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Suggest Treatment For Side Effects Of Antidepressants
Question: My Mother has been very ill for last 2 months we are assuming due to incorrect meds as listed below. Anxiety was the chief concern until the uncontrollable pacing around every room of the house started. She is unable to sit still or sleep for more than 3 to 4 hours in the night. This started 2 months ago even when exhausted and medicated with clonazepam and sleeping med.
She has tried most of the newer and older antidepressants and does not tolerate them well. After running her DNA we discovered that she is a low metaboliser of antidepressants.
After presenting with moderate shaking (convulsions) she was told
To drop the Wellbutrin dose from 300mg/day to 100md /day and
To discontinued Abilify due to akasthesia.
She was on an incorrect dose of Synthroid - 125 mcg for the past 1year It was reduced from 125 mcg to 100 mcg during the past 3.5 weeks and then approximately a week ago dropped to 88mcg after completing bloodwork.
Is presently on clonazepam 2.5mg TID
She made improvement after D/C the Abilify and decreasing the Wellbutrin three weeks ago.
Presently her anxiety has increased to 8.5/10. Her agitation is increasing and clenching of jaws has started tonight.
Should the Wellbutrin be STOPPED ?
Is Serritonin Syndrom a possibility ?
Could you please offer any advice
An additional piece of information:
Approximately three weeks ago she was given a trial prescription for a different antidepressant, Fluvoxamine. This was taken at the same time as the Wellbutrin was being decreased in strength.
In approx. one and a half weeks the convulsions reoccurred. When it was discontinued abruptly the convulsions stopped.
The clonazepam wears off every 6 hours. iff the clonazepam is not taken the anxiety reoccurs immediately.
She has tried most of the newer and older antidepressants and does not tolerate them well. After running her DNA we discovered that she is a low metaboliser of antidepressants.
After presenting with moderate shaking (convulsions) she was told
To drop the Wellbutrin dose from 300mg/day to 100md /day and
To discontinued Abilify due to akasthesia.
She was on an incorrect dose of Synthroid - 125 mcg for the past 1year It was reduced from 125 mcg to 100 mcg during the past 3.5 weeks and then approximately a week ago dropped to 88mcg after completing bloodwork.
Is presently on clonazepam 2.5mg TID
She made improvement after D/C the Abilify and decreasing the Wellbutrin three weeks ago.
Presently her anxiety has increased to 8.5/10. Her agitation is increasing and clenching of jaws has started tonight.
Should the Wellbutrin be STOPPED ?
Is Serritonin Syndrom a possibility ?
Could you please offer any advice
An additional piece of information:
Approximately three weeks ago she was given a trial prescription for a different antidepressant, Fluvoxamine. This was taken at the same time as the Wellbutrin was being decreased in strength.
In approx. one and a half weeks the convulsions reoccurred. When it was discontinued abruptly the convulsions stopped.
The clonazepam wears off every 6 hours. iff the clonazepam is not taken the anxiety reoccurs immediately.
Brief Answer:
Likely side effects of Bupropion (wellbutrin)
Detailed Answer:
Hi,
Thanks for writing to us,
I went through the history you have provided. You mentioned that your mother has been tried on many antidepressants and that she has not been tolerating them well.
Since she is a slow metabolizer of antidepressants, it is possible she is experiencing side effects of the drugs on usual maintaining doses, more like toxicity of the drug even without getting toxic doses. This is usually side effects of the drug. Serotonin syndrome is quite rare, and the symptoms or signs of this disorder is not what your mother is experiencing. But you have to be on a watch for symptoms of this syndrome as well in her.
Bupropion (wellbutrin), has a side effect profile different from most antidepressants. Activating side effects like insomnia, anxiety and agitation are commonly encountered in patients. Seizures have also been documented as a side effect of this drug. It is very much possible that the problems you talk of right now side effects of this drug. In that case yes, it must be stopped immediately. This can be better confirmed by her treating psychiatrist who has been following her up regularly.
Benzodiazepine drugs like Clonazepam, are long acting ones and are useful in treating anxiety, seizures and drug-induced akathesia, all of which are the current symptoms that your mother is experiencing. This drug is usually avoided on a regular basis in the young due to the fear of dependence and withdrawal side effects, but in exceptional cases who are not tolerating any other drugs and in some exceptional elderly cases can be used for a longer term during acute stages of illness.
What was her diagnosis for which she was tried on several antidepressants? What are her complaints if she is not on any antidepressant? Has her MRI or CT scan Brain been done off late? What other medications is she on, other than the ones you have mentioned? Any other obvious possible cause of her restlessness?
Hope my answer sheds light on your doubts,
You are welcome to ask any more queries,
Dr A Rao
Likely side effects of Bupropion (wellbutrin)
Detailed Answer:
Hi,
Thanks for writing to us,
I went through the history you have provided. You mentioned that your mother has been tried on many antidepressants and that she has not been tolerating them well.
Since she is a slow metabolizer of antidepressants, it is possible she is experiencing side effects of the drugs on usual maintaining doses, more like toxicity of the drug even without getting toxic doses. This is usually side effects of the drug. Serotonin syndrome is quite rare, and the symptoms or signs of this disorder is not what your mother is experiencing. But you have to be on a watch for symptoms of this syndrome as well in her.
Bupropion (wellbutrin), has a side effect profile different from most antidepressants. Activating side effects like insomnia, anxiety and agitation are commonly encountered in patients. Seizures have also been documented as a side effect of this drug. It is very much possible that the problems you talk of right now side effects of this drug. In that case yes, it must be stopped immediately. This can be better confirmed by her treating psychiatrist who has been following her up regularly.
Benzodiazepine drugs like Clonazepam, are long acting ones and are useful in treating anxiety, seizures and drug-induced akathesia, all of which are the current symptoms that your mother is experiencing. This drug is usually avoided on a regular basis in the young due to the fear of dependence and withdrawal side effects, but in exceptional cases who are not tolerating any other drugs and in some exceptional elderly cases can be used for a longer term during acute stages of illness.
What was her diagnosis for which she was tried on several antidepressants? What are her complaints if she is not on any antidepressant? Has her MRI or CT scan Brain been done off late? What other medications is she on, other than the ones you have mentioned? Any other obvious possible cause of her restlessness?
Hope my answer sheds light on your doubts,
You are welcome to ask any more queries,
Dr A Rao
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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