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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by Treehugger on November 25, 2008, at 10:24:26
Hi - I started taking wellbutrin 75mg a day, half in morning half at night & zoloft 25mg in the morning, suggested by my new doctor. I also take .5 clonazepam 3 times a day. It has been 25 days on the AD's & I am actually feeling worse - maybe the dose is too small?, maybe just a bad combo, maybe still too early to know. He said together they should act like an maoi - I don't know where he got this information, I have never heard of it. I had success with Nardil many years ago. I have heavy depression, worse upon waking, and social anxiety disorder. Starting to lose the slight optimism I have always had, and I am fantacizing about running off the road or into a tree while driving - not good. Any comments would be great - thanx, Tree
Posted by Phillipa on November 25, 2008, at 12:18:11
In reply to Zoloft +Wellbutrin - any success?, posted by Treehugger on November 25, 2008, at 10:24:26
Tree I'm sure not a med expert but myself have taken 50mg of zoloft and no effect good or bad with benzos. Wellbutrin another time with benzos acted manic. But I've heard effexor and wellbutrin work well together. Just example . But how would zolft and wellbutrin work like an Maoi? Sounds like a call to the pdoc is in order. I do know the run into a tree feeling frustration. Geez I hope someone with med knowledge of neurotrasmitters answers this but know at least that I'm feeling for you. Love Phillipa
Posted by raisinb on November 25, 2008, at 15:02:39
In reply to Zoloft +Wellbutrin - any success?, posted by Treehugger on November 25, 2008, at 10:24:26
I had a great couple of months on this combo. I still had to take sleep meds, but felt great emotionally. 50 mg of Zoloft was not enough for me, though; I had to be increased to 100. And 300 mg WB was too activating for me, so I went down to 150. 100 Zoloft and 150 Wellbutrin was very good.
Posted by azalea on November 25, 2008, at 18:12:50
In reply to Zoloft +Wellbutrin - any success?, posted by Treehugger on November 25, 2008, at 10:24:26
MAOIs like Nardil increase serotonin, norepinephrine, and dopamine. Zoloft inhibits reuptake of serotonin and Wellbutrin inhibits reuptake of norepi and dopamine. So, hypothetically, the combo should cover all 3 neurotransmitters. In reality, this combo may not be as effective as an MAOI. Perhaps you could go back to the Nardil? (after a 2 week washout)
He said together they should act like an maoi - I don't know where he got this information, I have never heard of it. I had success with Nardil many years ago. I have heavy depression, worse upon waking, and social anxiety disorder. Starting to lose the slight optimism I have always had, and I am fantacizing about running off the road or into a tree while driving - not good. Any comments would be great - thanx, Tree
Posted by Treehugger on November 25, 2008, at 20:23:29
In reply to Re: Zoloft +Wellbutrin - any success? » Treehugger, posted by raisinb on November 25, 2008, at 15:02:39
> I had a great couple of months on this combo. I still had to take sleep meds, but felt great emotionally. 50 mg of Zoloft was not enough for me, though; I had to be increased to 100. And 300 mg WB was too activating for me, so I went down to 150. 100 Zoloft and 150 Wellbutrin was very good.
raisinb, hi - just a couple of months? you quit, it pooped out, or tried something else? Thank you for your post. Tree
Posted by Phillipa on November 25, 2008, at 20:24:06
In reply to Re: Zoloft +Wellbutrin - any success?, posted by azalea on November 25, 2008, at 18:12:50
Azalea really? Then a person would have the feeling on an maoi without the risk and food restrictions? Am I reading your correctly. Thanks Phillipa
Posted by raisinb on November 25, 2008, at 21:15:39
In reply to Re: Zoloft +Wellbutrin - any success?, posted by Treehugger on November 25, 2008, at 20:23:29
Zoloft + Wellbutrin was basically the first thing I tried, and it worked. However, I was prescribed it by my primary care dr, and subsequently decided I'd better get a pdoc.
The one I've got (who's great, otherwise) is a bit of a perfectionist. My depression was totally gone, and my anxiety wasn't too bad either, but I was still very thin (lost tons of weight from depression and wasn't gaining) and still had to take meds for sleep. She felt that we shouldn't stop until I got "complete remission of symptoms" and that going on Remeron would be better. Well, Remeron did not work at all, so I started taking Zoloft/WB again. I was so depressed at this point that I think I titrated up too quickly and experienced horrible anxiety. Or maybe the combo just didn't work the same after I'd gone off of it.
Now my pdoc has me on Lexapro (10 mg). I'm also still on Zoloft 50 mg. I'm doing okay, but sometimes I wish I hadn't gone off Zoloft and Wellbutrin, because it's the best I've had it so far. Then again, it's the holidays, and it would have to be a "miracle drug" to get me completely depression-free during November and December.
So...there's my unfinished story, and your mileage may vary. The worst side effect from the combo I experienced was some sexual dysfunction--I'd have orgasms, but not really feel them. Very frustrating.
Posted by llurpsienoodle on November 26, 2008, at 6:42:45
In reply to Zoloft +Wellbutrin - any success?, posted by Treehugger on November 25, 2008, at 10:24:26
hi tree hugger,
I currently take 100mg of zoloft in the pm, and 150 wellbutrin am and also in the afternoon (sometimes I forget ! yikes!)-- another 150 wellbutrin.I also take 300mg of lamictal and ambien or sonata for sleep, as needed.
