Fluoxetine/Bupropion

[Catriona]

Hello folks,

Has anybody been on both fluoxetine and bupropion (zyban/wellbutrin) before? I am currently on 40mg of fluoxetine and 150mg of bupropion. The bupropion is due to be upped next week to 300mg (150mg in the morning and evening)

I have been searching daily for information on this combination but I am finding it very difficult. There is plenty on fluoxetine, but very little on bupropion as it is off-label in the UK.

Currently I am experiencing increased anxiety and low mood, both of which have been exacerbated on this medication (I have been on 40mg of fluoxetine for just over a week and I started the bupropion 3 days ago) Is it normal for things to deteriorate before there is any improvement? If so how long does this last for?

Any help would be very much appreciated :)

[Emphyrio]

For SSRIs at least, it can take up to 12 weeks before you gain their full benefits. While my situation is complicated, I found that it took 3-4 months after taking 20mg fluoxetine again to feel improvements to my anxiety/intrusive thoughts. Fluoxetine is also a stimulating SSRI, and takes a while to reach a steady state within the body owing to its long half-life. Were you started on 40mg fluoxetine or had you been on 20mg for a while? 40mg is a high starting dose - I also personally believe that anything above standard doses of SSRIs can bring few benefits given that you are only getting slightly higher occupancy of the serotonin transporter.

http://www.mediafire.com/view/f3h1ao5ijfj93/papers#0yp2c8pbjrziaab

I don't have any experience with bupropion but I gather that it is the most stimulating antidepressant owing to the fact that it inhibits the reuptake of noradrenalin and to a lesser extent, dopamine (fluoxetine also has slight affinity for noradrenalin). Again, it may take a number of weeks before you notice a difference.

How does your anxiety manifest itself?

[Catriona]

Thank you for getting back to my post :)

It looks like my psychiatrist is going to take me off of fluoxetine and bupropion because they are too anxiety provoking. I've been finding it increasingly difficult, and at times impossible, to leave the house or do things outwith the house without other people. I have been practising CBT and have even made my own worksheets to fill out if I get intrusive thoughts but it just isn't working. I believe that my psychiatrist wants me to try an MAOI next. This means a 5 week wash-out from fluoxetine and dietary changes, but if it gets me better I am more than happy to do it