Which antidepressant/anxiety treatment to choose?

April 25, 2008 2:08 PM

Help me decide between Lexapro and Wellbutrin.

I've begun treatment for depression and anxiety. After several sessions in talk therapy, my therapist suggested I see a psychiatrist about some medication to help the process.

The psychiatrist seemed to think I would be best suited for Lexapro or Wellbutrin. I was wondering if anyone has had experience with either or both of these drugs, and could share some experiences that might help me with a decision.

posted by saturn25 to health & fitness (23 comments total)

Can you tell us more about what matters to you? Some things that might be important are cost, sexual side effects, etc. Do you smoke?
posted by stuboo at 2:21 PM on April 25, 2008

From personal experience and that of friends and family, the only way to know how a given anti-depressant will affect you is to take it. I don't know how much anecdotes from other people is going to help you. That said, it seems like everyone in my family responds very well to one particular med, so maybe if you have a family member who has taken one of these, they could tell you how they reacted.
posted by Mavri at 2:23 PM on April 25, 2008

I could relate my experiences to you with both of these drugs, but no matter what any single person gives you as anecdote, it shouldn't factor into your decision as these drugs interact with everyone's body in drastically different ways and so you're likely to have very different experiences. The best thing you can do is begin one or the other with a sense of optimism about it as both of these drugs have, to my knowledge, nearly equal benefits statistically speaking. Don't expect to draw any conclusions until at least 4-6 weeks after beginning your regiment.
posted by tybeet at 2:23 PM on April 25, 2008

What Mavri says. I do agree, based on personal experience, that side effects tend to run in genetic families. I had a very rare reaction to Wellbutrin and later found out that my father also had it.

My go to place for these kinds of questions is CrazyMeds. You'll find both Wellbutrin and Lexapro listed on the sidebar, and while doctors tend to hate Crazy Meds, ignore that. It is awesome for exactly this kind of question.

They are, by the way, different drugs. One is an MRI and the other is an SSRI. Crazy Meds will tell you the difference there, as well.
posted by DarlingBri at 2:39 PM on April 25, 2008

I whole heartedly agree with the above comments that each drug will react to you differently. Therefore my experience will not be your experience. That being said, you asked for experiences. I was on lexapro for around 9 months or so. It took about a month for it to fully kick in for me, but very soon after starting it, I began to see some improvement (probably 3 or 4 days). When it was fully integrated into my system, I had no real side effects. I loved it. I also was taking it for anxiety and the depression that resulted from the anxiety. I have yet to run across any friends or acquaintances who have had a bad experience with Lexapro, but I would imagine you might hear from some here.

Anxiety is tough because it just wears you out. It is emotionally, spiritually and physically draining. But, and this is a huge but, it is fixable. It is so good that you are taking care of yourself and being proactive in your own health.

The thing that helped me get through the adjustment period when going on the drug was to remember that I shouldn't take any of my thoughts too seriously. I was very aware that I was messing around with my brain chemistry and that it was going to take a while for everything to even out. That being said, it was also incredibly comforting that I knew there was a goal in sight. I was taking active steps to make my life better, and that was everything. If these drugs don't work for you, there are others that will work. It is just a matter of time.

When going off of Lexapro, it wasn't too bad. I had read some horror stories and was a little afraid to go off of it. I cut down to half a dose for about a week, and then stopped taking any. I had one day of feeling kind of odd....sort of like I had the flu but without any fever or aches. I was more mildly nauseous and kind of physically off balance. But, the anxiety as a whole has gone away. I may have a day of very mild anxiety every two months or so, but nothing that disrupts my life.
posted by Bibliogeek at 2:58 PM on April 25, 2008

Well, I'm a Wellbutrin user practically since the stuff was first released and think it's a great medication. I've not taken Lexapro, though.

If you go with Wellbutrin, just beware of the Teva Pharmaceutical generic. There are threads about it at CrazyMeds.
posted by Thorzdad at 3:13 PM on April 25, 2008

My mother just came off Welbutrin after 3 years on the stuff. She appreciates having it available when she needed it, but it started causing her stomach to bleed. She noticed several changes in her behavior after her weeklong comedown period, the most marked change being a return of her creativity. She started painting and sewing again almost immediately.
posted by tmt at 3:25 PM on April 25, 2008

The most common complaints about Lexapro are the sexual side effects (anorgasmia and loss of libido) and the highly unpleasant withdrawal period. Anecdotally, it seems like everyone I know who has taken Lexapro has had sexual side effects, although they are often less severe than with other SSRIs.

Wellbutrin side-effects tend to be more amphetamine-like (insomnia, weight-loss, heart racing/anxiety). I know some people who have been prescribed Wellbutrin in addition to Lexapro, apparently to ease some of the sexual side effects. But, as Thorzdad pointed out, there have been significant problems with Wellbutrin generics (particularly with the extended release, I believe), so be cautious if you are given a prescription for generic Bupropion.

There is no generic Lexapro available yet, although Lexapro is very similar to Celexa, which does have a generic.

