Wellbutrin & Eating DisordersConcerned about my Treatment Plan
[Home] [Bipolar News] [Bipolar Disorder] [Medications] [Treatments] [Bipolar Disorder/Job/School] [Disabilities] [Ask the Doctor] [Ask David] [Self-Injury] [Personal Stories] [Graham's Column] [Steven's Column] [Storm's Column] [Columnist Archives] [Suicide] [Community Support] [Family Members] [Expressions] [Greeting Cards] [Books] [Awards] [Links & Rings] [About Us] [Contact Us]


Q:  Wellbutrin & Eating Disorders : Concerned about my Treatment Plan

I'm pretty new to this site and for the most part I've just been browsing. Everyone here seems to be very informed about the curse called manic depression. Well, I'm a 25 year old man who is right now on disability and living with my mother. She's been great about it but the problem is, I need my own place, my own source of income, my own life. I don't have a job, as I can't get myself stable on the medication yet (I started taking Lithium again in early Feb. 2003). Right now my dosage is 900 mgs of Lithium and 75 mgs of Wellbutrin. To make a long story as short as I can, the improvements are not coming fast enough. Back before I was on the meds I was doing all sorts of crazy things while manic, like disturbing the peace and driving much too fast. I couldn't help myself, I just got so hyper that I had to make noise, drive like I was in a drag race, etc. The other problem was that I got myself in debt for about a thousand dollars. I am currently paying this off, but   it's part of a major problem. Even now I feel urges to buy all kinds of worthless trinkets off the Internet. I give out my credit card number like candy on Halloween. I guess what I'm saying is that my manic tendencies have not been completely banished, and my mood swings, while less frequent, are still as severe as a year ago. Deep sadness over television commercials, fierce anger over spilling some milk, it goes on and on. I need help!! I can't go out into the real world and get a job, deal with people, or even get a girlfriend until I clear this up. I don't think the Wellbutrin is working because it's supposed to help with the depression and I'm still depressed. I've raised this concern with my doctor and she won't change the meds, period. She's convinced everything will work out with time. But I was on Wellbutrin before, years ago and it didn't work, and plus I am still skinny from being anorexic all through high school. Is it true that anorexics should not take Wellbutrin? Should I demand that she discontinue that and put me on a mood stabilizer, like Zoloft or Tegretol? I also think I need some kind of tranquilizer to calm me down at night, but I'm at a loss about those. Or maybe my Lithium just needs to be cranked up to a higher level. My blood tests indicate that I'm nowhere near the toxic levels recognized by doctors...I'm just confused and need some medical advice. I have to get back into society. Thank you for taking the time to reply to this message.

Dear RL -- 
There are several concerns in your painful-to-read story, and my first thought is to try to help you keep some hope going in the face of this.  You now have excellent insight into what's been happening, and many people don't get that -- so you're way ahead there.  But as you say, you've got a long way to go and it can be very frustrating when things don't get better as fast as your insight does...

You're right to wonder about your treatment options.  Sounds like you will benefit from learning some more about your options.  Here's a list of current mood stabilizers to review.  You are right that there was some concern about using Wellbutrin in people with a history of eating disorders, though the focus there was more on bulimia nervosa and some experts think that was a bit of a statistical fluke; in any case the concern is to avoid the risk of seizures which Wellbutrin poses particularly when the dose goes beyond 300 mg. and especially when it gets up around 450mg, and especially  if the immediate release (as opposed to slow-release, which is not generic yet) version is used, in which case you musn't take more than 150mg at a time and must keep the doses well-spaced, at least more than 4 hours).  Anyway, the point of all that was that your current dose, on this basis, is not particularly worrisome as far as this risk-in-eating-disorders thing goes.  

Instead the concern would be that you still get depressed while taking it, and your story seems to perhaps be describing continued cycling (mood swings are less frequent but still severe, e.g.).  In that case most mood experts would be thinking about getting you more mood stabilizer -- so that's why you need to look over that list.  If you come in pretty well informed about their risks and benefits and say you want to add an additional mood stabilizer, you may not get as much resistance as if you want to raise the dose of the antidepressant, which carries more risk.  Unfortunately, as you'll see there, just about all your options except Trileptal, at least in the routinely used stuff, carry the risk of weight gain.  Taking a medication with that risk is hard for anybody to handle, but especially if there's been a struggle about body weight and image in the past.  So, you'll really need to have a good working relationship with your doc' if possible to evaluate your options and monitor the side effects.  I hope that can be worked out with your current doc' . 

Dr. Phelps

Published May, 2003


Bipolar World   1998, 1999, 2000, 2001, 2002, 2003, 2004, 2005, 2006, 2007, 2008, 2009, 2010, 2011, 2012, 2013, 2014
Allie Bloom, David Schafer, M.Ed. (Blackdog)
Partners:  John Haeckel, Judith (Duff) 
Founder:  Colleen Sullivan

Email Us at Bipolar World


About Us  Add a Link  Advance Directives  Alternative Treatments  Ask the Doctor   Ask Dr. Plyler about Bipolar Disorder   Ask The Doctor/ Topic Archives  Awards  Benny the Bipolar Puppy  Bipolar Chat  Bipolar Children  Bipolar Disorder News  Bipolar Help Contract  Bipolar World Forums  Book Reviews  Bookstore  BP & Other mental Illness   Clinical Research Trials & FDA Drug Approval   Community Support   Contact Us  The Continuum of Mania and Depression   Coping   Criteria    Criteria and Diagnosis  Criteria-World Health Disabilities,  DSMV-IV   Dual Diagnosis  eGroups  Expressions (Poetry, Inspiration, Humor, Art Gallery, Memorials  Family Members   Getting Help for a Loved One who Refuses Treatment  Greeting Cards  History of Mental Illness  Indigo  Job and School  Links  Manage Your Medications  Medications   Medication and Weight Gain    News of the Day  Parent Chat  Pay for Meds  Personal Stories  Self Help  Self Injury  Significant Others  Stigma and Mental Health Law  Storm's Column  Suicide!!!  The Suicide Wall  Table of Contents   Treatments  Treatment Compliance  US Disability  Veteran's Chat  What's New?