# Wellbutrin for atypical/bipolar depression (need data)



## bmwfan07 (Jun 3, 2007)

Has anyone here done well (or poorly) on Wellbutrin for *atypical* depression or bipolar depression with anergic/atypical features? I am *not* interested in feedback about melancholic depression in this thread, since I am convinced these syndromes arise from neurobiologically distinct etiologies. I was prescribed 150mg XL on Monday and have already felt a bit of an increase in energy; mood is relatively unchanged, but this is confounded by my severe flu. Titrating to 300mg XL this coming Monday.

Here are the main symptoms for each to help distinguish:

*Atypical depression or bipolar depression with anergic/atypical features* - low energy/fatigue, psychomotor retardation, oversleeping, *possible* overeating, possible carb/sugar cravings, worse mood at night, apathy/anhedonia/amotivation, possible mood reactivity to positive or negative external events with possible disproportionate interpersonal oversensitivity (e.g. plunging into a state of despair or sleeping 15 hours because someone makes an offhanded remark about you), feeling disconnected from emotions or numb but not necessarily "sad" (it's hard to say which is worse).

*Melancholic depression or bipolar depression with melancholic features* - insomnia (often with early morning waking or inability to stay or fall asleep), undereating, psychic anxiety (which may appear to cause insomnia) and dread about the future, anhedonia, regret and guilt about past misdeeds or failures, worse mood in the morning or constant throughout the day, mood non-reactivity (not mood-responsive to positive or negative events), pervasive feelings of sadness or emptiness.

If you've had any experiences, good *or* bad, with this drug and suffer(ed) from atypical depression, please post here with your experience, any other drugs/conditions, and your particular depressive symptoms if you're able. I'm trying to get a handle on whether this drug actually works for atypical/anergic depression, since few seem to for any length of time.

Thanks.


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## melissa75 (Feb 16, 2010)

I have atypical depression, not melancholic depression. I have yet to believe I am bipolar II but am visiting another psychiatrist next Friday. If I think this one knows what he is talking about, I may believe it this time. Previous doctors think I'm bipolar II because I have atypical depression and I seem to have hypomania. I think you've responded to me before with the same comments, as well. 

Anyway, I took 150 mg Wellbutrin XL for 4 months and stopped taking it 3 weeks ago. Tried increasing to 300 mg but thought I was going to have a heart attack so never did. I started taking Topomax as a migraine preventative a month after starting wellbutrin. Also took maxalt whenever a migraine attack occurred. 

I started taking WB because I was in a severe depression and requested a non-SSRI that wouldn't make me gain weight. My GP gave it to me. 2 weeks in:

*lots of energy
*rapid heart rate here and there
*increased anxiety
*BAD insomnia
*no appetite/weight loss
*little depression
*couldn't focus/memory loss

The rapid heart rate tapered off around 4-5 weeks and memory improved. Depression started to come back after 2 months. Insomnia never went away. Doctor started me on ambien CR because I could fall asleep but I couldn't stay asleep. Stayed on ambien CR or 10 mg melatonin until I stopped wellbutrin. I can now sleep...too much so. 

Around the 3rd month on wellbutrin, I got into a deep depression again and felt irrational/confused about everything. It stopped working. Depression was worse than before I started taking it. Took it for another month until my doctor switched me to Lexapro, which I've been on for 23 days now. So far so good...

I'm not taking wellbutrin again. It definitely did not help me.


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## bmwfan07 (Jun 3, 2007)

melissa75 said:


> I have atypical depression, not melancholic depression. I have yet to believe I am bipolar II but am visiting another psychiatrist next Friday. If I think this one knows what he is talking about, I may believe it this time. Previous doctors think I'm bipolar II because I have atypical depression and I seem to have hypomania. I think you've responded to me before with the same comments, as well.


I believe I recall responding vaguely, but probably not as well as I should, hehe. 

I've never had hypomania, to my knowledge, but I do believe atypical depression generally includes some amount of bipolarity. It may not be as severe as typical bipolar II, but it's on the spectrum. I'm still not sure what I should call or how I should diagnose myself, though. I don't think there's an official diagnosis--certainly not in the DSM-IV--for soft bipolar or bipolar spectrum disorder, so the diagnosis for recordkeeping and insurance purposes would probably be bipolar II--if my p-doc, of course, shared my sentiments. My new one, one of the best in the area supposedly, has yet to make an official diagnosis (I've only seen him once).

How do you believe your hypomania manifests? Is it more irritable, dysphoric, or euphoric?



> Anyway, I took 150 mg Wellbutrin XL for 4 months and stopped taking it 3 weeks ago. Tried increasing to 300 mg but thought I was going to have a heart attack so never did. I started taking Topomax as a migraine preventative a month after starting wellbutrin. Also took maxalt whenever a migraine attack occurred.


Ah, so you have migraines. Did WB make it worse? It's interesting--a very high percentage of people with bipolar II have migraines. A higher-than-average percentage of people with major depressive disorder and bipolar I do, but not as high as bipolar II. This is probably significant in some not-yet-understood way.



> I started taking WB because I was in a severe depression and requested a non-SSRI that wouldn't make me gain weight. My GP gave it to me. 2 weeks in:
> 
> *lots of energy
> *rapid heart rate here and there
> ...


I've had some of those side effects. The focusing issue and insomnia, manifesting for me as waking up a lot (at least last night), as well as the weird dreams I'm getting (oh, and constipation... bad), are the most troubling. Like you, I hope the focusing/short-term memory issue goes away. So your depression was nearly demolished by the end of the second week? That sounds like an abnormally fast response, at least according to the literature and anecdotes.



