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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by Christ_empowered on June 12, 2016, at 15:32:34
I am diagnosed w/ bipolar I. I take: 1200/Trileptal, 100/Lamictal, 30/Abilify, and 400/Wellbutrin SR. Overall, I'm doing quite well.
Only problem...I have some lingering depressive stuff (I had a couple cycles of psychotic depression that went un- or under-treated), plus some OCD-ish issues. I don't think I'm currently diagnosed with full fledged OCD; its more like...obsessive weirdness that pops up with mood swings (in my case, much more deep dips than trips into manic or mixed states).
I can take 100mgs/neurontin 2x daily as needed, plus I have 2mgs/risperidone when I get agitated. I don't usually take either.
Sooo...wellbutrin has been a godsend, but the obsessive stuff and the lingering depressive symptoms (sleeping too much sometimes, then waking up too early other nights; apathy; difficulty doing basic tasks, etc.) kinda has me concerned.
To be fair, life brings with it a certain degree of mood swings and such, so I don't wanna overdo it on AD meds. At the same time...I was so severely depressed for so long that now I'd really, really like to have remission.
Effexor+wellbutrin? I guess lexapro+wellbutrin would be easier, but I kinda want something to add a bit of stimulation, too. Cymbalta? At least the dosing's fairly easy...
I don't think I wanna try remeron. Its community/public mental health, so I won't get to adjust the dose for 3 months+/- (this is why I thought of cymbalta).
Any ideas? I thought Prozac, but it seems like that'd potentially mess up the blood levels of everything, plus I don't want to turn apathetic...
Advice?
Posted by rjlockhart37 on June 12, 2016, at 22:05:12
In reply to wellbutrin+effexor?, posted by Christ_empowered on June 12, 2016, at 15:32:34
prozac is my godsend, i've taken prozac 60mg with 300mg wellbutrin 7 years ago, its a good combination, but some people don't perfer prozac and more selective ones, you could ask about lexepro or luvox ... luvox is very good for obessive symptoms.....
luvox is good for obsessive symptoms......maybe ask your doctor about the L antidepressants, luvox and lexepro
Posted by Mary GG on June 14, 2016, at 14:45:54
In reply to wellbutrin+effexor?, posted by Christ_empowered on June 12, 2016, at 15:32:34
I just got off the cocktail of Wellbutrin and Effexor. I really loved what it was doing for me. Effexor made me very tired (as all drugs in that class do) but I tolerated it better than a lot of other drugs just as my DNA tests indicated I would. Wellbutrin gave me the extra boost of energy and motivation I needed during the day. Unfortunately I had a bizarre skin reaction to Wellbutrin which is uncommon but can happen. If you aren't as susceptible to side effects as some of us I'd certainly give that combo a shot. We are all so very unique and what works for one of us won't work for the next but I had tried EVERYTHING and that combo was really nice for me (minus my weirdo reaction). Please don't let my weird side effect deter you. You never know, this could be perfect for u. Anything is worth a shot for us to feel better.
Posted by Christ_empowered on June 14, 2016, at 17:06:21
In reply to Re: wellbutrin+effexor?, posted by Mary GG on June 14, 2016, at 14:45:54
oh, wow. Welcome to Psychobabble, btw.
I don't mean to be too nosy, but...what doses were you taking? I'm almost maxed out on Wellbutrin (400mgs, the SR, 2x daily version), so that's why I'm thinking that adding something might be the only viable option.
Thanks.
Posted by SLS on June 14, 2016, at 18:49:00
In reply to Re: wellbutrin+effexor?, posted by Mary GG on June 14, 2016, at 14:45:54
> I just got off the cocktail of Wellbutrin and Effexor. I really loved what it was doing for me. Effexor made me very tired (as all drugs in that class do) but I tolerated it better than a lot of other drugs just as my DNA tests indicated I would. Wellbutrin gave me the extra boost of energy and motivation I needed during the day. Unfortunately I had a bizarre skin reaction to Wellbutrin which is uncommon but can happen. If you aren't as susceptible to side effects as some of us I'd certainly give that combo a shot. We are all so very unique and what works for one of us won't work for the next but I had tried EVERYTHING and that combo was really nice for me (minus my weirdo reaction). Please don't let my weird side effect deter you. You never know, this could be perfect for u. Anything is worth a shot for us to feel better.
