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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by Sheilac on December 14, 2016, at 14:10:51
At first I had anxiety on Wellbutrin SR 100mg. Finally, after about 2 weeks the depression lifted and the anxiety went away.
I stopped the Seroquel due to severe tight muscle pain. It was awful.
Then I started feeling a little depressed, so I went up to Wellbutrin SR 150mg. It helped with my depression, but I feel tired. I have ADD, so I was hoping for more energy and concentration.
Will this go away? I don't want to be tired on Wellbutrin. I'm not depressed, but it sucks to not be able to read a book. I need energy & focus. I had to stop taking the Adderall because it irritated my Interstital Cystits.
It's been about 5 days on Wellbutrin SR 150mg.
Any ideas?
Posted by Christ_empowered on December 14, 2016, at 15:32:47
In reply to Wellbutrin Tired! No energy, posted by Sheilac on December 14, 2016, at 14:10:51
have you ever tried ritalin or focalin? I think ritalin comes in all kinds of long acting formulations and focalin comes in an xr.
There are other amphetamine preparations you can try, too. Dexedrine and Evekeo, vyvanse.
There's also Provigil or NuVigil, if your insurance will cover them.
Rarely, doctors will use methamphetamine (Desoxyn). I think the appeal is that its more potent than the other amphetamines, so lower doses are used and there often aren't as many side effects.
There is (or was...) a transdermal stimulant patch. I think it was Ritalin. That seems like it might be a viable option.
There's also Emsam. That's a low dose MAOI that's applied as a transdermal patch. I don't know that it'd be great for the ADD/ADHD, but it is helpful in some forms of depression and can be stimulating.
Posted by rjlockhart37 on December 15, 2016, at 0:52:53
In reply to Wellbutrin Tired! No energy, posted by Sheilac on December 14, 2016, at 14:10:51
bupropion is a mild stimulant, but it's more classified as antidepressant, it does the same as methyphedniate(ritilin) and cocaine, but a much much lesser extent, it effects more norepinephrine than dopamine,some dopamine properties....it does help motivation but soemtimes ill drink caffeine and i get tired, or sleepy.....it don't know how to describe it, but bupropion could have a slowing effect, even thought its a stimulant-like antidepressant......but im thinking if you increase it more it can cause more anxiety, but the standard for wellbutrin in XL form (which I used to take) is 300mg daily, 100mg's released 3 times in the day
have you thought maybe a small benzo to add on that, sometimes like benzo can loosen you up and feel more content (lower doses) but that's up to your doctor
there's also a form wellbutrin that's called Aplenzin which is a diffrent delivery system than the XL form
Posted by rjlockhart37 on December 15, 2016, at 0:59:28
In reply to Wellbutrin Tired! No energy, posted by Sheilac on December 14, 2016, at 14:10:51
174mg is equal to 150mg XL
348 is usally standard
522mg is higher dose, more like 450mg in XL form
Posted by Sheilac on December 15, 2016, at 6:20:16
In reply to Re: Wellbutrin Tired! No energy, posted by rjlockhart37 on December 15, 2016, at 0:52:53
But Wellbutrin is making me tired. I was hoping it would give me more energy. I don't know if it's because I went up to 150mg? Maybe a lower dose would help? Maybe the tiredness of the 150mg will wear off?
Posted by SLS on December 15, 2016, at 7:17:43
In reply to Wellbutrin Tired! No energy, posted by Sheilac on December 14, 2016, at 14:10:51
> At first I had anxiety on Wellbutrin SR 100mg. Finally, after about 2 weeks the depression lifted and the anxiety went away.
>
> I stopped the Seroquel due to severe tight muscle pain. It was awful.
>
> Then I started feeling a little depressed, so I went up to Wellbutrin SR 150mg. It helped with my depression, but I feel tired. I have ADD, so I was hoping for more energy and concentration.
>
> Will this go away? I don't want to be tired on Wellbutrin. I'm not depressed, but it sucks to not be able to read a book. I need energy & focus. I had to stop taking the Adderall because it irritated my Interstital Cystits.
>
> It's been about 5 days on Wellbutrin SR 150mg.
>
> Any ideas?Yes.
Wait.
- Scott
Posted by Sheilac on December 15, 2016, at 10:41:19
In reply to Re: Wellbutrin Tired! No energy » Sheilac, posted by SLS on December 15, 2016, at 7:17:43
I had stopped taking 100mg of Seroquel. Do you think adding back a small dose, like 25mg, would give me a boost of serotonin and give me some energy?
Posted by baseball55 on December 15, 2016, at 17:59:18
In reply to Re: Wellbutrin Tired! No energy » SLS, posted by Sheilac on December 15, 2016, at 10:41:19
> I had stopped taking 100mg of Seroquel. Do you think adding back a small dose, like 25mg, would give me a boost of serotonin and give me some energy?
