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Welbutrin (Bupropion) is a dopamine-norepinephrine reuptake inhibitor; its occupancy at dopamine transporter (DAT) is 23%; whereas over 75% causes euphoria (ex. cocaine). A dopamine reuptake inhibitor (DRI) is a class of drug which acts as a reuptake inhibitor of the monoamine neurotransmitter dopamine by blocking the action of the dopamine transporter (DAT). Reuptake inhibition is achieved when extracellular dopamine not absorbed by the postsynaptic neuron is blocked from re-entering the presynaptic neuron. This results in increased extracellular concentrations of dopamine and increase in dopaminergic neurotransmission. I am currently taking Abilify 400 mg every 3 weeks (~ 20 mg / day) and 300 mg of Welbutrin. I was complaining to my psychiatrist about the side effects of Abilify I was suffering from; depression (low mood), sexual dysfunction, anhedonia, from a condition called "Neuroleptic Induced Deficit Syndrome" . I complained that I had totally lost my motivation, drive, and initiative and was experiencing anhedonia (lack of pleasure), emotional suppression, etc. It is like living in a mental restraint "straigthjacket". So my psychiatrist added Welbutrin. Abilify dampens down dopaminergic activity in three of the four dopaminergic pathways; It is the only Antipsychotic that I know of that can increase mesocortical dopaminergic activity. Other partial agonists like Brexiprazole and Cariprazine might do this also, whereas a silent antagonist cannot. Welbutrin has treated my low mood; I am euthymic now, but I am still anhedonic from Abilify being so frequent for such a dose; I am taking the daily equivalent of 20 mg: 400 mg per 3 weeks. At lower doses Abilify has a more stimulating effect. The Welbutrin he added certainly helps; but is unfortunately not enough. I am considering adding a dopamine full agonist such as Ropinirole, Rotigotine, Cabergoline and Pramipexole to my prescription meds. Some dopamine agonists are useful at treating depression resistant to SSRI-treatment. Dopamine agonists can be given to counteract the side effects of antipsychotics and serotonergic antidepressants. No doubt that dopamine antagonism has a negative effect on mood. In the mesolimbic pathway *(reward pathway)* Aripriprazole reduces dopaminergic activity; which reduces motivation - salience (liking, rewarding), which can be identified as a major source of anhedonia. Aripriprazole does not reduce dopamine transmission in the mesocortical pathway in people whose mesocortical pathway has .less than normal activity. The dopamine boost that Welbutrin provides keeps me stable; counterbalances some of the negative effects of Abilify. I just need more help in alleviating this zombified state of existence in which I am alienated from my own real self. and cannot enjoy the things I used to enjoy; food, drugs, sex. I live in anhedonia, a state of a loss of pleasure; due to the neurological inhibition caused by Abilify. Welbutrin works as a wakefullness promoting agent, a mild stimulant.
I've perused the boards for similar posts, but thought I'd throw out an arguably selfish request for evaluations of my particular mix. I know the answers are throughout the boards, but I hope to come to Cocktails for a tailored response. I know redundant posting is faux pas on message boards. In return I can only respond to threads where my input would be valuable. I'll do so. Current meds: Lamotrigine (150 mg 2x daily), Latuda (80mg 1x daily), Escitalopram (10mg 1x daily), Bupropion XL 24 hr (300mg 1x daily), Amantadine (100mg 3x daily), Clonazepam (0.5mg 3x daily), Methylphenidate (50mg distributed throughout day) History and Background: I've seen the same psychiatrist for years and he trusts and works closely with me given our history. I am diagnosed with major depression which is persistent and has been for years. Another significant diagnosis is one or another form of anxiety - primarily social. No panic problems, thankfully. I am doing as well as can be and function well consistently. I can tolerate medication changes well given experience. Current Questions: (1) Sleepiness, and Memory Problems Sleepiness has always been an issue, and I accept it to a big degree. I've learned to time dosing properly for the most part. Memory problems have grown and are very apparent in recent months. I blame 5+ years of Clonazepam at 0.5mg 3x daily. Latuda and Escitalopram do a lot for my particular anxiety. I'd like to move benzos to an as needed basis. I was actually given stimulants to combat sleepiness - nothing to do with attention disorder (1a) What can I change to minimize these, especially memory? Is tapering off Clonazepam feasible or adequate? What could be upped or added to mitigate its loss? (1b) What might be causing memory problems other than Clonazepam? Will awareness and cognition improve with its removal or is the damage done? (1c) Given the necessity and value of much of my cocktail, what can I do to mitigate sleepiness with little change? (1d) Is there any subset of drugs among those I'm taking that could be most blameworthy for cognitive problems or sleepiness? That is, is there a simple switch? (2) Akathesia, EPS, and Options Cogentin and its class are just not an option for me. Blurred vision, chemical dry mouth, and cognitive problems are just not worth it. I save it for dystonia in the emergency room. Amantadine has worked pretty well, but I cannot afford it on my upcoming insurance. This is with certainty. I don't know how Propranolol will balance with the other meds. (2a) Does anyone see implications of a switch from Amantadine to Propranolol given this cocktail? (2b) Any suggestions for akathisia given this mix? Cogentin is off the table. (2c) Are the effects of propranolol on the circulatory system, norepinephrine, and blood pressure contraindications with the rest of my meds (in your experience)? (3) Any other thoughts, experiences, advice, or criticism? Thanks! Past meds: Cymbalta (caused anxiety), Strattera (caused even more anxiety), Remeron (sleep oddities), Lithium (don't remember), Risperdal (extreme dystonia - thank goodness for Cogentin), Cogentin daily (dry mouth and very blurred vision), Xanax (very briefly - too strong), Focalin (dexmethylphenidate), Geodon (first breakthrough), other? Current meds: Lamotrigine (150 mg 2x daily), Latuda (80mg 1x daily), Escitolopram (10mg 1x daily), Bupropion XL 24 hr (300mg 1x daily), Amantadine (100mg 3x daily), Clonazepam (0.5mg 3x daily), Methylphenidate (50mg distributed throughout day)