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Re: QUESTION FOR CAM!! » femenist

Posted by Cam W. on May 25, 2001, at 23:31:30

In reply to QUESTION FOR CAM!!, posted by femenist on May 25, 2001, at 21:30:50

Hi Rose -I aways say to stay on an antidepresant for 8 weeks before giving up on it. You may want to try staying on this combination for another couple weeks, but I think that you Wellbutrin dose is too low to be effective as an antidepressant.

If I said not to mix SSRIs with Wellbutrin™ (bupropion), it must have been at least a year ago. I probably said this with the evidence that SSRIs can decrease seizure threshold in susceptible people. As I gained experience with the use of Wellbutrin, I can to realize that this warning (which I believe I heard from a rep, when they first started detailing Wellbutrin) is very overblown. While I have seen seizures occur in people taking Wellbutrin with conventional antipsychotics (1 with chlorpromazine - Largactil™; and one with thioridazine - Mellaril™), I have never seen seen anyone seizure taking an SSRI-Wellbutrin combo.

Actually, adding Wellbutrin to an SSRI is one way to try to decrease the sexual dysfunction that can occur with SSRIs. Also, adding Wellbutrin to a regimen where somebody has partially responded to an SSRI sometimes works.

Sarafem™ (fluoxetine or Prozac™) can work well with Wellbutrin. It is sorta similar to taking Effexor XR at higher doses, but very little risk of withdrawl syndrome and not as much sedation or activation. The one thing that I have noticed is the thing that you mention; the "blah" feeling. It is sort of a euthymia, but with no emotion (don't feel like doing anything and little pleasure in anything. I would blame the Saraphem for this feeling.

I have seen this blah thing a few times. It usually happens when someone is taking Prozac 20mg daily and Wellbutrin SR 100mg or 150mg in the morning. We have tried a couple things, the most successful being adding another 100mg to 150mg of Wellbutrin in the afternoon (about 4:00pm). This works in about 50% of the cases we have tried.

We have tried to increase the Prozac, but this hasn't been very successful. Twice we have dropped the SSRI (both times it was Paxil™ - paroxetine, though; which is more sedating than Paxil) and increased the Wellbutrin and the persons were able to "feel" again.

The blah feeling and brain can happen when someone is taking an SSRI alone at too high a dose. I am not sure of the long-acting mechanism of Saraphem, but it could either be building up in your system, or your body is somehow releasing the Saraphem too quickly into your body, or the antidepressants aren't working.

I guess the first thing to do would be to ask your doc about increasing the Wellbutrin. He/she may not want to do this (seizure risk). Also, I would probably want to use the longer acting Wellbutrin SR, as it will cover you better, for more of the day. For you, and increase to Wellbutrin SR 100mg twice daily may be a viable option (ask your doc).

The other option is to switch to Prozac daily, at a lower dose (I wouldn't be in a hurry to do this, as the track record isn't that great, but I have seen it work). You could consider adding a stimulant, but where I work, this would a choice of very last resort. Most docs here would prefer a switch to Effexor XR (venlafaxine) and try to get the dose to 225mg to 300mg daily to increase energy in a person.




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