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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 18 of 18. This is the beginning of the thread.
Posted by JESSsMom on February 4, 2006, at 9:35:49
Hey All,
I've been away from the board for a while. For those who remember me, my anxiety has eased up but my depression has been profound. Worst episode ever (started last July).
On top of the terrible depression, I have developed almost daily constant dull headaches which have turned into violent migraines roughly 15 times over the last few months.
An MRI came back unremarkable and I now see a neurologist in addition to my pdoc. The neurologist put me on Lyrica daily as a preventative measure b/c the Imitrex (and others) I was taking after the onset of the migraines did not work AT ALL. The Lyrica seems to decrease the incidence of headaches somewhat.
Anyway, here's my question because the depression has GOT to be dealt with: all other AD's I've tried have either been ineffective or had intolerable side effects: SSRI's, TCA's, and SNRI's.
Wellbutrin, on the other hand, lifts my mood the very day I take it. I feel optomistic and energetic for a change. It's SUCH a good feeling after months of barely functioning. I find myself making plans for the future instead of laying in bed wondering when God will take me. Not to mention it curbs my smoking and outrageous appetite.
I believe these benefits derive from Wellbutrin's dopamine and norepinephrine reuptake blocking.
PROBLEM:
Wellbutrin's only (yet totally intolerable) side effect for me is HEADACHES! I don't know what to do after mustering up the strength (those who are/have been deeply depressed know how difficult that is to do) to go back to my pdoc for help yet again, and to start seeing the neurologist for the headaches.
What to do? Does anyone know of a drug similar to Wellbutrin: dopamine and norepinephrine reuptake blocking, energizing, optomism producing, etc.?
I can't find anything else after googling and don't have another pdoc appointment for two weeks.
There's often really good information and advice on this board so I thought I'd give it a shot.
Thanks for reading,
JESSsMom
Posted by Racer on February 4, 2006, at 12:27:21
In reply to AD similar to Wellbutrin?, posted by JESSsMom on February 4, 2006, at 9:35:49
The only thing I can offer is a link to SLS's great drug chart. It shows a lot about the various drugs, and I've found it helpful in my own searches.
Good luck to you.
http://sl.schofield3.home.att.net/medicine/psychiatric_drugs_chart.html
Posted by JESSsMom on February 4, 2006, at 12:30:49
In reply to AD similar to Wellbutrin?, posted by JESSsMom on February 4, 2006, at 9:35:49
Headache is just klling me over here....really painful....been searching and searching on Internet for relief.
Am now wondering if, since Wellbutrin is in a class of AD's all by itself anf there might NOT be an alternative to it, could there be a remedy to Wellbutrin headaches/migraines?
Again, any advice/ideas/opinions are appreciated.
JESSsMom
Posted by JESSsMom on February 4, 2006, at 12:36:37
In reply to Re: AD similar to Wellbutrin?, posted by JESSsMom on February 4, 2006, at 12:30:49
Thanks for such a comprehensive list, Racer.
God, I hope there's something out there with the benefits of WB minus these headaches.
JESSsMom
Posted by blueberry on February 4, 2006, at 16:38:50
In reply to AD similar to Wellbutrin?, posted by JESSsMom on February 4, 2006, at 9:35:49
The weight loss med tenuate is similar to wellbutrin. Other than that, phentermine or ritalin or adderall. I mean, they are all quite different than wellbutrin, but they act on the same brain chemicals. Tenuate would be the closest. There is no way to predict whether that translates into anything useful or not.
That's a real set back when you find a med you like but it has a bad side effect like migraines. I don't get migraines, but the side effect I get from SOOO many things is loud ringing in the ears. So at least know you aren't the only one hindered by secondary problems to an otherwise good medication.
Posted by Phillipa on February 4, 2006, at 20:46:37
In reply to Re: AD similar to Wellbutrin?, posted by blueberry on February 4, 2006, at 16:38:50
Blueberry you always come up with the greatest ideas. Fondly, Phillipa ps are you in the medical field just curious
Posted by Racer on February 4, 2006, at 21:29:41
In reply to Re: AD similar to Wellbutrin?, posted by JESSsMom on February 4, 2006, at 12:30:49
I am afraid I think you're right about there not really being another drug similar to WB, which doesn't cause migraines for you. My now-ex-pdoc said that the headaches were from the increased norepinephrine in the brain, and I have no reason to doubt him. I'd suspect that most any drug that increases NE action, whether by inhibiting reuptake or by stimulating production, will increase headaches.
I'm luck with WB, because though I do get more headaches on it, I'm actually getting FEWER migraines. These are now just headaches -- none of the photosensitivity, the seasick feeling, the nausea. But, it's also a drag having even regular headaches...
