Wellbutrin for Type III (overfocused subtype)?

[PinkPanther_04]

I was diagnosed with AD/HD a couple of weeks ago, and due to my subtype under the Amen Clinic's system my therapist thinks I'd do well on an SSRI like Effexor (that's the one that's recommended because it has stimulant properties). The problem is that all the SSRIs have negative sexual side effects (that's NOT acceptable!), so I'm thinking of asking to try Wellbutrin (bupropion) first.

Has anyone here used Wellbutrin to treat the overfocused subtype?

[exeter]

Side effects are not guaranteed to happen. If they do, you can always talk to your doc and stop the medication. I'd say go for it and see.

Otherwise, the Amen web site recommends L-tryptophan, 5HTP, or St. John's Wort supplements. I would still talk to the doctor about these, but they don't really appear to have many, if any, side effects, as long as you aren't taking any other meds. I haven't done a whole lot of research on this, so you'll be best off doing that yourself.

There's also a chance the Wellbutrin will help. It's supposed to primarily act on dopamine, though, which is where it gets its stimulant properties. If Amen's web site is correct, then Wellbutrin might actually make the problem worse. All the stims basically stimulate by acting on dopamine as well.

Note: I don't know how much stock I put in Dr. Amen's theories. It's not that I don't believe him, I just don't know enough to believe or disbelieve him.

[PinkPanther_04]

The thing is, I would rather remain unmedicated than have the sexual side effects. I know that not everyone on SSRIs or SSNRIs (like Effexor) have those effects, but they are known to cause problems in a pretty large percentage of people. I would rather try something with fewer possible side effects, even if it's not quite as effective.

I think what he said about stimulants with subtype 3 is that they can make it worse if they're used alone without fixing the cingulate/serotonin problem. Stimulants are used in conjunction with anti-depressants to help subtype 3. Since Wellbutrin isn't listed as a preferred medication for that subtype, even though it's supposed to be a stimulating anti-depressant like Effexor, I do wonder whether it's contraindicated for some reason.

As far as "natural" remedies, I don't want to use St. John's Wort because I'm out in the sun a lot and that stuff is reported to cause sensitivity to the sun. I don't know anything about 5-HTP, but I'll look into it (have been meaning to, but forgot...duh ). Maybe a combination of that and L-tyrosine would be helpful.

[paulbf]

Effexor is the least likely of the seratonin meds to cause sexual side effects. I got a little problem then it cleared up fine. I did have trouble sleeping with effexor & wellbutrin which I attribute to the noradrenaline component, that's the main component in wellbutrin which has a minor dopamine effect. The stimulants are mostly dopamine with a bit of noradrenaline. Effexor is mostly seratonin with a tad of the other two. Effexor is really powerful triple whamie medicine & I would not recommend it generally unless you are terribly depressed or suicidal but some folks do fine with it. If you aren't depressed, maybe a very very small dose of effexor or another SSRI combined with stimulants. Of course I'm no doctor.

Stimulants alone can make overfocused type more overfocused, that's the case for me but I would start there & see what happens because as you say it's got the least spooky side effects. Then maybe add a small dose of SSRI. Or give wellbutrin a shot, it's not too spooky & might help though you are right, it's not really the correct med for your condition but you never know.

I'm currently trying some 'grey market' meds that act on dopamine without the adrenaline & getting good results so far. The other thing I'm considering is a small dose of SSRI's with traditional stimulants. I was kind of upset at my doc for giving me the whamie effexor though there was some benefit it was just too much & when I quit, I found I was so happy to have my feelings back again. But it's different for everyone.

[PinkPanther_04]

Thanks, Paul. It does seem like, from what I've read, Effexor might be a little much unless it's a really small dose. I imagine that Dr. Amen's recommendations may be based on more severe cases and I think my symptoms are comparatively mild. I went ahead and got some 5-HTP and L-tyrosine to see how that helps. If I don't feel like it's working in another month I'll start looking into something else.

[exeter]

Originally Posted by PinkPanther_04

The thing is, I would rather remain unmedicated than have the sexual side effects.

