My Cocktail

[Rylie]

Hello! I am brand new to the forum as of 5 minutes ago, and figured I'd share my cocktail & how long I've been taking the medications. I don't take much medication but would love any and all opinions on them individually and/or as a whole!

50mg Sertraline (Zoloft) every morning (2 years)

300mg Gabapentin 3x a day (1 week)

50-100mg Trazodone PRN (1 month)

[melissaw72]

Just want to welcome you to CB! 

The only med I am on of the ones you listed is trazodone (except I take it on a schedule rather than PRN).  It works well for me with the voices ... for some odd reason it got rid of the last of the voices.  Many take it for sleep. 

 

[jt07]

Hello and welcome aboard! I'm glad you joined us. As far as your cocktail goes, it looks to me in my unprofessional opinion that it is weighted more heavily towards controlling anxiety than depression because you are on a low dose of Zoloft. You've got room to go up on all your meds, but a lot of room to go up on the Zoloft. But it's not important what we think about your cocktail. The main question is how it is working for you.

[Rylie]

The low-dose Zoloft definitely does help with my anxiety more than it does with depression. I have dealt with depression my entire life. It is way more manageable nowadays, but there's definitely room for improvement. A lot of my depression nowadays seems to be circumstantial.  

The trazodone is PRN, but I can't remember a night that I haven't taken it since I've been prescribed it. I've only done 100mg once as opposed to my normal 50mg and the sleep I got was the best I've had in a long time. I did wake up groggy the next morning but it wasn't anything too severe. 

The gabapentin has been a lifesaver. I am a recovered drug addict and alcoholic, and as a result of that I have random spouts of tremors and the inevitable severe anxiety. Gabapentin really aids both of those well. 

[jt07]

If your depression isn't being controlled well enough, then I think that is a good reason to bring it up with your doctor. Your doctor could raise the Zoloft, add an adjunct like Abilify, or switch to a different SSRI or other antidepressant. The point is that you to feel as good as you can with this depression beast.

[Rylie]

I will bring up the depression aspect to my doctor. I also find myself to be more drowsy than usual during the day - in your opinion, what is the best drug to help with this that is non-narcotic? I am a recovered drug addict/alcoholic so narcotics are totally out of the question. 

[notloki]

Depression often comes with fatigue. This might resolve itself once you get the depression under control. If I am depressed I feel like I never fully wake up. I am glad you are going the speak to your doctor about it.

[melissaw72]

32 minutes ago, Rylie said:

I will bring up the depression aspect to my doctor. I also find myself to be more drowsy than usual during the day - in your opinion, what is the best drug to help with this that is non-narcotic? I am a recovered drug addict/alcoholic so narcotics are totally out of the question. 

If you can't get the depression resolved in another way, have you tried wellbutrin?  That helps me stay awake during the day.

 

[Rylie]

2 hours ago, melissaw72 said:

If you can't get the depression resolved in another way, have you tried wellbutrin?  That helps me stay awake during the day.

 

My doctor in Austin prescribed me Wellbutrin right before I was shipped off to rehab 2 months ago but I never got a chance to fill the prescription and try it. I wouldn't want to stop taking my Zoloft because of how much it helps - do they work well with each other? 

2 hours ago, notloki said:

Depression often comes with fatigue. This might resolve itself once you get the depression under control. If I am depressed I feel like I never fully wake up. I am glad you are going the speak to your doctor about it.

I am very well of the fatigue that comes with depression as I've had it my whole life and this isn't that. I believe this has to do with the Trazodone. 

Edited April 10, 2017 by Rylie

[TakeAChillPill]

I've been on a Zoloft and Wellbutrin combination before.  I've heard that combining the two are common practice.  

[melissaw72]

6 hours ago, Rylie said:

My doctor in Austin prescribed me Wellbutrin right before I was shipped off to rehab 2 months ago but I never got a chance to fill the prescription and try it. I wouldn't want to stop taking my Zoloft because of how much it helps - do they work well with each other? 

