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Wellbutrin lamictal lexapro cocktail


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I am diagnosed bipolar 2, OCD, GAD, and at one point ADHD although the psychs can’t decide if it’s true or not.

 

my cocktail:

wellbutrin xl 450 mg in morning

lamictal 200mg at night

lexapro 10mg morning for the GAD and OCD my OCD is the obsessive thoughts type.

 

My issue being mainly that I lack motivation and am tired all the time as well very hungry and have gained weight but can’t find the hunger control to diet and can’t find the motivation to exercise.

yes it’s terrible and could be affecting all of this but for years it’s the only way I can function half a pot or a whole pot of coffee in the morning and  occasionally a monster or two in the afternoon I practically live on caffeine.

i sleep ok usually about 7-8 hours a night.

luckily I have a job currently although I’m a serial job hopper.

somehow I have a wife and daughter who put up with me. I’m on my 20’s

im 6 foot tall and was originally 225 when I was exercising but after wife’s pregnancy and post partum and life of course I’m now 289.

just trying to see if anyone has experienced similar cocktails because although I’ve been under treatment off and on since 15 I have honestly not tried many meds more so favoring trying different doses of the same med because I have enough of a hard time holding a job without the med game happening.

i have tried seroquel which is a never again

strattera which messed with blood pressure. Gabapentin which is absolutely not. Adderall which was obviously awesome but is likely bad for the bipolar. Abilify which made me feel mentally handicapped. Buspar which made me practically forget my own name. 

 

Just found this place and basically looking for any experiences, thoughts etc.

 

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I mean it might be working I’m not honestly positive like I said I’m still sleepy even after an entire pot of coffee. And we have discussed it but thus far we are playing with dosages we just adjusted up my Wellbutrin and down my lamictal and lexapro and seeing what happens. And my family takes Wellbutrin and experiences that as well but I don’t find it typically stimulating for me. I’m just not sure what I’m supposed to feel honestly. I mean I don’t feel terrible but I have junky stuff going on in my opinion. I just want my dang motivation and energy back and to be able to lose weight I’m so sick of my weight.

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Amphetamines are used it bipolar, it seems some do well and some do not.  A low dose trial, perhaps, would be a ways to access things.

From "Stimulants for adult bipolar disorder": https://www.mdedge.com/psychiatry/article/63348/stimulants-adult-bipolar-disorder/page/0/3 and https://academic.oup.com/ijnp/article/16/1/55/629710

"Another retrospective chart review described 8 patients with iatrogenic sedation or depression who received adjunctive methylphenidate, mean 20 to 40 mg/d, or a racemic mixture of amphetamine salts, mean 20 to 40 mg/d. Overall bipolar symptoms decreased in severity, as measured by Clinical Global Impression (CGI) scores, but the authors did not directly measure sedation or depression. The stimulants were well-tolerated, with no evidence of stimulant-induced mania.13"

13. Carlson PJ, Merlock MC, Suppes T. Adjunctive stimulant use in patients with bipolar disorder: treatment of residual depression and sedation. Bipolar Disord 2004;6(5):416-20.

Edited by notloki
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I'm bipolar type 2 and take have been on stimulants (mostly amphetamine-type) for years and do very well with them. It really sounds like you might be ADHD (but I can't say, I'm not a doctor or psychiatrist) and that you might could stand for another trial of a stimulant.

Also, Lexapro made me gain weight like crazy when I was on it in high school. It also made me feel very lazy and unmotivated.

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Interesting the lexapro has two good things going for it it helps with the anxiety and counteracts the SD the Wellbutrin gives me interesting this is my second day on 450xl Wellbutrin I took it this morning with my 10mg lexapro but I had taken my lamictal last night around nine ish because I thought it was making me tired and about an hour and a half a go I completely forgot about being hungry. It was strange. 

Im loving the opinions and stories I hope people contribute more I’ve had the issues for a very long time but haven’t really tried very many different things and my rock has always been caffeine and nicotine as long as I had those two even unmediated I could pretty well function and forget trying to work on my doctoral assignments without another pot of coffee and some nicotine I won’t even be able to open the laptop.

7 minutes ago, mikl_pls said:

Do you have epilepsy?

No epilepsy around the time I was on adderall I was jumped in the neighborhood and had my head stomped on 5 times my neurologist said there was no damage but my old psychiatrist was afraid saying my seizure threshold is lowered for my couple of knocks on the head.

although I have a new psychiatrist now who doesn’t seem to spend every minute covering his ass like the other one so I may bring it up again I honestly had forgotten about my ADHD diagnosis til I posted. That was my first ever diagnosis 

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I've been on the wellbutrin/lamictal combination for years now, but the depression broke through and I tried adding on Abilify, which helped but I had a big side effect problem that made me stop, so I switched to Lexaro like you're on (I'm also BP, OCD, GAD.  I have a BP1 label but I honestly think I'm BPII because I'm depressed more often than anything else) .   Like you, I was exhausted, sleeping 12-13 hours on the weekends, no energy otherwise, lots of caffeine to just get by.  I just switched from Lexapro to Trintillex because I felt the Lexapro wasn't doing me any good, and after a couple weeks on the Trintillex (and Wellbutrin/Lamictal), I'm seeing improvements to my energy level and mood.  I did a ton of work on a project yesterday, got up and went to the gym today, both things I could not manage a month ago.  It hasn't been all that long, but I think I'm a fan of the Trintillex along with the other two. 