I found that once I had gotten used to the wellbutrin (it took about 8 weeks for things to settle down) I had no need for the benzos and was able to stop taking klonopin. Just a warning is that I DID have a lot of hypomania and racing thoughts and stuff on the wellbutrin.
When I started taking the wellbutrin (I added it onto the zoloft that was already in place) I felt fine for a few hours and then the agitation and anxiety would return around dinnertime. So, that's why I take it twice a day. I wonder if your dosages are too conservative, especially if you are starting to have thoughts of dying...
Please take good care of you, and keep your pdoc up to date about the "tree hugging"
-Ll
Posted by Medline on November 26, 2008, at 13:48:44
In reply to Re: Zoloft +Wellbutrin - any success? » Treehugger, posted by llurpsienoodle on November 26, 2008, at 6:42:45
Combining Bupropion with SSRIs will increase levels of 5-HT, NE and DA. MAOIs like Parnate also "hit" this systems (and many others), but via a completely different mechanism and probably "harder" (AFAIK Bupropion is not a very strong DRI). Nardil also increases brain GABA levels as one of it's metabolites is a GABA-transaminase-inhibitor.
To make a long story short: Bupropion/SSRI-combos are no "MAOI-substitutes". Nevertheless this AD augmentation/combination-strategy can be a very effective one, also for partial- or non-responders to SSRIs. The prefered SSRI should be one with low interaction potential like Citalopram/Escitalopram/Sertraline as Bupropion interferes with the metabolism of many drugs including some SSRIs like eg. Paroxetine.
Posted by Treehugger on November 26, 2008, at 21:52:43
In reply to Bupropion + SSRI, posted by Medline on November 26, 2008, at 13:48:44
Wow, thank you everyone for such helpful info - I raised my dose today - still being conservative, so upped both 50%. I would so much like to get off the clonazepam - have tried before & just couldn't. If this combo finally works maybe it will make the taper down smoother. Tree
Posted by Medline on November 26, 2008, at 22:16:22
In reply to Re: Bupropion + SSRI, posted by Treehugger on November 26, 2008, at 21:52:43
I don't know your exact Bupropion dose at the moment or for how long you took the Clonazepam (1.5mg?). But Coming off Benzos could/will be harder and more problematic if someone also takes Bupropion (increased seizure risk, more anxiety...). Just take it slow and listen to your body and Pdoc. Good luck, Medline ;-).
Posted by Treehugger on November 29, 2008, at 10:22:18
In reply to Re: Bupropion + SSRI, posted by Medline on November 26, 2008, at 22:16:22
Med - I have been on clnazepam for about 5 years, mostly at about 1mg per day -now 1.5. I upped the dosage of Bupropion & Zoloft on Nov. 26 to 112.5 & 37.5 respectively. Having trouble sleeping but making it - no sleep meds. I am not feeling better, worse I would say. No motivation, agitated & tired at the same time - pretty much constant depression. Maybe I should stop the meds? Having trouble thinking so I am not sure what is the best decision. Next doc appointment Dec. 8. So looking for more input - thanx, Tree
Posted by raisinb on November 29, 2008, at 18:19:34
In reply to Re: Bupropion + SSRI » Medline, posted by Treehugger on November 29, 2008, at 10:22:18
That is a really low dose of Zoloft. 50 mg made some difference for me, but I did not see complete remission until I took 100 for awhile.
Posted by Treehugger on November 30, 2008, at 9:58:11
In reply to Zoloft +Wellbutrin - any success?, posted by Treehugger on November 25, 2008, at 10:24:26
Hi again - I'm not having much success - I know that my dosages are low, but after a total of 5 weeks I think that this is a bad combo for me - too agitating even with my 1.5 clonazepam. So I think I will stop - wondering how slow I have to taper after such a short term, or if I can just stop. Thanx for all your comments, Tree
Posted by JadeKelly on December 1, 2008, at 10:49:37
In reply to Zoloft +Wellbutrin - any success?, posted by Treehugger on November 25, 2008, at 10:24:26
Hi Treehugger,
I think I posted this somewhere else, but success story worth repeating, right? I am close to someone who tried Wellbutrin alone, nothing. Cymbalta alone, nothing. His PDoc combined the two and he's in remission as a result. Let me know if you would like dosage info., s/e's etc.
Keep trying, something will work!
~Jade
Posted by raisinb on December 1, 2008, at 13:34:19
In reply to Re: Zoloft +Wellbutrin, posted by Treehugger on November 30, 2008, at 9:58:11
You don't have to taper Wellbutrin, according to my pdoc (and I have stopped taking it suddenly in the past and it didn't seem to do anything, though use your judgment).
Any SSRI, including Zoloft, should be tapered down. Can you ask your pdoc for a tapering schedule?
Wellbutrin causes anxiety in lots of people. Zoloft can also cause increased anxiety--I have a friend who had severe panic attacks from it.
Keep trying, there are so many med options and something will be the right combo for you.
This is the end of the thread.
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