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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by pedr on February 3, 2002, at 6:49:28
Fellow Babblers,
I'm on day 9 of starting wellbutrin SR, on 300mg. I also take 12mg reboxetine. I am experiencing intense feelings of depression:
- heavy feeling in stomach
- dull but pounding heart
- terrbible low feeling in gutsbut am not detecting *any* form of typically causal thinking. In fact, my general outlook, negative thinking, fears, social anxiety and distorted beliefs are all significantly improved and yet the feelings of depression are very intense. Yesterday I had these just bareable feelings from 1p.m. until midnight, again with no apparent initiator.
Has anyone else experienced or heard of anything like this? I've had headaches and nausea but that's not bothering me as they are well known side effects. If these powerful feelings of depression persist then I'll have to stop the wellbutrin and that'd be a shame as I'm already noticing cognitive benefits.
Thanks in advance,
pete.
Posted by Bekka H. on February 4, 2002, at 3:14:12
In reply to Intense biological depression on Wellbutrin, posted by pedr on February 3, 2002, at 6:49:28
Hello, Pete!
I had the same problem on Wellbutrin. I was feeling suicidal on it and I had to stop. My negative thoughts were relentless and obsessional, like an endless tape or broken record. The odd thing is, I had taken Wellbutrin about 5 or 6 years ago, and I didn't have that problem, but I had it this past year when I tried it. This was quite a shock and disappointment to me because, in the past, it was the only antidepressant I could tolerate, and it gave me energy and drive, both of which were numbed on all the other antidepressants. For some reason, my body just can't tolerate it now. I have a thought, and I wonder whether you've checked with your doctor about this. . .I don't know too much about Reboxetine since it's not available in the U.S., but after reading your post, it occurred to me that Reboxetine and Wellbutrin might compete for some of the same liver enzymes and, therefore, might be rendering each other less effective. Do you know about the cytochrome P450 enzymes? Nearly every drug requires some metabolism by the cytochrome P450 enzymes. The problem is, some drugs are substrates of the enzymes, some drugs are inhibitors of the enzymes and some drugs are inducers of the enzymes. If you take one drug that inhibits an enzyme (let's call it enzyme IID6, for example), and you take a second drug that is a substrate of IID6, then that second drug won't be properly broken down because the first drug inhibited the enzyme that was needed for the second drug's metabolism. As I said, I don't know much about reboxetine, but I do know that Wellbutrin metabolites affect some of the cytochrome P450 enzymes. If I'm not mistaken, I believe that hydroxy-bupropion, the major metabolite of Wellbutrin, inhibitis cytochrome P450 IID6.
Another thing to consider is the half-lives of the various drugs. Bupropion itself has a fairly short half life of about 14 hours or so; however, its metabolites have half lives of 2-3 days, so I wonder how that might be interacting with reboxetine. I wish I knew more about reboxetine so I could help you. Also, I wonder how you would be responding to Wellbutrin if you weren't on reboxetine. How long have you been on reboxetine? Have you ever taken Wellbutrin without reboxetine and, if so, did you have the same reaction?
Posted by Willow on February 4, 2002, at 7:35:50
In reply to Intense biological depression on Wellbutrin, posted by pedr on February 3, 2002, at 6:49:28
> I'm on day 9 of starting wellbutrin SR
Pete
Talk to your pharmascist or doctor. I had the same sensations when starting effexor, and it was helping the cognitive problems. With time the physical stuff went away. You've only been on it for 9 days, remember it can take months to feel the full benefits of the medication. I've been on the effexor for over a year. I'm so glad I stuck with it since it has made such a difference regarding cognitive problems.
BEST WISHES
Willow
Posted by pedr on February 4, 2002, at 8:15:50
In reply to Re: Intense biological depression on Wellbutrin, posted by Bekka H. on February 4, 2002, at 3:14:12
> Hello, Pete!
>
> I had the same problem on Wellbutrin. I was feeling suicidal on it and I had to stop. My negative thoughts were relentless and obsessional, like an endless tape or broken record. The odd thing is, I had taken Wellbutrin about 5 or 6 years ago, and I didn't have that problem, but I had it this past year when I tried it. This was quite a shock and disappointment to me because, in the past, it was the only antidepressant I could tolerate, and it gave me energy and drive, both of which were numbed on all the other antidepressants. For some reason, my body just can't tolerate it now. I have a thought, and I wonder whether you've checked with your doctor about this. . .I don't know too much about Reboxetine since it's not available in the U.S., but after reading your post, it occurred to me that Reboxetine and Wellbutrin might compete for some of the same liver enzymes and, therefore, might be rendering each other less effective. Do you know about the cytochrome P450 enzymes? Nearly every drug requires some metabolism by the cytochrome P450 enzymes. The problem is, some drugs are substrates of the enzymes, some drugs are inhibitors of the enzymes and some drugs are inducers of the enzymes. If you take one drug that inhibits an enzyme (let's call it enzyme IID6, for example), and you take a second drug that is a substrate of IID6, then that second drug won't be properly broken down because the first drug inhibited the enzyme that was needed for the second drug's metabolism. As I said, I don't know much about reboxetine, but I do know that Wellbutrin metabolites affect some of the cytochrome P450 enzymes. If I'm not mistaken, I believe that hydroxy-bupropion, the major metabolite of Wellbutrin, inhibitis cytochrome P450 IID6.
