![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 4 to 28 of 28. Go back in thread:
Posted by SalArmy4me on May 10, 2001, at 23:54:29
In reply to (more) Wellbutrin advice, posted by pellmell on May 10, 2001, at 10:08:08
Many patients who show this response to buproprion do well when one of the mood-stabilizing anticonvulsants is added: http://www.dr-bob.org/tips/split/Irritability-from-medicati.html
Posted by Sunie on May 11, 2001, at 0:56:47
In reply to (more) Wellbutrin advice, posted by pellmell on May 10, 2001, at 10:08:08
I, too, just started taking Wellbutrin SR.
I, too, had great initial response to Effexor XR.
I have never tried a straight-up SSRI.RE: The Wellbutrin Side Effects...
100 mgs in the AM for ten days, no problem.
100 mg EA am and pm and experienced acute physical signs of anxiety (muscle tension, chest tightness, tremor, headache, and PISSED OFF thoughts) but that was a 100% jump in medication level, and staying up all night to get an important task done didn't help. :-|Today is day 6 at 200 mg and asymptomatic again.
I think going up slowly is a good idea, and go to 250 tomorrow. This will be only a 25% increase in medication, so I hope it will be smoother this time.
My pdoc did reassure me that most people lose the irritability and anxiety after a few weeks at theraputic dose. I don't really care, though... it feels great to be a b*** instead of a soggy puddle of lethargy, apathy, and hopelessness. ;-)
hope this helps,
-Sunie
Posted by pellmell on May 11, 2001, at 9:47:24
In reply to Re: (more) Wellbutrin advice, posted by Sunie on May 11, 2001, at 0:56:47
Thanks, all of you, for the advice... My pdoc should return my call sometime today. In my message I told him I wanted to give Wellbutrin a full 4-6 week trial, but that I was having lots of trouble with the side-effects and possibly "unmasked" anxeity.
I meet my newish girlfriend's family today, and I'm trying not to be anxious about the fact that I might be anxious (heh) and irritable around them... Maybe I'll try not taking my afternoon dose this weekend. I'll definitely try some of the cognitive restructuring tips I've learned in therapy (I should use them more often, anyway).
Wish me luck.
"Your mind is the most powerful pill" is an aphorism that tumbled its way down to me from my pharmacist through one of his assistants. It's cheesy, I know.
I'll try to believe in cheese.
-pm
Posted by Leighwit on May 11, 2001, at 15:55:40
In reply to Re: (more) Wellbutrin advice » pellmell, posted by SalArmy4me on May 10, 2001, at 23:54:29
I've taken Wellbutrin for a couple of years and it works better at relieving my depressive lethargy than anything else (I've been on all of the SSRIs except Luvox, as well as Norpramin, Effexor, Reboxetine and a few others.)
Wellbutrin in my case, definitely brings an irritability side effect that scares me as a parent. I loose my temper far too quickly; find myself annoyed to the point of anger at absurdly small "stuff". This was alleviated by a small dose of Celexa added to the WB for over one year.
It worked great. Unfortunately I gained 30 lbs in that year. I'm a Type I diabetic and weight changes of that magnitude are not an acceptable side effect.
Now that I'm off the Celexa, the irritability is back and it's terrible. My Pdoc added Serzone a few days ago, and I'm hoping (!!!!) it works.
I've taken Celexa and Serzone each alone in the past. Neither one did anything for my depression or related lethargy. Yet Celexa worked a miracle in improving the performance of Wellbutrin. Maybe the Serzone can accomplish that without the weight gain in my case.
Wellbutrin is currently an irreplaceable drug for some people. I'm one of them. If anyone has found a drug that works to alleviate these agitation side effects, please let us know. And for anyone dealing with this side effect for more than a few months who hasn't tried augmenting Wellbutrin with Celexa -- it worked very well for me and you might want to consider it. Were it not for the weight gain, I found the combination the most effective of many I've tried.
Celexa, by the way, does not statistically have a high-risk profile for weight gain. Of course, statistics are meaningless unless they support your own experience. < g >
Leighwit
Many patients who show this response to buproprion do well when one of the mood-stabilizing anticonvulsants is added: http://www.dr-bob.org/tips/split/Irritability-from-medicati.html
Posted by Paige on May 11, 2001, at 17:56:46
In reply to Re: (more) Wellbutrin advice, posted by Leighwit on May 11, 2001, at 15:55:40
Leighwit,
Did the Celexa help your depression at all?
I took Celexa and know it helped mine and I
often wondered about the combo of Wellbutrin
and Celexa. I just got off the phone with my
psychiatrist and he seems to want me back on Well-
butrin but augmented. I really liked Wellbutrin
but I couldn't handle side effects.
paige
Posted by Sunie on May 11, 2001, at 21:12:54
In reply to Re: (more) Wellbutrin advice » Leighwit, posted by Paige on May 11, 2001, at 17:56:46
Well, I thought I was doing great on this drug, but today has been really rough. I woke up this morning with my two front teeth aching mildly. I ignored it, took my dose (150 just up from 100 yesterday in the am) and went about my day. The aching has grown rapidly worse, and I'm getting swelling in the gums.
