SSRI + Wellbutrin?

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Sunnivara
Regular Member


Date Joined Apr 2007
Total Posts : 115
   Posted 5/1/2007 6:37 PM (GMT -7)   
I'm taking Zoloft for SA (Social Anxiety) and mild depression. I started at 50mg and after a few months I had some relief from the depression but no improvement with the SA. This was still good because, feeling less depressed, I was feeling more motivated and getting more done which, in turn, was making me feel better about things and further lifting my depression. But since it was doing nothing for my SA my doctor increased my dose to 100mg. That was about 2 weeks ago. Now I just feel tired and spacey all the time. There's still no improvement in my SA and now I've lost the motivation to get things done again due to the lack of energy and this is starting to depress me. So down I go. I was really hoping I'd be able to get out and live life again with Zoloft, not just sit here in a stupor.
 
I did some more research on the web and it seems Zoloft is not really affective for SA anyway, It's better for generalized anxiety (GAD), which I don't really have:
 
"Unfortunately, while the SSRI's are very useful for a variety of depressive and anxiety disorders, even drug company sponsored double blind clinical trials show they FAIL to produce ANY positive response in 75-85% of those who take them in monotherapy for the treatment of SP (Social Phobia)."
 
 
I've also read that combining a SSRI with Wellbutrin can be very effective for both depression and SA. It seems it can work because Wellbutrin gives a person feelings of self-confidence and assertiveness but the SSRI calms the anxiety Wellbutrin may cause. Wellbutrin can also help offset the lack of energy and brain fog caused by SSRI's.
 
Supposedly the best thing for SA is a MAOI but with all the dietary restrictions and potential drug interactions I refuse to try a MAOI ... at least not before I've tried everything else first. They supposedly work best because they effect all 3 neurotransmitters, serotonin, norepinephrine, and dopamine, while SSRI's only affect serotonin. But with the Zoloft working on the serotonin and the Wellbutrin working on the dopamine and norepinephrine wouldn't combining these two drugs have the same effect as a MAOI without so many risks and restrictions?
 
Have any of you had experience with combining a SSRI with Wellbutrin? Did they help balance each other out?
I don't want to stay on the Zoloft alone because I don't think it will acheive what I want but I'm not sure what to try next or what to tell my doctor. Any suggestions?
 

ShynSassy
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Date Joined Dec 2005
Total Posts : 3036
   Posted 5/2/2007 5:16 AM (GMT -7)   
Hi Sunnivara
I have been on wellbutrin but they combined it with Tranxene,so I am not sure about the other meds.
Hopefully other members will know.



Shy
Mod- Depression

Chronic Depression, Panic Attacks,Anxiety Attacks,Anorexia

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"I am woman,hear me roar one day and cry the next!!!"


Geebs
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Date Joined Jan 2007
Total Posts : 184
   Posted 5/2/2007 5:32 AM (GMT -7)   
Combining an SSRI with Wellbutrin is a very common tactic for treatment-resistant depression as well as reversing apathetic symptoms that sometimes occur with long-term SSRI treatment. It is well-tolerated by most people with minimal side effects.

I am not aware of the combo being used for social anxiety, but definitely talk with your doctor about it.

harry4
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Date Joined Mar 2005
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   Posted 5/5/2007 3:26 PM (GMT -7)   

I dont think the result of any antidepressant can be predicted, you have to try it for up to 6 weeks, with anxiety and depression, it may work for one, the other, both, or neither

I finally found the SSRI type helped a lot for my anxiety but have never found any AD that helps with my depression


recovered former longtime anxiety and panic attack sufferer and helper of other sufferers  but no training or  qualifications in medicine or psychology, any remarks that may be taken as advice must be confirmed with doctor or other health professional
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TexasJen
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Date Joined Dec 2006
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   Posted 5/5/2007 3:49 PM (GMT -7)   
What exactly is Social Anxiety? I really want to know. For me, the definition of SA means I have a really difficult time in situations where I am exposed to people I don't know personally - like large parties. After many, many years of avoiding such events, I finally determined that I'm sick and tired of feeling left out. I went to such events knowing they would be uncomfortable for me, and I had to force myself to put on my "happy face" and endure them. It took a couple of years or more, but now, I am not bothered. People will either enjoy my company - or they won't. Not my problem anymore. SSRI's certainly helped, but they weren't a cure.
Living in the Republic of Texas minus a gallbladder, a couple of cervical discs, appendix, uterus, and 18" of colon; but living with my wonderful husband, 2 dogs, 1 cockatiel, and 2 gold fish. 


