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  #1  
Old 17-09-2009, 07:34
takenbyRX takenbyRX is offline
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Temazepam useless with Wellbutrin (Bupropion)?

HISTORY: SWIM is bi-polar I. SWIM has had a history of severe mania triggered by insomnia. And has had no major depressive issues ever until this last month.

As far as benzos SWIM is prescribed 30mg/day of Temazepam (Restoril) and 1.5mg/day of alprazolam (xanax). This was generally more than what was needed to overcome insomnia. This dosage has been taken for approx. 5 months, but not necessarily everyday.

Since this major depressive episode (lack of motivation, work/family problems, et cetera) the psyciatrist has precribed 150-300mg of Buproprion (wellbutrin).

This DRI has been a life saver. SWIM is motivated, happy, and feeling the best he has in 3 years; more productive, confident, and feeling lucid/sober.

HERES THE PROBLEM: This dosage of Wellbutrin causes extreme insomnia. SWIM has slept 10 hours in about 4 days. Since his mania is triggered by insomnia this seems to be a problem. SWIM is trying to battle insomnia with the prescribed benzos.

NOTE: SWIM has a tolerance, but 90mg of temaz. and 2 mg of alpraz. have been taken about an hour ago. Yet SWIM is very lucid and here typing.

SWIM doesn't want to take more benzos (although the LD50 is extremely high for them alone). SWIM is afraid that the seizure warning on Wellbutrin advising against heavy hypnotic usage. But for someone of SWIM's tolerance what would be a proper dose?

Should SWIM give up on the benzos and switch to something else for sleep. Or increase benzo dosage?

SWIM needs sleep! But doesn't want to quit the wellbutrin because it has had such a positive impact on lifestyle in the last week.

Any help is appreciated, and apologies for a long post.
  #2  
Old 17-09-2009, 10:00
Amnesia Amnesia is offline
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Re: Temazepam useless with Wellbutrin?

SWIM would not advise increasing the dosage of the benzos as the likely culprit is the Bupropion, which can trigger switches into hypo mania and mania. Because of this it is usually prescribed with a mood stabiliser in order to prevent or minimise the risk of a switch.

SWIM wonders why SWIY has been given an antidepressant alone to treat bipolar I. Monotherapy with an antidepressant is not suitable for bipolar patients. It is not considered a safe option due the occurrences of random switches into mania caused by antidepressants in those suffering from bipolar disorders. The prolonged use of antidepressants as monotherapy can also lead to rapid cycling which can become permanent.
A study by Sach et al. (1994) showed 11% of patients switched into a hypo or manic episode whilst using Bupropion, even though the patients were taking Lithium, Valproic acid or Carbamazepine – mood stabilisers which work by reducing mania.
If SWIY’s main problem tends to be mania then a more suitable medication to begin with would have been Lithium, Valproic acid or Carbamazepine. Lithium has also been shown to be as effective as tricyclic antidepressants in several double blind studies – it is generally considered the first line of treatment for bipolar patients.

SWIY probably ought to try reducing the dosage of the Bupropion to see if the symptoms alleviate at all. But, as SWIY probably already knows, insomnia leads to mania, which causes insomnia itself, which leads to an increase in the severity of the mania in a self perpetuating cycle. The cycle may have already begun and may be very difficult to stop now. If SWIY is at the beginning of a manic episode it will almost definitely be being exacerbated by the Bupropion.

The Role of Antidepressants in Treating Bipolar Disorder
  • The efficacy of maintenance antidepressants in treating bipolar disorders is not established.
  • Cycling and/or switches while on antidepressants have been demonstrated in three randomised, placebo-controlled studies.
  • Antidepressant monotherapy is not recommended for bipolar-I disorder; data are insufficient to support recommendation for bipolar-II.
  • Antidepressants with a mood stabiliser should generally be reserved for severe bipolar depression, or cases in which an adjunctive mood stabiliser has failed.
  • When antidepressants are used, they should be tapered and discontinued after recovery from depression; they should be maintained only in those who have repeatedly relapsed soon after discontinuation.
    (Ghaemi et al. 2003)
SWIM hopes this is helpful for SWIY

Last edited by Amnesia; 03-11-2010 at 10:44. Reason: typo & in text
  #3  
Old 17-09-2009, 12:55
donkeygospel donkeygospel is offline
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Re: Temazepam useless with Wellbutrin?

