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Whiteandgreen

Whiteandgreen: Quitting Wellbutrin XR when SR or IR alternatives not available

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A new member here, looking for some advice :)

 

Two questions first, following my story (sorry, a bit long)

 

1) How to quit Wellbutrin XR 150mg safely, when IR or SR versions are not available? I have read the thread on tapering off, but I live in a country where the IR or SR versions are not sold, only 150mg and 300mg XR. I have now been on Wellbutrin for 6 weeks, when I was diagnosed with severe post-partum depression.

 

2) I've also on 100mg Ketipinor and 7,5-15mg Zimovane (I seem to be needing 15mg lately most nights) for the past 6 weeks. Which would be the best order of trying to get off the meds?

 

So, I have an almost 6-month-old daughter, who decided to wean herself from breastfeeding at 2,5 months (early July 2016). After that I still continued to pump for another 4 weeks , after which Idecided enough was enough; I was pumping 4-5 times a day, which was exhausting. Around the same time as the breastfeeding ended I started having trouble sleeping. Even when the baby slept (and she's a great sleeper, thank goodness!) I could not. When I quit pumping, it got even worse. I was not really sleeping, and I was with the baby all day, and my mood really started to sink.

 

A bit more than 6 weeks ago I went to see a psychiatrist. I had already self-diagnosed the PPD (all the symptoms matched; I was crying, having negative thoughts about being a mom, having disturbing thoughts, borderline suicidal). After chatting for 45 minutes (I'd never seen the doctor before), she wanted to put me on a small dose of Lexapro, I think it was 5mg.

 

I have previously been on Lexapro and other SSRIs for years (~20) on and off. I quit Lexapro in Januart while pregnant, but I had started to taper off 1,5 years before, small steps at a time, coming from 20mg to 2,5mg before quitting altogether.

 

However, this time I got horrible symptoms almost immediately after starting Lexapro. I didn't sleep for ~72 hours, my anxiety was through the roof, I could not stay still. My husband took me to the ER after the third sleepless night, and I was hospitalized for two weeks. The hospital psychiatrista immediately took me off Lexapro, and started me on Wellbutrin, as well as the rest of the meds (Seroquel every night, and Zimovane as needed). I was not in the mental capacity to really question any of these decisions, and (as typical of psychiatrists, I've found), they don't really seem to care too much - one drug doesn't work, let's just try the next one. No matter that Wellbutrin is basically a stimulant, and one of my most pronounced symptoms was insomnia!

 

Fast forward 6 weeks, I'm still on all of those meds. I haven't slept one night without the Zimovane, and of course I've had to up the dosage. Obvioisly, the sleep has helped tremendously (and I'm also getting more help with the baby), but it feels like absolute craziness to take stimulants in the morning and then sedatives in the evening. Some mornings I feel completly groggy, to the point of being unable to care for the baby. And even though I stay asleep for hours, the quality of the sleep is poor.

 

I've done a lot of reading lately, and I've come to the conclusion that while antidepressants can be necessary and helpuf in acute stages of severe depression, in long-term use they are not only ineffective, but downright harmful. That's why I do not want to stay on the meds any longer than I absolutely have to. Ask a doctor, however, and they *never* recommed coming off them, ever. Worse, they want to up the dose, or just get you to try yet another one. Now, I know that most of the studies indicating that antidepressants are ineffective in the long run have been done on SSRIs, and Wellbutrin isn't an SSRI. Nevertheless, it just messes with different neurotransmitters.

 

I'm also pretty sure that my insomnia was/is hormonal, caused by the end of breastfeeding, which then lead to depression. Granted, I've was struggling even before that with the fact that my whole has been turned upside-down by the birth of my daughter.

 

Anyways, I'd love any input, especially concerning the order of quitting the meds, and the mechanics of quitting Wellbutrin. If anyone here has suffered from PPD, I'd really like to hear from you :)

Edited by scallywag
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Hi Whiteandgreen,

A moderator will be along before too long to give you info and links regarding your questions and situation. I am not a moderator but I have had PPD and my main problem was insomnia and anxiety. The moderators will tell you to quit the more activating medications first so probably the Wellbutrin. They will give you links on not tapering faster than 10% per month and links to tapering your specific meds (how to options) and will ask you to put in your medication signature for the last 12 - 18 months. You won't have to give exact dates - just appox. like started mid april ect... Anyways I feel for you - not fun to be put on 'uppers' in morning and 'downers' in the eve. It does seem silly to me too. However you will want to be very careful coming off so as to minimize your withdrawal especially considering you have a baby girl to care for. Best of luck to you.