I did pretty well on a combination of Effexor + nortriptyline. I wonder if you might want to try it. Perhaps you can add Focalin in place of Wellbutrin to give you energy.
- Scott
Posted by Horse on June 14, 2016, at 21:29:37
In reply to wellbutrin+effexor?, posted by Christ_empowered on June 12, 2016, at 15:32:34
This is not answering your question exactly, and I note you want a little more stimulation. Personally, and I feel we are perhaps constitutionally different, that combo would increase my anxiety. My doc was contemplating adding Wellbutrin to my Trintellix. (Instead we went with Nuvigil.)
So Trintellix for example? In case synergy might produce something better than adding more stimulation. Just a thought.
Have you done well on Effexor?
Posted by Mary GG on June 14, 2016, at 23:52:40
In reply to Re: wellbutrin+effexor?, posted by Christ_empowered on June 14, 2016, at 17:06:21
I was taking 300mg Effexor and 300 mg of Wellbutrin. As well as 30 mg of Deplin (folic acid deficiency), 10 mg Dexedrine (ADD and just to keep me awake), and Xanax as needed. With regards to the Effexor and Wellbutrin it wasn't enough, I wasn't remotely "happy" but I managed. Unfortunately managing is now what I've learned to be grateful for. Effexor felt like a horse tranquilizer to me but my suicidal thoughts lessened. Wellbutrin gave me a bit more energy and I found myself with a bit more motivation which is why I am so disappointed that I had that bizarre skin reaction, I wanted to up the dose to 400mg. My ongoing issue is that my brain desperately needs more meds but my body has such severe reactions and side effects I can never get to an effective dose.> oh, wow. Welcome to Psychobabble, btw.
>
> I don't mean to be too nosy, but...what doses were you taking? I'm almost maxed out on Wellbutrin (400mgs, the SR, 2x daily version), so that's why I'm thinking that adding something might be the only viable option.
>
> Thanks.
Posted by Christ_empowered on June 15, 2016, at 2:20:21
In reply to Re: wellbutrin+effexor? » Christ_empowered, posted by Horse on June 14, 2016, at 21:29:37
hi.
I'm basically trying to get AD effects w/o too much apathy and/or sedation.
do you think Trintellix is the way to go?
One problem...I'm prone to apathy and all that slowed down, lethargic stuff, but my pdoc has me on 2 anticonvulsants. Standard dose (1200mgs) trileptal and low dose (100mgs) lamictal. Before the wellbutrin was added, it was a doozy...calmer, yes; less moody, absolutely; I was also out of it and weirdly sedated.
So, one reason we settled on wellbutrin was to counterbalance the 2 anticonvulsants. I don't know why I'm still on 2 of them. Could be worse...
Anyway, thanks for the replies.
Posted by horse1 on June 16, 2016, at 19:57:27
In reply to wellbutrin+effexor?, posted by Christ_empowered on June 12, 2016, at 15:32:34
Ack! Those lingering symptoms bite. I don't know what you could add, I guess I was suggesting a different tack. Is a stimulant off the table for you? Nuvigil has helped me, although, granted I need to cut my dose because of anxiety.
Did you mention Lexapro as a possibility? I didn't catch the mention of OCDish stuff the first time I read your post. Trintellix, I don't know if that would help or not. Phiddipus took it for awhile, and I think he liked it (he has major ocd), although it caused mania eventually, but I could have his experience all wrong.
Now that I've thought about that, I just saw my doc, and he's adding 450 mg trileptal because we're unclear why I feel a little agitated. So take my comments in light of this :)
Does trileptal cause cognitive you difficulties?
