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wellb1989: Why is Skipping Doses a Poor Way to Reduce Intake?


wellb1989

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Posted

 

I have a genuine question about the science of withdrawing from these drugs...why is it not smart to withdraw from them by skipping days between doses. Here is what I mean:

 

I started out at 300 mg XL and after 18 months my doctor said to taper off to 200 mg.  After 2 weeks I felt okay, but he wanted to be safe so said wait another two weeks before going down in dose.  I found that after one day of missing a dose I felt no side effects....then another day....no side effects.  Why would it not be smart to taper by saying taking the 200 mg and then skipping the next two days?  At this point I actually find I feel worse every time I take the Wellbutrin and reintroduce it to my system.  Just curious. Please educate me.

 

 

 

 

300 mg Wellbutrin XL (5/4/2020)

200 mg Wellbutrin XL (5/18/2020)

2013-2018: Various trials of Celexa, Cymbalta, Pristiq, Zoloft, Prozac; never for more than 1 month except Celexa for approx 5 months

2018-2020: Wellbutrin 300 mg XL

5/4/2020: Start Taper with 200 mg XL per dr.

 

  • ChessieCat changed the title to wellb1989: Why is Skipping Doses a Poor Way to Reduce Intake?
  • Administrator
Posted

There is quite a large body of research showing that when people skip doses, they get withdrawal symptoms.

 

Baldwin, D. S., Cooper, J. A., Huusom, A. K. T., & Hindmarch, I. (2006). A double-blind, randomized, parallel-group, flexible-dose study to evaluate the tolerability, efficacy and effects of treatment discontinuation with escitalopram and paroxetine in patients with major depressive disorder. International Clinical Psychopharmacology, 21(3), 159–169. https://doi.org/10.1097/01.yic.0000194377.88330.1d
Bauer, R., Glenn, T., Alda, M., Sagduyu, K., Marsh, W., Grof, P., Munoz, R., Murray, G., Ritter, P., Lewitzka, U., Severus, E., Whybrow, P. C., & Bauer, M. (2013). Antidepressant dosage taken by patients with bipolar disorder: Factors associated with irregularity. International Journal of Bipolar Disorders, 1. https://doi.org/10.1186/2194-7511-1-26
Bulloch, A. G. M., & Patten, S. B. (2010). Non-adherence with psychotropic medications in the general population. Social Psychiatry and Psychiatric Epidemiology, 45(1), 47–56. https://doi.org/10.1007/s00127-009-0041-5
Dilsaver, S. C., & Greden, J. F. (1984). Antidepressant withdrawal phenomena. Biological Psychiatry, 19(2), 237–256.
Drug Ther Perspect. (2001). Antidepressant discontinuation syndromes: Common, under-recognised and not always benign. Drugs & Therapy Perspectives, 17(20), 12–15. https://doi.org/10.2165/00042310-200117200-00004
Gallagher, J. C., Strzinek, R. A., Cheng, R. J., Ausmanas, M. K., Astl, D., & Seljan, P. (2012). The effect of dose titration and dose tapering on the tolerability of desvenlafaxine in women with vasomotor symptoms associated with menopause. Journal of Women’s Health (2002), 21(2), 188–198. https://doi.org/10.1089/jwh.2011.2764
Greden, J. F. (1993). Antidepressant maintenance medications: When to discontinue and how to stop. The Journal of Clinical Psychiatry, 54 Suppl, 39–45; discussion 46-47.
Haddad, P. M. (2001). Antidepressant Discontinuation Syndromes. Drug Safety, 24(3), 183–197.
Henry, M. E., Moore, C. M., Kaufman, M. J., Michelson, D., Schmidt, M. E., Stoddard, E., Vuckevic, A. J., Berreira, P. J., Cohen, B. M., & Renshaw, P. F. (2000). Brain kinetics of paroxetine and fluoxetine on the third day of placebo substitution: A fluorine MRS study. The American Journal of Psychiatry, 157(9), 1506–1508. https://doi.org/10.1176/appi.ajp.157.9.1506
Kaplan, E. M. (1997). Antidepressant noncompliance as a factor in the discontinuation syndrome. The Journal of Clinical Psychiatry, 58 Suppl 7, 31–35; discussion 36.
Meijer, W. E. E., Bouvy, M. L., Heerdink, E. R., Urquhart, J., & Leufkens, H. G. M. (2001). Spontaneous lapses in dosing during chronic treatment with selective serotonin reuptake inhibitors. British Journal of Psychiatry, 179(6), 519–522. https://doi.org/10.1192/bjp.179.6.519
Michelson, D., Fava, M., Amsterdam, J., Apter, J., Londborg, P., Tamura, R., & Tepner, R. G. (2000). Interruption of selective serotonin reuptake inhibitor treatment. Double-blind, placebo-controlled trial. The British Journal of Psychiatry: The Journal of Mental Science, 176, 363–368. https://doi.org/10.1192/bjp.176.4.363
Osterberg, L. G., Urquhart, J., & Blaschke, T. F. (2010). Understanding Forgiveness: Minding and Mining the Gaps Between Pharmacokinetics and Therapeutics. Clinical Pharmacology & Therapeutics, 88(4), 457–459. https://doi.org/10.1038/clpt.2010.171
Rosenbaum, J. F., Fava, M., Hoog, S. L., Ascroft, R. C., & Krebs, W. B. (1998). Selective serotonin reuptake inhibitor discontinuation syndrome: A randomized clinical trial. Biological Psychiatry, 44(2), 77–87. https://doi.org/10.1016/s0006-3223(98)00126-7