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Hi Whiteandgreen,

 

And welcome to SA.  Firstly, congratulations on the birth of your baby girl.  Life definitely changes once you have a little one in the family.  Some people find that as they reduce their drug dose they start to feel improvement.

 

As herewego said (thank you herewego) we start new members off with links to relevant topics which we suggest you read and then you can ask questions here in your Intro/Update topic.  You can also journal your progress here.  Click "Follow" top right and you will be notified when someone responds.

 

Please put your Withdrawal History in Signature.  Please include details for the last 12-18 months of all drugs, dates, doses and discontinuations & reinstatements.  Please include all types of drugs, both prescription and non-prescription and also any supplements your are taking.  If you can't remember dates, please write it as "early March" or "mid-August".  Please provide a summary of any drugs prior to that which can just be listed with start and stop years.

 

Before you begin tapering what you need to know

 

Why taper by 10% of my dosage?

 

Tips for tapering off Seroquel (quetiapine)


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

 

Tips for tapering off Z drugs for sleep (Ambien, Imovane*, Sonata, Lunesta, Intermezzo, etc.)

 

*Zimovane contains zopiclone; Imovane contains zopliclone)

 

Taking multiple psych drugs? Which drug to taper first?


"If you're not having an adverse reaction from the other medications, taper the most activating drug first. This is usually an antidepressant or stimulant (ADHD drug)."

 

The first post mentions a Drug Interactions Checker.  I suggest you enter your drugs and copy and paste the results in a post here in your topic.

 

These helped me understand SA's recommendations for tapering using a harm reduction method:

 

Brain Remodelling


Video:  Healing From Antidepressants - Patterns of Recovery

 

I understand it can be a bit overwhelming receiving so much information in one go.  Just check out the topics (usually the first post is the most important one), read through them bit by bit and maybe go back over them again because you may miss some things on the first read or things might make more sense once you have read other information.  Jot down any questions and then come back here and ask them.

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Thank you both :)

 

The biggest problem with getting off Wellbutrin is, like said. that there are no other options than the extended release tablets (those other versions are not sold in this country), and there are no compounding pharmacies :( So basically, my only two options are either quitting cold turkey, or start cutting the pills on my own. I will actually contact Glaxo Smith Kline to see if they have any official line as to how to quit - they have a number for product information, but honestly I don't expect much help.

 

When I tapered off Lexapro, I did it *very* gradually, max. 2,5mg per time, and I spent 1,5 years on the process. I hardly experienced any symptoms of the "discontinuation syndrome" (nice euphemism..). Now I'm terrified of having to possibly quit cold turkey.

 

It makes sense to quit the most stimulating drug first, especially given my sleep problems.

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Ha, just called GSK. According to them, clinical studies have not indicated any adverse effects from quitting Wellbutrin, and that's why they don't have any recommendation on how to do it.

 

I'm really scared now :(

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Hi W&G,

 

I can understand you feeling scared, but SA mods and members can support and offer suggestions through your withdrawal journey.  That's what this site is all about.

 

Please do not go cold turkey.  Other members here are tapering Wellbutrin.  Here is link to a google search that I did:  survivingantidepressants.org+wellbutrin.  Check out some of the members who are on the same drug.

 

Have a really good read of the first post here Tips for tapering off Wellbutrin, SR, XR, XL (buproprion).  Take notes, ask questions here in your topic.  You could ask your pharmacist if there is a generic version of the drug available.

 

Post in this topic to see if there are other people in your country who can make suggestions: Finnish / Nordic members , please check in here

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Whiteandgreen -- Welcome to Surviving Antidepressants (SA)

 

In the first post of the topic about Wellbutrin (bupropion) that ChessieCat posted, there's information about dealing with the XR versions:

 

If you cut up Wellbutrin or bupropion XR, what's inside is regular immediate-release bupropion. When you break the time-release coating, the tablet loses its extended-release characteristic and you would be taking bupropion IR.

 

Below that statement are suggestions about how to handle dose reductions when one is cutting the tablets.

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I'm seeing another doctor tomorrow morning. Unlikely that he will recommed getting off any meds, but I will tell him it is my goal.

 

If anyone has tapered off Wellbutrin XR, without switching to SR or IR, I'd love to hear how you did it (timing of the doses etc.). I'm afraid cutting the pills in quarters, or even smaller pieces, will not be very precise. I just tested on a tablet today, and was left with four pieces that were all different sizes. But I guess that's my only option, really.