Posted by Christ_empowered on June 17, 2016, at 9:24:32
In reply to Re: wellbutrin+effexor? » Christ_empowered, posted by horse1 on June 16, 2016, at 19:57:27
hi. I think stimulants are out. Its community mental health. I think maybe they use provigil in recovering meth users (?), but not for everybody else. Go figure.
The more I read about the ill effects of effexor and cymbalta tapers, the less inclined I am to ask for an add-on. That's what I cannot stand about antidepressants...you need something to get through a patch, then you're stuck on it. Ugh.
Maybe Lexapro...the problem is that the last time I was on an ssri, it was just 20mgs/celexa added to the 30mgs/abilify. It was awesome for a couple months, because I'd been --so-- agitated and out of sorts, but then...wow...I was too placid, unmotivated, etc. I dropped it. Predictably, everything came back, plus extra.
Ugh. Maybe...with wellbutrin on board, I can take the lexapro or celexa w/o too much apathy and lack of motivation. Thing is...I don't wanna go above 4 daily meds if I can help it. I asked the pdoc if he'd pick 1 anticonvulsant and drop the other, and he said No. I don't know what that's about. Again: its public mental health...from what I've seen and heard, the meds kinda pile on, and nobody does anything about it. :-(
The trileptal was good when I was severely agitated and such, but...1200mgs on top of everything else kinda strikes me as a bit much, at least now that I'm stable and functioning at a higher level.
Ugh. Maybe I'll do some kinda alternative remedy. The most obvious move would be to ramp up my niacinamide (b3) dosage to more like 4-6 grams/day, and see where that takes me.
Thanks for the input.
Posted by Horse on June 17, 2016, at 14:31:27
In reply to Re: wellbutrin+effexor?, posted by Christ_empowered on June 17, 2016, at 9:24:32
Well, I can understand his reluctance to cut a mood stabilizer because you are stable and he doesn't want to mess with this. I think the lamictal is a depression prophylactic. It's not a mood stabilizer at this point (my assumption which can be very wrong).
I understand wanting to limit the number of meds.... I'm take more than I ever thought and that troubles me. But I am doing better.
Would he even prescribe an ssri given your diagnosis. Do you still take abilify?
Maybe he'd go for a tiny bit of provigil? It's now an relatively inexpensive generic. I understand about those lingering symptoms, and I hope he's willing to address them if you ask.
Posted by Christ_empowered on June 18, 2016, at 9:22:15
In reply to Re: wellbutrin+effexor? » Christ_empowered, posted by Horse on June 17, 2016, at 14:31:27
I doubt he'd go for Provigil :-(
I don't know about the ssri. I think now I'll just stick with what I'm on. Like I said, its community/public mental health, so they load people up on meds and are reluctant to take them/us off anything.
I do think the 100mgs/Lamictal is for depression. I was Rx'd that after Luvox and Prozac and Tofranil just made me feel weird and didn't do a whole lot to help me. Now, I take Wellbutrin SR @ 400mgs/day, and that's been a godsend.
I dunno. I appreciate the concepts behind community/public mental health...treatment in the community, recovery model, etc., but where the rubber hits the road...the focus is on meds, meds, meds, especially neuroleptics. I mean, I need a neuroleptic, so that's not a big deal for me, but...I dunno. Sometimes I perceive the clinic as a form of social control.((Feelin' kinda Marxist today))
Posted by Ruuudy on June 27, 2016, at 18:11:34
In reply to Re: wellbutrin+effexor?, posted by rjlockhart37 on June 12, 2016, at 22:05:12
> prozac is my godsend, i've taken prozac 60mg with 300mg wellbutrin 7 years ago, its a good combination,
I suggested augmenting my fluoxetine with Wellbutrin at my last vist, but he seemed a little hesitant, stating that he thought the Wellbutrin might cause an increase in my anxiety.
Can you recall any issues with Wellbutrin stirring up any anxiety with you treatment?
Thanks!
Rudy
This is the end of the thread.
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