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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 2 to 26 of 26. Go back in thread:
Posted by Phillipa on May 12, 2014, at 15:20:19
In reply to Wellbutrin, posted by Beckett on May 12, 2014, at 14:25:36
Beckett it was very stimulating for me at only 150mg of the once a day pill. Off it per doc in one week. Not good to stay in your house. Phillipa
Posted by Beckett on May 12, 2014, at 16:56:30
In reply to Re: Wellbutrin » Beckett, posted by Phillipa on May 12, 2014, at 15:20:19
Hi Phillia,
Well, now I have fetzima samples from the doc. Hard not to be cynical. However the doc has held back from going after the depression except by lamictal until now. It's gotten bad again. Don't hold out much faith for fetzima. Not sure why doc thought this was preferred over wellbutrin, esp. given the bipolar thing. See him next week so he can make sure I am alright relativity speaking. I hate being alive because it is unreliable and elusive, and life is beautiful.
Also have cbt referrals to address fears of leaving the house.
Posted by phidippus on May 12, 2014, at 18:03:15
In reply to Wellbutrin, posted by Beckett on May 12, 2014, at 14:25:36
A norepinephrine-dopamine reuptake inhibitor, the primary pharmacological action of Wellbutrin is as a mild dopamine reuptake inhibitor and also a much weaker norepinephrine reuptake inhibitor as well as a nicotinic acetylcholine receptor antagonist.
In the nervous system cholinergic stimulation mediated through nAChRs controls pathways such as release of transmitters and cell sensitivity, which can influence physiological activity including sleep, anxiety, processing of pain and cognitive functions.
Eric
Posted by Phillipa on May 12, 2014, at 18:18:58
In reply to Re: Wellbutrin » Phillipa, posted by Beckett on May 12, 2014, at 16:56:30
Not familiar with this name. Will google as I'm the Queen. CBT will be a good thing. Also if that sample is a generic or new name for wellbutrin. Isn't wellbutrin one of only ad's for bipolar? Phillipa
Posted by jono_in_adelaide on May 12, 2014, at 18:23:17
In reply to Wellbutrin, posted by Beckett on May 12, 2014, at 14:25:36
If anxiety is an issue, could I suggest taking welbutrin with an SSRI (say Lexapro 10mg each morning) or Remeron (30mg at night)
Posted by Phillipa on May 12, 2014, at 18:29:39
In reply to Re: Wellbutrin » Beckett, posted by Phillipa on May 12, 2014, at 18:18:58
New med I'll be darned!!!
Posted by Beckett on May 12, 2014, at 21:25:34
In reply to Wellbutrin, posted by Beckett on May 12, 2014, at 14:25:36
I can't take the fetzima. These things really don't help. I wish they did. I feel worse. Versions of what already did not work. I cannot seem to stop crying now. Now I'll need to call the doc to say I can't or won't. I wish I hadn't agreed.
Posted by Phillipa on May 12, 2014, at 22:47:02
In reply to Re: Wellbutrin, posted by Beckett on May 12, 2014, at 21:25:34
I'm sorry if you can't then don't. You know what's best for your body. Phillipa
Posted by Chris O on May 14, 2014, at 14:32:12
In reply to Wellbutrin, posted by Beckett on May 12, 2014, at 14:25:36
Beckett:
I'm on Day 5 of combing Wellbutrin 300mg with Brintellix 30mg a day. So far, not a huge difference in depression or anxiety. Like you, I flirt with agoraphobia. Hard to say it's helping much with that. I'm definitely not able to work and function normally on this combo. It's not strong enough, or not lifting (enough of) this feeling of heaviness and worry that blankets my whole being. I'm taking the Par Pharm generic from CVS. I don't know if it's any different from the brand name, which costs $500 a month with my insurance. Good luck.
Chris
Posted by Beckett on May 14, 2014, at 15:24:01
In reply to Re: Wellbutrin » Beckett, posted by Chris O on May 14, 2014, at 14:32:12
Hi Chris,
I'm sorry to hear you're not getting a better lift of your symptoms yet. Regarding wellbutrin, my understanding is that it does not work immediately. But I could be wrong. Are you disappointed with Brintellix (sp) compared to other ADs? My doc offerer that as well. I think the zoloft I took years ago was better for anxiety and panic, though it did induce an hypomainc response. They all poop out over time. I forget why you do not use benzodiazepine. I did, and it was the only thing that worked, but it was decided I had developed a dependency. Really? After 15 years? No sh*t Sherlock. But I feel better off somehow, but I can't leave the house!