 

We have seen many people come here with severe withdrawal symptoms after following their prescribers' or their own misguided plan to skip doses in order to taper.

 

You may hear of people who got away with skipping doses to taper. That is possible, some people cold turkey without a problem. However, after cold turkey, skipping is perhaps the most risky way to come off psychiatric drugs. NEVER SKIP DOSES TO TAPER.

 

If after seeing this, you decide to skip doses to taper and get withdrawal symptoms, do not come back here asking for help.

 

I hope that answers your question.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

  • Administrator
Posted

This is the only topic in all caps anywhere on this site

 

 

I hope the warning is clear.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

  • Moderator Emeritus
Posted (edited)

HI wellb and welcome to SA.

 

SA's recommended taper protocol is to reduce by no more than 10% of the current dose followed by a hold of about 4 weeks to allow the brain to adapt to not getting as much of the drug.

 

Sometimes when people are taking a high dose they are able to make a large reduction at the start, but then afterwards they need to start tapering by the 10% method explained above.  Some members find that as their dose gets lower they need to reduce less than 10% and/or hold for longer.  This topic may help to explain why:   Why taper paper: dose-occupancy curves

 

Why taper by 10% of my dosage?

Dr Joseph Glenmullen's Withdrawal Symptoms

 

tips-for-tapering-off-wellbutrin-sr-xr-xl-zyban-buproprion

 

So that the moderators can see your history at a glance please create your drug signature.  Please include any other drugs you have previously or are currently taking.  Instructions for what is needed:  please-summarize-your-withdrawal-history-in-your-signature

 

This link goes to your signature.  Remember to Save after creating/editing it.  Account Settings – Create or Edit a signature

 

Thank you.

 

Edited by ChessieCat

* NO LONGER ACTIVE on SA *

MISSION ACCOMPLISHED:  (6 year taper)      0mg Pristiq  on 13th November 2021

ADs since ~1992:  25+ years - 1 unknown, Prozac (muscle weakness), Zoloft; citalopram (pooped out) CTed (very sick for 2.5 wks a few months after); Pristiq:  50mg 2012, 100mg beg 2013 (Serotonin Toxicity)  Tapering from Oct 2015 - 13 Nov 2021   LAST DOSE 0.0025mg

Post 0 updates start here    My tapering program     My Intro (goes to tapering graph)

 VIDEO:   Antidepressant Withdrawal Syndrome and its Management

Posted

@wellb1989

I too had no problems if I skipped a dose or two while taking Wellbutrin regularly (I did NOT skip doses to taper, I did cold turkey which was one of the worst mistakes of my life).

 

I felt just fine for a few months until one day it hit me like a ton of bricks. I’ve come to learn it’s not at all unusual for people to have a “honeymoon” period when eliminating a drug or reducing its dosage, and then get railroaded by withdrawal. I would not recommend skipping doses to taper. You might very well end up with a situation that is much more difficult to manage. It’s not as simple as just reinstating a medication once a certain window has passed. 

Age 6-8: Luvox    Age 7-9: clonidine

Age 7-14: Ritalin, Adderall, other stims

Age 15-18: 20mg Celexa, 300mg Wellbutrin, 1mg Tenex 2x a day, 50mg Seroquel.

Quit all meds cold turkey at age 18 (2014), causing serious anxiety, emotional blunting, dysphoria, lack of concentration, fatigue. It’s been a long journey, but not every part of every day is painful anymore.