Have you tried something like a bit more caffeine when you feel one coming on? Sometimes that has helped me in the past. Imitrex doesn't help, huh? Excedrine? (Seriously -- sounds silly to suggest an OTC when Imitrex doesn't do it, but it really does work better for some people. Ditto Advil, at 800mg. For some people, one of those two drugs can be more effective than the prescription med.)
Good luck, whatever happens.
Posted by yxibow on February 6, 2006, at 2:03:46
In reply to Re: AD similar to Wellbutrin?, posted by blueberry on February 4, 2006, at 16:38:50
> The weight loss med tenuate is similar to wellbutrin. Other than that, phentermine or ritalin or adderall. I mean, they are all quite different than wellbutrin, but they act on the same brain chemicals. Tenuate would be the closest. There is no way to predict whether that translates into anything useful or not.
>
> That's a real set back when you find a med you like but it has a bad side effect like migraines. I don't get migraines, but the side effect I get from SOOO many things is loud ringing in the ears. So at least know you aren't the only one hindered by secondary problems to an otherwise good medication.I was going to say Tenuate too.. but its harsher than Wellbutrin and not prescribed much any more; its off label. Its a weight loss drug distantly similar to amphetamines.
You won't have the dopamine effect, but Cymbalta is worth a trial.
As for the migraines, extra strength ibuprofen with coffee or Excedrin migraine (pretty much the same thing) helped me with blips with my current Trileptal experiment.
Posted by JESSsMom on February 6, 2006, at 8:23:59
In reply to Re: AD similar to Wellbutrin?, posted by blueberry on February 4, 2006, at 16:38:50
> The weight loss med tenuate is similar to wellbutrin. Other than that, phentermine or ritalin or adderall. I mean, they are all quite different than wellbutrin, but they act on the same brain chemicals. Tenuate would be the closest. There is no way to predict whether that translates into anything useful or not.
>
> That's a real set back when you find a med you like but it has a bad side effect like migraines. I don't get migraines, but the side effect I get from SOOO many things is loud ringing in the ears. So at least know you aren't the only one hindered by secondary problems to an otherwise good medication.Isn't it though? Unbelievably frustrating. I've never had ear ringing but I remember when I was on Effexor, for instance, sweat just poured off of me. Then the discontinuation was more than I ever want to go through again.
I think Cymbalta and Effexor are similar in that they are both SNRI's, so no thanks to Cymbalta either.
Thanks for the tenuate idea but after reading up on it, I highly doubt my pdoc would prescribe it.
I have tried SO many AD's that either block serotonin or serotonin and norepinephrine reuptake without success. The fact that Wellbutrin makes a positive difference leads me to believe that my depression is alleviated by WB's effect on dopamine.
Because of my years of anxiety I could never tolerate WB before. My primary diagnosis now is depression, which I believe is why WB's not making me agitated or irritable.
Damn, the perfect med for my symptoms.
The WB I was prescribed is neither SR nor XR. I read somehwhere that extending the release of a med can help alleviate side effects. Anyone know if this is true?JESSsMom
Posted by JESSsMom on February 6, 2006, at 8:41:07
In reply to Re: AD similar to Wellbutrin? » JESSsMom, posted by Racer on February 4, 2006, at 21:29:41
> I am afraid I think you're right about there not really being another drug similar to WB, which doesn't cause migraines for you. My now-ex-pdoc said that the headaches were from the increased norepinephrine in the brain, and I have no reason to doubt him. I'd suspect that most any drug that increases NE action, whether by inhibiting reuptake or by stimulating production, will increase headaches.
>
> I'm luck with WB, because though I do get more headaches on it, I'm actually getting FEWER migraines. These are now just headaches -- none of the photosensitivity, the seasick feeling, the nausea. But, it's also a drag having even regular headaches...
>
> Have you tried something like a bit more caffeine when you feel one coming on? Sometimes that has helped me in the past. Imitrex doesn't help, huh? Excedrine? (Seriously -- sounds silly to suggest an OTC when Imitrex doesn't do it, but it really does work better for some people. Ditto Advil, at 800mg. For some people, one of those two drugs can be more effective than the prescription med.)
>
> Good luck, whatever happens.Thanks. You have me wondering about the NE link to headaches now. Gonna look into that. Never got headaches with Effexor though, just excessive sweating.
As for the head pain, I *think* that sometimes the reason Imitrex didn't work for me was b/c I didn't take it "at the onset" of a headache. I didn't know if it was just going to hurt all day or turn into a whopper migraine and at $20/pill--yes, $200 for a prescription of ten pills--I kind of waited the headache out and tried advil, caffeine, excedrine, etc. first.
But there were also times where I was so scared of my headache when I first woke up in the morning I would take an Imitrex and it still didn't work.
