AuntieBea: tapering Celexa and Wellbutrin

[Altostrata]

Interactions between buproprion and other antidepressants are very well-known in the literature -- though not by doctors.

 

Wellbutrin being an appetite suppressant is also very well known.

 

I would change the Wellbutrin schedule first -- do not change two drugs at the same time. I'd move the Wellbutrin earlier by one hour each day. Please post daily notes while you make drug changes.

[Gridley]

4 hours ago, AuntieBea said:

Wondering what you would suggest at this point?

I haven't had Internet all day, so I apologize for my late response.  I wouldn't move both the Celexa and the Wellbutrin. If you move the Wellbutrin, do it by moving it one hour earlier per day until you reach the point in the morning when you want to take it.

 

Then I'd wait around a few days to let that settle and see how you do.  If all is okay, I think you could start tapering the Wellbutrin.

 

I don't know what rate to suggest.  You had reactions with the 2 1/2% Brassmonkey slide but you later said you might have been overreacting.  If you're comfortable trying that again, that would be a conservative taper.  If you want to go even slower, you could do 5% per month.

 

It's a push-pull between wanting to get off the med which is causing a lot of side effects vs. not wanting to experience too much withdrawal  Another factor to consider is that side effects generally lessen the lower your dose.

 

Are you going to stay with the tablet rather than do a crossover to liquid?

 

[Giulietta]

Dear AuntieBea,

 

How are you? I have been thinking of you as I saw some of the interactions between you, Alto and Gridley.

 

I am so glad you got yourself a weighted blanket and that it helps you sleep! It is one of the best purchases I made. Did you get a cover for it as well? I purchased one to protect the blanket (I can't imagine cleaning it). It took me about 40 minutes to get the blanket in it... 🤣 I think it has 12 or 16 ties....The black out eye mask helps me with insomnia, too. I wish I had known about these things years ago. 

 

 

7 hours ago, AuntieBea said:

But the upheaval in this case was all about old abandonment issues which are also asking to be healed at this point in my life...so it seems to be all part of the package for me

 

This is so positive - that you associated / understood the cause of emotional turmoil and that you are  able to work on it.  Many of us (most? several?) are working on developing skills to overcome anxiety, panic, etc. andtakes time, commitment and patience. Maybe healing your abandonment issuees will need the same. I am re-learning cognitive bvehavioral therapy techniques - it is a huge process to make negative thoughts and feelings adaptive and positive ones.

 

7 hours ago, AuntieBea said:

I have had so many sleepless nights for the last six months that there’s anxiety just anticipating going to bed.

 

I hope you will now look forward to going to bed knowing you can sleep under your new weighted blanket. It has made a positive difference in my life!

 

All kind wishes to you,

 

Giuilietta

 

 

 

 

 

[AuntieBea]

@Altostrata

Hello again,

 

17 hours ago, Altostrata said:

I would change the Wellbutrin schedule first -- do not change two drugs at the same time. I'd move the Wellbutrin earlier by one hour each day. Please post daily notes while you make drug changes.

 

Thanks, I will start moving the Wellbutrin forward today and post daily notes for a few days.

 

15 hours ago, Gridley said:

Then I'd wait around a few days to let that settle and see how you do.  If all is okay, I think you could start tapering the Wellbutrin.

 

 

 

 

Would this also be your suggestion or is it more important for me to gradually move my Celexa dose to the evening as you suggested in an earlier post, in order to determine how the two drugs might be affecting me in isolation of each other?

(I can’t seem to move the quote over here from the previous page....)

 

”Do you know how the Celexa affects you on its own?

My guess is that separating your Celexa dose from the Wellbutrin dose might reduce the symptoms you tend to report a couple of hours later.”

[Gridley]

50 minutes ago, AuntieBea said:

Would this also be your suggestion or is it more important for me to gradually move my Celexa dose to the evening as you suggested in an earlier post, in order to determine how the two drugs might be affecting me in isolation of each other?

That was Alto's suggestion.  Why don't you wait and see how moving the Wellbutrin affects you?

[AuntieBea]

@Gridley

 

Yes, I will do that first for a few days to see how it affects me. And I will post notes about it.

 

I guess what I was trying to clarify is whether or not moving the Celexa to the evening was still something to shoot for (Alto mentioned it previously as a possibility), or whether it would be better to go straight into tapering the Wellbutrin. I thought maybe there was some value to knowing how the Celexa affects me separate from the Wellbutrin, and visa versa.