els
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Date Joined Oct 2005
Total Posts : 4031
   Posted 5/6/2007 3:08 AM (GMT -7)   
Sunnivara, I left you a comment on your post regarding the Zoloft issue.  I wont go back into all that again here as well but here is the link to that post so you and others may view it easily.  I really do think you need to take this into consideration.  http://www.healingwell.com/community/default.aspx?f=19&m=803096

Elisha
Co~Mod: Depression
Moderator: Heart & Cardiovascular Disease
http://www.healingwell.com/donate


karenb
Regular Member


Date Joined Apr 2007
Total Posts : 58
   Posted 5/8/2007 3:46 AM (GMT -7)   
Hi Sunnivara,
I will list several options for social anxiety other than SSRIs, and if you find something suitable you may discuss it with you doctor:
Cognitive-behavioral therapy also may be effective treatment for SA. (Effectiveness of CBT in social phobia )
Gabapentin looks like promising medication with very mild side effects
Mirtazapine, this medication is associated with high rates of weight gain
 
As for Zoloft+Wellbutrin, this combination is used often, but mainly as antidote to SSRI's side effects (sexual dysfunction, fatigue) and when SSRI alone do not completely relieve depression.
Don't you want to to try Cognitive-behavioral therapy? It is never too late to add medication.

Sunnivara
Regular Member


Date Joined Apr 2007
Total Posts : 115
   Posted 5/8/2007 2:13 PM (GMT -7)   
karenb said...
Hi Sunnivara,
I will list several options for social anxiety other than SSRIs, and if you find something suitable you may discuss it with you doctor:
Cognitive-behavioral therapy also may be effective treatment for SA. (Effectiveness of CBT in social phobia )
Gabapentin looks like promising medication with very mild side effects
Mirtazapine, this medication is associated with high rates of weight gain
 
As for Zoloft+Wellbutrin, this combination is used often, but mainly as antidote to SSRI's side effects (sexual dysfunction, fatigue) and when SSRI alone do not completely relieve depression.
Don't you want to to try Cognitive-behavioral therapy? It is never too late to add medication.

 

Thanks for the info.

Yes, actually, I was planning on trying some CBT for the SA ... later. The problem is, until the depression lifts, I don't think it will be effective. I don't have the mental/emotional energy to dedicate myself to such therapy. Since Wellbutrin seems to be energyzing and motivating for a lot of people I was also hoping that it might add the energy and sense of confidence needed to be more effectively learn from CBT and to practice what I learn in real-life situations. Does that make sense?

karenb
Regular Member


Date Joined Apr 2007
Total Posts : 58
   Posted 5/9/2007 1:36 PM (GMT -7)   
I wish I can help you more, but I'm not a doctor and can't give you any advise. I can only share with my knowledge.
 
Yes, Wellbutrin is somewhat energizing, but it is usually not the best option when anxiety is present. However, antidepressant's effect is hardly predicted, as everyone is different.
 
To me, it seems it would be better if you can return to the 50 mg dose (as it was enough to relieve mild depression symptoms, and increased dose brought only adverse effects) and try CBT for anxiety. But I don't know if it is possible now to reduce dose and have previous good results without side effects.
 
I would like to let you know, that CBT may help with depression too, and it can have a long-term effects.
Here is info about CBT for depression: http://en.wikipedia.org/wiki/Cognitive_behavioral_therapy
A comparison of cognitive-behavioral therapy, sertraline, and their combination for adolescent depression at PubMed
The evaluation of cognitive-behavioral group therapy on patient depression and self-esteem at PubMed
 
I think, if you want to,  you have good chances to overcome both depression and anxiety without additional medications.

