SSRI v. Wellbutrin

June 24, 2022 1:08 AM

I've recently gone back on SSRIs, specifically Sertraline (Zoloft in the U.S, I believe). I've taken them before and they've been great in some ways, however the numbing, apathetic effect is not ideal and I was wondering if anyone had any comparative experience with Wellbutrin or a non SSRI? I'm not looking for medical advice, just want to hear your personal experiences.

I've decided to go back on them because my near constant, second by second grief about my upbringing has become too overwhelming to manage. In addition, my obsession with my boyfriends ex is just not going away (the two are obviously linked) and I just want to blast both things from my mind at this point.

I'm also feeling just intense levels of fear and social anxiety on a daily basis, to the point its debilitating.

Sertraline is helping to calm the anxiety, I feel very blank and much less emotion. The obsessive ruminating thoughts are still there but feel much more distant, less intense. I'm not feeling that intensity of grief anymore.

However, I am feeling noticeably unapathetic and unmotivated. So the blunting effect is a two edged sword.

It also completely deadens my libido and ability to orgasm (which was limited anyway due to nearly a decade of taking Celexa). That doesn't feel great.

I think I'm just scared because I'm hindsight I can see that taking Celexa during my twenties was helpful, it enabled me to get jobs and make friends, it also made me extremely lazy and apathetic. I wasn't motivated in my career or to improve my life, I'd just do the bare minimum and it wouldn't bother me.

Anyway, that's my experience on SSRIs, has anyone been on Wellbutrin and what was that like? Can the two possibly be combined?

I've heard it's not great for social anxiety or anxiety in general, which is one of my major presenting problems.

posted by Sunflower88 to Human Relations (27 answers total)

I dislike SSRIs for the same reasons you do, and did not have those negative side effects from Wellbutrin. Wellbutrin neither helped nor significantly worsened my anxiety, but my anxiety is not as intense as yours so your mileage may vary.
posted by metasarah at 4:56 AM on June 24, 2022

So I halved my dose of Sertraline due to anorgasmia and supplement with Agomelatine, brand name Valdoxan in Europe. I am extremely stable and happy on this regime. It requires a blood test for liver function, and I repeat that every six months.
posted by DarlingBri at 4:57 AM on June 24, 2022 [1 favorite]

I’ve been taking bupropion (wellbutrin) for many years, and I’m a big fan. It’s the only antidepressant I’ve used that doesn’t hit me with any undo side-effects. Bupropion is one of the few meds that doesn’t appear to affect libido. Honestly, it’s one of the only antidepressants I’ve tried that doesn’t seem to have any serious side-effects*

It’s not really intended for anxiety, though, and many doctors add an anti-anxiety med to the buproprion. Unfortunately, that gets you back on the medication rollercoaster, trying to find the right anti-anxiety med. I’ve yet to find one that doesn’t make me lose my shit.

*-there was a period back in the 90s/early 2000s where a widely-distributed version of generic bupropion made people suicidally worse. It turned out to be a problem with how the generic was manufactured, and had nothing to do with buproprion itself.
posted by Thorzdad at 5:01 AM on June 24, 2022 [2 favorites]

In an earlier ask, you mentioned suspicions of ADHD but that you didn’t have easy access to diagnosis. Wellbutrin is identical prescribed off-label for ADHD, so you may find that helpful.
posted by wyzewoman at 5:07 AM on June 24, 2022

On my first go around with head meds I had Celexa and it made me feel like I was 10,000 feet above all my emotions and experiences. I got off of it for that reason, it was too numbing. Now, I'm on Abilify (generic Aripiprazole) and it has basically zero side effects for me. I'm primarily treating anxiety, FWIW. Wellbutrin made me feel crazy(er).
posted by Medieval Maven at 5:35 AM on June 24, 2022

Well, when I was on Zoloft, I took the lowest dose I could divide out (12.5) and while it still raised the threshold, I wasn't anorgasmic or lacking motivation. Would also recommend investing in a wand for your pleasure, because self-care.

Additionally, yes people use wellbutrin as an adjunct to zoloft, that is a thing that happens.

Wellbutrin is an SNRI, the N is for norepinephrine, and it acts on the same neurotransmitters as some ADHD meds, so it makes sense that some people with anxiety may find the stimulation to be unpleasant.

Abilify does have side effects and I recommend that you read the package insert if you haven't already to learn about them, but I'm glad you're not experiencing them, other person in the thread!
posted by sibboleth at 5:50 AM on June 24, 2022

Wellbutrin may help offset Zoloft's libido/orgasm side effects so that alone may make it worth trying. You could also try a different SSRI--I have anxiety and Zoloft wipes out my anxiety with no numbing effect so Zoloft may just not be right for you. Maybe Lexapro (Escitalopram) might be better.

