Jump to content

Doe1: Possible SD upon discontinuation of Bupropion - advice appreciated


Doe1

Recommended Posts


Hi,
 

Since June 2016, I've taken bupropion XL. 150mg a day for first month, 300 for second month, and then on, 450mg a day until May 2018. As far as I could notice, it did not effect my sexuality either negatively or positively.
 

Around, I believe, the middle-to-end of May this year, I stopped the bupropion pretty much cold turkey because I thought it was just elevating my anxiety and not really helping depression. I did not, at the time, believe I had any negative withdrawal symptoms. It seemed pretty painless.
 

At the beginning of this August, I started taking 150mg of bupropion a day again because I thought - why not - see one more time if a lower dose can help while not increasing your anxiety.
 

Now, though, I'm considering if my noticeable sexual dissatisfaction/lowered libido for the past little while may be connected to my cold turkey discontinuation of bupropion back in May. I'm not 100% sure - I couldn't say exactly how much my current sexual dissatisfaction aligns with the discontinuation, since I hadn't thought to watch for that (I thought bupropion couldn't cause negative sexual side effects.) But based on what I do remember, it seems like a very real possibility, which makes me scared of PSSD (so to speak, since bupropion is not an SSRI.)
 

As I said, I reinstated the bupropion at the beginning of August at 150mg XL a day.  In terms of effects, I wonder if for this past week it might be elevating my anxieties again, though It could just be my natural anxiety going into overdrive in reaction to the possibility of PSSD. I don't think there's been a positive effect on my sexuality over the month - though it's seemed a bit more okay these past two days, but that could very well be due to hormones from my period that just arrived, or from abstaining a few days from sexual activity before hand. I don't think it's had a negative effect either - my sexuality has been noticeably not good over the course of this month, but my best guess is that this predates the reinstatement. (But I will admit that I am working off of imperfect memory and not careful tracking.)
 

If it is indeed a symptom of the withdrawal/discontinuation, I am wondering if I should be tapering off (safety and slowly, this time,) or if I should basically continue with the reinstatement in some manner. This site says that reinstatement for withdrawal symptoms is most likely to work within a month and gets more unpredictable the later you go on. It's been 3 to 3.5 months since my discontinuation of 450mg bupropion, and about 1 month now since my 150mg reinstatement.
 

I am worried that, if this was induced by the discontinuation, staying on the medication that caused the problem will potentially cause more long-term damage. But I am also worried that this might be my best opportunity left for reinstatement to work, if it will work, since it's been sub-4 months since the cold turkey discontinuation.


What should I do? What is the safest bet here to preserve  and heal sexual functioning? Taper off, stay on 150mg longer (and for how much longer?), or increase dosage (and if so, increase it to what, for how long)? Is a reinstatement of this nature likely to work on PSSD symptoms? Is it worth the risk? I do still have some sexual functioning/libido, which I value and can enjoy, even if it's noticeably not what it used to be in the earlier months of this year. I really don't want things to get worse. But of course, I'll be unhappy if they don't ever get better again, either. Is there a wrong choice, here?
 

In honesty: a very large part of me feels sick and anxious at the idea of staying on any longer than necessary, in fear that staying on will potentially cause more long term damage. I *want* to start tapering off safely as soon as possible. And I don't want the possible further elevated anxiety of increasing doses. But I worry I won't heal this possible PSSD naturally, either, and that I'm missing my best chance here by not reinstating further. And not knowing how to proceed - fear of making the wrong choice - is distressing me.


Other questions:
 

- Before this, I have never considered myself even remotely sensitive to withdrawal symptoms. I'd cold turkey'd off of, or tapered down fast from, a variety of drugs without any apparent consequence. Even with this most recent CT off the bupropion, the sexual dissatisfaction is the only thing I can think to possibly associate with the discontinuation. How should this information effect my decision, if at all, and does my historical insensitivity to withdrawal symptoms possibly make it more likely that this particular symptom - if it is a withdrawal symptom - will heal naturally?
 

