21 Jan 03 – Diary
I started taking Wellbutrin (Zyban; 150 mg sustained release once per day) 5 days ago on Saturday. So far I like it more than Prozac – it’s a much less intrusive drug with regard to side effects. In fact the only noticeable side effect is that I started having sinus problems and sneezing Saturday night. It felt as if I had an allergy reaction similar to hayfever. Except that I don’t suffer from hayfever. Of course I had the flu as well, so I wasn’t too sure which one was causing this. But I had had the flu for a week before and I didn’t sneeze at all. Then I start taking Wellbutrin and I start sneezing continuously. Very suggestive.
The sneezing was actually quite annoying – ask anyone with hayfever. But because it felt more like the flu and less like a side effect of a medication, it didn’t feel as if it was the Wellbutrin’s fault. So even though the Wellbutrin probably did affect me substantially, I don’t feel as if it did and I still like it.
The Wellbutrin may have had no noticeable effect because I took it on one of my up cycles. It may be somewhat camouflaged by my mild mania. I have a sneaking feeling that the Wellbutrin is contributing to my mild mania, but because I’m still in the “high efficiency” section of the cycle, I’m not worried. I’ll worry when I get into the “I can’t think clearly anymore” phase.
Just for comparison, Prozac would have brought me off the mania by now so I wouldn’t have been so efficient in all I do. You can see why I like Wellbutrin more.
I’ve started back taking an antidepressant mostly because I will be going on a one month pilgrimage in February. I’m expecting it to be reasonably high stress and I don’t want to get depressed while I’m on it. By starting on medication two weeks before I go, I hoping to be primed (not depressed) by the time I’m ready to leave. I’ll also be staying on the medication while I’m away. We’ll see how this works as a coping strategy.
I’m also writing this at 3 am. I went to the pharmacy this afternoon to get medication for the cough and sneezing from the flu, Just for the record, it is now almost impossible to get a tablet just for sinus problems or a cough syrup just for cough suppression. Most tablets have combinations of drugs – pain killers, antihistamines, decongestants, expectorants, cough suppression ingredients, and occasionally codeine. This might be all fine for the flu, but I have to worry about drug interactions between all these and the Wellbutrin and I’d rather get each drug separately. Anyway after spending nearly twenty minutes reading labels I finally got a cough syrup with dextromethorphan (the most common cough suppressant) and a tablet for my sinus problems.
And so I went home and then spent half hour on the internet looking up each of the active ingredients in the medicines and looking to see if any had warnings not to take with Wellbutrin. No obvious drug interactions or warnings. Then I had a good meal, took the Zyban, took the cough syrup, thought about it and held off taking the sinus medication. And then I went to sleep at about 9 pm because I was tired.
So, it is now after 3 am and I am wide awake and alert. I actually got up close to 11 pm after two hours of sleep. The cough is gone completely and so is my desire to sleep. I’m betting that the dextromethorphan in the cough syrup is interacting with the Wellbutrin. My sinuses are clogged and painful because in addition to everything else they don’t particularly like being awake at this hour, but I’m afraid to take the sinus tablets I brought. Who knows what will happen if I do that.
So off I go. What can one do at 3 am?
2 Feb 03
I’m still taking the Zyban. This is pretty impressive. I usually don’t stay on any medication this long either because it stops working or because it causes me problems of one sort or another. But no problems yet with the Zyban. Also, given that I started taking it when I was manic, I should have cycled into depression by now, and while I did notice a dip in productivity one day last week, I never was anywhere close to being depressed. So perhaps it is working as advertised.
To summarise. I’m not sure the Zyban is working. But I’m not depressed so perhaps it is working. But it could be that I just haven’t had a depression period, so perhaps I haven’t really had a chance to test it yet. I kinda feel like that joke about the guy who goes around waving a fan made of ostrich feathers. When asked why he does it, he says it’s to keep the pink elephants away. And when he is told there are no pink elephants, he says “see, I told you it’s working.”
This kind of thinking is enough to drive you crazy. I’ll just not keep going in those circles and keep on taking the Zyban. The longer I don’t have a depression episode, the more I’ll believe that the Zyban is doing something.
I’ve also have a theory about why so many bipolar persons stop taking their medication. It has to do, in part, with the difference between how Prozac and Wellbutrin affect me.
Let’s start with the basics. If I’m depressed I won’t take medication. So I have to start taking the medication when I’m feeling good, and hope that it kicks in before I get back depressed. And here is where the difference between Prozac and Wellbutrin is. Prozac works pretty well against depression. I know this. Unfortunately Prozac also tends to bring me down off my hypomanic moods. So from my point of view, if I start taking Prozac while I’m hypomanic (as I need to do), I actually have an immediate decrease in the quality of my life because being hypomanic is better than being normal. Prozac will also damp my depressions so that they are milder, but I will still notice that I am getting somewhat depressed. Psychologically, I will end up feeling that by taking Prozac I am giving up my hypomania for no great improvement in my depressive episodes.
More objectively, if the damping effect of the Prozac on my hypomania is greater than the damping effect on my depression, then although the Prozac works as an antidepressant as advertised, I end up a net loser. So I may choose to not continue medication, even though I will simultaneously admit that Prozac works well as an antidepressant.
(Actually what I check is whether the drop in productivity because I am not as hypomanic outweighs the gains in productivity because I am not as depressed.)
Wellbutrin has no noticeable effect on my hypomania, and it seems to decease the severity of my depression. So while Wellbutrin probably doesn’t work any better on my depression that Prozac does, I am more likely to stay on Wellbutrin than I would on Prozac because I get to keep my hypomanic periods. It’s like having my cake and eating it too. I am therefore be much more likely to take the Wellbutrin consistently whereas I am more ambivalent about taking Prozac.
The point is, it is not sufficient to look at antidepressant medicines as just whether they relieve depression. They also need to be looked at as to how they affect hypomania as well. This makes a substantial difference whether we actually take the drugs.
More on drug interactions with Wellbutrin. While it doesn’t seem to affect my hypomania, it does seem to interact with almost every over the counter drug I’ve taken. And not for the better. I’ve mentioned how dextromethorphan (cough suppressant) and Wellbutrin interact to keep me awake. I’ve taken the common nasal decongestant (pseudoephedrine hydrochloride) one night and it seems to interact with Wellbutrin to put me to sleep the following day. Not helpful. Moreover, two beers interact very badly with Wellbutrin to make me nauseous.
Beautiful. I’m passing up on alcohol at the moment, and I’m now afraid to take any drug in addition to Wellbutrin. At some point I going to have to take Acetaminophen (the pain reliever in Tylenol), and I wonder what the drug interaction effect will be. I’m not looking forward to this at all. If I get a headache, I may consider gritting my teeth and bearing it.
To change the subject. My one month pilgrimage will be starting on the 4th February. I will see if I am able to stay on Wellbutrin all this time and if I don’t get depressed.
Hope that I can report on the best news – that it goes as I plan.