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Melancholya

Sertraline + bupropion?

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Hi all, I thought I would start a new topic separate to my bupropion one as I have actually stopped taking bupropion now.

So I was off all antidepressants for just over a week, and found myself getting really angry and irritable. I'm not seeing my psychiatrist until the 16th May so for now I've "defaulted" back onto sertraline, which I think was the most recent best antidepressant I have taken. I've been on it for about 4 days now. As a quick recap, I stopped bupropion (300mg) because I couldn't cope with the increased heartrate and anxiety I was feeling. I'm feel much better now being off it, and I am already having a benefit from sertraline. However, I know that sertraline will take away my sex drive and energy (I am already feeling like I want to take naps, when I didn't when I was off SSRIs and only taking bupropion).

Since I have a psych appointment coming up, I'm wondering if it's worth asking if I should take a lower dose of bupropion (150mg) along with the sertraline? Is this a combination that is generally quite successful with helping with the energy and sexual problems that come from SSRIs? 

If anyone has any experiences to share taking this combo, I'd appreciate it :) Thanks.

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That's my combo. There have been some dose mishaps along the way but at this point it's honestly pretty perfect. The side effects counteract each other, for me. My sertraline side effects over 100mg were sexual side effects and emotional blunting. Bupropion takes care of that, and the sertraline takes care of the heightened anxiety from the bupropion. 

It affects everyone different and all, but it definitely seems like a reasonable thing to ask about.

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I haven't been on both at once, but i did fail a trial of sertraline..though probably med compliance had something to do with it. For me it did seem to take effect pretty quickly, not sure if it was placebo or ha, fucking brain.

Augmenting an SSRI with bupropion or mirtazapine is common practice to help with sexual dysfunction caused by the SSRIs. Both bupropion and sertraline are cyp2d6 inhibitors, so they will increase the amount of both drugs in your system. Probably won't double it, but something to note.

There's another member here,  @Sync who is / was on both, until she hit 250mg of bupropion which took the train off the rails, so to speak.

hey that @ stuff works again. neat

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10 minutes ago, argh said:

I haven't been on both at once, but i did fail a trial of sertraline..though probably med compliance had something to do with it. For me it did seem to take effect pretty quickly, not sure if it was placebo or ha, fucking brain.

Augmenting an SSRI with bupropion or mirtazapine is common practice to help with sexual dysfunction caused by the SSRIs. Both bupropion and sertraline are cyp2d6 inhibitors, so they will increase the amount of both drugs in your system. Probably won't double it, but something to note.

There's another member here,  @Sync who is / was on both, until she hit 250mg of bupropion which took the train off the rails, so to speak.

hey that @ stuff works again. neat

Yup, 250mg bupropion set my entire life on fire, lmao. Dropping that back down to 150 and going from 150 => 200 on the sertraline seems to have done the trick though. I think 150 is just a hard limit for how much bupropion I can tolerate. I love it to death but boy does it hit me like a runaway freight train.

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4 minutes ago, Sync said:

Yup, 250mg bupropion set my entire life on fire, lmao. Dropping that back down to 150 and going from 150 => 200 on the sertraline seems to have done the trick though. I think 150 is just a hard limit for how much bupropion I can tolerate. I love it to death but boy does it hit me like a runaway freight train.

Ah that answers my next question, which was how much you're taking. :) It's great to hear you've had success on 150mg because I am hesitant to try 300mg again because of how unbearable I found the increased heart rate and anxiety, but I was a little worried that 150 might be too low to be effective. Out of curiosity, are you quite small in stature? I am really short (5'1) and my father in law, a doctor, wondered if 300mg is just a lot for someone of my size. 

Sertraline I think helps my anxiety too, so hopefully this will be a great combo for me to try. Thanks so much for your input, it has given me back some hope. 

@arghI have always found sertraline to work very quickly. I've been on it a few times now. 

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2 minutes ago, Melancholya said:

Ah that answers my next question, which was how much you're taking. :) It's great to hear you've had success on 150mg because I am hesitant to try 300mg again because of how unbearable I found the increased heart rate and anxiety, but I was a little worried that 150 might be too low to be effective. Out of curiosity, are you quite small in stature? I am really short (5'1) and my father in law, a doctor, wondered if 300mg is just a lot for someone of my size. 

Sertraline I think helps my anxiety too, so hopefully this will be a great combo for me to try. Thanks so much for your input, it has given me back some hope. 

@arghI have always found sertraline to work very quickly. I've been on it a few times now. 

Nah, not particularly. 5'5", not super skinny or anything. If you haven't tried 150mg I'd definitely recommend it, it's had a pretty dramatic effect for me.