Did I mention that Lyrica really helps my GAD? But at the higher dose (600 mg.) I feel so dumb. Have you tried it?
I hope the wellies kick in for you.
Posted by Beckett on May 14, 2014, at 15:27:50
In reply to Re: Wellbutrin, posted by jono_in_adelaide on May 12, 2014, at 18:23:17
Hi Jono,
Nice to hear from you.
Yes anxiety is very big. Not sure how to treat it given that I deal with bipolar as well. What does your current treatment look like?
Posted by Beckett on May 14, 2014, at 15:30:58
In reply to Re: Wellbutrin » Beckett, posted by phidippus on May 12, 2014, at 18:03:15
Hi Eric,
Thanks for weighing in. My hope was a combo treatment for depression and ADHD. Not sure why the doc didn't prescribe. Haven't taken the fetzima yet. Still not leaving the house.
Posted by Chris O on May 14, 2014, at 15:49:27
In reply to Re: Wellbutrin » Chris O, posted by Beckett on May 14, 2014, at 15:24:01
Yeah, I'm very sorry that I'm not getting more relief too. Brintellix is doing something, but it's on the mild side. It's better than Viibryd which I took for 8 months when it came out. It's better than a series of generic SSRIs and SNRIs I took over the last five years (Prozac, Lexapro, Luvox, Paxil, and Serzone, to name a few). But none of these feel as strong as the initial time I took a Prozac/Wellbutrin combo, then a Celexa/Wellbutrin combo back in 1999-2000. Even though these did not completely alleviate my GAD and depression, I felt something lift a bit from my eyes, like I could be more free and open and expressive. That is not happening with the Brintellix. I still feel boxed in and worried and closed down. I'll give the Wellbutrin a chance. It's been less than a week. But I'm not incredibly hopeful.
The other thing I noticed about all of the SSRIs and SNRIs I've taken in the past five years is that, unlike my initial go in 1999-2000, where there was a gradual build-up such that even if I missed a dose or two or three, it was okay, now (and in the past five years), it seems like any of these drugs I take wear off very quickly, within a day, almost benzo-like. So, with Brintellix, if I don't take my 10mg dose at night (after my 20mg in the morning), I start to feel crappy, like mini withdrawals.
I've never tried Lyrica. I tried Neurontin briefly during the last five years and didn't feel like it was doing much. I probably did not give it a fair trial, though. Think it was less than two weeks.
My psychiatrist just told me he was getting a TMS machine in his office soon (as he has seen some of his patients go into remission after treatment and was pleasantly surprised by it). And, I just found out my insurance may cover it with doctor's convincing. He wants me to try it, so that will probably be my next attempt at treating this debilitating obnoxiousness.
I hope things get better for you too. Thanks for the interaction.
Chris
Posted by Beckett on May 14, 2014, at 16:37:59
In reply to Re: Wellbutrin » Beckett, posted by Chris O on May 14, 2014, at 15:49:27
Hi Chris,
Lyrica effects me differently than gabapentin. Gabapentin did zip. I wanted to share my experience.
Again, good luck with the wellies.
And yes, I have experienced that instant withdrawal thing. And I was able to quit a drug without much ado either.
Posted by LouisianaSportsman on May 14, 2014, at 22:21:05
In reply to Re: Wellbutrin » Beckett, posted by Chris O on May 14, 2014, at 15:49:27
Chris, with the partial response to Brintellix, maybe we can work on that?
If you claim to have had response to augmenting bupropion, a dopaminergic, maybe you try a stimulant-- a clean one such as the Daytrana patch? It metabolizes the methylphenidate through the stomach so you essentially get the whole dosage. Multiply the strength of the patch by 2 to get the Ritalin IR dosage. The lowest strength of the patch is 10mg. so that is like taking IR 10mg. X2 a day or 2.2mg./hr. It's very clean, stimulating and effective. It might brighten your mood and be a good maintenance therapy.
If the patch is not available, Focalin IR (dexmethylphenidate) tablets are just almost as good of an alternative. It's a very clean stimulant.
If you can't get stimulants and have to do bupropion, try doing it as an instant-release form as it may give you more energy and it might not have been tried in the past. It is effective for anhedonia moreso than extended-release.
I highly suggest you try the Daytrana patch as well as Lyrica. I actually got addicted to Lyrica if that says anything about its effectiveness.
Daytana is my highest suggestion to you, Chris, after much reflection. It is what I'd write as a theoretical PDOC.