Posted

Thanks ddub; out of curiosity; what was your experience on Celexa re side effects.  One side effect I have to date is somewhat of a lack of libido, which some doctors attribute to depression, but I noticed it disapear with Celexa, and hasn't come back since (although slight boost with wellbutrin)

2013-2018: Various trials of Celexa, Cymbalta, Pristiq, Zoloft, Prozac; never for more than 1 month except Celexa for approx 5 months

2018-2020: Wellbutrin 300 mg XL

5/4/2020: Start Taper with 200 mg XL per dr.

 

  • Moderator Emeritus
Posted (edited)

Thank you for creating your drug signature. 

 

4 hours ago, Altostrata said:

There is quite a large body of research showing that when people skip doses, they get withdrawal symptoms.

 

That's a really great list of research that you've provided Alto.

 

5 hours ago, wellb1989 said:

I have a genuine question about the science of withdrawing from these drugs...why is it not smart to withdraw from them by skipping days between doses.

 

5 hours ago, wellb1989 said:

Please educate me.

 

You didn't make any response to the post by Altostrata.  Does what Alto provided answer your question? 

 

Edited by ChessieCat

* NO LONGER ACTIVE on SA *

MISSION ACCOMPLISHED:  (6 year taper)      0mg Pristiq  on 13th November 2021

ADs since ~1992:  25+ years - 1 unknown, Prozac (muscle weakness), Zoloft; citalopram (pooped out) CTed (very sick for 2.5 wks a few months after); Pristiq:  50mg 2012, 100mg beg 2013 (Serotonin Toxicity)  Tapering from Oct 2015 - 13 Nov 2021   LAST DOSE 0.0025mg

Post 0 updates start here    My tapering program     My Intro (goes to tapering graph)

 VIDEO:   Antidepressant Withdrawal Syndrome and its Management

Posted

Thanks for your post Chessie and for your question.  I did read both your and Alto's posts (not every article, but I did read the abstracts).  I definitely appreciate research and the literature--but I didn't see any articles that were posted in the literature specific to Wellbutrin, which was my question.  Anecdotally, my experience with these drugs suggests they do very different things to our brains, and so I was hoping to find specific research on wellbutrin and withdrawal.

2013-2018: Various trials of Celexa, Cymbalta, Pristiq, Zoloft, Prozac; never for more than 1 month except Celexa for approx 5 months

2018-2020: Wellbutrin 300 mg XL

5/4/2020: Start Taper with 200 mg XL per dr.

 

Posted

@wellb1989 The Wellbutrin seemed to cancel out the libido-crushing effects of the Celexa (I was never on them separately), although I did experience problems initially. I would say my libido is more or less normal now, but what you’re describing is unfortunately not uncommon and is called Post-SSRI Sexual Dysfunction (PSSD). It’s not a topic I know much about.

 

Regarding your reply to Chessie about not seeing any articles regarding Wellbutrin withdrawal specifically, I would strongly recommend stick with a 10% monthly taper. Switching to one dose every three days is a 66% reduction and is not only unpredictable in its effects, it’s not good for your brain. I strongly regret the way I came off my meds and hope you go about it the safe way. 

 

 

 

Age 6-8: Luvox    Age 7-9: clonidine

Age 7-14: Ritalin, Adderall, other stims

Age 15-18: 20mg Celexa, 300mg Wellbutrin, 1mg Tenex 2x a day, 50mg Seroquel.

Quit all meds cold turkey at age 18 (2014), causing serious anxiety, emotional blunting, dysphoria, lack of concentration, fatigue. It’s been a long journey, but not every part of every day is painful anymore.

  • Moderator Emeritus
Posted (edited)

 

 This is at the beginning of Post #1 - Tips for Tapering Wellbutrin topic:

 

On 7/17/2011 at 6:28 AM, Altostrata said:

Wellbutrin (bupropion) is an atypical antidepressant with a lower reported rate of withdrawal syndrome compared to the SSRIs and SNRIs such as Paxil, Effexor, or Cymbalta.

However, patients have reported withdrawal symptoms, sometimes severe, from too-short tapering.

Bupropion is a bit of an oddball because it "is thought to be" a dopamine and norepinephrine reuptake inhibitor and a nicotinic receptor antagonist, which is why it is sometimes used to help people stop smoking - Zyban.
 
