Psycho-Babble Medication Thread 1103210

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Treatment Resistant Depression + Wellbutrin Add On

Posted by bonesintoronto on February 12, 2019, at 11:00:53

Hello Everyone.

I'm new to the forum and am hoping for some advice from people who have lived the experience. I just turned 60 years old, female. I have dx. of OCD and anxiety with post partum depression. Have been on an SSRI (currently on Prozac) since 2001 when my OCD became out of control. It helped me tremendously. Although I've suffered with OCD and social anxiety most of my life I didn't suffer with depression. When I hit menopause - about 5-6 years ago I started to experience major depression with suicidal thoughts. I've tried a number of SSRI's at various doses that didn't help. My psych doc (at time - just consult) suggested I augment with Lyrica - which I have been for past 2.5 years. It worked very well at first - improved mood, sleep and anxiety. Now effects are fizzling out. Memory is dreadful. Will have to keep increasing dose which I feel is making me more stupid. (I keep fearing that I have early dementia.) I recently added Wellbutrin XL 150 mg to augment my Prozac 20 mg. Only been on 4 days but I am totally wired. There have been improvements in my mood - feeling hints of my old self. Memory is amazing - remembering all the names of my clients again. LOL. Motivation improved. The trouble is I'm not sure I can live with this terrifically wired feeling and insomnia. Insomnia has been the worst of my depressive symptoms and a series of 'bad nights' exacerbates my OCD. I'm still working at a somewhat demanding job. I've read to "keep on plowing through" the side effects and they will subside after a couple of weeks. Not sure I can do it. Another night (4th) of 4 hours sleep and racing thoughts. Took clonazepam 0.5 last night and helped a little. Five hours sleep. I'm thinking that I can ask doc for clonazepam bid for next month until symptoms possibly subside?? But really do NOT want to take a sleep aid. Tried all of them and find that they don't help. Magnesium the best. Trazadone - hung over. Zopiclone - 4 hrs. sleep only. Clonazepam helps but developing tolerance, and don't want to get dependent. I can see the benefit of this augmentation with my depressed mood, but it is increasing anxiety and insomnia. Questions are: 1) Do you think if I switch to Wellbutrin IR from Wellbutrin XL and drop the last dose prior to sleep, that my mood would be maintained and sleep improved? 2) Do you think I should continue with Lyrica and Prozac - although I am obviously developing tolerance to Lyrica and is terrible for memory. 3) Any other suggestions for augmentation?
I'm wondering if 20 years of a seretonin enhancing med has caused my other neurotransmitters dopamine and norepinephrine to be 'out of wack' and hence the improvement in depression with Wellbutrin?

Thank you everyone. I realize this message is a little long, but a lot of needed details.


Re: Treatment Resistant Depression + Wellbutrin Add On

Posted by Christ_empowered on February 13, 2019, at 5:48:36

In reply to Treatment Resistant Depression + Wellbutrin Add On, posted by bonesintoronto on February 12, 2019, at 11:00:53

hi. ssri+wellbutrin is a fairly common strategy. I've had a couple of acquaintances who did well on Lexapro+wellbutrin...the only difference, I think, is that Prozac is generally regarded as more "activating" than lexapro.

lyrica...I dunno. Here in the US, it doesn't seem to be as popular for anxiety as it is elsewhere. Meanwhile, benzodiazepine prescribing has hit new highs (true story). But..sedatives, in general, carry some risk of cognitive problems related to treatment. benzodiazepines in some populations are associated with more accidents, falls, impaired cognitive performance. Even the sedating older antidepressants (tricyclics) are kind of frowned upon in some groups, for similar reasons.

but..."do what works," right? I will say that I take gabapentin, which is less potent than lyrica but I think chemically-related, is effective for anxiety, etc. with other stuff on board, but I kind of suspect clonazepam, lorazepam (high potency benzodiazepines) caused fewer concentration and memory problems, during treatment.

clonazepam can be great for agitation, anxiety....but over the long haul, it seems more likely than many other benzodiazepines to cause depression or make depression worse. way back when, I had some -severe- mood problems that were definitely at least partly due to long term, daily clonazepam treatment. im not trying to scare you, just saying...psychiatrists seem to be willfully blind to this "side effect." :-(

i dont know your medical coverage situation, but some people swear by modafanil. here in the US, its a controlled substance, but not as heavily controlled as traditional uppers. Ritalin is a traditional stimulant that is also used in depression now and then, especially when there are issues with other health problems, fatigue, concentration problems, lethargy, etc.

its still "off label," but some cns drugs are used in mood problems, such as mirapex. I think its fda-approved for dementia (?), but the appeal is that it can help lift mood by acting on dopamine...

but its not a traditional stimulant, so there's not a big problem with psychosis, euphoria, dosage escalation, agitation, etc.

-if- you and your prescriber decide to see about stopping the lyrica, please please please do yourself a favor and ask for a very, very slow taper. same with any benzodiazepines, especially the high(er) potency ones.

ok. hope this helps a bit.


Re: Treatment Resistant Depression + Wellbutrin Add On

Posted by PeterMartin on February 13, 2019, at 15:29:55

In reply to Re: Treatment Resistant Depression + Wellbutrin Add On, posted by Christ_empowered on February 13, 2019, at 5:48:36

I would highly recommend a very tiny dose of Seroquel (only for sleep) at bedtime. That's all I take it for. I take 12.5 to 25mg of Seroquel and that has gotten me to sleep for 12yrs now regardless of whatever else I've been taking. There's no addiction, no tolerance, no weight gain. At low dosages Seroquel pretty much just hits the histamine receptor really hard.

The problem w/ switching to IR is that you'll have to deal w/ crappy generics. There are a lot of issues w/ Wellbutrin generics (trust me google it). I think Sandoz is the brand people recommend but best to read up on them and call pharmancies ahead to see what they carry if you go that route.


Re: Treatment Resistant Depression + Wellbutrin Add On

Posted by creepy on April 7, 2019, at 22:21:26

In reply to Treatment Resistant Depression + Wellbutrin Add On, posted by bonesintoronto on February 12, 2019, at 11:00:53

That is a really, really stimulating combination. I wouldnt do that if you have anxiety and sleep issues. coming off of lyrica can be tough too.
I have been through a pile of trials of wellbutrin and all it does now is make me anxious and irritable.
I think that combination may interact and cause higher than expected levels of both drugs. you may want to ask about that, and possibly ask about lowering prozac.

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