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Please read these before seeing your doctor.  I particularly like what one member said about lowest possible dose, with the intention of getting off completely.

 

What should I expect from my doctor about withdrawal symptoms?


How do you talk to a doctor about tapering and withdrawal?

 

If your doctor does suggest an increase in dose, or a taper method, or want to add another drug please don't do anything until you have posted here about it so you can get opinions, which will help you to make an informed decision.

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Thanks ChessieCat :)

 

Now that I think back on my life, I can clearly see that all my deprsessive episodes have been related to major life changes accompanied by loneliness. And by depression I mean the unable-to-get-out-of-bed variety.  I'm actually pretty surprised that I've never realized it this clearly before!

 

First episode was a bit after finishing high school. I grew up with alcoholic parents. My dad was a loud and aggressive drunk, who, while not necessarily violent towards my sisters and I, he was physically abusive to my mother, and verbally abusive to everyone. Without going into too much details, one night, when I was 19 and still living at home, he came home drunk and actually hit me. No slap on the face, either, he hit me with his fist, repeatedly. So, the next day I found my own apartment and moved. I had pretty much no money, so I was collecting unemployment benefits and moonlighted as a babysitter. My BF had dumbed me a few months earlier, all my high-school friends were off to college, and I was completely alone. So, all I did (outside the babysitting gig) was sleep, and then drink heavily on the weekends. This went on for a few months.

 

The next two times were when I was living abroad, first as an au pair and then later as a college student. The same thing: I did the absolutely minimum that I had to in order to not get fired/kicked out from school, and then just slept. After the second time, when I was 21, I got my first diagnosis of depression, and my first prescription of antidepressants (Prozac). And since then I've been on different SSRIs almot continuosly until January this year. I started tapering off them after after a suggestion by my husband. He had done a lot of reading into the possible long-term effects of SSRIs, and was rather worried. T

 

I quit drinking alcohol altogether at 31 (I'm turning 40 next week), which was one of the best decisions of my whole life. If there is a problem, you can count on alcohol making it much worse. After the rocky start in my 20's, I've earned academic education (have a PhD), and found an amazing partner. But the issues from my childhood are still haunting me. They have left me with low self-esteem, terrified of abandonment, being really hard on myself - the standard stuff of adult children of alcoholics. I've been in therapy for two and a half years, but it hasn't really helped that much.

 

And here we are, with a new baby, in a completely new situation. This country has a very generous maternal-leave system, so I've been home with the baby since April. My husband does more than his fair share, but he has to work long hours. I knew the first year would be no picnic, but I was still ill prepared for the totality of it. Life as I knew it no longer exits. In light of how I have previously reacted to changes in my life, the depression is not surprising.

 

Sorry for the long story.. not sure if members usually share this much of their background, but I find it quite therapeutic to write about this.

 

Off to see the doctor now.

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Hi,

 

Members do often share some of their background.  It helps to build a picture of where a person is at.  And you are right - it is therapeutic.  I can relate to on-going issues with depression, having spent most of my life learning to deal with it.  I've been through times where I believed I'd never recover, and yet I'm still here.  It's been a long path, but these days I believe I can recover, and I'm doing a lot better.  (If you think you'd find it helpful, have a look at my blog - it's got my story of healing along with all the ups and downs.  The link is in my signature).

 

I hope your doctor's visit goes okay.  Whatever happens, remember that you are in charge of you.

 

Welcome to SA,

Karen

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Thanks Karen :)

 

So, saw the doc this morning. He was a quite young fellow, about my age, and for some reason that got my hopes up. Well, no such luck. He was nice enough, but he gave me the typical scpiel about how depression is a biologically determined disease which is likely to require lifelong medication. When I told him I'm starting to believe that antidepressants actually make depression chronic by decreasing, in time, the body's own neurotransmitters, he said that's no longer the theory of how they work; SSRI's, for example, don't work by increasing serotonin levels, but by helping the brain to excrete some other chemicals that then help to cope with stress reactions. Of course, he didn't tell me what those other chemicals might be.

 

I told him that my goal was to be drug free. He was symphatetic, but said I need to undestand that without ADs, I am likely to relapse.

 

We went back and forth, and he gave me options:

 

1) Discontinuing all medication immediately (although I'd told him I'm not looking to do that, but to taper off gradually).

2) Discontinuing one med at at time, starting from Zimovane, which is the most habit forming. In his opinion, Wellbutrin should no longer contribure to my sleep problems, as it's been six weeks.