> Around the 3rd month on wellbutrin, I got into a deep depression again and felt irrational/confused about everything. It stopped working. Depression was worse than before I started taking it. Took it for another month until my doctor switched me to Lexapro, which I've been on for 23 days now. So far so good...
> 
> I'm not taking wellbutrin again. It definitely did not help me.


I'm sorry to hear WB didn't help. The depression being worse than before is quite alarming to me. I certainly feel sometimes like my depression couldn't get any worse, or I wouldn't be here.

Thanks for the data point, though, and I'm glad Lexapro is helping, although 23 days, again, sounds like a very fast response. I think this is actually common in people with bipolar disorder who are given A/Ds. I've heard of people going hypomanic in the first few days and then tapering out but still feeling better than before they started taking the A/D. This is not how they're supposed to work and often indicates some level of bioplarity.


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## jim_morrison (Aug 17, 2008)

bmwfan07 said:


> I've had some of those side effects. The focusing issue and insomnia, manifesting for me as waking up a lot (at least last night).


That's the downside (or in some cases upside) of wellbutrin XL being in your system 24 hours a day. It keeps neurotransmitters such as norepinephrine which should ideally be 'switched off' during sleep turned on. 
Compare this with for example, Ritalin (immediate release) which, if taken in the morning should be largely out of your system by the time you go to bed.


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## JohnG (Sep 3, 2010)

I used it for 3 month, at 150 mg/die. He definitely worked, for depression and focus functions, but I also had bad insomnia and extreme anxiety in the night. Benzo, are not useful to treat WB's insomnia because of some interaction of the medication with enzyme P450 (no I dont remember the specific action on it), so was a very bad situation to treat.

Also, memory after 2 month was gone, I think due to Ach antagonism. For my experiences, WB is not a good medication :roll

Methylphenidate (or bettere amp), are definitely better in my case.


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## heroin (Dec 10, 2010)

Not sure what kind of depression I have but:

I have been on it for something like 4 months now. 300mg a day. I'm not sure how much difference it is making. There really was no change in my depression from this drug. It might have reduced the physical soreness and fatigue somewhat, but that could have been Duloxetine (SNRI) too (60mg a day). I've been on these two for quite a few months now. I don't feel as fatigued as I used to, but there is practically no change in moods from this for me.

I've only had one positive mood change four days ago while I had been on 20mg ritalin daily in addition to the two drugs mentioned above for more than a month. But when I visited the psychiatrist yesterday he changed the meds and now I'm on 37.5 mg of tianeptine and 100 mg of levosulpiride a day in addition to bupropion (wellbutrin) and duloxetine.

So I'm not quite sure what my diagnosis is.


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## melissa75 (Feb 16, 2010)

bmwfan07 said:


> How do you believe your hypomania manifests? Is it more irritable, dysphoric, or euphoric?


I feel euphoric, not irritable at all. It comes in bursts and can lasts days. However, I can go to sleep no problem and sleep, sleep, sleep. But, I've been in a cleaning frenzy. Like I said in one thread last week, I started throwing everything out, and if I had the strength, my nice living room furniture would be on the street. I want everything out of my house. I want a clean house...nothing in it. It feels good to be going through these moods...so much better than that depression. And, I talk a lot and fast at times. People at work have commented on how they want what I'm "taking". They don't know that I'm taking anything, of course. And, I'm spending money more. I usually save b/c when I'm depressed, I don't care...have no desire to purchase even food.



bmwfan07 said:


> Ah, so you have migraines. Did WB make it worse? It's interesting--a very high percentage of people with bipolar II have migraines. A higher-than-average percentage of people with major depressive disorder and bipolar I do, but not as high as bipolar II. This is probably significant in some not-yet-understood way.


I've had migraines since I can remember. I remember my first bad headache when I was watching a football game with my dad when I was 5 or 6 years old. We think WB made them occur more frequently, and I ended up getting an MRI and MRA while on WB b/c my neurologist wasn't sure what was going on. But, I have a lot of work stress and responsibility, as well.



bmwfan07 said:


> I've had some of those side effects. The focusing issue and insomnia, manifesting for me as waking up a lot (at least last night), as well as the *weird dreams I'm getting* (oh, and constipation... bad), are the most troubling. Like you, I hope the focusing/short-term memory issue goes away. So your depression was nearly demolished by the end of the second week? That sounds like an *abnormally fast response*, at least according to the literature and anecdotes.
> 
> I'm sorry to hear WB didn't help. The depression being worse than before is quite alarming to me. I certainly feel sometimes like my depression couldn't get any worse, or I wouldn't be here.


I had insane dreams immediately upon starting WB. I could write Stephen King-type novels, I'm sure...lol. The problem with those dreams is I never felt like I was ever sleeping. So, the ambien CR definitely helped with that. It sucks that you have to take a sleep med to take WB. I don't like that at all. It never got better for me. Yes, the depression went away very quickly as it did with Lexapro. Lexapro...it went away the 2nd day. My doctor was shocked, too. So, I'm extremely nervous Lexapro will stop working for me as WB did in a few months. And, then, the depression will be worse than ever before. I can't imagine that, either. It won't be good.

My last psychiatrist (who _thinks_ I'm bipolar) gave me Abilify. I took one pill, and it made me extremely ill within 2 hours, and then it took me 16 hours to recover. I can't handle that. So, I feel like if I have that kind of response then her diagnose might be wrong :stu.


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## peaceandlove09 (Aug 10, 2010)

Ahhhh mr Wellbutrin. It's a love/hate relationship for me. 

It does work. It destroyed my suicidal depression in about a month. I just stopped dwelling on "bad thoughts" and I started living more in the moment. I am not as hypercritical of everyone and i get along better with people. It also gives me more energy, kind of a "pep" in my step. 

