Need some meds feedback..

Have to revise my initial mood for today...been an emotional roller coaster, cycling repeatedly, with really dark depression. Finally gave in and called my doc - of course I wait til the end of the day on a Friday - can anyone say "self-sabotage"? OK...actually had to pause a minute because the doc was calling me back...
anyway, upping the Lamictal and adding Welbutrin..what's the skinny on the Welbutrin?

I can't tell from your post if your mood is cycling between mild and major depression or if you are going hypomanic as well. If it's just depression an anti-d may do the trick. The newer anti-d's like wellbutrin tend to be better for people diagnosed in comparison to SSRI anti-d's.

If your mood is going up and down the addition of any anti-d may not be the best idea. You may need the lamictal increased or may need an add-on med for the lamictal like abilify. Many people that are on lamictal need an add-on med because the lamictal isn't as good at controlling the highs.

I'm on wellbutrin. I prefer the XL, but it doesn't come in a dose lower than 150 mg. I was getting too high even on the 150 mg since my med change to lamictal.

I'm sorry you are having a hard time.

Wellbutrin made me feel aggressive and impulsive when I first started it, but then it kept me feeling neutral after the side effects wore off. I tolerated it better than any of the SSRIs, but it never cured my depression. Hope it works for you. Everyone's brain is different. My cure has been an SSNRI...Cymbalta and yet the other well known in that class...Effexor...made me nervous, jittery, eyes dilated, teeth chattering, couldn't stop shaking. It was awful. Go figure. Wishing you lots of luck.

Yesterday I was right at the edge of hypomanic but didn't go over. I'm not noticing mild depression, just a kind of normal feeling then instantly into major depression. This started when I first went off Prozac on and the Lamictal, but it seems like the depression gets worse and happens more often in direct relation to the hypomanic getting better. Today I was bouncing back and forth so rapidly, I may as well have been depressed the whole time. I've been putting off calling my doctor because I thought it might settle down. wrong..I'm hoping the Wellbutrin and the increase in Lamictal will keep me from having the hypomanic/anxiety episodes I had with the Prozac. Fingers crossed and thanks for your help
thanks for your input, thinker ..it helps to know what to look for..if weird things happen, I'll be coming to you for advice

If it helps any I had the same issues when I started lamictal. I had gone off my lithium 2 weeks prior and being off a mood stabilizer was not a good thing for me. My mood was up and down until about the 2nd month I was on lamictal. I'm now up to 100 mg am/pm.

I'm not a fan of the SSRI's (prozac is a SSRI), but without a mood stabilizer wellbutrin would trigger me in a mixed state or hypomania too.

I only took wellbutrin for a short time, it didn't work for me. My son has been on it for a while for obsessive compulsive disorder, it's the only thing that helped him. Lamictal works great for my depression, I love it. I think with all meds, each meds works differently for each of us.

Actually, Wellbutrin is a norepinephrine reuptake inhibitor as an atypical antidepressant and marketed under the name Zyban as a smoking cessation aid. Wellbutrin is really in a class of its own and not to be confused with SSRIs like Celexa or Prozac. If Prozac made you anxious, you would probably respond very well to Celexa (also marketed as Lexapro) and visa versa. This is because the mode of action related to your particular genetic structure. Celexa, like Wellbutrin, has anti-anxiety properties.
Do not confuse the NRI with the SNRIs such as Cymbalta, Effexor XR and Pristique. These also work on keeping the norepinephrine and serotonin present longer in the brain chemistry.These are also called dual reuptake inhibitors. Unlike the SSRIs, if you respond well to one SNRI, you are likely to do well with each of them which is great news as Cymbalta is currently the most expensive anti-depressant on the market in the US followed by Pristique and then Effexor XR. Effexor (non extended release is available in generic form.
Now here is the exciting news. The NRI (Wellbutrin) is often used as a piggyback drug with your effective SSRI (in your case, again, if prozac wasn't working, you would probably do very well with Celexa) both Celexa and Wellbutrin, anxiety is decreased. Additionally, the addition of Wellbutrin increases the efficacy of the Celexa often negating some of the side effects and making it a more effective anti-depressant. There is no wonder though really. The NRI and SSRI predates the SNRI or dual reuptake inhibitors, exactly what the combination of an NRI and an SSRI becomes at a fraction of the cost!
Don't you just love how the drug companies love to make a buck by combining existing medications whose patents have run out and raising the price to nearly $900 per month for one drug?
Be patient my friend and keep asking questions. It might take some time to find the right combination of meds but it will be well worth it! Anytime I can help, do not hesitate to reach out.
Finally, just to clarify what is often misunderstood, while Lithium Salts were the first effective mood stabilizer, Lamictal is the first mood stabilizer on the market that has the FDA's approval for on-label use as a mood stabilizer in the treatment of bipolar disorder. It is very effective at the optimum dosage of 200 mg. However, it is very important that your doctor start you off at the lowest dosage, 25 mg, and work up to 200 mg over a 5-6 week period. Otherwise you risk responding with a life threatening rash and will never be able to take Lamictal again. If you go off Lamictal and wish to start taking it again, it is necessary to titrate up your dosage once again. Other popular mood stabilizers, although I do not find them to be as effective, are depakote and topamax. Again, these can be used in combination with Lamictal which is also sold in the US under the generic name, Lamotrigine. (Yea, generic,... lower co-pay)
God Speed and Best Wishes,
ptk

I am not yet on any mood stabilizers ( appt. next week) and I have been on Wellbutrin for the last 2 years. My experience with it is that it really helps with anxiety but does little for the depression. I was content to be on it because it did not send me over the edge like Paxil did (suicidal) and worst hypomanic or manic period that I ever had.
I had no idea at that time that I was BP. Another plus with Wellbutrin is that it decreased my appetite.

