Transitioning off Wellbutrin

[alawyerperson]

'll try to keep this brief, but I tend to...not be brief, so bear with me. 

Roughly nine or ten years ago, I was diagnosed with GAD and OCD (mostly "O"). At the time, I was in therapy and taking Zoloft. I continued doing so for a few years, at which time I felt I wanted to wean off the Zoloft. I was in a pretty secure place in my life, and it seemed appropriate. 

I was fine for several years, but, a couple of years ago, I found myself in a very stressful relationship and life situation, and my anxiety was just spiraling out of control. I was prescribed Zoloft again, but started to become unhappy with the sexual side effects. My doctor then prescribed me a low dose of Wellbutrin (well, buproprion) to combat that. 

I found that even with the Wellbutrin, I was having sexual side effects. With my doctor's supervision, I weaned off of Zoloft. I found that the Wellbutrin dose I was taking, standing alone, wasn't doing much, so we upped my dosage to the point where I am now taking 450 mg/day (1 300 XR and 1 150 XR in the morning) and having been doing so for nearly a year. 

In some ways, I like the way Wellbutrin makes me feel. It gives me energy, it keeps me in generally good spirits, and, while at times I feel a little TOO excitable (usually when I drink too much caffeine), it's a different kind of anxiety, and I find it easier to deal with.

THAT all said, there are things about being on Wellbutrin that really don't appeal to me. I understand that most people go the other direction as far as sexual side effects when they start taking Wellbutrin, but I still feel...a bit...dulled, I guess? It's worlds better than being on Zoloft, but there's still something there that's not quite right, if that makes sense. I haven't heard anyone else saying that they've had this experience, so maybe it's just me. While I do find the "kind" of anxiety I experience on Wellbutrin to be more manageable, it's still kind of uncomfortable, and there have been times when I feel like the Wellbutrin is making me OVERLY emotional, mostly in the anger and resentment direction. I also have ton of stomach issues, and I'm not thrilled with putting chemicals in my body if I don't have to(please note, I'm not saying I'm against people putting chemicals in their body if they need or want to, just in my particular situation...it feels unsettling). In addition, I do believe it affects my sleep, some times more than others. My doctor prescribed me Trazodone, but I didn't care for it. I am also a MMJ patient because of my stomach problems, so I like using that better to assist with sleep, although lately I've been having trouble sleeping even with that. I am in a much calmer and secure place in my life than I was when I first started back on meds, and I think now would be a good time to try to get off them if possible. 

I'm wondering a few things. First of all, has anyone had success doing this? I guess the worst case scenario is I have to go back on the meds, and that's that. I've tried to be diligent about self-care, taking appropriate supplements, etc. to make the transition as easy as possible, but I know there will be a period where I'm experiencing some kind of withdrawal symptoms. What can I expect in that area? 

My final question, and this feels odd to ask, but I figure I'll just put it out there...what I WOULD like to do, just as a safety net, is try a prescription for Xanax or Ativan or something, only to be used in emergency situations. Are there others who use those meds in that fashion? How do you approach it with your doctor? I know my prescriber is VERY reluctant to prescribe benzos (understandably so), and I'm anxious (hah!) about being perceived as "med-seeking" or eager to go on some weird benzo binge. I took Klonopin BRIEFLY when I was first on meds, and hated the way it made me feel and act, so I pretty abruptly stopped using it regularly and only saved it for emergency situations, which was helpful. After that, I never renewed my prescription. 

Any thoughts on this situation would be much appreciated. Thanks in advance.

[melissaw72]

Welcome to CB!

2 hours ago, alawyerperson said:

I am in a much calmer and secure place in my life than I was when I first started back on meds, and I think now would be a good time to try to get off them if possible. 

That is great you are much calmer and more secure in your life now.  I was thinking how the meds are working right now, and if you were to go off of them, you might start having problems again that need the med/s back.  And sometimes if you go off of them, then come back on the meds you had been on, it is not always the same as it was when you had been taking them.  If that makes sense.

2 hours ago, alawyerperson said:

I guess the worst case scenario is I have to go back on the meds, and that's that

But like I wrote above, going off meds, to back on them, you may not feel the same as you initially did when on the meds.  I have not stopped meds because I was feeling better.  I stayed on them to continue to feel better.

About the withdrawals that could happen, I think you should work out a weaning down schedule (or whatever it is called) with your pdoc (psychiatrist).  I would not go cold turkey (NOT saying you would be, just saying some people do).

