Jshect major issues with Wellbutrin/Deplin and klonopin addiction

[Altostrata]

Yes, they can make a 149mg SR capsule. They crush it to a powder. This destroys the binder. Then it's not much different from IR.

 

I would consider this a waste of money myself.

[Jshect]

Yes, they can make a 149mg SR capsule. They crush it to a powder. This destroys the binder. Then it's not much different from IR.

 

I would consider this a waste of money myself.

That's fraud. Why would they even still call it an SR tablet??? I assumed they actually created a 149 SR tablet that would break down slowly like the manufacturer's SR. What a rip-off. Well I guess I better order a scale.

[Jshect]

Is there really no pharmacy in America where I could have a 149 mg SR tablet made? That sucks. That would have made things so much easier. Well I'll cross my fingers, and try your method. The important thing is that the PVCs are not harmful. If I get them I'll just have to find a way to deal with the anxiety.

[Altostrata]

No, you cannot. Crushing tablets or making liquids is as advanced as their technology gets.

 

If it was possible for a compounding pharmacy to reformulate a drug in an extended-release form, it would make tapering a lot easier for our people on Effexor XR and Cymbalta, too. I've looked for this service and it does not exist.

[Jshect]

Damn  BigPharma, they could care less about getting people off their drugs. It's been about 3 years since I first tried to get off Wellbutrin. That's 3 years I've been paying them monthly for a medication that's causing me problems. Well, the good thing is, I'm cutting back at work to 3 days a week starting January 5th while I try to get off of these meds. Generally my job is not too strenuous. I see Dr. Kane on the 7th. So, I can start after he writes me a 100 SR and 50 SR script. Depending on how bad the PVCs are, if there are any, I'll have to determine how much to cut the sedatives by and which ones to cut. When I see Dr. Kane on the 7th I'll ask him if he would like to speak to a 450 interactions expert or if he thinks he can handle this by himself. It might even be wise for him to speak with a cardiologist, so Kane could talk about what the medications are doing biochemically, the cardiologist could try to figure out why it's causing PVCs. 

Merry Christmas by the way. Thanks for talking to me on Christmas.

[Meimeiquest]

I almost got Wellbutrin formulated by a local compounding pharmacy. He was going to mix it in methyl cellulose which takes a number of hours (I can't remember how many) to be absorbed, and the drug in it. So the half-life would have been based on the combination of the half-life of methyl-cellulose and the half-life of plain bupropion. But I decided to try making it myself and it worked, so I didn't pursue it any further.

 

You have to remember that the half-life of bupropion varies a lot from person to person, and with all the hepatically-metabolized drugs you are on, the numbers are virtually irrelevant in your case.

 

One of the things that happens in withdrawal is that the brain becomes excessively conscious of the body's internal processes (Healy refers to this in his latest document). It's not psychosomatic, it is an over-activation of a part of the brain. A big part of "getting off" is just to overrule those sensations. I think your biggest task is to stop psyching yourself out and get through it one moment by one moment. As a symptom comes and goes, and then another, don't let the stress of something that you have already gotten through get to you, just surf those waves one at a time. Put that energy into the dietary changes you said you'd like to make. I certainly say that in the spirit of "it takes one to know one"

[Jshect]

I almost got Wellbutrin formulated by a local compounding pharmacy. He was going to mix it in methyl cellulose which takes a number of hours (I can't remember how many) to be absorbed, and the drug in it. So the half-life would have been based on the combination of the half-life of methyl-cellulose and the half-life of plain bupropion. But I decided to try making it myself and it worked, so I didn't pursue it any further.

 

You have to remember that the half-life of bupropion varies a lot from person to person, and with all the hepatically-metabolized drugs you are on, the numbers are virtually irrelevant in your case.

 

One of the things that happens in withdrawal is that the brain becomes excessively conscious of the body's internal processes (Healy refers to this in his latest document). It's not psychosomatic, it is an over-activation of a part of the brain. A big part of "getting off" is just to overrule those sensations. I think your biggest task is to stop psyching yourself out and get through it one moment by one moment. As a symptom comes and goes, and then another, don't let the stress of something that you have already gotten through get to you, just surf those waves one at a time. Put that energy into the dietary changes you said you'd like to make. I certainly say that in the spirit of "it takes one to know one"

That's interesting, I'll call my local compounding pharmacy and see if they can do that.

The numbers are irrelevent and they aren't in my opinion. The average half-life is 17 hours. My liver's so clogged up with meds it's probably longer than that in me. So all I know is right now I'm taking 150 mg Wellbutrin SR with an average half-life of 17 hours and NOT having PVCs. That may not be the half-life in my body, but that's all I've got to go by. So I don't want to, if possible, take 49 mg IR with an average half-life of 10 hours. By cutting a 50 mg SR pill, I may get 24 mg (IR) with an average half-life of 10 hours, and the remaining pill being 25 mg (still SR) with an average half-life of 17 hours.