It shouldn't take that long to figure out if you're going to have side effects at all. If you do, it won't take that long to stop the medication, after talking to your doc. That's why I said go for it and see what happens, unless there's something I'm totally missing.

[paulbf]

For the SSRIs it takes at least 6 weeks to consider it a fair trial and then the withdrawal can last that long before it's done messing with your mind & body. I didn't get the sexual side effects until about a week into the second dosage increase, then they went away in another week. Each increase runs you through that cycle again. Wellbutrin should also be tried for a month before it's real effect is known but it can be stopped at any time without problems. That said, I did feel the impact of both almost immediately but that can be different from the long term effect. It is standard to expect bad side effects at the begining & have to wait that out to feel the benefit. Strattera seems to work that way also. If you feel really awful, you can of course quit sooner but it's expected to feel bad in the beginning with these kinds of meds. Stimulants generally give the full effect in about 20 minutes but in some cases might take a month to really understand how it's working and adjust to side effects. And they can be stopped without withdrawal except the very short rebound effect.

[PinkPanther_04]

Originally Posted by paulbf

For the SSRIs it takes at least 6 weeks to consider it a fair trial and then the withdrawal can last that long before it's done messing with your mind & body.

That's exactly why I'm nervous about starting anything like that. If it were just a matter of taking it for a few weeks then stopping if I didn't like it, there wouldn't be a problem. But if Paul's correct (and I believe he is) then there goes three months of my life possibly being much worse off than I am now. If I felt that my ADD was severe this wouldn't be a concern, but I do cope relatively well as is so any medication will have to have a lot more plusses than minuses. The biggest thing I fear with any medication is not feeling like myself. I don't care how well I'd be able to focus, etc., if I feel like a totally different person. That's not better in my definition - it's just a new problem.

I think I've decided to stick with the 5-HTP and L-tyrosine for a month and then talk to my therapist and an MD about my concerns if that isn't working. Thanks for the advice, though. It really has helped.

[paulbf]

Well you can also look at some success stories. Gabriela & ltangl (spelling?) here have had good results with effexor.

[Gregster]

There really are not a lot of sexual side effects associated with SSNRI's like Effexor. Wellbutrin is also not know to cause a lot of problems in this regard. I have taken several different SSRI's over the years and found that for me, the worst was Paxil. I didn't get any with Zoloft, and have no problems with the Remeron I take currently. Even with the Paxil, I didn't have any problem until the dose got fairly high. The stimulants I take can cause problems if I have taken the drugs within one or two hours, but after that, there is no issue for me anyway.
Effexor is quite an effective drug and while a small percentage of people do have problems when trying to quit taking it, most people don't. You really won't know how it will effect you until you try it - but if you take it expecting it to cause problems, I wouldn't be surprised if your fears translate into a self-fulfilling prophesy.
If you feel that your ADD is causing you problems (it's not a "disorder" if it's not) isn't it worth giving the drugs your Doctor suggests a try? Nutritional suppliments like 5-HTP and L-tyrosine have helped people, judging by anicdotal evidence, but I don't believe that there are any studies that have proven them to be theraputic.
As far as these drugs making you feel as if you are not "yourself", I don't find that they do that to me - Stimulants and anti-depressants won't change your base personality, value system, or your cognitive abilities; people aren't likely say that "you are a different person" - but of course feeling "yourself" is a subjective thing, so there is no way to know until you give the drugs a try and give them time to work. Treating ADD is not necessarily an easy or exact process, but it's worth the effort if your ADD is holding you back, etc.
Good luck,
Greg

[paulbf]

Originally Posted by Gregster

As far as these drugs making you feel as if you are not "yourself", I don't find that they do that to me - Stimulants and anti-depressants won't change your base personality...

Thanks for making that point.The whole objective in fact is to feel *more* like yourself and it's more important than anything else in the world.

And it's possible.

[exeter]

Originally Posted by Gregster

There really are not a lot of sexual side effects associated with SSNRI's like Effexor. Wellbutrin is also not know to cause a lot of problems in this regard.

Just like to add one thing... Wellbutrin does have one fairly common sexual side effect... increased libido. ;-) hehe