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Discussion Starter · #1 ·
Back in December I had a major anxiety attack & went to see a walk-in-clinic doctor who gave me some lorazepam and he referred me to a psychologist. I had my first appointment today with the shrink, who in my opinion had no idea what he was talking about and tried to tell me that I have ADD along with anxiety. Which I absolutely do not have. He was a 'junior psychologist' by the way & he prescribed me:
Wellbutrin: 300g
Risperidone: 0.25g
The second one is an antipsychotic drug used to treat adolescent schizophrenia, bipolar & irritability in kids with autism. I do not have any of the above.

Sooo... I was totally confused and rather upset by his ADD diagnosis, which is incredibly hard to grasp when I concentrate just fine, am a straight A student & I prefer sleeping and lounging around to any physical activity.So I went back to the walk in clinic to get a second opinion on the ADD thing. It was a different doctor than the one who referred me the first time. He confirmed that I don't have ADD and said that shrinks often confuse anxiety with ADD. This doctor tells me I have SAD, general anxiety disorder and a mild case of post traumatic stress disorder from a sexual assault. He seemed to get everything I was saying and made so much sense. I was diagnosed with SAD about 9 years ago as well & was prescribed paxil but stopped taking it and the anxiety has gotten worse over the years. The second doctor who is a GP but says he has quite a bit if experience with anxiety & depression prescribed me:
Citalopram: 10mg for a week (go back to see him) then 20 mg for 10 days
Lorazepam: 10mg for when my anxiety is really bad

Questions:
Which treatment/drug plan makes more sense to you? Also the GP told me that Citalopram will cause me to gain weight, this concerns me because weight is a huge part of my anxiety. He recommended that I start a regular exercise routine if I am worried about the weight gain and that it's fairly minimal (about 5lbs). I have taken Lorazepam before & it really helps with the major attacks. Anyone have experiences they can share about these drugs? Also I should add that I don't suffer from anything other than anxiety and have bouts of depression.
 

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You misplaced the decimal in the lorazepam (Ativan) dose and must mean 1 mg otherwise you're popping 5 of the largest dose Ativan pills each time you get nervous. That's likely to work.

If you want to not gain weight and hopefully get not depressed go with the Wellbutrin instead. It tends to cause weight loss. It definitely will NOT cause weight gain in anybody.
 

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The Wellbutrin would just make the anxiety worse and I don't see a reason why you should be placed on an antipsychotic. IMHO you should take the advice of the 2nd doc (Citalopram + Lorazepam as needed).
 

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Discussion Starter · #4 ·
You misplaced the decimal in the lorazepam (Ativan) dose and must mean 1 mg otherwise you're popping 5 of the largest dose Ativan pills each time you get nervous. That's likely to work.
Yes, sorry it is 1mg not 10. I am new to this whole meds thing.

About the Wellbutrin most are saying it's not very effective for anxiety and it's meant to treat depression. I wouldn't say I am depressed just anxious and when the anxiety gets really bad and starts interfering with my life thats when the depression kicks in. I decided to get the prescription for Celexa and Lorazepam but I am really freaking out about the weight gain. I have such a poor body image as it is. Also I took one yesterday & I was up all night, is this a normal side effect? Will it last long?
 

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Discussion Starter · #5 ·
The Wellbutrin would just make the anxiety worse and I don't see a reason why you should be placed on an antipsychotic. IMHO you should take the advice of the 2nd doc (Citalopram + Lorazepam as needed).
Thank you. I am going to start Celexa & Lorazepam. I don't want to take an antipsychotic drug. I really felt more comfortable with the second doctor too. He understood what I was talking about and when I googled his name it turns out that he has written a bunch of medical journals on anxiety. I really didn't like the first doctor and his 'conclusions' and 'diagnosis' really don't describe how I feel. The second doctor also wants to get me in to see another shrink & start cognitive therapy.
 

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The Wellbutrin would just make the anxiety worse and I don't see a reason why you should be placed on an antipsychotic. IMHO you should take the advice of the 2nd doc (Citalopram + Lorazepam as needed).
1. Wellbutrin didn't increase my anxiety at all. Though I am an oddity -- I'm saying it before you or anyone else here notes this obvious fact.

