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tiger8

Wellbutrin with SSRI - questions

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Hi all, I might have had dysthymia since age 19 (I'm 34 now). That is quite unemotional by default for some reason but I have many symptoms of it anyway, low energy/fatigue, oversleeping, lack of positive moods (but I'm reactive in the sense of reacting positively to positive stuff coming up), limited enjoyment of stuff (had more anhedonia before but it's still strong in some aspects), slight cognitive symptoms. This recently turned into extreme hopelessness with a lot of crying and pain which seems to match double depression that dysthymics can get. I managed to distance myself from that after a few weeks of it, but it's lurking under the surface along with negative thinking about my situation. I used to never have negative thoughts surface like that. I was more like I was stuck in my situation (isolation also since age 19) but I was relatively content on the surface (under the surface maybe not). Then I tried to get out of it by trying to change things actively about my situation. By making sense of things in how my attitudes and thoughts were wrong and fixing those (think CBT), tried to increase emotional awareness too a bit, tried to connect with people more on the whole. And that didn't work out and after a long time of trying and then failing big time this summer, is when things turned actively negative, in thinking and the double depression thing came.

I've also been going to therapists for 2.5 years now, been sticking to one therapist for 1 year now. I tried Wellbutrin once but it was weird. It worked for the first four days in the sense that I got positive energy from it, like a strong wind was reallllly pushing me from behind to keep moving ahead, I had to control things actually to not get scattered :) but it was great. Great for this anergic (low-energy) version of dysthymia. I also felt like some underlying feelings got "blocked out" that would otherwise suck me into my head too much thinking-analyzing all the time as a distraction. But then after 4 days I had a negative situation with people and I felt the negative more strongly than usual (I'd just be detached by default but that's what comes with low energy!), and then the positive energy turned off and never truly came back. 95% of it was gone instantly and the last 5% dwindled down over the next few weeks. After a month no effect whatsoever remained, I was back to the low energy unemotional mode.

 

OK, well, after describing my situation as above, my questions, would an SSRI be a good idea for this at all along with the Wellbutrin? I read SSRIs can blunt emotions and actually make people have lower energy or is this not a common effect? Because if this is true, it'd just make the baseline mode as described above worse. And, is my experience with Wellbutrin common at all?

 

Thanks for any replies.

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23 minutes ago, tiger8 said:

I read SSRIs can blunt emotions and actually make people have lower energy or is this not a common effect? Because if this is true, it'd just make the baseline mode as described above worse.

People react differently, I had one coworker who was on Prozac (SSRI) and she reported having a lot more energy after a few weeks. When I tried it it did nothing for me whatsoever, neither positive nor negative. I'd say ask your doctor about it and give it a try, it's the only way to find out. Wellbutrin can be a tricky one, in my case it strongly amplified negative emotions such as anger and anxiety but I've also heard of people who had amazing results with it. It's a crapshoot really, for some people it works great for others not at all, it's all trial and error and definitely not an exact science. 

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It seems to me that for Wellbutrin:

a) It on average takes longer to kick in than SSRIs
b) The variation in effect between people is greater than with SSRIs
c) The variation in effect for one single person varies over time with Wellbutrin more so than with SSRIs

I base this on nothing but reading a lot of accounts on this and other forums, so it might be complete b* though :-)

As for your reaction -- most people do not feel any effect at all the first few days on Wellbutrin, so what you experienced might be placebo or a natural variation?

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On 10/10/2017 at 9:48 AM, lonelyforeigner said:

People react differently, I had one coworker who was on Prozac (SSRI) and she reported having a lot more energy after a few weeks. When I tried it it did nothing for me whatsoever, neither positive nor negative. I'd say ask your doctor about it and give it a try, it's the only way to find out. Wellbutrin can be a tricky one, in my case it strongly amplified negative emotions such as anger and anxiety but I've also heard of people who had amazing results with it. It's a crapshoot really, for some people it works great for others not at all, it's all trial and error and definitely not an exact science. 