When I'm having 10 PVCs a minute, the anxiety is so bad, I'm often close to panic-attack (all of the time.) So my goal here is to minimize PVCs. I don't know, this could be a disaster or it could work. All I can do is try. And yes, I feel like medications cause the PVCs first, and then how well my body recovers from them is influenced to some degree by diet. I definitely will have large quantities of healthy food prepared before I start this taper. But I've done things in the past to reduce (other) negative Wellbutrin side effects by barely raising the amount of Oxcarbazepine I take and immediately get hit with a wave of PVCs. So minute measurements will probably matter. My body is very sensitive, and the PVCs, although not harmful, cause horrible agitation. Agitation that prevents me from functioning well. 

 

I'm really going to have to plan out and explain my situation as best as I can to Dr. Kane. If he grasps it and agrees and is definitely up for going through this with me than that will be great. I will see if he would be up for a consultation with some of the Psych's recommended by Dr. Sandson.

 

I'll look up this Healy fellow. I would like to read more about withdrawal. I did purchase the book Alto recommended 2 days ago on Xanax and have almost finished it. If you can recommend any books on withdrawal I will buy them and read them. Thank you. 

[Jshect]

I'm sorry Alto I am just now reading your

Tips for tapering off Wellbutrin, IR, SR, XR, XL (buproprion)

thread. I will make sure and reread this entire thread before I begin tapering to if there is anything else I haven't read.

 

Thanks again, everybody. Merry Christmas.

[Jshect]

I don't know maybe I could take 100 mg Wellbutrin SR, create 49 mg Wellbutrin IR solution and carry around the solution all day in a flask and sip it periodically like a drunk sips whiskey. Just joking, but maybe not. I'll look into the methyl cellulose. That's interesting that XL actually lasts longer and has less of a drop on the graph than SR. XL gives me PVCs so I assumed SR was the longest lasting.

[Jshect]

Yea, the more I talk about the more I think a leading expert might have valuable insight into the PVC paradox (as Alto suggested.) It's very simple in a way: why does reducing the stimulants (Bupropion, Deplin, or Trazodone) cause PVCs, and why does raising a sedative (Oxcarbazepine or Loxapine) also cause PVCs and most importantly what to do about it? I think I should just email this question to the two Psychiatrists Dr. Sandson recommended and than let them decide what I should do next. If they could just simply consult with Dr. Kane, or I guess I could drive 3 hours to Maryland. I guess it wouldn't hurt to at least email them. I think I'll do that. 

 

In fact I just emailed Dr. Mark Komrad (the celebrity psychiatrist) recommended by Sandson

 

In fact I could send this by email or letter to several psychiatrists, cardiologists, and neurologists in the area, and say tell your secretary to call me to schedule an appointment if you think you know what's going on and how to solve it. 

[Jshect]

Well, I've got good news. I called the local Williams and Hughs pharmacy and the fellow said he "thinks" he may be able to make a compounded Wellbutrin 140 mg pill and keep the SR properties. I don't know how I should have asked him. He didn't want to try 149 mg, I guess that does sound ridiculous to someone who doesn't know what I've been through. If he could make 140 or 145 SR, I could then try crushing the oxcarbazepine and creating a solution, and slowly lowering that and Loxapine until the PVCs go away. This is great news. I guess I better make sure he can actually create an SR and not an IR. I really should have asked him how he keeps the SR properties. He's going to call back today or Monday to tell me, so I'll ask him then. This is great news.

[Altostrata]

Very interesting. i wonder how he's going to do it.

 

Then, you can take 140mg SR and take the rest of your Wellbutrin dosage in an IR liquid for a bit.

 

...

One of the things that happens in withdrawal is that the brain becomes excessively conscious of the body's internal processes (Healy refers to this in his latest document). It's not psychosomatic, it is an over-activation of a part of the brain. A big part of "getting off" is just to overrule those sensations. I think your biggest task is to stop psyching yourself out and get through it one moment by one moment. As a symptom comes and goes, and then another, don't let the stress of something that you have already gotten through get to you, just surf those waves one at a time. Put that energy into the dietary changes you said you'd like to make. I certainly say that in the spirit of "it takes one to know one"

 

This is autonomic hyper-sensitivity. We have been calling it dysregulation. Yes, that is what is happening in Jshect's case, the drugs are affecting the heart time-keeping, an autonomic function.

 

I don't know maybe I could take 100 mg Wellbutrin SR, create 49 mg Wellbutrin IR solution and carry around the solution all day in a flask and sip it periodically like a drunk sips whiskey. Just joking, but maybe not. ...

 

This is not such a very odd idea.

 

Please do study the Wellbutrin tapering topic thoroughly.

[Jshect]

Yes, I read through the tapering wellbutrin section. Thank you Alto and Meimeiquest!

[Jshect]

I left a message with the "holistic" psychiatrist quickly summarizing my dilemma, and he called me back after business hours to talk about my situation. That's great that he would do this. Dr. Kane is a nice guy, but he would never go out of his way to call a new patient after hours to find out about their situation. This is promising. Plus, I like the fact that this psychiatrist actually takes into consideration that there are other methods to reach your psychological potential than just those advocated by the pharmaceutical companies. Dr. Kane is over-weight and I don't think he's ever asked me about my diet (and I've been seeing him for about 5 years). That is just unconscionable to me. Dr. Kane is brilliant, which means he's got to know there is a world outside of pharmaceutical drugs. I almost get a sneaking suspicion Dr. Kane's depressed. Ironic. 

