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Wellbutrin And Anger/rage - Does It End?


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#1 In_Remission_jjbird

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Posted 12 December 2007 - 08:49 PM

I'm on Wellbutrin in treatment of depressive drop and was pleased the first month, till dosage was increased to 300 mg, when I got unbelievably angry and irritated - mad at the world and full of road rage. I also take Trazodone for insomnia and thought the two would even out, and wonder if anyone else has taken Wellbutrin long enough to see if the intial anger/irritation side effect goes away, or stays the same?

Aside from the anger, I was energized, less depressed and lost weight - but if the anger remains, I'll have to pass.

Thanks.




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#2 Sasha

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Posted 12 December 2007 - 09:33 PM

It sounds to me like your dosage is too high, and I doubt the anger you're experiencing is likely to just resolve itself so long as you stay at your current dose. Have you considered talking to your pdoc about going back down to your previous dosage - the one at which you were getting good results, without all these problems?
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#3 In_Remission_nutjobnextdoor

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Posted 13 December 2007 - 02:10 PM

Gosh, I don't really know what to say. I've been on Wellbutrin for what, 6 months? I ended up on the max dose. Anger wise, I never thought it was the wellbutrin, I never even heard of that as a side effect. Personally I'm just yelling a lot because I have 4 kids still at home, and they annoy the heck out of me a lot. But my anxiety which translates into biting everyones head off is such that my doc just added the buspar. 2 days later it seems to help level me out a bit. I'm not rubbing my head anymore, thats a start. Depression...I cant take any more than I am taking, and a lot of mine is situational anyway, it bounces up and down. Maybe I'm bipolar, who knows. Will you let us know what the doc says? I'm interested to see how this goes for you!

The weight loss is great though(30lbs for me).

#4 In_Remission_jjbird

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Posted 25 December 2007 - 06:12 PM

Sorry didn't reply till now - just got back to board. My doctor reduced my Wellbutrin dosage to 150 mg but the anger/irritaiton was close enough to dysphoria that she put me on Lamictal, which worked fine for the first seven days, then brought on a return of the anger. It wasn't as sharp as the Wellbrutrin rage, but just irritation with the world, insomnia, etc. She'd already warned me not to take any of the energizing AD (Wellbutrin, Cymbalta, etc.) because they seem to trigger a mean stripe of dysporia, and now that Lamictal didn't work out, don't know what I'll do. The small dose of Trazodone is working for sleep and stress and I'm ready to settle for that. I go back to the pdoc and we'll see what she says.

Lamictal works well for many BPII, but it made me feel almost disassociative - one step removed from myself, as if watching in third person. If I knew that and the anger were transient, I'd be willing to stick it out, but no one seems to know if it'd go away or worsen. I only know that for my own brain chemistry, I have to be careful with noreppinephrine or I'll trigger something unpleasant. If anyone has a suggestion for a combo that works well on BPII/ADHD brain that doesn't trigger anger, I'd like to hear it.

#5 In_Remission_jjbird

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Posted 25 December 2007 - 08:44 PM

Well maybe I'm jumping to a conclusion about the norepinephrine. I'm almost sure it was the culprit in the AD, but apparently not the one in Lamictal. As a matter of fact, I'm not sure why the Lamictal gave similiar symptoms of the old dysporia: aggitation, irritation, and insomnia. It would very well be an adjustment that would pass, but dr doesn't seem intent on pursuing. I'm ready to settle for a floor with Trazodone and let it go. I have such nasty manias that I'm sure I'm hyper-vigilant.

#6 sorrel

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Posted 26 December 2007 - 10:17 AM

I have such nasty manias that I'm sure I'm hyper-vigilant.



Well, then it would seem especially prudent for you to be on a mood stabilizer so you can prevent these manic episodes from occurring. I'm a little confused that your doctor would decide to leave you on just Ritalin and a microdose of trazodone. Your bipolar disorder is essentially untreated right now. 25mg of trazodone is not even acting as an antidepressant, just a sleeping pill.

It doesn't have to be Lamictal (although it sounds like you may not have given it a fair chance) but definitely ask about other mood stabilizers. Lithium, Depakote, Trileptal, etc.
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#7 In_Remission_jjbird

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Posted 26 December 2007 - 01:07 PM

I hate to sound naive, but I have no idea why I get put on what. I had great hopes for the Lamictal and was disappointed when the old symptoms emerged, even after the dose was reduced to just 12 mg. The rage with Wellbutrin was scary. It might have made me less willing to deal with early irritation with Lamictal or maybe Lamictal isn't the drug for me. As for other MS, haven't tried lithium and depokote made my hair fall out and Tegretol didn't work (years ago.)