 

Sorry, I couldn't come back to reply for a while. Thanks for the input. I did have some sort of anxiety amplified while on it yeah, but even that effect was gradually dwindling down and I truly felt back 100% to being usual low energy unmotivated with lack of moods (positive especially) etc...

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On 11/10/2017 at 0:23 AM, Caprioli said:

It seems to me that for Wellbutrin:

a) It on average takes longer to kick in than SSRIs
b) The variation in effect between people is greater than with SSRIs
c) The variation in effect for one single person varies over time with Wellbutrin more so than with SSRIs

I base this on nothing but reading a lot of accounts on this and other forums, so it might be complete b* though :-)

As for your reaction -- most people do not feel any effect at all the first few days on Wellbutrin, so what you experienced might be placebo or a natural variation?

Thanks for your input too. So my dropping it after one month was too fast? How long should I have been trying it? I did that because I could watch how all the effects I was experiencing were dwindling down. I don't think it was purely placebo, I talked to a friend, they also felt at least the energetic effect in the first couple days. But then it was gone for them too.

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21 hours ago, tiger8 said:

Thanks for your input too. So my dropping it after one month was too fast? How long should I have been trying it? I did that because I could watch how all the effects I was experiencing were dwindling down. I don't think it was purely placebo, I talked to a friend, they also felt at least the energetic effect in the first couple days. But then it was gone for them too.

First of all I would like to express my sympathy for your condition. I've been in a somewhat similar state for quite a few years, due to a burnout slowly building up (it happened so slowly, though, so I was not aware). I, too, have experienced the double depressions, and it is truly shait.

Anyway, back to Wellbutrin. It is normally reccommended to stay on one dosage for atleast a couple of months (I have heard accounts of stable state not reached before three months have passed, but that is in the rare end of the spectrum).

However, it is your body, and you know best if things seem to be going in the right direction. It is truly a two-faced drug, with some people  seeing great results, while being totally crap for others.

I am not a doctor, but on the surface I think you are a good candidate for trying it. It is an activating drug, primarily increasing the amount of noradrenaline in your system, and dopamine to a lesser extent. But as far as statistics go, it works for some, and not for others. 

It is quite a powerful drug, meaning almost everyone see a fairly strong effect from it. Trouble is, of course, that those effects are not necessarily all of the good kind. To take myself as an example, I have had good effect in terms of reducing depression and anxiety, but it made me way too stressed out, so I am currently stepping down in order to try Brintellix instead.

I believe Wellbutrin not to be the first drug on the list of meds to try in most cases. Pure SSRI is usually the first weapon of choice, but your doc may have judged your condition to be suited for testing Wellbutrin first.

Personally, I would have tried an SSRI on its own to see how you respond. Would it blunt your emotions and give you less energy? While that might be true for some, others report exactly the opposite, especially when it comes to the energy.

In general, antidepressants do not have any lasting effect, in that their dierct effects on your body vanish when you stop taking them (they can, however, help you through a depression, which will be gone when you quit). This is good, as it makes "experimenting" with various drugs over time fairly safe and unproblematic.

If you decide to try SSRI, be aware that for most everyone it will provide a heavy blow to the between-the-legs department. The amount of people experiencing this is underestimated by a large margine in the drugs' information package. Both sexes usually see a heavy drop in their libido. Men can have trouble getting and keeping an erection, numbed sensation, and - worst of all - reaching orgasm can be close to impossible (prostate stimulation might be a must). Women can become dry and have their sensation numbed. Orgasm I am a bit unsure of.

If this is important to you, you might consider some of the newest generation of ADs, such as Brintellix that I am going to try myself. My GP consulted a psychiatrist for advice when I said I wanted to stay away from the "old school" SSRIs due to the above, as she did not have a lot of experience with newer meds such as Brintellix. I believe that to be the case with most GPs.

Best of luck with finding a combination of therapy and drugs that work for you :-)

Let me know if you have further questions!

