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  1. Hi, I should have updated this a while ago, sorry! I am really sad to hear that others have had some similar experiences. Thankfully, since my original post I have been able to find a regimen that makes things manageable for me. By no means is the constipation gone, but I feel functional and am no longer turning down social engagements to go lie in bed, having awful sharp pains, etc. This means I am able to stay on the Wellbutrin and still live a pretty normal life, which to me is definitely worth it because of the profound improvement Wellbutrin brings to my mental health. Dosage is steady at 300mg/day. The long and short of it is that I need to be on a constipation medicine that works on motility specifically. As my doctor explained it to me, most available meds pull water into the stool but only a few actually cause intestinal contractions. Those are the mestinon and the Resolor. I stayed on the mestinon, 60 mg, 3x a day and stuck to between 1 heaping and 1.5 capfuls of Miralax every night. I would say it took about 1.5-2 months for things to settle and really start feeling the effects, because when I first started the mestinon it was like everything screeched to a halt. This supports my very non-scientific theory that these medicines take time to build up their effects but that's just my opinion. Staying on that regimen I have been able to go consistently at least 1x a day. I rarely feel fully evacuated, but it's been such a long time since those days I don't really notice it. The huge difference is that I also rarely have times that I think I'm ready to go and then nothing will come out. Those are the most frustrating and uncomfortable moments so that makes a big difference. The Miralax keeps everything very soft and the mestinon helps move it out. Other things I have figured out about myself/notes: -Do. Not. Get. Off. This. Schedule. This is critical for me. Missing a pill or Miralax 1 night can set me back for 2-3 days. -A plate of pasta is pretty much guaranteed to cause a back up. Same with pizza, not quite as bad. It might have to do with refined carbs like flour but I really don't think I have a gluten sensitivity and the tests show I am not a Celiac. -I eat largely vegetarian, meat about 2x a month, but that was for ethical and environmental reasons and I don't think that makes or breaks anything with the constipation. It does mean I am eating softer foods typically, think tofu vs. steak, so I don't think it hurts. My GI wants me to see a nutritionist because I lost a lot of weight from the Wellbutrin + not being able to eat as much with the constipation and I will still do that at some point. -Be *hyper* aware of how much I am eating and how quickly. I typically eat half my lunch and save the rest for late afternoon or dinner. Even if it tastes delicious, if I hit this point where I suddenly feel this sort of lurch in my stomach I put my fork down immediately. It's when I keep going that I exacerbate the constipation considerably. Yes, people will ask me if the food was bad or I didn't like it sometimes at restaurants but you learn how to talk around that. And it's really none of their business how much I can or can't eat in one sitting. -I try to eat either plain oatmeal with cinnamon and flax seed or a yogurt for breakfast -I do take some daily supplements, including a probiotic. Again, this was not the magic bullet but I don't think it hurts. -I like popcorn as a snack, this doesn't seem to cause me to have a bowel movement but it also never makes me feel worse, and there are lots of snacks that are more hit or miss. -I try to exercise a few times a week for health but this really doesn't affect my constipation either way, sadly -I don't drink as much water as I should many days but again, doing so doesn't really help the constipation Side effects I experienced from the Mestinon were increased urge to urinate, random bouts of sweating (I don't really sweat normally and suddenly I'd find myself with wet armpits sometimes), and occasional foot cramps. All these are small prices to pay for a sustainable constipation management program, IMO. I have also heard that Huperzine-A works in the same manner and may even be more effective than mestinon, but I have yet to try that. My doctor is always wary of herbal supplements and liver toxicity, though she said if I did find something like that that worked she would just test my liver levels regularly. I may still try this, TBD. I did recently start a trial of the Resolor and it was having a positive effect, though my GI movement was more stop and start than with the mestinon. I have decided to invest in a one month supply to give it more time to settle in and see if it's any better than the mestinon. I not, I will return to the mestinon and my doctor said I could potentially keep Resolor on hand as a backup when I need a boost to the mestinon. I stay on the Miralax whether it's mestinon or Resolor. I'll post back after I complete the Resolor trial. @Rache1, it is up to you but my first question would be how well is the Wellbutrin working? Is it making a huge positive impact or is it just ok? If it helps a little but perhaps there are other drugs that could work the same or better for you I would say stop the Wellbutrin and keep looking. If you can find an alternative it would always be preferable to avoid this problem altogether instead of having to treat it. However, if the Wellbutrin is changing your life, or if it's the only drug that seems to do anything for you (both were true for me), then I would stay on it and see if things resolve themselves. For many people supposedly the side effect DOES go away. You're only 3 months in so if you do feel it's worth sticking it out and you can tolerate that, you can always decide after 6 months or even a year if it's the right long-term solution for you or not. Hang in there, I know all too well how physically debilitating it can be and the accompanying frustration. I have cried in the bathroom at work many times if that makes you feel any better :/ I don't wish that on anyone. Best of luck to you and post back how you're doing later on if you can!