2 hours ago, alawyerperson said:

what I WOULD like to do, just as a safety net, is try a prescription for Xanax or Ativan or something, only to be used in emergency situations. Are there others who use those meds in that fashion? How do you approach it with your doctor?

I am on xanax as an as needed med for emergencies.  I didn't need to approach my pdoc about it.  Just talking to him and telling him what was going on, he prescribed them without me asking.

2 hours ago, alawyerperson said:

I'm anxious (hah!) about being perceived as "med-seeking" or eager to go on some weird benzo binge.

I think how you word things makes a difference.  Without asking directly for a benzo, I would tell pdoc what is going on in your life, and was wondering if s/he (pdoc) had any suggestions.  And within that conversation maybe suggest a benzo.  But I would not flat out ask for a benzo.  That could look like med-seeking and you do not want that put on your records.

2 hours ago, alawyerperson said:

abruptly stopped using it regularly and only saved it for emergency situations, which was helpful. After that, I never renewed my prescription. 

Just wondering ... Why didn't you renew the prescription if it was helping you in emergency situations?

 

 

[alawyerperson]

I complete understand what you're saying. I guess I should just stick with it? I do like Wellbutrin, but as I said, I don't like how keyed up it makes me feel sometimes...I MUCH preferred Zoloft, but I really was unhappy with the sexual side effects. If those didn't exist, I wouldn't have switched over, but...I don't know. I hate having to choose between not being anxious and having a normal sex life, which is something that is really important to me. I don't know how to solve that problem. 

Thank you for your advice on talking to my doc. I am seeing her next week. I'm really back and forth on this. I should have clarified about the Klonopin - it was prescribed to me at the end of college (c. 10 years ago), and by the time I finished the scrip, I had a. moved away from my pdoc and hadn't found another one and b. was 22 and foolish and thought I didn't need it. 

Thanks again for your thoughts. Any further advice is always appreciated! 

[melissaw72]

5 minutes ago, alawyerperson said:

I complete understand what you're saying. I guess I should just stick with it?

Personally speaking, I would continue taking it.

6 minutes ago, alawyerperson said:

I do like Wellbutrin, but as I said, I don't like how keyed up it makes me feel sometimes

Maybe it could be something like a dose change that you need.  I would ask your pdoc about possible lowering the dose.  Wellbutrin can make a person keyed up if on too much.

8 minutes ago, alawyerperson said:

I hate having to choose between not being anxious and having a normal sex life, which is something that is really important to me. I don't know how to solve that problem. 

This is something that I'd talk to your pdoc about ... there are meds out there that are prescribed for sex problems (Idk names of any other than viagra, but I think your pdoc might have some other suggestions).

Ohh, ok, I understand about the klonopin now.  Thanks for the explanation.

I hope you have a productive appt next week!

[alawyerperson]

Lowering the dose is a great idea. I kicked up to 450 when I was tapering off Zoloft because my moods were going off the rails. Maybe now I could move back down...

[Wooster]

Howdy and welcome to CrazyBoards.

I'm currently taking both sertraline (100mg) and Swellbutrin (450mg, same as yours w timing and extended release), and have both 20mg tabs of propranolol (can take up to 100mg as needed) and 0.5mg clonazepam for ridiculous anxiety that my other tools aren't as effective as I would wish. My current rate of clonazepam usage is about half of a 0.5mg tablet 2-3 times a month, so a 30# prescription lasts me quite a while. I suspect this is because I really only use it as a very last resort, and when I've exhausted my ability to use skills to cope.

Have you therapy under your belt like CBT or DBT or MBSR/MBCT to help you manage the anxiety? It seems approaching benzos as a "lifeline"/rescue med with a very small number prescribed (ie 10 tablets in a month or so) is an approach a lot of prescribers would be willing to adopt, especially if you have no history of addiction or substance abuse AND are willing to use behavioral strategies first.

While Swellbutrin is somewhat infamous for causing increased anxiety, I too have found it quite effective for OCD (primarily pure O) and general anxiety symptoms plus depressive symptoms (mine are mostly in response to PTSD that kicks my ass from time to time). I suspect there may be some adverse sexual effects, but to be honest, I don't really notice or mind all that much because of other factors. And similar experience that it's WAY better than sertraline alone, and definitely better with the combo of sertraline and Swellbutrin.

