 

Re: 'Pulsing' Wellbutrin Dose Chtorr281

Posted by torrid on September 30, 2011, at 16:38:50

In reply to Re: 'Pulsing' Wellbutrin Dose, posted by Chtorr281 on September 30, 2011, at 16:24:44

yes, it's not exactly week on and week off but I don't take it consistantly, I may take it for 2-3 weeks straight and then take a week off. I also try and skip at least one day a week. I take busbar and cymbalta and conceta but wellbutrin has been the best med I've ever taken. After it pooped out the first time it was hard and my doc lowered it to 100mg /day and added busbar and cymbalta. I tryed going off the wellbutrin entirely wondering if it was doing anything and thats how I started putting it on holliday

 

Re: 'Pulsing' Wellbutrin Dose SLS

Posted by Chairman_MAO on October 1, 2011, at 15:29:14

In reply to Re: 'Pulsing' Wellbutrin Dose, posted by SLS on September 29, 2011, at 17:21:43


> Throughout my treatment history, it was recommended by doctors that I NOT pulse antidepressants. I am not sure of all their reasons why, but I think treatment resistance was a concern.

There's an exception to [nearly] every rule, but there are myriad reasons for this. I'm sure your familiar with a lot of them.

This is one reason: http://en.wikipedia.org/wiki/Kindling_(substance_withdrawal)

This is a neurological term used when talking about seizures, but it very well could apply here.

I think there is also a danger with certain agents of inducing bipolar disorder/mood swings.

Bupropion does have long-acting metabolites, though, and you could stagger doses just to get low levels of the long-acting ones (maybe? I really dont recall enough about it to tell you offhand).

In the final analysis, whatever works for you is what works for you, but I think most likely you're at best going to end up with a suboptimal solution.

 

Re: 'kindling substance withdrawal Chairman_MAO

Posted by torrid on October 1, 2011, at 18:55:57

In reply to Re: 'Pulsing' Wellbutrin Dose SLS, posted by Chairman_MAO on October 1, 2011, at 15:29:14

I'm curious about this, when an AD poops out and I abrupty stop, I never have withdrawal but if I stop taking it while it's working I have had bad withdrawal symptoms. This has been true SSRI's I've used.

I figure when there was no withdrwal the med pooped out long ago.

Sometimes I have stopped taking an AD just to is if it's working and in a couple days if I clearly have withdrwal, the answer was yes it's working.

I'm on Cymbalta and resently I stooped it for 5 days and I didn't have dramatic withdrawal other then vertigo and I can't say the vertigo was withdrwal because it continued weeks after I restarted the cymbalta.

I did read something that said not to take drug holliday with cymbalta but reason wasn't stated.

Is there a reason other then some health risk not to holiday cymbalta?

I do think the wellbutrin is working in combination with my busbar and cymbalta but I don't think it ever worked the way it did the first 6 months I took it, it was miraculos the first 6 months of treatment.

I looked up that link and it didn't seem to get me to the article.

 

Re: 'kindling substance withdrawal torrid

Posted by Chairman_MAO on October 5, 2011, at 22:29:02

In reply to Re: 'kindling substance withdrawal Chairman_MAO, posted by torrid on October 1, 2011, at 18:55:57

"Sometimes I have stopped taking an AD just to is if it's working and in a couple days if I clearly have withdrwal, the answer was yes it's working."

All that means is that you're experiencing withdrawal symptoms; it is entirely possible to become dependent on a drug and experience withdrawal symptoms even if it didn't help you.

One should not take "drug holidays" with SSRIs or antidepressants in general.

 

Re: 'kindling substance withdrawal Chairman_MAO

Posted by SLS on October 6, 2011, at 5:45:26

In reply to Re: 'kindling substance withdrawal torrid, posted by Chairman_MAO on October 5, 2011, at 22:29:02

Hi C_M.

> One should not take "drug holidays" with SSRIs or antidepressants in general.

Exactly. Pulsing antidepressants may lead to treatment resistance.


- Scott

 

Re: 'kindling substance withdrawal Chairman_MAO

Posted by torrid on October 6, 2011, at 11:43:53

In reply to Re: 'kindling substance withdrawal torrid, posted by Chairman_MAO on October 5, 2011, at 22:29:02

yes, that's withdrawal but other times when it feels like the AD has pooped out and I suddenely stop taking it but experience NO withdrawal, that tells me, yes it indeed has pooped out. After years of relapsing I've learned to detect poop out and manage the AD poop out, now I'm in true recovery, now I'm making use of therapy because I no longer relaps and no longer go into the hospital. without my former relapses I don't loose the gains, my gains have become stable bricks under my feet that I'm able to build apon.

 

Re: down regulation opose to tolerance build up?

Posted by torrid on October 6, 2011, at 12:01:16

In reply to Re: 'kindling substance withdrawal Chairman_MAO, posted by SLS on October 6, 2011, at 5:45:26

Scott, treatment resistance doesn't seem to be an issue for me. I have always responded to AD treatment within days to weeks. Gosh, I'm so sorry for you folks that are resistant, it must be terrible. On the other hand poop out is a big problem for me. AD's poopout between 3-9 months for me, The good thing is most will work again the second third forth... time around. I've lenthened the time to poopout by hollidaying my AD's. All I can say is it has worked for me.

Is there different causes of poop out, down regulation or just a tollerance build up? I think it's down regulation with me because I react to SAMe with in hours and use SAMe to manage poop out by useing it on long drug hollidays and use SAMe in combination with my AD when the AD has pooped out but I'm not ready to holliday or switch AD's


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