Wellbutrin: Am I Doing This Right?
April 25, 2022 4:00 PM Subscribe
I've recently been prescribed Wellbutrin by my new primary care provider, and I'm wondering if the instructions I've received are accurate or typical.
I've been prescribed 100mg Wellbutrin SR tablets by a nurse practitioner I have just started seeing.
For context, I have a history of less than ideal medical providers (for example, my previous primary care doctor lost his license for handing out scrips for Adderall, and some other "fun" pills to friends and family. He was also continuously trying to increase my dose of Adderall despite my being perfectly satisfied with my dose, prescribed Xanax for minor anxiety, etc), so I'm a little paranoid about whether I'm receiving competent care.
I met the nurse practitioner and stated that I was interested in trying Wellbutrin, both as an antidepressant and for off label ADHD treatment. I had read about it being used with some success to help with ADHD symptoms, am currently unmedicated for ADHD, and am hoping to find a non-stimulant medication that might work. I am not currently on any other medications.
When I mentioned this, the nurse took out her smart phone and looked it up, and began typing out the instructions. I have limited experience with medical professionals and no previous experience with nurse practitioners, so the use of a smart phone stuck out to me as odd and has contributed to me questioning whether I am receiving competent care.
She told me that the tablets last 12 hours, so I should take them 12 hours apart.
I was instructed to take only one tablet in the morning for two days. After two days, I am to take one tablet in the morning and then one tablet 12 hours later. After three weeks of this, I am instructed to take two tablets in the morning and then one tablet 12 hours later.
I went through the first two days of only one tablet in the morning ok, experiencing some irritability, perpetual low grade anxiety, and a bit of mood swings. Nothing major, but definitely a change from normal. These side effects are persisting. It feels like I'm quitting cigarettes all over again. The constant anxiety is the most challenging for me to deal with, but so far all of the side effects are manageable.
Last night was the first PM dose which I took as instructed, 12 hours after the first, at 8 PM.
I had a horrible night of sleep. Insomnia (not at all uncommon for me), waking up seemingly at random multiple times throughout the night (uncommon), and terrible nightmares (very uncommon). These are deal breakers. I do not want to experience another night like that.
I did a bit of Googling and found that many people report taking their second dose only 6-8 hours after their first, in order to avoid sleep disruption. I asked the nurse practitioner if I could or should try something similar, and she said it was ok to try. I also read that many people only take one Wellbutrin SR pill in the morning, without taking a second dose at all.
My partner was also surprised that the dosage was being doubled after only two days, as it runs counter to their experience with SSRIs (though I am aware Wellbutrin is not an SSRI).
I guess my questions are two fold:
-Does any of the above strike you as a red flag toward this medical professional?
-Are the instructions I have received on increasing my dose or timing my dose typical for Wellbutrin SR, in your experience?
You are not my doctor, and your answers do not constitute medical advice. I am just trying to put feelers out to contextualize what I am experiencing and whether it is anomalous.
I've been prescribed 100mg Wellbutrin SR tablets by a nurse practitioner I have just started seeing.
For context, I have a history of less than ideal medical providers (for example, my previous primary care doctor lost his license for handing out scrips for Adderall, and some other "fun" pills to friends and family. He was also continuously trying to increase my dose of Adderall despite my being perfectly satisfied with my dose, prescribed Xanax for minor anxiety, etc), so I'm a little paranoid about whether I'm receiving competent care.
I met the nurse practitioner and stated that I was interested in trying Wellbutrin, both as an antidepressant and for off label ADHD treatment. I had read about it being used with some success to help with ADHD symptoms, am currently unmedicated for ADHD, and am hoping to find a non-stimulant medication that might work. I am not currently on any other medications.
When I mentioned this, the nurse took out her smart phone and looked it up, and began typing out the instructions. I have limited experience with medical professionals and no previous experience with nurse practitioners, so the use of a smart phone stuck out to me as odd and has contributed to me questioning whether I am receiving competent care.
She told me that the tablets last 12 hours, so I should take them 12 hours apart.
I was instructed to take only one tablet in the morning for two days. After two days, I am to take one tablet in the morning and then one tablet 12 hours later. After three weeks of this, I am instructed to take two tablets in the morning and then one tablet 12 hours later.
I went through the first two days of only one tablet in the morning ok, experiencing some irritability, perpetual low grade anxiety, and a bit of mood swings. Nothing major, but definitely a change from normal. These side effects are persisting. It feels like I'm quitting cigarettes all over again. The constant anxiety is the most challenging for me to deal with, but so far all of the side effects are manageable.
Last night was the first PM dose which I took as instructed, 12 hours after the first, at 8 PM.