But maybe that’s just jumping the gun for now...I’ll just keep it simple and stay focused on the Wellbutrin for the moment....

 

Yes, I plan to start tapering with the tablet instead of the doing a crossover. It’s easy enough for me to weigh the dose, although at the lower end of the taper I may decide to switch over if weighing becomes problematic. I think I read somewhere though that you still weigh your doses even at the lower end...?

 

Thanks Gridley. It’s quite alright about the internet. It’s amazing how simple life becomes when it shuts down. Although I count on it so much at this point for getting through life that “simple” can get pretty complicated when it does. Anyway, glad to know you’re back on line! 

 

I hope you you have a good day!

Auntie Bea

[Altostrata]

On 10/20/2019 at 9:50 AM, Altostrata said:

The other option would be to gradually move the Celexa dose later in the day -- but that might affect your sleep as well.

 

As I explained before, moving the Celexa later might have unintended consequences. I suggested taking the Welllbutrin earlier because the risks are less.

 

We've been talking about reducing Wellbutrin since you started this Intro topic. You've acknowledged several times that you are probably getting serious adverse effects from Wellbutrin. Why are you hesitating on taking steps to 1) possibly reduce adverse effects; 2) reduce and finally go off Wellbutrin?

[AuntieBea]

@Altostrata

 

There was confusion on my part because all along I have taken the Celexa and Wellbutrin together usually around 10:00 AM.

Sometimes earlier, sometimes later. This morning I moved the Wellbutrin to 9:00 AM and took the Celexa at 10:30. It doesn’t seem like much of a change from taking them together at around 10:00, but maybe that much could make a difference as far as reducing adverse effects. I should have mentioned this confusion of mine in the first place.

 

I did not entirely understand that moving the Wellbutrin earlier was intended as an alternative to taking the Celexa later. It is completely my misunderstanding. 

 

So should I stay with 9:00 for the Wellbutrin and 10:30 for the Celexa? Or maybe move the Wellbutrin even earlier?

 

I am not hesitant to go ahead with the taper. I would like to start it ASAP. I appreciate that you are trying to guide me through this so that I can regain my health. 

 

 

 

 

 

[Altostrata]

Please keep daily notes as you make these drug changes.

 

What is the earliest time in the morning you can take Wellbutrin, that will be convenient for you so you can do it every day?

[AuntieBea]

@Altostrata

 

I can easily take the Wellbutrin at 7:00 AM each day.

 

I would back it up to 8:00 tomorrow, then to 7:00 on Wed.

 

 

 

[Altostrata]

Okay. Please keep notes while you do this.

[AuntieBea]

@Altostrata

 

Yes,, I will do that.

Thank you!

 

[AuntieBea]

@Altostrata

 

Day 1 Symptom Chart 10/21/19 (spacing out Wellbutrin and Celexa)

 

  9:00 PM. Sleep (10/20/19)

12:30 AM. Woke up. Agitation, anxiety. Went back to sleep.

  2:30 AM. Woke up. Agitation, anxiety. Stayed up.

  3:30 AM. Back to bed. Did not sleep. Can’t rest. Agitation, anxiety.

  5:30 AM. Got up. Agitated, lightheadedness, palpitations. Head throbbing, headache.

  6:30 AM. Back to bed under weighted blanket. Lots of agitation.

  7:45 AM. Got up. Ate cereal.

  8:30 AM. Symptoms continue.

  9:00 AM. Took 100mg Wellbutrin.

10:30 AM. Took 5.4mg Celexa.

10:45 AM. Second breakfast.

11:00 AM. Symptoms continue, palpitations getting worse.

12:30 PM. Anxiety, agitation, palpitations all getting worse.

  2:00 PM. Lunch.

  4:30 PM. Anxiety, agitations, palpitations continue.

  7:15 PM. Dinner.

  7:45 PM. Anxiety , agitation diminishing. Palpitations continue.

  8:30 PM. Sleep.

  

This was an unusually difficult night with lots of symptoms, but these occurred the night before changing the time of the Wellbutrin dose so were clearly unrelated. As usual though, symptoms did ramp up a couple of hours after taking the Wellbutrin. 

 

[Gridley]

7 minutes ago, AuntieBea said:

As usual though, symptoms did ramp up a couple of hours after taking the Wellbutrin. 

Keep posting these, AuntieB.  Once you're down to 7am, it's probably time to start thinking about doing your taper.  The Brassmonkey slide seems to me to be a good middle-of-the road approach between the 10% taper and a micro taper.  Obviously the Wellbutrin doesn't agree with you.

