Posted by JohnL on June 22, 2000, at 5:47:14
In reply to drug alternatives, posted by ksvt on June 21, 2000, at 18:38:31
> I've been on 400 mgs of Wellbutrin for a few years with no side effects. Recently I reduced to 300 mgs per day and 50 mgs of Zoloft. This has made me inorgasmic, as was the case when I took Prozac several years ago. Is there another drug I can take to augment Wellbutrin which might not yield this side effect? If I go off Zoloft temporarily, how quickly would this side effect disappear?
ksvt,
The Zoloft question is the easier one. The inorgasmia should resolve pretty fast, like maybe 3 days to 10 after discontinuing the med. That was my experience with Zoloft anyway. I also had total lack of desire while on Zoloft. That took almost 3 weeks to finally resolve after being completely off the drug.
Which drug to augment Wellbutrin with that won't give the sexual side effect is a tougher question. It's almost a sure thing that any of the SSRIs will do that. But what also complicates the picture is we don't know how the other new additional drug you try will affect how you feel. You might get better, you might get worse. Or you might yet have other side effects that are intolerable. There's just no way to tell without personal trials. But you can probably safely rule out the whole SSRI class.
There are some options to consider. Your doctor is the one qualified to guide your decision making process, but here are some suggestions to ask him/her about.
Serzone. 'Possible' complications...lethargy, worsening of depression.
Remeron. 'Possible' complications...sedation, weight gain.
Desiprmaine. 'Possible' complications...dry mouth, constipation.
Nortriptyline. 'Possible' complications...dry mouth, constipation.
St Johnswort. "Possible'complications...none in particular.These are just off the top of my head as the first things I would, or have, considered. There are plenty of other choices. Your doctor may well have other suggestions that are better than these. For example, if your remaining symptoms are of the melancholic unmotivated anhedonic nature, then the stimulant class might be a better way to go. Things like Ritalin, Adderall, Dexedrine, Provigil, in no particular order. The cool thing with these is that if they are to work, they will do so in 24 to 72 hours. No long trial to find out. If after a week one is disappointing, move on to the next. No wasting time.
From the list above, I would favor good ole St Johnswort first. Brands Kira, Movana, Nature's Way Perika, Ricola, or New Chapter. It stands just as good a chance as anything else, but has far less potential for any troubling side effects. It might mix real well with Wellbutrin. But it would be hard I think to find a doctor to endorse it. However, my own family physician suggested it to me a while back. He said he had read a lot about it and concluded that SJW could be combined with a lot of different antidepressants, with the exception of Paxil. Paxil+SJW=not cool. But of course, every doctor will have a different opinion. In my own non-professional opinion, I like the sound of Wellbutrin+SJW. If you went this route, the recommended dose could be tried. But keep in mind the most successful trials of SJW occurred with amounts 2 to 3 times higher.
With the other choices, well, flip a coin. At mentalhealth.com I saw some abstracts where combinations of either Desipramine or Nortriptyline with Wellbutrin were very successful. Though they could give sexual side effects, it isn't likely. Both Serzone or Remeron are sex-friendly.
Just so you know, there are nationally acclaimed psychiatrists out there who prescribe Wellbutrin up to 650mg routinely. Unless you have a known risk for seizures, that is certainly an easy and logical option. Especially since you have no side effects at 400mg, this may be the best option of all.
Whether you go with SJW, other non-SSRI antidepressants, stimulants, or increased Wellbutrin dose, I think it all depends on how you would describe your remaining symptoms and what kinds of possible side effects you are willing to accept.
JohnL
poster:JohnL
thread:38032
URL: http://www.dr-bob.org/babble/20000619/msgs/38078.html