I'm bipolar as well. I am prescribed Wellbutrin, with Abilify to potentiate it. This is in addition to a mood stabilizer.

I am also prescribed temazepam for sleep. I find that the drug works just fine, even a few hours after I have taken Wellbutrin. I also get the Wellbutrin insomnia; it is somewhat of a stimulant, after all.

Last night I took 100mg Wellbutrin at around 10:30 PM, and then took 60mg temazepam at 1:30 AM. I was asleep by 3:00 AM at the latest.
  #4  
Old 18-09-2009, 09:52
takenbyRX takenbyRX is offline
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Re: Temazepam useless with Wellbutrin?

Thanks AMNESIA for the reply. I guess I wasn't clear on the reasons buproprion was RXed.

I've been extremely (hypo)manic for about 5 years with no sign of depression. I would get schizo/manic paranoia that one day I would finally become depressed. My doc said that only about 8% of patients have 'bi-polar I' and only experience mania their whole life. I was hoping that I was one of those lucky 8%. Although I don't enjoy when I get mania flare ups because they lead to harmful self-destruction, but mania has increased my outlook on life and I see the euphoric and artistic endeavors that it gives me which I see as a blessing.

As my Doctor put it, because I am a professional artist and musician that he wanted to avoid traditional antipsycotics because they often dull creative thought (or all thought in general). We decided to use Lamogrtine (Lamictal) as a mood stabalizer in lieu of lithium. This seems to have very little effect other than I haven't had a full-blown manic episode since the treatment. that suicide would seem reasonable.

I tried apriprazole (abilify) 7.5mgs, but that made me feel so strange I quit immediately.

So now on to where we are now prescription wise. Typical Lamictal treatment, with alprazolam 1 mg (xanax) for acute-mania. Temazepam 30 mg nightly for sleep. This worked quite well. The only worry was long term benzo use. My doc has basically wrote the standard texts for benzos and taught at universities doing mostly benzo research, and if he's not worried I guess I shouldn't be.

I had a series of very unfortunate events in my life and I slipped into a true clinical depression. I started to feel suicidal. I went to him and described the situation. SSRI's are contraindicated (I believe in mania) plus I almost black out when I take lexapro or prozac.

Now where the buproprion comes in-150mg XR, tells me to take it immediatly when waking to avoid insomnia. Which I do and is no help. But my depression disappeared in about 2 days. I had energy and motivation, and best of all I didn't feel as if I had taken any medication what-so-ever. Until I tried to sleep.

For now I am trying to exercise and wear my self out in the day time to sleep better, this kind of works. The doc suggested Seroquel 25 mg and said that should take care of insomnia. I feel though that it is just too much RX's (although insurance covers 100% of all meds and visits). I also know Seroquel can really change congnition. Which is not exactly what I'm looking for.

I want to continue Buproprion because I've never been so happy, friendly, witty, and gernerally MOTIVATED, and in a great mood. Other than massive benzos or seroquel, are there good options?. I just want to take the buproprion because it helps SO much, but this insomnia is sure to trigger a manic episode.

What should I tell the doc? I just want buproprion in day and sleep at night. and Lamictal to keep from swings. I just can't go to sleep without 4mg alprazolam or equiv.

I know that's not good in the long run (and I've already been on benzos for 6 months).

Lastly, are there risks on my liver with this regimen? I mean I feel truly CRAZY buproprion, xanax, temazapam, lamictal.

This one was really long but again, its 4:00 am and I need some help. Just took 3mg alprazolam and 30 mg temazapam, and I'm losing coordination but not speed of thoughts.

sorry so long, thanks.

PS - All these medications were taken by prescription so I hope I can refer as "I" instead of SWIM

takenbyRX added 9 Minutes and 25 Seconds later...

"Donkey," I saw you used abilify to potenate the wellbutrin. What dosage? I only used abilify for 2 days at 7.5 and it made me feel really strange. Anyway, I've heard positive things about 2mgs. But never tried because the stuff was so wierd and I couldn't come down from its dulling anti-phycotic effects. I have 5-10-15mg pills that can all be split.