>
> Another thing to consider is the half-lives of the various drugs. Bupropion itself has a fairly short half life of about 14 hours or so; however, its metabolites have half lives of 2-3 days, so I wonder how that might be interacting with reboxetine. I wish I knew more about reboxetine so I could help you. Also, I wonder how you would be responding to Wellbutrin if you weren't on reboxetine. How long have you been on reboxetine? Have you ever taken Wellbutrin without reboxetine and, if so, did you have the same reaction?Wow,
much thanks for the reply Bekka. Just to clarify something - you seem to have had the *opposite* reaction to Wellbutrin than I did i.e. increased very negative distorted thinking. I just *feel* depressed, my thoughts and outlook are overall improved. Weird.Thanks for the suggestions about the P450 enzymes. I know pretty much zilch about this sort of stuff, I never know where to start learning about it. I shall print out this post and see what my pdoc thinks. So far I've not been too impressed with his knowledge, for example, he says that Wellbutrin affects only dopamine which I know not to be the case.
The best info I've found on reboxetine is at:
http://www.smart-drugs.net/reboxetine/reboxetine-articles.htm
http://www.mentalhealth.com/drug/p30-r06.html
http://www.ijmt.net/3_4/3_4_26.htmlIf you have the time [and desire] to look into the possible interactions I'd love to hear your findings and don't worry, I won't go changing dose/drug/whatever without consulting my pdoc :-]
To answer your latter questions:
How long have you been on reboxetine? - I've been on it for 4 months now. Incidentally I was plagued with constant suicidal thoughts for the first 2 weeks - just like you when you started wellbutrin the second time.Have you ever taken Wellbutrin without reboxetine and, if so, did you have the same reaction? - no. I wonder what it'd be like without it.
Thanks for your time and for sharing your knowledge,
pete.
Posted by pedr on February 4, 2002, at 8:23:33
In reply to Re: Intense biological depression on Wellbutrin, posted by Willow on February 4, 2002, at 7:35:50
> > I'm on day 9 of starting wellbutrin SR
>
> Pete
>
> Talk to your pharmascist or doctor. I had the same sensations when starting effexor, and it was helping the cognitive problems. With time the physical stuff went away. You've only been on it for 9 days, remember it can take months to feel the full benefits of the medication. I've been on the effexor for over a year. I'm so glad I stuck with it since it has made such a difference regarding cognitive problems.
>
> BEST WISHES
> WillowHi Willow,
glad to hear that this isn't a unique terminal sign I'm getting. It just bothered me that I've not seen/found any other posts regarding increased feelings of depression on Wellbutrin - 99% of people find it too agitating.I'm aiming to hold out to the 2 week mark. From the 100's of posts I've read about Wellbutrin, the side-effects *should* ameliorate around then. Fingers crossed that this depression is exactly that - a side-effect.
Thanks for the input and glad to hear things are going well,
pete.
Posted by IsoM on February 4, 2002, at 14:12:40
In reply to Intense biological depression on Wellbutrin, posted by pedr on February 3, 2002, at 6:49:28
Pete, have you ever taken any other ADs? In the doctors' & pharmacists' CPS, it seems every AD has the note that a patient has the potential for committing suicide when first starting an AD.
It seems that initially a person may feel so depressed that they have little energy to do anything. When the AD starts taking effect, the person is roused from the deeper depression but still feels like sh*t but now has enough energy to kill themself. Not implying that you're suicidal but it seems to be common enough that some people will respond to the AD with a certain lifting of their depression but paradoxically also feel worse at first then improve more.
As others have said, mention this to your doctor (& ask your pharmacist too if she/he is good). It may need adjusting, patiently waiting longer, or even stopping it. Alternatively, maybe Klonopin might be added for a while.
Posted by pedr on February 5, 2002, at 8:52:01
In reply to Re: Intense biological depression on Wellbutrin » pedr, posted by IsoM on February 4, 2002, at 14:12:40
> Pete, have you ever taken any other ADs? In the doctors' & pharmacists' CPS, it seems every AD has the note that a patient has the potential for committing suicide when first starting an AD.
>
> It seems that initially a person may feel so depressed that they have little energy to do anything. When the AD starts taking effect, the person is roused from the deeper depression but still feels like sh*t but now has enough energy to kill themself. Not implying that you're suicidal but it seems to be common enough that some people will respond to the AD with a certain lifting of their depression but paradoxically also feel worse at first then improve more.
>
> As others have said, mention this to your doctor (& ask your pharmacist too if she/he is good). It may need adjusting, patiently waiting longer, or even stopping it. Alternatively, maybe Klonopin might be added for a while.Hi IsoM,
I've heard of the phenomenon you describe regarding A/Ds giving people enough energy to go and do it. I have been suicidal from time to time over the years but the period I'm experiencing at the moment is quite different and odd.My mood, outlook and thought processes are what I would term "good" [probably not what healthy people would term "good" though :-) ] The problem is the sensations of depression I'm getting that seem to have no corresponding causal thinking. You know the feeling - bowling ball in the stomach, heart feels heavy but is pounding, basically that unique, foul sensation of depression. I have "felt" depressed without any causal thinking before e.g. when facing the morning ahead but this sensation is different. As you can tell, it's difficult to describe.
To answer your question, I've been on effexor, paxil, seroxat and surmontil before. I can't really remember anything similar on those as I was in such a bad way at the time.
Thanks for the suggestions,
best wishes,
pete.
Posted by Jonathan on February 8, 2002, at 8:17:07
In reply to Intense biological depression on Wellbutrin, posted by pedr on February 3, 2002, at 6:49:28
Posted by pedr on February 11, 2002, at 8:52:35
In reply to Did you get Wellbutrin on the UK NHS? (nm) » pedr, posted by Jonathan on February 8, 2002, at 8:17:07
Not a chance mate. I asked my GP, who is really cool and she asked the local health < something or other > and her fellow GPs in her practice. Zyban is only licensed for stopping smoking and thus they gave the thumbs down.
Basically they shit themselves that something bad might happen and it'd be their responsibility which is fair enough. It's also a good way for the NHS to save money as I have to buy it at 55 quid a month now.HTH,
pete.
This is the end of the thread.
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