- If this is PSSD, then it's noticeable and I want it fixed, but it's not as severe as I know other people's symptoms are. I do still have some sexual functioning which I can enjoy to a certain extent. Could this also make the chance of natural recovery more likely?
 

- I have not had the chance to discuss the situation fully with my GP yet and tell him my concerns over possible sexual dysfunction caused by discontinuation. I don't know how that information might effect his advice. But, my pharmacist called him and absent these full details, my GP recommends as a process for weaning off bupropion - should I choose to do so - to updose for 2 weeks to 200mg SR (as opposed to 150mg XR I'm on now) and then taper off, I think, by 100mg every two weeks. I already know that's way faster than what this site recommends, but what about the initial up dose to 200mg? Is that a bad/good idea? What is the value in it? I will be seeing my GP to discuss this with him in a week.


Thanks.

 

Best reconstruction of my drug history I can manage with the gaps in my memory, based on prescription records:

Bupropion - June 2016 to mid or end of May 2018, 450mg for all but first two months. Went off cold turkey. Reinstatement of 150mg August 2018 to present. Methylphenidate - Oct-Nov 2016, 5mg possibly up to 40mg. Likely tapered off in a month or two. September 2017 - 4 pills of 18mg. Amphetamine - January 2016 - 5mg possibly up to 40mg. Trialed again sometime in 2016, probably up to 20mg, possibly 40mg, for a month to a month and a half. Likely tapered off in a month or two (though with 2nd trial,  maybe just a few weeks. Sertraline - Jan-March 2017 - 25mg up to 50mg, possibly up to 100mg. Likely tapered off in a month or two. Escitalopram - April-June 2017 - 5mg up to 20mg. Likely tapered off in month or two. Vyvanse - October 2017 - 20mg for a week, then possibly up to 40mg, but only for a few days.
Quetiapine - January 2017 to some time in late 2017 - 25mg at first, gradually increasing over the months up to 100mg as I felt I needed for sleep aid. Possibly inconsistent with the dosages over the months. Probably went off cold turkey. December 2017 - tried the extended version, 50mg up to possibly 100mg, for a little bit. Stopped again probably in late Dec to early 2018, maybe in Jan. August 2018 - 4 isolated Quetiapines of varying dosages for sleep aid. 3 extended, 1 immediate release.

Link to post
  • ChessieCat changed the title to Doe1: Possible SD upon discontinuation of Bupropion - advice appreciated
  • Administrator

Welcome, Doe.

 

Yes, nervousness and anxiety are well-known side effects of Wellbutrin.

 

While you felt Wellbutrin's effects on you were tolerable, your nervous system and entire hormonal network became dependent upon it while you were taking it. When you cold-turkeyed, it upset your nervous system balance and your sexual response. Did you also have any sleep problems?

 

Going on and off psychiatric drugs with or without withdrawal symptoms and experiencing adverse reactions such as antidepressant-induced anxiety can be wearing on the nervous system, making it hypersensitive to any neuroactive drugs and even supplements and foods. Consequently, you are having your customary adverse reaction to Wellbutrin at a lower dose.

 

What symptoms caused you to reinstate Wellbutin? Since you've been taking it only a month and you have side effects, I would reduce 150mg by 25mg to start. Tips for tapering off Wellbutrin, SR, XR, XL (buproprion) explains how to take a smaller dose.

 

It will take about a week to see what effect this has. Please keep daily notes on paper about your symptoms, when you take your drugs, and their dosages. Use a simple list format with time of day on the left and notation (symptom, drug and dosage) on the right.

 

Many people do better with fish oil and magnesium supplements, see http://survivingantidepressants.org/index.php?/topic/36-king-of-supplements-omega-3-fatty-acids-fish-oil/
http://survivingantidepressants.org/topic/15483-magnesium-natures-calcium-channel-blocker/

 

A lot of people find them helpful. Try a little bit of one at a time to see how it affects you.

 

PS Your history of many miscellaneous psychiatric drugs in a short amount of time suggests your doctor is over-inclined to experimentation with the drugs and may not know what he or she is doing.

 

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.

Link to post

Thank you for your reply, I appreciate it.

