Success stories combining wellbutrin with SSRI's?

Question

HI.I have had depression for 10 years plus.It's been pretty much untreated because the meds give me bad side effects or they stop working after a while.It's gotten so bad,I know I need to get back on something.I've tried almost every antidepressant available.SSRI's like zoloft and celexa make me so apathetic and indifferent that I become worthless,caring about nothing. Effexor made me gain 30 lbs.Wellbutrin gave me alot of anxiety.My question is,does anyone have success stories about using an SSRI at the same time as Wellbutrin.I liked the way wellbutrin made me feel more focused and energized,but the anxiety was too much.I was thinking putting an SSRI in the mix would help curb that a bit since it is more calming.I think the wellbutrin would also help curb the apathetic feelings from the SSRI.My insurance doesn't cover Psychiatrists and I can't afford out of pocket.I need to get the drugs from my primary doctor but wanted to ask some of you to share your experiences with mixing the 2.

Answer 1

Here is some data from the medical literature for you and your doctor to consider. It looks as though the combination has worked very well for many patients. The New England Journal of Medicine is a very well regarded journal. Biological Psychiatry has a good reputation.

I've also included some case reports on the kinds of problems the combination can cause for a few people. Note that case reports are not high quality evidence, just hints that problems/solutions may exist.

Trivedi MH et al. Medication augmentation after the failure of SSRIs for depression. New England Journal of Medicine. 354(12):1243-52, 2006 Mar 23.
TRIAL: citalopram therapy (mean final dose, 55 mg per day) PLUS sustained-release bupropion [Wellbutrin] (at a dose of up to 400 mg per day)
CONCLUSIONS: "Augmentation of citalopram with either sustained-release bupropion or buspirone appears to be useful in actual clinical settings. Augmentation with sustained-release bupropion does have certain advantages, including a greater reduction in the number and severity of symptoms and fewer side effects and adverse events."

Zisook S. Rush AJ. Haight BR. Clines DC. Rockett CB. Use of bupropion in combination with serotonin reuptake inhibitors. Biological Psychiatry. 59(3):203-10, 2006 Feb 1.
LITERATURE ANALYSIS: "The available data suggest that, although not an approved indication, the combination of bupropion and either an SSRI or an SNRI is generally well tolerated, can boost antidepressant response, and can reduce SSRI or SNRI-associated sexual side effects. Additional randomized controlled studies are needed to answer important questions, such as those regarding optimal dose and duration of treatment. [References: 46]"

Chan CH. Liu HC. Huang MC. Delirium associated with concomitant use of low-dose bupropion sustained release and fluoxetine. Journal of Clinical Psychopharmacology. 26(6):677-9, 2006 Dec.
CASE REPORT: " Here, we report a case of delirium caused by concomitant use of low dose bupropion SR and fluoxetine."

Shin YW. Erm TM. Choi EJ. Kim SY. A case of prolonged seizure activity after combined use of bupropion and clomipramine. Clinical Neuropharmacology. 27(4):192-4, 2004 Jul-Aug.
CASE REPORT: "A case is reported of seizure development after combined use of bupropion and clomipramine."