I've posted on the Wellbutrin forum but didn't receive a whole lot of responses. Not a big deal, but I really could use advice on this one and don't want it overlooked. This is not necessarily medication specific so I will post it here.

I have been on Wellbutrin XL for 3 weeks. It is not working. It is in fact making matters worse. I am sleeping constantly...as in 12 hours at night and catching cat naps at work, much to the boss' dismay. There is more, but I've already posted about it and I am rambling already anyway, no need to make this longer than necessary.

I made an appt to see my pdoc to discuss this. I do not want to continue taking this because of the negative effect it is having on not only my ADHD but my so-called "depression" - I feel I am just more distressed by the ADHD symptoms than depressed. I am so exhausted since beginning it that I can not focus on anything at all. I am also very weepy, to the point I annoy myself. I discussed the exhaustion with my pharmacist and therapist. They both were very concerned about the paradoxical effect it was having. I tell my pdoc this and what does she say? I never ever heard of anyone getting tired on it. So, I guess the pharmacist who has a dozen years of training in pharmacology is just an idiot?!?

So, I go in today and tell her all this. What does she do? Puts me on the SR version to try. WTF??? Does this make any sense? Okay, I am having problems with the Wellbutrin XL and want to discontinue, so her solution is to give me a different release version of the same drug that I am having problems with!?!

I am almost in tears as I type. This is so frustrating. Now what do I do? Oh and among other things she sends me in for a whole load of blood work. I just had a full blood panel, including thyroid and cholesterol done in August. Everything came back fine and I offered to provide copies of the results, which I have. HELLO!?! I am 26 years old and in good physical condition. Is there any reason to have these expensive tests redone so soon?

I am just beside myself. Any advice?

Sorry this is so long! :o

Hey! I'm sorry things have been so frustrating for you! I dont' know what other said to this post in the other forum, but I'm towards the end of my schooling in pharmacy, so maybe i can help a little?

Wellbutrin XL is one of those medications that takes a while to see a positive effect. For its antidepressant effects, they say it takes at least 2 weeks to start seeing any improvement in symptoms, and "several weeks" (ie up to 5 or 6) to get to maximum benefit. It increases the levels of norepinephrine and dopamine in the brain, the same chemicals that the stimulants work on, but just takes longer to work.

I just reviewed the full prescribing information, and fatigue/somnolence is not listed...its mainly side effects such as insomnia, appetite suppression, jitteriness, etc. Because you are experiencing such severe fatigue, it is a good idea to have that full blood panel done, or if you can't afford the full one, at least get thyroid (low thyroid hormone is fairly common in women, and can produce effects such as excessive fatigue, depression, etc). Another thing you might want to get checked out also is your iron level. Iron deficiency is one of the most common causes of fatigue in women (because of our lovely menstrual cycles). :)

Review your sleeping habits at night...ie going to bed at the same time every night, sleeping in a quiet environment, etc. If you're not sleeping well at night, you would obviously get the daytime fatigue. If you are getting those 12 hours of sleep, and waking up exhausted, there may be something else going on (hence getting the blood tests). Sleep apnea is another common cause of daytime fatigue because you don't get a restful sleep. If you snore or anything, you might want to get that checked out.

Were you prone to fatigue before you started the medication? Has there been a direct correlation between the fatigue and when you started the Wellbutrin? If so, the wellbutrin MAY be the culprit, but that side effect is extremely rare, and not even documented. If you were fatigued before you started the wellbutrin and it just got worse, it might be something else. Have the depression symptoms worsened since you started the meds? Everything is just so related. Depression can manifest as excessive fatigue, but fatigue can also cause depression because of the frustration associated with it.

As for the XL to SR switch, I do find that a little odd. The only difference between the two is the way it is released in the body, and you need to dose SR twice a day where XL was only once. You will still get the same amount of drug absorbed in either case. Usually with a sustained release tablet (such as XL) you get less of a peak effect of the drug, and possibly less side effects. I would think, logically, that SR would peak at a higher level just becuase it is released more rapidly. I don't really know what evidence there is for that, however.