>
>Neither seroquel nor wellbutrin really affect serotonin levels. I agree with Scott. Wait. It's only been a few days. I had a paradoxical reaction to wellbutrin at first also - it made me very tired. But that went away after a week or so.
Posted by phidippus on July 16, 2017, at 19:08:44
In reply to Re: Wellbutrin Tired! No energy » SLS, posted by Sheilac on December 15, 2016, at 10:41:19
Dopamine acts as referee for the sleep/wake cycle. Too little dopamine and you can experience fatigue and too much can produce addictive behaviors and too much energy. I think you may need to increase dopamine, so I would actually increase your Wellbutrin, as it acts as dopamine reuptake inhibitor, increasing extracellular levels of dopamine.
Eric
Posted by Tony P on January 15, 2018, at 2:46:44
In reply to Wellbutrin Tired! No energy, posted by Sheilac on December 14, 2016, at 14:10:51
I am on Wellbutrin. My pdoc had to take long-term leave right after he prescribed it, and I have been without a psychiatrist for a year & a half; the clinic discharged me as part of triage due to insufficient staff. So I experimented quite a lot on my own, and recent updates to the Wikipedia article on bupropion make some sense of my experimental results with a statistical sample of one.
Knowing from past experience that I was very sensitive to Wellbutrin, and cautious about interactions with my SSRI, I started taking just a quarter tablet, 37.5 mg. I got a huge boost of energy almost immediately that lasted a couple of weeks. Then I lost the good feeling (dopamine) and got fatigued and depressed again. Increasing the dose to 75 & then 150 mg (XR) just didn't give me the same boost; I'm currently on a compromise of 75 mg/day, 1/2 XR tab. Yes, I know you're not supposed to cut them, but both my pdoc & pharmacist agreed it would be safe at that dosage & preferable to dosing every other day.
I'm tempted to go off it for 2 weeks & then back on to see if I can recover that initial boost. But right now I'm trying to stay on good terms with my new GP, who is young, conservative, and not kindly disposed to my experimenting! I do appreciate her position; how can she prescribe if she never knows what I'm going to do with it, or what I may take on the side.
Speaking of "on the side", I have been taking small doses of Ritalin (5-10 mg, and not every day), when I can get it from a friend, which *does* give me the energy and feeling of confidence & optimism I otherwise lack. But I really can't see my GP prescribing it for me, especially when we're trying to reduce the number of meds I take.
What I learned from Wikipedia, https://en.wikipedia.org/wiki/Buspirone#Pharmacology is that Wellbutrin/bupropion is not the "real" active compound. Instead it is metabolized into several other active stimulants, of which hydroxybupropion is the most important. Over a week to 10 days, the hydroxybupropion builds up in your system until there is 10 times as much of that as the original bupropion. So it takes over.
The hitch is that bupropion is an NDRI (norepinephrine-dopamine reuptake inhibitor) whereas hydroxybupropion is only an SNRI (selective norepinephrine reuptake inhibitor). What that means in practical terms is that you go from feel-good plus energized to mostly just energized, and I find the energy side poops out pretty quickly & I'm back to tired, restless and anhedonic.
I don't have any perfect answer; the small doses of Ritalin do help me, although I often become over-stimulated, compulsive, and even hypomanic, so I lose my focus and priorities. Many doctors are reluctant to prescribe it except for ADD & narcolepsy and it is potentially addictive. There are, however, a couple of safer alternatives I have used successfully.
Ropinirole (Requip, Adartrel, etc.) is a dopamine agonist mostly used for Parkinson's and Restless Leg. It does have a small but significant adjuvant (helper) effect combined with almost any other antidepressant (there's a reference in the archives somewhere here on Psychobabble to the original Short Communication in Can J Psych).
Modafinil (Alertec etc.) is called an "alertness enhancer" by the manufacturer to avoid the stigma of calling it a "stimulant". It works as well as Ritalin for me, although the underlying biochemistry is apparently different. In fact, it is better in some ways; I can keep focus better, it's much less addictive, and (a big plus) it doesn't interfere with sleep. In fact, the most important way it helped me was turning around my sleep pattern to "normal" from sleep all day, awake all night. But it is a safe and effective mood booster and energizer, and most doctors are familiar with it. It has a first cousin, Adrafanil, a "prodrug" or precursor for modafinil, which is unscheduled in many countries and may sometimes be bought from Europe. It works the same as modafinil but a bit slower & requires higher doses.
