Lexapro/bupropion: light at the end, or just a really long tunnel?

July 25, 2008 11:53 AM

Without going into whole life stories/clinical history, I just want to know - does the exaggerated anxiety that appears as a side effect of Wellbutrin subside after a while?

My wife was prescribed Wellbutrin (actually, generic bupropion) to augment her current antidepressant (Lexapro) Wednesday. Over the past week, she had been anxious, but able to function. Yesterday, after taking the bupropion, the anxiety became too much, she felt "fidgety" all day, and broke down into several panic attacks. She said she couldn't control her thoughts, or get out of her own way enough to do anything. Today, she's ever so slightly better (no major crying/panic attacks), but the crippling anxiety and fidgety-ness still seem to be there.

She's suffered from depression and anxiety for years, so naturally I'm curious as to why her psychiatrist would prescribe her something that lists anxiety and agitation among its first few side effects, but IANAD, so I'd assume he knows what he's doing. After talking to him yesterday, he also prescribed her some Xanax or something similar in an attempt to take the edge off. Understandably, she only wants to take them as a last resort, since they basically knock her out.

Of course, YA also NAD. That being said, is there reason to believe this will pass (or at least lessen in severity), or do we wait out the weekend and call her psych Monday to say "this isn't working"?

posted by anthom to health (26 comments total)

Give it a week or two, and see if she can go for some walks. You do feel jittery when you first start taking it. The doc should be able to prescribe something to take the edge off that DOESN't knock her out if for some reason this continues.

She really should be feeling better in about a week or so. I know I did, when I was taking it.
posted by konolia at 12:02 PM on July 25

One caveat-if she is still having panic attacks and having problems functioning after the first week, have her screened for bipolar type two just to cover your bases...that's important.
posted by konolia at 12:03 PM on July 25

Expect the unexpected. That's what I came to expect from psych drugs. Oddly enough, Wellbutrin is the one that worked for me, without any anxiety at all. Paxil, on the other hand, had me bouncing off the walls with anxiety. Zoloft made me a complete and utter moron (some would say permanent damage), and Celexa dehydrated me.

Point being, all anti-depressants act differently with different individuals. It takes time, but you need to work with and have patience with her doc. It may take several different prescriptions and iterations to find the right balance for her. Good luck to both of you.
posted by netbros at 12:10 PM on July 25 [1 favorite]

Antidepressants are more art than science. Her doctor prescribed it as part of the trial and error effort it takes to find a winning combination. Just because a side effect is listed does not mean any given patient will experience them. I took bupropion and had no panic or anxiety effects. That said, if it's intolerable, stop and try something else.
posted by chairface at 12:10 PM on July 25 [1 favorite]

With wellburtrin, this heightened anxiety passed for me after about two weeks. The shaky hands remained, however. I stuck with it because it worked better than anything had before. Good luck to your wife.
posted by meerkatty at 12:27 PM on July 25

I was on Wellbutrin for a couple of months and the anxiety, jitters, clenched teeth, and sleeplessness never went away even on a reduced dose.
posted by porpoise at 12:28 PM on July 25

I was on Wellbutrin SR for a long time and had some initial teeth-clenching anxiety. It subsided after a couple weeks.

However, when I was switched to the XL formulation (because I would often forget to take the second pill) I had a major meltdown and became unable to function because of panic. I thought I was dying. I was then switched back to the SR and everything went back to the same as before.

I never had a problem with anxiety before taking the drug and now that I'm off it, I no longer have anxiety.
posted by howrobotsaremade at 12:50 PM on July 25

Spend some time researching what's been reported on the net about generic Wellbutrin. There's supported speculation that the drug works differently (or not at all) in its generic form.
posted by Breav at 12:56 PM on July 25

There's supported speculation that the drug works differently (or not at all) in its generic form.

More specifically, the TEVA brand of the generic, especially the XL. There's some evidence that TEVA's version releases an inordinate amount of the active ingredient very quickly, leading to a spike and then a sudden drop in levels in the bloodstream. Normally, the active ingredient should slowly release throughout the day.