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9 minutes ago, Sync said:

Nah, not particularly. 5'5", not super skinny or anything. If you haven't tried 150mg I'd definitely recommend it, it's had a pretty dramatic effect for me.

Hopefully my psychiatrist will be on board with me trying it :) I could try it before seeing him but I'm a bit worried about it, I'd rather have his approval first. 

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Just now, Melancholya said:

Hopefully my psychiatrist will be on board with me trying it :) I could try it before seeing him but I'm a bit worried about it, I'd rather have his approval first. 

Oh yeah, for sure. I'd definitely talk to him about it first. I'd never recommend experimenting without psych say-so, way too many complicated interactions out there.

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Sertraline + bupropion = triple reuptake inhibition (SNDRI). You get serotonin from sertraline, and norepinephrine from bupropion, and dopamine from both sertraline and bupropion. It's a very good combination.

Personally, I don't see anything wrong with 300 mg bupropion + sertraline. I took it like that for a while and did very well on it.

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Thanks @mikl_pls. It does sound like a promising combination.

Unfortunately, hope may be lost. I got in touch with my psychiatrist via email to ask his thoughts on this. He has never prescribed this combo before, and said the literature states an increased risk of seizures, so he will not recommend it for that reason. He did say though that if I want to trial it I will need to be aware of drug interactions. I'm not sure how to interpret that... He won't give me his recommendation but he's saying I can try it anyway? I am not sure. 

As for drug interactions, does anyone know where I can find information about what to avoid while taking both? @Syncperhaps you have some up to date info on it as it's what you currently take? 

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1 hour ago, Melancholya said:

Thanks @mikl_pls. It does sound like a promising combination.

Unfortunately, hope may be lost. I got in touch with my psychiatrist via email to ask his thoughts on this. He has never prescribed this combo before, and said the literature states an increased risk of seizures, so he will not recommend it for that reason. He did say though that if I want to trial it I will need to be aware of drug interactions. I'm not sure how to interpret that... He won't give me his recommendation but he's saying I can try it anyway? I am not sure.  

As for drug interactions, does anyone know where I can find information about what to avoid while taking both? @Syncperhaps you have some up to date info on it as it's what you currently take? 

I believe it comes down to how the two drugs are metabolized and effectively raise serum levels of each other. Specifically it is CYP2D6 inhibition, as both are CYP2D6 inhibitors.

More bupropion = higher seizure risk. Though it's not going to turn 150mg of bupropion into 300mg, which is not the highest therapeutic dose possible.

Is mianserin available where you live?

https://www.ncbi.nlm.nih.gov/pubmed/9197943

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8 minutes ago, argh said:

 

I believe it comes down to how the two drugs are metabolized and effectively raise serum levels of each other. Specifically it is CYP2D6 inhibition, as both are CYP2D6 inhibitors.

More bupropion = higher seizure risk. Though it's not going to turn 150mg of bupropion into 300mg, which is not the highest therapeutic dose possible.

Is mianserin available where you live?

https://www.ncbi.nlm.nih.gov/pubmed/9197943

Yeah, I'm only on 50mg of sertraline right now, and just wanted to try that with 150mg bupropion. I can understand my psychiatrist's hesitancy as he has never prescribed it before. I don't think bupropion is commonly used as an antidepressant here, it sounds much more common over in the States.

Unsure about mianserin's availability here. I can ask. The thing that annoys me is that my psychiatrist keeps on saying he has no more options for me, and I have to keep on suggesting things to him. I feel he should be looking into alternatives and suggesting them to ME. For months he told me there was nothing new I could try and then I asked about bupropion and he was like yeah OK. 😕 

I'll see what I can find out about mianserin. @argh do you know if it's also activating? Sertraline is making me really tired.

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6 minutes ago, Melancholya said:

Yeah, I'm only on 50mg of sertraline right now, and just wanted to try that with 150mg bupropion. I can understand my psychiatrist's hesitancy as he has never prescribed it before. I don't think bupropion is commonly used as an antidepressant here, it sounds much more common over in the States.

Unsure about mianserin's availability here. I can ask. The thing that annoys me is that my psychiatrist keeps on saying he has no more options for me, and I have to keep on suggesting things to him. I feel he should be looking into alternatives and suggesting them to ME. For months he told me there was nothing new I could try and then I asked about bupropion and he was like yeah OK. 😕 

I'll see what I can find out about mianserin. @argh do you know if it's also activating? Sertraline is making me really tired.

it's related to mirtazapine. if the effects are the same (mianserin is not available here), it is a horse tranquilizer, with massive H1 affinity, which also happens to be an antidepressant. But of course, everyone will react differently.  It does have an NRI component to it, so it is probably not at all like mirtazapine. As it increases dopamine, norepinepherine and serotonin by dis inhibition, it should become somewhat simulating at higher doses.