I suffer from pain from my medication. How could he not know that Turmeric is a natural anti-inflammatory, so you should try that before Allieve which wreaks havoc with your gut flora and can cause heartburn, intestinal bleeding and death. There's a study I should post a link to in your research section about schizophrenics having significant reduction in symptoms compared to the placebo when placed on a gluten-free diet. There's an even more amazing, breakthrough study on nutrition and autism that I will post in your research area. Psychiatrists just ignore nutrition altogether and it's insidious. They're pharmaceutical prostitutes. Our entire brains and bodies are made from and function because of the food we eat and that's ignored. Is this reality?? Is this really the world we live in or am I dreaming this? There are herbs people in China and India have been taking to successfully treat health issues for thousands of years and our billion dollar (or is it trillion dollar) health industry won't even bother to study them scientifically because they can't patent them.

 For nearly my entire life I've lived with an awful brain fog and I've almost exclusively dealt with psychiatrists concerning this for the last 15 years. I put my trust and tens of thousands of dollars in this crooked industry because I was raised to believe that these were the experts who could help you. They had the studies to prove it, didn't they? All of this wasted time. When I was younger I was always top of my class (Honors and AP) in mathematics, I could run a 4:40 mile even with this lingering, horrific brain fog, depression, and anxiety. I thought I would be a working professional now with a family.  I'm 36 years old, I live with my aging and ailing parents, and I make $8.50 an hour. I've got to keep believing things are going to get better. I have to. I know things are going to get worse for a while as I get off of these meds, but I've got to believe it will get better after that. At least I'm finally somewhat on the right track. That should give me hope. I just hope I have what it takes to make it through most likely years of anxiety-inducing PVCs and Benzo withdrawal.

[Altostrata]

You will get better, Jshect. Will the holistic psychiatrist help you to go off the drugs?

[Meimeiquest]

I don't have any meaningful response to your last post. Our world has lost it's moorings in so many ways. One great thing is that what a Kelly Brogan calls health freedom is so accessible today. We all have access to Dr. Google, and have the option to take charge of some of these things. Most doctors don't have real solutions to offer. But there is a lot of good information available, if you can sift through it. And, yes, I do think pdocs are really stressed. More and more patients to see, and it's not so much fun not having actual helpful strategies to offer them.

 

I think your idea of taking some extended release Wellbutrin and using IR when WD symptoms hit would help enormously, and also help you get through this roadblock of it all seeming so very hard. I am a huge, huge fan of small, frequent doses...they have gotten me through some tough times and I usually can feel the first glimmer of relief in fifteen minutes as the liquids are absorbed quickly. I don't deny it is hard....the side effects of the drugs, the withdrawal effects, and the need to get to the root cause all at the same time.

[Jshect]

Thank you guys, I think the holistic psychiatrist will but I'll have to talk to him to get a sense of his competency and how well he listens etc. There is a concern I have with this fellow. He's hollistic, but I just don't know how hollistic. He likes to test your vitamin levels and your thyroid and whatever, but then I think he wants you to buy all of your supplements through him. His secretary said that is because he knows and trusts his source as a reliable and honest manufacturer. One thing that is a red flag, though I may be wrong, is that it says on his website "Ask about our confidential pharmacy and pharmaceutical grade vitamins and minerals." My concern is the word confidential. Is he going to insist we buy our "supplements" from him, and since it may be from his confidential manufacturer, if that's what it means, that would mean we don't know who he's buying them from and how much he's paying. So my concern is he going to be some supplement middleman, jacking up the prices and insist we keep coming back to him for out supplement fixes? Maybe I've got it all wrong.

 

Here's his website if you want to check it out.

http://www.michaelhoffmanmd.com/About-Us.html

[Jshect]

I mean the only reason I'm would go to any type of psychiatrist now, holistic or not, is because I'm stuck in psychiatric mess, so I need someone who knows psychiatry. For now the most important thing is that he's competent and that he motivated and wants to help me get off these meds to the best of his ability. I understand if he's not prescribing meds because he actually cares enough to acknowledge things like diet, exercise, hormone balance are important, that he's got make money and keep people coming back &so buying supplements from him might be his way to stay in business. Hell, a psychiatrist has guaranteed eternal business from you by law, because even if you don't change your medications, you still have to check in with him, and by check in I mean pay him $100 to talk to him for ten minutes, every three months. What a scam. Sorry, I rant a lot. Yea, I'll talk to Dr. Hoffman ASAP and let you know what he says.

[Jshect]

You will get better, Jshect. Will the holistic psychiatrist help you to go off the drugs?

Oh sorry, I didn't phrase that correctly, he left a message after his business hours on my answering machine, but I was at work and didn't get to talk to him. If he's willing to chat after business hours I'm off tomorrow so I'll see if he'll talk on Sunday.

