Cymbalta + Adderall OR Wellbutrin + Adderall et al ?

[Sleepyhead]

I'm having problems with my meds and need your help. I've been somewhat depressed ALL my life that I remember, but particulary 'stuck' the past 12 years. I have a family history of chronic MDD and possible undiagnosed ADD/ADHD in first and second degree relatives. Here's a brief history of my meds and whether they worked:

Age 18: Prozac 20mg for 3 years - helped me get out of bed but not much else

Age 19: Dothiepin ?mg for 2yrs for fibromyalgia and insomnia - MAJOR carb cravings and grogginess

Age 22: Prozac and Elavil (low dose pm) again for another year until I switched to......

Age 23: Zoloft for improved concentration and Ambien 10mg - kept for 3 years then dropped 'cause I was still tired, groggy with trouble concentrating.

Age 28: Adderall 10mg for trouble concentrating - helped but made me more anxious and irritable.

Age 28: Concerta 18mg " " " - kept for a year, but still had lots of trouble with tiredness and focus.

Age 29: DX with PLMD - maybe THAT's why I feel like cr*p all the time. Read about possible dopamine connection between atypical depression (which I have), PLMD, ADD, PMDD and Fibro.

Neurontin 100mg > 600mg = sleeping much better

Jan '07: Cymbalta 60mg - first AD that really seems to have worked for me!

Jul '07: Strattera >80mg added to the mix. Pooped out BIG TIME and dropped that.

Aug'07: Vyvanse 30mg added but caused BP to go from 115/70 to 140/90 in pm so dropped

Oct' 07: Ritalin 10-20mg instead of Vyvanse as a stop gap until I saw PDOC again

Nov' 07: Adderall XR 10mg seems to be working but need a bit more. Discussed ZERO libido on Cymbalta (nobody seems concerned apart from me and hubby!) tried 30mg Cymbalta instead of 60.

Dec' 07: PDOC agrees that I can try Wellbutrin instead of Cymbalta to try and improve libido. Tells me to take both for a week then drop the cymbalta. Now on Wellbutrin XL 150mg + Adderall 20mg.

So now I am feeling very BLAH and irritable, although I have been a little more awake 'down there'. I am worried that dropping the Cymbalta is NOT a good idea. It is the first AD that ever seems to have worked for me. Taking it I feel better that I have in 12 years and actually had some motivation and hope for the future. However, I am married and having zero sex drive is not helping our already difficult relationship (Hubby is also depressed and I think ADHD too). I have never taken Wellbutrin by itself so I don't know how it would compare with the cymbalta for me. However, I do tend to be a little obsessive and anxious about things, plus I have self-diagnosed PMDD and SAD. Maybe I need some serotonin reuptake? St. John's Wort didn't do anything for me although 5-HTP helped a little.

I am really worried that without the cymbalta I will sink into the hole I was in this time last winter - and I simply have TOO much to do for that.

Should I try combing the Wellbutrin and Cymbalta (with Dr's OK) or try another combination? My PDOC seems a uninterested and unconcerned - my GP is great but too busy to really discuss all this stuff. I think I lean towards soft bipolar from what I've read, although I've never had what I would judge as anything manic going on, but my moods can change quite rapidly. Lamotrigine?

Please help me if you can.

[null0trooper]

Jul '07: Strattera >80mg added to the mix. Pooped out BIG TIME and dropped that.

I've read on CrazyMeds that people may do better starting with a rather low dose of Straterra and only slowly increasing the dosing. Otherwise it tends to stop working quickly.

St. John's Wort didn't do anything for me although 5-HTP helped a little.

So, do you think Wellbutrin+Adderall+5HTP or a low dose of Lexapro (or even Elavil) might work? Some folks do well on Cymbalta + Wellbutrin, but I don't think it's as common as Wellbutrin+SSRI.

[meg]

Dec' 07: PDOC agrees that I can try Wellbutrin instead of Cymbalta to try and improve libido. Tells me to take both for a week then drop the cymbalta. Now on Wellbutrin XL 150mg + Adderall 20mg.

----------

Should I try combing the Wellbutrin and Cymbalta (with Dr's OK) or try another combination? My PDOC seems a uninterested and unconcerned - my GP is great but too busy to really discuss all this stuff. I think I lean towards soft bipolar from what I've read, although I've never had what I would judge as anything manic going on, but my moods can change quite rapidly. Lamotrigine?

first of all-- welcome to CB!

glad you could join us for cocktails.