One benefit which i really love, possibly the reason i have stayed on the med, is that it completely curbs my desire to drink, gamble, and do other bad stuff. I used to drink fairly regularly (once or twice a week) and i used to goto the casino a fair bit. Those activities pretty much stopped after Wellbutrin. I have tried drinking on it, and I feel disoriented and wierd. And generally i just dont want to drink. When I think of alcohol, my brain says: "Gross. Why do you want to put that crap into your body?" whereas before i would CRAVE alcohol. If i went a few weeks without it, I would need to have a bender type night. 

This is a major reason why I am still on the med. Not drinking is very good for me. It keeps me on track with my life. And I can still go out and enjoy myself without booze. 

Now for the "cons" ... 

I do have serious memory loss. I don't remember sh*t anymore. What did I do yesterday? It's just a blur. Even big events, i barely remember. On one hand it's cool because it's like i'm living in the moment. OTOH, it's kinda scary because man, i have to strain to remember simple details. I'm like the guy in momento who has no memory of anything. Not sure how I am gonna go back to school with this memory. I may have to switch meds because i can't retain/remember things on this med. 

Wellbutrin makes me a bit socially "anxious" for lack of a better word. I have started taking it at night, before bed, and this sort of helps. I sometimes have trouble making eye contact with people on this med. I have been working on it more, and i can do it, but i'm not as "chill" as I used to be. This is double edged sword because i want to be chill, but at the same time, I want to have energy and go out and do things. I am going to re evaluate this side effect and see if it really detrimentally affects my life or not. 

I also have loss of appetite and i have to eat more to maintain my weight. 

I am still taking the med because (a) i dont feel depressed (b) i love that i dont crave alcohol anymore

Those two benefits basically outweigh the side effects. 

I have also decided other meds SUCK BALLS so i don't have too many other options anyway. I'm not gonna subject myself to the sexual dsyfunction, fatigue and apathy, and emotional numbness of ssri's. No thank you. 

I've tried Celexa, Lexapro and Zoloft, and all three of those meds destroyed my libido. I liked Zoloft the best (it felt the most natural) but the anorgasma on that was embarassing. I couldn't even "get off" beating my meat furiously for half hour. :roll

I need some sort of support, and i'd rather have a few side effects than feel depressed for no reason.

Wellbutrin is the best med from what is currently available.


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## bmwfan07 (Jun 3, 2007)

jim_morrison said:


> That's the downside (or in some cases upside) of wellbutrin XL being in your system 24 hours a day. It keeps neurotransmitters such as norepinephrine which should ideally be 'switched off' during sleep turned on.
> Compare this with for example, Ritalin (immediate release) which, if taken in the morning should be largely out of your system by the time you go to bed.


Last night was actually better. I only woke up once, that I can remember, at around 5:30am. But, I felt extremely *weird*--dissociated, almost like I was in a half-dream state. I was confused and disoriented and just felt extremely odd. I can't really explain it. I quickly went back to sleep so I wouldn't start panicking about it. Woke up at 9:30 and felt fine, but tired.



JohnG said:


> I used it for 3 month, at 150 mg/die. He definitely worked, for depression and focus functions, but I also had bad insomnia and extreme anxiety in the night. Benzo, are not useful to treat WB's insomnia because of some interaction of the medication with enzyme P450 (no I dont remember the specific action on it), so was a very bad situation to treat.
> 
> Also, memory after 2 month was gone, I think due to Ach antagonism. For my experiences, WB is not a good medication :roll
> 
> Methylphenidate (or bettere amp), are definitely better in my case.


It's too bad WB didn't work for you, but I'm glad Ritalin has.

What kind of depression did/do you have? Is it more atypical or melancholic (please see my first post for the distinction between the two)?



heroin said:


> Not sure what kind of depression I have but:
> 
> I have been on it for something like 4 months now. 300mg a day. I'm not sure how much difference it is making. There really was no change in my depression from this drug. It might have reduced the physical soreness and fatigue somewhat, but that could have been Duloxetine (SNRI) too (60mg a day). I've been on these two for quite a few months now. I don't feel as fatigued as I used to, but there is practically no change in moods from this for me.
> 
> ...


I had to look up levosulpride, but it appears to be an anti-psychotic. What country are you in? I've never heard of it. I'm not sure about the tianeptine; I've heard mixed things. But it's too bad the WB hasn't seemed to work.

Based on my first post, which depressive syndrome best fits you? If you have an adequate mix of both symptoms, you may have an undifferentiated syndrome, but I think most people on this board fall more into one category than the other.


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## bmwfan07 (Jun 3, 2007)

melissa75 said:


> I feel euphoric, not irritable at all. It comes in bursts and can lasts days. However, I can go to sleep no problem and sleep, sleep, sleep. But, I've been in a cleaning frenzy. Like I said in one thread last week, I started throwing everything out, and if I had the strength, my nice living room furniture would be on the street. I want everything out of my house. I want a clean house...nothing in it. It feels good to be going through these moods...so much better than that depression. And, I talk a lot and fast at times. People at work have commented on how they want what I'm "taking". They don't know that I'm taking anything, of course. And, I'm spending money more. I usually save b/c when I'm depressed, I don't care...have no desire to purchase even food.


This does sound like classic hypomania. And you're quite lucky it's of the euphoric variety...the others aren't so pleasant. 

Even based on conventional DSM criteria, there seems to be no doubt you have bipolar II, but I hope I'm not striking a nerve here.



> I've had migraines since I can remember. I remember my first bad headache when I was watching a football game with my dad when I was 5 or 6 years old. We think WB made them occur more frequently, and I ended up getting an MRI and MRA while on WB b/c my neurologist wasn't sure what was going on. But, I have a lot of work stress and responsibility, as well.


They're no fun. I've never had one, but my friend had them chronically and would be out of school for a couple of days every so often, vomiting and bed-ridden all day.



