Wellbutrin - losing effectiveness?

I have been on Wellbutrin SR for about 5 years. Lots has happened over the past 5 years (death of father, awful job, better job change, etc), and Wellbutrin has seemed to work fine - for the most part. Most of my issues seem to lie in anxiety/derealization - just feeling disconnected when I think about how we are here and then we aren't/existential stuff that can't really be helped. However, I do fall in these ruts (not sure of a better word) where I can't seem to ever sleep enough, and I just cry all the time. Over. Everything. This is one of those times when I had a really big feeling the last time would really, truly be the last. This feels a lot more difficult than the other times. I can barely watch TV shows, listen to music, etc. I can barely make it through the work day without thinking about all the hardships my students and the others in their class will inevitably face and ducking into the bathroom to cry. It's like these sad, true thoughts get stuck in my brain.

I am not suicidal and have no plans or anything like that. But I do have this passing thought some times that it would be great to just stop feeling so much. I would never do anything. It's honestly just a thought. I have been diagnosed with depression before - and was put on Wellbutrin during one of these ruts I am describing.

I have made a lot of changes over the past few months also - for example, I haven't drank any alcohol in almost 130 days. And I am proud of myself because this is a time I would be drinking a lot, and right now, I would like to just drink a bottle of wine, but I'm not. So I am more confused why I am feeling this way.

Could Wellbutrin be losing its effectiveness? Has it lost effectiveness for anyone here? I take the SR 150 mg twice daily.

Do you think therapy would help? I have been in and out of therapy - I had experiences with one therapy whose focus was positive psychology that was honestly life changing. However, it has been difficult to find that. Also - can I hear some thoughts and experiences regarding online therapy? Or should I do that on another thread?

Thanks to everyone. I am scheduling an appointment with my new primary doctor to discuss this. Just wanted to ask other people too.

Some people taking antidepressants commonly find that they *poop out* after long term use. It happened to me with Wellbutrin and with Effexor. Sometimes a dosage adjustment will solve the problem but often you'll need to switch to a different AD.

Sometimes meds stop working. Also 150 mg is a relatively low dose. You could go as far up as 300mg. Talk to you Pdoc.

I believe you can go all the way up to 450mg. I take 300xl and it works great

hi. i think 450 is the usual maximum. when wellbutrin first hit the market, higher doses were common, but...those higher doses=a higher rate of drug-induced seizures. ugh.

"augmenting," or adding a drug to one you're already taking, is fairly common. ssri drugs can be added if anxiety and obsessive thoughts are a problem. remeron might help if one needs help sleeping, with anxiety, low mood, etc. it really depends.

the only downside to being on wellbutrin is that, as the dose gets higher, the doctor has to be more cautious about any additional drugs, because of drug-drug interactions, the potential for seizures, etc. that seems to be why most people who take wellbutrin with another antidepressant take something newer--an ssri, remeron, now and then effexor or cymbalta--versus a tca.

depending on the nature of your problems, something just to calm you down might help. gabapentin, lyrica, maybe a benzodiazepine (long term use...can be a problem...).

hope this helps.

Ask your doctor about an add-on like Abilify or Rexulti. They work in their own right and can also booster the good effects of your AD. Vraylar was also great for me, but $$$$$. Abilify is now working pretty well too.

Just a heads up - this question/reply will have weight related questions and talk about weight struggles.

Did any of those meds cause weight gain? I finally am back to where I was before Seroquel and Celexa weight-wise. And it seemed so impossible and am not sure I would have done it without Wellbutrin. It is entirely superficial, and I am a bit embarrassed that it’s a factor to me, but it is what it is.
Thanks for your reply - I appreciate it.

if Wellbutrin worked well for you - did you find anything else that helped? I have had minimal side effects with Wellbutrin - has seemed too good to be true. My previous doc said she was a little surprised that just Wellbutrin was working for me as my primary issues was anxiety related and she has seen Wellbutrin agitate that.

Thank you!

300 mg twice a day? Or total? I take 150 twice a day. Will speak to my doc. Thanks!

It really helps. An add-on has been talked about before when I brought up my sporadic anxiety/panic/etc. Just a heads up - the next few sentences are weight related/talk about weight issues. Celexa worked wonders for my obsessive thoughts and paranoia. But also caused massive weight gain - which like I said to another poster - I know is superficial and shouldn’t be a factor of mine but it is. I am back to where I was weight wise before Seroquel and Celexa - which I thought was impossible.

I had a prescription for Ativan that actually really, really helped. This was prescribed by someone I no longer have access to. Would it be inappropriate or weird for me to ask for a prescription for a benzo? I do not have a history of medication abuse if that matters. I’m just afraid of an add-on that I would have to take all the time when I was prescribed Ativan, i felt like just knowing that I had it helped, and I felt that in itself helped calm me. Thank you!

hi. docs can be weird about benzodiazepines. some are easy breezy, as long as you don't have a problematic history and you're not asking for high doses, etc. other docs have anti-benzo dogma going in a big, big way. it really depends, honestly.

gabapentin works for some people, daily or as needed. i dont much care for it, but when i need to sleep, it gets the job done. lyrica is like super neurontin, but it is a controlled substance. its schedule V, less controlled than the benzos in schedule IV, and long term use does require a slow taper. its also new, so insurance coverage is sometimes an issue.

prozac sometimes helps w/ obsessive thoughts and such w/o so much weight gain. i think its one of the more stimulating ssri drugs. it is combined w/ wellbutrin at times, although again...the doctor should be careful, because of the seizure risks.

other than that, straight up ocd is sometimes treated w/ luvox, but its not very popular. i dont know the adverse effect profile.

sorry about all this. psych drugs...not fun times, usually. i hope you and your doctor can find a work-able solution.

Gained 10lbs on lithium but not an ounce on any other AD's or AP's or AC's. Weight IS a factor if it's an unhealthy amount or if it helps to devastate your self-esteem.

I don't see why it would be inappropriate to ask for a benzo prescription. My shrink is of the "whatever works" school and I have prescriptions for both Ativan and Xanax, though I use the Xanax only rarely. The Ativan helps me stay asleep longer than three - four hours which is obviously important. Sometimes I take it during the day as needed. I honestly feel we need to get rid of the fear of "needing something all the time". We suffer from chronic conditions for which long term administration of meds is often needed. I'd rather be "addicted" and be able to get though my day with relative ease and comfort than "clean" and constantly miserable. Of course that doesn't mean we should be heedless pill poppers - I assume very few, if any, here are. Talk therapy and any other adjunct therapy is always an excellent idea. But please do ask for what you feel helps you. An understanding physician is a battle half-won