Idk, I have never been on zoloft.

[mikl_pls]

10 hours ago, TakeAChillPill said:

I've been on a Zoloft and Wellbutrin combination before.  I've heard that combining the two are common practice.  

Indeed, so common that Stephen Stahl calls the combo in his psychopharmacology textbooks "WellLoft."

You get serotonin reuptake from the Zoloft, double dopamine reuptake from Zoloft and Wellbutrin, and norepinephrine reuptake from Wellbutrin, causing trimonominergic reuptake inhibition.

I've been on both Zoloft and the combination of it and they are both effective, especially together.

Edited April 10, 2017 by mikl_pls

[Rylie]

1 hour ago, mikl_pls said:

Indeed, so common that Stephen Stahl calls the combo in his psychopharmacology textbooks "WellLoft."

You get serotonin reuptake from the Zoloft, double dopamine reuptake from Zoloft and Wellbutrin, and norepinephrine reuptake from Wellbutrin, causing trimonominergic reuptake inhibition.

I've been on both Zoloft and the combination of it and they are both effective, especially together.

Great bit of information, thank you for that. I will fill the Wellbutrin script if my depression feels unmanageable, but as of near past it hasn't been present much.

[browri]

On 4/10/2017 at 9:28 AM, Rylie said:

Great bit of information, thank you for that. I will fill the Wellbutrin script if my depression feels unmanageable, but as of near past it hasn't been present much.

@Rylie When you fill the Wellbutrin, go slow and be careful with the stimulants like coffee during the day. Anxiety is a difficult thing for me too particularly the cardiac symptoms of intense anxiety. Start with just the 150mg for a week or two and then work up to the 300mg if you tolerate it and you feel like you need it.

If it makes you feel too jittery, you can try the Aplenzin brand which is bupropion hydrobromide instead of the bupropion hydrochloride. I found that all the anxiety from Wellbutrin went away when I switched to Aplenzin and greatly reduced my caffeine intake.

[melissaw72]

8 hours ago, browri said:

@Rylie When you fill the Wellbutrin, go slow and be careful with the stimulants like coffee during the day. Anxiety is a difficult thing for me too particularly the cardiac symptoms of intense anxiety. Start with just the 150mg for a week or two and then work up to the 300mg if you tolerate it and you feel like you need it.

If it makes you feel too jittery, you can try the Aplenzin brand which is bupropion hydrobromide instead of the bupropion hydrochloride. I found that all the anxiety from Wellbutrin went away when I switched to Aplenzin and greatly reduced my caffeine intake.

Not sure what kind of wellbutrin you have the script for ... XL, SR, IR ... but IME the IR gives me immediate relief, but if you are sensitive to anxiety, it might make it worse.  Fortunately I didn't have that problem with anxiety ... but can see how it would effects people with anxiety.  I was also on the SR (before IR), and that didn't have that effect on me.  On IR now, 2 times a day going on to 3. (100 mg pills each dose).

FWIW ...    IR comes in 100 mg pills, but the SR and XL come in the 150s.

I agree with @browri to go slow, as well as with other things with caffeine in them (ie the coffee, or stuff like red bull).

[HAL9000]

On 4/9/2017 at 4:24 PM, melissaw72 said:

If you can't get the depression resolved in another way, have you tried wellbutrin?  That helps me stay awake during the day.

 

Just a note that it doesn't keep everyone awake during the day.  I take 450mg of Wellbutrin and konk out during the day.   *But I think my DX is whatever that sleep disorder is where you just wake up suddenly in the middle of the day.   Anyhow I take a adderall for that and the combo works.

[melissaw72]

4 hours ago, HAL9000 said:

Just a note that it doesn't keep everyone awake during the day.  I take 450mg of Wellbutrin and konk out during the day.   *But I think my DX is whatever that sleep disorder is where you just wake up suddenly in the middle of the day.   Anyhow I take a adderall for that and the combo works.