> I had insane dreams immediately upon starting WB. I could write Stephen King-type novels, I'm sure...lol. The problem with those dreams is I never felt like I was ever sleeping. So, the ambien CR definitely helped with that. It sucks that you have to take a sleep med to take WB. I don't like that at all. It never got better for me. Yes, the depression went away very quickly as it did with Lexapro. Lexapro...it went away the 2nd day. My doctor was shocked, too. So, I'm extremely nervous Lexapro will stop working for me as WB did in a few months. And, then, the depression will be worse than ever before. I can't imagine that, either. It won't be good.
> 
> My last psychiatrist (who _thinks_ I'm bipolar) gave me Abilify. I took one pill, and it made me extremely ill within 2 hours, and then it took me 16 hours to recover. I can't handle that. So, I feel like if I have that kind of response then her diagnose might be wrong :stu.


I can relate to the Stephen King thing, although the frustrating thing (or maybe the good thing) is that because my memory is so bad with this WB, I can't remember almost anything in my dreams! I just "feel" weird, like I've been impacted by them, and remember extremely brief, fleeting snippets.

I know when I woke up this morning at 5:30am (not because I wanted to), I was panicking somewhat because I thought I had two personalities. I think my dreams, several of them, last night were about psychiatric disorders. That isn't surprising, because the subject has been pretty all-consuming for me as of the past half-year.

I've not heard very good things about Abilify. Lamictal is far better as a mood stabilizer.



peaceandlove09 said:


> Ahhhh mr Wellbutrin. It's a love/hate relationship for me.
> 
> It does work. It destroyed my suicidal depression in about a month. I just stopped dwelling on "bad thoughts" and I started living more in the moment. I am not as hypercritical of everyone and i get along better with people. It also gives me more energy, kind of a "pep" in my step.
> 
> ...


Thanks for that in-depth response. I'm glad that the WB is helping, although I can certainly empathize with the memory issues and the somewhat increased anxiety. I haven't been social enough in the past week to know how my social phobia has been impacted, although I've actually heard it can help a bit with that due to dopamine agonism. In general, though, it seems to worsen anxiety due to its noradrenergic effects.

Does your depression seem more atypical or melancholic (please see first post)? This is very important information.

The sexual dysfunction with SSRIs really is not much better than depression (it's depression-inducing in and of itself), and in addition, SSRIs are far less than ideal for atypical depression.


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## jim_morrison (Aug 17, 2008)

bmwfan07 said:


> SSRIs are far less than ideal for atypical depression.


The exception to that rule appears to be Fluoxetine which works better for atypical depression than standard SSRI's. Interestingly it's also the only SSRI which does not statistically increase suicidal ideation or risk of seizure.

http://www.biopsychiatry.com/fluoxgaba-a.htm


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## JohnG (Sep 3, 2010)

bmwfan07 said:


> *atypical* depression


I'm not saying that WB doesn`t work, it worked quite well, but the side effects (memory loss, extreme anxiety and insomnia) were too bad to sustain them.

For anhedonia and atypical depression works, focus is back, motivation too, I also noticed some decrease in OCD thoughts, and alcool craving. By the way, seems like you will never be sure about which meds to take, you are "OCDing" too much.

just try it


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## heroin (Dec 10, 2010)

bmwfan07 said:


> I had to look up levosulpride, but it appears to be an anti-psychotic. What country are you in? I've never heard of it. I'm not sure about the tianeptine; I've heard mixed things. But it's too bad the WB hasn't seemed to work.


I'm from India. I was on flupentixol, which is another anti-psychotic, for around a month too a few months ago. I'm not sure why I am being prescribed anti-psychotics. I've never had hallucinations or delusions. Maybe the way I think about and perceive things is delusional? Or maybe because I am suicidal? I don't know. Or maybe they are prescribed to stabilize the effects of other drugs?

Maybe burpopion is keeping the fatigue away, so I can't say for sure if it's done no good. But it certainly hasn't affected the moods. I think the only side effect I have from it is interrupted sleep.



bmwfan07 said:


> Based on my first post, which depressive syndrome best fits you? If you have an adequate mix of both symptoms, you may have an undifferentiated syndrome, but I think most people on this board fall more into one category than the other.


More of the atypical depression symptoms seem to fit me than the other type.


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## peaceandlove09 (Aug 10, 2010)

bmwfan07 said:


> Does your depression seem more atypical or melancholic (please see first post)? This is very important information.


I'm not sure if it's atypical or melancholic. I can tell you that over the past 5 years i have had 6-7 major depressive episodes. They usually last a few months and then i'm fine for a few months and then the cycle repeats.

I could always somewhat function through my depression, but then last year an event made me spiral into basically the depths of hell and last year i was irritable, and emotionally numb, and i would lie in bed most of the day and pretty much do nothing.

But i have symptoms of both atypical and melancholic so not sure if i can categorize it.


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## bmwfan07 (Jun 3, 2007)

jim_morrison said:


> The exception to that rule appears to be Fluoxetine which works better for atypical depression than standard SSRI's. Interestingly it's also the only SSRI which does not statistically increase suicidal ideation or risk of seizure.
> 
> http://www.biopsychiatry.com/fluoxgaba-a.htm


Interesting... I'd never heard of that aspect of fluoxetine. Docs seem to prefer Zoloft and Lexapro now, although Prozac has been around the longest and is still, I believe, the third most commonly prescribed SSRI.



JohnG said:


> I'm not saying that WB doesn`t work, it worked quite well, but the side effects (memory loss, extreme anxiety and insomnia) were too bad to sustain them.
> 
> For anhedonia and atypical depression works, focus is back, motivation too, I also noticed some decrease in OCD thoughts, and alcool craving. By the way, seems like you will never be sure about which meds to take, you are "OCDing" too much.
> 
> just try it


I definitely am "OCDing" too much, John. I like the way you put that, hah.

