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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by oceancat on August 15, 2008, at 2:36:32
Hi everyone,
I recently took Wellbutrin SR 200mg/day for 5 weeks along with my usual Zoloft with amazing results for my depression, but as with other noradrenergic/dopaminergic meds I've tried, it pooped out despite a raise in dose and eventually left me feeling really lousy and depressed and extremely exhaused, oddly. I was wondering, has anyone with stimulating med poop-out ever tried taking tiny, subtherapeutic doses and seeing what happens? I'm considering trying Wellbutrin SR again at 25mg 2x/day, but would like to know if there's anyone who's actually tried this or who know why it might theoretically be helpful. And any remedies for poop-out are most welcome too!Thanks so much,
oceancat
Posted by SLS on August 15, 2008, at 5:03:31
In reply to Wellbutrin/stimulant poop-out--pls help w/ idea, posted by oceancat on August 15, 2008, at 2:36:32
> Hi everyone,
> I recently took Wellbutrin SR 200mg/day for 5 weeks along with my usual Zoloft with amazing results for my depression, but as with other noradrenergic/dopaminergic meds I've tried, it pooped out despite a raise in dose and eventually left me feeling really lousy and depressed and extremely exhaused, oddly. I was wondering, has anyone with stimulating med poop-out ever tried taking tiny, subtherapeutic doses and seeing what happens? I'm considering trying Wellbutrin SR again at 25mg 2x/day, but would like to know if there's anyone who's actually tried this or who know why it might theoretically be helpful. And any remedies for poop-out are most welcome too!
>
> Thanks so much,I'm sorry that the "Welloft" treatment didn't produce a long-term remission.
My doctor and his colleagues have found Wellbutrin + Lamictal to be a particularly good combination. However, he never mentioned using such a subtherapeutic dosage of Wellbutrin in this context.
My current treatment:
Nardil 90mg
nortriptyline 150mg
Lamictal 200mg
Abilify 20mg
Deplin 7.5mg
N-Acetylcysteine
Lovaza 4gm (Fish Oil)
- Scott
Posted by bleauberry on August 15, 2008, at 19:05:41
In reply to Wellbutrin/stimulant poop-out--pls help w/ idea, posted by oceancat on August 15, 2008, at 2:36:32
Pure hypothesis on my part, but when stimulating noradrenergic meds poopout and leave you feeling worse and tired, it is my guess that what happens is the feedback loops sense too much NE and slow down or stop firing in an effort to maintain genetically programmed homeostasis. This has been a possible theory as to the lag time for an antidepressant to work...as the neuros are increased, firing comes to a slowdown, but after a few weeks they adjust and firing resumes. But with some people, maybe the firing never does resume? And then they just feel yuck?
If that hypothesis were correct, then a med that will stimulate firing, such as remeron, possibly risperdal, might work to restore things.
And yes, some people do best on very low doses that are supposedly subtherapeutic. I've seen reports of people where their magic doses were things like...25mg lamictal; 15mg cymbalta; 5mg prozac; 3mg lexapro; 150mg st johns wort; and like that. Everyone's bodies are different. Everyone metabolizes drugs differently. Malfunctions of each of us are different. When drug companies set dose levels, it is mainly for convenience of doctors to prescribe and for economics. Those doses are usually justified with clinical trial evidence, but that is not always reliable. But that's another story.
A recent article in Consumer Reports said patients should take the smallest dose that works, which is apparently often lower than what their doctor prescribed. Lower doses can work just as good but can take longer to do so.
Some clinical trials show that there is no benefit from higher doses. For example, 120mg cymbalta was no better than 60mg; 100mg zoloft was no better than 50mg; and such.
Anyway, back to your situation. Been there done that. Sorry. It does feel really bad, I know. The only way I've been able to get out of it is to lower doses of the meds I suspect.
Also keep in mind that a not-too-uncommon side effect of Wellbutrin is...depression. Check the side effects for Zyban (the name wellbutrin gets when used to quit smoking). Depression is a possible side effect. The depression can kick in anywhere from a few days to a few weeks.
