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Does Wellbutrin plays the role of adjunct to SRIs?

Posted by SLS on December 28, 2022, at 15:48:18

Adding Wellbutrin (bupropion) to Effexor (venlafaxine) or Pristiq (desvenlafaxine) is one of treatments that I see the most success with in treatment-resistant cases. If intolerance to side effects is not an issue, I think Effexor would carry with it a higher probability of working than Pristiq. When you introduce venlafaxine into the body, most of it is metabolized into desvenlafaxine - Pristiq. That leaves Effexor as being two drugs in one - much like tertiary tricyclics are. I wouldn't call these drugs "pro-drugs" though. That's because the parent compound is biologically active. For me, Effexor can budge my depression. Pristiq was without effect. My guess is that some people don't need venlafaxine, and may actually have more side effects with it. This leaves Pristiq being a better choice for some people.

In practice, I don't think it makes sense to stop increasing the dosage of Effexor until 300 mg/day is reached. 225 mg/day just doesn't cut it for many people. It never did for me. An ideal target treatment might be to combine Effexor 300 mg/day with Wellbutrin 300 mg/day. The dosage of Pristiq that works most of the time is 100 mg/day. I don't know if there is any advantage to going higher than that. That's what doctors get paid to know. They might be treating as many as one hundred people at any given time in their practice. They know from working with 100 real people what works and what doesn't. They accomplish this without knowing the details of G-protein second-messenger cascades.

I feel that the role that Wellbutrin might serve best as is that of an adjunct / augmenter to serotonin reuptake inhibitors - selective or not.

Remember when Zoloft first came out? The combination of Wellbutrin and Zoloft was nick-named "Welloft" by psychiatrists. I have no idea which among the SRIs work best in combination with Wellbutrin.

- Scott

Some see things as they are and ask why.
I dream of things that never were and ask why not.

The only thing necessary for the triumph of evil is that good men do nothing.




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