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Bupropion augment for anxiety?


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Hi again everyone, 

I'm looking for an augmentation strategy for bupropion XL 150, which helps tremendously with  my depression, but worsens anxiety (GAD/obsessive worry)...I had OCD as a kid and I find bupropion brings up some of those old symptoms, mostly thoughts not compulsions, but I don't want to go off it because I love what it does for my mood, motivation and patience. I don't have access to a regular pdoc but there's one who works with my GP who I've requested to see, but usually my GP just prescribes and clears things w the pdoc. 

Last time I saw him the pdoc suggested buspar, which I have tried for a number of months at 20 then 25 mg/day and it doesn't seem to do anything for the anxiety, helps a bit with bruxism though. 

His other suggestions were remeron but I'm super afraid of weight gain or lyrica/pregabalin, which sounds like it has a lot of weird side effects like edema and cognition stuff. I'm an artist and I am especially reluctant to try anything that dampens creativity and thinking. 

I've been curious to try lamictal for a long time but my GP is always like "you're not bipolar", but I know lots of people do take it for unipolar depression....any chance it would help with anxiety? I would be open to either augmenting or replacing the bupropion w this one...

Any thoughts would be so helpful!!! Thank you!!!

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2 hours ago, Selkie said:

Any thoughts would be so helpful!!! Thank you!!!

I actually tried Wellbutrin for awhile, but I stopped it due to the extra anxiety.......I haven't tried Lamictal, so I can't comment on that one.....Buspar did nothing for me, either.

Here is a page I found with various meds used for anxiety disorders:     https://anxieties.com/152/med-intro   As you can see, there are quite a few options.

As for me personally, I take a benzodiazepine drug called clonazepam (brand name Klonopin) for anxiety.

Edited by CrazyRedhead
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Also curious about augmenting with a tricyclic ? (I am done with SSRI's SNRI's so those  aren't an option)....Can anyone explain or point me to a thread that helps explain why tricyclics have fallen out of fashion/what the big differences are between those and SSRIs? 

 

 

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47 minutes ago, Selkie said:

Thanks @CrazyRedhead, I take clonazepam too but my new young GP doesn't want me to keep taking it, which is really annoying, and so we're trying to find something else 😕

Ah, okay....maybe Gabapentin?........Some folks here do take it.......I've tried it, but I personally could not tolerate the side effects....Could be worth a try if you're running out of options.......

19 minutes ago, Selkie said:

Also curious about augmenting with a tricyclic ? (I am done with SSRI's SNRI's so those  aren't an option)....Can anyone explain or point me to a thread that helps explain why tricyclics have fallen out of fashion/what the big differences are between those and SSRIs? 

In general, tricyclics do tend to have more side effects than SSRIs and SNRIs...I'm guessing that's why doctors lean towards SSRIs and SNRIs first................Some tricyclics that might be used for anxiety disorders are:  imipramine, desipramine, nortriptyline, amitriptyline, doxepin, and clomipramine.

Edited by CrazyRedhead
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2 hours ago, Gearhead said:

@notloki Would be most welcome, too.

I first thought you’d said “weird side effects like edamame.” Immature soybeans would be a very peculiar side effect. 

LOL wow yes edamame would be a bizarre se indeed!!!! Thanks for the extra tag :)

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3 hours ago, CrazyRedhead said:

Ah, okay....maybe Gabapentin?........Some folks here do take it.......I've tried it, but I personally could not tolerate the side effects....Could be worth a try if you're running out of options.......

In general, tricyclics do tend to have more side effects than SSRIs and SNRIs...I'm guessing that's why doctors lean towards SSRIs and SNRIs first................Some tricyclics that might be used for anxiety disorders are:  imipramine, desipramine, nortriptyline, amitriptyline, doxepin, and clomipramine.

I am going to second talking about gabapentin 

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19 minutes ago, Selkie said:

@Iceberg is there a reason for gabapentin over lyrica ? the doctor said that lyrica is basically a newer/less side effects version of gabapentin...

Not really it all depends on tolerability. I know my doc usually tries gabapentin first... I just mentioned it cuz it wasn’t in your first post 

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There is also vistaril which is more commonly PRN these days but also a benzo alternative 

And while lamictal sometimes helps unipolar depression I don’t think it could reliably take over for your bupropion in a. One to one swap, that seems risky 

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Yeah that makes sense. FWIW I wasn't thinking of stopping the wellbutrin and starting lamictal at the same time. I guess I really want to try lamictal because it's different from anything I've taken, weight neutral, seems to have a pretty low side effect profile (other than "the rash") and although it's not first line for anxiety it seems to have good off label reviews for anxiety and unipolar depression....just one of those things where I feel like "I want to try that med" but don't have enough backup or evidence to advocate for myself w the doctor. Thanks for the help and listening 🙂🙏

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have you considered augmenting with a low dose antipsychotic? when zoloft made me twichy and obsessive my pdoc prescribed low dose (<1 mg) risperidone, which ended up being a great med for me. 

also, i take clomipramine and have found it very useful for general anxiety and OCD flavoured symptoms. from what i've read and what my pdoc has told me about TCAs, the side effect profile is "dirtier" so to speak. my pdoc was quite concerned about weight gain when i first started titrating up. personally i find my hands shake a bit more than they used to (but they've never been super steady anyway), and i experience dry mouth which is fairly easily mitigated by sipping water all day.

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On 1/28/2021 at 3:27 PM, Selkie said:

Also curious about augmenting with a tricyclic ? (I am done with SSRI's SNRI's so those  aren't an option)....Can anyone explain or point me to a thread that helps explain why tricyclics have fallen out of fashion/what the big differences are between those and SSRIs? 

 

 

If you're open to doing another run of trial and error, a tricyclic might be an option; but I will say though that, if you're really concerned about side effects, tricyclic may not be the road you want to go down. Historically, they tend to have more and greater likelihood of side effects compared to other antidepressants. 

As for why some prescribers don't prescribe tricyclic (or MAOI's for that matter), it may have to do with their significant cardiotoxicity in accidental or intentional overdose. Plus, the relatively newer SSRI, SNRI, NDRI, etc. medicines have better results and more mild side effect profiles for the average person.

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