My neurologist gave me a prescription for duradrin which *eventually" takes the migraine away about 50% of the time.
I didn't take any WB over the weekend and was headache free yesterday (Sunday). Today I split my 100mg tablet in half and took 50mg. Tiny dose but I want to see what happens.
I posted above about possibly switching to the XR or SR versions. I just don't know.
JESSsMom
Posted by Racer on February 6, 2006, at 11:45:14
In reply to Re: AD similar to Wellbutrin?, posted by JESSsMom on February 6, 2006, at 8:23:59
> >
> Isn't it though? Unbelievably frustrating. I've never had ear ringing but I remember when I was on Effexor, for instance, sweat just poured off of me. Then the discontinuation was more than I ever want to go through again.
> I think Cymbalta and Effexor are similar in that they are both SNRI's, so no thanks to Cymbalta either.
Actually, you might want to rethink that, if you had any benefits from Effexor, because Cymbalta is in the same class of drugs -- and is a very different drug. I've taken both, and I promise they're not the same.I took Effexor a number of years ago, and it is the ONLY antidepressant I will never take again. It helped, but not enough; it stopped working after about a year; it helped me gain about 55 pounds; and then it took me almost 8 months to taper off it, with nasty discontinuation effects even then. NEVER again.
Cymbalta is worth a try. It didn't help me even as much as Effexor did -- though I'm pretty well treatment resistant these days, on a lot of levels -- but it also didn't come with the same sorts of problems. A little sweating at first, I think it caused some weight gain -- though I'm pretty sure Wellbutrin is causing weight gain for me now, so I might just be nuts where weight gain is concerned -- and when I went off it, I had no trouble, after a year and a half.
As for the XL/SR versions, if the drug is helping you, they're certainly worth a try.
Good luck.
Posted by yxibow on February 6, 2006, at 12:22:30
In reply to Re: AD similar to Wellbutrin?, posted by JESSsMom on February 6, 2006, at 8:23:59
> The WB I was prescribed is neither SR nor XR. I read somehwhere that extending the release of a med can help alleviate side effects. Anyone know if this is true?
>
> JESSsMomYes. Its rather odd for someone not to be prescribing Wellbutrin SR these days. You're getting a pure shot of a very distant cousin of amphetamine all at once. Plus, SR carries a lower risk of seizures than the original, though its always worth taking a pinch of Klonopin or Valium with Wellbutrin. SR/XR might be of better value, and you may discover that there are less side effects. These effects may diminish over time as well.
Posted by elkat on February 9, 2006, at 0:18:34
In reply to Re: AD similar to Wellbutrin?, posted by JESSsMom on February 6, 2006, at 8:41:07
I take the XR version 300 mg. It is very smooth, very few side effects. I get headaches now and then. You should give the XR a try. It is not generic, so it's more expensive. Try to get some samples.
Posted by JESSsMom on February 10, 2006, at 8:16:05
In reply to Re: AD similar to Wellbutrin?, posted by elkat on February 9, 2006, at 0:18:34
Thanks to all for the advice/ideas. Can't take these headaches.........sigh......... and have also noticed insomnia and a bit of irritability.
I've been asked before, "What's worse? Your depression or the side effects of a med that helps?"
Well, insomnia, as we all know, makes for lonely, anxious nights and then there's the difficulty getting up in the morning and getting through the day dead tired.
The slight irritability would be easy to deal with except I found myself being snappy with my little girl the other night--unacceptable. She's the one who actually pointed it out by asking why I was being mean? That day was my last dose of WB.
Gonna continue (as I've done for years with some short "oh, I give up on meds" periods) to find the right med/combo for me.
JESSsMom
Posted by elkat on February 10, 2006, at 10:59:38
In reply to Re: AD similar to Wellbutrin?, posted by JESSsMom on February 10, 2006, at 8:16:05
I agree insomnia is the worst and nothing is really worth that...my doctor put me on remeron for a sleeper. Too much drugs...kind of the Valley of the Dolls deal. I dropped the remeron and I sleep OK.
Posted by TJO on February 14, 2006, at 6:14:39
In reply to Re: AD similar to Wellbutrin?, posted by JESSsMom on February 10, 2006, at 8:16:05
Hi,
I take Wellbutrin and have a "wicked" coffee and decaf habit. I take 300 mg of the XL version in the am and it helps a great deal. (With my illness, not the coffee habit)
So my ideas are:
1) take the XL version once a day.
2) take it in the am since it can have a stimulating affect.
3) make sure the nasty headaches aren't caffeine withdrawal headaches.
4) try "Zyban"-it is the anti-smoking form of Wellbutrin (what is prescribed for folks without a depression dx that want to quit smoking). I couldn't tolerate Zyban but love Wellbutrin - which just proves how little we know about the body.