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4 hours ago, Drjekyll said:

No epilepsy around the time I was on adderall I was jumped in the neighborhood and had my head stomped on 5 times my neurologist said there was no damage but my old psychiatrist was afraid saying my seizure threshold is lowered for my couple of knocks on the head.

Jeez! That's awful! Yes that is true, traumatic brain injuries can lower your seizure threshold, but stimulants can also help you recover from them faster, plus you're on an anticonvulsant. If it's been a good while since the incident, you might be able to resume taking the Adderall safely.

Methylphenidate (Ritalin) is more pro-convulsant than Adderall, Dexedrine, or any other amphetamine stimulant, though.

4 hours ago, Drjekyll said:

although I have a new psychiatrist now who doesn’t seem to spend every minute covering his ass like the other one so I may bring it up again I honestly had forgotten about my ADHD diagnosis til I posted. That was my first ever diagnosis 

It may be worth bringing up again. From your OP, you really sound like you have some really bad ADHD going on and you're self-medicating with all the caffeine and nicotine (attempting to modulate your dopamine levels). 

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Quietly,

my wife was on trintillex for a short time didn’t do anything for her post partum but I may have to talk to the doc about it. Also don’t get me wrong I never sleep 12-13 hours more so I make myself get out of bed and spend the rest of the day after a pot of coffee dreaming about the bed yawning and trying to keep my eyes open. On the weekends though I do occasionally squeeze in a two hour nap.

 

Mikl,

thanks for the info it has been 10 years since my last head injury and I have practically lived on caffeine pretty much since when I was 12 minus the times I was on stimulants. And I’ve lived on nicotine with the caffeine for about 10 years now. I plan to bring it up to the doc next visit considering I haven’t mentioned it. I think one time I googled about dopamine and had a lot of the symptoms of low dopamine even on my meds but I’ll have to check again and discuss with my doctor.

side note I am amazed that I’ve been on 450mg of Wellbutrin for a very short time with full pots of coffee and haven’t experienced racing heart or extreme agitation occasionally my hands will barely shake but they have been doing that for years but honestly you can’t really even tell I have that much “activating” stuff going on.

thanks for the thoughts I was just so glad last night to finally eat like a normal person again the amount of food I had to eat to not be crazy hungry was insane and it’s not lack of water because I drink about a gallon a day.

 

 

 

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Based on some googling If my doc is thinking stimulants I’m kinda tempted by vyvanse with my lamictal from what I have been reading although my lamictal is down to 150mg now like the doctor wanted to try and I don’t feel quite so bad. Only had a half pot of coffee this morning.

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More to add my dr had told me I can adjust my lexapro up and down from 10mg as I needed. That being said after having a couple days of some motivation no insane hunger and less sleepiness I decided since my lamictal is cut in half let’s try going back up to 20mg lexapro and see if there is a difference so I can figure out what medicine is causing my issues.

results were hunger didn’t come back I honestly almost forgot to eat because I was busy. No real extra tiredness. Kind of motivated. The worst part and reason I’m going back down to 10mg is I felt strange kind of like edgy not particularly angry but not particularly patient and way more anxious than normal. 

So just my thoughts. I also had to sit down and write my next paper for my doctorate last night needless to say summoning up the focus and the will is rough so I did what I always do for school work I made coffee drank half a pot and practically chain smoked while listening to music so loud I couldn’t hear anything else and was able to finish it in 3 hours. Only issue is then I was up 1.5 hours longer than I wanted to be courtesy of the coffee.

the more I look at how I’ve always done school work the more I think maybe I am at least ADD self medicating with coffee and nicotine and using loud music to block out other distractions.

Edited by Drjekyll
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Next day in the saga unfortunately I had to drop back to the 300mg Wellbutrin at least for testing because I already have a mean temper occasionally but I was mad at every little thing and not just annoyed but angry even my wife noticed.

so now I’m currently doing

wellbutrin xl 300mg

lamictal 150mg

lexapro 10mg.

 

eventually going to talk to my doctor but my insurance has changed so that changes things but adhd discussion is first order of business but until then coffee and nicotine bandaid.

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Cannot wait to talk to the new doc I wish it would hurry up unfortunately I’ve had some bad temper days and still lack in energy and motivation even with lowering my medicine. For my doctoral work I’m completely dependent on coffee and nicotine otherwise nothing gets done. Not feeling quite myself it’s strange I would say I feel unstable not dangerous or otherwise more so just not where I need to be. 

