wellbutrin and/or tricyclics for brain fog

[Ema]

Hi Ema, such a long time since my thyroid was tested so not sure though I don't seem to fit a clinical picture of hypo or hyperthyroidism. I understand you're a steroids guru. My doc has suggested I try two steroid regimes. One of low dose 2mg Pred a day for a month. And then if no response 25mg Pred once a week for a month. I've started on the 2mg dosing, initially a slight improvement in fog an energy but now day 4 nothing. If low dose is going to help do you think I would notice it daily or only after a few weeks? If immediately do you think its too low of a dose? Thanks for your input!

The problem with prednisone is that it is a medium-length acting steroid...this means that you end up with levels higher than optimal at times when it is undesirable ie at night when you would prefer to be sleeping.

Most people with adrenal issues do best on hydrocortisone. It is a short acting steroid that can be dosed across the day to mimic the natural diurnal variation.

However, some people with a history of infection may need a combination of longer and shorter acting steroids to keep levels steady due to the increased need caused by the infections.

2 mg of prednisone is roughly equivalent to 10 mg of HC. Depending on your adrenal status, this might actually make you feel worse by suppressing more steroid production than you are replacing. I think the 25 mg of pred once a week is nuts.

Have you had an adrenal saliva test? Any adrenal testing at all?

I would definitely not embark on a long-term steroid protocol before doing appropriate testing. High and low cortisol sometimes overlap symptoms-wise and it is important to know what you are trying to treat first. Keep in mind that steroids should be weaned rather than stopped abruptly in order to give your own adrenals a chance to recover. Testing should be done after no steroid use for at least 2-4 weeks.

 

[nanonug]

The Wellbutrin I am on is still messing up my sleep big time despite me trying last night for the first time 3mg's of sublingual melatonin

If you are being kept awake by increased levels of norepinephrine, melatonin won't do anything. Lithium orotate might, though.

I'm cutting back my Wellbutrin dose to 225mg's

How much were you taking? Wellbutrin XL 150mg is the usual starting dosage. After a month on this, if there are no side effects such as unable to sleep, one increases to 300mg.

 

[Rand56]

hi nanonug

Never knew you had to stay on the 150mg for a month. Actually according to this.....

"Major Depressive Disorder: Initial Treatment: The usual adult target dose for WELLBUTRIN XL is 300 mg/day, given once daily in the morning. Dosing with WELLBUTRIN XL should begin at 150 mg/day given as a single daily dose in the morning. If the 150-mg initial dose is adequately tolerated, an increase to the 300-mg/day target dose, given as once daily, may be made as early as day 4 of dosing. There should be an interval of at least 24 hours between successive doses"

http://www.drugs.com/dosage/wellbutrin-xl.html

I started at 150mg's per day and stayed on that for a whole week before I bumped it up to 300mg. I tried the LO after I saw you suggested that before. Yes it calmed down the wiredness in my brain but ultimately did not effect my sleep. Guess we are all different. Let me ask you this....I don't have typical MDD....I'm atypical. Think I could possibly have a positive effect with less than 300mg's?

Rand

 

[nanonug]

Never knew you had to stay on the 150mg for a month.

According to my psychiatrist, it takes a good 30 days for any dosage to stabilize. Increasing dosages too fast leads to increased number and severity of side effects. The same is also true for Strattera (my son takes this for ADHD.)

If the 150-mg initial dose is adequately tolerated, an increase to the 300-mg/day target dose, given as once daily, may be made as early as day 4 of dosing.

Were you able to sleep well on 150mg/day?

I tried the LO after I saw you suggested that before. Yes it calmed down the wiredness in my brain but ultimately did not effect my sleep.

Ah, you are looking for immediate gratification again!

Give lithium orotate a good 30-60 days at least. It promotes neurogenesis but these things take time...

Think I could possibly have a positive effect with less than 300mg's?

I have no idea! But going slower, in my opinion, is advisable.

 

[Rand56]

hi nanonug

Yes my sleeping was better on the 150mg's. Wasn't until I bumped it to 300mg's that it effected my sleep more. I somewhat made a mistake when I said I'm melancholic atypical. I'm more atypical...I do not have the agitation nor anxiety. I'm low DA/NE. Stims help me the best for my depression but I had tolerance issues when I took Ritalin in the past. Tried Wellbutrin about 20 years ago when I had my first and only<knock on wood> bout of typical MDD. I had less side effects with it than a boatload of other AD's I trialed. Plus since it's a DNRI, I figured it would be a good fit. Someone else suggested Reboxetine would be a good choice for me so that will be an option if I can't get good enough results with Wellbutrin. Today was my first day of cutting back to 225. I'll track how my sleep goes to see if I need to keep cutting back. I'm assuming a slower taper down would be better than a jump from 225 to 150 or wouldn't it matter?

 

[Rand56]

nanonug

I hear what you're saying here....

