Wellbutrin not working - other antidepressants with no effect on libido?
February 21, 2014 2:50 PM   Subscribe

I am a naturally anxious person. I have been on Wellbutrin 150XL for over a month now for various life issues, and my anxiety, which was bad before, has gotten worse. It has manifested as extreme muscle tension/stiffness along with a bit of pain. My jaw is clenched 24/7, and my face and shoulders feel stiff. So, I would like to wean off, and I would like to find an antidepressant that gets me feeling good again - but doesn't affect my libido to the point where I am basically asexual.

Wellbutrin is the first medication that did not impact my libido in a negative way; it also toned down the negative self-talk. So although it worked on those ends, the physical anxiety that I'm getting has convinced me to stop taking the medication. I don't think my body likes it; I don't feel anxious, but my body is getting a lot of bad tension. My shoulders in particular are "clenching" in a sense. Which is a shame, since without the muscle tension I would love to have stayed on.

Other medications I've tried include zoloft and lexapro. Both of them helped with the mood, and if not for the sexual side effects I would still be on them. It's always one major side effect that ruins a medication for me.

So, I'm looking up other meds that I could possibly bring up to the doctor. I've heard good things about Remeron, but heard that you can get pretty sleepy and hungry while taking it (I'm skinny, so that shouldn't be a problem). I've heard that Buspar can counter anorgasmia when coupled with an SSRI. Someone else recommended Lamictal.

Are there any other med ideas I am not thinking of? I am exercising and eating well, but once I wean off the Wellbutrin I am concerned that I will go back to the state I was in before where I had a difficult time getting out of bed.
posted by BuddyBoo to Health & Fitness (26 answers total) 12 users marked this as a favorite

I hear good things about Cymbalta.
posted by infinitewindow at 2:56 PM on February 21, 2014 [1 favorite]

Did you see this thread? There may be some help in there.
posted by janey47 at 2:57 PM on February 21, 2014

I second Lamictal. It is generally used for Bipolar/Bipolar II, but I found it lifted my depression quite nicely when I used it. There were times when I also used a very small dosage of Seroquel with it—very sleep inducing, but if you can stay awake, no sex problems. Remeron made me gain a ton of weight and also made me very drowsy, almost hallucinogenically so.
posted by soulbarn at 2:58 PM on February 21, 2014 [1 favorite]

Whoops, I forgot - I tried cymbalta for about a month or so, and my libido was basically zero.
posted by BuddyBoo at 2:58 PM on February 21, 2014

Have you ever tried an SSRI in combination with Wellbutrin?
posted by Asparagus at 3:08 PM on February 21, 2014 [2 favorites]

If you can tolerate Lamictal, it's a very good option. It definitely helped stabilize my mood a bit - the lows weren't quite as low and I was able to rebound from them more quickly. It also had no effect on my sex drive. However, after being on it for just under a year, I started to develop the Lamictal rash and had to be taken off of it immediately - the withdrawals were pretty unpleasant (lots of brain and body 'zaps'). Still, a good option if you have no reactions to it.

I am presently on Busp and Seroquel. My sex drive has suffered from both - though it was much much worse when I was also taking Lithium and Effexor. The combination did get me out of a very bad time, but the side effects were too severe and started to make things worse. Now, being only on Busp and Seroquel, I find their effectiveness has plateaued - I'm no longer in the danger zone I was, but I feel quite emotionally numb and still suffer from Anhedonia.

I still think Lamictal is probably your best option. Just be very mindful of the side effects and keep your eyes open for any skin issues that suddenly pop up while on it - the rash is uncommon but does happen.
posted by stubbehtail at 3:10 PM on February 21, 2014

Presumably Welbutrin was prescribed by a doctor who cares to follow up. You should talk to her/him.

Muscle aches and stiffness are widely experienced side effects when starting Welbutrin, and often resolve in a time. Sometimes they don't.

There is also a 300mg XL version of Welbutrin, and many people find 150mg ineffective but find the 300mg dose effective.

