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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 clubfitter on November 2, 2007, at 19:11:56
Been on Wellbutrin for about 3 weeks and have yet to experience any stimulation what so ever. Isn't the stimulation supposed to start pretty quick? Thanks in advance.
Posted by Astounder on November 2, 2007, at 19:42:01
In reply to Wellbutrin Stimulation?? When does it start?, posted by clubfitter on November 2, 2007, at 19:11:56
> Been on Wellbutrin for about 3 weeks and have yet to experience any stimulation what so ever. Isn't the stimulation supposed to start pretty quick? Thanks in advance.
Wellbutrin is a really weak stimulant itself: Its effects rely heavily on its active metabolites. But three weeks should be enough for its stimulant-like effects to kick in, if not its antidepressant effects.
Keep in mind the original clinical trials for Wellbutrin went up to 900 mg/d. They warn against going this high because of a seizure risk, but the original trials where they first noticed this were in high-risk populations using the instant-release formulation. Even then the risk is not much higher than some tricyclics. So you might want to talk to your doctor about raising the dose.
Posted by War-Face on November 3, 2007, at 11:18:00
In reply to Re: Wellbutrin Stimulation?? When does it start? » clubfitter, posted by Astounder on November 2, 2007, at 19:42:01
Every time I've started Wellbutrin, I've always had a different response and response time.
The first time, I felt stimulation right away. AD response well within a week.
The most recent time, I didn't feel any stimulation or AD effect for 5-6 weeks, (I had been thinking that it wasn't going to work at all, and that my body had grown accustomed to it, but then it kicked in and worked better than ever - this was XL).
The subjective response can vary according to innumerable factors, but in my case I think it mostly has to do with the drugs I am taking prior to starting Wellbutrin. In the first case, I was suffering from a period of MDD where I couldn't even get out of bed all day - probably very low DA and NE levels. I hadn't been taking anything (not even ephedrine) for a year.
As per the second case, I had been taking Adderall for 2 years when I added Wellbutrin for depression. As you can guess, in the second case, subjective stimulation of Wellbutrin as compared to Adderall is minimal. Objectively, my body could have already been accustomed to the stimulating effects as well (NE and DA).
PS: I've always felt the stimulant and AD properties of Wellbutrin to be somewhat coterminous - with perhaps only a little bit of lag time for AD.
My main point, I suppose, is that response may vary. For whatever reason.
You aren't on generic, are you? I've always found them quite poor. I'm a big fan of the brand XL.
Posted by clubfitter on November 3, 2007, at 11:40:30
In reply to Re: Wellbutrin Stimulation?? When does it start?, posted by War-Face on November 3, 2007, at 11:18:00
I am on the generic Buporpion....Ive read that the Budeporion is the dud but the one i am taking is actually decent...what generic had you been on? thanks
Posted by Phillipa on November 3, 2007, at 11:43:08
In reply to Re: Wellbutrin Stimulation?? When does it start?, posted by War-Face on November 3, 2007, at 11:18:00
Wellbutrin was so stimulating for me at l50mg that I ended up in the hospital for a week as I was almost manic. At least my pdoc thought so. So they took me off it right away and zoloft was the one put on and nothing at all from that so does that mean I respond the no SSRI's but the neurotransmitter in wellbutrin? Is it dopamine or nortriptalline? Phillipa
Posted by War-Face on November 3, 2007, at 13:19:37
In reply to Re: Wellbutrin Stimulation?? )Warface, posted by clubfitter on November 3, 2007, at 11:40:30
I can't remember the various generic brands of buproprion IR and SR I have tried. I did try the infamously bad one, is it made by Teva? They were all pretty mediocre at best. You obviously won't even know how the generic fares for you versus the brand until you try the brand.
A couple of examples though of generics faring poorly for me:
1) I was on Wellbutrin XL but the prescription ran out and I was being moved to EMSAM, so I was left taking generic SR for 3 or 4 days. By the end of day 2, I felt depression increase by 30 to 40%. Anger and anxiety was up too. In fact, I would argue that it almost felt like a DIFFERENT drug.
2) I had taken brand Wellbutrin SR 300 mgs a day for around 3 years, before stopping for a year for poopout. When I started back up again, I tried a lower dose of generic SR. After a week or two, I developed a rash all over my arms and upper body. I had never had anything like that from brand. Everyone said it was likely related to the dye used in the generic. It was also much poorer for depression, increased anger, etc. Again, is it even objectively the same drug?
If it only means a slightly higher co-pay or if you have the means to pay for brand, I would try it at least for 2 months.
Posted by Larry Hoover on November 5, 2007, at 16:45:35
In reply to Re: Wellbutrin Stimulation?? When does it start? » clubfitter, posted by Astounder on November 2, 2007, at 19:42:01
> Keep in mind the original clinical trials for Wellbutrin went up to 900 mg/d. They warn against going this high because of a seizure risk, but the original trials where they first noticed this were in high-risk populations using the instant-release formulation. Even then the risk is not much higher than some tricyclics. So you might want to talk to your doctor about raising the dose.
I'm very uncomfortable with this assertion. Prior to 2004, the Wellbutrin monograph listed seizure risks of: at 300 mg/day, 0.1%; at 450, 0.4%; at 600, 4%. The latter risk value was subsequently revised down to 2.3% All are based on t.i.d. dosing of IR bupropion. B.i.d. intake would lead to greater fluctuation in blood concentrations, and thus would likely present a greater risk than suggested by these data.
If you plot these data, you will obtain an exponential curve. If you take enough bupropion, you will seize. The unfortunate truth is that we cannot predict an individual's seizure threshold dose, beforehand. Instead, we have to use a risk/benefit analysis. That has led to placing a maximum intake at 450 mg/day.
Lar
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