Has this happened to anyone else? Will it pass? Is it even from the Wellbutrin? Seems like it to me... I've never had problems with my gums or teeth like this before. :-(
What I'm really worried about is that this might be a sign of allergy or something. I also have a weird and intense pressure in my head.
Any comments? I'm kinda freaked out by this one.
Posted by Leighwit on May 14, 2001, at 11:31:39
In reply to Re: (more) Wellbutrin advice » Leighwit, posted by Paige on May 11, 2001, at 17:56:46
Paige,
The Celexa worked well for me WHEN COMBINED WITH Wellbutrin (WB). It substantially reduced the side effect of irritability/agitation that I'd experienced with WB. Is that the same side effect you had trouble with? When I had taken Celexa alone, it accomplished nothing (or very little)in alleviating my depression symptoms. Wellbutrin alone is more effective for me than is Celexa alone, although I only give it a B- performance grade. Celexa, however, not only minimized WB's irritability side effect, it improved its overall performance.
Leighwit
> Leighwit,
>
> Did the Celexa help your depression at all?
> I took Celexa and know it helped mine and I
> often wondered about the combo of Wellbutrin
> and Celexa. I just got off the phone with my
> psychiatrist and he seems to want me back on Well-
> butrin but augmented. I really liked Wellbutrin
> but I couldn't handle side effects.
> paige
Posted by Leighwit on May 14, 2001, at 11:59:27
In reply to Re: (more) Wellbutrin side effects?, posted by Sunie on May 11, 2001, at 21:12:54
Paige,
Wow. I did in fact go through major oral problems while on Wellbutrin, but I really don't think it was related. In fact, I needed a tooth extracted and a bridge. I saw three specialists including a periodontist and an oral surgeon. They each said it was a congenital defect in both of the teeth on each side of the front teeth -- something I was born with. One was a problem that has been fixed; the other I get to wait for the problem to appear I guess.
I don't know how old you are, but I was told that problems with teeth and gums frequently show up or progress to the point of needing attention at middle age, {plus I'm diabetic which increases my risk.}
I really doubt your pain is caused by the AD, but I also don't think anyone can ever be 100% certain about these drugs in every single body, and I sure understand the concern that it might correlate somehow. It's hard not to panic about side effects (been there, done that) but give it serious consideration/analysis before you make a decision to stop. Wellbutrin is unique and if it's working (you mentioned that it is) it will be hard to replace. Also, it's been around longer than a lot of the SSRI's currently available, which makes me think there's more (and perhaps better) data about its safety. Not sure about that -- but it's my perception, FWIW....
Any improvement in the pain since you first wrote?
Leighwit
> Well, I thought I was doing great on this drug, but today has been really rough. I woke up this morning with my two front teeth aching mildly. I ignored it, took my dose (150 just up from 100 yesterday in the am) and went about my day. The aching has grown rapidly worse, and I'm getting swelling in the gums.
>
> Has this happened to anyone else? Will it pass? Is it even from the Wellbutrin? Seems like it to me... I've never had problems with my gums or teeth like this before. :-(
>
> What I'm really worried about is that this might be a sign of allergy or something. I also have a weird and intense pressure in my head.
>
> Any comments? I'm kinda freaked out by this one.
Posted by Paige on May 15, 2001, at 4:27:07
In reply to Wellbutrin Celexa » Paige, posted by Leighwit on May 14, 2001, at 11:31:39
Leighwit,
Thanks for responding. I am tempted to get back on
Wellbutrin because i like some of the affects, but
found myself back in crying spell land while on it
and that made no sense to me. I have never tried it
with Celexa. The pdoc only said you cannot take
them at the same time, mucho upset stomach, but we
never got beyond that point. I worry about the
weight gain and sexual side affects. Celexa by itself
did not produce so much weight gain, but sex
drive went out the window. My only thought , as I am
stuck in my life , is that it would give me the energy
to move forward. Wellbutrin alone sis not do this.
Celexa made me feel a bit flat, where as Wellbutrin
kept an already active mind, even more active.
I see the doc in June. For now I take Klonopin for
sleep and I think I took too much (2mg) because I can never
wake up ! Are you still taking Wellbutrin and
Celexa?? How much Celexa? How much Wellbutrin?
Do you know what the differences are between the SR
and the other Wellbutrin? Any help is appreciated.
Thenks, Paige
Posted by Leighwit on May 15, 2001, at 11:05:04
In reply to Re: Wellbutrin Celexa » Leighwit, posted by Paige on May 15, 2001, at 4:27:07
Paige,
No I don't take Celexa anymore because of the weight gain problem. For the first time in a year (the time in which I took Celexa with Wellbutrin), I've stopped gaining weight and it appears to be a direct result of discontinuing its use. Almost two weeks ago, I started a Serzone and WB combination. By the way, I don't understand your Pdoc's statement about not taking Celexa and WB at the same time. I have a weak stomach, and it didn't bother me once in an entire year of use. I always took the Celexa at the same time as the WB.
