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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by Racer on August 25, 2004, at 13:15:50
This is pretty much just an academic question, but it's been on my mind, so I'm asking the people who might know from the inside:
Three doctors, three views on Wellbutrin's seizure risk.
Dr One: involuntarily hospitalized after S/A, said Wellbutrin was safe for someone with a history of eating disorders -- as long as the ED wasn't active. She prescribed it at a starting dose, which wasn't up to the therapeutic dose range but seemed to be starting to help when...
Dr Two: (Dr EyeCandy for anyone who's keeping score) *immediately* stopped it, said he had had too many patients experience seizures from it to risk it -- although, he wasn't concerned with any ED history, this was based solely on a skull fracture at the age of five -- and had very, very round eyes at the very thought of the danger. He did say, though, that the dosage was a factor: that his patients at doses over 400mg were 'something like ten times more likely' to experience seizures, but I've got a history of needing very high dosages to respond to any drug other than anti-biotics.
Dr Three: (initial eval yesterday, no *name* yet) said Dr EyeCandy was being *incredibly* overcautious: that Wellbutrin can be perfectly safe, at almost any dosage, for most people with a history of head trauma, and that the ED connection really is only related to purging behavior. He offered me three choices of meds to pick from, one of them was Wellbutrin. He told me the reasons he really didn't think it was the best choice for me, all of which sounded very reasonable and very valid to me, but said he would feel perfectly safe prescribing it to me, despite the history of (multiple) head traumas and the history of (and current) ED.
Yeah, yeah, I'm being much too suspicious of all the doctors say these days -- but I come by it honestly.
This question really ain't keeping me up nights, we did choose the new doc's first choice for me, but it did make me very curious to know what people here had experienced on this topic?
(Warning: I very nearly caught myself typing something like, "Are you now, or have you ever been..." Save us all from any attempt on my part to be funny today -- if you know something that might apply, all input very gratefully anticipated...)
Posted by partlycloudy on August 25, 2004, at 14:52:36
In reply to Opposing pdoc views re: wellbutrin and seizures, posted by Racer on August 25, 2004, at 13:15:50
I'm on 300mg of Wellbutrin XL. My p-doc is aware of a head trauma I had at age 9 but had no reservations at all putting me on it. I would think it would be a different story if you had a history of seizures.
I also quite happily take the dreaded effexor XR, 150mg.
Posted by Ilene on August 25, 2004, at 19:37:49
In reply to Opposing pdoc views re: wellbutrin and seizures, posted by Racer on August 25, 2004, at 13:15:50
Here's the quasi-official word on Wellbutrin and seizures:
http://www.rxlist.com/cgi/generic/buprop_wcp.htm
I wouldn't worry about it as long as your dose is below 450 mg. (400 for the SR version), you have never experienced a seizure, and you aren't taking anything else that lowers the seizure threshold. Since benzos and some drugs used to treat bipolar disorder are anticonvulsants, there's a good chance you're taking something else that raises the seizure threshold.
My old pdoc fretted about SEs too.
Supposedly, it can counteract the anorgasmia that SSRIs cause.
Posted by gromit on August 28, 2004, at 2:56:12
In reply to Re: Opposing pdoc views re: wellbutrin and seizures » Racer, posted by partlycloudy on August 25, 2004, at 14:52:36
> I'm on 300mg of Wellbutrin XL. My p-doc is aware of a head trauma I had at age 9 but had no reservations at all putting me on it. I would think it would be a different story if you had a history of seizures.
I have a history of seizures and multiple head traumas, and my old pdoc put me on 300 Wellbutrin (SR?). He didn't seem too concerned and I didn't have any problems as long as I avoided caffeine. Well one problem, bigtime hair loss, but no seizures.
Posted by SLS on August 28, 2004, at 7:21:54
In reply to Re: Opposing pdoc views re: wellbutrin and seizure, posted by gromit on August 28, 2004, at 2:56:12
Dr. No-Name seems to be enlightened. The major concern with seizure and Wellbutrin began during a pre-approval investigational clinical trial involving bulimics. The increased risk of seizure might have been linked to abnormal electolytes produced by chronic purging. If your ED doesn't result in abnormal electrolytes, I don't think you have anything to worry about. Note, however, that this can be an issue with anorexia.
