Upping Wellbutrin & Hypomania

I was diagnosed with bipolar in 2011. It took two or three years to find the right med combo; and for the last 10 years, everything seemed mostly OK. Things weren’t perfect but I wasn’t on the roller coaster anymore. Then somewhere around six or nine months ago I started getting really depressed and paranoid. I told my new psychiatrist about it and his first reaction was to focus on the depression without giving much consideration to the paranoia. He told me to increase my Wellbutrin and we didn’t change anything with mood stabilizers or antipsychotics. I think this helped with my depression, but I’ve felt more and more unstable. I think the increase in the Wellbutrin has pushed me into a hypomania. I know antidepressants can sometimes trigger episodes, but I just trusted my psychiatrist. Now I am wondering if I should have questioned him more and I really want to go back down to a lower dose of Wellbutrin. I know the responsible thing would be to talk to my psychiatrist first, but i’m not feeling very confident in him right now. Your thoughts?

I encourage you to talk to him and be frank with him. I am bumping up Wellbutrin to the max [450mg per day] after years of treading water on 300mg a day and no add-ons. The reason being I've been sliding lately and feeling worse more often. Adding a mood stabilizer was recently suggested to me but I decided to try the max dose first. My doc was ok with me trying that first.

Seems your Doc wants to try that same max-dose route first. If bumping up the Wellbutrin doesn't have the required effect for you then he'll likely want to go the add-on route. The only thing is, you have to give the Wellbutrin increase a good couple of months or so to see if it's acceptably effective for you. A good thing to realize is that most psy-docs will prescribe diff med/s if one isn't working. They have a responsibility to find you the most effective med/s for your situation. There are many meds available and the reason there ARE so many is because what works well for one may not for another.

I suggest asking him for a brief visit to talk about your situation and bring up the question about what might happen if the dose increase isn't effective. Ask him about add-ons and is that a route he would consider. He'll likely say yes and that knowledge should ease your concern a bit while you're waiting the 8 weeks or so to see if the anti-dep increase is effective.

I hope that's making sense and a bit of a help. Hey, and welcome to msf. It's a pretty big place and there's a lot of resources + ways to be involved on whatever level you like. The mods here are great and run a pretty safe ship. I'll check back here later. I hope you're doing ok.

Talk to him. It’s well known that some bipolars can’t take antidepressants.

I wasn't aware of this. Reading up on it now.

Wellbutrin in particular can cause insomnia and hypomania. Yes, please read up on the relationship between taking antidepressants and becoming hypomanic or even manic when bipolar. This phenomenon is at the root of why bipolar can be so hard to treat.

It’s been almost two weeks since my OP, so I thought I would give an update. I also want to say that I appreciate all of the responses because it’s way less scary when you’re in the thick of things if there are people who hear you and understand. I’ve also realized that I can search the forums for similar posts and get a lot of good insight, but like I said, it’s nice to engage with others about what I’m going through. Anyway, on to my update…

I did the irresponsible thing and changed my meds before talking with my psychiatrist, though I think I made the right move even if it wasn’t responsible. And after talking with my doctor I’ve got the green light to continue with the change. I’m back down to the original dose of Wellbutrin and I’m also taking a double dose of my mood stabilizer. I am feeling a bit better partly because I’m experiencing less dyskinesia. I know it’s probably too soon to realize a positive chemical change, so there might also be some placebo benefit for just believing I’ve made the right move.

I’m also in the process of changing my job. It’s with the same employer, just a different job. It’s not less stressful, but the stress is very predictable and involves less interaction with other people which is way better for me. It’s also great because I’m not giving up my 12 month qualification for FMLA. We’ve had better weather too and I’m taking horse riding lessons soon, so I’m feeling optimistic even though I’m not completely out of the woods yet.

Thanks again for your responses! TGIF!!!