Since I've stopped the Celexa, the WB isn't working very well for me either. I'm both depressed and unbelievably irritable. I don't have much hope for the Serzone, but I need to keep giving it some time I guess.
Wellbutrin SR is a slower release version of the drug. I've never taken the other one, so I have no personal point of comparison. I'm sure Cam W. can tell you the specifics. If you post with his name in the subject line he usually responds pretty quickly from what I've seen.
Hope something helps each of us very soon. This is a terrible thing for which to enjoy company, but it sure does help to know someone else is experiencing a similar set of reactions (or lack thereof!) to the same drug/drug combinations. I've been battling this condition for ten years now, and I feel that I spend 80% of my time "experimenting" with various drugs and drug cocktails. The other 20% of the time ~ wherein I'm taking something that works, does not last very long, or the side effects begin to have consequences that are detrimental to my physical health. The repetitive cycle is becoming increasingly clear. And that, in and of itself, is enough to depress any human being.
Keep writing and stay in touch please,
Leighwitsince I discontinued it. > Leighwit,
> Thanks for responding. I am tempted to get back on
> Wellbutrin because i like some of the affects, but
> found myself back in crying spell land while on it
> and that made no sense to me. I have never tried it
> with Celexa. The pdoc only said you cannot take
> them at the same time, mucho upset stomach, but we
> never got beyond that point. I worry about the
> weight gain and sexual side affects. Celexa by itself
> did not produce so much weight gain, but sex
> drive went out the window. My only thought , as I am
> stuck in my life , is that it would give me the energy
> to move forward. Wellbutrin alone sis not do this.
> Celexa made me feel a bit flat, where as Wellbutrin
> kept an already active mind, even more active.
> I see the doc in June. For now I take Klonopin for
> sleep and I think I took too much (2mg) because I can never
> wake up ! Are you still taking Wellbutrin and
> Celexa?? How much Celexa? How much Wellbutrin?
> Do you know what the differences are between the SR
> and the other Wellbutrin? Any help is appreciated.
> Thenks, Paige
Posted by Paige on May 15, 2001, at 18:31:20
In reply to Re: Wellbutrin Celexa » Paige, posted by Leighwit on May 15, 2001, at 11:05:04
Leighwit,
Boy, looking at my last post,it's a good thing i
didn't say I was an english manjor or anything.
Sorry for all the typos and I hope you made it though
them okay.Yes, maybe this is a terrible way, but I love this board
and the knowledge and support. My pdoc thinks I am a bit
crazy when i come back at him with mucho info, but
that is his perogative I suppose. I tried, once, some
time ago, the combo for one day of Celexa and 150mg
of Wellbutrin and I felt like I had food poisoning.
It was very strange. Maybe for some people it has
that affect . My doc is good, but he is very by the book,
and MDish. Typical, distant, take this pill, and take that pill
kinda guy. I guess alot of these psychiatrists are like this.
Great field if you can't cope with getting close to
people. Anyway! So I never bothered again and
is one of the reasons I was so curious about your combo.
How high of a dose of Celexa were you taking?
Couldn't a low dose keep the side effects at bay atleast
a little?I wish you all the luck there is out there. I hate
feeling so blue. Most people I know do not relate
to it at all and it leaves you feeling very much alone
and isolated, at least it does me. Nothing has
worked for me, nothing. I hope the Serzone combo works.
Sounds like your doc is working on several
"receptors" at once. Why the switch to Serzone? I have
never tried it.I have to do something soon because I am getting at
my lowest again which is pretty low. I don't
see the doctor crew until June 14th and I fear I
need them sooner. I have no insurance, so I
can't just randomly go anytime I want, I have to plan
every financial and psychological treatment move!Let me know how you are feeling and keep in touch too.
I have clinical depression, some genetic wiring,
some psychological. I have never felt right since
I can remember and I am 40. It hit me real hard
4 years ago. I have never been the same since.
I thinked I snapped back then and now here I am, not
knowing who or what or where and wondered if I ever
really did.Take care of yourself, Leighwit
Paige
Posted by CraigF on May 17, 2001, at 7:36:40
In reply to Re: Wellbutrin Celexa » Paige, posted by Leighwit on May 15, 2001, at 11:05:04
A couple of things...
I added WB to Serzone some time back to return some vitality I felt was missing with just Serzone. The initial effects were good, energizing, etc., but I eventually became aggressive, frustrated, and couldn't concentrate. Come to find out, a metabolite of Serzone that can cause anger is aggrevated by WB.
I'm curious to see how you fare on this
Also, more recently, I tried taking WB 75x2 per day so I can go down on my Celexa dose (50 mg). It made me cry a lot and feel hopeless (the same reaction I had years ago when I added it to Prozac!!)