We saw this with our son, who was on the TEVA brand generic. His anxiety increased alarmingly, and he suffered several very severe depressive episodes. Once we got him onto a different manufacturer's generic, things got a lot better very quickly.
posted by Thorzdad at 1:03 PM on July 25

I took Wellbutrin (actually I think it was Zyban, but it's the same bupropion) for two months when I quit smoking last year. For the first few weeks I definitely felt like I was having a speedball for breakfast... right around 9:30 or 10 am it would kick in with the force of a quintuple-shot espresso, put eyes on the back of my head and make me want to climb the walls. The sensation gradually subsided, or I got used to it, and all was well. And I'm still not smoking, so thank you, bupropion.

I wasn't clinically depressed or anxious when I was on Wellbutrin, so my mileage my vary from your wife's, but I wouldn't be surprised if the heightened anxiety and fidgetiness she's experiencing aren't so much psychological side effects as they are her reaction to the very real physical sensations that the drug gives rise to. It was annoying enough for me experiencing it with a relatively levelheaded mindset. I can imagine it being trebly disturbing if one is predisposed to anxiety.
posted by mumkin at 1:06 PM on July 25

I felt like that during the first week or so on Wellbutrin (taken by itself). For the first few days, I was irritable, mildly shaky (akin to over-caffeinated shakes) and feeling a bit over active and awake. I was anxious, especially about the effects the pill was having on me. After about a week and a half I was completely evened out in terms of the jitter, sleep, anxiety and overall hyperness. I was prescribed some seroquel to control anxiety if I needed it, but didn't end up using any. I probably could have benefited from it in the first week though.

So far, it seems to be working for me. Hopefully your wife will be so lucky, but of course HMMV.
posted by sunshinesky at 1:15 PM on July 25

she might need a slightly lower dose, as well. that anxiety and fidgetiness (and insomnia if that's happening too) tend to be symptoms of too much of a good thing.

definitely follow up with her doctor if it doesn't fade.

what helped for me was to gradually ramp up on the wellbutrin over the course of a couple of weeks til i was at full dosage, so it didn't hit my system like a truck.
posted by rmd1023 at 1:19 PM on July 25

re: Breav and Thorzdad -

Yeah, I did spend some time on Crazymeds and some other websites, having heard about issues with the generic formulation. I don't know that she's on the TEVA version, as I think it goes by a slightly different name, but I'll definitely check it out when I'm home and can look at the bottle.

Thanks everyone for the assistance so far. We all know the plural of anecdote is not data, but it's at least helping me to not feel quite so clueless...
posted by anthom at 1:24 PM on July 25

One of my relatives took was taking Wellbutrin and Prozac to combat depression. After becoming more and more apathetic over the years, (to the point of effecting their job and home life) they made the mistake of self-unmedicating for a few months and got really anxious to the point of alienating most of us in the family. It was pretty horrible.

They're now taking Buspar twice a day and apparently were given some Lorezapam as needed. Seems to have caused a 180 and they're doing great.

Have her talk to the doctor/therapist and see what alternatives are - there's quite a few out there and everyone's brain is a precious snowblob.
posted by bkdelong at 1:37 PM on July 25

One note - people have reported a difference between taking the generic Bupropion, and the name brand Wellbutrin. Especially with the generic XL version that just came out. I have been taking Wellbutrin without incident for years; when I got switched to the generic last month, it was horrible. My depression came back, my ADHD was back in full force, I got really ramped up with anger about little things, and my anxiety shot through the roof. Seriously. I thought my world was ending. I switched back to the name brand, and all those problems went away. (I think I was on the TEVA generic that others have mentioned).