Live free or die... but never depressed....

Regarding anti-depressants...

I said in my earlier message that there are basically two different kinds and which category works for you will be dependent on your genetic makeup. The best way to determine which drug works best for you is to experiment at the direction of your psychiatrist or in drug-resistant, long-term problems, a consultation with a psychopharmacologist may be in order. There are the different types including (NRI, SNRI, SSRI, Tricyclic) and method of inhibition (PgP or non-PgP):

P-glycoprotein substrates Inhibitors (PgpI) ie Celexa, Lexapro, Paxil, Zoloft (all are SSRIs) and then Elavil (which is a tricyclic) and Effexor (which is an SNRI)

NON P-glycoprotein substrates (non-Pgp) ie Prozac, Fontex, (SSRI) Remeron (Tricyclic)

Obviously this list is far from complete but I will continue to compile information. I have spent the last hour trying to categorize the method of inhibition for Cymbalta but was unsuccessful in my attempts. I will consult with some of my sources and repost when I have more details. However, in my research regarding Cymbalta, while it addresses neurological pain through inhibiting the reuptake of norepinephrine, when compared head to head with Celexa, Cymbalta's efficacy is significantly less while its potential serious side effects such as hypertension, renal failure and hepatic failure in addition to an increase in anxiety compared to that of Celexa leaves no logical rational for prescribing Cymbalta over Celexa or Celexa in combination with Wellbutrin. Before taking Cymbalta, please do your homework very carefully. It is being widely prescribed right now because it is being heavily marketed and doctors from family practitioners, rheumatoid specialists, endocrinologists as well as psychiatrists are dispensing samples and writing prescriptions for Cymbalta. Conversely, in a study conducted in 2009 the tricyclic anti-depressant Remeron was shown to have an efficacy rate equal to or higher than that of NRI, SSRI or SNRIs with much less side effects. Newer does not always mean better.
It is important to understand that a well trained psychiatrist usually sticks to between 15 and 20 drugs that he/she prescribes regularly even though there are many more choices available on the market. This practice is done for your safety. As new drugs are introduced, a prudent physician will hold off on prescribing the latest, greatest thing from the drug representative and doling out samples while that doctor does their own unbiased journal research on efficacy, drug-drug interaction, methods by which the drug works and how the drug effects the organism as a whole.
The best thing each one of us can do is become a partner in our own medical care. Make sure we use the same pharmacy for ALL prescriptions regardless of which doctor wrote them, if you are continuing to experience adverse symptoms talk to your pharmacist about which drug or drugs may be involved and what alternatives they may recommend, research your medications from at least 5 neutral sources and do the same with proposed medications. Finally, do not hesitate to speak up, make suggestions, ask questions and if your issue continues, you can continue to repeat your request for help (go on, be a broken record... it works!!!) with that particular problem while you seek a specialist in that area if at all possible. Remember though, when you are accessing your medical team, don't forget that pharmacists have had the same number of years of training as physicians but all they studied were medications. Don't hesitate to use them as a resource.

ptk

Hi PTK- Thanks for sharing your knowledge. I have never been prescribed a mood stabilizer before and I am very nervous about it.My main concerns are bad side effects that would result in me being even more depressed or a manic episode or in me being hospitalized ( which I have never been but probably should have) I was planning to spend time this weekend to do some research before my upcoming appt. which will be with a nurse practitioner .How do I research drugs from 5 neutral sources? Thanks,Joanie

Do you know how to access your private messages? I am already one step ahead of you <neener, neener, neener>

I want to say thanks to everyone for posting so much useful information. One thing I can say is that I'm glad I have a doctor who really listens to me and makes time for me even if he doesn't really have the time. The last one I had was part of the problem - he tut-tutted everything I ever said then did what he thought was best..which is why I had no medication and no diagnosis for years. Of course, I was too intimidated to speak up or to change doctors...I can do that now.

OK, day one of the Wellbutrin...does anyone know about how long it will take to kick in? Had a couple of depressive episodes today already...almost started crying at the pharmacy for no reason, but managed to hold it back.

I would say you'll probably feel the side effects soon, but I'd guestimate a week before you can judge if it's doing anything or not. It worked faster on me than the SSRIs...but I only knew that because of feeling aggressive and impulsive. Don't get behind the wheel before you're sure what it's doing to you. I made that mistake and was driving like a maniac! Ugh. Bad me. But I didn't realize it was the meds until later.