Edit to add --I tried adding Wellbutrin to my Zoloft to offset a side effect. In me it didn't make an improvement so I dropped the Wellbutrin, but that combo is definitely a thing that helps a lot of people
posted by jessica fletcher did it at 6:25 AM on June 24, 2022

Fwiw, for me side effects of Sertraline (inc sexual) wore off after 3-4 months so it might be worth trying it a little longer.
posted by Balthamos at 7:23 AM on June 24, 2022

Wellbutrin actually helps libido/orgasm in many people, including me. Some SRRIs caused a lot of fatigue for me, but Wellbutrin does not. At first when I took Wellbutrin I felt really good, then that moderated. I don't know how much it is still helping, but it has been the best one I tried in terms of definite effects.
posted by catquas at 7:52 AM on June 24, 2022

I am one of the rare people who got tinnitus from Wellbutrin, which eventually bothered me enough I quit. Other than that, I was happy with it.
posted by telophase at 7:58 AM on June 24, 2022 [1 favorite]

I'm on Wellbutrin now and was on a variety of SSRIs before. The big advantage is no sexual side effects. My tinnitus did get a bit worse which I didn't think was related until I just saw the comment before... Like others say it's great for my depression (I went on a drug holiday and immediately lost motivation and mood) but the effect on my anxiety and emotions has been kind of confusing.

I haven't had a serious panic attack since I've been on it, but I have a lot of low level anxiety and have a harder time fully relaxing. My emotions feel less strong than before, but it doesn't feel exactly the same as SSRI numbing vagueness. It's more that I'm not being overwhelmed as often by things like crying, but my defense mechanisms are still in place so I over-regulate myself and keep trying to calm down when I'm already fine. It's hard to describe, I'm not sure I love the experience but it's definitely better than full depression.
posted by JZig at 8:44 AM on June 24, 2022 [1 favorite]

Fwiw, I tried to switch from sertraline to a relatively low dose of Wellbutrin late last year. I didn't notice much improvement for about a month and then I tanked hard, going from passive to active suicidal ideation. I went off of it and after two days of not taking it the suicidal feelings really spiked. I decided to stay off of it and go off meds entirely and within a couple of weeks I was doing a lot better. I've never hit a low like that since.

On the other hand, I have a bunch of friends who have had great experiences with Wellbutrin, so clearly I'm in the minority. Just be aware that this may happen.
posted by derrinyet at 9:57 AM on June 24, 2022

I have taken Sertraline, found it lacking, my doc suggested Wellbutrin in addition and I was miserable. Wellbutrin gave me terrible mood swings, it was awful. Now I've taken Cymbalta for a while (which is an SSNRI) and it's been so so so much better.
posted by wellifyouinsist at 10:41 AM on June 24, 2022

Wellbutrin has saved my life. I failed multiple SSRIs, tried some tricyclics and first-gen antihistamines until they failed, and finally got the ok for Wellbutrin. I take a lot of it. It does nothing for my anxiety, but it has alleviated my MDD to a point where my anxiety is not continually trying to drop more dirt on me while I’m busy digging a now-shallower depressive hole. I have no negative side effects that I suffered from previous medications.
posted by sara is disenchanted at 10:57 AM on June 24, 2022

I take both Zoloft and Wellbutrin (generics versions of each), and I am very happy with the combination. Please feel free to memail me for more specifics.
posted by maleficent at 11:02 AM on June 24, 2022

Apparently it's such a common combination that some call it "Welloft." I've been taking Wellbutrin for a few years and I just started Sertraline, so I've had a real baseline from which to measure the side-effects, and Wellbutrin never really had any side-effects for me.

I can empathize a lot with what you've been experiencing, and I can say that it has helped a lot even taking side-effects into account.

My prescriber said she could move me from Sertraline to Trintellix if I wanted, which I guess is new and something I've only seen on TV commercials (...), but which doesn't have the sexual side effects of Sertraline and which she said is otherwise comparable. I decided to trust her first impressions and save that decision for later.