I would also try adding Pexeva (paroxetine mesylate) tablets at a target GAD dosage of 20mg. to augment the Brintellix. You can start right at 20mg. and try the patch at 10 and 20 and see what you think. You might like the 20mg. See if you could get 45 10mg. patches so you could try 20mg. dosage for 15 days and see how well the Paxil is working for you with the Brintellix.
Next visit, try seeing if your PDOC would allow augmenting:
#45 10mg. Daytrana or Focalin IR if not stimulants, then do instant-release bupropion and not extended-release bupropion target dose of 100mg. IR X 2 then try 150mg. X 2 next month if not effective
#30 Pexeva 20mg.
#90 Lyrica 150mg. TID (PRN) or #90 Klonopin 0.5mg. TID (PRN) or #45 15mg. BusparTake the Lyrica throughout the day but feel free to skip doses on particularly good days. 450mg. a day would provide a response, for sure, no doubt, but it would also generate many side effects, but you could manage your dosing accordingly and might need as many next visit. I would do two (300mg.) in the morning and one at night QHS if you really want to see what Lyrica is about at an effective dosage. If you can't do Lyrica, I still suggest that you need a benzo like Klonopin dosed similarly.
If not a benzo, low dosages of Buspar such as 15mg. PM and 7.5mg. AM could be dopaminergic and anxiolytic, but very subtle. #45 15mg. Buspar would get you there.
I think these additions might help your mood and get you to where you want to be.
Keep in touch and good luck, buddy!
Posted by Chris O on May 14, 2014, at 23:02:42
In reply to hey, Chris, long time no see-- some suggestions!, posted by LouisianaSportsman on May 14, 2014, at 22:21:05
Always impressed with your pharmacological expertise, Sportsman. Really appreciate the feedback. I tried Paxil and Klonapin without much luck in the past. I think I took both Paxil (75mg) and Klonapin (3 mg) a day for about a year. The Paxil did not do much of anything, and the Klonapin just left me mildly drowsy, but no real deep relief of my symptoms. I would be willing to try a stimulant, though a I suspect it might move me toward panic. But I have never tried stimulants before, so it is certainly on my list. I'll to talk to my doctor about Lyrica too. And perhaps when I did use Wellbutrin in 1999, I was on the instant release, as I do not believe they had extended release at that time. So, there is a lot to think about here. I'll try to keep you guys posted. I always appreciate your feedback. Hope you are doing well, too.
Chris
Posted by jono_in_adelaide on May 15, 2014, at 0:35:16
In reply to Re: Wellbutrin » jono_in_adelaide, posted by Beckett on May 14, 2014, at 15:27:50
Hi, I'm doing well,, current cocktail is
Nardil 15mg x 2 three times a day
Xanax 1mg three times a day
Nortriptyline 75mg at bedtime
Risperidone 1mg at bedtime
You could try risperidone 1mg at bedtime with the welbutrin, I found it helps releive anxiety and depression, with few side effects (apart from drowsiness during the first 3-4 days)
> Hi Jono,
>
> Nice to hear from you.
> Yes anxiety is very big. Not sure how to treat it given that I deal with bipolar as well. What does your current treatment look like?
Posted by LouisianaSportsman on May 15, 2014, at 13:07:35
In reply to Re: Wellbutrin, posted by jono_in_adelaide on May 15, 2014, at 0:35:16
> Hi, I'm doing well,, current cocktail is
>
> Nardil 15mg x 2 three times a day
>
> Xanax 1mg three times a day
>
> Nortriptyline 75mg at bedtime
>
> Risperidone 1mg at bedtime
>
> You could try risperidone 1mg at bedtime with the welbutrin, I found it helps releive anxiety and depression, with few side effects (apart from drowsiness during the first 3-4 days)
>
>
> > Hi Jono,
> >
> > Nice to hear from you.
> > Yes anxiety is very big. Not sure how to treat it given that I deal with bipolar as well. What does your current treatment look like?
>
>Not the worst idea.
Chris, I think stimulants would change your life.
If not, advanced solutions like MAOIs, etc, may as well. Try an appropriately dosed stimulant and see what happens.
Posted by Beckett on May 15, 2014, at 13:41:09
In reply to Wellbutrin, posted by Beckett on May 12, 2014, at 14:25:36
Since I was given the sample of Fetzima, I have been reading reviews, etc. I have also been thinking about what I would be willing to go through to achieve relief. In the past SSRI's have not provided full relief--only partially for depression. Anxiety levels have been helped somewhat, but not social anxiety nor panic (I think it lessened the frequency of panic which is saying something significant).