5) try lots of caffeine when you feel a hedache coming on. Also lots of loud rock helps me get rid of a "pulsing" headache.
Tam
Posted by JESSsMom on March 2, 2006, at 11:23:38
In reply to Re: AD similar to Wellbutrin?, posted by TJO on February 14, 2006, at 6:14:39
Hey all,
I chose to discontinue the WB altogether since I had a many months long headache problem in addition to the many months long depression problem.
I gathered up the nerve to try Topomax for my headaches. I had been thinking about it for some time, and when the Lyrica failed to make so much as a dent, I thought about the Topomax even more. I was scared of crazymed's "dumber than a box of rocks" remark, though, I admit it.
The last thing I needed was to have head pain, be so depressed, and then cognitively dull on top of it all.
So I started out at a mere 25mg Topamax at bedtime. Was looking forward to headache relief, some bedtime sleepiness, and a little weight loss would have been nice, too.
Nothing happened.
We doubled my dose to a still small dose of 50 mg and the results are in:Headaches are not entirely gone but are less frequent and have't turned into a migraine once since (might raise my dose a little more, don't see why anyone should have to live with headaches at all, even if they are less frequent),
50mg Topomax plus my 2mg Klonopin knocks me OUT for the entire night and I wake up feeling refreshed, goodbye insomnia (at least for now),
I haven't noticed any word finding problems or other cognitive problems at all (and pdoc says I would have by now if I were going to),
Unfortunately, no change whatsoever in appetite/taste of food---extra weight isn't going anywhere via Topomax
My mood has changed for the better-------? not sure why? depression has lifted considerably--because of Topomax (which we all know is NOT an AD)? or because my head feels better?
The obvious would be that my head pain has improved but I *know* there's something else going on here.........can't put my finger on it. I just feel a lot better. Like most of my depression is gone. Not sure why but I'll take it.
Anyone have an idea why such a small dose of a mood stabilizer would make a non bipolar's depression lift?
JESSsMom
P.S.
Side note: Lyrica *does* help with nerve pain in the back and legs.
Posted by JESSsMom on March 6, 2006, at 10:33:18
In reply to Re: AD similar to Wellbutrin? Headaches/Topomax, posted by JESSsMom on March 2, 2006, at 11:23:38
> Hey all,
>
> I chose to discontinue the WB altogether since I had a many months long headache problem in addition to the many months long depression problem.
> I gathered up the nerve to try Topomax for my headaches. I had been thinking about it for some time, and when the Lyrica failed to make so much as a dent, I thought about the Topomax even more. I was scared of crazymed's "dumber than a box of rocks" remark, though, I admit it.
> The last thing I needed was to have head pain, be so depressed, and then cognitively dull on top of it all.
> So I started out at a mere 25mg Topamax at bedtime. Was looking forward to headache relief, some bedtime sleepiness, and a little weight loss would have been nice, too.
> Nothing happened.
>
> We doubled my dose to a still small dose of 50 mg and the results are in:
>
> Headaches are not entirely gone but are less frequent and have't turned into a migraine once since (might raise my dose a little more, don't see why anyone should have to live with headaches at all, even if they are less frequent),
>
> 50mg Topomax plus my 2mg Klonopin knocks me OUT for the entire night and I wake up feeling refreshed, goodbye insomnia (at least for now),
>
> I haven't noticed any word finding problems or other cognitive problems at all (and pdoc says I would have by now if I were going to),
>
> Unfortunately, no change whatsoever in appetite/taste of food---extra weight isn't going anywhere via Topomax
>
> My mood has changed for the better-------? not sure why? depression has lifted considerably--because of Topomax (which we all know is NOT an AD)? or because my head feels better?
>
> The obvious would be that my head pain has improved but I *know* there's something else going on here.........can't put my finger on it. I just feel a lot better. Like most of my depression is gone. Not sure why but I'll take it.
>
> Anyone have an idea why such a small dose of a mood stabilizer would make a non bipolar's depression lift?
>
> JESSsMom
> P.S.
> Side note: Lyrica *does* help with nerve pain in the back and legs.
I can hardly believe this (shouldn't be surprised, I guess) but I wrote the above last Thursday and am now on day three of a headache that started Saturday.So far the worst was Saturday when nausea was present. Anyone with headaches knows how tiresome and painful this is.......... <sigh>.
Don't have a psych or neuro appointment til tomorrow (Tues.) so I took it upon myself to double my Topamax to 100mg over at bedtime this past weekend to see if it would make a difference. It didn't. Have a headache as I type.
Also still not getting any side effects at 100mg though, and mood is still OK. Not sure what to ask docs for tomorrow?
Any ideas are appreciated. Really cannot bear these headaches anymore.
Thanks,
JESSsMom
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