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switching from Lex+wellb to segeline patch


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do i have to taper off the wellbutrin XL first, then the lexapro?  how long do i have to be off the lexapro before i can start the patch, and how long is it supposed to take for the patch to work?  if it doesn't work, how long do i have to be off it before i can resume the lexapro which is really important to my stability.  any help is welcome. ;)

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  • 2 weeks later...

do i have to taper off the wellbutrin XL first, then the lexapro?  how long do i have to be off the lexapro before i can start the patch, and how long is it supposed to take for the patch to work?  if it doesn't work, how long do i have to be off it before i can resume the lexapro which is really important to my stability.  any help is welcome. ;)

<{POST_SNAPBACK}>

I'm not sure about the order of the taper in terms of Lexapro vs. Wellbutrin. I was on that combo before, but hypomanic. I tapered Lexapro then Wellbutrin and ended up getting stuck in anxiety/dysphoria. But it turns out that I'm BPII, so who knows.

You can start the patch after the pther drugs has washed out of your system, which for Lexapro is (on average) about a week. For Wellbutrin, it's about the same for the parent drug, while the metabolites may require an extra couple days. Note that this is the time for the average person to get below 1% of the initial drug concentration. You may be faster or slower, and you might not need to get all the way down to 1% to avoid a bad reaction. I think most pdocs would stick with a week here.

After stopping EMSAM, I think conventional wisdom would be two weeks before restarting another drug because that's about how long it takes for the MAO enzymes to regenerate. (Selegiline itself leaves your system pretty quickly.)

Standard disclaimers: I'm not a doctor, listen to yours, YMMV, etc.

~cache-monkey

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On the selegiline patch PI it indicated that a 1 week washout will cover most SSRIs, SNRIs and most other antidepressants that have relatively short half lives. Prozac would call for a longer washout period. On the other end, selegiline has a relatively long half life, so you would have to wait two weeks after your last dose to start another AD.

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