I don't think I have it in me for an snri trial. Sometimes NE can increase pain levels, make me sick, or create a jagged feeling. Fetzima is an snri.
I have had partial success with Emsam, and would be on ot now except that I would need to change pain medication from tramadol ER and wait 14 days.
I could give a hoot about the diet restrictions of Nardil. My concerns are insomnia and feeling somehow strange (which I did not on Emsam).
I would like to feel better across a spectrum of symptoms and dx's. In addition to the mentioned dx's, I have adhd imattentive which disappeared on dexedrine (as did social anxiety), but it made me very hypomanic and had other disadvantages as well. But the adhd hasn't ever been treated nor is currently being treated.
Ramble, ramble.
Posted by Beckett on May 15, 2014, at 13:45:38
In reply to Re: Wellbutrin, posted by jono_in_adelaide on May 15, 2014, at 0:35:16
Hi Jono,
Glad you are doing well. That is great! I see you are taking nortriptyline along with Nardil, so I think you have a good pdoc. Is this the one you fly in to see?
I have a question or two about Nardil (if you do not mind).
Does it induce insomnia? Are there other health/side effects?
Posted by jono_in_adelaide on May 15, 2014, at 17:46:01
In reply to Re: Wellbutrin » jono_in_adelaide, posted by Beckett on May 15, 2014, at 13:45:38
Nardil induced insomnia for the first 2 nights, but that was it (though those 2 nights were quite uncomfortable)
Other side effects have been mild to non existant
Posted by Chris O on May 16, 2014, at 17:09:35
In reply to Re: Wellbutrin, posted by jono_in_adelaide on May 15, 2014, at 0:35:16
Jono:
If you don't mind my asking, what specific effects do you get from the Nardil + Nortrip combo? What was your physical/mental state like before and after taking this combo? These are the two drugs I will probably try next if my current trial of Brintellix + Wellbutrin continue to be so "meh." Thanks.
Chris
Posted by Catling on June 9, 2014, at 3:41:52
In reply to Re: Wellbutrin » Phillipa, posted by Beckett on May 12, 2014, at 16:56:30
> Hi Phillia,
>
> Well, now I have fetzima samples from the doc. Hard not to be cynical. However the doc has held back from going after the depression except by lamictal until now. It's gotten bad again. Don't hold out much faith for fetzima. Not sure why doc thought this was preferred over wellbutrin, esp. given the bipolar thing. See him next week so he can make sure I am alright relativity speaking. I hate being alive because it is unreliable and elusive, and life is beautiful.
>
> Also have cbt referrals to address fears of leaving the house.Hi Beckett,
I read through the different responses to your thread and I didn't see anyone mention Latuda so I thought I might mention it. It's shown efficacy in treating depression for bipolar patients. It primarily works on serotonin and dopamine. I don't have bipolar but my quack (lol) wanted me to try it to see if it would augment my Parnate so I did a lot of research on it. It seems like some people are getting good results with it. Don't know if it would be appropriate in your case but thought it was worth mentioning.
Best,
Cat
Posted by Beckett on June 9, 2014, at 14:55:33
In reply to Re: Wellbutrin » Beckett, posted by Catling on June 9, 2014, at 3:41:52
Hi Cat,
Thanks for responding. Have you tried it? I didn't do well on it. I will not use an AP again--not good for me. Have you tried it? Right now I am waiting to see if I can get back on Emsam.
Thanks for your suggestion :-)
Posted by Catling on June 10, 2014, at 11:50:03
In reply to Re: Wellbutrin » Catling, posted by Beckett on June 9, 2014, at 14:55:33
Hi Beckett, I did try Latuda and it was horrible! lol. I'm not sure if I was starting to get serotonin syndrome or NMS but I spent four days in sheer agony with full on flu symptoms, migraine, body heat dysregulation, couldn't stay out of bed, dizziness, horrible nausea, the works. The half life is so long that it takes at least 72 hrs for 90% of the med to be out of your system and I have a slow metabolism so it took even longer. I went off all my meds for those days because I was so worried that one of them would make it worse. Even trying to take just one 10mg parnate five days later brought the symptoms back so I gave it a full week before I started back on my regular meds. I have never had such a bad reaction to any medication as I did with that med. I have two full sample boxes of it sitting here too, but there's no way I would try it again.
This is the end of the thread.
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