There is an antidepressant that comes in a skin patch. I believe it's called Emsam and is a MAO inhibitor. It comes with some dietary restrictions for things that contain tyramine (fermented cheese, meat, wine/beer, etc), and it's not usually a first or even second line treatment because of that. However, if you're really uneasy about stomach issues, it might be worth talking about with your prescriber.

Keep us posted!

[HAL9000]

I can relate to wanting doable Mental Health more then a normal sex life but thankfully my GDoc would have nothing with that option and changed me off celexa and onto wellbutren.  I think dose does matter.  I got a goofed up script for a rather crazy huge dose and it made me feel pretty weird and twitchy.   Like what would happen if you drank a pot of coffee all at once or something along that line. 

[alawyerperson]

Thanks for your thoughts everyone. I have been back in therapy for the past year and a half or so, but I've been going more sporadically. My pdoc knows that, so you're right - hopefully if I do end up requesting benzos, she'll understand that I am someone who is not going to just use them willy-nilly...I'm willing to put the work in. I also don't have a history of substance abuse or anything like that. 

Wooster, I'm glad you noted how effective Wellbutrin is for OCD. I've had that experience as well, and in the days since I've posted this, I've been thinking about whether or not I can live with my intrusive thoughts coming back. I guess there's no guarantee that they will, but they always have before. I hope that you guys are right and that there is some happy medium that can be reached with a lowered dosage or different cocktail or something. 

I'll be sure to keep everyone updated! 

[Mochitto]

On 27-10-2016 at 9:17 PM, melissaw72 said:

Welcome to CB!

That is great you are much calmer and more secure in your life now.  I was thinking how the meds are working right now, and if you were to go off of them, you might start having problems again that need the med/s back.  And sometimes if you go off of them, then come back on the meds you had been on, it is not always the same as it was when you had been taking them.  If that makes sense.

But like I wrote above, going off meds, to back on them, you may not feel the same as you initially did when on the meds.  I have not stopped meds because I was feeling better.  I stayed on them to continue to feel better.

About the withdrawals that could happen, I think you should work out a weaning down schedule (or whatever it is called) with your pdoc (psychiatrist).  I would not go cold turkey (NOT saying you would be, just saying some people do).

I am on xanax as an as needed med for emergencies.  I didn't need to approach my pdoc about it.  Just talking to him and telling him what was going on, he prescribed them without me asking.

I think how you word things makes a difference.  Without asking directly for a benzo, I would tell pdoc what is going on in your life, and was wondering if s/he (pdoc) had any suggestions.  And within that conversation maybe suggest a benzo.  But I would not flat out ask for a benzo.  That could look like med-seeking and you do not want that put on your records.

Just wondering ... Why didn't you renew the prescription if it was helping you in emergency situations?

 

 

I wa since 2 years on 50gr zoloft (sertraline) wich stalised my depression without too much side effecrs except sex drive which was more or less gone. I switched to luvox (luvoxamine) 100mg  and after 5 weeks I notice a significant diffrence when it comes to sex drive...still not as good like in the old days but hugh improvement...really enjoying sex again!! :-) wich makes a big difference. The backside is that im still verry tired on Luvox but its seem to slightly improve. Furthermore I don't feel as stable in my mind (anxiety in the begining) an d now still combination of really good happy days followed by depressed/anxiety days. i hope this will improve. Great to have my sex drive back for 60%...however I want some stabilety and specially more energy as i feel often verry tired.                                                                         Does anyone has simmilar experience? Will the fatigue/energy level get better?  Any other ecommendations??

 

 

 

 

[melissaw72]

1 hour ago, Mochitto said:

I wa since 2 years on 50gr zoloft (sertraline) wich stalised my depression without too much side effecrs except sex drive which was more or less gone. I switched to luvox (luvoxamine) 100mg  and after 5 weeks I notice a significant diffrence when it comes to sex drive...still not as good like in the old days but hugh improvement...really enjoying sex again!! :-) wich makes a big difference. The backside is that im still verry tired on Luvox but its seem to slightly improve. Furthermore I don't feel as stable in my mind (anxiety in the begining) an d now still combination of really good happy days followed by depressed/anxiety days. i hope this will improve. Great to have my sex drive back for 60%...however I want some stabilety and specially more energy as i feel often verry tired.                                                                         Does anyone has simmilar experience? Will the fatigue/energy level get better?  Any other ecommendations??

Personally, I would tell pdoc about what you said here (in your post) and see what pdoc says.  Maybe he'll re-evaluate you and offer a new med, and/or a med tweak?