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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by Gabriel14 on March 9, 2021, at 15:47:05
I've been on brand name Wellbutrin, i.e. bupropion, for over a decade, but I only recently discovered that there's a blood test that measures your levels for bupropion and its metabolite, hydroxybupropion...
I decided to have the test done. To my surprise, my levels were well below the reference range. For bupropion, it was only 13.5 ng/mL, compared to the reference range of 50.0-100.0 ng/mL. For hydroxybupropion, it was just below the bottom of the reference range, which is 600.0-2,000.0 ng/mL.
It seems like a lot of psychiatrists don't use these tests, so I've been having a tough time getting professional guidance on what to make of these results. I figured it couldn't hurt to ask folks here for their thoughts.
Might I have a bad batch of Wellbutrin right now? Or perhaps my body isn't properly metabolizing the drug? This is a bit concerning.
Posted by Gabriel14 on March 9, 2021, at 15:48:17
In reply to Guidance on blood tests results for bupropion?, posted by Gabriel14 on March 9, 2021, at 15:47:05
Oh, I should have mentioned that I'm on 300 mg of Wellbutrin XL, in case that's helpful.
Posted by linkadge on March 9, 2021, at 16:50:53
In reply to Guidance on blood tests results for bupropion?, posted by Gabriel14 on March 9, 2021, at 15:47:05
Interesting.
There is only one antidepressant I know of (nortriptyline) for which a therapeutic blood level has been established.
The fact that you have lower bupropion, but higher hydroxybupropion indicates to me that you may be a faster metabolizer of bupropion. However, from what I understand, a significant degree of wellbutrin's antidepressant effect is from the metabolites. So a lower level of bupropion may not be detrimental. Personally, I would go based on therapeutic responses. Do you feel your depression is being adequately treated? If not, have you considered a higher dose? If not, have you tried other agents (i.e. SSRIs) which may augment it? For example, even a low dose of escitalopram may augment it. Zoloft may be an option too, however it can increase blood levels of bupropion (to keep in mind).
Linkadge
Posted by Christ_empowered on March 9, 2021, at 23:37:31
In reply to Re: Guidance on blood tests results for bupropion?, posted by linkadge on March 9, 2021, at 16:50:53
not at all an expert, but...here goes (it is The Internet, after all...)
what effects are you looking for from wellbutrin treatment, treatment in general? Wellbutrin is basically a mild stimulant. chemically, if I recall correctly, it's closely related to Tenuate, one of the milder, less addictive, less euphoric diet pills.
If you need help with energy, focus, attention, etc., then my wild guess would be to either work with a doctor to transition from wellbutrin to something else (uppers are still used in some forms of low mood/depression, with or without a diagnosis of add/adhd), or perhaps...consider 'augmentation strategies' (adding pharmaceuticals, supplements, etc. to hopefully get better results, more in line with what you need).
my concern with relying on a blood test that I think is not cleared for use in clinical practice by the fda (could be wrong...) is that the obvious "solution" in your situation would be to increase the dosage. problem there, of course, is that ramping up wellbutrin dosage can result in seizures, or at least...
wellbutrin is more likely to induce seizures at the high(er) end of the dosage range than many other pharmaceutical options available.:-(
rambling... ideally, treatment should focus on the individual's needs/'symptoms,' not so much on official diagnoses, with an eye to safety and overall quality of life.
in terms of augmentation strategies...with Wellbutrin, adding remeron seems somewhat popular. Remeron tends to be sedating, more so at lower doses. I forget the dosage at which it becomes less sedating for many people...maybe 30mgs? 45? it is not an ssri or ssnri, it is often used for night time sedation, and some people find it effective against low mood with anxiety, ruminations, weight loss, etc.
an ssri..maybe? it seems far more common to add wellbutrin when an ssri drug helps some problems, but causes apathy. if one has obsessive stuff going on, I could see a carefully selected ssri being helpful. my current psych claims that she uses prozac with wellbutrin and finds that 'they play well together.' clearly, im just repeating 2nd hand information to show that one has options, i'm not recommending anything.
not to push 'alternative mental health' on you (or anyone), but I have found that some supplements help me, personally, and others on this board and elsewhere have, also.
i hope this helps. if it wasn't for the seizure risk (and the availability of other drugs), then working with a psych to max out the wellbutrin dosage might be the easiest, quickest option. --not an expert-- or anything, but...i personally think other options might be worth pursuing, depending on what you want/need out of drug treatment.
