[hopeful]

Hi,
I'm wondering if anyone can tell me if after a week off of Cymbalta I can still have withdraw symptoms.

My symptoms have changed no tears but I am completely miserable. Literally yelling at my husband and my son. Just so you know this is not like me at all.

After I do it I feel terrible. How many times can I say I'm sorry when I continue the behavior. I feel like a brut!

Please let me know if you have any information concerning this.
I'm praying it gies away soon but I'm wondering how long that will take!

[mrsD]

Time for the tryptophan to enter your life.

The long term use of SSRI type drugs leads to low serotonin levels. It takes a long time for the cells to wake up and make
more. The tryptophan will help stimulate new synthesis and
then you may be less agitated.

Also the Wellbutrin may be a factor. A dosage adjustment may help.

Dealing with these sophisticated drugs that alter neurotransmitters is really dicey...hit and miss. This is because people all vary in ratios of these chemicals naturally, so taking a drug upsets quite a bit.

[Dr. Smith]

Originally Posted by mrsD

Time for the tryptophan to enter your life.

YES! YES!! A THOUSAND TIMES, YES!!!
(and magnesium )

(From the husband of a post-Celexa/citalopram shrew—she's feeling MUCH better now... )

Hopeful, we talked about this before. Everyone is different, so it could take some time (according to what I've read—depending on how long you've been on it). BUT IT TOO SHALL PASS!

Doc

[hopeful]

Thanks for the input!
Mrs D. I did speak to the doctor today and he increased the Wellbutrin to 300mg. Hopefully, that helps. I am also going on line today to find a place to order the tryptophan. I know you and doc mentioned a dosage before so I'll search for it.

Dr. Smith, I'm betting right about now my husband thinks I'm a shrew too!! Can't say I blame him!

I think my brain is no longer producing serotonin from being on the Cymbalta and it is going to take a while for it to start producing it again.

What a mess! Eli-Lilly deserves to have the pants sued off of them!

Thanks again! It's at least comforting to know it's not just me and this too shall pass.

[mrsD]

Doctor's Best and NOW are good brands.

Start at 500mg a day and work up to 1 gram. That is possibly all you will need. Take tryptophan alone, away from any protein foods. The other aminos compete with it at the blood brain barrier, and you want it to cross in good amounts.

If you take the first dose on an empty stomach in the morning wait at least 1 hr before eating any protein.

I found tryptophan can help with sleep too.

300mg of Wellbutrin may be too much for you.. keep that in mind.

[hopeful]

Mrs D.
I just want to be sure of taking Wellbutrin with the tryptophan. I have been doing research that states it is not good to take with antidepressants. Although, there is info on many of the most popular antidepressants there is little on Wellbutrin. I just want to be sure.

Also, may I ask why you think 300 of Wellbutrin may be to much for me? I just want to know what I should be aware of.

As always thanks for your advice!

[Dr. Smith]

Originally Posted by hopeful

I just want to be sure of taking Wellbutrin with the tryptophan. I have been doing research that states it is not good to take with antidepressants. Although, there is info on many of the most popular antidepressants there is little on Wellbutrin.

It's a good question to ask. The theory (now in question) is that depression was linked to low levels of serotonin in the brain. The antidepressants of concern—SSRIs and SNRIs—work by preventing reuptake (reabsorption) of serotonin, artificially keeping levels higher than they would be without intervention. This works for some people (but now they're finding it's more complicated than just that).

Wellbutrin (bupropion) doesn't work that way; it's considered an "atypical" antidepressant. It works on norepinephrine and dopamine instead of serotonin, preventing reabsorption of those chemicals. SNRIs work on norepinephrine too, but it's the serotonin that's thought to be the problem.