I'm very tired right now so I'm going to try to make this clear, hence the bullets sorry if I ramble, I tend to do that:

• if you aren't familiar with http://www.crazymeds.us/ yet, then go introduce yourself, or at least flirt a little. very helpful and simplifies some of this research and different meds without dumbing it down. it's been in my 'bookmark' folder for a couple of years and I still pop over there to check things quite often
  
• from what I've heard, cymbalta isn't always a total joy to taper off of (like other some other multiple reuptake inhibitors, or anything if it's down too fast) so it's *possible* that a week was a bit quick to get off of it and therefore you might feel extra-bad now because of that. can be headaches, mood swings, and generally feeling like horse manure-- depends on the person and many people don't get any of those discontinuation symptoms, but I wanted to mention it. you were tapering down from 30mg (not 60), right? either way, you might allow a little longer to see if it's the wellbutrin or what
  
• if you keep feeling worse, or don't feel any effects from wellbutrin after a little while, then I would talk to your pdoc about maybe adding the cymbalta back in, but I'm warning you that she might want to increase wellbutrin (xl, right?) to 300mg and see how that goes before adding anything back in
  • even though cymbalta is a multipleRI, seretonin is usually the kicker (iirc)-- and it's pretty common to combine SSRIs with wellbutrin. it's not a out-there idea so it's worth bringing up to the doctor. she might want to just give you a plain SSRI to add in though, to make things a bit simpler.
    
  • a lot of this is me talking out of my own experience-- I'm taking wellbutrin xl 450mg (highest recc'd dosage) along with 150mg of zoloft and it's done a pretty good job of keeping me out of the hole-- but didn't 100% kick the depression, it's been more than a year and a half (a bit on and off due to hyper pdoc who liked to prescribe new things to try every other week) but overall, the combination of WB and an SSRI (zoloft) has been really good to me. and WB did certainly kick up the libido..much more so on it's own, but I'm sure helped once the zoloft was added too.
    

  [*]Lamotrigine?-- I'm glad you brought up my love, Lamictal and I are very happy together.

  • Lamictal is the one that finally kicked depression's bony butt to the curb for me, I'm in my 2nd month of remission (remission! crazy.) and I've been taking it for about 3 months. I'm at 100mg by the way, and at no point have had any suspicion of bipolar from doctors-- my pdoc and I decided to try it 'off-label' for my unipolar depression since it has such a good track record with bipolar depression--- and voila! I'm ME! (me is a person I haven't had the pleasure to meet since 3rd grade, she's a pretty neat chick)
    
  • in summary (haha.): Lamictal is another great idea to bring up with the pdoc, but I think since you've had such success with seretonin alone that you should keep going in that groove since you *know* that it can work. lamictal might just be the plan b to your plan b, but it's always good to talk about options, and never too early to research.
    

essay completed.

almost.

I feel a little odd giving you all this advice since I'm only 20 and have only been on the med-go-round for two years, but man I've had a lot of misses and dissapointments and now finally success, but I'm sure it's not over for me either. just wanted to let you know that I might be new to this whole game, but we're still on the same team (haha, what a terrible analogy.) and we all kind of pick and choose from eachother's experience around here, so I hope you can pick at least one thing out of my rambling if not, well, you know somebody is rooting for you (just to finish off the 'same team' bit)!

now I'm done, going to bed, really, nice to meet you,

meg

[Sleepyhead]

Jul '07: Strattera >80mg added to the mix. Pooped out BIG TIME and dropped that.

I've read on CrazyMeds that people may do better starting with a rather low dose of Straterra and only slowly increasing the dosing. Otherwise it tends to stop working quickly.

I definitely think that the PDOC had me titrating up WAY too fast and too far considering I was on 60mg of Cymbalta at the time. Their was nothing in the Strattera literature about combining it w/ Cymbalta, but their were warnings about SSRIs. I actually think I did well on the Strattera 25mg, but by 80mg, I was almost comatose! I did check crazymeds, after I posted here in June/July and read about the zonk-out effects of too much NE reuptake.

[Sleepyhead]

Dec' 07: PDOC agrees that I can try Wellbutrin instead of Cymbalta to try and improve libido. Tells me to take both for a week then drop the cymbalta. Now on Wellbutrin XL 150mg + Adderall 20mg.

----------

Should I try combing the Wellbutrin and Cymbalta (with Dr's OK) or try another combination? My PDOC seems a uninterested and unconcerned - my GP is great but too busy to really discuss all this stuff. I think I lean towards soft bipolar from what I've read, although I've never had what I would judge as anything manic going on, but my moods can change quite rapidly. Lamotrigine?

first of all-- welcome to CB!

glad you could join us for cocktails.

I'm very tired right now so I'm going to try to make this clear, hence the bullets sorry if I ramble, I tend to do that:

• if you aren't familiar with [link=http://www.crazymeds.us/"'>http://www.crazymeds.us/" target="_blank]http://www.crazymeds.us/[/link] yet, then go introduce yourself, or at least flirt a little. very helpful and simplifies some of this research and different meds without dumbing it down. it's been in my 'bookmark' folder for a couple of years and I still pop over there to check things quite often
  
• from what I've heard, cymbalta isn't always a total joy to taper off of (like other some other multiple reuptake inhibitors, or anything if it's down too fast) so it's *possible* that a week was a bit quick to get off of it and therefore you might feel extra-bad now because of that. can be headaches, mood swings, and generally feeling like horse manure-- depends on the person and many people don't get any of those discontinuation symptoms, but I wanted to mention it. you were tapering down from 30mg (not 60), right? either way, you might allow a little longer to see if it's the wellbutrin or what
  
• if you keep feeling worse, or don't feel any effects from wellbutrin after a little while, then I would talk to your pdoc about maybe adding the cymbalta back in, but I'm warning you that she might want to increase wellbutrin (xl, right?) to 300mg and see how that goes before adding anything back in
  • even though cymbalta is a multipleRI, seretonin is usually the kicker (iirc)-- and it's pretty common to combine SSRIs with wellbutrin. it's not a out-there idea so it's worth bringing up to the doctor. she might want to just give you a plain SSRI to add in though, to make things a bit simpler.
    