[AuntieBea]

@Altostrata

 

Day 2 Symptom Chart 10/22/19 (spacing out Wellbutrin and Celexa dose)

 

  8:30 PM. Sleep (previous night).

10:30 PM. Woke up. Intense heat, flushing in face, feet, legs. Palpitations.

11:00 PM. Got up. Toast and tea. Feet intensely hot, lightheaded.

12:00 AM. Fell asleep.

  4:00 AM. Woke up. Feet hot, heart pounding, lightheaded.

  4:30 AM. Got up.

  7:45 AM. Really hot feet. Mild palpitations, no pounding. Generally calm.

  8:00 AM. Took 100mg Wellbutrin.

10:00 AM. Slight increase in symptoms.

10:30 AM. Took 5.4mg Celexa.

  2:30 PM. Some palpitations. Right eye pain. Minimal symptoms.

  5:30 PM. Some palpitations. Right eye pain. Minimal symptoms.

  6:00 PM. Dinner

  6:30 PM. Right eye pain. Feeling quite normal.

  8:00 PM. Sleep.

 

Poor sleep and quite intense symptoms through the night. As the morning went on symptoms began to diminish. Overall I felt quite normal all day. Definitely one of my better days in a while.

[Altostrata]

That appears to be an improvement, would you say?

 

It will take at least 4 days for the new drug schedule to settle in. Please keep posting your daily notes.

[AuntieBea]

@Altostrata

 

Day 3 Symptom Chart 10/23/19 (spacing out Wellbutrin and Celexa dose)

 

  8:00 PM. Sleep (previous night).

  4:00 AM. Woke up. Had been in a half sleep for a couple of hours. Lightheadedness, palpitations, headache.

                   Feel odd, drowsy. Back to bed. Did not sleep.

  6:00 AM. Got up. Lightheadedness, palpitations, throbbing sensation, headache.

  7:00 AM. Took 100mg Wellbutrin. Symptoms continue.

  8:30 AM. Breakfast.

10:00 AM. Lightheadedness, palpitations, headache. Brain fog. Symptoms have increased.

10:30 AM. Took 5.4mg Celexa.

11:30 AM. Lightheadedness, palpitations, headache. Brain fog.

  1:00 PM. Brain fog, lightheadedness continue. Seem to be getting worse. Headache, palpitations more intense.

                   Eye pain.

   2:00 PM. Lunch

   2:30 PM. Symptoms continue to be intense. Not functioning well. Lie down.

   4:30 PM. Symptoms are noticeably less intense. Feeling better.

   6:30 PM. Headache is the most noticeable symptom. Also palpitations. Overall feel better than I have all day.

   7:00 PM. Dinner.

 

I haven’t felt especially well today. Not like yesterday. I was symptomatic from 4:00 AM through the morning, but it did noticeably intensify 2-3 hours after taking the Wellbutrin. It was milder yesterday by comparison. I am noticing that  the words anxiety and agitation are missing from my symptom description today and yesterday...maybe some symptom relief from spacing out the Wellbutrin and Celexa dose??? Probably too soon to tell....

[AuntieBea]

@Altostrata

Hello Alto,

Yes, yesterday was very encouraging. Lots of symptom relief. Today (just posted a moment ago) I’m not feeling as well, but still overall an improvement. Noticeably less anxiety and agitation. 

Today was 7:00 AM for the Wellbutrin and 10:30 for the Celexa. I’m planning to stay with that unless you suggest something different. I’ll continue to post the daily notes.

 

[AuntieBea]

@Gridley

Hello again,

 

I’ve posted yesterday’s and today’s daily notes...there has been some noticeable symptom relief from spacing out the Wellbutrin and Celexa doses. I’ll give it a few more days to settle in. 

 

On 10/20/2019 at 5:24 PM, Gridley said:

It's a push-pull between wanting to get off the med which is causing a lot of side effects vs. not wanting to experience too much withdrawal  Another factor to consider is that side effects generally lessen the lower your dose.

 

Are you going to stay with the tablet rather than do a crossover to liquid?

 

 

The Brassmonkey Slide does seem like a good middle of the road place to start the taper, but the push-pull that you mention

related to my vision problem has me wishing I could step it up faster. Best to start conservatively though.

[Gridley]

44 minutes ago, AuntieBea said:

Best to start conservatively though.