[Jshect]

"I think your idea of taking some extended release Wellbutrin and using IR when WD symptoms hit would help enormously, and also help you get through this roadblock of it all seeming so very hard. I am a huge, huge fan of small, frequent doses...they have gotten me through some tough times and I usually can feel the first glimmer of relief in fifteen minutes as the liquids are absorbed quickly. I don't deny it is hard....the side effects of the drugs, the withdrawal effects, and the need to get to the root cause all at the same time."

 

 

Yes, I agree. I think, the best thing to do is lower the Wellbutrin by as little as possible, and with Dr. Kane or Dr. Hoffman, try to figure out how much to lower the Loxapine and/or Oxcarbazepine by simultaneously. And I can even play it by ear. If I lower the Wellbutrin and Oxcarbazepine, and I'm still having PVCs. I'll just have to try to lower the Ox or Lox by a few more mg each night until the PVCs stabilize. The key will be not to overreact due the PVC-induced anxiety and drop the the Loxapine or Oxcarbazepine too much. This is going to be juggling act because I don't want to start withdrawing from Klonopin too much. Thank God lowering the Oxcarbazepine increases the amount of Klonpin in my system. Why is that? That really works out well because I can alternate between lowering Oxcarbazepine (to incr. Klonopin) and lowering Loxapine (to decr. Klonopin). I think no matter which doctor I work with this is going to be a lot of trial and error no matter what. Damn, I see Wellbutrin shares CYP2C19 and CYP3A4 with Klonopin, so I guess lowering the Wellbutrin will cause Klonopin to be reduced faster. So I guess the main sedative I will be lowering to keep the PVCs at bay will be Oxcarbazepine (since it raises Klonopin blood levels). Loxapine will be secondary. 

[Meimeiquest]

You'll just about have your PharmD by the time this is over

[Altostrata]

Thank you guys, I think the holistic psychiatrist will but I'll have to talk to him to get a sense of his competency and how well he listens etc. There is a concern I have with this fellow. He's hollistic, but I just don't know how hollistic. He likes to test your vitamin levels and your thyroid and whatever, but then I think he wants you to buy all of your supplements through him. His secretary said that is because he knows and trusts his source as a reliable and honest manufacturer. One thing that is a red flag, though I may be wrong, is that it says on his website "Ask about our confidential pharmacy and pharmaceutical grade vitamins and minerals." My concern is the word confidential. Is he going to insist we buy our "supplements" from him, and since it may be from his confidential manufacturer, if that's what it means, that would mean we don't know who he's buying them from and how much he's paying. So my concern is he going to be some supplement middleman, jacking up the prices and insist we keep coming back to him for out supplement fixes? Maybe I've got it all wrong.

 

Here's his website if you want to check it out.

http://www.michaelhoffmanmd.com/About-Us.html

 

I think you can assume he's marking up the supplements. Most likely, your insurance will not cover any of them.

 

It may be a challenge to work with him. He have some good ideas and he may have some off-base ideas. You'll have to determine which is which.

 

The key to getting you off drugs is tapering, not to add supplements. If he goes in the direction of claiming adding supplements will solve your problem, you'll know he's off-base.

 

If he gets he needs to focus on tapering, there may be value for you to see him. You'll have to decide if you trust him more than Dr. Kane.

 

If I were you, I would not adjust the dosages of 3 drugs at the same time. First, you need to change your mode of Wellbutrin dosage, in a very controlled way, to part tablet and part liquid. Get stable on that before making any other changes. Be sure to do your Wellbutrin dosing on the same schedule every day so you can isolate problems.

 

If you think adjusting oxcarbazepine will substitute for increasing Klonopin, I would do just that and leave the loxapine as is. Also, be sure to keep notes of the times and dosages.

[Jshect]

 

 

 

I think you can assume he's marking up the supplements. Most likely, your insurance will not cover any of them.

 

It may be a challenge to work with him. He have some good ideas and he may have some off-base ideas. You'll have to determine which is which.

 

The key to getting you off drugs is tapering, not to add supplements. If he goes in the direction of claiming adding supplements will solve your problem, you'll know he's off-base.

 

If he gets he needs to focus on tapering, there may be value for you to see him. You'll have to decide if you trust him more than Dr. Kane.

 

If I were you, I would not adjust the dosages of 3 drugs at the same time. First, you need to change your mode of Wellbutrin dosage, in a very controlled way, to part tablet and part liquid. Get stable on that before making any other changes. Be sure to do your Wellbutrin dosing on the same schedule every day so you can isolate problems.

 

If you think adjusting oxcarbazepine will substitute for increasing Klonopin, I would do just that and leave the loxapine as is. Also, be sure to keep notes of the times and dosages.

 

 

Well, Dr. Hoffman tried calling me again today so I do appreciate his persistence, but I am highly skeptical about his practice. To me holistic and psychiatrist shouldn't even be in the same sentence. His website was very vague about the types of holistic treatments offered beyond vitamins and minerals.  

