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SSRI + Wellbutrin. My consultant thinks that it is dangerous.


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He said that it can cause serotonin syndrome.

Is this bullshit, or should I avoid this combo?

Hell, I know a lot of people use the combo in the States.

As dianebea said, WB doesn't affect serotonin, SSRIs mostly do not affect norepinephrine and dopamine.

It's like worrying about a mid-air collision between a flying fish and a plane operated by Phish.

The risk comes from some bupropion competitively inhibiting the liver enzyme (P450 isoenzyme 2D6 -

that should be enough for a search) that metabolizes certain SSRIs (Paxil, Prozac, Fluvox),

along with Straterra, Effexor, Cymbalta, some of the antipsychotics, several TCAs, and lots of other meds.

Without an alternate pathway for removal (e.g., amphetamine clears out via the kidneys), the other

medication can build up dangerously.

However, Celexa and Lexapro are metabolized through a different (iso)enzyme. Fluvox and Prozac appear

to be metabolized by more than one isoenzyme. So medication buildup leading to serotonin buildup and

serotonin syndrome isn't completely guaranteed for all SSRIs, just certain SSRI medications. That's without

getting into that odd concept of reducing the dosages used in a combination.

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I'd be a lot more worried about combining fex and an SSRI and than wellbutrin and an SSRI. I'm a big fan of the wellbutrin/SSRI combo. You'll find a lot of people here have been on it.

There is virtually no risk of Serotonin syndrome. Wellbutrin has about the same effect on serotonin as amphetamine. I've been on some form of Wellbutrin and SSRI for 10 years.

My best guess:

The warning is in the official product literature just to make sure Glaxo can't be sued if someone with a fucked up a metabolism takes them together and gets SS or if the two are taken in conjunction with herbal products which also increase serotonin and SS results. In such cases the Wellbutrin could legally be considered a contributing factor to the S.S. even if it would not ordinarily cause any problems.

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He said that it can cause serotonin syndrome.

Is this bullshit, or should I avoid this combo?

Hell, I know a lot of people use the combo in the States.

As dianebea said, WB doesn't affect serotonin, SSRIs mostly do not affect norepinephrine and dopamine.

It's like worrying about a mid-air collision between a flying fish and a plane operated by Phish.

The risk comes from some bupropion competitively inhibiting the liver enzyme (P450 isoenzyme 2D6 -

that should be enough for a search) that metabolizes certain SSRIs (Paxil, Prozac, Fluvox),

along with Straterra, Effexor, Cymbalta, some of the antipsychotics, several TCAs, and lots of other meds.

Without an alternate pathway for removal (e.g., amphetamine clears out via the kidneys), the other

medication can build up dangerously.

However, Celexa and Lexapro are metabolized through a different (iso)enzyme. Fluvox and Prozac appear

to be metabolized by more than one isoenzyme. So medication buildup leading to serotonin buildup and

serotonin syndrome isn't completely guaranteed for all SSRIs, just certain SSRI medications. That's without

getting into that odd concept of reducing the dosages used in a combination.

Edit: So do you think that Prozac + Wellbutrin dodgy? Maybe I'm getting you wrong.

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