Buspirone (Buspar), was developed as an anxiolytic drug as an alternative to benzos. I would describe it more as a stress reducer. It was then discovered that it can significantly augment antidepressants, and it is now quite commonly prescribed for this. Unlike most anxiolytics, the pharmacology of buspirone is not related to that of benzodiazepines & other GABA receptor agonists, so it does not carry the risk of physical dependence or abuse. It is less impairing than benzos at therapeutic doses. I found it energizing and it improved my assertiveness and decision making. Unfortunately, it seemed to have no effect combined with Cymbalta, so I dropped it when I was on that AD. Now, for the reasons above, it's hard for me to get back on it. I do highly recommend trying it; it is very safe and low in side-effects. Some people find it totally ineffective, while others like me get a big benefit from it. YMMV; you won't know until you try it for several weeks whether it's for you.
This has been a long post, but I needed to get it off my chest as I've been ruminating too much about my similar problems, and needed to share my ideas and my frustration with not having a pdoc, having a very busy & go-slow GP, and not being able to be my own doctor ;-) except occasionally when friends help out. I hope I didn't get too technical; I know we have some very knowledgeable long-time posters here who will appreciate the details, and I wanted to get some that background into my post. Of course, I hope as well my experiences may be useful to you, Sheilac, and others.
Posted by Tony P on January 15, 2018, at 3:32:50
In reply to Wellbutrin Tired! No energy, posted by Sheilac on December 14, 2016, at 14:10:51
One more antidepressant augmenter I forgot to mention: Kava-kava. I've used it a lot recently in high doses. It should be available in Health Supplement stores and many pharmacies (Webber brand is common here in BC). The scare some years ago over liver damage turned out to be due to contamination or deliberate adulteration; it's gradually coming back into favour and availability. As it's an herbal remedy, this really belongs on the P-B Alternative board, but I hate to break the thread. I'll keep it to the bare minimum.
Kava is now known to have 18 active ingredients with quite different properties, so it's an anxiolytic (like benzos), a DNRI anti-depressant & an MAOI-B anti-depressant (safe with all foods afaik) all rolled into one. In my experience, large doses produce initially mood improvement and activation similar to Ritalin, gradually shifting to more relaxation.
I'm a big fan - it's safe, effective, doesn't cause physical dependency, but it requires some experience to get the full benefit. I believe I've posted about it before on the Alternative board - go there for more info.
Posted by SLS on January 15, 2018, at 9:36:59
In reply to Re: Wellbutrin Tired! No energy » Sheilac, posted by Tony P on January 15, 2018, at 3:32:50
Abilify?
It is a sort of dopamine system stabilizer. At low dosages (up to 5 mg/day), it helps with unipolar depression when used as an augmenter of standard antidepressants. It helps my bipolar depression at 15 mg/day when combined with the other drugs I'm taking. The improvement has remained consistent over the course years. Of possible importance, Abilify is a potent 5-HT1a partial agonist - as is buspirone.
By the way, MAO-A inhibition is more important when treating depression than is MAO-B inhibition. Selegiline works only when a dosage is reached that inhibits MAO-A. This is stated clearly in the manufacture's label monograph.
I hope you find what you are looking for. I haven't. For me, Parnate seems to be a dead-end. It helps in that I receive a partial increase in mental energy and concentration. It doesn't help much for anhedonia and mental clarity. However, I am grateful for being able to read more than two or three sentences at a time and have the words make sense.
Because my psychiatric treatment regime was interrupted for the time I was in the hospital, it makes sense for me to give Parnate more time. Just prior to my hospitalization, I reduced my dosage of prazosin from 30 mg/day to 15 mg/day. I began to feel better for having done this. Again, though, I remain in an anhedonic brain-fog with little interest or motivation in doing anything.
Depression is an altered state.
- Scott
Posted by Tony P on January 15, 2018, at 22:51:41
In reply to Re: Wellbutrin Tired! No energy » Tony P, posted by SLS on January 15, 2018, at 9:36:59
Thanks for the update on MAOI's. I sort of knew that, but your information is more precise. I was on a low dose of selegeline at one point, found it only moderately helpful at that dose.
No information yet (at least in Wikipedia) on whether Kava can cause MAO-food-phenethylamine drug problems. I've never noticed a headache or a significant BP rise with it, and I take high doses & do use decongestants & eat the proscribed foods regularly. It's a good heads-up. The South Sea Islanders have used it safely for centuries, but then I imagine they don't traditionally eat much aged cheese or sausage!
I like your last statement. Major Depression used to be classed as a psychosis. I'm certainly more or less out-of-touch with reality in a depressive episode.
It can apply to addiction too; doctors would describe me as having concurrent or comorbid disorders, and claim depression & addiction can be diagnosed separately, but I have trouble distinguishing them from "inside". A fellow alcoholic & I, both in recovery, were chatting once, and he said "It's funny: when the craving hits, it's like an altered state of consciousness". Yes. I'm tempted to borrow that line for my signature.
This is the end of the thread.
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