Getting off Effexor.............Wellbutrin is doing the trick

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    Feb 13, 2011 12:34 AM GMT
    Just to follow up on the great advice many of you gave about my a/d's. I went to the pharmacist first. She checked Effexor (off of which i am weaning) against Wellbutrin and sure enough...Effexor has a 12% problem with ejaculation....so off to my sawbones....he agreed and again cautioned about just dropping off effexor...it has powerful withdrawal symptoms.

    So he has me started on a slow weaning off of Effexor and a quck intro of Wellbutrin............thanks guys,,,,,,,,the pump is working again....anyone experience sexual misfunctions due to Effexor, see your pharmacist...they know more than the doc,,,,,it's there job................Keith
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    Feb 13, 2011 1:53 AM GMT
    stilsurchin said

    ...see your pharmacist...they know more than the doc,,,,,it's there job................Keith


    dangerous generalization above....

    if you had come to me, you would never have been put on Effexor owing to its generally well-known side effects of erectile dysfunction, delayed orgasm and GI impact. it is also common knowledge that it is a difficult medication to stop and that the patient should be tapered down when stopping. whether you were told this by your doctor or not is more a comment about your doctor's attention to detail than his lack of knowledge. in our office, the preferred AD is bupropion (Wellbutrin) because it avoids the adverse effects generally associated with selective serotonin reuptake inhibitors (SSRIs). however, sometimes impacting the dopamine and norepinephrine pathways (like bupropion does) isn't enough to lift a patient's depression, so you will have to add a selective serotonin reuptake inhibitor to make sure all three chemical pathways are addressed. we will sometimes prescribe Wellbutrin to offset the problems caused by SSRIs if a patient is already stable on an SSRI. the combination of Wellbutrin and SSRIs is pretty safe. btw, Wellbutrin has been associated with lowering the seizure threshold, particularly in individuals with a history of seizures. the combination of Effexor and Wellbutrin can further increase the risk of seizures (although the overall risk is still quite low).

    pharmacists are great at understanding the physiological mechanisms by which allopathic (Western) medications work... they are not, however, allowed to 'prescribe'. just like all practitioners, they are too overwhelmed to keep all potential side effects and interactions with other medications in their heads.... they look it up... as do i prior to prescribing any new medication. all practitioners should do this as well but unfortunately don't. pharmacists have an automated system for checking interactions for any patient who gets all of his or her medications from the same location/chain. try to get all your meds from the same pharmacist.

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    Feb 13, 2011 1:59 AM GMT
    Wellbutrin made me gain weight. icon_eek.gif
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    Feb 13, 2011 2:09 AM GMT
    Keith,
    I discovered the no ejaculation thing on my own. Couldn't handle that! I weaned off of Effexor about 10 years ago.

    What I found out about Wellbutrin is that it stimulates the sex area in my brain, (as if it needed to)! After starting the Wellbutrin, the first 2 nights I had wet dreams. Any time a Doctor wants to try Effexor on me, I refuse!!! Still taking Wellbutrin after all these years!

    Murray
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    Feb 13, 2011 2:12 AM GMT
    One of Welbutrins side effects is an increase in the libido in some patients. Ask me how I know.


    btw as you probably already know but others might now.. Welbutrin for a/d is the same drug as Zyban for quitting smoking.
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    Feb 13, 2011 2:14 AM GMT
    Good luck getting of Effexor. I was never able to. Literally. I can't ever go off it. Even weening down to one less granule within each capsule per day gave me the most intense restless leg syndrome and electrical nerve tingling sensation after one month that I had to go back on it.
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    Feb 13, 2011 5:29 AM GMT
    i know that it is a long weaning period and was warned as much by my doc prior to starting...he also warned me about the sexual disfunction but at the time, he figured it the best drug for my symptoms....I just went to mexico and forgot my meds. The first day without Effexor i felt total shit..like i had an extreme flu....I found out I could buy both a/d's over the counter and the next day, i was fine....

    Now i am weaning every other day, then every third day and so on until i am done with effexor.

    To the Physician above....thanks for your input...well put and well taken..but speaking as a patient and agreeing with a point at the end of your post, docs' get too busy sometimes to follow every med out there. The pharm did look up both drugs manually, whereas my doc only looked up effexor because that is what the walkin clinic doc first prescribed...No fault, no foul....Keith..

    and it is nice to finally climax again....(blushing)icon_redface.gif
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    Feb 13, 2011 6:18 AM GMT
    rightasrain said

    in our office, the preferred AD is bupropion (Wellbutrin) because it avoids the adverse effects generally associated with serotonin reuptake inhibitors (SSRIs). however, sometimes impacting the dopamine and norepinephrine pathways (like bupropion does) isn't enough to lift a patient's depression, so you will have to add a selective serotonin reuptake inhibitor to make sure all three chemical pathways are addressed.