Boy wouldn’t this be easier if picking a med was as easy a choice as Tylenol or ibuprofen. 

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It's interesting that your pdoc says they don't want you on Adderall because of seizure risk but they have you on 450mg of Wellbutrin which would certainly carry a higher seizure risk on its own than Adderall would. Lol.

I would think a more activating combination (that wouldn't make you as mean the way the Wellbutrin does) would be:

Trintellix 10-20mg

Vyvanse or Adderall (not sure on dose, likely 30-50mg for Vyvanse or 20-30mg for Adderall)

Lamictal 100-200mg

Not sure how long you've been on the bipolar 2 train but it's good to determine at some point whether your mood is better stabilized by anticonvulsants like Depakote, Tegretol, Trileptal, and Lamictal or if you respond better to atypical antipsychotics like Risperdal, Seroquel, Geodon, or Zyprexa. After I was diagnosed with BP2, we cycled through several different AAPs: Latuda, Saphris, Fanapt, Zyprexa, Loxitane, Abilify, and now Rexulti. What I ultimately discovered is that the doses necessary to stabilize my mood were above my akathisia threshold. Any dose that controlled my mood swings and irritability also invariably caused akathisia. This is when we realized that we had to place more emphasis on anti-convulsant mood stabilizers and use APs as "boosters". I still need an AAP as part of my cocktail, but for me Rexulti takes a backseat to the Depakote.

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I know that seroquel and abilify are huge absolutely nots for me. Seroquel knocks me out even got a job random drug test pulled on me because they thought I was messed up. 

Abilify completely ruined my ability to think it was terrible. I’m thinking antipsychotics aren’t my thing.

lamictal I have been on off and on ever since I was diagnosed it seems to work for me. 

I honestly haven’t played with too many meds compared to most of you. Mainly have stuck with lamictal and Wellbutrin. 

Ive only recently been diagnosed with the anxiety and OCD and the lexapro is my most recent med.

my original diagnosis 12 or 13 years ago was adhd with something moods I can’t remember what they called it and then when I got older after I messed up and stopped seeing psychs for a bit and went back my ADHD plus diagnosis was pushed aside for a bipolar 2 diagnosis.

 

side note turns out my psych doctor is really gonna be changing soon I got fired yesterday apparently I don’t make a very good teacher like I thought I did. I made it a month and a half but I am sad because this is the first time I have ever been fired.

 

so I am on the job hunt luckily have some left over refills of my current meds so may be able to limp by until things shake out. But unfortunately won’t be able to get the help I really need until things figure out.

 

the psych I go to when I don’t have insurance or am broke or between jobs is a sliding fee scale one and a part of a group that also does substance abuse issues so it really limits the meds they are willing to try or prescribe. 

That is another reason I have to find a new psych before I can really test anything.

so fun times hopefully I’ll figure something out since I can’t really afford to self pay almost 100 dollars a visit plus meds to see a different doc

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  • 4 weeks later...

Went to the new psych finally.

she believes I have terrible adhd and the symptoms the previous docs thought were hypomania were actually adhd symptoms. She’s in the fence if she agrees about my bipolar diagnosis.

she wants to make one change at a time so she added adderall xr 20mg 

the plan is to lower and most likely remove me from Wellbutrin and eventually replace the lexapro with another SSRI such as Zoloft. 

not sure if she is going to replace the Wellbutrin or not king road if experiments ahead.

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Well it seems like she has a plan at least which is good. I personally am not a fan of Wellbutrin. It does work for my depression but it can make me snappy and irritable and my emotional memory recall is really turned up. Like fond emotional memories seem to just appear in my head for no apparent reason. It also causes the jitters and anxiety for me. Effective but the tolerability....

If you find that the Adderall isn't lasting you all day, I would recommend talking to your pdoc about Vyvanse. I know you mentioned that you just lost your job. So I'm not sure what your insurance situation is right now. Adderall XR will of course be cheaper because it's available as a generic, but if you have insurance that covers Vyvanse, the savings card will pay up to $60 of the insurance copay. (You pay the first $30, then the savings card pays $60, then you pay the difference).

A combination of Zoloft+Adderall should be a nice kick because Zoloft generally tends more towards the stimulating side of things. Combine that with Adderall and you should be rip-roaring ready to go.

Will you still be taking Lamictal as well or is the plan Adderall+Zoloft (or some other SSRI) for now?

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Yea the Wellbutrin seems to do nothing for me except make me aggressive at 450mg. I will be keeping the lamictal at least for now because I think it works somewhat and she sees no issue with it so we can focus on the other issues but at a later date she may circle back. 

We went with adderall so if at a later date I need something that lasts longer we can try and get an auth from the insurance for Vyvanse. 

The Zoloft I suggested because I heard it was good but she also mentioned like Prozac and things of that nature.

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