 

Let's start conservatively and see how it does after 6 weeks (the 4 week taper and the 2 week BM taper hold).  If all is well, you can increase to the regular 10%/4 week taper and if that goes well, faster.  Wellbutrin uniquely seems seem allow for a faster taper, so let's take it a step at a time.  Certainly your side effects argue for a more rapid taper if you can tolerate it.

[Giulietta]

Hello AuntieBea,

 

Just stopping by to say a quick hello.  I'm glad to see you are on the up and up!

 

9 hours ago, Gridley said:

Let's start conservatively

 

I hope you make this wise choice.

 

Giuilietta

[Altostrata]

AB, it looks to me like you are experiencing adverse effects from Wellbutrin, these get worse when you add Celexa -- consistent with the drug interaction profile -- and diminish as the Wellbutrin wears off later in the day.

 

This is Wellbutrin XL, correct? Please update your signature.

 

Once you get your drug schedule settled, I would taper Wellbutrin, as Gridley suggested, maintaining your Celexa dosage while you do this.

[AuntieBea]

@Altostrata

Hello Alto,

2 hours ago, Altostrata said:

This is Wellbutrin XL, correct? Please update your signature.

 

No, I am using Bupropion HCL, that’s immediate release unless I am mistaken.

[AuntieBea]

@Gridley

Hello Gridley,

21 hours ago, Gridley said:

Let's start conservatively and see how it does after 6 weeks (the 4 week taper and the 2 week BM taper hold).  If all is well, you can increase to the regular 10%/4 week taper and if that goes well, faster.  Wellbutrin uniquely seems seem allow for a faster taper, so let's take it a step at a time.  Certainly your side effects argue for a more rapid taper if you can tolerate it.

 

That sounds like a really good tapering plan. I’ll spend a few more days getting my drug schedule settled then be ready to begin the taper.

Thanks so much for all your help with this!

 

[Altostrata]

https://www.ncbi.nlm.nih.gov/books/NBK470212/

 

Quote

 

The onset of therapeutic effect of bupropion usually occurs in the second week of taking the medication. The time to peak serum concentration is 2 hours for immediate release, 3 hours for sustained release, and 5 hours for extended release. The duration of action is 1 to 2 days.

....

The half-life of bupropion is 3 to 4 hours distribution, but the half-life extends to about 21 hours when dosed chronically. 

 

 

You appear to be having an adverse reaction to buproprion, which lasts throughout the day. Once you get your schedule set, if I were you, I'd start to taper it. Leave the citalopram schedule and dosage the same. See Tips for tapering off Wellbutrin, SR, XR, XL (buproprion)

[AuntieBea]

@Altostrata

 

18 minutes ago, Altostrata said:

The half-life of bupropion is 3 to 4 hours distribution, but the half-life extends to about 21 hours when dosed chronically. 

 

I often feel best about three hours in the morning prior to taking the bupropion. Not sure I’m understanding it correctly but I’m guessing that would be hours 22-24 after my dose the day before, when the concentration of the drug in my body is at its lowest. 

 

31 minutes ago, Altostrata said:

Once you get your schedule set, if I were you, I'd start to taper it

 

I’d like to bump the Wellbutrin dose back up to 8:00 AM. And then push the Celexa up to maybe 11:00 AM.

Unless you tell me that is a bad idea at this point.

[Altostrata]

1 minute ago, AuntieBea said:

I’d like to bump the Wellbutrin dose back up to 8:00 AM. And then push the Celexa up to maybe 11:00 AM.

 

Yes, if you can keep that schedule.

[AuntieBea]

@Altostrata

 

OK. I will get settled on that schedule then.

Will also continue to post the daily notes.

 

I appreciate your help, Alto. Thank you!

[AuntieBea]

 @Gridley

Hello Gridley, 

 

I’m trying to update my signature...I’m adding three lines for a total of twelve lines and it’s not being accepted. I’ve run into this before which is why I haven’t updated it recently. 

I don’t know about the pixels, URLs and images but it’s pretty simple what I’m trying to do. 

Can you help me out with this? I’m clearly not doing something right.

 

Thanks

 @Gridley

Hello Gridley, 

 

I’m trying to update my signature...I’m adding three lines for a total of twelve lines and it’s not being accepted. I’ve run into this before which is why I haven’t updated it recently. 

I don’t know about the pixels, URLs and images but it’s pretty simple what I’m trying to do. 

Can you help me out with this? I’m clearly not doing something right.

 

Thanks

 @Gridley

Hello Gridley, 

 

I’m trying to update my signature...I’m adding three lines for a total of twelve lines and it’s not being accepted. I’ve run into this before which is why I haven’t updated it recently. 