Assuming there's an equal chance they'll alleviate your depression, you're going to have to initially choose one based on the cost (or your insurance's formulary restrictions) and potential side-effects. If you're in a relationship and you don't want to screw with your sex drive, for example, then Wellbutrin might be a better choice to start off with.

You should hold off on a final decision until you've spoken with your prescribing doctor/psychiatrist. They'll be better informed about your medical needs as well as the pros and cons of each, and will be in a much better position to advise you about your options.
posted by stefanie at 3:56 PM on April 25, 2008

I've been on Wellbutrin XL, 300mg for about 9 months, and am very, very glad I made the decision to do so. It's the first crazymed I've tried and its effect on the depression is nothing short of magnificent. I credit my survival through this past winter to my medication... it has eleminated the drowning black despair, guilt, and senseless negativity I lived in. However: please take the reported "common" side effects with a grain of salt. When I first began taking it, I was excited about the possibility that it may also help with weight loss. Unfortunately my experience has been exactly the opposite and I have gained about 40 lbs since beginning the med. Apparently this is an extremely rare side effect of Wellbutrin. Also, I never noticed the energizing effects of the drug: I've been sleeping very well and am in fact quite drowsy some days. Which I've heard is unusual and most people find it to be stimulating. One thing I will caution against with Wellbutrin is to not take pseudoephedrine any closer than 3-4 hours after your antidepressant: I found out by accident that this results in a state that is very much like having taken hallucinogens (I felt very very high, giddy & giggly, impossible to pay attention to one thing, mild visual abnormalities). This happened pretty consistently the few times I did take the pseudoephedrine so close to the Wellbutrin so I'm quite sure there's a relationship. Not a good thing to have happen while you're at work! I was quite surprised and now take care to wait a few hours between the meds if I need to take any kind of cold or allergy pills. But, my oddball weight thing aside, I can't recommend it highly enough. Also, be aware that the GENERIC VERSION IS NOT AT ALL THE SAME DRUG AS WELLBUTRIN XL and many people have very bad experiences with the generic. I did myself - it was horrible. See this link at the Peoples Pharmacy. For your own health, it pays to demand the brand name Wellbutrin only, do not accept generic. Good luck!
posted by cuddles.mcsnuggy at 4:31 PM on April 25, 2008

Oh, and one more thing about the Wellbutrin: no problems at all with libido. Everything in that regard is ticking along just swimmingly. :-)
posted by cuddles.mcsnuggy at 4:32 PM on April 25, 2008

Seconding (thirding?) Mavri and tybeet. You can scour anecdotes and blogs and reviews and drug literature all day long, but none of it will reveal how your unique chemistry will react to either drug.
posted by hollisimo at 4:50 PM on April 25, 2008

I was faced with the same choice and a very similar diagnosis. My psychiatrist and I ended up opting for Lexapro first, because of the fact that Wellbutrin sometimes increases anxiety. I have had no appreciable side-effects from Lexapro. It kicked in relatively quickly for me - within two weeks, I'd say - and when starting out, I only felt a little dizzy and spacey for a few days. No horrible symptoms when I've missed a day of meds.

However, in the end, you don't know what your experience will be like until you try it. Definitely ask any family members who've dealt with similar problems about their reactions to drugs. Unless the side-effects are awful, don't make any judgements until 4-6 weeks have passed, because both drugs sometimes kick in fairly slowly. Good luck!
posted by ubersturm at 5:38 PM on April 25, 2008

I tried Wellbutrin first and had cripplingly bad anxiety. It was horrible and I couldn't get off it fast enough. Then I went on Lexapro and I loved it. I've been on and off Lexapro for several years now and it's changed my life. That said, yes, I got the anorgasmia side effect; I didn't lose weight (didn't gain any either) and, for some reason, after four or five months on Lexapro, it starts to play havoc with my memory. However, I've never had any trouble going off it.

Mavri has a very good point, though. Ask your family if at all possible; my brother had the same reaction to Lexapro, weird memory glitches and all, that I did, and my son reacted very badly to Straterra, which is related to Wellbutrin.
posted by mygothlaundry at 5:47 PM on April 25, 2008

I've taken both, also. The Lexapro had a weird sweating/clammy effect on me and I didn't like it at all. The Wellbutrin had minimal bad side effects (with the exception of a seriously increased libido) but at that point I was mostly taking it to help with the smoking.
posted by IronLizard at 6:04 PM on April 25, 2008

i had the same experience as mygothlaundry. wellbutrin was horrible. yes, i wanted to bang everything in sight, but my heart raced, i couldn't sleep, concentrate, eat, or accomplish anything. i couldn't sit still for a half-hour tv show. i couldn't study. god help me if i'd actually had to go to work (i was in school). and that was on a half-dose. i went on lexapro, and it was gorgeous. love it. i haven't had serious side effects--no weight gain, and my libido is actually a bit better than it was. so ymmdefinitelyv.

my totally unprofessional guess is that if you lean toward anxiety, try lexapro first. if you lean toward depression, try the wellbutrin first.
posted by thinkingwoman at 6:43 PM on April 25, 2008

Really, all of these anecdotes are just proving the point that Your Brain Chemistry May Vary.