When I reported this to the doc, he mentioned that quite a few of his patients have had the same reactions to the generic version of XL Wellbutrin. So, if possible, I'd recommend a trial on the name brand drug before rejecting it out of hand. Luckily, my insurance pays for the name brand if recommended by the doctor.
posted by spinifex23 at 1:47 PM on July 25

I'm on the same mix as your wife - in February, Wellbutrin (SR) was added to the Lexapro I'd been taking for a couple of years. When I started the Wellbutrin I'd get stomach-knotting anxiety in the late afternoon - I called it "the crash." I was tapering off Cymbalta at the time, so it might have been related to that. I suspect it was the Wellbutrin, though, because when I upped the dose it came back briefly. Despite the anxiety, I could tell the Wellbutrin was working within a few days. For what it's worth, at first I was on a non-TEVA generic, and then when my doctor increased the dose I went on the brand name.
posted by granted at 2:04 PM on July 25

For the record, I, myself, have been a long-term Wellbutrin user (starting with the brand back when it first hit the market). It's been a good match for me. I've been on one brand or another of generic ever since they became available (insurance company insisted) and I've had one encounter with a "bad" generic. That was ages ago, before I knew about the TEVA problem, and I have no idea what maker it was. Today, I just call around to the local pharmacies and ask which manufacturer they are carrying this week (it varies, depending on where their distributor sources from).
posted by Thorzdad at 2:45 PM on July 25

When I was on Wellbutrin for dysthymia, I also took a low dose of Zoloft to mitigate the anxiety issues Wellbutrin was lousy at managing. My psychiatrist recommended the double dosing and my GP said she saw no reason not to do it.

[No longer on either, due to a change in diagnosis and treatment approach, although I'd not hesitate to go back on that particular cocktail again. It felt the closest to my beloved Serzone, which unfortunately appears to eat human livers for a light snack, so I no longer take it.]
posted by catlet at 3:44 PM on July 25

Wellbutrin was absolutely wonderful for me, just the perfect drug. I was prescribed Wellbutrin for mild depression, but it actually knocked out the reason I was mildly depressed - the stress of being in school while struggling with ADD.

For the semester I was taking it, I was focussed and organized, and happy with the way my life was going. But I also started having horrible panic attacks, something I'd never experienced before or since. I also became a hypochondriac and brooded about my health.

Those symptoms never went away. In fact, the anxiety and hypochondria had a cumulative effect, and towards the end of the semester, I began to identify strongly with the characters in old Woody Allen movies. I had to discontinue the Wellbutrin.

After I stopped the drugs, the anxiety and hypochondria stopped, and haven't come back.
posted by freshwater_pr0n at 4:39 PM on July 25

I take that. When I was on the generic I was hot, anxious, jittery, my hands shook it was awful. I switched to the name brand and all the side effects went away including the anxiety.
YMMV IANAD
posted by meeshell at 5:12 PM on July 25

Wellbutrin was absolutely awful - world destroying panic attacks - for me and I jumped off it after three weeks of hell. My only regret is not stopping after three days. Plain Lexapro alone has, on the other hand, been a godsend.
posted by mygothlaundry at 7:12 PM on July 25

I took Wellbutrin for almost two years, and the heightened anxiety and sleep disturbances (especially, in my case, vivid dreams) never went away. It was worth it, though, and I only stopped when my insurance situation changed.
posted by pullayup at 8:34 PM on July 25

It will get better (I lost 10 pounds my first month), but it shouldn't be that painful. She should ask her doctor about scaling back the dosage.
posted by gesamtkunstwerk at 7:49 AM on July 26

I had a strong and unsettling reaction with caffeine (with my one little cup of green tea) when I was on Wellbutrin, and cut back on (okay, quit) that for a while to help. I think I was able to have my tea again after a couple of weeks, when I'd kind of adjusted to the Wellbutrin. I had to quit the Wellbutrin shortly after that, on advice from my stomach.
posted by dilettante at 8:18 AM on July 26

My anxiety passed, but my heart rate never went below 100 the whole time I was on it. I quit due to this because it was making me incredibly nervous when exercising/drinking caffeine/looking at side effects on the internet. ymmv
posted by sian at 8:49 AM on July 26

Thanks again for all the info, everyone. Days 2,3,and 4 went a lot better than the first day - of course we had a friend visiting, so we weren't just sitting around doing nothing, either. She's still quite anxious and jittery at times, but it's not inducing the major panic attacks that it was on her first day with the stuff.

If the physical anxiety continues at the same level, we plan on calling her psych, but for now it seems like more of a "get used to it" kinda thing, and so far, she is.
posted by anthom at 3:56 AM on July 28