:-)
Posted by Gabriel14 on March 10, 2021, at 23:26:53
In reply to Re: Guidance on blood tests results for bupropion?, posted by Christ_empowered on March 9, 2021, at 23:37:31
> not at all an expert, but...here goes (it is The Internet, after all...)
>
> what effects are you looking for from wellbutrin treatment, treatment in general? Wellbutrin is basically a mild stimulant. chemically, if I recall correctly, it's closely related to Tenuate, one of the milder, less addictive, less euphoric diet pills.
> If you need help with energy, focus, attention, etc., then my wild guess would be to either work with a doctor to transition from wellbutrin to something else (uppers are still used in some forms of low mood/depression, with or without a diagnosis of add/adhd), or perhaps...
>
> consider 'augmentation strategies' (adding pharmaceuticals, supplements, etc. to hopefully get better results, more in line with what you need).
>
> my concern with relying on a blood test that I think is not cleared for use in clinical practice by the fda (could be wrong...) is that the obvious "solution" in your situation would be to increase the dosage. problem there, of course, is that ramping up wellbutrin dosage can result in seizures, or at least...
>
> wellbutrin is more likely to induce seizures at the high(er) end of the dosage range than many other pharmaceutical options available.:-(
>
> rambling... ideally, treatment should focus on the individual's needs/'symptoms,' not so much on official diagnoses, with an eye to safety and overall quality of life.
>
> in terms of augmentation strategies...with Wellbutrin, adding remeron seems somewhat popular. Remeron tends to be sedating, more so at lower doses. I forget the dosage at which it becomes less sedating for many people...maybe 30mgs? 45? it is not an ssri or ssnri, it is often used for night time sedation, and some people find it effective against low mood with anxiety, ruminations, weight loss, etc.
>
> an ssri..maybe? it seems far more common to add wellbutrin when an ssri drug helps some problems, but causes apathy. if one has obsessive stuff going on, I could see a carefully selected ssri being helpful. my current psych claims that she uses prozac with wellbutrin and finds that 'they play well together.' clearly, im just repeating 2nd hand information to show that one has options, i'm not recommending anything.
>
> not to push 'alternative mental health' on you (or anyone), but I have found that some supplements help me, personally, and others on this board and elsewhere have, also.
>
> i hope this helps. if it wasn't for the seizure risk (and the availability of other drugs), then working with a psych to max out the wellbutrin dosage might be the easiest, quickest option. --not an expert-- or anything, but...i personally think other options might be worth pursuing, depending on what you want/need out of drug treatment.
>
> :-)
Thanks, Christ. My main goal with Wellbutrin, which I've been on for over a decade, has been to treat my depression. I'm not really looking for help with anxiety, ADHD, or other stuff along the lines of what you mentioned. It's really primarily depression.I've had multiple doctors bring up the possibility of introducing an SSRI or something similar to the mix, to be paired with the Wellbutrin. I haven't taken this step yet, though. Maybe I should be more open-minded about it if other folks have found that it makes a significant difference?
Posted by Gabriel14 on March 10, 2021, at 23:27:35
In reply to Re: Guidance on blood tests results for bupropion?, posted by linkadge on March 9, 2021, at 16:50:53
> Interesting.
>
> There is only one antidepressant I know of (nortriptyline) for which a therapeutic blood level has been established.
>
> The fact that you have lower bupropion, but higher hydroxybupropion indicates to me that you may be a faster metabolizer of bupropion. However, from what I understand, a significant degree of wellbutrin's antidepressant effect is from the metabolites. So a lower level of bupropion may not be detrimental. Personally, I would go based on therapeutic responses. Do you feel your depression is being adequately treated? If not, have you considered a higher dose? If not, have you tried other agents (i.e. SSRIs) which may augment it? For example, even a low dose of escitalopram may augment it. Zoloft may be an option too, however it can increase blood levels of bupropion (to keep in mind).