Have you taken anything else for ADHD, or was this a first choice from your provider? If you haven't tried anything else, there are a bunch of different options as you are probably aware of, and each person responds differently to all of them. Next time you see your doc...ask what the basis was for switching you to the SR form, just to make sure she had an educated plan for you. I know a pharmacist I work with that was put on wellbutrin (not for ADHD), but felt like absolute crap while she was on it. Her doctor changed her meds, and she felt so much better on something else.

Ok, now I rambled too much. :) Sorry..its late, and I'm "taking a break" from studying. :) Good luck, and keep us updated! Hang in there!

~KGro

Unfortunately, I don't really have any advice. I'm not real sure what I'd do in a situation like that. I can't see any reason to repeat the blood tests if you had them done 7 months ago, unless something else has changed. Maybe a second opinion (i.e. a different doc) is in order?

Hey Fox. Are you sure they are doing to same blood work ups? Could they be testing a blood level of one of your meds?
It doesn't make sense to me either for the tests to be repeated. It's been 8 or 9 months? Do you think they are being overly cautious to your benefit?
I can certainly understand your frustration.

Thanks kgro555...that is very well thought at post.

I know that it takes at least 2 weeks to see any improvement when it comes to most AD's. It's been 3 weeks for me on Wellbutrin and I am seeing nothing but negative effects, no improvement whatsoever. It is in fact enhancing the ADHD symptoms I already have problems with.

The fatigue did not start until I started taking the Wellbutrin. I have never had a problem with fatigue. I have a lot of hyperactivity and am always doing something. I do not have sleep problems. I have always went to bed around 10pm, had little trouble falling asleep, do not wake up in the middle of the night and am awake in the morning around 6am. I never get tired during the day and have never been a napper.

I still feel the blood work is unnecessary. As I said, all of this was tested 6 months ago. I have yearly blood work and never have anything but perfect results. If the fatigue had been an issue before I started the Wellbutrin, I would definitely go for blood work, but since that's not the case, I feel it's a waste of time. I do not have any other symptoms of hypothyroidism as well. I'm not concerned about low iron levels, as I do not get a period and I give blood regularly in which they check my iron first, it's never been a problem.

I was so upset last night regarding my pdoc's dismissal of the the fatigue that I really dug deep into research. I have found clinical studies from almost 15 years ago which states that fatigue and sedation is a side effect seen in 2-3% of cases. True, it's not listed with the package insert, but quite frankly, a lot of side effects are listed in those.

So get this, I start reading in some chemistry/pharmacology site that sedation is COMMON in people who take SNRI's (which Wellbutrin is) that do not have enough norepinphrine to uptake. See, SNRI's don't INCREASE norepinephrine and dopamine. What SNRI's do is uptake the amount already in you and make it last longer. So, what happens when you don't have enough to uptake in the first place, the SNRI actually causes a depletion in the supply. This is why some people feel wiped out. It also said something about the chemicals going after your neurons, which repel because there isn't enough available and then the neurons become hypersensitive causing the sedation. So, I have printed a huge load of information and studies and am now fully armed for a battle if necessary.

Now, get this. I brought my script to work this morning to make a photocopy for my files. I've always done this. And what do I notice? She has written the script for Wellbutrin SR 75mg BID. Uhmm, Wellbutrin SR does NOT come in 75mg tablets. Only the immediate release version comes in 75mg. Is she just totally wacked? I am looking at seeing someone else for a second opinion on medication. If she doesn't even know what she is prescribing I think that's a bad thing.

How do I approach a different doctor? Do I need to have my therapist send anything over to them about my diagnosis?

This is the first choice of drug from this pdoc. I am not on any other medications, besides birth control, so it's not like I'm having a reaction due to mixing drugs.

