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My new p-doc doesnt even now what wellbutrin is!

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Hi guys,

I'll try and keep this brief.

I have been seeing a new p-doc for 8 months, 6 months of which was a clozapine trial. The cloz has worked out well, for the most part. I am still getting some break through symptoms., and it is likely that my new p-doc will increase my clozapine dose in 4 weeks time.

Anyway, unfortunately my p-doc has just retired, and I am seeing a new p-doc who has replaced him. Yesterday was my second appointment (seeing him every 3-4 weeks). I brought up a couple of things in my appointment.

1) I have recently quit smoking cigarettes. Ive been clean for 4 months now. My agitation levels have increased since I quit smoking. I have done some research and it would appear that wellbutrin, or zyban as its called here in Australia, could well work for my smoking related agitation, as well as augmenting the effect of my ssri.

2) So I mention to my new p-doc, hey, what about zyban. He says to me, yes, Ive heard of it, and proceeds to look it up on the net using his iphone. He asks me if there is nicotine in it. I say to him, umm, no? He then does a drug interactions check and says, possibly dangerous interaction with clozapine. So there goes that idea.

3) I currently take 10mg valium prn. I ask p-doc about xanax. He says no way, too addictive. He says stick with the valium. I say to him, I am currently getting valium from my GP (as well as my prozac). He says, he is happy to take over this script but not until my next appointment. So I have to wait another 4 weeks. Meanwhile I will need to see my GP again to get more.

4) I say to p-doc, mate what about increasing my clozapine - Im still getting intrusive thoughts. He says, yes that is a good idea, but we need to do a blood test to check the cloz levels first. Now this pisses me off as I had 4 blood tests done the day before my appointment, but not a cloz level test. So no action will be taken until my next appointment. So I have to wait another 4 weeks. FFS.

So he then dismisses me 10-15 minutes later. I walk out feeling like I have just wasted my time and will not see any improvement for another 4 weeks minimum.

What do you guys think? Are my expectations unreasonable?

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Here is a drug-drug interaction that I did on drugs.com using the drugs in your sig and zyban:


So you can check that out.

I can understand how some docs don't want to prescribe Xanax. I don't think my pdoc really likes me taking the amount of Xanax that I am on (2mg/d), but he understands that I don't abuse the drug, or take more than prescribed, so he has been giving me the script month after month.

I'm surprised that a Clozaril level wouldn't come from your routine blood work for the medication. That's new to me. I've never heard of that before so I can't comment in that department, but having to wait 4 weeks I don't understand. If you went for that blood work, wouldn't the p-doc get the results in a couple of days and then you can go back to see where to continue? As I've not heard of the Clozaril Level thing, I don't really fully know what to recommend.

I don't think you fully wasted your time because you did express your needs. You asked about Zyban but it interacts with your other meds. Better than him giving it to you and you have a drug-drug reaction. And although not right away you will get an answer next month about your Clozaril, but at least you mentioned something.

While it may not have totally gone the way you liked, I think you did accomplish something.

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According to the link Andy gave above, it is just the standard warning about monitoring for seizures that comes up for Wellbutrin and just about any other psych drug. I don't understand why he doesn't know anything about it and thinks that this "interaction" is all that terrible. Doctors in the US don't have a problem with it.

I just want to say that I understand your frustration with your pdoc. I have a similar frustration too. At least in my case he only does things slowly, but I still walk away feeling like he is wasting my life by moving so slowly because I have to wait at least 4 weeks until my next appoinment.

I'm not sure why your pdoc is putting everything off for a month though. That is strange.

I'm sorry for your situation, and I hope you can get some satisfaction at your next appointment.

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I answered you in chat... but - it only takes 3 days for a blood test. It wouldn't be unreasonable to have one done, then forward the results to your doc for a script. There's really no reason to wait for 4 weeks. Go to a GP, and fax the results via the pharmacy (they will) asking for a refill with a note of "modify my dose".. see what happens.

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According to the link Andy gave above, it is just the standard warning about monitoring for seizures that comes up for Wellbutrin and just about any other psych drug. I don't understand why he doesn't know anything about it and thinks that this "interaction" is all that terrible. Doctors in the US don't have a problem with it.

It is not approved for depression in his country so i would not expect docs to know anything about its a} Use in depression or b} long term use.


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