 I can't recall any trouble sleeping - any more so than usual - after I cold turkey'd. I wasn't really keeping track, but nothing sticks out in my mind. (I am having trouble right now, though.)

I reinstated due to issues with depression, the notable symptoms of which are extremely low self-esteem and hopelessness for the future and myself, which I think prevent me from functioning like I want to/need to. I have also historically felt like I've had trouble with attention deficit in general, which is why I have experimented with ADD drugs.

I also may have thought something like, "my libido sucks right now - hey, maybe going back on the Wellbutrin would kick start it again, since it's supposed to do that, right?" And - um - I also didn't want my doctor to think I wasn't...  doing anything to treat my depression/mental illness (though I'm in counseling), and I thought going back on the Wellbutrin would be a harmless thing. I didn't really have any idea what the risks of reinstatement could be.

I currently have a bottle of 100mg generic Bupropion SR tablets at my disposal. I don't think they are name brand - would it be safe to try cutting them up? I will be seeing my GP on Friday and I hope to convince him to also prescribe me some form of IR tablets (should it be 100mg IR tabs?) to incorporate in tapering, since that seems to be what the thread you linked recommends.  Maybe I can ask if there is any way for him to prescribe name-brand Wellbutrin SR tabs, since you say in the thread those are safe to cut. How would you recommend I instate the 125mg dose? Something like: 1 tab 100mg SR in morning, 25mg of IR in afternoon or evening?  Or 1 tab 100mg SR, and cut up another SR for 25mg? And how many hours apart exactly should I take each dose, at most/at least?

I already do take fish oil and magnesium, and have for some time, though I'd have to check the dosages as my parents prepare my supplements for me (I take a number).

If it matters, I did also start taking a quarter tea spoon (1.25ml) of niacin at night these past few nights (though I forgot to take last night's dose) - I thought it really calmed me down the first night I took it, at least for a few hours, though I don't think it managed to do as much for me in the nights afterTonight's dose feels like it's calmed me down some, thankfully. Since the flush is mostly gone now, my father is recommending I up dose.

Will try to keep a proper dose/symptom journal for now on.

As a symptom/mood update: In addition to elevated anxiety, I have also for the past few days had trouble sleeping and bad loss of appetite, and what I think may be a constantly elevated heart beat rate. My sexual functioning/libido has seemed actually somewhat better these past few days, though, at least in comparison to the worst it's been this month and earlier. Not sure if that's connected to the medication or other factors (like the period I mentioned), or what to do with the information. Will try to begin monitoring it more consistently with a personal journal, as with everything else.

Best reconstruction of my drug history I can manage with the gaps in my memory, based on prescription records:

Bupropion - June 2016 to mid or end of May 2018, 450mg for all but first two months. Went off cold turkey. Reinstatement of 150mg August 2018 to present. Methylphenidate - Oct-Nov 2016, 5mg possibly up to 40mg. Likely tapered off in a month or two. September 2017 - 4 pills of 18mg. Amphetamine - January 2016 - 5mg possibly up to 40mg. Trialed again sometime in 2016, probably up to 20mg, possibly 40mg, for a month to a month and a half. Likely tapered off in a month or two (though with 2nd trial,  maybe just a few weeks. Sertraline - Jan-March 2017 - 25mg up to 50mg, possibly up to 100mg. Likely tapered off in a month or two. Escitalopram - April-June 2017 - 5mg up to 20mg. Likely tapered off in month or two. Vyvanse - October 2017 - 20mg for a week, then possibly up to 40mg, but only for a few days.
Quetiapine - January 2017 to some time in late 2017 - 25mg at first, gradually increasing over the months up to 100mg as I felt I needed for sleep aid. Possibly inconsistent with the dosages over the months. Probably went off cold turkey. December 2017 - tried the extended version, 50mg up to possibly 100mg, for a little bit. Stopped again probably in late Dec to early 2018, maybe in Jan. August 2018 - 4 isolated Quetiapines of varying dosages for sleep aid. 3 extended, 1 immediate release.

