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Re: Does Wellbutrin plays the role of adjunct to SRIs?

Posted by SLS on December 28, 2022, at 17:23:38

In reply to Re: Does Wellbutrin plays the role of adjunct to SRIs? SLS, posted by undopaminergic on December 28, 2022, at 16:48:12

> > 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
> I tried bupropion (Wellbutrin, Zyban, Voxra) at very high doses, chasing (at least an inkling of) a stimulant effect. It was ineffective. I would be interested in trying it again in combinations with other agents.
> -undopaminergic

I was treated with Wellbutrin while it was still investigational. An ideal dosage range had not yet been established. I took 900 mg/day for perhaps four weeks. If anything, Wellbutrin made me feel tired and slowed-down. When I discontinued it, I experienced a rebound-improvement that lasted a day or two. I get the feeling that dopamine and norepinephrine may not be the most important targets for Wellbutrin. I think nitric oxide should be looked at more closely. So, thinking of Wellbutrin as being a DA / NE reuptake inhibitor might lead people to expect a decrease in anhedonia. I would look instead at the SRI for improvements in motivation and reward. An SRI is more likely to cause you to want to do things and experience pleasure while doing it. I think Wellbutrin helps by increasing one's sense of mental energy and allows someone to persist at performing tasks. So, a primitive notion might be that a SRI gets you to want to do stuff and Wellbutrin gives you the mental energy to do it. Of course, apathy can be a side effect of SSRIs. However, my guess is that this is far less of a problem with Effexor and Pristiq. I don't know about Cymbalta.

- 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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