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5 minutes ago, argh said:

it's related to mirtazapine. if the effects are the same (mianserin is not available here), it is a horse tranquilizer, with massive H1 affinity, which also happens to be an antidepressant. But of course, everyone will react differently.  It does have an NRI component to it, so it is probably not at all like mirtazapine. As it increases dopamine, norepinepherine and serotonin by dis inhibition, it should become somewhat simulating at higher doses.

I just feel so done with trying various things. I'm so tired of trying new stuff. They all make me feel sick or weird.

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8 minutes ago, Melancholya said:

I just feel so done with trying various things. I'm so tired of trying new stuff. They all make me feel sick or weird.

I hear you.  That seems to be a disclaimer for all psych meds. In almost the same boat myself. Found a combo that works very well, might have to remove the newest due to SJS concerns. 2nd time is the charm as they say, but they say a lot of folksy bullshit not grounded in reality. Or something.

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15 minutes ago, argh said:

I hear you.  That seems to be a disclaimer for all psych meds. In almost the same boat myself. Found a combo that works very well, might have to remove the newest due to SJS concerns. 2nd time is the charm as they say, but they say a lot of folksy bullshit not grounded in reality. Or something.

Apologies but what is SJS? 

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3 hours ago, Melancholya said:

Thanks @mikl_pls. It does sound like a promising combination.

Unfortunately, hope may be lost. I got in touch with my psychiatrist via email to ask his thoughts on this. He has never prescribed this combo before, and said the literature states an increased risk of seizures, so he will not recommend it for that reason. He did say though that if I want to trial it I will need to be aware of drug interactions. I'm not sure how to interpret that... He won't give me his recommendation but he's saying I can try it anyway? I am not sure. 

As for drug interactions, does anyone know where I can find information about what to avoid while taking both? @Syncperhaps you have some up to date info on it as it's what you currently take? 

I mostly just ask my pdoc any time I'm thinking of taking something new, anything over-the-counter or anything. It strikes me as real weird to say "be aware of drug interactions." That's his job, isn't it? How are you supposed to know about drug interactions? If he doesn't know, can't he consult his literature or a pharmacist or something?

The big one is I'm not allowed to drink at all on bupropion because it increases seizure risk. But I think that's in place for bupropion by itself, too, so you probably already know that one. 

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12 minutes ago, Sync said:

I mostly just ask my pdoc any time I'm thinking of taking something new, anything over-the-counter or anything. It strikes me as real weird to say "be aware of drug interactions." That's his job, isn't it? How are you supposed to know about drug interactions? If he doesn't know, can't he consult his literature or a pharmacist or something?

The big one is I'm not allowed to drink at all on bupropion because it increases seizure risk. But I think that's in place for bupropion by itself, too, so you probably already know that one. 

Yeah, I did know not to drink with bupropion... I found that out myself, not from my psychiatrist. 😕 I don't like drinking anyway so no problems there. 

Yeah my psychiatrist is a bit odd. I don't have that much confidence in him. 

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Oh, my pdoc did mention that anything psychoactive at all, like any sleep aids or weird herbs or anything needed to be run by her. Maybe if you ask a pharmacist they can give you info about it?

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1 hour ago, Melancholya said:

Apologies but what is SJS? 

Stevens Johnsons Syndrome.  It's a potential side effect of lamotrigine. There's a 10% chance of a completely harmless rash. There's a .03% chance of an anticonvulsant hypersensitivity reaction which causes SJS and if it progresses unchecked, TENs. Basically causes your skin to die as your antibodies attack it and the treatment is  treatment in a burncenter if it isn't caught in time. If you have a strong stomach, turn off your explicit filter in google and search for stevens johnsons syndrome or SJS

Any rash you get needs to be looked at immediately; most of the time you'll be told to stop the med. If the rash is deemed to not be the SJS rash, you can restart, however you have to start titrating over from the beginning if you've stopped the med for 3+ days.

Got a bunch of rashes, was told to hold off. Was on week 5 at 100 mg. They checked out as not SJS, but about 5 days had passed. I'm trying it again and hoping for no rashes. It's a bit frustrating as to avoid SJS/rashes you go 25mg for 2 weeks, 50 for 2 weeks, then 100mg for 2 weeks then 200mg. Takes a while. I'm rashy in general, I'm sure i just got a rash right now by virtue of sitting down and thinking about rashes, so that doesn't help. pdoc might just throw in the towel and try something else.

ok off my soapbox.

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