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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.


Depression is an altered state of consciousness - SLS
============
Escitalopram
Bupropion XR
Diazepam 5 mg tid - weaning
Robaxin - non-prescribed
Kava - non-Rx, prn


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