Since the proctors of this board seem up to date on meds and reactions, can I ask why low-dose Ritalin + Trazodone aren't considered kosher? That combo makes me more focused during the day and then I can sleep at night. I do have ADHD and the Rit has no side effects other than worsening of insomnia. I've never gone dysphoric/angry on ritalin, though I do take a very small dose. Just curious. I'm all out to sea on this, and pdoc seems competent as far as I can see. I've never had standard BPII and wonder if my diagnosis is correct as it is partially based on 15-year-old manias. I'm mostly depressive spectrum and my presenting problem was insomnia and depression/grief from loss of friend in accident. The traz did help me sleep, which is the reason its still on my plate, and the Rit is from primary care dr for ADHD (pdoc knows I take it.) I quit taking it when I was taking Wellbutrin (didn't need it) and also when I was on trial for Lamictal (which now that I think of it was more like ten days then seven, if that makes a difference.) All of this is very confusing to me. Thanks for clarity.

#8 sorrel

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Posted 26 December 2007 - 01:41 PM

can I ask why low-dose Ritalin + Trazodone aren't considered kosher?




It's just that they are treating peripheral symptoms and not the primary problem. Like, let's say you went to your primary doc with this list of symptoms including, among other things, constipation and dry skin. He did some tests and determined you have hypothyroidism. But instead of giving you thyroid hormone, he gives you laxatives and lanolin salve for the constipation and dry skin. Sure, maybe those things work. But even though you're not constipated anymore, you're still hypothyroid and eventually it's going to cause all kinds of other problems*. And if he just treated the hypothyroidism, then you might not need the laxatives and the skin salve.

*Forgetting the analogy, the "other problems" in reality are that neither of those drugs is protecting you against mania OR depression. Especially not mania. Ritalin, a stimulant, can cause mania (although in your case it looks unlikely to do so, since you've been taking it for a while with no problems.) Trazodone, at that dose, is unlikely to either help depression or cause mania.


I've never had standard BPII and wonder if my diagnosis is correct


That was going to be my next question -- whether you thought your diagnosis is correct. If you do amazingly well with just low-dose Ritalin and low-dose trazodone, and can sustain that long-term, go for it. Sounds like you were misdiagnosed, if that's the case. Maybe it was insomnia and reactive depression, as you say. Can you describe one of your past hypomanic episodes?
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It's terrible, Bob, to think that all I've suffered, and all the suffering I've caused, might have arisen from the lack of a little salt in my brain.

--Poet Robert Lowell, to publisher Bob Giroux, about lithium

#9 In_Remission_jjbird

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Posted 26 December 2007 - 02:35 PM

My manias were back in my child-bearing years, fifteen years ago, when I had several episodes of hypomania/mania, though never the psychotic sort. The swings were pronounced back then, with a few deadly depressive drops; one almost terminal. I was diagnosed BPII back then and since then, have been off and on AD's with generally little sucess, but aside from hypomania and chronic dysthymia-like depression, no major life-threatening episodes. I have classic ADHD and ritalin and the like really do make me sleepy (though of course, insomnia eventually decends.) It seems so odd to me that ADs like Wellbutrin and MS like Lamictal could make me jittery, almost manic-y, and ritalin doesn't. Can't figure it out and maybe I'm a depressive with severe ADHD that mimics BP.

Thanks for your reply - your explanation made it very clear. I know my pdoc isn't a fan of ritalin and wanted to replace it with Wellbutrin, but that wasn't to be. Oh and sorry - I'm taking Traz at 50 mg now, not 25. That was a mistype.

#10 In_Remission_jjbird

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Posted 30 December 2007 - 07:01 AM

Hi all,

Just wanted to add an update: as stated above, I quit Wellbutrin because of anger/rage, and was just taking Trazodone and Ritalin cocktail, which pdoc wasn't crazy about anyway. I was too afraid of rage to consider Wellbutrin again, but after reading posts and site and considering it, something occured to me: the week I'd had the flip out on Wellbutrin, my doc had briefly changed by sleep med from Trazodone to Remeron. I only took it a week, if that, and quickly moved back to Trazodone, then promptly forgot that it was this combo that had flipped me out. Thanks in part to your very sound advice, I talked it over with pdoc and shifted back to low dose of Wellbutrin (75 mg to start) and Traz (50 mg) and have found a nice place of stability. I will eventually titrate up to 150 mg on Wellbutrin, but very slowly, because any sign of irritation/anger really does flip me out. And on this cocktail, I don't have to take ritalin at all.

So thanks for sharing and thanks for the site. It really has been most helpful.

#11 In_Remission_jjbird

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Posted 30 December 2007 - 01:03 PM

Hi Jook,
Think the pdoc is waiting to see how this cocktail works for two weeks (mid-January) before she adds another. If Wellbutrin and Traz play well together, I assume she'll want to add low-dose Lamictal, if she is really sure of BPII diagnosis. Since Wellbutrin seems to be doing its job, the rush to anti-depress won't be so pressing.

#12 In_Remission_jjbird

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Posted 15 January 2008 - 06:00 AM

Since I started this thread, I'll end it by answering my own question: after a month on Wellbutrin and adjustment of Trazodone to 50-60 mg, the anger/irritation has indeed gone away and I'm on full 300 mg dose, still done in split doses, 150 mg am and the other after lunch. It took a few adjustments of doses in both Wellb and Traz to keep me in zone between too anxious/irritable and too lethargic, but fortunately, for me, the anxiety side effect has pretty much passed, and in strange jump, I have more patience and less stress now. Go figure.


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