    Glad that bupropion is your go-to AD med in your clinic--better than it being an SSRI, as it still is in most practices. I still prefer prescribing to a patient's individual presentment over a one-size-fits-all approach, though (eg, bupropion when mild-moderate depression is coupled with severe fatigue, avoidance of SSRI/NRI combos when depression is coupled with anxiety.)
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    Feb 13, 2011 6:27 AM GMT
    stilsurchin saidJust to follow up on the great advice many of you gave about my a/d's. I went to the pharmacist first. She checked Effexor (off of which i am weaning) against Wellbutrin and sure enough...Effexor has a 12% problem with ejaculation....so off to my sawbones....he agreed and again cautioned about just dropping off effexor...it has powerful withdrawal symptoms.

    So he has me started on a slow weaning off of Effexor and a quck intro of Wellbutrin............thanks guys,,,,,,,,the pump is working again....anyone experience sexual misfunctions due to Effexor, see your pharmacist...they know more than the doc,,,,,it's there job................Keith


    I am finishing pharmacy school in May. Your comment made me feel good, ha. Thanks!
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    Feb 13, 2011 7:31 AM GMT
    Most SSRIs (such as Effexor) have sexual side effects, usually being delayed ejaculation.... but when you are depressed you usually dont want to have sex anyway. At least with the medication your mood would be better!

    So many people come back to their psychiatrists saying, "I cant have sex... give me back my symptoms!" lol.

    But... for you I am glad that the Wellbutrin seems to be working. It is in a different drug class (NDRI) so it has different indications and side effects...

    The thing is that Wellbutrin isn't as effective as other SSRIs at treating symptoms of anxiety, which is commonly seen co-occuring with depression....
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    Feb 13, 2011 5:06 PM GMT
    ^^ I do experience the odd panic attack but that was when i was on Effexor, so it obv. wasn't addressing the prob....what would you physicians recommend as top on your list?

    Keith
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    Feb 13, 2011 5:29 PM GMT
    BoulderingBum said
    rightasrain said

    in our office, the preferred AD is bupropion (Wellbutrin) because it avoids the adverse effects generally associated with serotonin reuptake inhibitors (SSRIs). however, sometimes impacting the dopamine and norepinephrine pathways (like bupropion does) isn't enough to lift a patient's depression, so you will have to add a selective serotonin reuptake inhibitor to make sure all three chemical pathways are addressed.


    Glad that bupropion is your go-to AD med in your clinic--better than it being an SSRI, as it still is in most practices. I still prefer prescribing to a patient's individual presentment over a one-size-fits-all approach, though (eg, bupropion when mild-moderate depression is coupled with severe fatigue, avoidance of SSRI/NRI combos when depression is coupled with anxiety.)


    agree completely. didn't mean to imply we only prescribe bupropion. SSRIs (old and new) and SNRIs are appropriate contingent on the patient's needs. we simply find most of our patients (99% gay) are unwilling to accept any impact on their sexual function, so a DNRI is a good choice a lot of the time.
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    Feb 13, 2011 5:31 PM GMT
    ZbmwM5 saidMost SSRIs (such as Effexor) have sexual side effects, usually being delayed ejaculation.... but when you are depressed you usually dont want to have sex anyway. At least with the medication your mood would be better!

    So many people come back to their psychiatrists saying, "I cant have sex... give me back my symptoms!" lol.

    But... for you I am glad that the Wellbutrin seems to be working. It is in a different drug class (NDRI) so it has different indications and side effects...

    The thing is that Wellbutrin isn't as effective as other SSRIs at treating symptoms of anxiety, which is commonly seen co-occuring with depression....


    indeed.... as BoulderingBum already alluded to, the norepinephrine reuptake inhibition of Wellbutrin can incite or worsen anxiety/panic in some patients and thus may not be the best choice for someone with depression and anxiety.
  • Darsena532

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    Feb 13, 2011 5:36 PM GMT
    I stated taking WBXL to quick smoking (did two rounds of Chantix previously) and thus far have been successful- quit day after Xmas and doing fine. What I have found is that my general mood is so much better (little of the post-holiday blahs) and the adverse affects of the meds have been minimal.

    I guess it depends upon what is most important to you right now. For me it was the smoking- I needed to quit. Whatever affects associated with the meds (tired, lower libido- whatever) were secondary and acceptable to me.

    Really, what is your ultimate goal? To feel better or not? Sometimes one has to rob Paul to pay Peter.
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    Feb 13, 2011 5:39 PM GMT
    To anyone taking Wellbutrin- how long did it take for it to improve your mood?

    I've taken it for 5 weeks so far and don't really feel "happier" though my depression was mild to begin with. What has happened is that it gives me more energy during the day and cuts my hunger. I've lost 10 pounds (which I'm happy about). No sexual side effects, but no libido lift either.

