What to do when Welbutrin stops working?

[rosewild]

I'm so weary it's hard to pull my thoughts together.

I have a history of recurrent major depression. My mom has recurrent major depression, and my brother has bipolar disorder.

When I was diagnosed for the first time, I took Prozac for 6 months - stopping as soon as I felt better. I was okay for about two years.

When the depression returned, I was given Zoloft. I took Zoloft for about 2 years - the depression improved, but I was numb and fat. My pdoc then suggested Welbutrin, which I've been taking ever since (for the past 15 years).

I have struggled with depression, in spite of the Welbutrin - and have tried adding Prozac, since it worked before but the GI effects were severe.

Then we tried adding Lexapro - Nausea and reflux were so bad I needed anti-nausea meds at times.

I need some suggestions about what I might try to add to the Welbutin to see what can be done to lift the depression I have now.

I'm wondering if all SSRIs are likely to cause ongoing severe GI issues, but I have to try something. I also wonder about Cymbalta or Effexor.

[crtclms]

I'm a little confused. First of all, how much Wellbutrin on? And are you on name brand or generic?

[Velvet Elvis]

You can take up to 450 mgs a day of wellbutrin so don't rule out increasing the dose.

I only have GI side effects for the first few weeks I'm on a new SSRI. Zoloft might have been worse.

Remeron is a medication commonly used in conjunction with Wellbutrin. It's one to consider in addition to the ones you named.

[rosewild]

I'm a little confused. First of all, how much Wellbutrin on? And are you on name brand or generic?

Understandably confused. Sorry!

I'm currently taking 150 mg SR generic - once a day.

I've taken brand name in the past, but don't know if I could tell a difference between brand and generic. I have the option of trying brand again - the pharmacy can get it, and my insurance pays a good portion of it. I just haven't asked the doctor for a brand-only prescription.

One of the side effects that's never gone away for me is the insomnia. so I've not done well when I've tried to increase to higher doses of Welbutrin. Extreme difficulty falling asleep and staying asleep. Last spring I weaned off the klonopin I'd been taking for a long time to help with sleep because it wasn't helping anymore. It was a pretty unpleasant experience the withdrawal). I had bad experiences with Ambien as well.

I usually take 50 mg of trazodone (and or various herbs/OTC remedies) to sleep with varying degrees of success.

I'm going on about the sleep issues, because the lack of it really impacts my mood.

Velvet Elvis ~ thanks - I'd not considered remeron. I don't know if I gave prozac a fair shot re: the GI issues and think I'd be willing to try again. I was miserable with lexapro (and took it for at least 3 months without any real improvement.

[pajamas]

I've been on Wellbutrin for about 5 years... it stopped working a while back, but now I'm adding Lamictal and it's helping a LOT! It's activating and doesn't have the weight gain side effect. In fact, I am losing weight on it. I think it helps some people sleep? It's one of those drugs that everyone responds to a little differently, but definitely worth considering. Good luck!!

[fluffybirdie]

How about Wellbutrin XL? It's what I take, and I believe most of here take that instead of the SR. With that one, you need to be real sure you get the brand, though. Generic has been bad news for a lot of people, myself included. My only thought is that XL might possibly keep you steadier through the day...

[rosewild]

I'm adding to my list of things to talk about when I go to the pdoc in 3 weeks.

I tried Welbutrin XL (300 mg - brand) several years ago. If I recall correctly (and I honestly don't know if I can), things didn't improve (or get worse) in terms of depression. I can't recall what happened with the insomnia. Regardless, it's something to consider trying again.

I'd also not thought about mood stabilizers.

Thanks for all the suggestions.

[rollercoaster]

Yes i would second that lamictal addition. I added lamictal to my wellbutrin and it made a world of difference. it is a mood stabilizer, but works more on the depression spectrum rather than the mania. it was a life changer for me. hang in there...keep trying...feeling better is so worth it.

[notfred]

I regained the effectiveness to Wellburtrin by going to 450 mgs.

nf

[Catnapper]

300mg is usually considered the theraputic dose of Wellbutrin. I have been as high as 450mg the last time I was depressed. I've been on both the SR and XL (currently), and although others have had bad experiences with generics that's all I've ever had. I'm not sensitive to generics like that either, but lots of others are. It may be worth trying to up the dose first before adding anything in.

About a year and a half ago the pdoc put me on Lamictal because he suspects bipolar II. I don't care what my dx is called, but I can tell you that Lamictal has made a HUGE POSITIVE impact in my life. I feel like my old self again. The slow titration kind of sucks, and I got headaches for a few days every time my dose increased, but I love it. The headaches went away after a few days.

I'm a 51 year old female who never had trouble sleeping until I had hot flashes, so now I also take Ambien every night. Getting good sleep is probably the most important thing for me to keep my mood stable.

My pdoc started me on morning doses of Lamictal, but I find it sedating so now take it at night. The pdoc says about 20% of his patients find it sedating, and of course there's no way to find out without trying it.

I never had any luck with SSRIs, they turned me into a zombie and I slept all the time. Hope you find something that works for you, depression sucks.

[celestia]

Have you thought about Abilify? I just went from 300 XL to 450 XL of WB and it's made a noticeable difference. I'm pulling out of a sucky depression that's been going on for a few months. Pdoc also increased my Lexapro to 30, fortunately, Lex works well for me. However, he was going to add Abilify next if the increases didn't work.

I hope something happens for you soon. Don't lose hope!

[rosewild]

All the feedback is going to make my conversation with the pdoc much easier for me.

I'd rather have a pdoc who leaves the decisions to me. Yet it would be nice if he didn't leave everything up to me. When someone is depressed, that's a heavy load.

I'm tred of my life as it is. I know I'm unable mentally to make the changes that need to be made so I can return to the land of the living. My world has become very small, and the longer I stay stay holed up, the harder it is to even consider leaving. I'm tired of my own excuses.

I'm afraid to drop the Welbutriin completely because I'm fairly sure it is keeping me from the bottom of the depths of despair (and I've been there before). I also know that Welbutrin is unique in terms of what neurotransmitters are impacted. I think that means I need to try an increase. I've been reluctant to try that because my sleep is really horrible - and what underlying anxiety I do have might become a bigger problem. At this point, though, I know I simply have to find out by trying.

As far as adding a mood stabilizer or something else - If you change more than one med at a time (increase current meds and add something new at the same time), how do you know what made the difference or caused the side effects?

I'm thinking one thing at a time.