Psycho-Babble Medication Thread 1093606

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Wellbutrin anxiety/Seroquel add on...

Posted by Sheilac on December 23, 2016, at 8:20:00

Last year at this time I was taking 160mg of Geodon and it really helped me with my depression, anxiety and mania.
My doc took me off it this year because of the horrible shaking (couldn't even bring a glass to my mouth).

Now I'm taking 2500mg Keppra as my mood stabilizer (I've failed the others) and 100 Wellbutrin SR for depression.

I'm sleeping great and feel good in the morning. However, as the day goes on and after I take my Wellbutrin, I'm feeling manic.

My doc said to take the Seroquel 100-200mg. My insurance doesn't cover the XR form.

I'm wondering if taking 100mg at night is good enough? Should I take any during the day?

I've got to get ahold of this terrible mania. Xanax isn't helping.

Does anyone take it at night and during the day?

 

Re: Wellbutrin anxiety/Seroquel add on...

Posted by phidippus on October 7, 2017, at 14:11:54

In reply to Wellbutrin anxiety/Seroquel add on..., posted by Sheilac on December 23, 2016, at 8:20:00

You're on the low end of the dose spectrum on KEppra. Studies with bipolar patients used up to 4000 mg of KEppra, so increasing your Keppra may help.

100 Wellbutrin is probably not even effective. I don't think its causing your mania. I think you're just having untreated mania.

You would want to take your Seroquel twice a day and at 100 mg, its not doing much. 300 mg would be a more effective dose. A plus to that dose is also an increased antidepressant effect.

A benzo will never help with mania...

I took Seroquel twice a day.

Eric

 

Re: Wellbutrin anxiety/Seroquel add on... Sheilac

Posted by Tony P on January 31, 2018, at 15:18:16

In reply to Wellbutrin anxiety/Seroquel add on..., posted by Sheilac on December 23, 2016, at 8:20:00

Some of us are super-sensitive to Wellbutrin - I am. 100 mg is for me a fairly large dose; on 300 I was borderline manic - certifiable, according to my family.

Trouble with Seroquel is, all it does is negate the good effects of the Wellbutrin. I keep some Seroquel or Risperdal around to bring me down off an uncomfortable hypomanic high, but I suspect mixing Wellbutrin with an antipsychotic regularly is counterproductive. Instead, why not lower your dose of Wellbutrin?

I've been experimenting with this for over a year, since my pdoc prescribed the Wellbutrin, then promptly had to take LTD leave, & is now retired & unreplaced, so I have no pdoc. There's no short-acting, low-dose Wellbutrin available any more in Canada, so I have experimented with (1) splitting the pills (2) taking my 150 mg XR every other day.

(1) splitting the SR or XR pills: not recommended by the manufacturer (written more by lawyers than doctors, I suspect), but at the dose you're taking the risk of seizure is < 0.1% either way. I prefer this; my pharmacist endorses it; and my pdoc & my GP both OK'd it. I've split 150XR into quarters & halves. Incidentally, there's a "honeymoon" period in the first 2 weeks of Wellbutrin, which I experienced on only 37.5 mg/day. After that, dopamine effects drop off & NE takes over, which I find agitating & unproductive; I'm currently on week 2 of a "holiday" from Wb in hopes of recapturing that initial effect.

(2) taking the med every other day: recommended by the mfgr for those with poor liver function. In my experience, smoother than split pills, but still a "one day up, one day down" sort of feel.

(3) tried taking the Wellbutrin at night. Not much difference with unsplit XR; maybe a trifle more insomnia. Not a good idea generally I'd say.

Wellbutrin is rather well-known for causing or worsening mania in those with a predisposition. There lots of other antidepressants and augmenters which are less likely to trigger mania too many to list, so I'll just mention a few oddball ones I've used:

- Buspirone: works for about 1 person in 5. Very few side-effects.
- Tianeptine: very gentle, few side-effects. Unfortunately, only available online from France or UK.
- Ropinirole/Requip: off label use as an A/D augmenter. No use on its own, but significant improvement with almost any antidepressant or mood stabilizer. (Ref: Short communication in Can. J. Psych., in the archives somewhere).
-Kava-kava: coming back into use as a herbal supplement, it contains antidepressant components that act immediately. Be careful though: too much makes me hypomanic. More on the Alternative board.


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