 

Then he said if I decided not to use any meds, they could also offer me electroconvulsive therapy! I don't even know what to think about that. It would involve a series of treatments, 3 times a week for a month, when I would be put under anesthesia and given electric shocks. I asked about adverse effects. He told me memory loss is one of them, but it is only temporary. Like, you forget how you came to the hospital, what you ate that morning, etc. I'm thinking: NO!! I work with my brain, not going to mess with it even worse.

 

Anyways, should I ever decide to get off Wellbutrin, I should do it by only taking it every other day. According to him, the contents of the tablets are "destroyed" if the cover is broken. And he said I should stay on it for at least a year.

 

Ok. Two doctors and a pharmacist have now told me to get off Zimovane first. Then I'd be left with "only" two meds. If necessary, I could increase the dosage of Seroquel up to 200mg to compensate. On one hand, it seems counterintuitive to get off the sleeping med, but on the other hand it *is* habit forming, and only supposed to be used for 2-4 weeks.

 

I got him to prescribe me with a lower dose Zimovane, 5mg. I've now been using 1,5 of the 7,5mg tablets, so 11,25mg. I could now taper off more slowly, 10mg --> 7,5mg --> 5,75 --> 5 --> 3,25 --> 2,5 --> quit. Or even cut the tablets to make the taper even slower. How does that sound?

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You'd be well advised to put at least one step in between 10 mg and 7.5 mg in your plan above. For example, 9 mg = 7.5 mg + 1.5 mg

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"Anyways, should I ever decide to get off Wellbutrin, I should do it by only taking it every other day."

 

Scallyway, not sure if you noticed this.  Is this okay, or should it be taken daily like other ADs?

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Since I'm here I hope it's okay for me to jump in with some info from the Wellbutrin page: 

As with all other psychiatric medications, do not skip doses to taper. If you're susceptible to withdrawal symptoms, this is an excellent way to trigger them.
 
If you are very sensitive, you may wish to start with a 10% reduction per month, as we recommend with other antidepresssants. Base your decrease on the last dosage: The amount of the decrease keeps getting smaller.

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Thanks Karen.  I looked for it and couldn't find it.  I should have done a Ctrl + F "skip". :blush:

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I got the same advice from the pharmacy. Taper it off by taking it every other day. It sounds kind of weird to me, as you'd have a huge spike every other day..

 

Anyways, these are the options all pharmacists and doctors will give you in this country: 1) cold turkey, or 2) every other day.

 

If the stuff inside is exactly the same as in the immediate release versions, and one can take 3 100mg pills/day, I don't really understand why cutting the pill would lead to "overdosing" on it, as it absorbs so fast. If the half-life charts on the Wellbutrin page are accurate, the IR version spikes pretty fast with 100mg, in about half an hour - so why would it be dangerous to take, say, one third of the XR 150mg tablet, i.e. 50mg?

 

But probably even the IR tablets have some sort of a coating, and the release is not as sudden as when taking a piece of a XR pill, which then has a broken coating?

 

It irritates me so much that the drug companies will not release these details to patients!

 

Anyways, I was talking to my hubby last night, about doctors in general - his view (and he pretty much was told this by a doctor once) is that doctors do not really know how medication works, nor do they really care about what causes symptoms. All they care about is patching the patient up, so that they're at least semi-functional. For example, if a person has vitamin D deficiency, they may rule out some obivious potential causes, but once that's done, they'll just tell you to take vitamin D in a pill form. It could be that the same reason that causes the deficiency cause some other problems, but the doctors are not really interested exploring it any further, as it probably would be expensive and time consuming. So they just treat the symptom.

 

Same with the psychiatrists. They don't necessarily really know how the meds work, nor do they care what causes depression. I suspect that my PPD is strongly linked to hormones (the end of breastfeeding lowers level of oxytocin and prolacting, for example, an they are well-know "feel good" hormones). Not one of the doctors I've been realing with, in the hospital or in the outpatient unit, has ever suggested checking my hormone levels. This whole thing might have been treatable with short-term hormone replacement therapy, and maybe some sleeping meds to get over the worst phase of the insomnia. Instead, they put me on a host of meds, which will have to be taken long term, or even indefinitely.

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Oh, I decreased the Zimovane to 10mg last night. Slept ok. Will keep at that for a few nights before another decrease to 8,75. That is one 7,5mg pill and a half of a 5mg pill. The 5mg pills are so small, I doubt I can cut them any more than that, unfortunately.

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The only tablets available are 7,5mg and 5mg :( I'm afraid cutting them smaller than 1/2 will not be possible.

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