Psych Central

Go Back   Forums at Psych Central > Treatments and Self-Care Strategies > Psychiatric Medications



advertisement
Reply
Thread Tools Display Modes
Unread 04-11-2005, 02:05 AM   #1
Member
 
Bjork's Avatar
Bjork has no updates.
 
Member Since: Nov 2004
Posts: 52
8 yr Member
Default Wellbutrin, Eating Disorder, Seizure

Hi!

I have kind of a strange question or two here. I know that Wellbutrin is *supposed* to not be prescribed (though it was to me) to eating disordered patients (I have Anorexia Nervosa), but I'm not sure why. Is it because of the seizures? Here's my thing: I've been taking Wellbutrin for about a year now with moderate side effects, nothing I can't handle, and then [b]BOOM[b] I have a nasty Grand Mal Seizure. Why would that suddenly happen after a year of taking the drug? Does anybody know?

P.S. The ER docs took me off the Wellbutrin and thought I was nuts for taking it in the first place. I'm no longer taking Wellbutrin.

Bjork
Bjork is offline   Reply With Quote
Unread 04-11-2005, 03:58 AM   #2
Veteran Member
 
CamW's Avatar
CamW has no updates.
 
Member Since: Sep 2001
Location: Alberta, Canada
Posts: 349
10 yr Member
Default Re: Wellbutrin, Eating Disorder, Seizure

Bjork - Many people with anorexia nervosa will have a lowered seizure threshold, whether they take Wellbutrin (bupropion) or not. The reason for the lower seizure threshold is not fully understood, but if I had to hazard a guess, I'd say that it may be due to an electrolyte imbalance brought on by vomitting &/or diarrhea.

When one vomits excessively, or has bouts of protracted diarrhea, and is not adequately rehydrated with electrolytes (esp. potassium, sodium, etc.) this can affect the transmission of electrical impulse along (and between) nerves. The electrical signal that is carried along axons (the long part of the nerve cell that makes connections to the next nerve cell) is a result of an eletrical charge difference between the inside of the nerve cell and the outside of the nerve cell. The inside of a nerve cell is slightly negatively charged relative to the outside.

This electrical gradient is maintained by sodium-ion pumps imbedded in the axon membrane. The sodium-ion pump moves the positively-charged sodium ions out of the nerve cell. Proteins inside the nerve cell are negatively charged. Thus, the interior of a nerve cell, when at rest, is negatively charged, relative to the exterior of that neuron.

An electrical signal travels the length of an axon and when it reaches the end of one axon, neurotransmitters are released into the (synaptic) gap between two neurons. If the electrical signal is strong enough, a sufficient amount of neurotransmitter is released causing the next neuron to "fire" and the electrical signal is propagated (ie. travels) along the axon of that nerve cell.

It is the above mentioned electrical gradient across a neuronal membrane that allows an electrical signal to travel along the axon toward the next neuron. How this is accomplished is as follows. As an electrical signal( called and "action potential") moves along the neuronal membrane (ie. the nerve's cell wall) the "electricity" causes normally closed sodium-ion channels that span the width of the neuronal membrane to open briefly. Sodium ions flood into the nerve cell by diffusion. The high concentration of sodium ions outside the cell pour into the cell where there is a low concentration of sodium ions, due to the action of the sodium-ion pump, which normally keeps sodium ions out of the neuron.

This causes a flip-flop of polarity of the electrical gradient of the across the neuronal membrane. The outside of the nerve cell is now slightly negavtively charged, relative to the inside. This flip-flopping of charges lasts only a fraction of a second and the sodium-ion channels slam shut, stopping the sodium ions from moving into the cell. The sodium-ion pumps again move the sodium ions back out of the cell.

Here is an animation of the movement of an electrial signal along a nerve cell's axon, whic is also called "Propagation of an Action Potential" .

For a more scientific explanation of an electrical signal travelling along a nerve cell, see: "Action Potential" .

Perhaps an Overview of the Human Nervous System may help.

BTW: Na+ is a sodium ion and K+ is a potassium ion. The potassium ions act as a buffer to smooth out the transition between positive and negative states during the "flip-flop" of polarity between the inside and outside of the nerve cell.