    How long would you give it to work? I'll contact my doctor once it's been a full 6 weeks.
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    Feb 13, 2011 5:49 PM GMT
    brueges saidTo anyone taking Wellbutrin- how long did it take for it to improve your mood?

    I've taken it for 5 weeks so far and don't really feel "happier" though my depression was mild to begin with. What has happened is that it gives me more energy during the day and cuts my hunger. I've lost 10 pounds (which I'm happy about). No sexual side effects, but no libido lift either.

    How long would you give it to work? I'll contact my doctor once it's been a full 6 weeks.


    ideally, its effects should be subtle. you are a good case of that. you notice very few adverse events but have a lift in energy. hopefully, a mild lift in mood will come as well. we were taught (although there are no hard and fast rules about this) that you should not make a call about the efficacy of an antidepressant until about 8-12 weeks after initiation.

    it is common to see 5-10% weight loss in individuals on Wellbutrin due to the increase in synaptic norepinephrine.
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    Feb 13, 2011 5:55 PM GMT
    stilsurchin said^^ I do experience the odd panic attack but that was when i was on Effexor, so it obv. wasn't addressing the prob....what would you physicians recommend as top on your list?

    Keith


    ask your doctor about BuSpar (buspirone). it is a dopamine reuptake inhibitor with weak serotonin properties. in some individuals, it works well to reduce anxiety without the addictive qualities of benzos (valium, xanax, ativan, et al). the combination of BuSpar and Wellbutrin is safe and has no serious interactions. BuSpar is taken twice daily every day (usually with breakfast and dinner), not on an as-needed basis.
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    Feb 13, 2011 6:06 PM GMT
    rightasrain said
    brueges saidTo anyone taking Wellbutrin- how long did it take for it to improve your mood?

    I've taken it for 5 weeks so far and don't really feel "happier" though my depression was mild to begin with. What has happened is that it gives me more energy during the day and cuts my hunger. I've lost 10 pounds (which I'm happy about). No sexual side effects, but no libido lift either.

    How long would you give it to work? I'll contact my doctor once it's been a full 6 weeks.


    ideally, its effects should be subtle. you are a good case of that. you notice very few adverse events but have a lift in energy. hopefully, a mild lift in mood will come as well. we were taught (although there are no hard and fast rules about this) that you should not make a call about the efficacy of an antidepressant until about 8-12 weeks after initiation.

    it is common to see 5-10% weight loss in individuals on Wellbutrin due to the increase in synaptic norepinephrine.


    Thanks, man. Maybe I'll give it longer then. I'm taking 300mg a day, all in the morning.

    The other side effect I forgot to list is that I can't really drink alcohol anymore. If I have more than one or two drinks, I get a horrible hangover that lasts all the next day, even if I drink water like crazy before bed. I know alcohol isn't good for depression anyway, but this has had an annoying effect on socializing. I was not a big drinker to begin with.
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    Feb 13, 2011 6:11 PM GMT
    brueges said
    rightasrain said
    brueges saidTo anyone taking Wellbutrin- how long did it take for it to improve your mood?

    I've taken it for 5 weeks so far and don't really feel "happier" though my depression was mild to begin with. What has happened is that it gives me more energy during the day and cuts my hunger. I've lost 10 pounds (which I'm happy about). No sexual side effects, but no libido lift either.

    How long would you give it to work? I'll contact my doctor once it's been a full 6 weeks.


    ideally, its effects should be subtle. you are a good case of that. you notice very few adverse events but have a lift in energy. hopefully, a mild lift in mood will come as well. we were taught (although there are no hard and fast rules about this) that you should not make a call about the efficacy of an antidepressant until about 8-12 weeks after initiation.

    it is common to see 5-10% weight loss in individuals on Wellbutrin due to the increase in synaptic norepinephrine.


    Thanks, man. Maybe I'll give it longer then. I'm taking 300mg a day, all in the morning.

    The other side effect I forgot to list is that I can't really drink alcohol anymore. If I have more than one or two drinks, I get a horrible hangover that lasts all the next day, even if I drink water like crazy before bed. I know alcohol isn't good for depression anyway, but this has had an annoying effect on socializing. I was not a big drinker to begin with.


    we will typically start someone on the 150mg dose (always in the morning) before moving them to 300mg (assuming they need to be bumped in dosage). not questioning what your doctor did... just usually find that a titration upward is generally more well-tolerated.

    sorry about the alcohol consumption, but you will find the warning to avoid alcohol consumption on every antidepressant package insert. a few (occasional) drinks are typically well-tolerated, but if you're that sensitive, it's best to avoid excessive consumption.

    be well.
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    Feb 13, 2011 7:52 PM GMT
    some great input and advice here...Is buspar prescribed or over the the counter? i'll talk to my doc about it...................Keithicon_wink.gif