I had a horrible night of sleep. Insomnia (not at all uncommon for me), waking up seemingly at random multiple times throughout the night (uncommon), and terrible nightmares (very uncommon). These are deal breakers. I do not want to experience another night like that.
I did a bit of Googling and found that many people report taking their second dose only 6-8 hours after their first, in order to avoid sleep disruption. I asked the nurse practitioner if I could or should try something similar, and she said it was ok to try. I also read that many people only take one Wellbutrin SR pill in the morning, without taking a second dose at all.
My partner was also surprised that the dosage was being doubled after only two days, as it runs counter to their experience with SSRIs (though I am aware Wellbutrin is not an SSRI).
I guess my questions are two fold:
-Does any of the above strike you as a red flag toward this medical professional?
-Are the instructions I have received on increasing my dose or timing my dose typical for Wellbutrin SR, in your experience?
You are not my doctor, and your answers do not constitute medical advice. I am just trying to put feelers out to contextualize what I am experiencing and whether it is anomalous.
I have ADHD, depression, and anxiety. I take 300 mg of Wellbutrin XR and it has been a life-changer for me. It took about a month to filly kick in. It does cause a little insomnia and a horrible dry mouth, but turning off my racing mind was worth it for me.
I wouldn't be bothered by the cell phone - my PCP uses hers all the time because their software is so slow on the in-room PC.
If you're not loving the current dosage schedule, ask to adjust. My partner has to take their buproprion in the morning or they cannot sleep. I'm fine if I take mine before lunch.
posted by notjustthefish at 4:51 PM on April 25, 2022 [2 favorites]
I wouldn't be bothered by the cell phone - my PCP uses hers all the time because their software is so slow on the in-room PC.
If you're not loving the current dosage schedule, ask to adjust. My partner has to take their buproprion in the morning or they cannot sleep. I'm fine if I take mine before lunch.
posted by notjustthefish at 4:51 PM on April 25, 2022 [2 favorites]
This is one of those areas where different things work for different people and you'll have to figure out what works for you. Insomnia is common with Bupropion. Figuring out what works for you may involve different timing or taking the extended release (XL) version instead of the sustained release you have now.
You found out that taking a second dose at 8pm didn't work for you, now you can try something different. You could ask your doctor for the 150mg XL version (which is the lowest dose available), which you could take once per day in the AM. You could try taking the second dose earlier in the day. You could even try just once per day in the AM with the SR for a while to see how your other side effects go (this isn't totally ideal as the half-life of Bupropion is about a day, so your levels will vary a little, but if it works, it works). As you've seen online, different things work for different people.
posted by ssg at 5:05 PM on April 25, 2022
You found out that taking a second dose at 8pm didn't work for you, now you can try something different. You could ask your doctor for the 150mg XL version (which is the lowest dose available), which you could take once per day in the AM. You could try taking the second dose earlier in the day. You could even try just once per day in the AM with the SR for a while to see how your other side effects go (this isn't totally ideal as the half-life of Bupropion is about a day, so your levels will vary a little, but if it works, it works). As you've seen online, different things work for different people.
posted by ssg at 5:05 PM on April 25, 2022
This fits what NAMI say about Wellbutrin SR dosing. It follows their suggested schedule and falls within their suggested dosage range. They're a source I trust — they're not drug company shills or antipsychiatry weirdos. So it might or might not be the right dose for you, but it's not utterly off the deep end.
I'd tell your doctor about what you're experiencing, ask to go back to the lower dose, and see how they react. If they're not a jerk about it, then you're good. If they are, then that's the red flag — not the initial advice, but the bad attitude.
The nurse saying "go ahead and dose earlier if that works better for you" is also a good sign, not a red flag. This is not a drug where having a little too much in your system is dangerous, so it's reasonable to be flexible and do what works best.
posted by nebulawindphone at 5:10 PM on April 25, 2022 [5 favorites]
I'd tell your doctor about what you're experiencing, ask to go back to the lower dose, and see how they react. If they're not a jerk about it, then you're good. If they are, then that's the red flag — not the initial advice, but the bad attitude.
The nurse saying "go ahead and dose earlier if that works better for you" is also a good sign, not a red flag. This is not a drug where having a little too much in your system is dangerous, so it's reasonable to be flexible and do what works best.
posted by nebulawindphone at 5:10 PM on April 25, 2022 [5 favorites]
This sounds like a normal and reasonable medical interaction to me, and a reasonable starting attempt at a dosage schedule. It's to be expected that any individual may need to mess around with the timing to find what works best for them, and it's good that your medical professionals recognize that and I'll are supportive of you trying a different approach.
posted by Stacey at 5:35 PM on April 25, 2022
posted by Stacey at 5:35 PM on April 25, 2022
I was on 150mg ER, each morning, for awhile. A couple weeks ago, decided to double the dose. 150mg wasn't really a "therapeutic" dose ( but did establish my lack of bad reaction).