For what it's worth, this course began as a self-suspicion of ADHD, which I think is probably common when people notice they aren't doing stuff.
posted by rhizome at 11:05 AM on June 24, 2022

The only SSRI I have taken which didn't kill my libido and cause weight gain has been the very first one I tried, Imipramine HCL (Tofranil). It worked well for about 15 years before my doctor changed me to Prozac, then Welbutrin, then Zoloft and then Lexapro. After many years of unsatisfactory results, I asked my doctor if I could return taking Imipramine HCL. My libido came back, I was able to orgasm and lose weight. The most notable side effect is mouth and sinus dryness, which is beneficial to me since I have several pollen allergies. The allergies hardly affect me at all now.
posted by a humble nudibranch at 11:09 AM on June 24, 2022 [1 favorite]

two things about wellbutrin:
generic and brand name were two totally different experiences for me. (brand name better).
there was stomach irritation but you can get it in a buffered form
posted by evilmonk at 11:25 AM on June 24, 2022 [1 favorite]

Wellbutrin did significantly increase my anxiety. I'm more serene on Prozac. I also just generally felt a little "speedy" on Wellbutrin, the effect subsided after a couple weeks but never entirely went away. Wellbutrin actually had positive sexual side effects for me, but over time I just found it exhausting to be a little "up" constantly and it also made me unwilling to increase the dosage. Prozac has upset my digestion significantly and even a little alcohol seems to hit me harder / be unpleasant now (I may just be getting older).

If you were getting jobs and making friends while on Celexa, what made you feel like you were apathetic and lazy? I'd probe if that was anxiety talking rather than a fact about the situation.
posted by momus_window at 11:27 AM on June 24, 2022

Wellbutrin gave me pretty intense "free floating" anxiety when I first started taking it. That side-effect didn't last long, thankfully, and it was replaced by a significant up-tick in my libido. I ended up taking Wellburtin for well over a year. It didn't do anything for my depression, so my psychiatrist experimented with combining it with other drugs, though I can't remember all of them. None of them had any effect on my depression. None. And one of the drugs (probably Paxil / paroxetine / Seroxat) caused me to gain something like 50 pounds. I lost some of the weight when I finally quit all my psychotropic meds, but much of the weight remains to this day.
posted by akk2014 at 11:49 AM on June 24, 2022

I take both Celexa (20 mg) and Wellbutrin (150 mg), and that seems to be a good combination for me. Celexa works for the anxiety, and Wellbutrin has helped me gain focus and energy (and offset the side effects typical of SSRIs). The only side effect I had was headaches for the first week or two after adding the Wellbutrin.
posted by sugarbomb at 11:52 AM on June 24, 2022

Generic Wellbutrin gave me hives and brand Wellbutrin had no effect (good or bad).
posted by sm1tten at 11:59 AM on June 24, 2022

One thing that hasn't been mentioned yet is the different types of Wellbutrin (which are both available generic):

Wellbutrin SR is taken twice a day and release medication faster over a 12 hour period, where Wellbutrin XL is taken once a day and releases over 24 hours. I'm definitely happier with the XL than I was with SR, I wonder if some of the different experiences about anxiety are related to the release rate. It's easy to swap between the two once you're on one, and of course there are various dosages.
posted by JZig at 3:29 PM on June 24, 2022

Knowing people who are/have been on sertraline, I’ve seen it be helpful — but at the cost of the exact issue you mention, which they talked about as being a big problem. Wellbutrin, I know only one person (albeit very closely) and it was a good fit for them, without such costs.

However, these things are not equivalents, even though they might be used for similar reasons. Brain chemistry is as distinctly personal as personal as our problems are, and what’s good for one person may not be for another. Don’t settle for the first thing you’re given if it’s causing you problems that you find hard to cope with; you can always come back to it later if nothing else is better.

Interesting thing: bupropion’s only recognised use in the UK is as a smoking cessation aid, which underlines that even doctors have wild differences of opinion on this stuff. I hope you find something that works to help you.
posted by breakfast burrito at 6:17 PM on June 24, 2022

I had the same issue with Zoloft, and Wellbutrin wasn’t really helpful, my doctor put me on Mirtazipine and that’s been great (for over a decade now).
posted by billsaysthis at 9:02 AM on June 25, 2022

For me, Sertraline works pretty well, while Wellbutrin was a complete nightmare of frequent suicidal ideation. A close friend is now taking Wellbutrin and it’s working great for her.

The most illumination thing a doctor once told me is that (a) nobody really has a clue how things like anxiety/depression work and (b) nobody really knows what these medications do, either. Ideas like “serotonin uptake” are basically “just so” stories trying to posit causal mechanisms for observed phenomena, and in terms of predictive power they’re about as reliable as a horoscope.

That’s not to say that meds don’t work — they absolutely do — just that they’re largely shots in the dark and all you can really do is keep taking shots until one hits your target.
posted by bjrubble at 8:35 AM on June 26, 2022 [3 favorites]

@ a humble nudibranch - imipramine isn't an SSRI, it's a tricyclic antipressant.
posted by osmond_nash at 4:18 PM on July 2, 2022