Effexor and Wellbutrin

Hi....

I was on Effexor in the past....Wellbutrin too (not both at the same time, but separately). Both medications made me sick and gave me various negative side effects - I couldn't tolerate them. They also did not help with my depression. I know they have new extended-release formulations now. I saw my primary-care doctor today and talked about trying anti-depressants. He wants me to try Effexor XR first, with the possibility of going to the maximum dose, and if that doesn't help enough, he wants to add in Wellbutrin SR as well. I gather he has had good success with this combination of meds. I am wondering how different the new formulations really are, and whether it is worth trying this, given my bad experiences of the past. Even the idea is making me a bit nervous....I'm not really sure what to do. I also don't have any other ideas at the moment. I'm also noticing both meds are pretty expensive. hmmmmmmm. Does anybody have any experience with these meds, before and after their reformulation, and using them in combination? Any input would be most helpful. Thanks.

Take care,
ErinBear

Erin, I am on Effexor now, 3 times a day. What side effects did you have? Just curious because it has actually made me less drowsy and more alert, better memory.....now much for my depression though.

Mary Alice

Hi Mary Alice,

It's been a long time since I was on it, so my memory is a little sketchy, but if I remember correctly, this is one of the meds that caused a lot of nausea and vomiting for me. And since the problem which brought me to the doctor in the first place is causing nausea....I don't know about this! <G> I guess I'll find out. I'm about to take my first dose.

I'm glad the Effexor has helped you in some ways but am sorry it hasn't helped as much with the depression. It sounds like it has helped with some functional things though - would that be a fair description? I couldn't tell that it helped me at all previously. But I'm trying again.

Thanks, Mary Alice. I'm still thinking of you and sending good thoughts your way.

Hugs, ErinBear

Thanks Erin......it has helped with alot of the functional things. I'm sorry that it made you so ill before. At least you're trying again.

You are so sweet............thank you. Same to you. xoxoxo

Erin - I am currently taking 225mg of Effexor XR (venlafaxine) and 300mg of Wellbutrin SR (bupropion) daily (the Effexor XR in the morning and 150mg of Wellutrin SR twice daily). It took about six months to find this combination. I was taking 450mg of Effexor XR daily, but I was in such a fog and was so fatigued and tired that I was pretty much nonfunctional.

After a month of 450mg Effexor XR daily, my doc and I decided to lower the dose to 300mg daily, but the fog was still there. I was taking 10mg of Dexedrine Spansules (dextroamphetamine, slow release) in the morning and at noon (and sometimes another 10mg at 1:00pm) and that help with the fatigue and tiredness. I was able to work, but wasn't as alert as I should have been.

My doc said to try to add Wellbutrin SR since it had worked for me in the past (although I tried it for two months before switching to Effexor XR). I was able to drop the Effexor dose to 225mg daily. Well that did the trick; the fog is gone (more often than not) and this combination is still working for me (as far as I can tell) I find it hard to objectively gauge my own progress, so I rely on my wife and my doc to tell me if am euthymic or more depressed than usual.

I still take 10mg of Dexedrine Spansules in the morning, but I really think that this is more of a security blanket than an actual necessity. My doc doesn't want me to stop this drug until after the lawsuit is settled.

As for the new formulations, they are more gimmicky than providing better therapeutic relief. The only reason to take a once daily Wellbutrin is if you are constantly forgetting the afternoon dose. Other than that I don't see a once daily Wellbutrin as having any clinically significant advantages over the twice daily version.

That being said, drugs with very short half-lives (eg. less than 12 hours of efficacy per tablet) are an inconvenience. It is not that they work better or give better blood levels of the drug, but, as stated above, it is an issue of convenience. Both regular Effexor and Wellbutrin must be taken three times daily because of their extremely short half-lives. A missed dose of Wellbutrin is not so much a problem as a missed dose of Effexor.

When you miss a dose of Effexor you risk experiencing serotonergic withdrawl effects, as is seen with Paxil (paroxetine), Luvox (fluvoxamine), and Zoloft (sertraline). These withdrawl effects (eg. headache, lightheadedness, flu-like symptoms, etc.) can occur within 8 hours of a missed dose of the regular Effexor.

