Posted by JohnX2 on March 5, 2002, at 18:09:19
In reply to Switching to Celexa/maybe Wellbutrin?, posted by maribeth on March 4, 2002, at 13:29:17
Hi,Wellbutrin has a very narrow therapeutic dosing
window, and so your pdoc may be right that if you
go slower with the anti-psychotic medicine in place
then odds are you won't have the psychotic episode.Also dexedrine is a potent dopaminergic medicine
which can induce a psychosis by itself over time.
The combo could have just sent you over the tilt.Here is a possible prozac interaction that may
have caused a problem. It has to do with inhibition
of the liver enzyme cyp450-2d6. I
have seen conflicting data on this but it could
explain wellbutrin reaching toxic levels with
Prozac. One of wellbutrin's more potent metabolites
(hydroxybupropion) does a lot of work for the medicine.
I.e. the main medicine bupropion gets broken up by your
liver into a few metablites (little "sub-medicines"), and
these metabolites are thought to be psychoactive. Its my
understanding, and I see a lot of conflicting info for
wellbutrin, but its generally the case that these
hyrdroxy-blah-blah chemicals need to be deactivated in
the liver using the cyp450-2d6 enzyme. But prozac
is known to POTENTLY inhibit the production of that
liver enzyme. So its possible, just a thought, that the
prozac was causing the wellbutrin to reach toxic levels
in your system. I don't think celexa goes down
that liver route, and don't know about seroquel.
Another issue is that 1 in 20 cuacasions is a poor
metabolizer of cyp450-2d6 medicines in general.But what happened on the last pschotic trip?
How did they treat it at the hospital? Did they
put you onto an anti-psychotic medication at the
time?Anyways, how would you describe "the quality of
life" improving on wellbutrin. People who become
manic and then psychotic got lots of dopamine running
through their body and this can make them feel real
good. Or were you feeling something else?
Ever had diagnosis of manic/hypomania in the past?
Any family history of bipolar?just a few thoughts. Hope it is not too
technical.-John
> Hi Y'all
> It has been awhile since I have posted here, but things have been going well. I have been on Effexor XR which my pdoc has me coming off of while - I slowly work up to Celexa. (Current Eff is 150mgm-- current Celexa -- 15mgm.) He expects me to end up on 30 or 40mg of Celexa. I was on 325mgm Effexor at tops. He tells me that if the Celexa doesnt do the trick, we will either add or switch to Wellbutrin.
> Now here is the screamer.----
> Three and a half years ago I was put on Wellbutrin SR 150mgm bid (unsure of dose-red pill) to take the place of Ritalin. It worked wonderfully, for about 48hours, then I got very delusionally psycotic and spent four or five days in the seclusion room at the local Univ. Hosp Psych ward. I was also on Prozac 30mgm at the time, I had taken 10mgm of dexadrine (from a friend) the day before, the Wellb. took about a week to work -but WHILE it worked it qave me a quality of life unlike anything I have ever known. My pdoc knows about all of the above and says not to worry, we would go slowly and use smaller doses. Besides, he tells me, since I now take Seroquel 400mgm daily that would "protect"
> me from the psycosis.
> I would really like to hear from some of you. The thought that maybe I COULD benefit and have what I did have for that brief time IS SO TEMPTING. However, the fear of that horrible time that came right after (I do not remember only the very beginning)is still with me.
> I was diagnosed ADD Many years ago, (1986) long before it was really noticed in adults. I was put on Ritalin. This was possible mostly because I worked in the same institution as my therapist and prescribing pdoc. It worked wonders, but my husband refuses to allow any "controlled substances")
> I am 59 now and had almost forgotten what the "focused life" was like! Is it possible that after all of these years there is an answer? Will being on the Seroquel really "protect" me from the psychosis? Was the psychotic episode due to the Dexedrine? (my husband's theory) How much Celexa must I take to "equal" the 325mgm of EffexorXR? PLEASE SHARE YOUR WISDOM WITH ME!! maribeth
> PS I am getting off the Effexor due to weight
> gain -- 30lb in 2 years!
poster:JohnX2
thread:96340
URL: http://www.dr-bob.org/babble/20020301/msgs/96585.html