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Low dose wellbutrin - ideas?


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Hi there, hope everyone is doing okay, this is truly a challenging time for mental health, basically been working for the past 10 years on *not* self isolating. 

I used to take Wellbutrin 150XL, and it worked well but caused bruxism and a bit of increased anxiety. I also liked Trintellix but it caused sexual side effects (not as much as other ssri's but still more than I wanted to tolerate). What I want to try is taking a low dose of Trin (like 5mg) w a low does of Wellb (75?)

Covid 19 is giving me a major upsurge in anxiety and depression symptoms, and I am wondering if anyone has any advice on how to take a lower dose of wellbutrin. I know the governing logic says not to cut XL tabs in half,  but I also read somewhere that the extended release for these particular tablets isn't due to the coating, but is distributed throughout the pill. But it was just something I read on one reddit thread so...grain of salt. But if anyone has anecdotal experience with this I'd hear it!

Or - IR tabs? SR?  

Thanks everyone & stay safe ❤️

 

Edited by Selkie
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2 hours ago, Selkie said:

I don't have any of these meds atm so would need to get new rx's anyway. :)

Just FWIW, I am on Trintellix 15mg currently.....When I first started it, pdoc put me on 5mg, and I experienced an increase in anxiety and agitation on that dose, plus some insomnia......When my doc increased the Trintellix to 10mg, and then 15mg, the extra agitation was greatly decreased, for me.

I have seen a few others here say the same basic thing about Trintellix--that for them the lower doses resulted in more anxiety, and higher doses were more calming.

Everyone is differerent, though, and you might react differently to low dose Trintellix......Just my 2 cents, and I wish you the best.

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Just so you know, there is an interaction between Trintellix and Wellbutrin that will result in increased Trintellix levels in your system. So 5 mg Trintellix will effectively be a higher dose in your system, and it's recommended not to exceed 10 mg Trintellix while taking it with Wellbutrin.

That being said, taking it with a lower dose of Wellbutrin may theoretically not result in this interaction and allow for a higher dose of Trintellix should you decide to do this... but Wellbutrin 75 mg is really not enough to do much for anyone. The only way to take this dose of Wellbutrin effectively is to take the instant release Wellbutrin 75 mg tablets, and that won't get you through the whole day. You could probably take a 100 mg SR tab, but that too won't really get you through the whole day. Taking 75 mg IR twice daily or 150 mg XL once daily is really the best way to go, but as you said, that causes bruxism and anxiety. However, if you take Trintellix with it, maybe it will decrease the anxiety, but it has a chance to worsen bruxism, as serotonergic antidepressants also cause bruxism.

If Trintellix caused sexual side effects that you weren't willing to tolerate, there is another medicine in the same class (though not with as many novel mechanisms of action) called Viibryd. It was way more effective for me than Trintellix, which actually worsened my depression and anxiety. Viibryd for many has some pretty intense gastrointestinal side effects, so that's something to watch for.

SNRIs, while not as novel as the SMSs (Trintellix and Viibryd), generally carry less of a risk of sexual side effects. Those may be worth checking out.

TCAs, believe it or not, even with all their side effects, tend not to have as much sexual side effects as SSRIs/SNRIs. The secondary amine TCAs (nortriptyline, desipramine, and protriptyline) have the least side effects of the TCAs. They primarily are noradrenergic reuptake inhibitors (each one varies in their degree of selectivity for the NET over the SERT), and can be even stimulating for some depending on the dose, especially desipramine and protriptyline, rather than sedating like the tertiary amine TCAs (like amitriptyline, imipramine, clomipramine, doxepin, etc.). They also cause little to no weight gain compared to the tertiary amines. They're worth checking out.

There are various combination strategies for severe depression that hasn't responded to first- and second-line therapies. Bupropion + sertraline, mirtazapine + SNRI (prototypically venlafaxine, but any will do), sertraline + nortriptyline (but any secondary amine TCA will do), SSRI + buspirone, any antidepressant + atypical antipsychotic (one particularly effective combination is sertraline + aripiprazole). You may also try subsituting bupropion with methylphenidate or an amphetamine stimulant, which can actually be less anxiogenic than bupropion (my personal experience and have read that from others as well) in any combination with any other antidepressant you chose, probably most likely a serotonergic one to balance the increase in dopamine and norepinephrine.

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  • 2 weeks later...

@mikl_pls thank you so much for taking the time and care to answer this. I'm having a phone call with my GP later this morning to talk about meds. Right now they've put me back on wellbutrin 150xl, 15mg buspar (so far doesn't do anything..) & .5 mg clonazepam prn (helpful but would prefer to transition away  from relying on benzos. 

The pdoc that works with my GP recommended Lyrica/pregabalin for anxiety. I'm also thinking about asking to try Lamictal, I've never been on it before but have a lot of friends who have had success for unipolar depression/anxiety. 

You are clearly very very knowledgeable - any info / insight on either of these?  

Thank you & hope you're well....very difficult times right now ❤️ 

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Cutting a Wellbutrin XL or generic of the XL will not do what you want. It has a unique delivery system so cutting a pill in half will not render half a dose.

Important to note, Wellbutrin is, dose for dose, a weak antidepressant, even the manufacturer says so in the PI. It mainly hits Dopamine.  it has several metabolites, some active and some we don't know. It is one of the few true antidepressants that does not touch serotonin  It That is why many to take 300-450 mg of it for an effective response. Sometimes the 150 XL is used to augment or quell side effects.

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Thanks @notloki this is helpful ---- just to say that no matter what the manufacturer says, 150xl is strong for *me* ... I'm super sensitive to meds generally and often have gotten effects from sub therapeutic doses, go figure. Anyway I'm going to give 150 a try again for now, it's been a couple years. All the best :)

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FWIW I'm also usually really sensitive to medication and I had a strong response on 100mg IR. I abruptly fell asleep like eight hours after taking it though, lol. I believe they also make 100mg SR (which I haven't personally tried), that might mitigate that problem if you find the 150XL ends up being too much for you and you want to try and go down in dose. Just something to keep in mind for the future if you're looking at trying lower doses again.

Also FWIW, if sexual side effects were your main problem with SSRIs, I used to get sexual side effects on sertraline by itself, and they have completely gone away since adding wellbutrin. If you haven't tried the SSRI + wellbutrin together, it might be something worth discussing with your doctor if what you're currently trying doesn't work out for you.

I got nothing for bruxism though. I just wear a mouth guard at night and it lasts about half as long as it's supposed to because I chew right through the thing.

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  • 2 weeks later...

@Sync thank you so much - would you be open to me messaging you about this (SSRI + buproprion and SSE)? 

Everyone else: interestingly, I'm on 150mg wellbutrin now and I actually can't feel it at all and am considering trying 300mg. I am also taking 25mg buspar, which I think might be helping with the bruxism/slightly anxious edge wellbutrin has given me in the  past. I experienced *day* bruxism, kind of like a tic, and I'm really glad it's not bothering me this time (yet). Wondering though if the buspar is dampening the beneficial effects of the wellb. Going to talk to my MD tomorrow. Thanks so much for all of your help :)

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