  • a lot of this is me talking out of my own experience-- I'm taking wellbutrin xl 450mg (highest recc'd dosage) along with 150mg of zoloft and it's done a pretty good job of keeping me out of the hole-- but didn't 100% kick the depression, it's been more than a year and a half (a bit on and off due to hyper pdoc who liked to prescribe new things to try every other week) but overall, the combination of WB and an SSRI (zoloft) has been really good to me. and WB did certainly kick up the libido..much more so on it's own, but I'm sure helped once the zoloft was added too.
    

  [*]Lamotrigine?-- I'm glad you brought up my love, Lamictal and I are very happy together.

  • Lamictal is the one that finally kicked depression's bony butt to the curb for me, I'm in my 2nd month of remission (remission! crazy.) and I've been taking it for about 3 months. I'm at 100mg by the way, and at no point have had any suspicion of bipolar from doctors-- my pdoc and I decided to try it 'off-label' for my unipolar depression since it has such a good track record with bipolar depression--- and voila! I'm ME! (me is a person I haven't had the pleasure to meet since 3rd grade, she's a pretty neat chick)
    
  • in summary (haha.): Lamictal is another great idea to bring up with the pdoc, but I think since you've had such success with seretonin alone that you should keep going in that groove since you *know* that it can work. lamictal might just be the plan b to your plan b, but it's always good to talk about options, and never too early to research.
    

essay completed.

almost.

I feel a little odd giving you all this advice since I'm only 20 and have only been on the med-go-round for two years, but man I've had a lot of misses and dissapointments and now finally success, but I'm sure it's not over for me either. just wanted to let you know that I might be new to this whole game, but we're still on the same team (haha, what a terrible analogy.) and we all kind of pick and choose from eachother's experience around here, so I hope you can pick at least one thing out of my rambling if not, well, you know somebody is rooting for you (just to finish off the 'same team' bit)!

now I'm done, going to bed, really, nice to meet you,

meg

Thanks so much for your reply.

- I have read up on my meds at crzymeds, but I have not joined the forums there yet.

- I think I was having symptoms of Cymbalta withdrawl, but without the brain zaps that many people get. It could also be the depression returning, esp. w/o the Cymbalta at this time of year.

- I have temporarily added the Cymbalta back in at the lower 30mg dose. I'll discuss this with my PDOC or GP, whichever I get to speak with first. I'm not willing to sink into despair just for some libido!

- Has anybody successfully taken Cymbalta and Wellbutrin together? Is that too much NE reuptake?

- Although SSRIs alone have helped my depression SLIGHTLY, the effect of Cymbalta on NE was I think, the key for me. However, I think maybe I could still benefit from the calming effect of having more serotonin around in my brain.

- I am a bit scared to bring up or try lamotrigine, although I have a family member who has had treatment resistent MDD most of her adult life, and apparently she is on it (+SSRI I believe) and doing very well.

- I also sawpped my Adderall XR to generic IR about a week ago. I don't feel the generic IR is doing much at all, and pooping out fast. This is not helping my mood any and only adding to my frustration and sense of slight anxiety because I'm not getting much of anything done! eg. No Xmas cards, tree gifts etc yet - and I have laundry, cleaning, bills, paperwork and house projects to organize!

Thanks Again for any help you guys can give me. I want to get my life back on track

[null0trooper]

- I have temporarily added the Cymbalta back in at the lower 30mg dose. I'll discuss this with my PDOC or GP, whichever I get to speak with first. I'm not willing to sink into despair just for some libido!

Some people are willing to do just that. Maybe they just need yoga

- Has anybody successfully taken Cymbalta and Wellbutrin together? Is that too much NE reuptake?

I know that some people here have done fairly well on the combination. For others, that would be way too much NE reuptake inhibition.

- I also swapped my Adderall XR to generic IR about a week ago. I don't feel the generic IR is doing much at all, and pooping out fast. This is not helping my mood any and only adding to my frustration and sense of slight anxiety because I'm not getting much of anything done!

If your depression is getting worse, there's only so much that Adderall can do to help. The generic standard-release does wear off a bit faster (depends on the person though) but the doses can be timed to coincide with things like morning commuting and evening shopping. For me, that's a huge plus (It doesn't hurt that the coffee pot in the office stays on all day long.)