Link to post
  • Administrator

Anxiety, sleeplessness, rapid heartbeat, etc. are common side effects of Wellbutrin.

 

If you cut up a 100mg SR tablet, it becomes IR. If I were you, I'd  lower the dose by cutting tablets for now.

 

Either of these could work:

35 minutes ago, Doe1 said:

Something like: 1 tab 100mg SR in morning, 25mg of IR in afternoon or evening?  Or 1 tab 100mg SR, and cut up another SR for 25mg? And how many hours apart exactly should I take each dose, at most/at least?

 

I would take these 12 hours apart, with lower amount in the evening. Keep daily notes.

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.

Link to post

Ok, thank you.

I just went to see if I could actually effectively cut up the SR tabs I have into quarters. There's no split of any kind in the tabs, so that makes it harder. I did it with a kitchen knife; I don't know if there's any kind of proper pill cutter in the house. As it is, I was able to cut it into rough quarters, but it's not an exact thing - powder was lost, of course, and the quarters don't look quite as equal as they could be; some of the quarters may be slightly bigger than the others. Is this enough of a concern that I should wait for IR tablets that can be cut up easier? (Can the IR tabs be cut up easier?) Or should I just... make sure to do my best?
 

Best reconstruction of my drug history I can manage with the gaps in my memory, based on prescription records:

Bupropion - June 2016 to mid or end of May 2018, 450mg for all but first two months. Went off cold turkey. Reinstatement of 150mg August 2018 to present. Methylphenidate - Oct-Nov 2016, 5mg possibly up to 40mg. Likely tapered off in a month or two. September 2017 - 4 pills of 18mg. Amphetamine - January 2016 - 5mg possibly up to 40mg. Trialed again sometime in 2016, probably up to 20mg, possibly 40mg, for a month to a month and a half. Likely tapered off in a month or two (though with 2nd trial,  maybe just a few weeks. Sertraline - Jan-March 2017 - 25mg up to 50mg, possibly up to 100mg. Likely tapered off in a month or two. Escitalopram - April-June 2017 - 5mg up to 20mg. Likely tapered off in month or two. Vyvanse - October 2017 - 20mg for a week, then possibly up to 40mg, but only for a few days.
Quetiapine - January 2017 to some time in late 2017 - 25mg at first, gradually increasing over the months up to 100mg as I felt I needed for sleep aid. Possibly inconsistent with the dosages over the months. Probably went off cold turkey. December 2017 - tried the extended version, 50mg up to possibly 100mg, for a little bit. Stopped again probably in late Dec to early 2018, maybe in Jan. August 2018 - 4 isolated Quetiapines of varying dosages for sleep aid. 3 extended, 1 immediate release.

Link to post

Alright, never mind, I bought a pill cutter and the quarters are much cleaner.

Just one more question for now, maybe a silly one: I actually tend to wake up every day between 11am and 1pm, which is why right now I'm taking my 150mg XL at 1pm. Does it strictly matter for any reason if I take my first SR dose in the literal 'morning', or is just around when I typically wake up ie. noon to one fine, as long as the next dose is still 12 hours later as you recommend.

Best reconstruction of my drug history I can manage with the gaps in my memory, based on prescription records:

Bupropion - June 2016 to mid or end of May 2018, 450mg for all but first two months. Went off cold turkey. Reinstatement of 150mg August 2018 to present. Methylphenidate - Oct-Nov 2016, 5mg possibly up to 40mg. Likely tapered off in a month or two. September 2017 - 4 pills of 18mg. Amphetamine - January 2016 - 5mg possibly up to 40mg. Trialed again sometime in 2016, probably up to 20mg, possibly 40mg, for a month to a month and a half. Likely tapered off in a month or two (though with 2nd trial,  maybe just a few weeks. Sertraline - Jan-March 2017 - 25mg up to 50mg, possibly up to 100mg. Likely tapered off in a month or two. Escitalopram - April-June 2017 - 5mg up to 20mg. Likely tapered off in month or two. Vyvanse - October 2017 - 20mg for a week, then possibly up to 40mg, but only for a few days.
Quetiapine - January 2017 to some time in late 2017 - 25mg at first, gradually increasing over the months up to 100mg as I felt I needed for sleep aid. Possibly inconsistent with the dosages over the months. Probably went off cold turkey. December 2017 - tried the extended version, 50mg up to possibly 100mg, for a little bit. Stopped again probably in late Dec to early 2018, maybe in Jan. August 2018 - 4 isolated Quetiapines of varying dosages for sleep aid. 3 extended, 1 immediate release.