What dose of each do you take and how does that 'potenate' the feeling. Or rather what changes are noticeable?

Last edited by takenbyRX; 18-09-2009 at 09:52. Reason: Automerged Doublepost
  #5  
Old 19-09-2009, 16:53
Amnesia Amnesia is offline
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Re: Temazepam useless with Wellbutrin?

No worries about the long post – this is going to be one too
Please excuse the lack of references this time, SWIM is too tired to go through her books.

First of all, it sounds like you have a very good doctor there. He has obviously taken your worries and occupation into account when it comes to prescribing.
SWIM can completely understand why you don’t want to stop the Bupropion, she had a similar response to Citalopram. The day before she started it she was actively suicidal. The morning after taking it (she was told to take them before bed) she was happy as all hell (looking back she can see it was hypo mania and she had literally switched overnight). Unfortunately, after several weeks the hypo mania became full blown, severe mania.

Just to let you know, Lamotrigine has no proven efficacy in preventing mania, just depression – it is said to have a similar efficacy as Lithium in treating bipolar depressions. It has also been shown to cause switches into mania (but these are rare). Although, just because its efficacy is unproven doesn’t mean it won’t work for some people – it just doesn’t work for enough (against placebo) to be considered an anti-manic drug. It is proven to extend the periods of ‘normality’ between episodes however. Despite this, in the UK it is not considered a good enough mood stabiliser to be licensed for use in bipolar disorders.

SSRIs can be used during depressive episodes but only in conjunction with a mood stabiliser and during the acute episode. They should be used with caution and close monitoring of the patient is essential; they have to be discontinued once the depression lifts or if there are any signs of a switch. Due to your previous response to SSRIs SWIM thinks they should be avoided entirely in your regimen.

Benzos can have a massive effect on cognition; they certainly do for SWIM (except when she is hypo or manic, then they have the same effect on her mind as spitting at the sun in an attempt to put it out). Does your doctor want you take the Quetiapine (Seroquel) in conjunction with the benzos? If so, SWIM thinks this might lead to excessive and persistent sedation and cognitive slowing. Swapping one for the other may provide the relief you need but after such a long period on a high dose of benzos it will take at least a month to withdraw them – slow withdrawal is essential in order to avoid very serious withdrawal effects such as seizures and death. So you’re probably going to have to take them at the same time.

The fact that your brain is still running fast after a high dose of benzos is an indication of hypo mania, so it may be worth trying the Quetiapine to avoid it developing in to full blown mania. You can always stop taking it if you find the cognitive effects too much to bear.
SWIM would advise discussing it with your doctor, if you haven’t already done so, and for you to advise him that cognitive impairment is a side effect you find unacceptable. Perhaps you could agree to take the Quetiapine for just a few weeks and see if it helps level out your sleeping pattern again, then come off it. This should help avert a manic episode if it helps you sleep. SWIM sees no reason for you to stay on this drug permanently, just long enough to prevent you from becoming manic - she'd guess at no more than 2 months at the longest.
Be aware that there may well be a prolonged period of trial and error involved in finding a suitable medication regimen, and as annoying and daunting as that can be it is often essential.

Please make sure your doctor fully explains the possible side effects of anti-psychotics as some of them are dangerous and will require immediate cessation of treatment (notably, involuntary movement in the face and/or body). Also ask your doctor about your worries for your liver - SWIM can not give any advice in that regard, she simply doesn’t know, sorry.

On a final note, please be sure to discuss all changes to your medications with your doctor before initiating them – particularly the lowering of a dose or withdrawal of a drug – to avoid any unpleasant or dangerous withdrawal effects.

SWIM hopes some of this is helpful and wishes you all the best

Last edited by Amnesia; 19-09-2009 at 18:17. Reason: typos
  #6  
Old 20-09-2009, 06:31
takenbyRX takenbyRX is offline
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Re: Temazepam useless with Wellbutrin?

Thanks for all the help, Amnesia. It is reassuring to hear from someone with similar experiences and some knowledge, too. Having both experience and knowledge in this situation is rare.

Trying to wind down for sleep now.

Take care.

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benzos with, bupropion, drugs, insomnia, lithium, restoril, temazepam, wellbutrin, zyban

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