Personally, I do not like regular Effexor because I have seen withdrawl effects from it far too often. I was involved in a case where a 90 year man with Alzheimer's disease was given 37.5mg of Effexor in the morning (depression is quite common in those with Alzheimer's). The pdoc that wrote the prescription assumed that the pharmacist would give Effexor XR, as the dose was once daily. Because the prescription only read Effexor, the pharmacist gave the regular Effexor (I make no excuses for those in my profession; I just shake my head and sigh a lot). The elderly gentleman was feeling awful every night at bedtime; he'd get a headache, runny nose, and feel nauseous. This went on for 4 or 5 months. His psychiatric nurse consulted with me on this case and I started to go through the drug file to see if I could find anything. I should add that this was in the days (mid-1990's) when the drug companies were still denying the existence of serotonergic withdrawl effects. I had the file for a couple of days, but found nothing exciting in the way of drug interactions, or dosages at were too high for the patient's age.

Then one night, just as I was falling to sleep, a thought just sprung into my mind to check which type of Effexor the gentleman was taking. His drug file at the Mental Health Clinic said Effexor XR. I called the pharmacy at the nursing home where this man was living and asked the pharmacist to fax me the man's drug file.

Bingo! The pharmacist was giving the regular Effexor, not the XR (extended-release version). The minimal effective blood concentration of Effexor was not maintained over 24 hours. In other words, this gentleman was going through mini-withdrawls every night! It was this case that convinced me of the existence (and potential severity) of serotonergic withdrawl.

Enough of my preaching; the only advise that I can give to you is to start the Effexor XR at a low dose (37.5mg/day) and then increase it slowly. How slowly you raise it depends upon how you feel; if the start-up side effects (eg. headache, nausea, etc.) are still bad at one dose, either ask the doc to lower the dose for awhile before increasing it. I usually say to increase the dose in increments of 37.5mg once or twice a week, depending upon how you feel. This does mean that it will take a lot longer than normal to reach a target dose (150mg to 300mg), but you do reach it with a minimum of discomfort. Also, using this method is more expensive than the normal initial dosing regimen. Ask your doc if this method is right for you.

I hope that this is of some help. - Cam
P.S. More on the case of the elderly gentleman; I called the pharmacist back and told him about the mini-withdrawls and he hadn't heard about it, but changed the gentleman over to Effexor XR. The pharmacist called me back within a week and thanked me; he also revealed that he had a few other patients taking the same drug and had the same complaints. He just thought that it was an unfortunate side effect of Effexor in the elderly.

Cam, I am on 37.5mg. three times a day. Is that alot? I was thinking of actually increasing the dosage, but what do you think? I've been on it for about 2 months now.

Mary Alice

Hi Cam,

Thank you so much for the information. I've been taking the 37.5 dose once daily of Effexor XR for a week now, and it is already making me sick. Tomorrow I'm supposed to go up to 75 mg. I'm not optimistic! But my doctor wants me to keep taking it regardless of how sick I get. I'm not sure about this. We'll see what happens. Anyway, your post was really informative...thank you so much for sharing the information with me. And I'm so glad that the Effexor/Wellbutrin combination has worked for you. That's good news. If they both hadn't made me sick in the past, I'd be more hopeful. Neither worked for me in the past either....sigh....but my doctor is very determined. Anyway, I'm still trying. :-)

Thanks again!

Take care,
ErinBear

PTE - 37.5mg three times daily is not a high dose for treating depression "for most people"; still, many find relief at 75mg per day (Everyone is different!!!) You are taking a total of 112.5mg of Effexor (venlafaxine) daily. I find that a normal antidepressant dose "for most people" is 150mg per day.

NOTE: Be sure to run the dosage increase past your doctor first before just increasing it yourself. There may be a reason for your low dose (ie. doses to treat anxiety are usually 37.5mg to 112.5mg) and you should check this out with your doc.

Hope that this is some help. - Cam

Thanks Cam - your input is always appreciated. I called my pdoc and left a message about increasing the dosage. Hopefully he'll get back to me soon.

Thanks again. Oh, will there will some side effects when the dosage increases?

Mary Alice

Hi Cam,

I was taking 37.5 mg for a week, working up to a higher dose gradually. This is under my doctor's guidance. I started the 75 mg dose today. I was on 75 mg in the past, and I know it didn't work then in terms of alleviating depression, so you're right, at least in my case. However, if it makes me much sicker than I am now, I won't be able to stay on it, period. I've lost 4 pounds in a week Anyway, thanks again for the advice!

Take care,
ErinBear

Erin - Just give the Effexor a little more time. The nausea should abate; in some people it just takes longer than in others.