I titrated up to 300mg today, and so far no additional side effects. I'm keeping my fingers crossed that I don't get any others or that the current ones don't get worse. So far, the constipation is objectively the worst, since it's definitely not healthy. I hope the 300mg doesn't make it worse... and I hope it goes away! Can anyone with this side effect comment on that?



heroin said:


> I'm from India. I was on flupentixol, which is another anti-psychotic, for around a month too a few months ago. I'm not sure why I am being prescribed anti-psychotics. I've never had hallucinations or delusions. Maybe the way I think about and perceive things is delusional? Or maybe because I am suicidal? I don't know. Or maybe they are prescribed to stabilize the effects of other drugs?


Anti-psychotics are definitely overprescribed here, and probably there, too. Perhaps it's being used in your case as a sort of mood stabilizer, though lithium and the anti-convulsants are much better and safer for that purpose.



> Maybe burpopion is keeping the fatigue away, so I can't say for sure if it's done no good. But it certainly hasn't affected the moods. I think the only side effect I have from it is interrupted sleep.


That's too bad.



> More of the atypical depression symptoms seem to fit me than the other type.


Thanks.


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## bmwfan07 (Jun 3, 2007)

peaceandlove09 said:


> I'm not sure if it's atypical or melancholic. I can tell you that over the past 5 years i have had 6-7 major depressive episodes. They usually last a few months and then i'm fine for a few months and then the cycle repeats.
> 
> I could always somewhat function through my depression, but then last year an event made me spiral into basically the depths of hell and last year i was irritable, and emotionally numb, and i would lie in bed most of the day and pretty much do nothing.
> 
> But i have symptoms of both atypical and melancholic so not sure if i can categorize it.


One of the most sensitive predictors of atypical depression are oversleeping and overeating, often with carb cravings. Do either one of these occur during most of your depressive episodes? How about mood reactivity--your mood improving slightly or worsening > 50% in response to external events, relationships, social functions, etc.?


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## DarthNova (Jan 17, 2011)

I'm not exactly sure I have atypical depression as you described it in this post (I'm probably a bit more melancholic-like) but I want to offer my insight after being on Wellbutrin XL 300mg for over two years in the hope that it can help you in some way.

Before starting Wellbutrin I had been on SSRI's for about a total of 4 years prior (2 years on Zoloft, stopped taking it due to side effects and was on nothing for a year, then another 2 years on Lexapro before switching immediately (no gap) to Wellbutrin). 

The reason I switched to Wellbutrin in the first place was because of SSRI-related side effects which manifested (perhaps ironically) somewhat like atypical depression. I felt tired and lethargic all the time, slept 14-15 hours a day with long naps even after full night's sleep, I overate and gained weight (eating crap food), cried a lot, and felt significant emotional blunting (no real highs or lows if that makes sense, little emotional feelings in general), couldn't focus. Worst of all was the sexual dysfunction which is the smoking gun reason why I had enough of the SSRI's. Was still feeling depressed while on them. 

Wellbutrin changed all of this within the first few weeks of being on it, but transitioning onto Wellbutrin was a very bumpy road at first. The first few days (on 150mg XL) I felt like I was on speed -- very focused, stimulated, minor euphoria the first day, attentive -- pretty good overall. After a week though I didn't feel much at all, and told the doc who upped the dose to 300mg XL. I certainly felt the 300mg help with the depression but boy oh boy did it make me anxious. During the first month of 300mg each day felt like an emotional roller coaster. I'd have highs, I'd have lows -- I'd get anxiety/panic attacks, I'd -want- to cry (but couldn't actually physically cry on this med without really trying). The anxiety attacks at times were so severe that I felt "paralyzed by stress" or "paralyzed by anxiety". 

Went back to the doc at the end of the month and told him all of this. I said the depression itself was improving but these panic attacks were cropping up big time. Was given 0.5mg and then later, 1.0mg, clonazepam (Klonopin) to take as needed when these panic attacks occurred. Doc felt that I would get accustomed to the meds overtime and not get such bad attacks in the long term.

Well, the doctor was correct. The anxiety attacks tapered off in frequency and severity (though they still would happen from time to time) but overall things were better, and I could perform sexually which helped a lot (even felt better too)--one of my biggest gripes with the SSRIs. 

After the second month I noticed some odd side effects which I think will help you keeping an eye out for since you said you're going up to 300mg soon: 

- Despite increased attentiveness and focus overall, I have some short-term memory problems. For ex: If someone introduces themselves to me and we talk for a few minutes, I may forget what their name was or how we got onto that subject of conversation. 

- Insomnia, sometimes severe, but not to the point where I would be up all night. Just instead of falling asleep when I wanted, it may take an extra hour or two or more effort. 

- A pretty significant loss of appetite, leading to pretty significant weight loss (eventually will plateau or bottom out). This was beneficial as I was slightly overweight at the time, but lost about 20 lbs in about 3 months on it which isn't exactly safe when you aren't exercising or trying to lose it. 

- Mild paranoia/hypervigilance -- you may begin to notice/perceive things about every day life and your surroundings that you once ignored or never thought about. I spoke to somebody who is also on 300mg XL and they said they experience this phenomenon as well. 

- Constipation or diarrhea (would alternate, but also is influenced by diet)
- Increased anxiety/worrying
- Dry mouth
- Increased sweating/thermogenesis (sweat for no reason sometimes)

- Temporarily (for a few months) would periodically crave nicotine when I didn't even smoke. I had tried cigarettes a couple of times but never liked it but there would be a time where I wanted to smoke a cigarette and had absolutely no reason or basis to desire it. Probably from its NACh antagonism -- this went away after 6+ months of taking the meds and not engaging in any nicotine use whatsoever. 