"Give lithium orotate a good 30-60 days at least. It promotes neurogenesis but these things take time"

But who the heck wants to wait 30-60 days when I need sleep NOW cause I've only been getting about 3 hours a night LOL

 

[nanonug]

Yes my sleeping was better on the 150mg's. Wasn't until I bumped it to 300mg's that it effected my sleep more.

The solution is staring you in the face, then!

Someone else suggested Reboxetine

I don't think this is available in the US. If Wellbutrin doesn't work, why don't give Strattera a try? It is an SNRI but with stronger reuptake inhibition action of the norepinephrine transporter.

Today was my first day of cutting back to 225. I'll track how my sleep goes to see if I need to keep cutting back. I'm assuming a slower taper down would be better than a jump from 225 to 150 or wouldn't it matter?

[/quote]

To be honest with you, I don't know. Given that you switched dosages too fast, switching back to 150mg doesn't sound so bad to me.

 

[nanonug]

But who the heck wants to wait 30-60 days when I need sleep NOW cause I've only been getting about 3 hours a night LOL

I hear you! Have you given Benadryl (25 or 50mg after dinner) a try?

 

[Rand56]

hi nanonug

Doing Benadryl tonite

Strattera is on my list as another option. I can get Reboxetine cheaper. This is important to me since I have to get drugs without a script.

Rand

 

[nanonug]

I can get Reboxetine cheaper.

You may want to read this first, though:

The antidepressant reboxetine: A “headdesk” moment in science

 

[tommykazim]

I'm in the UK and tried Reboxetine which gave me a few days break from brain fog but otherwise just serious insomnia and jitteryness. I had read the articles about it not being an effective AD but as I dont think I have typical depression thought it worth a shot especially as I'm running thin on the AD menu. It is bizarre though the AD licensing worldwide, Reboxetine here but not in the US, wellbutrin there but not here, probably money related.

Ema thanks for the steroid low down. My brain was too fogged out during my consultation to question the docs differing steroid regimes. He's an immunologist. I think though that the once weekly higher dose regime may be in an effort to knock back lymphocytes, in particular B cells, if they do that? Perhaps to mimic Rituximab? Am I talking nonsense?!
From my understanding although high at 25mg if just one day a week shouldnt confuse adrenals into crisis but yes am aware of tapering otherwise if on long term and stronger doses. I havent had saliva testing. Is it accurate enough to dictate treatment or non treatment? Adrenal wise I've just been tested for phaeo, no synacthen nor dexamethasone tests which yes you'd think should have been done before treating BUT I'll give anything a go at this point BUT I hear what you're saying about the strength of pred and will tread lightly!
Thanks!

 

[Rand56]

You may want to read this first, though:

The antidepressant reboxetine: A “headdesk” moment in science

hi nano

Thanks for the link. I actually read that article not too long ago. It did give me pause but yet, this made me laugh....

"It turns out that publication bias was rampant. Pfizer and Lundbeck, the two companies running the studies, didn’t publish a lot of their data, especially the data showing no effect and unfortunate side effects."

SO, what kind of logical conclusion can one make about this drug based on this above quote? Are there other studies coming to the same conclusion that this drug doesn't work? I don't live in the UK but I guess if it didnt work, it would not have been on the market that long. I'm only assuming it's probably been around for awhile. What...was Pfizer trying to debunk the effectiveness of this drug cause they can make more money on something else? This would not surprise me in the least.

Rand

 

[Rand56]

According to my psychiatrist, it takes a good 30 days for any dosage to stabilize. Increasing dosages too fast leads to increased number and severity of side effects.

hi nano

If someone did the 150 for 30 days, then bumped up to 300, and since he says it takes 30 days for any dosage to stabilize, I"m assuming it can take an additional 30 days for the 300 to stabilize? If so, couldn't one possibly experience the same side effects at that time like I have with the insomnia issues from bumping it up too quickly? I can see someone like myself who bumped up too quickly might have those side effects more pronounced, but if they can be managed properly, it would take less time as a whole for your body to get used to 300 if you bump up sooner than later no? I'm just curious to know why your doc's plan of attack is far different than what the drugs.com site says that you can bump up after only 4 days.

Rand

 

[nanonug]

I'm just curious to know why your doc's plan of attack is far different than what the drugs.com site says that you can bump up after only 4 days.

He's plan of attack, as you say, is based on his clinical experience. I clearly recall him talking about how the information on Strattera, for example, suggests increases after only a few days. However, this resulted in very pronounced side effects for the kids. Do he decided to not only "start small" but always "give it time" between dosage increases. Given that these medications are messing with one's brains, I appreciate him being careful.

PS. Any luck with the Benadryl?

 

[Lotus97]

Since switching from Prozac to Paxil a few weeks ago I've come to realize that Prozac was helping my ADD/brain fog. I suspect the reason for this is that unlike most other SSRIs Prozac can also raise norepinephrine and dopamine. I do find Elavil (Amitriptyline) quite useful for sleep however. Tricylic antidepressants can deplete B2 so you want to make sure you're supplementing with that. Actually, everyone here should be taking all the b vitamins anyway.