Not sure what you should do. In your shoes I would be reducing doses, which aint easy either. I just don't see how I could stay where I was if I felt like you do now. Something would have to change.
Posted by MattSanz on August 15, 2008, at 22:19:36
In reply to Re: Wellbutrin/stimulant poop-out--pls help w/ idea, posted by bleauberry on August 15, 2008, at 19:05:41
Bleauberry, how can a side effect of Wellbutrin be depression when Wellbutrin is used to combat depression? I am not saying you are wrong, I was just wondering how that is possible. Do you think depression is a possible side effect for SSRI's as well?
Posted by Phillipa on August 16, 2008, at 0:23:54
In reply to Re: Wellbutrin/stimulant poop-out--pls help w/ ide, posted by MattSanz on August 15, 2008, at 22:19:36
I'd like to know the answer to that myself. Phillipa would explain a lot
Posted by raisinb on August 16, 2008, at 10:20:08
In reply to Wellbutrin/stimulant poop-out--pls help w/ idea, posted by oceancat on August 15, 2008, at 2:36:32
Hi oceancat--
Are you sleeping? When I began Wellbutrin, it caused such severe insomnia that after a couple of weeks, I began feeling exhausted and extremely fragile emotionally. I'd cry all day sometimes. I never figured out if that was because the WB wasn't helping my depression or if the instability was from only sleeping 3 hours per night. My dr. said it didn't matter--that it wasn't working, so we needed to adjust things.
Posted by raisinb on August 16, 2008, at 10:23:44
In reply to Re: Wellbutrin/stimulant poop-out--pls help w/ ide, posted by MattSanz on August 15, 2008, at 22:19:36
From what I've read, any antidepressant *can* cause increase in depression/suicidal ideation. Many people say that this is why the "chemical imbalance causes depression; raise the chemicals and fix the depression" theory is crap (or at least way too simplistic.) Depression may have a different cause altogether--or, more likely, multiple different causes for each person.
It might be that more dopamine just didn't help oceancat. Maybe stimulation of something else is what's needed. At the very least, IMHO, all these neurotransmitters work in a delicate balance and too much of a good thing is as bad as not enough. After all, vitamins and minerals work that way.
Posted by superman on August 21, 2008, at 12:56:30
In reply to Re: Wellbutrin/stimulant poop-out--pls help w/ ide » MattSanz, posted by raisinb on August 16, 2008, at 10:23:44
Hi,
I agree 100% with what raisinb said... the brain/mind is an amazingly complex system, and there is much more to the story than level of this or that neurotransmitter.Indeed, depression or worse anxiety, or even increased chanced of suicide are pos sible side effects for most psycho-active meds, even if they are *meant* to fight depression or anxiety or whatever. Everyone reacts differently. The truth is we don't really have a good understanding of how most of these meds really do work (when they do) or what's going on in the brain. The best we ever have is somewhat educated guesses.
I believe just because you get a good response initially does not mean it's a good bet for help long-term. In fact, if looking for long-term relief, this may not be desirable. bleauberry mentioned feedback-loops, and that is important to keep in ind. This is why we don't all just do crack cocaine to fight depression, because feedback-loops are at work, and tolerance will set in - so obviously crack is a horrible choice for long term relief, despite that you'll likely feel great the first while while on it.
Anyhow, sorry to ramble. My advice, if it means anything, would be to try something else. Wellbutrin doesn't seem to suit you - I wouldn't be thrown off by the fact you felt good on it for the first short while. Further, I don't see any good reason why this "sub-therapeutic dose" idea would be any better if it made things worse at the higher dose.
Good luck and all the best.
-T> From what I've read, any antidepressant *can* cause increase in depression/suicidal ideation. Many people say that this is why the "chemical imbalance causes depression; raise the chemicals and fix the depression" theory is crap (or at least way too simplistic.) Depression may have a different cause altogether--or, more likely, multiple different causes for each person.
>
> It might be that more dopamine just didn't help oceancat. Maybe stimulation of something else is what's needed. At the very least, IMHO, all these neurotransmitters work in a delicate balance and too much of a good thing is as bad as not enough. After all, vitamins and minerals work that way.
This is the end of the thread.
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