These were the most noticeable/pronounced side effects I've dealt with while on the drug. 

Make of it what you will, but I hope my experiences on it are helpful and I appreciate your comments in my other thread about the Adderall. If you require any clarifications I'd be happy to provide them.


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## bmwfan07 (Jun 3, 2007)

DarthNova said:


> I'm not exactly sure I have atypical depression as you described it in this post (I'm probably a bit more melancholic-like) but I want to offer my insight after being on Wellbutrin XL 300mg for over two years in the hope that it can help you in some way.


Thanks for the post!



> Before starting Wellbutrin I had been on SSRI's for about a total of 4 years prior (2 years on Zoloft, stopped taking it due to side effects and was on nothing for a year, then another 2 years on Lexapro before switching immediately (no gap) to Wellbutrin).
> 
> The reason I switched to Wellbutrin in the first place was because of SSRI-related side effects which manifested (perhaps ironically) somewhat like atypical depression. I felt tired and lethargic all the time, slept 14-15 hours a day with long naps even after full night's sleep, I overate and gained weight (eating crap food), cried a lot, and felt significant emotional blunting (no real highs or lows if that makes sense, little emotional feelings in general), couldn't focus. Worst of all was the sexual dysfunction which is the smoking gun reason why I had enough of the SSRI's. Was still feeling depressed while on them.


Yep, SSRIs are not highly regarded on this forum for the reasons you listed, and more (largely also because they're usually ineffective for any length of time in treating social phobia).



> Wellbutrin changed all of this within the first few weeks of being on it, but transitioning onto Wellbutrin was a very bumpy road at first. The first few days (on 150mg XL) I felt like I was on speed -- very focused, stimulated, minor euphoria the first day, attentive -- pretty good overall. After a week though I didn't feel much at all, and told the doc who upped the dose to 300mg XL. I certainly felt the 300mg help with the depression but boy oh boy did it make me anxious. During the first month of 300mg each day felt like an emotional roller coaster. I'd have highs, I'd have lows -- I'd get anxiety/panic attacks, I'd -want- to cry (but couldn't actually physically cry on this med without really trying). The anxiety attacks at times were so severe that I felt "paralyzed by stress" or "paralyzed by anxiety".
> 
> Went back to the doc at the end of the month and told him all of this. I said the depression itself was improving but these panic attacks were cropping up big time. Was given 0.5mg and then later, 1.0mg, clonazepam (Klonopin) to take as needed when these panic attacks occurred. Doc felt that I would get accustomed to the meds overtime and not get such bad attacks in the long term.
> 
> Well, the doctor was correct. The anxiety attacks tapered off in frequency and severity (though they still would happen from time to time) but overall things were better, and I could perform sexually which helped a lot (even felt better too)--one of my biggest gripes with the SSRIs.


As someone who's experienced panic attacks myself, I can definitely attest to their extreme unpleasantness. I'm glad they went away for you, though. I haven't heard of that side effect, in particular, but it sounds like perhaps the noradrenergic effects could have done that.

How long did the 300mg take to kick in and make a dent in your depression? I've just titrated from 150 to 300 today, after a week, and have been feeling depressed to varying degrees since about 3:30pm. My depression, being atypical, though, is more like a feeling of numbness and being "down" without actually being sad, in most cases (unless I'm watching a sad movie, in which case I'm prone to sudden crying where when I'm not depressed, I wouldn't cry at all). It's like my emotions have been sucked out by a vacuum cleaner and hidden away from me. It's very cruel. So, I only noticed this depression when I started to enjoy my conversation over lunch with a friend less, as the anhedonia set in. I am hoping for some serious relief soon.



> After the second month I noticed some odd side effects which I think will help you keeping an eye out for since you said you're going up to 300mg soon:
> 
> - Despite increased attentiveness and focus overall, I have some short-term memory problems. For ex: If someone introduces themselves to me and we talk for a few minutes, I may forget what their name was or how we got onto that subject of conversation.


I've noticed that already, I believe. I actually seem to have less focus, but that may be because of my depression itself and I'm "focusing" on that lack of focus, heh. Also, my ADHD pretty much precludes focusing for any length of time... The short-term memory thing seems to be cropping up a bit, too, but not severely. I hope it doesn't worsen.



> - Insomnia, sometimes severe, but not to the point where I would be up all night. Just instead of falling asleep when I wanted, it may take an extra hour or two or more effort.


I've definitely been noticing this, mostly manifested for me as waking throughout the night anywhere from one to four or five times. It isn't horrible, because I go right back to sleep after a couple of minutes, but it's bothersome and I usually feel disoriented because of the wacky dreams I'm also getting on WB. Did you notice weird dreams?



> - A pretty significant loss of appetite, leading to pretty significant weight loss (eventually will plateau or bottom out). This was beneficial as I was slightly overweight at the time, but lost about 20 lbs in about 3 months on it which isn't exactly safe when you aren't exercising or trying to lose it.


Definitely noticed this, but with my depression, I'm prone to eating the usual amount or even overeating, in some cases. So, it's welcome to me!

For '10 resolutions, I'd set out to lose weight. I ended up losing about 35 pounds in four months, adhering to a strict low-calorie diet (1500-1800 per day, less obviously as I lost weight). I promptly gained all that weight back, which wasn't the fault of the depression, but it certainly hasn't helped.



> - Mild paranoia/hypervigilance -- you may begin to notice/perceive things about every day life and your surroundings that you once ignored or never thought about. I spoke to somebody who is also on 300mg XL and they said they experience this phenomenon as well.


I think I noticed a little bit of that today. I haven't really been out recently because of a severe flu (sickest I've been in my life), but today I finally ventured out to meet a friend. I noticed that I was a little more paranoid than usual. But, I'm also very suggestible, and I read posts about that earlier and in the past few days, so maybe I was just "OCD'ing," as John said, about it.