Sunnivara
Regular Member


Date Joined Apr 2007
Total Posts : 115
   Posted 5/9/2007 4:08 PM (GMT -7)   
karenb said...
I wish I can help you more, but I'm not a doctor and can't give you any advise. I can only share with my knowledge.
 
Yes, Wellbutrin is somewhat energizing, but it is usually not the best option when anxiety is present. However, antidepressant's effect is hardly predicted, as everyone is different.
 
To me, it seems it would be better if you can return to the 50 mg dose (as it was enough to relieve mild depression symptoms, and increased dose brought only adverse effects) and try CBT for anxiety. But I don't know if it is possible now to reduce dose and have previous good results without side effects.
 
I would like to let you know, that CBT may help with depression too, and it can have a long-term effects.
Here is info about CBT for depression: http://en.wikipedia.org/wiki/Cognitive_behavioral_therapy
A comparison of cognitive-behavioral therapy, sertraline, and their combination for adolescent depression at PubMed
The evaluation of cognitive-behavioral group therapy on patient depression and self-esteem at PubMed
 
I think, if you want to,  you have good chances to overcome both depression and anxiety without additional medications.
This could be due to my depressed perspective but ... I don't have a lot of hope for overcoming depression with behavioral therapy alone. I was "born" depressed, according to my mother. I cried all the time as a baby. I was never a happy, playful child. I was reclusive and shy in my earliest social situations. In my teens and early 20s I read many self-help books, studied Zen, tried self-hypnosis tapes for various attitude changes and building confidence, took classes in overcoming shyness, and even went through seminars like Lifespring (similar to est). Nothing had much effect or lasted long. My mother was suicidally depressed much of her life, my father was a dysthymic robot. Both of my grandmothers suffered from depression. One also suffered from agoraphobia. (I didn't know my grandfathers) Considering all that, I don't think I have a good genetic foundation to work with.

Sunnivara
Regular Member


Date Joined Apr 2007
Total Posts : 115
   Posted 5/9/2007 4:34 PM (GMT -7)   
karenb said...
Yes, Wellbutrin is somewhat energizing, but it is usually not the best option when anxiety is present. However, antidepressant's effect is hardly predicted, as everyone is different.
Actually, the more I think about it the more I'm beginning to think my Social Anxiety is not so much true anxiety as it is anti-social depression. I'm not afraid of people. I have no problem talking to someone when it's not a social call and I know what I'm there for (e.i. negotiating with a car salesman). I just don't like to socialize because I feel I never have anything interesting to talk about. Because of this I feel awkward when conversations turn to me, or when that horrible lull in the conversation occurs. Often I don't participate in conversations but just sit on the side and listen to others, talking only if someone talks to me directly. This makes me feel like people think I am boring, depressed, or find them boring ... all of which is probably true. If my depression causes a lack of interest in things and life it's hard to make conversation that isn't fake. I don't like to be fake. So I am honest or cut it short if my answers would be negative. For example, if someone asks me what I think of the recent news about the female celebrity who's going to jail and I don't have anything to say other than, I don't really give a darn if she goes or not, I usually just give a shrug or say I don't know about it. That's not a great way to carry on a conversation so  the conversation dies. This happens repeatedly and they think I'm boring and soon quit talking to me. Or I listen to my coworkers at lunch going on and on about some new movie coming out, like Spider Man 3. They'll ask, "Hey, did you see that new SM3 trailer? It looks awesome!" I'll just say, "yeah" while thinking silently to myself, "I don't go to movies, so I don't care." Conversation dies. They think I'm boring, move on to the next person at the table. It's easier to just go sit by myself than to try and pretend to be interested in things I'm not. If I could lift the depression and actually get some pleasure out of life, find some interests that actually excite me, I might find I actually enjoy talking about the things others enjoy talking about. At least some things. Right now there is NOTHING I can get excited about talking about. Thus, social situations get uncomfortable for me because I either have to sit there silently knowing I'm the bump on the log, or try to force myself to fake it, neither of which makes me relish social situations. So is that true Social Anxiety? Or is that just anti-social behavior resutling from depression?
 