I told my doctor about the reaction and she took the easy way out:
"It's your worsening depression and not anything to do with WB...increase you Celexa"
But I see a pattern, due to my past experience with WB and Prozac.
Can anyone relate to this SSRI/WB phenomenon? does it going away after several days? I don't want to make myself feel any worse than I have to.
Thanks
Posted by CraigF on May 17, 2001, at 17:39:26
In reply to Mixing wellbutrin/help! » Leighwit, posted by CraigF on May 17, 2001, at 7:36:40
>Sorry for the cheap attention grabber, but I really was hoping for some help before the threads reset and my question is once again lost.
Please Read....
>
> I added WB to Serzone some time back to return some vitality I felt was missing with just Serzone. The initial effects were good, energizing, etc., but I eventually became aggressive, frustrated, and couldn't concentrate. Come to find out, a metabolite of Serzone that can cause anger is aggrevated by WB.
>
> I'm curious to see how you fare on this
>
> Also, more recently, I tried taking WB 75x2 per day so I can go down on my Celexa dose (50 mg). It made me cry a lot and feel hopeless (the same reaction I had years ago when I added it to Prozac!!)
>
> I told my doctor about the reaction and she took the easy way out:
>
> "It's your worsening depression and not anything to do with WB...increase you Celexa"
>
> But I see a pattern, due to my past experience with WB and Prozac.
>
> Can anyone relate to this SSRI/WB phenomenon? does it going away after several days? I don't want to make myself feel any worse than I have to.
>
> Thanks
Posted by Paige on May 17, 2001, at 17:58:27
In reply to FIRE!RAPE!NAUGHTY BITS!, posted by CraigF on May 17, 2001, at 17:39:26
Got my attention! Might want to try it out on
this doctor you mentioned, but then she may add
more meds. These doctors...I am sorry to hear your
story, very sorry.I have not combined SSRI/WB (only for 1 day-so
that proves nothing), but I will say that as
I increased WB, I started crying again and got off
it and naturally my doc said I did not stay on
it long enough...how on earth could I??I hope you find your answer and soon. There have
got to be some rare side effects out there
somewhere. I know when I stopped Celexa (I only
took this by itself) and I weaned off it, I
cried and cried and cried for no reason. So rather
than go to a doc , I went to a pharmacist and she
shed the light on all that serotonin in your system
and now you don't have it and this is not an uncommon
side effect.On a lighter note, because I probably have not
helped you at all, only that we both cry and we
both took same meds, I thought about a new
treatment for depression, I take no meds and have
everyone else around me medicated instead. This
may solve more than I realize. I hope you at least
got a little laugh amongst your tears.Keep the faith, find a good doc who listens well.
Best of luck to you-
Paige
Posted by Paige on May 17, 2001, at 19:14:24
In reply to FIRE!RAPE!NAUGHTY BITS!, posted by CraigF on May 17, 2001, at 17:39:26
go to babble search and type in crying and read
some of the notes. I am wondering myself now
about Wellbutrin at high doses for some....
Paige
Posted by Cateb on May 20, 2001, at 2:01:41
In reply to Mixing wellbutrin/help! » Leighwit, posted by CraigF on May 17, 2001, at 7:36:40
Leighwit,
Great question I have been grappling with recently with Wellbutrin, Zoloft and Topamax. Here's my bottom line. If you've got this symptom (and I had the same one for 2 1/2 years before figuring out on my own that it was Wellbutrin), it won't go away; it's not like the nausea or dizziness you first get when you're adjusting to an AD. Beware. And lifting the dose defies common sense. That will only make it worse.
I had thought it was the combo of Topamax and Wellbutrin that was causing my problems but your question makes me wonder whether it could also have been an interaction of Wellbutrin and Zoloft. Where did you learn about the metabolites? In either case, I had a similar experience on Wellbutrin and all my doctor did (two of them actually; I moved from CT to MA and they were like clones) was give me Xanax to deal with the anxiety and rage that I was experiencing. Yet I had never had those feelings when I was just on the Zoloft. And with Zoloft I perversely never cried; even when I should have, at least while it was working correctly...
So why was I on Wellbutrin to begin with? Well, because I had terrible post-partum depressions after each of two children. The first led me to go on Zoloft, which I stayed on. The second led me to experience Zoloft poop-out, even though my doctors kept me on the drug throughout. So the solution was to add Wellbutrin. Then up and up it to 300 mg along with 3mg a day of Xanax. Then when the Xanax wasn't killing the rage/edge, they went to mood stabilizers: first Depakote then Topamax. Depakote gave me more typical side effects but somehow Topamax further combined with the Wellbutrin I think to make me agitated to the point of true psychic pain and churning/suicidal thoughts for the first time in my life. It was only when I removed both drugs that I not only felt like I was among the living again, but all symptoms of bi-polar just evaporated. (I now have to wonder whether these drugs actually *brought on* the bi-polar illness, since I'd never had any problems before and they disappeared so magically)
Now, I'm just on Zoloft...no Wellbutrin, no Topamax, no Xanax...it's great. and a miracle. Zoloft isn't in poop-out mode any more because of course I'm well beyond post-partum depression. I do get serious migraines, which I have also sought treatment for with these meds, but nothing is worth what I just went through. I can truly say that psychic pain is worse than physical pain now that I have experienced it.