You have two, very solid options. Pick one. Out of a hat, with a rabbit if you must, because it's still just going to be a guess. If you end up feeling better, well then - hurrah! You got it right the first time and won the cash prize instead of the toaster.

If you're more typical, it will be an uncomfortable experience in a non-predictable way. You'll taper down, and move on to find out what it's like behind Door Number Two. Eventually, something magical will happen in your brain and you'll stop wanting to excise your own conciousness and it will all be worth it.
posted by DarlingBri at 7:09 PM on April 25, 2008

My experience: I was on 10 mg of Lexapro for just under a year. It definitely helped me, but ultimately the side effects were too much. It had this weird effect of messing with my vision, where if I moved my head from side to side my vision would get shaky and overcompensate. For example, if I turned to the left a little and then stop, my vision would keep going for a moment and then jerk back to where it was supposed to be. It was very disorienting, but to be fair it only happened when I was going on to it, off of it, and when I'd forget to take it for a couple hours.

The other unique thing about lexapro for me was that it made me dream really intensely. There was a question that talked about it last week. I'm a pretty intense dreamer anyway, but the lexapro made me dream much more often and they became somewhat more nightmarish. By the end it was really messing with me since I didn't sleep as well, but it was kind of fun for awhile.

YMMV. You won't know how either one works until you try it.
posted by lilac girl at 8:58 PM on April 25, 2008

I loved Wellbutrin- until I became one of the 1% who got crazy itchy welts. Now I'm on Lexapro (but I'm easing down because the sun is out more often than not), and I'll be happy to let it go. The Lexapro helps me with the winter blues (and all the crabbiness that comes with it), but the "sexual side effects" suck.
posted by dogmom at 9:09 PM on April 25, 2008

I fifth or sixth the point that there's absolutely no way to predict what or experience will be, or which drug is likely to be more suitable. Both are good choices--low incidence of side effects. But the anecdotal experiences of others are truly irrelevant to your question. You just have to try stuff.
Incidentally, I've tried quite a few meds, and am currently having good results, finally. . .

The other point that I want to emphasize is that you need to find a shrink that you like, someone you trust, who is empathetic, caring, and has time for you. I've had good luck in this area. . . Personally, I like psychiatrists who are conservative in their approach to meds, and who give me a sense of ownership over the process, rather than the more imperious sorts that I've heard about.

Well, I just looked at your profile to see if you were, by any chance, in NYC. So. . .if you ever find yourself looking for a shrink, I've got two good recommendations for you. I'm extremely fond of my therapist as well. . .

Good luck! If you don't find the right treatment your first time out, just keep trying. Patience and attentive observation are the keys to making this work.
posted by flotson at 11:42 PM on April 25, 2008

Your psychiatrist will help you decide. One that I know likes to start people on wellbutrin unless they are obviously anxious. I think that she said that the reasons to stop wellbutrin will be apparent quickly (anxiety, insomnia), whereas SSRI sexual side effects don't bother people right away but eventually get them to quit taking their meds.
posted by a robot made out of meat at 6:44 AM on April 26, 2008

Lexapro made me feel agitated and like I was living in a nightmare. I stopped taking it after a 6 day trial.

Wellbutrin didn't have any affect on me at all.

Like everyone else has said, everyone reacts differently to antidepressants and it's nearly impossible to tell how you will respond until you try something. My brain has been tried on nearly every antidepressant out there and the only one that has worked for me with tolerable side effects is Paxil. Be prepared for the possibility of needing to try a few different things before finding the right one for you.
posted by kclassic at 11:03 AM on April 26, 2008

I took Lexapro for about 6 weeks, and it absolutely sucked for me. I gained weight, had wicked anorgasmia and could only take it at bedtime because it would knock me right out. On the other hand, Wellbutrin rocks my world. I barely even get PMS now, and the depression I lived with for way too many years is under control. Side affects are really minimal - I'm pretty much thirsty all of the time (I carry a water bottle with me everywhere) and occasionally, my hands will shake. Other than that, it's been an amazing improvement.

I'm really lucky - it didn't take a lot of trial and error to find the combo that works for me. I wish you the same success, and good luck with your decision. It's so worth it.
posted by Space Kitty at 1:36 PM on April 26, 2008

Wellbutrin SR worked really well for me for depression, but the XL formulation gave me severe anxiety that I didn't have before. I thought I was losing my mind.

Ultimately I was on a combination of a very low dose Prozac along with the Wellbutrin SR and that worked just dandy. Sometimes if you've been taking Wellbutrin for a prolonged amount of time it will "crap out" on you and stop working as well, but Prozac has the weird effect of making it work again for some reason.

Now things are much better for me and I don't need either. I had no problem tapering off the Wellbutrin but I felt like I was being zapped in the head with a taser on and off while I came off the really low dose of Prozac.

Brains are weird.
posted by howrobotsaremade at 6:34 PM on April 26, 2008