  2. Hello, I am posting this for a few reasons. First, to share my story in case anyone else has experienced anything similar. Second, to make anyone who is concerned about the severity of their constipation while taking Wellbutrin/generic bupropion aware of one person's specific experience. I think Wellbutrin is an amazing antidepressant and don't want to discourage anyone from taking it. At the same time, I would've liked to have read something like this earlier in my journey if someone else had experienced it. Lastly, if anyone has had a similar positive experience with Wellbutrin's effect on their depression but had to stop taking it for any reason and have found another drug that works as well for them, I would love to hear what those other drugs are. [I will use bupropion and Wellbutrin interchangeably here, but I have only ever been on generic bupropion, Aplenzin, and Forfivo.] I have been on bupropion on and off (mostly on) for about 7.5 years now. I noticed constipation as a side effect pretty much immediately after I started Wellbutrin, but it worked so amazingly for my depression, low energy, and lack of interest in life that I didn't really care. It began as a nuisance but just got progressively worse over the years, growing from a nuisance to an inconvenience, to a disruption, to a constant presence, and eventually to a chronic condition that profoundly changed how I live my life: thinking about it constantly, skipping social events because of the never-ending discomfort, spending around an hour a day on the toilet just waiting, sobbing when nothing helps and I can't take it anymore, no longer being able to read how better or worse I feel because my body can't even remember what's normal. Early on I tolerated this side effect while trying every basic constipation treatment you can imagine. These included drinking more water, trying to eat healthier, exercising, taking psyllium fiber, stool softeners, magnesium supplements, milk of magnesia, the occasional stimulant laxative. This went on in various permutations for a long time. Sometimes things would help a little and sometimes they'd seem to do nothing, but on average the constipation just got worse. It was after 5.5 years that things got bad enough I quit the Wellbutrin and stayed off it for about 1.5 years. The severity of the constipation decreased but it by no means went away. During this period I finally sought help from real GIs instead of just listening to my psychiatrists tell me over and over to eat more fiber and maybe try a stool softener. I started on Miralax and went to larger and larger doses, then Linzess, then Amitiza, then Amitiza with senna, then pyridostigmine (Mestinon), and now Mestinon with Miralax. Miralax and Linzess helped per se, but always brought along excessive trapped gas and cramping. Amitiza helped without the gas but still wasn't helping enough. Mestinon I really cannot get a read on. I will think things are getting better and then they will feel the worst they ever have, as if my system is utterly paralyzed for 1+ days. Adding Miralax on top has made it so I only have loose stool but hasn't removed the constipation. (If the concept of being constipated with diarrhea makes no sense to you, thank whatever higher power you may recognize.) While trying all these different treatments I had two full blood panels to test for all food allergies/sensitivities including Celiac as well as thyroid issues, several enemas, a colonoscopy prep kit to clear everything out without the actual colonoscopy, an actual upper endoscopy, a sitz marker test, and the most hellacious of them all, an MR defecography. They cannot find anything wrong except that I have very slow transit, which was already fully aware of. I've never felt like I can't push and physical exams confirmed that very early on. The only other finding was that I've developed a slight rectocele because of the years of issues. I should highlight that both GIs I've worked with as well as all three psychiatrists do not believe that the Wellbutrin is the culprit based pretty much solely on the fact that the constipation didn't resolve itself within a few weeks when I went off Wellbutrin. Well, going off Wellbutrin brought my depression back. I needed to do something so I tried other antidepressants in other classes. I had tried still others before I ever tried bupropion as well, and none of them seem to do anything. 5 doctors had told me for 5 years years that Wellbutrin wasn't causing such chronic, severe constipation so at that point I thought I agreed. About the time in my GI treatment that I started Amitiza I went back on Wellbutrin. I didn't think the constipation got worse, but part of that was that I didn't know what was better or worse anymore. It had devolved into trying to catalog whatever weirdness was going on, as in: lately I have more cramps, the gas seems to have gotten a little better, the stomach grinding seems to have gotten a little worse, my stool is looser or flakier or more red or green or I am using a heating pad more at night or feeling less sick every morning. It's now been about 8 months back on Wellbutrin. Mentally I feel wonderful again. But during this time period I have experienced new constipation symptoms including the sensation of pressure on my throat because the organs are being pushed up, being able to consciously sense my intestines, inability to eat for long periods of time, sharp abdominal pains when eating, and a bizarre buzzing sensation in what feels like my intestines