Hang in there, darlin' (Oh god! I'm starting to talk like a Floridian!) - Cam

LOL - Thanks, Dude (oh no, I'm talking like the Californian I am! LOL!) giggle

Anyway, thanks for the encouragement. I appreciate it.

Take care,
ErinBear

Cam, today my pdoc upped my dosage to the 50mg. three times a day.....now I wonder about the side effects from the increase.

I am also falling asleep while driving - not completely - but dozing off and then catching myself. It feels like I am really drugged and can't keep my eyes open. This just started within the last week.

I haven't changed meds, or done anything different. What's up with that? Will it get worse with the increase?

Mary Alice

Erin - Also try sucking on peppermints and taking small sips of flat ginger ale (ie. ginger ale with the bubbles stirred out). I find that the Canada Dry™ brand works better than Schweppes™, but this may just be in my head. This is just my impression over the last 20 years of recommending ginger ale; I have never made a formal comparison by collecting statistics, so my impression could be wrong.

Anyway, I am reasonably sure of my next statement (more so than the last): sugared ginger ale works better than diet ginger ale. Again, it must be flat (no carbonation), so, pour the ginger ale into a glass and either let nature remove the bubbles, or to hasten the process stir the ginger ale and carbon dioxide fizzes away faster.

NOTE <font color=red>When removing the carbonation from the ginger ale, I DO NOT RECOMMEND shaking a can or bottle and opening either quickly. This may be the fastest way to get rid of the bubbles, but it is also the messiest! </font color=red>
You could use ginger capsules, but I find that sometimes they work and sometimes they don't.

Some reasons for many of the treatment failures could be the tablet not containing enough of the active ingredient. This is occurring less frequently than in the past, but some herbal companies are standardizing the presumed active ingredient[s] of the ginger in order to set a standard dose. The bottle of ginger tablets may say 50mg (or whatever)/tablet, but that is only 50mg of the ginger, not 50mg of the active ingredient[s]. When buying herbal remedies the only one's I would choose are those that state (on the label) that these herbal pills have been standardized to such-&-such concentration[s] of the - proposed - active ingredient[s]. This raises the price of the herbal medication considerably, but it is the only way one could be reasonably sure that each pill has the same concentration of active ingredient[s] from tablet to tablet, case to case, lot to lot.

Some preggos..... er, I mean .... some of those <font color=blue>"compellingly-radiant, ethereally-alluring, and instrinsically-anxious parturients"</font color=blue> have benefitted from ginger tablets that we sell in our store, others haven't.

Peppermints and Scotch Mints (same thing, I think) do help to soothe the stomach of pregnant woman who are at that wonderfully enlightening and memorable stage between conception and motherhood ..... <font color=green>morning sickness</font color=green>.

I hope that one of these suggestions helps ease the next cople of weeks. - Cam

Thanks, Cam. I have resorted to using peppermint TicTacs, and drinking peppermint tea a bit recently. I haven't gone the ginger ale route yet, but I could, you're right, and I agree with you - regular ginger ale (as opposed to diet) works better. And I usually splurge and get Canada Dry under such conditions. I like it best also. Tomorrow I see my primary care doctor about this and I get to tell him I can't afford the Effexor and Wellbutrin combination he is proposing. Yikes! They're expensive. Anyway, thanks again, and take care.

Thanks,
ErinBear

i'd question going back on the same meds that caused trouble. there are so many choices now. tofranil and nardil were the first anti-ds, and still considered the 'classic cars' of meds by older shrinks. the dietary restrictions on nardil, an mao inhibitor, have been eased considerably. the beauty of maois and tofranil (imipramine hcl) is they are 'broad-spectrum' meds, particularly nardil. when you consider the number of neurotransmitters discovered keeps growing, you may see the advantage of 'non-specific' reuptake inhibitors vs. ssris. mono amine oxydase--mao--is the master enzyme that breaks-down All neurotransmitters---known and yet to be discovered-- so if your depression is related to something other than just seratonin, maois will likely stop it---you may get manic, but that goes with any anti-d, and may be adjusted. good luck, in any event. i'd at least run this by your dr. and, if he's young, ask he confer with some older drs. in his loop.

pirate

Erin, I have been on 225 mg or Effexor XR and 300 mg of Wellbutrin SR per day for the past couple of months. I haven't noticed any negative side effects from the combination.

Thanks Bunny and Somebodyelse....I really appreciate your sharing.

Take care,
ErinBear