Bupropion adverse effects
Like Chantix, as a smoking cessation aid (Zyban), bupropion has been found to cause suicidal thoughts or actions and displays an FDA black box warning accordingly.

Bupropion tends to be energizing and often causes anxiety, agitation, nervousness, loss of appetite, and insomnia as side effects. Bupropion usually is not an appropriate treatment for withdrawal symptoms, as it can aggravate them.
 
While it is less likely to cause sexual dysfunction like other antidepressants, other side effects are: lowers the seizure threshold (very bad for brain zaps), increases blood pressure, tremors, tinnitus, unusual behaviour changes, agitation, and hostility.
 
Bupropion as an adjunct to antidepressants to counter sexual side effects
Way back in ancient history, around the year 2000, it became apparent these fabulous wonder drugs, the SSRIs, which were supposed to alleviate depression with almost no side effects, had a huge drawback that might slow sales: They caused sexual dysfunction in a high percentage of those who took them.
 
This caused great consternation among the pharmaceutical companies, who went through varying cycles of denying that sexual dysfunction was a frequent consequence of SSRIs, claiming the sexual dysfunction was due to the underlying depression, and searching for pharmaceutical solutions to this adverse effect.
 
It was also observed that bupropion had fewer sexual side effects and that some patients found it sexually stimulating. Seizing the opportunity to preserve their sales, the drug companies initiated campaigns to educate doctors that, in the rare cases where sexual dysfunction was a problem, bupropion might be added to an SSRI to alleviate the problem.
 
It did seem to help some, but its usefulness for this purpose is mostly a product of drug company propaganda. Also, to preserve sales of SSRIs, the drug companies neglected to inform doctors that being an antidepressant itself, Wellbutrin might replace the SSRI, and there was no reason to keep people on two drugs when one drug would do.
 
(Later, when Viagra and Cialis became available, much research and furor was generated to recommend them as adjuncts to SSRIs -- adding yet another profitable drug. Alas, they proved to be ineffective for women.)
 
Bupropion, unfortunately, comes with a few common adverse effects of its own, such as jitteriness, agitation, nervousness, anxiety, fast heartbeat, and sleeplessness. Doctors were advised to add benzodiazepines to the mix for these symptoms. (Later, these symptoms were judged to be possible symptoms of bipolar disorder, indicated the addition of antipsychotics such as Seroquel.)
 
This ushered in the era of the common combination of an SSRI, bupropion, and a benzo (or low-dose Seroquel) for many people complaining of any kind of "depression." As all of these drugs incur physiological dependency, this cocktail is very well represented on this site.
 
But some doctors noticed bupropion was also an antidepressant as effective or ineffective as any other, without the sexual side effects. They began to prescribe bupropion first, before resorting to an SSRI. Wellbutrin or its generic bupropion is a very popular antidepressant. And that is why our Tips for tapering off Wellbutrin, IR, SR, XR, XL (bupropion) is the most frequently viewed topic in the Tapering forum. (Tips for tapering off Pristiq (desvenlafaxine) is a distant second, probably because tapering Pristiq is so difficult.)

 

 

Edited by ChessieCat

* NO LONGER ACTIVE on SA *

MISSION ACCOMPLISHED:  (6 year taper)      0mg Pristiq  on 13th November 2021

ADs since ~1992:  25+ years - 1 unknown, Prozac (muscle weakness), Zoloft; citalopram (pooped out) CTed (very sick for 2.5 wks a few months after); Pristiq:  50mg 2012, 100mg beg 2013 (Serotonin Toxicity)  Tapering from Oct 2015 - 13 Nov 2021   LAST DOSE 0.0025mg

Post 0 updates start here    My tapering program     My Intro (goes to tapering graph)

 VIDEO:   Antidepressant Withdrawal Syndrome and its Management

  • Administrator
Posted

Sorry the abstracts didn't contain enough information for you. Maybe you should read the entire articles. Oh, wait, not specifically about bupropion. "Spoonfeed me more evidence, talk me out of my dumb plan."

 

8 hours ago, wellb1989 said:

Thanks for your post Chessie and for your question.  I did read both your and Alto's posts (not every article, but I did read the abstracts).  I definitely appreciate research and the literature--but I didn't see any articles that were posted in the literature specific to Wellbutrin, which was my question.  Anecdotally, my experience with these drugs suggests they do very different things to our brains, and so I was hoping to find specific research on wellbutrin and withdrawal.

 

You're in the wrong place to get permission to go off Wellbutrin as fast as you'd like. Good luck. Don't come back here if it goes wrong.

