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Upping To 450 Mg Wellbutrin Xl


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#1 Tosca

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Posted 11 February 2009 - 12:03 PM

I'm currently taking Lexapro 40 mg along with 300 mg Wellbutrin XL for MDD and anxiety. I take the WB to augment the Lexapro, as well as to deal with some of Lexapro's side effects (mainly anorgasmia). When I first upped to 300 WB XL, I felt the difference in about a week. I felt normal, even good for about 4 days. The last couple of days I've felt iffy. It doesn't help that it's gone from being really cold and blindingly sunny (I love sun, don't care about the cold...I'm a bit SAD-ish in there i'm sure too) to being really grey and drizzly. Total yuck. I also have a couple of stressful things coming up later this week.

Pdoc (who I see again in 2 weeks) said that I should go up to 450 Wellbutrin after a week at 300 if I wasn't feeling better. Thing is, I *was*- for about 4 days. Every time he has suggested a med change, he ramps it up pretty quickly. I started seeing him when I was only on 20 mg Lexapro and it had stopped working. Right away, we upped it to 30, and then after (only) a week at 30, he said to up it to 40, for example. This seems fast to me, but maybe this is what they usually do. Dunno.

Anywho, one of the stressful events is coming up this weekend. I have to go out of town to visit my mother with my kids, it involves being in the car for 6 hours each way. Not exactly relaxing.

So, my question is: Do I up to 450 mg WB? (I know pdoc would want me to do this.) And if so, when? I am thinking it might be safest to wait until Monday, when I am back in town, if I this feeling doesn't pass by then.

Also, I'm really wondering if I simply haven't given 300 mg enough of a chance. I started 150 mg on Jan 20, then upped to 300 mg on Jan 28, which means I've been on 300 for about 12 days.

I'm not feeling unbearable. Just a bit down with some low-level anxiety.

I guess the nagging thing at the back of my head is the risk of seizure. I don't have any of the risk factors. I did ask pdoc about this, he said that 450 mg of the XL is fine- that other formulations at high dosages carry more of a risk.

Also wondering if it is okay to take the odd 0.5 mg of ativan when the anxiety is a bit too much. I don't take it regularly, and I've never taken more than 1 mg total in a day.

The other nagging thing at the back of my head is that maybe it's all about the Lexapro. It has worked at various doses- for awhile. Maybe it isn't quite right for me. The next step he said would be to swap the Lexapro for Cymbalta.

Help? Anyone?

#2 gaugreg1x

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Posted 11 February 2009 - 01:52 PM

I am not a psychiatrist but 12 days on 300mg ? No that does not sound like enough time to gauge effectivenes. Most of the posters around here are on 300mg, some on 150mg, not many on 450mg to my knowlege ? Greg

Pdoc (who I see again in 2 weeks) said that I should go up to 450 Wellbutrin after a week at 300 if I wasn't feeling better. Thing is, I *was*- for about 4 days. Every time he has suggested a med change, he ramps it up pretty quickly. I started seeing him when I was only on 20 mg Lexapro and it had stopped working. Right away, we upped it to 30, and then after (only) a week at 30, he said to up it to 40, for example. This seems fast to me, but maybe this is what they usually do. Dunno.

o, my question is: Do I up to 450 mg WB? (I know pdoc would want me to do this.) And if so, when? I am thinking it might be safest to wait until Monday, when I am back in town, if I this feeling doesn't pass by then.

Also, I'm really wondering if I simply haven't given 300 mg enough of a chance. I started 150 mg on Jan 20, then upped to 300 mg on Jan 28, which means I've been on 300 for about 12 days.

I'm not feeling unbearable. Just a bit down with some low-level anxiety.

I guess the nagging thing at the back of my head is the risk of seizure. I don't have any of the risk factors. I did ask pdoc about this, he said that 450 mg of the XL is fine- that other formulations at high dosages carry more of a risk.