Anyway, back to anorexia nervosa and lowered seizure threshold. With vomitting &/or diarrhea the body loses significant amounts of sodium ions and potassium ions (as well as other important electrolytes). This can interfere with the above propagation of action potentions, and the nerve cells cannot carry electrical signals from one neuron to the next as efficiently as they should. When this happens, the neuron can spasm or cut off signals that are supposed to be transmitted to other nerve cells. This interuption of electrical power supply, especially when it occurs in the temporal lobes, may result in seizure activity (similar to the seizures seen in temporal lobe epilepsy, but the ultimate causes are probably different). This may be how seizure threshold is lowered in people suffering from anorexia nervosa (at least in part; there are probably other mechanisms causing a disruption of action potential propagation).

Wellbutrin also lowers the threshold at which seizures occur. The additive effect of the two mechanisms may have caused the "nasty Grand Mal Seizure" that you experienced. Over the past year you may not have had the right (...er, wrong) combination of variables that would trigger a seizure. This time all the variables fell into place and "bingo", down you went. I am sure that there were a number of other variables involved outside of electrolyte imbalance and a Wellbutrin side effect, but my knowledge of the causes of seizures is limited.

I do hope that this is of some help. I know that the above is complicated, but I tried to simplify the whole process as best I could. The links that I provided may be able to clear up the murkiest parts of my attempted explanation. Then again, my whole hypothesis may be wrong.

I'd like to hear from Larry and T_MD (and anyone else with a little knowledge of physiology) to see if I am on the right track with my hypothesis. I'm old and it's hard to remember this stuff. I learned this over 20 years ago, and some of the details may have been updated. - Cam
__________________
Few arguments are more dangerous than the ones that "feel" right but can't be justified.
- Stephen Jay Gould
CamW is offline   Reply With Quote
Unread 04-11-2005, 07:50 AM   #3
Member
 
Bjork's Avatar
Bjork has no updates.
 
Member Since: Nov 2004
Posts: 52
8 yr Member
Default Re: Wellbutrin, Eating Disorder, Seizure

Oh no, I've never vomited (on purpose anyway), and don't have diarrhea. Also, I'm at quite a normal weight (unfortunately ) due to refeeding at a treatment center. This is why I am puzzled. Although I am Anorexic and do restrict my food intake, I am not emaciated like I used to be. Hmmm...

Bjork
Bjork is offline   Reply With Quote
Unread 04-11-2005, 10:02 PM   #4
Member
 
T_MD's Avatar
T_MD has no updates.
 
Member Since: Mar 2005
Posts: 87
8 yr Member
Default Re: Wellbutrin, Eating Disorder, Seizure

The FDA delayed approval of Wellbutrin originally because of several cases of seizures in young women in England with bulimia. This has never really been replicated again and the cases were found to be associated with excessive doses (over 450mg a day), previous seizures/head trauma etc. The doses we use now are less and the new Wellbutrin XL once a day dose reduces the chance of seizures even more. The fact is a number of antidepressants reduce the seizure threshold but Wellbutrin got stuck wilth (in my mind) an unfair reputation for causing them. I think the chances of Wellbutrin causing seizures is not anymore than most other antidepressants today. I probably wouldn't give a person who already has seizures Wellbutrin, but I can't find any really good reason to do so.

Seizures are most associated from low Na+ in people with diarrhea. The electrolytes lost in vomiting of most concern is potassium, as it can lead to fatal arrhythmias In an anorexic person not purging, electrolyte abnormalities are not present (only bulimics). Many things can cause seizures (stress, withdrawing from alcohol/medications) so the exact cause of your seizure will probably never be found. Several of my classmates in medical school had seizures from sleep deprivation, I know people that came off seizure drugs too fast (Neurontin) and others who have seized coming off a benzo (Klonopin). The neurologists have a saying "Everyone gets one free seizure." Which means that if a person only has one seizure in their life that is not considered enough to diagnosis them with a seizure disorder or put them on a seizure medicine. You may feel more comfortable off Wellbutrin, and that is something to consider too.
__________________
No warranties expressed or implied. Batteries not included. No actual letters were harmed in writing this post. Void where prohibited.
T_MD is offline   Reply With Quote
Unread 04-12-2005, 09:54 AM   #5
Veteran Member
 
Larry_Hoover's Avatar
Larry_Hoover has no updates.
 