> - Constipation or diarrhea (would alternate, but also is influenced by diet)
> - Increased anxiety/worrying
> - Dry mouth
> - Increased sweating/thermogenesis (sweat for no reason sometimes)


Noticed all of these. The first (and maybe second, but--cross my fingers--hasn't been that bad so far) is the most unpleasant, but I take supplemental fiber to help.



> - Temporarily (for a few months) would periodically crave nicotine when I didn't even smoke. I had tried cigarettes a couple of times but never liked it but there would be a time where I wanted to smoke a cigarette and had absolutely no reason or basis to desire it. Probably from its NACh antagonism -- this went away after 6+ months of taking the meds and not engaging in any nicotine use whatsoever.


That's odd. The nicotinic antagonism would seem to do the opposite, since it's used to help quit smoking, no?



> These were the most noticeable/pronounced side effects I've dealt with while on the drug.
> 
> Make of it what you will, but I hope my experiences on it are helpful and I appreciate your comments in my other thread about the Adderall. If you require any clarifications I'd be happy to provide them.


Thanks, I really appreciate the benefit of your experience. I'm not sure that I'll have the same experience with regard to benefits, due to my depressive syndrome, but one can hope. It would certainly seem that Wellbutrin is a more ideal drug for atypical depression than the SSRIs.


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## DarthNova (Jan 17, 2011)

bmwfan07 said:


> How long did the 300mg take to kick in and make a dent in your depression? I've just titrated from 150 to 300 today, after a week, and have been feeling depressed to varying degrees since about 3:30pm. My depression, being atypical, though, is more like a feeling of numbness and being "down" without actually being sad, in most cases (unless I'm watching a sad movie, in which case I'm prone to sudden crying where when I'm not depressed, I wouldn't cry at all). It's like my emotions have been sucked out by a vacuum cleaner and hidden away from me. It's very cruel. So, I only noticed this depression when I started to enjoy my conversation over lunch with a friend less, as the anhedonia set in. I am hoping for some serious relief soon.


I started feeling a response within 1-2 weeks of being on the 300mg, and I'd say the response peaked within a month or two (three at most). It's hard to remember when exactly but I do know it was pretty quick, much faster than an SSRI for sure. The other component that obscures things is that I was coming off being depressed both mentally and physically (lethargic, tired, overeating, unmotivated) and the WB almost immediately upon going to 300 negated and in fact reversed most of that to where I was no longer "physically" depressed and instead, stimulated. Feeling energetic again after not having felt that way for so long prior helped lift me out of some mental depression, especially after "reacquiring" certain abilities below the belt. The elation I felt from WB's stimulating effects I think bridged the gap while the medication was building its effectiveness for the long term mitigation of depression.

I too have suffered that feeling of sudden crying but its usually in those very situations as you said (like a sad movie) where I feel empathetic to what is happening on the screen and I actually put myself in the movie (I don't think I'd actually cry though). In fact, I used situations like watching a movie as a measuring stick as to how well my feelings of emotions were improving. If I could be empathetic enough or immerse myself into what is on the screen to the point I could feel sad if you're supposed to feel sad, or excited and happy in an exciting and happy moment, it told me I was no longer emotionally blunted.

I think if you give it some time, you'll surely rediscover your emotion and lose the anhedonia (the latter especially because it amplifies dopamine). I think my case of having a roller coaster of emotions is an extreme case, but I definitely "felt" things more while on WB, for better or for worse :blank.



> I've noticed that already, I believe. I actually seem to have less focus, but that may be because of my depression itself and I'm "focusing" on that lack of focus, heh. Also, my ADHD pretty much precludes focusing for any length of time... The short-term memory thing seems to be cropping up a bit, too, but not severely. I hope it doesn't worsen.


I think you nailed it there with the "focusing on the lack of focus". A better way I could've described this effect would be an "alteration or augmentation" of focus. You may not necessarily focus on the things you want though, for example instead of focusing on the content being discussed in a conversation, you are focusing on something else entirely. Not to be mistaken with zoning out, because you're definitely attentive -- just sometimes "wrongly" attentive if that make sense.

The short term memory issues will probably worsen initially (especially if you already notice it) but will level off one your body becomes accustomed to the meds. It can be pretty annoying, but it is just something you will need to be cognizant of, and compensate for accordingly.



> I've definitely been noticing this, mostly manifested for me as waking throughout the night anywhere from one to four or five times. It isn't horrible, because I go right back to sleep after a couple of minutes, but it's bothersome and I usually feel disoriented because of the wacky dreams I'm also getting on WB. Did you notice weird dreams?


The insomnia too, will level off once you get used to having the drug in your system. Good news is, if you start accruing a sleep debt, your body's lack of sleep will override any insomnia caused by WB. I think it did cause me to have wacky dreams on it, but it never became a real frequent thing or anything to cause me significant hardship. Confounding these observations was my heavy use of Cannabis (particularly at night) which, by itself, can cause some real vivid and far out dreaming.

If you're really struggling with the insomnia, try taking one Advil PM an hour before bedtime -- the diphenhydramine can do wonders when you need a sleep aid in a pinch. It may also negate some of the dream issues.



> Definitely noticed this, but with my depression, I'm prone to eating the usual amount or even overeating, in some cases. So, it's welcome to me!


I'd be surprised if you didn't lose weight in the first few months of taking WB, especially 300mg.



> That's odd. The nicotinic antagonism would seem to do the opposite, since it's used to help quit smoking, no?


I thought it was incredibly odd too as a quitting-aid. I almost thought the nicotinic antagonism as a non-smoker made me want to compensate by consuming nicotine, if that makes any sense. Just something to watch for I guess in case you experience something similar.