Though there is whole herd of folks here who claim potent stimulants (i.e. Adderall, Dexedrine) actually calm them and my VERY limited experience actually supports that claim, even though it would logically seem that stimulating someone who's already nervous would be like pouring gasoline on a fire.

2. One should keep in mind another option: Celexa (Citalopram) and Wellbutrin can be used together. To generalized that further, Wellbutrin can be used with any SSRI.
 

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1. You are on 10mg Xanax / day, this could be the reason Wellbutrin didn't increase your anxiety level.

2. One can't compare potent stimulants like Adderall & Dexedrine with Wellbutrin. Seems like comparing XTC with SSRIs.

3. A Wellbutrin + (Es)Citalopram combo could a good treatment IMHO, but Wellbutrin alone has never shown to be effective vs. SAD in randomized, controlled trials. The standard line for SAD is giving an SSRI first, not combining or augmenting ADs.

4. Wellbutrin should in general only be combined with low interaction SSRIs like Citalopram, Escitalopram. Combining it with eg. Paxil, could raise the paroxetine level too high.
 

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Though there is whole herd of folks here who claim potent stimulants (i.e. Adderall, Dexedrine) actually calm them and my VERY limited experience actually supports that claim, even though it would logically seem that stimulating someone who's already nervous would be like pouring gasoline on a fire.
From what I've seen, it depends how selective a stimulant is to dopamine over noradrenaline. If its effects are primarily increased dopamine, people tend to report feeling happy and calm. If there's a lot of noradrenaline action going on, people mostly report nervousness and agitation.

Wellbutrin could have either outcome, due to its complex metabolism. If you have more CYP2B6 enzymes (if you drink alcohol or take any CYP2B6 inducers), you get more of the noradrenaline-acting metabolites, and probably quite a horrible experience. If you have low CYP2B6 (paroxetine, fluoxetine and sertraline all inhibit this enzyme), you should get a more dopaminergic, fun experience without much anxiety. You can achieve the same result by sublingually dosing Wellbutrin. Of course, this has been associated with seizures so I'd assume the same risk if you take it with CYP2B6 inhibitors.
 

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From what I've seen, it depends how selective a stimulant is to dopamine over noradrenaline. If it's effects are primarily increased dopamine, people tend to report feeling happy and calm.
I gather amphetamines would primarily increase dopamine? What about Ritalin?
 

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I gather amphetamines would primarily increase dopamine? What about Ritalin?
It depends what form of amphetamine you get. In Adderall, you get mixed amphetamine salts of both the levo and dextro forms. Dextro is more selective to dopamine (you get it alone in Dexedrine and Vyvanse), and levo is more active on noradrenaline. Adderall has a bit more dextro than levo, so I'd assume it to be highly enjoyable, but moderately anxiety-inducing.

Ritalin is potent on both noradrenaline and dopamine, so its effects probably compare to Adderall in quality.

In fact, bupropion (Wellbutrin) is a potent, selective dopamine reuptake inhibitor. It just happens to be metabolised into less selective compounds, and has seizure risks.

If you can get a purely dopamine-acting drug, you will probably find benefit in many mental disorders, including depression and anxiety. It's hard to formulate any negative thoughts whatsoever when your pleasure centres are hotwired with dopamine stimulation. These drugs do exist, but aren't prescribed due to abuse, psychosis, and so on. Rocknroll's article shows DRIs of varying selectivity:

http://en.wikipedia.org/wiki/Dopamine_reuptake_inhibitor

I doubt you'll ever manage to get a script for a pure DRI (if only because of availability), but there are triple serotonin-noradrenaline-dopamine reuptake inhibitors in clinical trials, so it's not all bad.

Back on the subject of dopamine-releasers, there is an interesting plant called Lobelia inflata with similar mechanism of action to amphetamine (see lobeline). Not that I can vouch for its safety, but those who can't get a script for powerful psychostimulants may want to consider growing their own. There are literally hundreds of plants with effects comparable to prescription drugs.
 

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Generic Wellbutrin sucks monkey deck! It causes horrible bad breath!
 
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