Member Since: Sep 2004
Location: Ontario
Posts: 471
8 yr Member
Default Re: Wellbutrin, Eating Disorder, Seizure

The seizure risk (the population statistics) are 0.1% at 300 mg/day, 0.6% at 450 mg/day, and 6.0% at 600 mg/day.

That's an exponential increase in risk, and the reason maximum dose levels are set where they are.

Now, how do you convert population statistics into true individual risks? You make up a list of all individual risk factors. That's the hard part. Experiencing a seizure after one year, while apparently maintaining decent weight and food intake (from your later post), does present a bit of an interpretative challenge. One can only surmise.

Strong emotional stress can briefly affect blood electrolytes, and brain activity. Anything that causes sweating, or any strong physical exertion (even without sweating), that raises blood pressure. A viral illness. Antibiotics given for a bacterial infection. Changes in renal function (potentially arising from extended anorexia). And so on. I'm trying to do the "scattergun" approach to the things that may have influenced your having a seizure. If you're looking for triggering influences, you may find something there, if you consider your circumstances at the time of the seizure.

For the breadth of different comorbid states for seizure, see:

http://professionals.epilepsy.com/se...disorders.html

On the left, you'll see expandable lists (with multiple levels of detail), showing all the known comorbid risks.

Wellbutrin reduces the amount of physiological disturbance required to trigger seizure, but blaming it for a seizure that took place so long after you went on it.....I'm hesitant to blame it entirely for what happened.

As you've gone off the drug, I guess analyzing it to death is moot. But looking at those risk factors, in the context of your knowledge about your own health, might lead you to consider a specific risk for further monitoring or examination.

Lar
Larry_Hoover is offline   Reply With Quote
Unread 04-13-2005, 03:42 AM   #6
Member
 
Bjork's Avatar
Bjork has no updates.
 
Member Since: Nov 2004
Posts: 52
8 yr Member
Default Re: Wellbutrin, Eating Disorder, Seizure

Hmm... well anyway, I spoke to my psychiatrist today and he said that he doesn't know the cause of the seizure either (he also said that the wellbutrin only had a small chance of causing it, and I don't purge, so...). Basically, no one knows what caused my seizure, and no one ever will. That 's what I'm getting. The bloodwork came back fine and all, they just sent me back home. Oh well!

Bjork
Bjork is offline   Reply With Quote
Reply

Thread Tools
Display Modes

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is On
HTML code is Off
Trackbacks are Off
Pingbacks are Off
Refbacks are Off

Similar Threads
Thread Thread Starter Forum Replies Last Post
Taking LAMICTAL for seizure disorder Jenn1fer82 Psychiatric Medications 4 01-03-2007 08:56 PM
seizure disorder Jenn1fer82 Health Support 0 12-30-2006 02:24 AM
A poem of how I've been dealing with a physical illness, seizure disorder Jenn1fer82 Creative Corner 2 11-08-2006 05:15 PM
wellbutrin and minor seizure metoo Psychiatric Medications 0 08-06-2005 04:24 PM
Seizure risk from Wellbutrin? Genevieve Psychiatric Medications 6 09-28-2004 11:49 AM


All times are GMT -5. The time now is 11:25 AM.


Powered by vBulletin® — Copyright © 2000 - 2014, Jelsoft Enterprises Ltd.
SEO by vBSEO

advertisement

 

The material on this site is for informational purposes only, and is not a substitute for medical advice,
diagnosis or treatment provided by a qualified health care provider.
Always consult your doctor or mental health professional before trying anything you read here.

 

HomeAbout UsContact UsPrivacy PolicyTerms of UseDisclaimer
Forums HomeCommunity Guidelines Help

Helplines and Lifelines
eTrust Pro Certified