wellbutrin XL -?relationship to increased obsessional thinking (re:over eating and body image)

[kipsy]

Hi Dr Pitts...I am a mental health professional and have suffered MDD/dysthymia (SAD related) for many years and have been on antidepressants for about 7 years due to life stressors etc. (strong family hx of depression). been on Wellbutriin off and on since  2004.  after particularly difficult stressors past summer (with suicidal ideation)my MD doubled my dose to 300 mg Wellbutrin XL.  After losing weight over the summer due to stressors and then another 5 lbs after increased dose of med, recently have increased weight quickly and it is likely related to my overeating and obsessional thoughts re: body image and eating, hunger etc. I think I have had a bit of distortional thinking re: body image (critical of myself and others) for many years. I want to go to my MD and possibly change my meds as I dont think it is time yet to go off them totally.  (Oh, I should also note that I am 51 and am perimenopausal I believe).  Could there be a relationship between my Wellbutrin and my increase in obsessional thoughts re: weight/body image and eating??  Could there be relationship to perimenopause? I have been trying to research in the CPS to find out any new and/or more appropriate antidepressant--to help O/C thoughts as well as binging & depression but I didnt have much success.  If you could please offer some advice before I go back to my MD as I know he is not really comfortable (& I don't think is too aware) of psychotropic meds, with the exception of the drug rep of the week.  Thanks for any help you can offer, appreciate the aide!! It is extremely tough working in the field and attempting to hide and/or treat yourself but I realize everyone is human!  

thanks,  KIPSY

[Patricia Pitts, PhD]

Dear kipsy,
Thanks for writing.  Mental health professionals need support and consultation, too!  One question I have before I begin:  is there a reason you are seeking medication management from a physician that is not a psychiatrist?  If you could, I would recommend having a psychiatric consultation and follow-ups.  I would agree staying on medications is indicated.  Two symptoms of perimenopausal women are depression and weight gain.  As we get older, we have to work harder to manage our weight.  Eating cleaner and exercising consistently to name a few.  Loss weight on Wellbutrin could have kicked in your obsessive thinking about your weight, body image and eating.  Cognitive behavioral therapy, dialectical behavior therapy and interpersonal therapy can help you work through some of these obsessive thoughts.  Lexapro or zoloft as an antidepressant could be explored.  Of course prozac at high doses (60-80mg) has proven to be effective for bulimia and binge eating.  However, in 1/3 of the cases it causes weight gain.  Using a low dose of abilify (2-5mg) to augment your antidepressant could support decreasing obsessive thoughts and suicidal ideation.  You could consider this first before changing your anti-depressant.  You also might want to research topomax as a medication to help curb the desire to binge.  I hope your find this input helpful.

For more information on eating disorders, visit the bella vita website.

Best,

Dr Patricia Pitts
The Bella Vita
Los Angeles, CA

[kipsy]

Thank you very much for the advice!! To answer your questions to me, I would like to be followed by a psychiatrist but ours are so busy (our wait list is upwards of 4 months) although I have thought of trying to consult with one of them (also I am a bit nervous going to docs I work along side) .  In the mean time your advice is very much appreciated!!

Can I ask another question??? if I was to add the low dose prozac as you have suggested would you advise staying on the 300 mg of wellbutrin for a bit then maybe reducing it if I felt OK?? (and as summer is approaching hopefully better mood).

thanks for your help!!!

KIPSY