----

Anyway, I wish you the best of luck with WB and the atypical depression. I think it really helped me in my time of need and did some pretty good things for me. But, like so many medications out there, I think it eventually lost its effectiveness as the power of nature's "homeostasis" did its thing. 2 1/2 years is a pretty good run though.


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## bmwfan07 (Jun 3, 2007)

Damn it, Chrome on my Mac just went crazy on me and I lost the post I was working on. I hate when that happens. :mum



DarthNova said:


> I started feeling a response within 1-2 weeks of being on the 300mg, and I'd say the response peaked within a month or two (three at most). It's hard to remember when exactly but I do know it was pretty quick, much faster than an SSRI for sure. The other component that obscures things is that I was coming off being depressed both mentally and physically (lethargic, tired, overeating, unmotivated) and the WB almost immediately upon going to 300 negated and in fact reversed most of that to where I was no longer "physically" depressed and instead, stimulated. Feeling energetic again after not having felt that way for so long prior helped lift me out of some mental depression, especially after "reacquiring" certain abilities below the belt. The elation I felt from WB's stimulating effects I think bridged the gap while the medication was building its effectiveness for the long term mitigation of depression.
> 
> I too have suffered that feeling of sudden crying but its usually in those very situations as you said (like a sad movie) where I feel empathetic to what is happening on the screen and I actually put myself in the movie (I don't think I'd actually cry though). In fact, I used situations like watching a movie as a measuring stick as to how well my feelings of emotions were improving. If I could be empathetic enough or immerse myself into what is on the screen to the point I could feel sad if you're supposed to feel sad, or excited and happy in an exciting and happy moment, it told me I was no longer emotionally blunted.


Yeah, I like that as an emotional yardstick. I probably do something similar, albeit more unconsciously.



> I think if you give it some time, you'll surely rediscover your emotion and lose the anhedonia (the latter especially because it amplifies dopamine). I think my case of having a roller coaster of emotions is an extreme case, but I definitely "felt" things more while on WB, for better or for worse :blank.


I actually think the roller coaster of emotions is pretty typical for people with atypical depression. Dr. Hagop Akiskal, one of the preeminent researchers and psychiatrists studying bipolar disorder, in 2003 came out with a study that showed that 78% of atypical depressives were diagnosable with bipolar II: http://www.ncbi.nlm.nih.gov/pubmed/12507741 Another study indicating 72%: http://www.ncbi.nlm.nih.gov/pubmed/9515190

Whether atypical depression without a history of clear, prolonged, and spontaneous hypomania is as severe or the same as bipolar II with that history is unclear. There is also likely unipolar atypical depression, but it generally has a higher age of onset--usually > 25.



> I think you nailed it there with the "focusing on the lack of focus". A better way I could've described this effect would be an "alteration or augmentation" of focus. You may not necessarily focus on the things you want though, for example instead of focusing on the content being discussed in a conversation, you are focusing on something else entirely. Not to be mistaken with zoning out, because you're definitely attentive -- just sometimes "wrongly" attentive if that make sense.
> 
> The short term memory issues will probably worsen initially (especially if you already notice it) but will level off one your body becomes accustomed to the meds. It can be pretty annoying, but it is just something you will need to be cognizant of, and compensate for accordingly.


Yeah, I haven't noticed the memory issues that much, probably because I haven't done anything to really to bring them out.



> The insomnia too, will level off once you get used to having the drug in your system. Good news is, if you start accruing a sleep debt, your body's lack of sleep will override any insomnia caused by WB. I think it did cause me to have wacky dreams on it, but it never became a real frequent thing or anything to cause me significant hardship. Confounding these observations was my heavy use of Cannabis (particularly at night) which, by itself, can cause some real vivid and far out dreaming.
> 
> If you're really struggling with the insomnia, try taking one Advil PM an hour before bedtime -- the diphenhydramine can do wonders when you need a sleep aid in a pinch. It may also negate some of the dream issues.


The insomnia was actually not bad last night, on my first day of 300mg. I slept through the night--such as it was, about five hours--before getting up to take my pill. I then had a bit of a restless sleep for the next four hours. Whether this is attributable to the Wellbutrin or to my neurotic fears about not being able to sleep _because_ of the Wellbutrin is unclear. My life is full of these little self-fulfilling prophecies. Lovely, aren't they? :roll



> I'd be surprised if you didn't lose weight in the first few months of taking WB, especially 300mg.


Yep, I've definitely already noticed a decrease in appetite. Let's hope it continues. On top of the severe flu I had for the past week, I've probably already lost 5 pounds.



> I thought it was incredibly odd too as a quitting-aid. I almost thought the nicotinic antagonism as a non-smoker made me want to compensate by consuming nicotine, if that makes any sense. Just something to watch for I guess in case you experience something similar.


Interesting. I'm not sure about a neurochemical explanation for that one.



> Anyway, I wish you the best of luck with WB and the atypical depression. I think it really helped me in my time of need and did some pretty good things for me. But, like so many medications out there, I think it eventually lost its effectiveness as the power of nature's "homeostasis" did its thing. 2 1/2 years is a pretty good run though.


Thanks! Sorry if I missed this (perhaps this is that WB memory loss!), but I didn't realize it stopped working for you. Or are you stopping it because of the symptoms we discussed in the other thread? I'm not sure if it's fair to say that it stopped working; mixing it with amphetamines complicates things a lot. If you'd not added Adderall, it might have continued to appear to work, although obviously it's a matter of trade-offs when you have multiple conditions. I know this all too well. Hopefully, your depression won't come back. Adderall should be fairly effective by itself in preventing anergic depression, but it could also exacerbate mood issues as you've noticed.


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## bmwfan07 (Jun 3, 2007)

Any more anecdotes/data points?


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