Now I take 300mg ER, each morning. No problems, and I get more done. I also have ADHD, and some talk about the Bupropion helping that. But, I am only just getting the OK from cardiologist to try Aderal. (I'm a mess! Heart disease, ADHD, depression, autism, c-ptsd...who knows what else!).
Sleep? Don't think it's affecting that.
posted by Goofyy at 5:37 PM on April 25, 2022 [1 favorite]
Now I take 300mg ER, each morning. No problems, and I get more done. I also have ADHD, and some talk about the Bupropion helping that. But, I am only just getting the OK from cardiologist to try Aderal. (I'm a mess! Heart disease, ADHD, depression, autism, c-ptsd...who knows what else!).
Sleep? Don't think it's affecting that.
posted by Goofyy at 5:37 PM on April 25, 2022 [1 favorite]
Re: provider using cell phone during visit - this doesn’t strike me as odd. Epic, one of the largest electronic health software companies, has a product that works specifically with cell phones and tablets.
The best use of the technology that I’ve come across is taking pictures and uploading straight into the medical record. Epic’s software doesn’t save the photos to the devices camera roll and it’s only a couple of clicks to add pictures to a patients chart. So helpful in areas like dermatology where appearance really matters.
posted by MadMadam at 9:29 PM on April 25, 2022 [2 favorites]
The best use of the technology that I’ve come across is taking pictures and uploading straight into the medical record. Epic’s software doesn’t save the photos to the devices camera roll and it’s only a couple of clicks to add pictures to a patients chart. So helpful in areas like dermatology where appearance really matters.
posted by MadMadam at 9:29 PM on April 25, 2022 [2 favorites]
As a medical librarian, I’ll say that the nurse looking something up on their phone is a good sign! We love to see health professionals using the available information resources instead of trusting their (likely overtaxed) memory!
posted by Rock Steady at 2:15 AM on April 26, 2022 [2 favorites]
posted by Rock Steady at 2:15 AM on April 26, 2022 [2 favorites]
Antidepressants that work on me make me unable to sleep, no matter how slowly I ramp up, period, and I've had a zillion years to test this repeatedly. Wellbutrin does this a smidge less badly to me than Prozac (yes, I know that's the reverse of usual).
I think antidepressants permanently changed my brain, because I've been unable to sleep without sleeping pills since a long course of them years ago, and I've tried to wean off sleeping pills many times.
If I had it to do over again I would never have taken antidepressants for any length of time. I think they're far more dangerous than anyone understands.
No matter how slowly I titrate up I can't take antidepressants because they make me unable to sleep even with sleeping pills. I suspect a long course of them permanently torched my ability to sleep years ago, leaving me unable to sleep without pills even though I no longer take antidepressants.
Years ago I was told antidepressants weren't making it hard for me to sleep. Now it's a fairly well-known side effect.
Good luck. This really sucks, and I hope you find a way to make it work for you.
.
posted by liminal_shadows at 5:35 AM on April 26, 2022
I think antidepressants permanently changed my brain, because I've been unable to sleep without sleeping pills since a long course of them years ago, and I've tried to wean off sleeping pills many times.
If I had it to do over again I would never have taken antidepressants for any length of time. I think they're far more dangerous than anyone understands.
No matter how slowly I titrate up I can't take antidepressants because they make me unable to sleep even with sleeping pills. I suspect a long course of them permanently torched my ability to sleep years ago, leaving me unable to sleep without pills even though I no longer take antidepressants.
Years ago I was told antidepressants weren't making it hard for me to sleep. Now it's a fairly well-known side effect.
Good luck. This really sucks, and I hope you find a way to make it work for you.
.
posted by liminal_shadows at 5:35 AM on April 26, 2022
Response by poster: This has greatly helped my peace of mind.
I really appreciate the reassurance about my superficial phone use concern, and pointing out the green flag of "the nurse is listening to you, that's good."
It definitely sounds like asking the nurse about the extended release version is the next step for me.
Thank you all!
posted by rustybullrake at 12:31 PM on April 26, 2022
I really appreciate the reassurance about my superficial phone use concern, and pointing out the green flag of "the nurse is listening to you, that's good."
It definitely sounds like asking the nurse about the extended release version is the next step for me.
Thank you all!
posted by rustybullrake at 12:31 PM on April 26, 2022
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FWIW there are some ADHD people who have trouble sleeping if they’re under-stimulated so this schedule might work for other patients but not you. Maybe ask about trying a single dose of extended release?
posted by delezzo at 4:41 PM on April 25, 2022