Doctors do seem to make some people "jump through hoops" before prescribing stimulants. Given what you've said so far, I'll bet "Strattera" is the next drug she's gonna write on the scrip pad. Does she have any experience with treating ADHD? Finding a doctor that does know something about it would seem a good enough reason for me to change doctors. Strange about the blood work - perhaps she was looking for another reason for the lethargy that the Wellbutrin apprearently is causing, since it is a rather uncommon side effect (Wellbutrin is stimulating for most) - other physical causes would be more likely in "normal" people. I would hope that she'd be cognicent of the costs involved and not order anything that would be completely unnecessary(?)
It would be a good idea to have any info on your diagnosis forwarded to whomever you see next - otherwise you'll have to go through the full diagnosis again.
I would probably just flat out ask your current doctor to try you on Ritalin or Adderall first, before changing doctors. If you are in good health, I wouldn't think that a short trial would be a problem- she could do that at least! Stimulants are the medication that helps the largest percentage of people, and they work pretty much right away, once the dosage is in the right range.
When I first asked my GP for Ritalin I said something along the lines of "I don't know if you have problems with educated, professional, 40 year old men trying to "score" stimulants by claiming ADHD, but what I have read on the various medications, their effectiveness and their side effects, makes me feel that Ritalin would be the best medication to try next." Unfortunately at that time my blood pressure was a bit of an issue - I had to wait a couple of weeks as a result.

hey fox,

trust your gut and get a new doc!!! as fast as you can!!!

i don't know what your insurance is like, if you have to get a referral to get covered, etc. but do what you need to do!!!

if you can't get into a new p.doc right away, maybe try your family physician??? depends on your relationship with him/her. i know that in my case when i explained the frustration i was having with my p.doc, she took over prescribing what i needed. i hadn't been her patient long, so, didn't have an established relationship, but, i asked her if she'dbe comfortable prescribing dexedrine and she asked me a bunch of questions, then said "sure." also, since i was already on something that was working, she was fine with conitinuing the current prescriptions --- might be harder since you are just starting out though. but still worth a try. (one of the goofiest things my p.doc had me do was to cut my wellbutrin XL 150's in half when i was titrating up ... later found out why that is *not* a good thing to do and was happy i had made the switch...)

here's another thought -- it's not unheard of for meds to have a paradoxical effect on ADDers -- that's *why* stimulants make us calm instead of hyper in the right dose.... right???

but, stimulants in too high of doses do what? can't remember exactly, but, maybe they'd make you sleepy??? it's a stretch -- and not really well thought out, just thought i'd through my completely unmedical opinion into the mix. anyway, following this line of reasoning -- if you're currently on wellbutrin XL 150 , maybe you're getting too much -- i skimmed your post and caught the word "hypersensitive" - i should go back and re-read for context .....

if 150 XL *is* too much, maybe SR 75 will do the trick. it's easier to adjust too, if 2 75's are still making you feel wonky - maybe 1 75 daily would work????

if you've already got the script, it might be worth a shot. if nothing else, it'll be easier to get off the wellbutrin when the time comes. you won't have to cut your 150's in half :rolleyes: (i still can't believe my p.doc had me do that!)

i'd do the normal :consult with your physician: disclaimer at this point if it weren't for the fact that your physician is the reason you're here. so, try calling your pharmasicist to see if this is completely whacked.... though, sounds like yu are more schooled than I on how this medication works in your body, so, maybe you'll be able to teach me something new :D

sorry you're so frustrated now. there are posts on here about "finding a psychiatrist" -- check 'em out!

take care,

wheezie

I was so upset last night regarding my pdoc's dismissal of the the fatigue that I really dug deep into research. I have found clinical studies from almost 15 years ago which states that fatigue and sedation is a side effect seen in 2-3% of cases. True, it's not listed with the package insert, but quite frankly, a lot of side effects are listed in those.

So get this, I start reading in some chemistry/pharmacology site that sedation is COMMON in people who take SNRI's (which Wellbutrin is) that do not have enough norepinphrine to uptake. See, SNRI's don't INCREASE norepinephrine and dopamine. What SNRI's do is uptake the amount already in you and make it last longer. So, what happens when you don't have enough to uptake in the first place, the SNRI actually causes a depletion in the supply. This is why some people feel wiped out. It also said something about the chemicals going after your neurons, which repel because there isn't enough available and then the neurons become hypersensitive causing the sedation. So, I have printed a huge load of information and studies and am now fully armed for a battle if necessary.


SOUNDS LIKE YOU MIGHT BE ON TO SOMETHING
Chris