els
Veteran Member


Date Joined Oct 2005
Total Posts : 4031
   Posted 5/9/2007 6:44 PM (GMT -7)   

Sunnivara, let me just start here by saying I am a few credits away from my masters in psychology and I have worked in the mental health field (managing psychiatric care facilities) for over 11 yrs. I also have depression, anxiety/panic disorder and PTSD which is mostly due to my childhood. So, I do know a little about mental illness and the insight into it.

Just from what you have posted I wouldnt in anyway say that you are describing anti-social traits.  Depression...yes, maybe some social anxiety disorder going on also but this can be very commen with depression and mostly with those that have had it long term. 

It is extremely important that you have a psychiatrist to diagnose and prescribe medications for you.  It very much sounds to me as if you have done all this "research" and now you feel that your qualified enough to tell your doctor what you want to take based on what you have read.  Then are also looking for other diagnosis that may or may not be there...this is not productive nor mentally healthly for you. 

You state that you dont have the time or energy to devote to CBT right now due to the depression.  But you have energy to devote to posting on here about how depressed you are which I am sure takes up time and you do your research about depression and meds.  All I am saying is that you have to take the step to decide your going to make yourself get better...It's not your depression kicking your arse, it's you kicking depression.

Medication may always be in the cards for you...I know it is for me to function.  But so is counseling to learn the skills you need to know to cope with this on a daily basis.  Make your appointments...Get Better

 


Elisha
Co~Mod: Depression
Moderator: Heart & Cardiovascular Disease
http://www.healingwell.com/donate


Sunnivara
Regular Member


Date Joined Apr 2007
Total Posts : 115
   Posted 5/9/2007 10:12 PM (GMT -7)   
els said...

It is extremely important that you have a psychiatrist to diagnose and prescribe medications for you.  It very much sounds to me as if you have done all this "research" and now you feel that your qualified enough to tell your doctor what you want to take based on what you have read.  Then are also looking for other diagnosis that may or may not be there...this is not productive nor mentally healthly for you. 

You state that you dont have the time or energy to devote to CBT right now due to the depression.  But you have energy to devote to posting on here about how depressed you are which I am sure takes up time and you do your research about depression and meds.  All I am saying is that you have to take the step to decide your going to make yourself get better...It's not your depression kicking your arse, it's you kicking depression.

Wow. I thought this was a place I could come and share my feelings and ideas without criticism. I guess not. Where exactly did I say I knew it all and was going to tell my doctor what my diagnosis is or what medication I should be prescribed? I have every intention of asking my doctor what she thinks, and asking her who else I should see. My posts here are just for tossing out feelings and ideas to see if others have had similar experiences and what they think. Did you notice my previous post ended with questions? This means I'm just curious about these ideas, not making absolute conclusions. Since when is it mentally unhealthy to question things and explore ideas?

As for CBT, that requires a whole lot more energy and dedication than an occasional forum post, which I can do while at work on my coffee break. Are you saying changing my life with CBT is as easy as taking 5 minutes while sipping coffee to post in a forum? I wish!

Something to keep in mind....depressed people are often sensitive types. If you want to be a psychologist please try to word things in such a way that you do not put people on the defensive, as you have done here with me. You, of all people here, should know that criticising is the least effective way to get a positive response from someone. If you did not mean to criticize, I'm sorry. Then you just need to try to word things in such a way that it doesn't sound critical because, frankly, it did....the typical "get your $&!+ together" speech I've heard a hundred times in my life that's never worked.

I hope I don't p!$$ you off. That's not my intention. I realize that underneath all that you are only trying to help. But it bothered me and I felt I needed to say something.

