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jazzmugz

jazzmugz: rapid switch from moclobemide to bupropion

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jazzmugz

Hi all. Gotta start out with a big thanks to all the contributors here for both the wealth of advice and for the validation.

I was taking moclobemide (reversible MAOI) for approx 3yrs, 300mg/day. I found it to be very effective and honestly would have stayed on it quite happily for the rest of my days.

However, I recently emigrated from my home country to the US, where moclobemide isn’t available, and it seems there’s nothing even in the same class (RIMA) on the market.

I tried a rapid taper at one point, and all was good until about 2mths after complete discontinuation when mood nose-dived... so I re-instated.

But obviously I ran out at some point and ended up doing a rapid switch from moclobemide to bupropion, with no taper.

I wanted bupropion because I’m not willing to take SSRIs... been there briefly way back in my early twenties and it was not good. I also read that it’s easier to withdraw from than most other ADs.

Unfortunately I’m at about the 3mth mark and things ain’t good. I don’t know if it’s that bupropion doesn’t work for me (just gone up to 300mg/day) or if it’s just that it’s not able to mask the withdrawal effects from moclobemide, since it is acting on far fewer neurotransmitters than my brain is used to. Things also aren’t awesome in my personal life.

There don’t seem to be many experiences of moclobemide withdrawal on here so I’ve no idea what’s going on or what to expect. At this stage I metaphorically want to set my life on fire and I’m afraid my marriage isn’t going to survive this, but your stories give me hope.


2016-2019: moclobemide 300mg

2019: 2 failed tapers, 1 failed CT

late 2019: CT switch from moclo to bupropion

(due to drug unavailability)

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Gridley

Welcome to SA, jazzmugs.  I'm sorry you're going through this.

 

There's not a lot of information on the site on MAOI's because they're not commonly used.  Here is one link:

Littlebrooklyn: Moclobemide - Surviving Antidepressant

If you will Google survivingantidperessants.org moclobemide you ill find other links.

 

Due to your CT and fast tapers, you are suffering from withdrawal syndrome, and the information on withdrawal from other types of antidepressants and psychiatric drugs is applicable in your case.  Your CNS is sensitized and destabilized, and the substitution of one antidepressant for another doesn't protect you from the risk of withdrawal.  

 

What is withdrawal syndrome.

 

Glenmullen’s withdrawal symptom list.

 

When we take medications, the CNS (central nervous system) responds by making changes over the months and years we take the drug(s). When the medication is discontinued, the CNS has to undo all the changes it made. Rebuilding the neurotransmitter production and reactivating the receptor and transporter cells takes time -- during that rebuilding process symptoms occur.  

 

Video:  Healing From Antidepressants - Patterns of Recovery

 

It is true that bupropion sometines can be tapered faster than other antidepressants.  Generally we recommend tapering no faster than 10% of current dose every four weeks.

 

Why taper by 10% of my dosage?

 

The following link is specifically about tapering bupropion, including how to tell if you can taper faster and also how to obtain the nonstandard doses you'll need for your taper.  

 

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

 

We don't recommend a lot of supplements on SA, as many members report being sensitive to them due to our over-reactive nervous systems, but two supplements that we do recommend are magnesium and omega 3 (fish oil). Many people find these to be calming to the nervous system. 

 

Magnesium, nature's calcium channel blocker 

 

Omega-3 fatty acids (fish oil) 

 

Add in one at a time and at a low dose in case you do experience problems.

 

This is your Introduction topic, where you can ask questions nd connect with other members.  We're glad you found your way here.

 
 

 

 

 

 

 

 

 


Gridley Introduction

 

Lexapro 20 mg since 2004.  Begin Brassmonkey Slide Taper Jan. 2017.   

End 2017 year 1 of taper at 9.25mg 

End 2018 year 2 of taper at 4.1mg

End 2019 year 3 of taper at 1.0mg  

Oct. 30, 2020  Jump to zero from 0.025mg.  Current dose: 0.000mg

3 year, 10 month taper is 100% complete.

 

Lorazepam 1 mg 1986-1991 CT, resumed a few months later. CT 2000.  1 mg 2011-2016.  Sept, 2016 increased to 0.5 X 3 in split dose. Sept. 2019 increased to 0.625 X 3 after crossover to new brand

 

Imipramine 75 mg daily since 1986.  Jan. 2016 began every 3-weeks 10% taper, down to 15mg.  Aug 2016, discovered SA, updosed to 25mg and holding.  Taper is 66% complete.  

  

Supplements: omega, vitamins E and D3, magnesium glycinate, probiotic, melatonin .3mg


I am not a medical professional and this is not medical advice, but simply information based on my own experience, as well as other members who have survived these drugs.