Let me know how you fare. Cate.
A couple of things...
>
> I added WB to Serzone some time back to return some vitality I felt was missing with just Serzone. The initial effects were good, energizing, etc., but I eventually became aggressive, frustrated, and couldn't concentrate. Come to find out, a metabolite of Serzone that can cause anger is aggrevated by WB.
>
> I'm curious to see how you fare on this
>
> Also, more recently, I tried taking WB 75x2 per day so I can go down on my Celexa dose (50 mg). It made me cry a lot and feel hopeless (the same reaction I had years ago when I added it to Prozac!!)
>
> I told my doctor about the reaction and she took the easy way out:
>
> "It's your worsening depression and not anything to do with WB...increase you Celexa"
>
> But I see a pattern, due to my past experience with WB and Prozac.
>
> Can anyone relate to this SSRI/WB phenomenon? does it going away after several days? I don't want to make myself feel any worse than I have to.
>
> Thanks
Posted by Paige on May 20, 2001, at 6:43:13
In reply to Re: Mixing wellbutrin/help!, posted by Cateb on May 20, 2001, at 2:01:41
Cate,
Hope you don't mind if i add that a friend of mine
(also in CT, I lived there and moved to MA too!)
who had cancer was given prednisone on top of her
cancer meds and this induced diabetes. A friend found
her on the kitchen floor collapsed and in a diabetic
coma from the med/mix. She recovered, but it was
medically induced. Why would it be different from
AD? I have more anxiety with some and feel more depressed
from others and looking back when it all started
looked almost normal by comparison.I wish you
good luck and again, I apologize for interfering
with your post to Leighwit and to Leighwit too.
Paige
Posted by Cateb on May 20, 2001, at 16:44:37
In reply to Re: Mixing wellbutrin/help! » Cateb, posted by Paige on May 20, 2001, at 6:43:13
Paige, you don't need to apologize for commenting on a post; anything on the board is open for discussion and I was glad to hear from you. I enjoy your posts.
I had noticed that earlier you had said that WB had made you go on a crying jag. When I was on Zoloft alone I never ever cried. But last year I started these heavy crying benders. At the time I thought it was the Depakote they put me on (they gave me a new dx of bipolar II) but it was also then that my pdoc had moved me all the way up to 300 mg of Wellbutrin!! I remain convinced that somehow the WB was involved in creating some of the need for the mood stabilizers as well as Xanax. If I wasn't really bipolar, it certainly explains why I had such violent reactions to the Topamax in particular.
Like you, my depression hit out of nowhere, in my case five years ago after I had my first child, and then decided not to leave (neither the kid nor the depression!). I'm 42.
Keep posting! Cateb.
........................................
Cate,
>
> Hope you don't mind if i add that a friend of mine
> (also in CT, I lived there and moved to MA too!)
> who had cancer was given prednisone on top of her
> cancer meds and this induced diabetes. A friend found
> her on the kitchen floor collapsed and in a diabetic
> coma from the med/mix. She recovered, but it was
> medically induced. Why would it be different from
> AD? I have more anxiety with some and feel more depressed
> from others and looking back when it all started
> looked almost normal by comparison.
>
> I wish you
> good luck and again, I apologize for interfering
> with your post to Leighwit and to Leighwit too.
> Paige
Posted by Paige on May 20, 2001, at 17:36:14
In reply to Re: Mixing wellbutrin/help! » Paige, posted by Cateb on May 20, 2001, at 16:44:37
Thanks, Cate.
I always feel like I am intruding with the posts
sometimes. Look into the post I started below re:
dopamine and crying and read what everyone is saying.
It is very interesting and helpful I think.The only thing I take now is klonopin for anxiety, but
I know soon I will have to start with the other stuff.
I just dread it so much. I like WB, keeps me
focused, but I was awake at 4am every morning!
Now I sleep normal and don't need to take as much klon,
with wellbutrin I take 2mg, without I can wean off
nicely with no fear.It is hard on the system to deal with all these pills.
Mixing and matching and upping and lowering and
balancing and well, what have I left out???I wish you luckk and I promise to keep posting. Thanks.
Thanks for your support and kind words too.But please do read what Cam and St. james, and Sal and
a host of other far more well informed people
than I have to say.This board really , for me,
wonderful, helpful, and supportive.thanks again, Cate.
Paige
Posted by Leighwit on May 21, 2001, at 10:47:18
In reply to Re: Wellbutrin Celexa » Leighwit, posted by Paige on May 15, 2001, at 18:31:20
Paige,
A lot of your post (below) resonates with me. I'm 43, and generally concur with your overall sentiment(s).