I agree with you I should probably just stick to lowering the minimum amount of drugs possible. That does make the most sense to keep it simple to more easily track my progress and avoid confounding factors and confusion. After all even lowering just these two is going to effect at the very least the metabolism of all seven of my medications. And if I am having anxiety from the inevitable PVCs, lowering the Oxcarbazepine to reduce them and the subsequent boost in Klonopin that will cause could help reduce that anxiety, so that may be the way to go. I could save the Loxapine for when I taper off of Trazodone (but lets not get ahead of ourselves). I think Wellbutrin and Oxcarbazepine is a good place to start. 

Thanks.

[Jshect]

I talked to Willimson Hughs pharmacy and they said they could make two 70 mg bupropion using methyl celluose (spelling?) as mentioned above by Meim. Unfortunately the release is somewhere between IR and SR which is why I have to take it twice a day. Maybe I could see if they could make 2 72.5 mg pills. The pharmacist said it probably wouldn't be wise cutting of a little bit off of 150 SR because it would likely dump it all into my system like an IR. In fact, I think I tried that once and it did act like an IR and gave me PVCs. I've tried cutting, adding, reducing these meds in about every conceivable way. 

In fact I once tried shaving a little bit off of my 15 mg Deplin Tablet each day to see if that would reduce the pain, and irritability of the Wellbutrin. It takes 4-6 weeks for it to make a change in your system. Well after 4-6 weeks I got hit with a permanent slew of PVCs. I immediately started taking the full 15 mg Deplin. I suffered for a whole summer with awful anxiety and PVCs. I started a beta blocker, but I also went (out of sheer desperation) from 20 mg Loxapine to 10 mg Loxapine, and 300 mg Oxcarbazepine to 150 mg and the PVCs gradually went away. Dropping the Loxapine and Oxcarbazepine really didn't cause any noticeable bad withdrawal effects. Probably because whatever withdrawal effects there were were completely overshadowed by the release in the reduction of PVCs and anxiety. SO the hard part next will be reducing the Wellbutrin without PVCs. Once that happens I'll try to drop the Oxcarbazepine by just enough to get rid of the PVCs. It seems like gradually reducing both will be the best way to maintain heart rhythm homeostasis. 

[Altostrata]

Your theory about how the two drugs work together and affect your heart rate and benzo level is laudable but unproven.

 

Please move cautiously.

 

If you shaved a 150mg SR tablet and used a scale to manage dosage, most of it would stay intact and sustained-release. The SR is in the binder, not in the shell.

 

The more you cut up an SR tablet, the more binder would be damaged, and the less it would be SR.

[Jshect]

Your theory about how the two drugs work together and affect your heart rate and benzo level is laudable but unproven.

 

 

Of what theory are you speaking? Which two Drugs? Do you mean the hypothesis that Deplin enhances the Wellbutrin, well from personal experience it DEFINITELY DOES! My whole situation with the Irritability, energy, and anger got out of hand precisely 4-6 weeks after 15 mg of Deplin was added. I imagine it also made a difference that I was deficient in Folic Acid. After being on Deplin for years when I had my vitamin levels tested I was still only borderline so I guess I must have been deficient beforehand. As we discussed before, I think we both had the same results from the methylation genetic test and I'm B2 and B12 deficient. From experience, I am positive, when I reduce a stimulant (Trazadone, (or stimulating vitamin) Deplin, or Wellbutrin) I get PVCs or when I raise a sedative similar results. When I cut the Deplin, the Wellbutrin pain disappeared which shows they were acting together. I have no doubt that some type of synergistic effect is at work here. Yes, the Deplin definitely kicked me into overdrive and the symptoms were all of those typically occuring from Wellbutrin usage, so it appears that the hypothesis is correct (at least in my situation.) 

 

If you think shaving a bit off of the SR tablet would work using a scale I'll try it. The scales only $25 after all. I don't know why the pharmacist was so convinced it would become an IR. He said there is more than one way an SR tablet is made. I asked him if I found out which way the Wellbutrin SR was made would that make a difference and he said just not to do it. Like I said, I did cut the SR tablet before and it became an IR but I don't know remember how deeply I cut it. I have SR tablets so I could easily buy a scale and carefully chop off a mg and see what happens if you'd like? If I get PVCs I'll survive. Heck I could even try cutting it open just a minute, minuscule fraction just to barely puncturing the surface tomorrow (or in a a week because it's hectic at work.) just to see how I react. I guess you may want me to talk to a psych first though. my next visit is the 7th. But I have This Thursday to and it may be a good idea to try it, so I would know how I react, and then be able to report that to Dr. Kane.

Oh Alto, when are you going to medical school to become Dr. Altostrata, then I wouldn't have to bother with these other PsyDs. Heck, I guarantee you, you are more knowledgeable than most nurse practitioners, and probably way more knowledgeable also than Psychiatrists when comes to tapering off of medications. In my opinion there should be a psychiatrist who specializes in getting people off of meds. They could even have their own separate title and certification. If the FDA actually cared that would be a specialization. You'd have the foot doctor, the heart doctor, and the Get patients off Pharmaceuticals doctor.