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jazzmugz

Thanks so much for the reply and detailed info Gridley. I’m wondering if the bupropion is offering any protection at all from WD, or am I just giving myself a different problem for no reason.


Right now I am in a really bad place and feel closer to self-harm than I ever have in my life. I am wondering if in the experience of people here, should I attempt re-instatement and if yes at what dosage? I am not so far from Canada and believe moclobemide is available there.

 

Any recommendations at all... I am desperate right now.


2016-2019: moclobemide 300mg

2019: 2 failed tapers, 1 failed CT

late 2019: CT switch from moclo to bupropion

(due to drug unavailability)

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Gridley
18 minutes ago, jazzmugz said:

should I attempt re-instatement and if yes at what dosage? I am not so far from Canada and believe moclobemide is available there.

 

It is certainly a possibility.  I would hazard a guess that the bupropion  is not going to do much for you, as it is so different  a drug.   I need to know when was your last dose of moclo and the dose.  To say the least, it is really a shame it's not available here, putting you through all this.

 

So that we hit the ground running, here's some information on reinstatement.  

 

At this time, reinstatement of a very small dose of the original drug is the only known way to help alleviate withdrawal syndrome.  The only other alternative is to try and wait out the symptoms and manage as best you can until your central nervous system returns to homeostasis.  Unfortunately no one can give you an exact timeline as to when you will start feeling better and while some do recover relatively easily, for others it can take many months or longer.  
 
Reinstatement isn't a guarantee of diminished symptoms for everyone but it's the best tactic available.  You're still in the time period where reinstatement predictably works, up to 3 months after last dose.  It is best to reinstate as soon as possible after withdrawal symptoms occur. We usually suggest a much smaller reinstatement dose than your last dose.  These drugs are strong, and when reinstating it is better to start with a small amount and increase if symptoms remain unbearable. Your system has become sensitized and If you take too much it may be too much for your brain and can cause you become unstable. Then, once you've stabilized on that dosage, which can take several months,  you can begin a 10% per month taper down to zero.   Please read:
 
About reinstating and stabilizing to reduce withdrawal symptoms. -- at least the first page of the topic
 
 It takes about 4 days for a dose change to get to get to full state in the blood and a bit longer for it to register in the brain.
 
The three-month mark is not hard and fast.  There have been many successful reinstatements after that point.
 
Keep us informed on whether you can get the drug.  Please don't reinstate without letting us suggest a dosage for the reasons above,

 

 

 


Gridley Introduction

 

Lexapro 20 mg since 2004.  Begin Brassmonkey Slide Taper Jan. 2017.   

End 2017 year 1 of taper at 9.25mg 

End 2018 year 2 of taper at 4.1mg

End 2019 year 3 of taper at 1.0mg  

Oct. 30, 2020  Jump to zero from 0.025mg.  Current dose: 0.000mg

3 year, 10 month taper is 100% complete.

 

Lorazepam 1 mg 1986-1991 CT, resumed a few months later. CT 2000.  1 mg 2011-2016.  Sept, 2016 increased to 0.5 X 3 in split dose. Sept. 2019 increased to 0.625 X 3 after crossover to new brand

 

Imipramine 75 mg daily since 1986.  Jan. 2016 began every 3-weeks 10% taper, down to 15mg.  Aug 2016, discovered SA, updosed to 25mg and holding.  Taper is 66% complete.  

  

Supplements: omega, vitamins E and D3, magnesium glycinate, probiotic, melatonin .3mg


I am not a medical professional and this is not medical advice, but simply information based on my own experience, as well as other members who have survived these drugs.

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jazzmugz

Wow, I can’t say enough how grateful I am for your help and this community at large.

 

My last dose was close to 13 weeks ago, 300mg. Since then I have been on 150mg bupropion until 1 week ago when it was increased to 300mg. I recall having intense negative emotions when first starting bupropion, but I strongly suspect that this time around is withdrawal because it has hit about the same time as in past discontinuation attempts and started a few days before the increase, and comes with physical symptoms too.

 

Would it be best to decrease bupropion over a short time first, then allow a few days washout? Or washout only? My end goal has always been to get drug-free, but a taper with moclo seemed like a lot of effort given the availability issue and bupropion seemed like a viable bandaid. In hindsight the cost and making the occasional trip over the border doesn’t seem like such a hassle when faced with the real possibility that I might struggle to retain employment and important personal relationships.


2016-2019: moclobemide 300mg

2019: 2 failed tapers, 1 failed CT

late 2019: CT switch from moclo to bupropion

(due to drug unavailability)

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