I switched to Serzone from Celexa to augment the Wellbutrin, because the Celexa caused huge weight gain in me. Since discontinuing it, my weight gain has stopped. Stopped cold; for the first time since I started Celexa over one year ago (and 30 pounds lighter ago!)
The Serzone, after two weeks, is thus far not taking the edge off the WB side effects, nor is my depression as well treated as when I took the WB/Celexa combo.
I've been dealing with this since the birth of my first and only child ten years ago. While personal detachment is likely a requisite/critical professional skill for psychiatrists, I have indeed met one or two whose detachment level seems to reach the point of distraction. A distraction which might keep the patient from working at clear, precise communication (which is especially difficult for depressives); and a distraction that can keep the doctor from performing to the best of his or her ability. (Assuming that listening and disseminating information as "unique" to each patient is a performance measurement). --
Highly competent professional objectivity we need. Wrote verbal scripts and mechanical ears, we don't need. If it's all so standardized -- from the diagnostics to the treatment -- then perhaps all we need is a psychiatric nurse practitioner and far lower costs. I don't think it is that simple. Shame on psychiatrists who underestimate their potential value.
I have always chosen to put up with a fair amount of bland, no personality, never-a-smile practitioners if I felt the quality of their professional credentials/and or the quality of my own care experience, warranted me tolerating a lack of social grace.
Sounds like that's what you're doing with your current doctor, which might be good. IF you're feeling confident that his competence is exceptional.
Just remember, though -- lousy psychiatrists often charge the same fees as top-of-the-field psychiatrists charge. Same dollars. Vast difference in the quality of care.
People can argue semantics over this, but generally, it is true. I recently had surgery by a doctor listed in Chicago Magazine's List of Best Doctors. It didn't cost me more than the first opinion doctor would have. It might, however, have saved my life given the fact that complications kept me in the hospital for seven days following out-patient surgery.
Same thing has been true for the many endocrinogists I've been cared for over the past 32 of my 43 years. The best were not, at their respective times, more expensive than the worst.
Competence not only does not necessarily cost more, it doesn't have to come at the cost of your own personal comfort and "gut" confidence in your doctor.I have a lot of experience in this area, having been a juvenile-onset diabetic most of my entire life. I've usually seen at least six physician specialists on a regular basis; right now I see eight.
The best endocrinologist I've been treated by, was not generally considered a sociable personality type. Many patients would request to be seen by one of his partners because they couldn't get enough "warm and fuzzies" from him, typically termed "not a caring personality". In my mind, they were completely mistaken. The exceptional quality of his care produced a caring bond over the 12 years I saw him. I credit his cutting-edge efforts for being complication-free against most odds for someone diagnosed in 1968. I missed him terribly when we moved from the DC area, and continue to feel a deterioration in my previously optimum level of care. Perfect is tough to beat.
My long-developed theory on doctors is that those who excel in their field, are typically highly caring physicians. I not only do not think the two are mutually exclusive, I think they are intertwined.
I look first and foremost for exceptional credentials and competence; and then for the instinctive feeling that a doctor is not going to be a passive "witness", someone more interested in managing his time than in managing his patients' health care.
Find the "best of the breed" medical doctor or psychiatrist in your region, and you'll find a physician who, regardless of personality type, cares deeply about his/her patients.
Mediocre care from a nice doc, is not a good choice for body or mind. Top-notch care from someone we can trust, however,is a fabulous choice.
And the better the care, the farther your money will go. In your case, 100% of every expense is your money. Mediocre doctors are always more expensive. I was without insurance for several years in my twenties, and remember learning that lesson the hard way. It's particularly true for Pdocs. They aren't running tests typically, they're consulting. Once you are feeling better, you may only have to see him/her every 3-4 months. When things are not working, you need to see them more often. You don't feel well right now, and are waiting longer than you probably should in order to manage cash-flow. Is he worth this wait?
I know it's hard to make decisions, or to even think clearly at all -- when you're falling deeper in the well of depression. I also know that when you're feeling that way, and when every penny of care is from your own pocket (we have insurance and our out-of-pocket costs for 2000 reached $9K...) it's important to find the best doctor you can find your way to see. It's the mediocre ones that will empty your pockets for only mediocre results.
If your gut instinct tells you that this guy isn't going to be instrumental in continuously charting your "best possible" care and recovery, fire him. You can pick any doctor you choose since you don't have to use a PPO or an HMO...another reason not to settle for second-best.
Sorry for the ramble. Hope something here has either helped, or given you some thoughts worth adding to your own. If not, write back anyway. < g >
Leighwit
Leighwit,
>
> Boy, looking at my last post,it's a good thing i
> didn't say I was an english manjor or anything.
> Sorry for all the typos and I hope you made it though
> them okay.
>
> Yes, maybe this is a terrible way, but I love this board
> and the knowledge and support. My pdoc thinks I am a bit
> crazy when i come back at him with mucho info, but
> that is his perogative I suppose. I tried, once, some
> time ago, the combo for one day of Celexa and 150mg
> of Wellbutrin and I felt like I had food poisoning.