You're right, it doesn't ... I was just giving my experience with it. 

I found that the only kind of wellbutrin that helps me stay awake and work as an anti-depressant is the IR.  That is the kind that keeps me awake ... the SR did nothing for that.

[HAL9000]

Its just weird to have insomnia  at night and pitch forward asleep at random times for 10 minutes in the day for no apparant reason.  I'm taking the XL kind of Wellbutrens which I think its the  24 hour kind?   This is probably something I should know.  SIGH before I blather things like I know anything

 

[mikl_pls]

Saw my pdoc Thursday night hoping she'd put me back on Adderall because of my depression (to potentiate my MAOI) and because I'm now having more trouble with my ADHD than ever (so much so that I'm having problems with driving, especially if someone in the car is talking to me—almost ran a red light and slammed into a semi), but despite that she has prescribed Adderall and Dexedrine with MAOIs twice in the past (with Parnate and Emsam), she said the combo was too dangerous and I just needed to work on my psychotherapeutic coping mechanisms, like get out more with my friends, do things that interest me, keep track of how much time I'm spending indoors, etc. I guess I need to call up my therapist and start seeing her again (who is in partial retirement now). She did add a tiny dose of Rexulti.

So here's my cocktail:

• Lamotrigine ER (Lamictal XR) 300 mg 1 po q AM
• Marplan (isocarboxazid) 10 mg 2 po bid (40 mg)
• Phentermine (Adipex-P) 37.5 mg 1 po q AM
• Rexulti (brexpiprazole) 0.25 mg 1 po qhs
• Zonisamide (Zonegran) 100 mg 1 po q AM + 2 po qhs (300 mg)
• Oxazepam (Serax) 30 mg 1 po qd prn

[browri]

On 5/13/2017 at 1:13 PM, mikl_pls said:

Saw my pdoc Thursday night hoping she'd put me back on Adderall because of my depression (to potentiate my MAOI) and because I'm now having more trouble with my ADHD than ever (so much so that I'm having problems with driving, especially if someone in the car is talking to me—almost ran a red light and slammed into a semi), but despite that she has prescribed Adderall and Dexedrine with MAOIs twice in the past (with Parnate and Emsam), she said the combo was too dangerous and I just needed to work on my psychotherapeutic coping mechanisms, like get out more with my friends, do things that interest me, keep track of how much time I'm spending indoors, etc. I guess I need to call up my therapist and start seeing her again (who is in partial retirement now). She did add a tiny dose of Rexulti.

So here's my cocktail:

• Lamotrigine ER (Lamictal XR) 300 mg 1 po q AM
• Marplan (isocarboxazid) 10 mg 2 po bid (40 mg)
• Phentermine (Adipex-P) 37.5 mg 1 po q AM
• Rexulti (brexpiprazole) 0.25 mg 1 po qhs
• Zonisamide (Zonegran) 100 mg 1 po q AM + 2 po qhs (300 mg)
• Oxazepam (Serax) 30 mg 1 po qd prn

Let me know how the Rexulti works for you. I remember you had a failed Vraylar trial and am curious if this will be any different for you.

[mmaryland]

 I am on rexulti 1.5mg and it has been working amazingly for depression and mood stabilization, and every anxiety. Akathisia at first but it went away thankfully!

As for the SSRI antidepressant, maybe increase the zoloft dose, or perhaps switch to Prozac or Paxil, or even Lexapro, if zoloft isn't working for you. But there is always room for increasing the zoloft dose.

As for the gabapentin, maybe you could try a stronger anxiolytic if it's not doing it's job. Lyrica, a similar and more potent drug then gabapentni, or a benzo can really help. Paxil is really goof for anxiety disorders.

Like others said wellbutrin could help. Also, consider Effexor or Pristiq as they are more activating antidepressants. Or you could try adding Abilify or Rexulti to your regimen as an antidepressant add-on, this might suit you well.