Akathisia After Wellbutrin
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Q:  Akathisia After Wellbutrin

In Nov. 2002 I was given Wellbutrin as an aide to stop smoking.  12 days later I felt "like my insides were in turmoil and ready to come out of my chest."  I was then given paxil, changed to zoloft, changed to serax, changed to zyprexa, changed to depacote with the agitation getting worse with each change.  I have now been disgnosed with bi-polar/depression and the doctor has me taking ECT treatments!  I have read about akathesia, but the doctor insists I am bi-polar.  I cannot sit still more than a few seconds and when I do, my left twitches badly.  The ECT does not seem to help whatsoever.  Do you know of a specialist on the west coast I can call.  Please help - I am desperate.  I am only 56 years old and I was an analyst for the State of CA for 35 yrs. before this started.  There is no history at all of mental illness and no indications before the Wellbutrin that I had any problems. 
THANKS - pleae help me and my family.

Dear Gerry --
I've never seen something like this before. Sounds like akathisia that doesn't quit. Akathisia is one of a collection of movement problems collectively referred to as EPS: "extrapyramidal symptoms", meaning literally outside the "pyramidal system", which is the main voluntary movement center in the brain; so extrapyramidal means the non-voluntary muscle systems of the body, which are associated with setting muscle tone throughout the body, among other things.

EPS can be caused by antipsychotic medications, and occasionally by antidepressants -- particularly the serotonergic ones like Paxil and Zoloft. I've never heard of EPS from Wellbutrin; it can cause tremor and agitation, so I suppose some of that could be "EPS" in a sense.

Sorry, this is sort of thinking out loud, as I have no experience with this nor have I seen it in the literature as such. I wonder what a neurologist would say and do, though generally they seem to have little to offer in the way of treatment for something like this. So I offer the EPS business as link to the literature on "tardive dyskinisia" just in case what you have is something like that (TD is the long-lasting version of EPS, and includes some variations called "tardive dystonia" that are closer to your situation).

However, I must emphasize that this is mostly guessing and could be completely off base (probably is). If there is a history of mood problems in your family I'd go back to the "unmasked bipolar presenting as agitation after antidepressants" theory (while keeping my eye on non-psychiatric explanations as well, like checking thyroid and seeing smart internal medicine doctors also).

Dr. Phelps

Published November, 2003 


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