> It was very strange. Maybe for some people it has
> that affect . My doc is good, but he is very by the book,
> and MDish. Typical, distant, take this pill, and take that pill
> kinda guy. I guess alot of these psychiatrists are like this.
> Great field if you can't cope with getting close to
> people. Anyway! So I never bothered again and
> is one of the reasons I was so curious about your combo.
> How high of a dose of Celexa were you taking?
> Couldn't a low dose keep the side effects at bay atleast
> a little?
>
> I wish you all the luck there is out there. I hate
> feeling so blue. Most people I know do not relate
> to it at all and it leaves you feeling very much alone
> and isolated, at least it does me. Nothing has
> worked for me, nothing. I hope the Serzone combo works.
> Sounds like your doc is working on several
> "receptors" at once. Why the switch to Serzone? I have
> never tried it.
>
> I have to do something soon because I am getting at
> my lowest again which is pretty low. I don't
> see the doctor crew until June 14th and I fear I
> need them sooner. I have no insurance, so I
> can't just randomly go anytime I want, I have to plan
> every financial and psychological treatment move!
>
> Let me know how you are feeling and keep in touch too.
>
> I have clinical depression, some genetic wiring,
> some psychological. I have never felt right since
> I can remember and I am 40. It hit me real hard
> 4 years ago. I have never been the same since.
> I thinked I snapped back then and now here I am, not
> knowing who or what or where and wondered if I ever
> really did.
>
> Take care of yourself, Leighwit
>
> Paige
Posted by Leighwit on May 21, 2001, at 12:13:08
In reply to Mixing wellbutrin/help! » Leighwit, posted by CraigF on May 17, 2001, at 7:36:40
Craig,
Thanks for your comments about Serzone and WB combined. I'm not seeing any positive effects from the Serzone addition yet, maybe even some negative (mental confusion) so I think I'll probably move to something else next week at my next Pdoc appt.
I think I agree with your Pdoc about the WB not causing a deterioration in your depression symptoms. It's more likely to cause irritability. It's not likely at all to worsen depression symptoms, like melancholy. 75 mg. isn't much WB anyway. I took only 10 mg (1/2 tab) of Celexa at bedtime, along with 150 mg. of Wellbutrin 2x/day, and did quite well, were it not for the weight gain (not an acceptable side effect for a diabetic.) Do you know why your Pdoc is preferring to up the Celexa instead of upping the WB dosage? Just curious.
Thanks again for sharing the Serzone info. I took it alone for a couple of months a few years ago, and didn't accomplish anything. I'm not seeing much hope for it as an augmenter to WB, either (in my case, that is.)
Leighwit
> A couple of things...
>
> I added WB to Serzone some time back to return some vitality I felt was missing with just Serzone. The initial effects were good, energizing, etc., but I eventually became aggressive, frustrated, and couldn't concentrate. Come to find out, a metabolite of Serzone that can cause anger is aggrevated by WB.
>
> I'm curious to see how you fare on this
>
> Also, more recently, I tried taking WB 75x2 per day so I can go down on my Celexa dose (50 mg). It made me cry a lot and feel hopeless (the same reaction I had years ago when I added it to Prozac!!)
>
> I told my doctor about the reaction and she took the easy way out:
>
> "It's your worsening depression and not anything to do with WB...increase you Celexa"
>
> But I see a pattern, due to my past experience with WB and Prozac.
>
> Can anyone relate to this SSRI/WB phenomenon? does it going away after several days? I don't want to make myself feel any worse than I have to.
>
> Thanks
Posted by Leighwit on May 21, 2001, at 12:26:50
In reply to Re: Mixing wellbutrin/help!, posted by Cateb on May 20, 2001, at 2:01:41
Cate,
Wow. Very interesting stuff...
BTW, I wasn't the one who posted about metabolites, but I did read the post you were referring to. I'm not sure what a metabolite is, exactly.
Great to hear that you're doing so well one one drug. That's great!
Leighwit
> Leighwit,
>
> Great question I have been grappling with recently with Wellbutrin, Zoloft and Topamax. Here's my bottom line. If you've got this symptom (and I had the same one for 2 1/2 years before figuring out on my own that it was Wellbutrin), it won't go away; it's not like the nausea or dizziness you first get when you're adjusting to an AD. Beware. And lifting the dose defies common sense. That will only make it worse.
>
> I had thought it was the combo of Topamax and Wellbutrin that was causing my problems but your question makes me wonder whether it could also have been an interaction of Wellbutrin and Zoloft. Where did you learn about the metabolites? In either case, I had a similar experience on Wellbutrin and all my doctor did (two of them actually; I moved from CT to MA and they were like clones) was give me Xanax to deal with the anxiety and rage that I was experiencing. Yet I had never had those feelings when I was just on the Zoloft. And with Zoloft I perversely never cried; even when I should have, at least while it was working correctly...