and anus. If I had to guess, the last one is just being able to sense organs that shouldn't be consciously felt. But nothing is consistent. It's like that and then it's not like that and then it's different the next day or sometimes hour. I don't know what's up or down anymore. But when I look at the symptoms, I have to conclude that the constipation, on average, is worse since I went back on Wellbutrin. And after all these years I still haven't been able to find a single pattern but the Wellbutrin. I can eat half of a meal and have sudden diarrhea out of nowhere, then eat the other half the next day and immediately have immobilized guts lasting 24-36 hours. Sometimes it's worse when I eat fast food, sometimes better. Same with vegetables, dairy, anything you can think of. It's not related to what I eat or even if I don't eat at all. Exercising doesn't make it better nor worse. More or less sleep or water doesn't correlate with the symptoms. My heart says it is and always has been the Wellbutrin. I know supposedly 26% of people experience this side effect but it goes away on its own for many. I've actually never read an account of such a severe case as my own. Most people who post just say they quit Wellbutrin early on because of the constipation and never go back. I'm also aware that the half-life of bupropion is only about 21 hours. But if I listen to my intuition and the voice that won't go away, I wonder if being on a drug that compounds a problem for 5.5 years means it can't resolve itself after 1.5 years. My depression didn't return 2 weeks after my last pill; it took 8-10 months before I even realized that I'd backslid. Can't prolonged usage change your brain chemistry even after you stop a drug? Couldn't it be the case that it could take a very long time for this side effect to die down once removing the cause? I'm not a doctor. My rational side wants to say, here's the literature, this isn't the problem. But deep down I know it is. I'm also terrified of quitting Wellbutrin again. It's the only drug I've found that has remotely worked for me and I don't want to lose all the progress I've made for the second time, particularly not knowing when or if I'll find an equivalent alternative. I saw my GI last week and she told me that there isn't really a risk of permanent damage to my system unless I start not being able to pass anything, but just as she doesn't believe me, I don't really believe her. I am terrified of unknowingly locking in these problems, or worse, for the rest of my life. I'm only 31. But I'm also terrified of going off Wellbutrin again. I would have to just have to walk off the plank and find out if there's anything else that works for me. Before I ever got on Wellbutrin I went to the bathroom 2-3x a day, and easily, but the depression had reduced my life to being bedridden, jeopardizing my job, a cutting incident, and preoccupation with death which is a precursor to suicidal thoughts. So the stakes feel very high. I've found studies showing that: 1. Bupropion inhibits nicotinic acetylcholine receptors 2. Acetylcholine receptors facilitate the release of acetylcholine and so therefore might "play an important role in the regulation of gastrointestinal motility" 3. Mestinon is a cholinesterase inhibitor and so increases acetylcholine levels. This makes me want to stay on the Mestinon longer because it seems like it has a chance of actually addressing the problem eventually, but so far it doesn't seem to be doing much and my doctor is already talking about switching me to prucalopride (Resolor) which I will have to pay ungodly amounts out of pocket to buy from Canada. I still plan to try brand name Wellbutrin and elimination diets before truly considering giving up Wellbutrin for good. But it seems like a decision I will eventually have to make unless I can find the answer for the constipation somehow, after all this time. Anyone who read this far- thank you, and please comment if you have any similar experiences or thoughts. Thanks again.
  3. 7.5+ years in and it still hasn't gone away for me. It's only gotten worse and is now a severe, chronic condition. To make things even more pleasant, none of my doctors even believe it's the Wellbutrin because I went off for 1.5 years and the constipation didn't immediately go away (it did improve enough to notice a difference, and worsened again when I went back on, but my GI told me my symptoms are not worse now. Ok.) Without getting into all the gory detail and the full progression, I currently can barely eat, regularly have abdominal pain, miss social events all the time, try not to cry at work a lot, have one treatment left on my GI doctor's list to try, etc. I would never tell someone not to take this drug. I think it works stupendously and the only thing that has had a noticeable effect on my depression at all, and that's why I went back on it after my break. At that point, I had started to think I was crazy and was agreeing with my doctors it couldn't be the Wellbutrin. Once I went back on again and things got worse I knew it was. That said, I would think long and hard about things if you are like me and it doesn't go away on its own or you cannot find a constipation treatment that works. Everyone's body is different but in my case it began as a nuisance and grew into a life-altering condition I can't escape. I post this kind of thing because I wish there had been a post like this back when I first trying out the drug.
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