Many medications may have been incorrectly thought to cause serotonin syndrome.
....
Bupropion has also been suggested to cause serotonin syndrome,[6][25] although as there is no evidence that it has any significant serotonergic activity, it is thought unlikely to produce the syndrome.
http://en.wikipedia.org/wiki/Serotonin_syndrome

emphasis mine

FWIW, DW found the best deal (when she ordered it) was Source Naturals. She started on 500mg x 2/day, which worked the first day then stopped. After a few days, we upped it to 1000mg x 2/day, which is working for her. I'm not concerned if it had to go to 1500mg x 2/day, but higher than that I'd do some more reading (several sources said up to 4000mg/day was safe). We tend to be somewhat conservative and titrate slowly, so we use the minimum needed.

Depending on your various medical issues, other meds, etc., you may need a different dosage, but I'd still start low, listen to your body, increase slowly if need be, and keep your doctor in the loop.

Doc

[mrsD]

I have been studying these drugs for over a decade.

There are studies and clinical observations published that using a drug that alters a neurotransmitter in the brain, causes the brain to try to adjust things somehow (this is not well understood), and that affects others.

Here are some examples:
1) Some opiates (including tramadol), will affect serotonin levels (expression) as well as sitting on mu pain receptors.
Oxycodone is one synthetic that does this alot but others do too.
The "itching" they cause as a side effect is thought to be a serotonin release and not histamine effects.

2) Some neurotransmitters are stimulated by histamine in the brain. This cascade begins with histamine which acts like a trigger.
http://www.ncbi.nlm.nih.gov/pubmed/21713693

3) Long term use of SSRIs is thought to alter dopamine levels in the brain as a consequence. The reverse may also be true... using a dopamine based antidepressant like Wellbutrin, may reduce serotonin over time. (or affect its expression).
People on long term SSRI therapy may develop a syndrome similar to Parkinson's....or tardive ..where the legs twitch and facial, tongue and neck muscles twitch involuntarily. Not everyone gets this but about 10-15% or so do.

4) Here is a link...complex but maybe helpful for you from Dr. Kraslow:
http://www.drkaslow.com/html/neurotr...repletion.html

There are sites on the web explaining Wellbutrin/Zyban irritability side effects:
Just Google "Wellbutrin agitation", and you will find many discussions.

So it might be that RAISING your Wellbutrin is not the answer for you. Be very vigilant about side effects of this. Many doctors just automatically raise doses when patients complain... and for many this is not really a solution.

We really don't know if dopamine is a triggering neurotransmitter for some serotonergic responses. However reputable medical sites like WebMD where interactions are listed do not give Wellbutrin as a problem with tryptophan:
http://www.webmd.com/vitamins-supple...t_interactions

One solution for you long term may be SAMe. This supplement naturally offers stimulation and support to all neurotransmitters, and also liver metabolism support and joint/ligament repair.
It is slow onset, but very helpful to some people.

So the bottom line is: You may become more tetchy on higher doses of Wellbutrin. As the doses are raised you may have cardiac palpitations, which can be alarming...so watch for that.
Your new blood pressure medication might suppress this side effect for a while, so it might take time to manifest, if it is going to.

If tryptophan is too slow for you to give the results you want, you may try 5-HTP... 50 or 100mg at bedtime. Some people like this...it is made from tryptophan, and is really a pro-drug...a supplement with drug-like speed of onset. It is over the counter.
I personally didn't like it when I tried it during my menopause for sleeping problems...my solution was B12. But people do vary, and I've met them, mostly women who like 5-HTP.

[Stacy2012]

MrsD is samE safe to use with gabapentin? Iam having joint pain and wanted to start using it again. Sorry to interrupt. thank you

[mrsD]

Originally Posted by Stacy2012

MrsD is samE safe to use with gabapentin? Iam having joint pain and wanted to start using it again. Sorry to interrupt. thank you

Should be okay. Start slowly... 200mg a day on an empty stomach for at least 2 weeks. Move up to 400mg a day same way all at once.

SAMe can increase anxiety or cause insomnia in some people as they get used to it. It doesn't do this for me...but does for my son (but he is much younger). For this reason don't take it at night.