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Re: Wellbutrin/Zoloft

Posted by Scott L. Schofield on March 18, 2000, at 10:09:36

In reply to Wellbutrin/Zoloft, posted by Tammi on March 16, 2000, at 15:46:37

> Hi,
> I have been on Zoloft for 71/2 years and it has saved my life. My depression and anxiety was extremely severe. I tried Imipramine which helped the depression to a point but not the anxiety attacks. A couple years later after suffering another severe bout of depression my Dr put me on Zoloft which has taken away my depression and anxiety but I've gained about 45 lbs. The cravings have gotten worse over the years so now my Dr wants me to try Wellbutrin because of its weight loss effects on most people. He said I can continue to take 150 mgs of Zoloft because I was so nervous about going off it for fear I'd have another bout of depression. I'll be starting Wellbutrin (150 mgs) tomorrow.
> If anyone has taken both Zoloft and Wellbutrin, I would like to hear your experience and advise.
> Thanks, Tammi
> > Hi -- I just started today taking Wellbutrin. I have been on Zoloft for about 2 years because of depression and it really saved my life. Now I've been diagnosed with ADD (not ADHD) and the Dr. is trying me on Wellbutrin. He says to combine the 2 drugs for now and we can lower or eliminate the Zoloft later. The depression was so difficult that I had do something to get a handle on things but the possible side effects of another drug have me kind of nervous. Although what I've read about it being an appetite suppressant is a pretty good bonus. Does anybody have experience re depression + ADD treated by either Wellbutrin or Zoloft or both that they can share? Thanks, Laney



I have no personal experience with either ADD AD/HD or the combination of Zoloft and Wellbutrin.

I'm not sure I would be so quick to want to discontinue Zoloft (sertraline) after adding the Wellbutrin (bupropion, amphebutamone). There really is no need to, unless you are suffering any side effects that persuade you to stop taking it. Zoloft plus Wellbutrin can be a wonderful combination. I've seen many people who have responded only partially to Zoloft, or for whom the SSRI "poop-out" has occurred after responding well initially, gain a full response after adding Wellbutrin. One of the side benefits to adding Wellbutrin is that it can often mitigate the sexual side effects (anorgasmia and decreased libido) associated with SSRI antidepressants like Zoloft. It may even help offset the tendency toward weight-gain. Another consideration is the fact that frequently, after discontinuing a drug that has been working, restarting it does not recapture the antidepressant response once it has been lost. Another SSRI like Paxil can be substituted for Zoloft.

I imagine you already know that Wellbutrin has been shown to be effective to varying degrees for treating ADD AD/HD. From what I've read, it is often effective when the psychostimulants are not. However, caution should be exercised when treating children with Wellbutrin, as it can induce or exacerbate tics. Zoloft and other SSRIs don't seem to be at all effective.

- Scott


Child Adolesc Psychopharmacol 1996 Fall;6(3):165-75

Open-label treatment of comorbid depression and attentional disorders with co-administration of serotonin reuptake inhibitors and psychostimulants in children, adolescents, and adults: a case series.

Findling RL
Department of Psychiatry, Case Western Reserve University, School of Medicine, Cleveland, Ohio 44106, USA.

Attention-deficit hyperactivity disorder (ADHD) and major depression are common ailments that can cause significant dysfunction throughout the life cycle. These two disorders may occur comorbidly. This case series describes 7 pediatric patients (aged 10-16 years) and 4 adults (aged 38-44 years) whose ADHD and comorbid major depression were treated in a naturalistic open clinical fashion. For all 11 patients, symptoms of major depression appeared to respond well to either fluoxetine or sertraline monotherapy. Using starting doses of fluoxetine 10 mg or sertraline 25 mg daily, we did not observe any adverse behavioral activation or clinical deterioration. However, no improvement in ADHD symptoms was observed in any patient during fluoxetine or sertraline monotherapy. Adjunctive treatment with a psychostimulant seemed necessary for chronic ADHD symptoms to be effectively addressed. The psychostimulants did not appear to provide observable antidepressant effects. With the exception of one adult who had a 20 mm Hg increase in diastolic pressure on methylphenidate monotherapy at 22.5 mg daily, the administration and coadministration of these agents were not associated with significant changes in blood pressure or heart rate. No patient developed suicidality, increased aggressiveness, mania, or other problematic side effects. This combination therapy was well tolerated and appeared to be effective in ameliorating both ADHD and depressive symptoms. These cases support previous suggestions that adjunctive treatment with psychostimulants might be a safe and effective intervention for children treated with fluoxetine or sertraline who have persistent ADHD symptoms and suggests that such combined treatment may be suitable for adults as well.




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