>
> Linkadge
Thanks, Linkadge. That's an interesting point on the lower bupropion levels perhaps having to do with it being metabolized fast.However, my hydroxybupropion levels are also below the reference range - not as dramatically so as the bupropion, but below nevertheless. So it seems like there's a potential issue here no matter how you cut it.
As far as my response, I've been on Wellbutrin for over a decade, and overall the experience has been positive, but I do feel like the effectiveness varies from batch to batch, even with the brand name.
That's actually why I had this test done; I felt like my most recent batch of Wellbutrin has been a dud, and it convinced me that maybe it was a good idea, going forward, to start tracking its levels in my blood shortly after I start each new batch.
Posted by jay2112 on March 11, 2021, at 0:19:03
In reply to Re: Guidance on blood tests results for bupropion?, posted by linkadge on March 9, 2021, at 16:50:53
Hmmmmm.
I noticed you had mentioned escitalopram as working for you before. I used to try to get by all jazzed up during the day on Nortriptyline, and in the even would consume, on average, 35mg's of escitalopram. It would be like an amazing feeling came over me when I took the escitalopram, pure anxiety-melting head to toe. I used to meditate then, put on some really relaxing trance like Madonna's "Ray of Light". And then crash into an amazing sleep. Next morning, back to same old depressive self. :(
Jay
Posted by Lamdage22 on March 11, 2021, at 2:21:11
In reply to Re: Guidance on blood tests results for bupropion?, posted by Gabriel14 on March 10, 2021, at 23:26:53
A doctor (I didn't like) once told me I wasn't taking Parnate as prescribed because my blood level was too low. I was taking it and I did get an effect. If you get a good effect, I wouldn't worry too much about the blood level.
Posted by linkadge on March 12, 2021, at 14:03:04
In reply to Re: Guidance on blood tests results for bupropion? » linkadge, posted by jay2112 on March 11, 2021, at 0:19:03
Yeah 35mg of escitalopram is a LOT. I would not recommend doing this as it can prolong the QT interval.
I've never heard of escitalopram providing much of a short term buzz, but I know this can happen for some folks. If it occurred, I would certainly separate this from the 'antidepressant' effect.
Of course, not everybody responds to it. I thought it was ok in very small doses.
Linkadge
Posted by jay2112 on March 13, 2021, at 21:17:10
In reply to Re: Guidance on blood tests results for bupropion?, posted by linkadge on March 12, 2021, at 14:03:04
Well...the literature shows safe use at prescribed doses of 50 mg of citalopram. Yes, the heart condition possible, should be monitored for. But, my pdoc at the time said with ultra-high norepinephrine and dopamine levels during the day, escitalopram floods the brain with serotonin (from 1 hr after consumption), which I think of as a 'lighter' and 'non-toxic' working of something like extacy.(Or 'Molly'..whatever the kids call it today.)
The traditional uses and such of most antidepressants just barely, or don't work anymore.
SOMETHING has got to change QUICKLY.Jay
Posted by linkadge on March 15, 2021, at 16:17:02
In reply to Re: Guidance on blood tests results for bupropion? » linkadge, posted by jay2112 on March 13, 2021, at 21:17:10
>Well...the literature shows safe use at >prescribed doses of 50 mg of citalopram.
That's true, but 50mg of citalopram corresponds with ~25mg of escitalopram (possibly less, owing to the fact that one of the isomers of citalopram antagonizes the effect of the other).
>which I think of as a 'lighter' and 'non-toxic' >working of something like extacy.(Or >'Molly'..whatever the kids call it today.)
Ecstasy tends to cause more release of serotonin (as well as dopamine). But you're right, there is some overlap in their actions.
>The traditional uses and such of most >antidepressants just barely, or don't work >anymore. SOMETHING has got to change QUICKLY.
I agree. Much more needs to be done for those that are suffering. I get desperate myself sometimes and do stupid things.
Linkadge
This is the end of the thread.
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