 

 

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

Posted

Alto I read your warning the first time. 

 

Chessie thank you for reposting the article --I did read that but it did not look peer-reviewed so I didn't site that in my initial reply.  I am not here to poke holes in anyone's theory, despite Alto's tone.  I am looking for data on the withdrawal from wellbutrin to make an informed decision, that is all.  

2013-2018: Various trials of Celexa, Cymbalta, Pristiq, Zoloft, Prozac; never for more than 1 month except Celexa for approx 5 months

2018-2020: Wellbutrin 300 mg XL

5/4/2020: Start Taper with 200 mg XL per dr.

 

  • Moderator Emeritus
Posted
8 minutes ago, wellb1989 said:

I am looking for data on the withdrawal from wellbutrin to make an informed decision, that is all.  

 

Evidence doesn't always need to come from scientific research.  This site was started in 2011 by Altostrata when, after her own bad experience of stopping a drug, realised that the medical professionals knew very little about withdrawal syndrome and adverse drug effects.

 

These are links to searches I did for members taking Wellbutrin, buproprion, Zyban in the Introductions forum.  There will be some duplicates in the searches.  You could check these out to find out how other are managing with their Wellbutrin tapers.

 

wellbutrin

buproprion

zyban

 

It is important to understand that different people have different experiences in getting off their drug/s.  So even somebody who has the exact some drug history as yourself might have a different experience to you.  However nobody knows what group you fall into when it comes to the rate of taper that you can do.  We need to listen to our body carefully and use that as a guide as to how fast we can taper.  It is also important to know that withdrawal symptoms can be delayed, in my case it was about 2 months after a cold turkey as explained below.  As I think I mentioned before some members here have reduced Wellbutrin too quickly and developed insomnia.  Adding insomina to WD symptoms can be torturous.

 

We have members here who have ended up having to quit their job, some have had their relationships break down, some have had to move in with relatives/friends, some have become bedridden.

 

Sometimes if things go bad the doctors will add in or switch to different drug/s, and sometimes they don't get to a place of stabilisation.  We have members here who, if they had done a slow and cautious taper, would have been off their original drug.

 

I do realise that my drugs are different and that you want Wellbutrin specific data.  I've had two completely different experiences when getting off two different drugs.  The first one I cold turkeyed and felt fantastic for about 2 months, then I got sick and was bedridden for 2.5 weeks and lost 8kgs because I couldn't eat.  I ended up on a different AD, because I didn't know at the time that I was suffering from withdrawal.  The second experience was in reducing my dose by 50%.  I had extreme cog fog and even walking took my full concentration.  After 2 weeks I was unable to type.  I'm a professional typist so had a bench mark.  SA suggested taking more of my drug which I did.  About 4 hours later I was able to type again.  Because of the bench mark I know it was the drug.

 

Another thing that is helpful to know and understand is that updosing or reinstating does not always work.  I suggest that you read Post #1 of this topic:  about-reinstating-and-stabilizing-to-reduce-withdrawal-symptoms

 

I'm currently at 0.875mg Pristiq (original dose 100mg).  It is going to take about another year to get to 0.  That may seem like I'm being ridiculously over cautious.  It could be that if I stopped now I might be fine.  However, I don't know that.  I'd rather continue nice and slowly than to risk it.

* NO LONGER ACTIVE on SA *

MISSION ACCOMPLISHED:  (6 year taper)      0mg Pristiq  on 13th November 2021

ADs since ~1992:  25+ years - 1 unknown, Prozac (muscle weakness), Zoloft; citalopram (pooped out) CTed (very sick for 2.5 wks a few months after); Pristiq:  50mg 2012, 100mg beg 2013 (Serotonin Toxicity)  Tapering from Oct 2015 - 13 Nov 2021   LAST DOSE 0.0025mg

Post 0 updates start here    My tapering program     My Intro (goes to tapering graph)

 VIDEO:   Antidepressant Withdrawal Syndrome and its Management

  • Administrator
Posted
1 hour ago, wellb1989 said:

Alto I read your warning the first time. 

 

Chessie thank you for reposting the article --I did read that but it did not look peer-reviewed so I didn't site that in my initial reply.  I am not here to poke holes in anyone's theory, despite Alto's tone.  I am looking for data on the withdrawal from wellbutrin to make an informed decision, that is all.  

 

Heck, I'll ban you right now, you're annoying me. Use Google search on this Web site to see how people feel going off Wellbutrin or buproprion.

 

 

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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