Also wondering if it is okay to take the odd 0.5 mg of ativan when the anxiety is a bit too much. I don't take it regularly, and I've never taken more than 1 mg total in a day.

The other nagging thing at the back of my head is that maybe it's all about the Lexapro. It has worked at various doses- for awhile. Maybe it isn't quite right for me. The next step he said would be to swap the Lexapro for Cymbalta.

Help? Anyone?



#3 Burgy

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Posted 11 February 2009 - 02:21 PM

I agree with Greg that you haven't been on WB long enough to evaluate its effectiveness at 300mg. I'm no doctor either and I must give you the obligatory "do what they say" line, but I do personally think that your doctor is a little too eager. Even though 450mg is considered to be the maximum safe dosage, few people take that much, especially while on a substantial dose of another antidepressant, as you are.

If you read the thread about the WB honeymoon effect, you'll see that what you're experiencing is quite normal. Many, if not most people, feel much better almost instantly after beginning WB or upping the dosage, then crash after a few days. But then after a few weeks, they start to feel better again as the medication has a chance to build up and do its thing. It took me the full 8 weeks to stabilize on WB, to the point where my mood wasn't taking any major dips anymore. That's 8 weeks total on the drug, 4 at 150mg and 4 at 300mg.

It sounds like your pdoc is giving you some leeway, so I'd give 300mg more time, at least a month before you make any more changes.

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#4 amakgv

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Posted 11 February 2009 - 02:46 PM

I think these guys covered it pretty well. I'd like to also point out that wellbutrin could be the culprit in your current anxiety problem, and increasing the dose is likely to increase your anxiety more. The wellbutrin could be offsetting the anti-anxiety aspects of your lexapro, forcing you to adjust that dose to get it back.
Some docs are too conservative with meds, others too gung-ho. I think it's always a good thing when you question whether they are making the right decisions for YOUR health and you take the time to ask questions and learn more.
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#5 Darken

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Posted 12 February 2009 - 02:59 PM

Tosca,

Not much to add to what our other members have mentioned here. My doctor tends to be a little too fast in his decision to up my Wellbutrin as well..my second time on it he was upping it to 450 in a matter of 20 days. I told him I'll do it as I can tolerate and to this day I am still on the 300XL...450 being the maximum safe dose or not, still concerns me with seizure risk as it does you.

As the others have mentioned I think it makes more sense to gradually move up...(Originally I was 4 weeks on 150 and 4 weeks on 300) At least wait until after your trip to go to 450, that way if anything does happen you are home rather then away.

I will be curious to see if it helps balance out the side effects of Lexapro...my pdoc swears it will not change the sexual side effects of an SSRI...so if it does for you please post and let us know.

Lastly before changing your SSRI from Lexapro to Cymbalta take some time to read those forums here (if you haven't already) as its better to be educated in what you may be put on, (especially side effect wise) before finding out after.

Good luck and keep us posted.

Darken
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#6 Tosca

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Posted 12 February 2009 - 03:52 PM

Thanks everyone for your replies. They really help.

I have pretty much decided to hold off on changing anything at least until I am back from the weekend. At that point, I will have been on 300 mg for 17 days. I feel more comfortable upping to 450 mg after 2 1/2 weeks as opposed to 1 week. Anyhow, by the time I get back, the 300 mg will have stabilized and I'll be feeling better, or not. If not, I'll have to reassess and decide if I am going to try the 450 mg.

The good thing is that if I start the 450 mg, I will have had 9 days on it before I see pdoc again. I see this as saving him a step. If I could get him on the phone, I know he'd be telling me to start the 450 mg now for sure, because he told me to bump it up after only a week at 300 mg if I wasn't feeling better.

Darken- Funny, in the 4 day window where I was feeling better on the 300 mg, I did test out the sexual side effect theory about Wellbutrin. It definitely helped- but not completely. Still had some trouble having an orgasm, which is normally not at all difficult for me. Pdoc had mentioned that Mirapex might help too, but I haven't gone there yet. I'd rather get everything else stabilized for now.




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