>
> So why was I on Wellbutrin to begin with? Well, because I had terrible post-partum depressions after each of two children. The first led me to go on Zoloft, which I stayed on. The second led me to experience Zoloft poop-out, even though my doctors kept me on the drug throughout. So the solution was to add Wellbutrin. Then up and up it to 300 mg along with 3mg a day of Xanax. Then when the Xanax wasn't killing the rage/edge, they went to mood stabilizers: first Depakote then Topamax. Depakote gave me more typical side effects but somehow Topamax further combined with the Wellbutrin I think to make me agitated to the point of true psychic pain and churning/suicidal thoughts for the first time in my life. It was only when I removed both drugs that I not only felt like I was among the living again, but all symptoms of bi-polar just evaporated. (I now have to wonder whether these drugs actually *brought on* the bi-polar illness, since I'd never had any problems before and they disappeared so magically)
>
> Now, I'm just on Zoloft...no Wellbutrin, no Topamax, no Xanax...it's great. and a miracle. Zoloft isn't in poop-out mode any more because of course I'm well beyond post-partum depression. I do get serious migraines, which I have also sought treatment for with these meds, but nothing is worth what I just went through. I can truly say that psychic pain is worse than physical pain now that I have experienced it.
>
> Let me know how you fare. Cate.
>
> A couple of things...
> >
> > I added WB to Serzone some time back to return some vitality I felt was missing with just Serzone. The initial effects were good, energizing, etc., but I eventually became aggressive, frustrated, and couldn't concentrate. Come to find out, a metabolite of Serzone that can cause anger is aggrevated by WB.
> >
> > I'm curious to see how you fare on this
> >
> > Also, more recently, I tried taking WB 75x2 per day so I can go down on my Celexa dose (50 mg). It made me cry a lot and feel hopeless (the same reaction I had years ago when I added it to Prozac!!)
> >
> > I told my doctor about the reaction and she took the easy way out:
> >
> > "It's your worsening depression and not anything to do with WB...increase you Celexa"
> >
> > But I see a pattern, due to my past experience with WB and Prozac.
> >
> > Can anyone relate to this SSRI/WB phenomenon? does it going away after several days? I don't want to make myself feel any worse than I have to.
> >
> > Thanks
Posted by Leighwit on May 21, 2001, at 12:38:04
In reply to Re: Mixing wellbutrin/help! » Paige, posted by Cateb on May 20, 2001, at 16:44:37
Cate, Paige, all:
Interesting that you mentioned your pregnancy in conjuntion with recurrent (as opposed to post-partum) depression, Cate.
You were 37 when you had your first; I was 34. My depression also came on like a lightening bolt following that pregnancy, ten years ago.
I suppose we are all looking for correlations with which the onset of our conditions make some sort of sense ... but I have to wonder if first full-term pregnancies after thirty correlates with a risk for this. I've read about such occurances many times on various newsgroups but I never thought about a correlation until your post.
Not that it matters. I'm much more interested in learning of a cure rather than a prevention. How selfish, eh?
Leighwit
P.S. Me Too! (Re: Below)
< < < Paige, you don't need to apologize for commenting on a post; anything on the board is open for discussion and I was glad to hear from you. I enjoy your posts. Cate > > >
Posted by CraigF on May 21, 2001, at 14:00:19
In reply to Re: Mixing wellbutrin/help!, posted by Leighwit on May 21, 2001, at 12:13:08
Leighwit:
you might want to look into Remeron and WB combined. I think Remeron is a more effective AD than Serzone (which I wouldn't recommend to anyone after my experience) and may not cause weight gain and daytime sedation when taken at the higher doses.
Check it out! Also, I'm about to attempt replacing my Celexa with Amisulpride, an atypical Anti psychotic available overseas. No weight gain potential there, from what I hear.
and BTW, I returned my Celexa dose to 50mg, and tried adding Wellbutrin again, only to have the same crying/sadness bullshit return.
Posted by Leighwit on May 21, 2001, at 14:14:04
In reply to Re: Mixing wellbutrin/help!, posted by CraigF on May 21, 2001, at 14:00:19
Craig, Elizabeth, et al:
I'm not sure about Remeron. I put Elizabeth's name in the subject to ask this question of her. She's a "single-sourced multiple-resource databank" for this kind of stuff....
E: What are the pros and cons of mixing Remeron with Wellbutrin?
Too bad about your Celexa experience, Craig. Good luck with the amisulpride, of which I know absolutely nothing.
Leighwit
> Leighwit:
>
> you might want to look into Remeron and WB combined. I think Remeron is a more effective AD than Serzone (which I wouldn't recommend to anyone after my experience) and may not cause weight gain and daytime sedation when taken at the higher doses.
>
> Check it out! Also, I'm about to attempt replacing my Celexa with Amisulpride, an atypical Anti psychotic available overseas. No weight gain potential there, from what I hear.
>
> and BTW, I returned my Celexa dose to 50mg, and tried adding Wellbutrin again, only to have the same crying/sadness bullshit return.
This is the end of the thread.
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