[Altostrata]

I was referring to Wellbutrin and oxcarbazepine.

 

In brand-name Wellbutrin SR, the SR is in the binder. Your choice is to expect this or assume you're ingesting immediate-release buproprion.

 

There is still unpredictability in how you wiil react to any change in your Wellbutrin intake. I cannot guarantee anything. Anything you do will be an experiment. Move as cautiously as possible.

[Jshect]

I trust you, but why does the pharmacist seem to think it will immediately turn into IR? I mean "choose to believe", I don't know, I'm hearing two different things from two qualified people. I imagine you've helped 100s of people off of Wellbutrin, and this guy specializes in every BigPharma med under the sun, so I would imagine you're correct. It could be I cut it too deeply and punctured all the layers. It could be I'm so sensitive to this stupid medication that 125 mg SR plus whatever was left over in IR form when I cut it still caused PVCs. Yes, that is possible. And what theory about Oxcarbazepine and Wellbutrin are you referring to? That when I lower the Wellbutrin, lowering the Oxcarbazepine may reduce PVCs...it seemed to work in the past. It seems to work with the Loxapine for sure. Yes, I think that when I lower a stimulant lowering a sedative helps my heart reach a homeostasis faster. It seemed to work several times in the past, but that could be coincidence. That's the whole reason I immediately believed your hypothesis about the sedatives being more responsible for the PVCs, because before I met you, in desperation after cutting the Deplin, and having PVCs for a whole summer, I had no relief until I lowered the Loxapine and Oxcarbazepine, and then I very quickly had relief. I don't know this whole situation is a confusing mess.

I left a message for Dr. Hoffman to call me today, and he didn't. Dr. Kane's brilliant but he doesn't talk much. I'll have to reread this post and really prepare questions for Dr. Kane's visit on the 7th. I'm beginning this taper no matter what after the 7th. My mom is dying my dad has dementia, I don't have much time to get myself off these meds and stable. I've got to act soon. 

[Jshect]

I'll try contacting the two experts recommended by Dr. Sandson again tomorrow to see if they'd talk to Dr. Kane, or Hoffman if I end up switching to him. I'll also leave a message with the neurology department at a near by hospital to see if any of their neurologists have any clues how to handle my PVC situation. I could also leave a message tomorrow with the cardiologists.

I'm a little confused about the Wellbutrin SR situation. I reread some of your thread on tapering off of bupropion (it might be a good idea to remove some of the individuals posting on that thread about their individual issues that seemed somewhat unrelated to the thread (and distracting) and deserved to be individual threads, like mine) that way we could try to continue the tapering discussion for instance, like I said I'm a little confused about Wellbutrin SR. You said, since it has a binder, I guess thoroughly mixed in, you could cut it up into smaller amounts and still retain some SR qualities? Am I remembering that correctly. So it's the XR that has the two-compartment system, the core and the outer layer and the SR that has just a binder? Or does SR have both? I tired find info on this using multiple slightly different phrased searches on google and it's hard to find info on it. If it is a two-compartment system with a binder, I'm surprised the compounding pharmacist couldn't just cut an SR tablet open, remove 5 mg, and then reseal the outer layer. God that would make everything so much easier. 

So you said one option would be to take a 100 mg SR tablet and then create like 48 mg solution from an IR tablet? Or I guess you were saying in the "tapering off of bupropion" thread I could just cut a mg off of the SR tablet and weigh it on .001 gram scale? Do you have a preference over either of the two?

[Jshect]

This is the email I sent to one of Sandson's recommended doctors. I could really send this to a ton of psychiatrists, neurologists, and cardiologists. Are there any improvements you think I could make.

 

Dr. Konrad

 

I will keep this short and sweet. I am having psychiatric medication issues:

 

I started Wellbutrin several years ago. It made me energetic but irritable, angry and caused physical pain (calves, chest, back).

I tried several ways to reduce the effects of the Wellbutrin:

 

When I reduce Bupropion or other stimulants (Deplin or Trazodone) it causes PVCs, and when I raise a sedative (Oxcarbazepine or Loxapine) that also causes PVCs. It is a paradoxical reaction since raising stimulants usually causes PVCs not lowering them.

I know the PVCs are not harmful but still they cause me unbearable anxiety. I desperately want off of the Wellbutrin.

 

Do you think you could help me with this situation? I live three hours away. Would you do a telephone cosultation with me or my current psychiatrist or would I have to come to your office for an appointment? Or is there someone you could recommend (I live in Harrisonburg near UVA hospital.)

 

Thank you,

John

[Altostrata]

You should list ALL your drugs when you correspond with one of these doctors.

 

To arrange a consult, your doctor contacts the expert. You shouldn't have to arrange this. You need to communicate clearly to Dr. Kane that you would like him to talk to Dr. Soandso, an expert in drug interactions, about which drug to taper first and how to manage the PVCs. Give Dr. Soandso's phone number to Dr. Kane.

 

Name-brand Wellbutrin SR is still manufactured by GlaxoSmithKline. Name-brand Wellbutrin XL is currently manufactured by Valeant Pharmaceuticals.

