Posted by NKP on December 29, 2022, at 4:21:13
My psychiatrist has me on 225 mg/day venlafaxine, 150 mg/day bupropion (to counteract anhedonia and sexual side-effects of the venlafaxine), and 200 mg/day lamotrigine.
The side-effects of the venlafaxine are still a problem, even with the bupropion. It also causes me to sweat excessively, something that bupropion will not help with.
So I'm considering either (i) reducing the dose of the venlafaxine, or (ii) to ask my general practitioner to replace the venlafaxine with 50 mg/day of sertraline. Both of these options would be done without the blessing of my psychiatrist, as it takes weeks to get an appointment with him.
I doubt that my GP would agree to (ii) anyway, because in the past he was reluctant to interfere with what my psychiatrist was doing when I asked him for medication changes.
Back when I used 50 mg/day of sertraline, I had zero side-effects from it.
Would you say that venlafaxine is a better antidepressant than sertraline? Especially when combined with bupropion? Considering that bupropion has norepinephrine reuptake inhibition too?
To be fair however, the venlafaxine seemed to fix my cognitive problems better than sertraline did, so that's possibly a reason to stay on it.
My psychiatrist said that the next step would be to increase the bupropion to 300 mg/day if the 150 mg/day doesn't do the trick.
One problem that I see here, is that bupropion increases serum levels of venlafaxine, thus indirectly worsening the venlafaxine side-effects at the same time as directly counteracting them.
My psychiatrist seems to not want to mess with what's working. He said that he'd rather add things than remove things. He was very averse to even reducing the dose of my venlafaxine when I asked him about this ("maybe some day, but we're not there yet"), and when I suggested replacing the venlafaxine with sertraline and flupentixol, he was basically like "no way, forget about it".
What should I do?
poster:NKP
thread:1121393
URL: http://www.dr-bob.org/babble/20220917/msgs/1121393.html