I don’t know about the pixels, URLs and images but it’s pretty simple what I’m trying to do. 

Can you help me out with this? I’m clearly not doing something right.

 

Thanks

 @Gridley

Hello Gridley, 

 

I’m trying to update my signature...I’m adding three lines for a total of twelve lines and it’s not being accepted. I’ve run into this before which is why I haven’t updated it recently. 

I don’t know about the pixels, URLs and images but it’s pretty simple what I’m trying to do. 

Can you help me out with this? I’m clearly not doing something right.

 

Thanks

[CoolheadLuke]

2 minutes ago, AuntieBea said:

 @Gridley

Hello Gridley, 

 

I’m trying to update my signature...I’m adding three lines for a total of twelve lines and it’s not being accepted. I’ve run into this before which is why I haven’t updated it recently. 

I don’t know about the pixels, URLs and images but it’s pretty simple what I’m trying to do. 

Can you help me out with this? I’m clearly not doing something right.

 

Thanks

 

It looks like there are 3 blank lines at the end of your signature - if I click and hold to select your signature and drag down, it highlights 3 blank lines at the end.

 

Can you try to select the line under your Apr 21st line, and then start typing there (without hitting enter to add more lines)?

[AuntieBea]

@Gridley

Sorry about that repeated message Gridley. I goofed something up for sure!!

[AuntieBea]

9 minutes ago, CoolheadLuke said:

Can you try to select the line under your Apr 21st line, and then start typing there (without hitting enter to add more lines)?

 

OK, I added three lines but did not tap on Save. Is that what you wanted me to do?

[CoolheadLuke]

Just now, AuntieBea said:

 

OK, I added three lines but did not tap on Save. Is that what you wanted me to do?

 

You can still try saving it - just try to highlight the lines below your last line and type there, instead of hitting enter to add new lines.  Does that make sense?  

 

Also, sorry I'm about to head to therapy & work, but I'll try to check in again this evening (although I'm sure you'll have it figured out by then).

[AuntieBea]

6 minutes ago, CoolheadLuke said:

You can still try saving it - just try to highlight the lines below your last line and type there, instead of hitting enter to add new lines.  Does that make sense?  

Saving it didn’t work again. I’m not real savvy with this stuff so I’m hoping you are real patient....

 

I don't know how to highlight below the April 21st line as there’s nothing there to highlight. 

I am on an iPad. Don’t know if that makes any difference.

It’s unlikely I’ll have it figured out before this evening. I may have to get help from someone on this end, like one of my kids to even understand what it is you’re getting at.🙂

 

Hope you have a good afternoon, Luke. Talk to you later.

[AuntieBea]

Day 4 Symptom Chart 10/24/19 (spacing out Celexa and Wellbutrin dose)

 

  8:00PM. Fell asleep (previous night).

  9:00 PM. Woke up. Toast and tea.

12:00 PM. Back to sleep.

  3:00 AM. Woke up. Slept on and off till 6:00 AM.

  6:00 AM. Got up. Hot feet. Palpitations.

  7:00 AM. Took 100mg Wellbutrin.

  8:00 AM. Breakfast. Palpitations. Some anxiety, agitation.

10:00 AM. Palpitations. Increased agitation.

10:30 AM. Took 5.4mg Celexa. Continued palpitations, agitation. right eye pain.

11:30 AM. Symptoms continue.

  1:00 PM. Symptoms have all decreased significantly (I did just finish a session of energy healing work).

  1:30 PM. Lunch.

  3:00 PM. Right eye pain. Calm. Feel reasonably well.

  5:00 PM. Right eye pain. Calm. Feel reasonably well.

  6:30 PM. Dinner.

  8:45 PM. Right eye pain. Some palpitations. Otherwise still feel well.

  9:15 PM. Bed.

[CoolheadLuke]

6 hours ago, AuntieBea said:

Saving it didn’t work again. I’m not real savvy with this stuff so I’m hoping you are real patient....

 

I don't know how to highlight below the April 21st line as there’s nothing there to highlight. 

I am on an iPad. Don’t know if that makes any difference.

It’s unlikely I’ll have it figured out before this evening. I may have to get help from someone on this end, like one of my kids to even understand what it is you’re getting at.🙂

 

Hope you have a good afternoon, Luke. Talk to you later.

 

Hmmm ... the iPad might be the problem, I feel like a lot of sites are hit & miss on app type devices.  Do you have access to a laptop/desktop?