Post Edited (Sunnivara) : 5/9/2007 11:19:32 PM (GMT-6)


els
Veteran Member


Date Joined Oct 2005
Total Posts : 4031
   Posted 5/10/2007 3:59 PM (GMT -7)   

Hey Sunnivara, I'm sorry if have offended you with my post that wasnt my intention at all.  Your right that this site is for mutual support and understanding...which I have given to you.  I know CBT is a lot of work that was why I suggested counseling with a thearpist.  It is always your choice to decide to take another members advice/suggestions they give however, I have seen you ask lots of questions regarding meds and such yet not give any postive responses toward the feedback you have been given by those members.  Granted, this is your right to do but you have been given lots of excellent advice here and on multiple threads might I add.

It is easy for people to get wording mixed up when reading typing or get a feel of what someone really means when posting in a forum situation.  Perhaps I read you wrong and I am willing to concede that idea here.  For example:

Sunnivara said: Where exactly did I say I knew it all and was going to tell my doctor what my diagnosis is or what medication I should be prescribed? first post on this thread I don't want to stay on the Zoloft alone because I don't think it will acheive what I want but I'm not sure what to try next or what to tell my doctor.
I didnt say anything about you telling your doctor what your diagnosis is I just said it was up to a Psychiatrist to diagnosis these disorders.  In fact really a PCP shouldnt even be diagnosing any mental defects or disorders to start with but that is neither here nor there.  You have had 2 posts where your questioning what it is that you have...and trying to put a lable on it.  I can understand that as it is scary to feel this way...trust me I know. 
Research is good to do and I wouldnt want to discourage you from that.  It is so important to be informed of what your taking, possible side effects, and your diagnosis (when you get a rock solid one). 

Everyone here is at differant stages of depression which always makes a big differance with perception.  My post had nothing to do with telling you to get your crap together.  Fact is that people with depression dont seek help until it has reached an all time high point or crisis if you will.  We lack motivation to do anything other than what is necessary in life like work and eat.  It is just going through the motions.  I have been down in that dark hole so many times and each time it gets harder and harder to claw my way out.  I had my PCP for the longest time prescribing my medications and I too had done my homework and gave suggestions on what I wanted to take and didnt.  He always gave in or just wrote out the script.  I always thought I knew what I was doing, was informed and I guess most of that was stupidity since I had my degree BS in psych. and work with these medications.  I hit a hard spot in my life after I was diagnosed with my heart condition and my Zoloft stopped working for me.  I didnt go to the doc for an increase as I was at max dosage so I figured I could wait it out see if it gets any better...how stupid is that?!  It wont go away on it's own...lol!  I ended up back in the hospital (heart related) and really that is what saved my life as to the depression because my PCP referred that a private Psychiatrist come to the hosp. and see me.  He changed my meds straight off and I havent ever felt this good in my life.  That was a year and half ago and my Psychiatrist had to force me into counseling for childhood abuse issues...we all carry something around with us.  So no matter how much I thought I knew it turned out I didnt really.

I have strived to be supportive to everyone on this board and yeah, I am blunt and to the point which I wont appolize for, that is just me.  I dont dance around with words.  Critical I'm not as I have been there and know that at any one day I could be right back there and who know's how I would respond?  I hope it would be better than I have in the past.  Anyway, I do put alot of thought into what I write and how it is going to come across...the only thing is that I can not contol how someone may take it.


Elisha
Co~Mod: Depression
Moderator: Heart & Cardiovascular Disease
http://www.healingwell.com/donate


ShynSassy
Veteran Member


Date Joined Dec 2005
Total Posts : 3036
   Posted 5/11/2007 5:05 AM (GMT -7)   
Sunnivara
I am not sure why you think Elisha was being harsh. I will assure you that she is one of the most caring mods on this site,and gives great advice.
She is right sometimes when things are typed out then people take them the wrong way.



Shy
Mod- Depression

Chronic Depression, Panic Attacks,Anxiety Attacks,Anorexia
Meds I have taken throughout the years:Wellbutrin,Tranxene,Paxil,Prozac,Valium,
Currently taking none.
www.healingwell.com/donate

"I am woman,hear me roar one day and cry the next!!!"

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