Regards, Caprioli

Edited by Caprioli

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Hi there,

You should really give an antidepressant the full 8 weeks trial to decide if it's the one for you or not. I don't think your experience is unusual, the start-up effects of a drug are always weird and inconsistent. For me personally, my depression didn't begin to lift until about 2 months in on Wellbutrin. Another thing to consider is upping the dosage after a few weeks. I started on 150 mg and went up to 300. 

In regard to the SSRI question, I think it would be worth trying if the Wellbutrin doesn't work for you. Like other people said, yes some people will experience blunted emotions but other people get their emotions back and feel like themselves again on an SSRI. Everyone's chemistry is unique; it's really just trial and error. 

I know how awful dealing with this stuff is but stay strong, something will work for you and you will get better. 

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On 10/10/2017 at 8:20 AM, tiger8 said:
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Hi all, I might have had dysthymia since age 19 (I'm 34 now). That is quite unemotional by default for some reason but I have many symptoms of it anyway, low energy/fatigue, oversleeping, lack of positive moods (but I'm reactive in the sense of reacting positively to positive stuff coming up), limited enjoyment of stuff (had more anhedonia before but it's still strong in some aspects), slight cognitive symptoms. This recently turned into extreme hopelessness with a lot of crying and pain which seems to match double depression that dysthymics can get. I managed to distance myself from that after a few weeks of it, but it's lurking under the surface along with negative thinking about my situation. I used to never have negative thoughts surface like that. I was more like I was stuck in my situation (isolation also since age 19) but I was relatively content on the surface (under the surface maybe not). Then I tried to get out of it by trying to change things actively about my situation. By making sense of things in how my attitudes and thoughts were wrong and fixing those (think CBT), tried to increase emotional awareness too a bit, tried to connect with people more on the whole. And that didn't work out and after a long time of trying and then failing big time this summer, is when things turned actively negative, in thinking and the double depression thing came.

I've also been going to therapists for 2.5 years now, been sticking to one therapist for 1 year now. I tried Wellbutrin once but it was weird. It worked for the first four days in the sense that I got positive energy from it, like a strong wind was reallllly pushing me from behind to keep moving ahead, I had to control things actually to not get scattered :) but it was great. Great for this anergic (low-energy) version of dysthymia. I also felt like some underlying feelings got "blocked out" that would otherwise suck me into my head too much thinking-analyzing all the time as a distraction. But then after 4 days I had a negative situation with people and I felt the negative more strongly than usual (I'd just be detached by default but that's what comes with low energy!), and then the positive energy turned off and never truly came back. 95% of it was gone instantly and the last 5% dwindled down over the next few weeks. After a month no effect whatsoever remained, I was back to the low energy unemotional mode.

 

OK, well, after describing my situation as above, my questions, would an SSRI be a good idea for this at all along with the Wellbutrin? I read SSRIs can blunt emotions and actually make people have lower energy or is this not a common effect? Because if this is true, it'd just make the baseline mode as described above worse. And, is my experience with Wellbutrin common at all?

 

Thanks for any replies.

 

Hi tiger8

Yes, it's quite common to add Wellbutrin to SSRI treatment. I'm taking both. I also experienced an initial rush of energy 1 day after I started Wellbutrin (150 mg SR).  After 5-6 days, I started getting very irritated and that initial rush of energy was gone. However, I continued. The dosage was increased to 300 mg XL after 2 weeks. Ultimately, I started feeling the effects ( motivated, full of energy, concentration ) after 5 or 6 weeks.

My current regimen:

Lexapro: 10mg

Wellbutrin: 300 mg XL

Strattera: 60 mg

Lexapro seems to have higher success rate than other SSRIs. However, you need to wait for longer ( 6-8 weeks) to let it increase the level of Serotonin in your brain to an optimum level to feel its positive effects ( kick-in). I started taking Lexapro on 19 July, 2016 and it kicked in on Sep 5, 2016. You need a lot of patience while you wait for it to start working.

Wish you all the success & happiness,

Tashu

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