- Scott
Posted by Racer on August 28, 2004, at 11:42:09
In reply to Re: Opposing pdoc views re: wellbutrin and seizure, posted by SLS on August 28, 2004, at 7:21:54
Thanks everyone. Ilene's link to the rxlist info made it pretty clear that Dr EyeCandy's information was absolutely correct: there is a fourfold increase in seizure risk at doses over 400mg. I don't want to go back and check, but it's either .04% rather than .01% or .4% rather than .1%. Now, those are very worrisome numbers, aren't they? It's not worth it to me to research this, but I'd bet that more than 1% of the population within those studies had experienced head trauma, wouldn't you? (I'd guess that, in any population, at least 25% have experienced some degree of head trauma. Unless, of your, their parents packed their heads in styrofoam from birth to age 10.)
Well, Dr NoName had some other pretty good reasons to try Cymbalta rather than Wellbutrin, so it's OK -- but honestly, sure wish I'd known this stuff sooner. No wonder I rarely take what a doctor says at face value!
And thanks for the info, Scott, on the electrolyte thing. I know I've had some imbalances in the past -- working in outside in the summer heat all day, chugging plain water until someone lent me a clue and I tried adding Gatorade: all that amorphous weirdness went away the first day. Too bad I didn't think of asking to have the labs done to check on that. The Wellbutrin did seem to be working...
Posted by owensmar on August 28, 2004, at 17:00:50
In reply to Opposing pdoc views re: wellbutrin and seizures, posted by Racer on August 25, 2004, at 13:15:50
> This is pretty much just an academic question, but it's been on my mind, so I'm asking the people who might know from the inside:
>
> Three doctors, three views on Wellbutrin's seizure risk.
>
> Dr One: involuntarily hospitalized after S/A, said Wellbutrin was safe for someone with a history of eating disorders -- as long as the ED wasn't active. She prescribed it at a starting dose, which wasn't up to the therapeutic dose range but seemed to be starting to help when...
>
> Dr Two: (Dr EyeCandy for anyone who's keeping score) *immediately* stopped it, said he had had too many patients experience seizures from it to risk it -- although, he wasn't concerned with any ED history, this was based solely on a skull fracture at the age of five -- and had very, very round eyes at the very thought of the danger. He did say, though, that the dosage was a factor: that his patients at doses over 400mg were 'something like ten times more likely' to experience seizures, but I've got a history of needing very high dosages to respond to any drug other than anti-biotics.
>
> Dr Three: (initial eval yesterday, no *name* yet) said Dr EyeCandy was being *incredibly* overcautious: that Wellbutrin can be perfectly safe, at almost any dosage, for most people with a history of head trauma, and that the ED connection really is only related to purging behavior. He offered me three choices of meds to pick from, one of them was Wellbutrin. He told me the reasons he really didn't think it was the best choice for me, all of which sounded very reasonable and very valid to me, but said he would feel perfectly safe prescribing it to me, despite the history of (multiple) head traumas and the history of (and current) ED.
>
> Yeah, yeah, I'm being much too suspicious of all the doctors say these days -- but I come by it honestly.
>
> This question really ain't keeping me up nights, we did choose the new doc's first choice for me, but it did make me very curious to know what people here had experienced on this topic?
>
> (Warning: I very nearly caught myself typing something like, "Are you now, or have you ever been..." Save us all from any attempt on my part to be funny today -- if you know something that might apply, all input very gratefully anticipated...)
Hi Racer,I've been bulimic for 30 years (since age 17) in remission now. Daily multiple binging/purging behaviour during most of that time.
I've had two different doctors prescribe Wellbutrin for me, saying they weren't worried aobut a seizure risk. One of them I'd consider knowledgable and trustworthy, the other no.
Anyway, I tried it. Took the standard dose of WEllbutrin for about a month and half. No seizures (eating disorder active during this period). Stopped the WB because of side effects.
I think I probably have a high seizure threshold, though, since I quit a benzo cold turkey after 9 years of daily high dosages and didn't have any seizure problems.
Marsha
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