Link to post
  • 2 weeks later...

Update:

Have been taking the 125mg daily dose for just above a week now, since Sept. 4th. I take the 100mg SR pill at 12:30pm when I wake up, and the 25mg quarter at 12:30am.

In the last week/few days of taking the 150mg XL daily dose, I was experiencing insomnia (as in, not being able to fall asleep at all for multiple non-consecutive days), intensely elevated anxiety and heart beat, and poor appetite. There seemed to be a rise in libido I associated with my period.

On the 125mg, the bad insomnia is thankfully now gone. There have been a few nights where I laid awake in bed longer than I would have liked due to elevated anxiety/heartbeat, and a few days where I woke up earlier than I wanted, but on the whole I do eventually manage to fall asleep and stay asleep in a way I find okay.

Elevated anxiety and heartbeat is also noticeably improved, but I think, as of today, still present to a certain degree, and still uncomfortable. Poor appetite is improved over all, but gets worse with anxiety, of course.

Sexual libido/functioning took a dip on the first two days of the 125mg, which I thought to associate with the end of my period, since it aligned that way. However, for the next 3 days, I then experienced a sharp, noticeable rise in libido, something quite reminiscent of pre-dysfunction levels, and then back down again for the next few days in varying degrees. (So far today, it's seemed slightly better than yesterday.)

So: Nothing has gotten worse. Most things have gotten better in varying degrees. Sexuality has fluctuated over the week.

How should I be planning my next move? I was thinking I would make another 25mg reduction either right now, or at the end of week 2, since the Tips for Tapering Wellbutrin thread says that some people (if not everyone) do fine with tapering Wellbutrin at that rate, and I had only been on the 150mg XL dose for a month. I would prefer not to do any more long-term damage to my sexuality, of course, but I am also uncomfortable due to anxiety/heartbeat.

When I do make the next reduction, how do I divide it? If it were another 25mg reduction, would I, for example, just take the 100mg SR pill in day time - or would I cut up the 100mg and space it out throughout the day - and how exactly would it be spaced out?

Thanks.

Best reconstruction of my drug history I can manage with the gaps in my memory, based on prescription records:

Bupropion - June 2016 to mid or end of May 2018, 450mg for all but first two months. Went off cold turkey. Reinstatement of 150mg August 2018 to present. Methylphenidate - Oct-Nov 2016, 5mg possibly up to 40mg. Likely tapered off in a month or two. September 2017 - 4 pills of 18mg. Amphetamine - January 2016 - 5mg possibly up to 40mg. Trialed again sometime in 2016, probably up to 20mg, possibly 40mg, for a month to a month and a half. Likely tapered off in a month or two (though with 2nd trial,  maybe just a few weeks. Sertraline - Jan-March 2017 - 25mg up to 50mg, possibly up to 100mg. Likely tapered off in a month or two. Escitalopram - April-June 2017 - 5mg up to 20mg. Likely tapered off in month or two. Vyvanse - October 2017 - 20mg for a week, then possibly up to 40mg, but only for a few days.
Quetiapine - January 2017 to some time in late 2017 - 25mg at first, gradually increasing over the months up to 100mg as I felt I needed for sleep aid. Possibly inconsistent with the dosages over the months. Probably went off cold turkey. December 2017 - tried the extended version, 50mg up to possibly 100mg, for a little bit. Stopped again probably in late Dec to early 2018, maybe in Jan. August 2018 - 4 isolated Quetiapines of varying dosages for sleep aid. 3 extended, 1 immediate release.

Link to post

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now
×
×
  • Create New...

Important Information

Terms of Use Privacy Policy