 

In the name-brand Wellbutrin SR, the SR is in the binder. There is citation in the Wellbutrin topic for this. Generic versions (which would be called buproprion and not Wellbutrin) may be made differently. You'd have to contact the manufacturer to find out exactly how the tablet is formulated, or talk to a pharmacist specializing in psychopharmacology.

 

Name-brand Wellbutrin XL is formulated differently from Wellbutrin SR. The XL tablet has a shell coating a core of immediate-release buproprion. When the shell is broken, you get Wellbutrin IR.

 

Again, if you want exact formulation information for generic versions, you would have to contact the generic manufacturer.

 

Your pharmacist sounds unusually well-informed for a local pharmacist, Jshect. However, he may not have studied these drugs for the express purpose of tapering and may not be aware of the details, which I've spent many hours researching. I've supplied citations in the Wellbutrin topic for everything if you'd like to evaluate the evidence yourself.

 

If you wish to further investigate the various formulations of Wellbutrin, what you might do is contact a university near you with a Pharmacy department and discuss drug details with one of the faculty of the Pharmacy department.

 

As meimei noted above, even when tablets are not cut up, there is individual variation in how a person metabolizes buproprion. I cannot predict how any dose of any drug taken in any form will affect you.

 

Personally, I prefer using liquid formulations for careful dosing of a drug.

 

I think we've discussed every variation of taking Wellbutrin, it's up to you to decide what to do.

[Jshect]

"Personally, I prefer using liquid formulations for careful dosing of a drug.

 

I think we've discussed every variation of taking Wellbutrin, it's up to you to decide what to do."

 

Well really I could try both and see which one works best. If I could get an accurate enough scale and use that formula I could cut precisely (well roughly) 1 mg out of the 150 mg pill (of course a .001 mg scale is usually +/- .005 or some amount, however even with individual variation from day to day, the average over a 1 or 2 week period would likely come close to 149 mg per day. I might as well not mess around and buy Wellbutrin SR since you know it has the binder evenly mixed in with the Wellbutrin.  I could try that and then I could try 100 mg SR and 49 mg IR in liquid form. I can generally tell when I'm about to have PVCs, I get this sort of "pre PVC anxious feeling" when that comes I could take some liquid IR, and as you said get some instant relief. You like that method the best and I think I agree. If I get PVCs by just cutting of roughly 1 mg I just have to wait until the next day to take Wellbutrin. With the liquid method each time I felt that pre PVC feeling, I would have a remedy for however long that would last me. 

 

Yes, I will give Dr. Kane the numbers and ask him to please call one of the experts. Well I'll have to chose one expert.

Thanks

[Altostrata]

....

Well really I could try both and see which one works best. If I could get an accurate enough scale and use that formula I could cut precisely (well roughly) 1 mg out of the 150 mg pill (of course a .001 mg scale is usually +/- .005 or some amount, however even with individual variation from day to day, the average over a 1 or 2 week period would likely come close to 149 mg per day. ....  I could try that and then I could try 100 mg SR and 49 mg IR in liquid form.

 

If I were you, I'd try the 100 mg SR plus 49 mg IR in liquid form, planning on taking the liquid dose in the evening.

 

It's possible that in the first week or so, you'll find you need a "booster" of a few milligrams earlier in the afternoon. It may take a bit for your system to get used to the new dosing.

 

I would do this before going to the expense of ordering a scale.

[Jshect]

Well, I meet with Dr. Kane on Wednesday, (I think). 

 

"I am wondering if you lowered the oxcarbazepine, which is a cyp3A4 inducer, it might cause metabolism of clonazepam to slow and perhaps enable you to reduce the Klonopin a bit."

You said this and Dr. Kane said this as well, so, as I said, if I lower the Wellbutrin, I start getting PVCs, I may have to lower the brakes. So since Trileptal would possibly raise the klonopin, and keep that withdrawal at bay, but the question is how do I carefully reduce the Trileptal. Do I take a pestal and morter, crush it, add it to a liquid and remove a ml? Do I need a scale?

Also, if trileptal increases cyp3a4 meds then it's going to increase loxapine, trazadone, and bupropion as well. So this is a grand experiment, hopefully it will work!

[Altostrata]

Where did Dr. Kane get his information?

 

We discussed tapering oxcarbazepine before:

Well I don't know what to do. Whenever I lower Loxapine I have to raise the klonopin. This process would probably be about 1000 times easier if I had never been put on the Klonopin. I decreased the Loxapine from `10 mg to 8 mg, and I got major withdrawal from Klonopin. At first it's nice (boost in memory, cognitive functioning) but then it gets worse to the point where I start to lose touch with reality a little. Not Good!! At 10 mg loxapine, I was taking .625 mg klonopin. Now, I am taking about 1.75 mg just to feel normal. I think when the bad withdrawal symptoms go away I will be able to lower the Klonopin. I think now I am taking a larger quantity to reduce the withdrawal symptoms. I looked into liquid oxcarbazepine and it's like $150 a bottle. Is there anyway I can crush it, and create a solution?

