Hot flashes, night sweats and Wellbutrin

[Guest guest]

Hi All,

 

I just saw a new patient for the first time last night, and am pondering some

questions about yin deficiency and heat symptoms related to menopause and

medication. She's 52, and her chief complaints are hot flashes, insomnia

secondary to night sweats, and low libido.

 

Her info: (pardon disorganization ; I don't have her chart with me and am

working from memory)

 

Menses ceased in 2000. History of depression for 40 years, treated with a

variety of antidepressants, but most recently Wellbutrin for 5 years. Libido

has been best on Wellbutrin compared to the other meds, but now is dropping off.

She attributes this partly to being a mother of a 5 year old and not having

private time, and partly to " not feeling interested physically " . It is this

latter complaint which she would like to address.

 

Historically, her physical health has been strong, with few complaints and those

are related to injuries. She complains of recent loss of flexibility in her

joints. She's been a vegetarian most of her life. Appetite and thirst are low.

She's tall and lean, with a pale complexion and dry skin and hair. Overall, her

skin is slack and pasty in texture. She exhibits malar flush on her cheeks.

Her fingernails are purplish. She appears exhausted, drained and washed out.

Her shen appears obscured and diminished.

 

Hot flashes occur 4-5 times daily, and night sweats wake her 3-4 times nightly.

She does not recall dreaming and says she sleeps well when she is sleeping, but

the constant waking makes her tired. She is overly warm all the time. I

neglected to ask when her hot flashes and night sweats began. She also

experiences monthly migraine headaches, and occasional ocular migraines without

headache.

 

5 years ago she bore a child via IVF. She is planning on doing this procedure

again in January, with the help of hormone injections. After the birth of her

child, she began to experience incomplete urination - she will urinate and then

have to go again in 5 minutes. It is like this every time she urinates, about 4

times daily. Before her last pregnancy, she was diagnosed with a uterine

fibroid, which is still in place. Her MD says it will not interfere with her

pregnancy, but it is pressing against her vaginal wall, making sexual

penetration painful. She experiences vaginal dryness as well.

 

Bowel movements occur twice daily with ease and without urgency, are formed,

soft, and painless.

 

Pulse is thin on the left and slightly slippery on the right. Overall it feels

slower than its actual speed (72 bpm), weak, and deep. Initially, the middle

left position felt deeper and more difficult to feel than the rest, but after

she relaxed, all of the left pulses felt equally thin and deep (I find this is

common among patients I have seen who are taking meds for depression). Right

pulses are stronger and less deep and deficient than the left. Proximal pulses

on both arms are easily palpable, much to my surprise.

 

Her tongue is puffy, slightly toothmarked, pale, and slightly dusky, with some

light redness along either side of the center and the tip. There are a few

superficial longitudinal cracks in the Stomach area. Her coat is thin, greasy,

slightly yellow, and wetter than I'd expected, but not in extreme.

 

What she tells me, and what I see (with the exception of her tongue) bring yin

deficiency heat to mind, but her tongue indicates more dampness (which I don't

see reflected anywhere else) and stagnation of Qi, with some heat. It would be

easy to treat her for Yin xu, but I don't think this is the whole story, and I

am wondering if her heat may be more reflective of the hot nature of Wellbutrin

rather than of her inherent quantity of Yin. In addition, I have often seen

patients on meds for depression demonstrate signs and symptoms of dampness. So

my questions are this:

 

Can Wellbutrin use itself engender hot flashes, night sweats, and malar flush

which might seem to indicate Yin deficiency, but which might actually be excess

heat; too much heat for the relative Yin in the body? Meaning, she is not Yin

xu inherently, but only in relation to the heat this substance creates in her

body.

 

How long can/do menopausal hot flashes and night sweats continue after

menstruation ceases?

 

It is obvious that she has heat and dryness, but the question is why. I have

diagnosed her as having Kidney Yin and Qi xu with Liver Blood xu, as well as

Spleen Qi xu generating dampness, and Blood stasis in the uterus. But the Yin

xu diagnosis really bothers me; I keep wanting to see more heat, some

irritability, some thirst, dry throat, etc.

 

Mostly though, I am wondering how her meds are obscuring her true condition, and

whether I can trust my diagnosis. Any thoughts or related experience? I'd

appreciate any and all input.

 

Thank you,

 

 

 

 

 

 

 

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[Guest guest]

Can Wellbutrin use itself engender hot flashes, night sweats

>>>>It is quite common for welbutrin to cause sweats and hot feelings especially

at a dose larger than 150mg per day

Alon

 

 

[Guest guest]

Thank you, Alon.

 

Andrea Beth

 

ALON MARCUS <alonmarcus wrote:

Can Wellbutrin use itself engender hot flashes, night sweats

>>>>It is quite common for welbutrin to cause sweats and hot feelings especially

at a dose larger than 150mg per day

Alon