BETosca, you have a lot of stuff going on with your different meds and in your life too. Because right now you report feeling only a bit down and low level anxiety, I think you should hold off on increasing Wellbutrin until after this weekend's stressful events are over. Wellbutrin is not given for anxiety and can increase it, so I think increasing it right now before the upcoming stressful events is not a good idea, especially since your current anxiety level is only low. After the weekend, revisit the idea of increasing Wellbutrin. THat's just my opinion....
I increased Wellbutrin several times (up to 300 at one point) and each time, I experienced a few days of really feeling great, then it declined somewhat as I got used to it and my body adapted. So don't be worried about the first few days feeling different than later--that's not unusual. I do think being on Wellbutrin 300 for 12 days is enough time to know if it is doing the job for you. You were on a lower dose so already had a lot in your system, and there is not as long a ramp up with Wellbutrin as with SSRI ADs.
Lexapro is given for depression and anxiety. Not all ADs help with anxiety, but this one often does. If you feel you have been increasing Lex and Wellbutrin too fast, tell your pdoc you want to do it more gradually. I can't imagine anyone with argue with slowing down the rate of increase, especially if your depression/anxiety symptoms are not severe.
Have you tried some phototherapy to help with the SAD?
You seem worried you increased Lexapro too rapidly. What is making you think that? Are you having bad side effects? I don't know whether your increase was too fast or not, but usually people have some sort of specific complaint(s) if their increase was too fast, and you didn't mention anything.
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I'm not feeling unbearable. Just a bit down with some low-level anxiety.... Also wondering if it is okay to take the odd 0.5 mg of ativan when the anxiety is a bit too much. I don't take it regularly, and I've never taken more than 1 mg total in a day.
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Do you have a prescription for ativan? I think your pdoc is the best one to answer your questions about whether you should add ativan to your Lexapro and Wellbutrin and what dose. If the increased Wellbutrin is contributing to higher anxiety, then adding another drug to combat that seems kinda crazy, if you know what I mean, but that's the way things go when we're on multiple drugs. One drug helps solve the problems of another, rather than helping with our underlying symptoms. Maybe just take less Wellbutrin and then less need for ativan. But maybe you think having more Wellbutrin is essential to deal with the anorgasmia. There are often trade-offs. It's complicated, yeah. That's why we pay those pdocs.
I have heard that the risk for seizure with Wellbutrin is negligible until you start getting above 300. You can read up on the seizure risk on the Internet and see what it is at 450--sounds like your pdoc feels it is still too low to worry about. Ask him to show you some numbers!
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The other nagging thing at the back of my head is that maybe it's all about the Lexapro. It has worked at various doses- for awhile. Maybe it isn't quite right for me. The next step he said would be to swap the Lexapro for Cymbalta.
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Ouch. Cymbalta can be very hard to come off, so proceed with caution, but it can help people for whom SSRIs fail. Are you really sure there is a problem with your Lexapro? What symptoms do you have that are not helped by your Lexapro? Depression symptoms? Anxiety symptoms? If it were me, and anxiety was too high and not controlled by Lexapro, I would rather add a benzo like ativan than change to Cymbalta. But that's just my opinion and personal preference.
You describe your current depression as "just a bit down." Maybe Lexapro is really helping then, and the last little bit you can work on with regular exercise, getting enough sleep (very important), phototherapy, and psychotherapy.
Here is something I often wonder and this is just me thinking out loud. Wellbutrin is often added to an SSRI to "augment" it and fix SSRI side effects like lethargy and anorgasmia. Wellbutrin is itself an AD. Why don't more docs start with Wellbutrin, which doesn't have those particular side effects? Why aren't more people on Wellbutrin alone? Maybe you would do OK on Wellbutrin only, and get rid of the Lexapro. That won't help your anxiety, but why not Wellbutrin + Benzo instead of Lexapro and bad side effects? I'm sure that's very naive thoughts on my part, but I have wondered. Because Wellbutrin alone helps quite a few people with their depression, in the absence of any SSRI.
Good luck to you and with your stressful events this weekend.