 

 

You might find it less expensive to have it compounded into a liquid by a pharmacy.
 
Googling, I found this http://pedsbrain.com/TRILEPTAL.doc

Trileptal comes in tablets (150mg, 300mg, and 600mg)as well as suspension (300mg/5ml). The tablets may be crushed up or chewed. It is generally given twice a day and occasionally three times a day.

This might be good to discuss with a pharmacist http://www.sciencedomain.org/download.php?f=Rani412013BJPR4763_1.pdf&aid=2165
 
For DIY, making a suspension with pharmacy liquid base probably would be the best way to go. These are all my guesses, I haven't actually done this. I would check with a compounding pharmacy.
 
When questions like this arise, please get what information you can out of the smartest pharmacist you can find and Google to see if the question has been asked and answered elsewhere. Share any info you find here to inform others.

 

[Jshect]

I'll google how to best taper Trileptal. For some reason I can't open either link you've posted  Dr. Kane didn't say anything more than that. I'll have to prepare a list of questions for him. He's got to have some sort of insightful, educated guess as to the PVC/medicaton link but I know he's been sued before so that's why I think he is very hesitant to get involved. However, I will ask him if he wants to consult with one of the experts Sandson recommends. I'm also still trying to get a hold of the Hollistic Psychiatrist but for some strange reason I am having a hard time. We keep missing each other. There is no secretary who answers the phone when you call his office. You have to leave a message and she gets back to you. It is very frustrating.

 

I guess I could ask Dr. Kane "What do you think Wellbutrin/Deplin/Trazadone are doing to my body (and heart specifically) and what do you think the brakes are doing" He was a damn professor of psychopharmacology he's got have some sort of guess which he has yet to offer me. 

 

I've been "researching" (googling) Wellbutrin.

 

Here's a quote

"There is evidence that bupropion's development was inspired by the structure of amphetamine, which had been used, with limited success, as an antidepressant in the 1930s. Bupropion is similar in structure to the stimulant cathinone (a monoamine alkaloid found in the shrub Catha edulis - Khat), and to phenethylamines in general. It is a chemical derivative of diethylpropion, an amphetamine-like substance used as an anorectic"

 

http://en.wikipedia.org/wiki/Substituted_phenethylamine

 

So I guess Wellbutrin is considered a phenethylamine. In the above link there are many phenethylamine drugs listed. These do not look like safe drugs. Some are psychedelics and some are amphetamines. 

 

Every artilcle seems to indicate Wellbutrins similarity to Cathinone which according to Wikipedia is

 

Legality[edit]

Internationally, cathinone is a Schedule I drug under the Convention on Psychotropic Substances.^[3] Circa 1993, the DEA added cathinone to the Controlled Substances Act's Schedule I.

The sale of khat is legal in some jurisdictions, but illegal in others—see Khat (Regulation). Substituted cathinones were also often used as the key ingredient of recreational drug mixes commonly known as "bath salts" in the United States.^[4]

 

another quote

http://en.wikipedia.org/wiki/Substituted_cathinone

On 2 April 2010, the Advisory Council on the Misuse of Drugs in the UK announced that a broad structure-based ban of this entire class of compounds would be instituted, following extensive publicity around grey-market sales and recreational use of mephedrone, a common member of the family. This ban covers compounds with the aforementioned general structure, with 28 compounds specifically named.^[2]

"Any compound

(not being bupropion

or a substance for the time being specified in paragraph 2.2) structurally derived from 2-amino-1-phenyl-1-propanone by modification in any of the following ways, that is to say,

(i) by substitution in the phenyl ring to any extent with alkyl, alkoxy, alkylenedioxy, haloalkyl or halide substituents, whether or not further substituted in the phenyl ring by one or more other univalent substituents;

(ii) by substitution at the 3-position with an alkyl substituent;

(iii) by substitution at the nitrogen atom with alkyl or dialkyl groups, or by inclusion of the nitrogen atom in a cyclic structure."

—ACMD, 2nd April 2010

So, I guess that's why Wellbutrin, despite amazing sales,  it's basic structure has not been manipulated by other Pharma companies is because it is illegal (illegal, gee what a surprise, except for Wellbutrin.)

 

When I was reading about negative side effects amphetamines (the article was specifically talking about Adderall) can cause, that seems to be everything Wellbutrin/Deplin/Trazadone have done to me. In other words all of the negative side effects the article listed about Adderall, I have also experienced from my accelerator combination.

Everything from mania in people who have never had it before, constipation... I wish I could find that article again. So this combination seems to be acting almost like Adderall or an amphetamine. My bodies has this delicate homeostasis between extremely sedating drugs (so sedating I have to take them all at night), and extremely energizing drugs. The problem is both sets of drugs (brakes and accelerators) are operating at an EXTREME level on my body (like yin and yang on crack), I guess, which may be why the PVCs occur when the extreme sedatives overpower the extreme accelerators. 

I think a lot of this has to do with my genes and biochemistry because I have known people who have been on Wellbutrin and it seemed to have no effect but for some reason in me it has a tremendous effect.