Posted by Patient on October 26, 2003, at 17:33:11
In reply to Re: Lexapro w/ Wellbutrin , posted by Patient on October 11, 2003, at 18:24:22
> Hello,
>
> Many doctors will add or augment Wellbutrin to SSRI's. The added boost from the reuptake of norepinephrine and dopamine from the Wellbutrin can be helpful if one isn't completely responding to an SSRI, or, as in your case, to counteract daytime somnolence, as well as some other side effects of SSRI's.
>
> I have, unofficially, Borderline Personality Disorder-can be difficult to treat, especially anger outbursts have been a problem for me, as well as still getting depressed while taking SSRI's. I've been taking Lexapro since February of this year. I started out with 5mg daily in morning, and 250mg of carbamazepine(Tegretol, mood stabiliser) for the first month, then increased Lexapro to 5mg twice a day. (I couldn't tolerate 10mg at once on most days-it made me a bit on the anxious side.) After a month of this combination I couldn't take the severe somnelence-I was a walking and napping zombie. So, stopped the carbamazepine, only taking it a week or two before my period starts, since this is when I'm most irritable. After a couple months I reduced down to 5mg daily Lexapro, mainly due to affordability. For me, 5mg daily is just as effective as the twice a day dosage. As of recent, I no longer take Tegretol as it seemed to make the daytime sleepiness even worse, especially 12 or so hours after taking it. I really didn't notice any improvement with it anyway, though was taking a low dose.
>
> Here is where I finally get to the part about my experience with Wellbutrin (I can be long-winded).
>
> A couple of years ago I had been prescribed Wellbutrin SR and took 150mg a day. It made me relaxed, but I was quick to snap at my husband-it was a strange combination-to be relaxed and easily irritated at the same time. I tried increasing to 300mg a day and couldn't handle the "snappiness". That was my month+ experience with Wellbutrin by itself.
>
> In the past couple of months I have been experiencing what I call, false hunger pangs. While eating I would feel hungry, but an uncomfortable hunger. Just recently I stopped drinking real coffee-my stomach said no more. I don't know if it is from the Lexapro, but someone else on this board said they experienced acid reflux after taking Celexa. I have some leftover Wellbutrin SR and for the past few days I've been taking 150mg once in morning, and 5mg Lexapro in mid-afternoon. Wow-what a difference! I thought the Lexapro was helping, but after a few days on the Wellbutrin I feel ten times better-more alert-able to fill out a crossword puzzle within a shorter period of time, do not feel lethargic or tired during the day (just as you mentioned). The best part is that I feel relaxed-a calm feeling-and an added surpise is that my stomach is no longer bothering me. I do know that Wellbutrin can supress the appetite. I no longer am aware of my stomach throughout the day-no more pangs. I've only been on this combination a few days, but I am happy with the results so far. I'm ashamed to admit that I usually drink a glass of homemade wine or beer in the evenings to help calm me, and this isn't good, especially if you are taking any medications. Since I've taken the Wellbutrin I no longer want a glass of wine to relax me in the evenings. I have Ativan (lorazepam) if I need it, but I try to avoid it as my doctor told me the benzos can disrupt sleep cycles-eveningtime was usually when I'd take Ativan-it's effects lasting well into the A.M. hours.
>
> You are on a low dosage of Wellbutrin-make sure you take it as early in the morning as possible. Sometimes the insomnia-effect goes away after you've been on Wellbutrin a while.
>
> I would suggest you ask your doctor about trazodone (Desyrel). It's an older antidepressant that today is more commonly prescribed in a low dose to counteract insomnia caused by stimulating antidepressants. In my opinion, it works better than Ambien (zalpidem)or Sonata (zaleplon), as these only last a few hours, whereas trazodone helps one sleep the night through. Months ago my doctor prescribed 50mg trazodone taken at bedtime-he said it doesn't disrupt sleep cycles. It worked great at helping me sleep, but would cause stuffy nose and dry mouth, enough to keep me awake for the first two hours after taking it. Eventually I found 12.5mg worked fine without side effects. For me, it usually starts to make me sleepy in about thirty minutes to an hour.
>
Escitalopram and Bupropion updateI saw the psychiatrist last week. I have been doing well, so he merely renewed my prescriptions. He had written me a renewed prescription for Wellbutrin SR 150mg tablets a few months ago, but I never got it filled, because I had some tablets remaining from 2001 prescription. We talked about how much better I am doing since I added the Wellbutrin to the 5mg Lexapro; feeling calmer during day and into evening, no more alcohol, and I'm not snapping from the Wellby. The only trouble was that I had to start taking a small dose of trazodone every night to help me sleep, since the Wellbutrin in combination with Lexapro was causing mild insomnia. He gave me some samples of 100mgs of Wellbutrin SR to see if this lower dose would be better. It was! Now I rarely, if ever, need to take 12.5mg of trazodone to help me sleep. Doctor also told me, according to the Wellbutrin drug literature, that due to Wellbutrin's affect on certain isoenzymes (CYP2B6), that it could cause an increase in certain other drugs, including SSRI's; one may have to reduce SSRI dosage when taking them with Wellbutrin. I'm already taking a low dose of Lexapro, so this isn't a problem for me. If anything, he said I could take the Wellbutrin every other day, because many of Wellbutrin's important metabolites-with actions not quite understood-last in the body for more than a day (hydroxybupropion, threohydrobupropion, and erythrohydrobupropion). I haven't tried every other day Wellby, yet. Right now I am taking the Wellby in the morning and Lex in afternoon.
Doctor also renewed carbamazepine (Tegretol), but this time he forgot to make it the extended-release form. I tried the regular 200mg form and within about an hour+ I had false-hunger pangs like I complained about. I thought this was caused by the Lexapro, or maybe from my vitamin/mineral supplement. I looked in my drug journal and sure enough, during those days I took carbamazepine, whether timed-release formula or regular, it caused those wrenching false-hunger pangs. That mystery is solved! I looked at the side effect profile for carbatr. and it states "stomach distress" or "gastic distress". I'm not going to take it any more. If I can do well on the Lexapro and Wellbutrin combination, than that is all I want to take-don't like to take any more drugs than I have to. I like this energy I now have-no more apathy-and no more need for a glass of wine to calm me down in the evenings for I already feel calm. I find it strange that a so-called stimulant can make one feel calm-now I understand why some doctors prescribe it for those that have anxiety, not just depression-in certain situations stimulants have a calming effect instead of setting off anxiety.
That's it really. Just an update.
poster:Patient
thread:109458
URL: http://www.dr-bob.org/babble/20031025/msgs/273708.html