Welbutrin is also mildly stimulating, which can work against anxiolytic effects. That too sometimes resolves with time.

A month should generally be long enough to see some effects from Welbutrin, but it might be worth not ditching it until you've given it a little more time, after speaking with your prescribing physician about these concerns.
posted by spitbull at 3:18 PM on February 21, 2014

Your doctor should titrate the lamictal very slowly if you start—he'll likely give you some sample packs. It takes about two months to work up to an effective dosage. That's done to avoid the rash, which is very rare but very nasty (it is called Stephens-Johnson Syndrome. Don't look it up unless you're ready for gore.)
posted by soulbarn at 3:22 PM on February 21, 2014

I had a 9-month stretch on Celexa for anxiety. The first month and a half, my libido was deleted. Completely gone with no trace; I kept thinking, "this is just like being a small child again." After that, it totally came back, and stayed at my normal level, which is probably a bit on the high side of average.
posted by cairdeas at 3:36 PM on February 21, 2014

This is the sort of thing you should discuss with the physician who prescribed the medication to you.

That being said, I am on 300mg of Wellbutrin daily, and the only real side effect I've noticed is a very 'energizing' (like, just had a noseful of stimulants) effect. So I have clonazepam (Klonopin in the USA) to take with it; kills that side effect and also helps general anxiety.

I guess what I'm saying is, if the drug is working in other ways, probably best to look at ways of ameliorating the side effects first.
posted by feckless fecal fear mongering at 4:08 PM on February 21, 2014

I'm a very anxious person also, and my blood pressure has been going up the past year . Doctor put me on Cozaar (ABR blood pressure type med), and I'll be darned if it hasn't calmed me down. Feels nice -- hope the calmness continues.

Turns out, there may be something to this.
posted by I'm Brian and so's my wife! at 4:16 PM on February 21, 2014

Viibryd is a newer SSRI type drug... it takes a month to kick in but sexual side effects would be rare.
I was on Celexa for a dozen years and did not have any sexual side effects... but a lot of people say they do have issues with that. So, it can vary depending on the individual.
posted by KogeLiz at 4:34 PM on February 21, 2014

You might want to give it a little more time. My jaw-clenching and muscle tension started to go away after a month on Wellbutrin.
posted by fivesavagepalms at 4:38 PM on February 21, 2014

Your mileage may vary, but when I was first starting out with antidepressants due to some late adolescence onset depression, I found Welbutrin ineffective and prone to produce anxiety. I was simply not in the right mental state to handle more energy from Welbutrin.

After a while on Effexor, I felt better but was fatigued from the SNRI, so I tried a Welbutrin adjunct to it, and was able to taper off the Effexor to the point that I take a very small dose that does not impact my libido. And the side effects of Effexor did taper off over time. I think your body just builds up tolerances to it in some ways but not others. I find my mood is leveled by it more now, oddly enough.

I'd like to say you could do the same thing and it'd work out great, but unfortunately, I had to try a lot of meds to find what worked for me. All I can say is don't get discouraged.
posted by mccarty.tim at 4:42 PM on February 21, 2014

I had the exact same thing happen on (I forget) 150 or 200mg...really sort of 'itchy' right? Had my doctor take me down to 100mg and it's been smooth sailing ever since.
posted by sexyrobot at 4:51 PM on February 21, 2014

A friend of mine has found Abilify to be very helpful and it's had no negative effect on his libido.
posted by kattyann at 5:24 PM on February 21, 2014 [1 favorite]

I had worse anxiety on Wellbutrin than I have on Adderall, which is saying something. I don't really need an antidepressant atm, but when I have been on them more recently I've had very good results from tricyclics.
posted by Sequence at 5:39 PM on February 21, 2014

Definitely talk to your doctor, but just on remeron - "sleepy" and "hungry" are understatements - I took it as an antidepressant + sleep aid in addition to a few other medications (including Wellbutrin) and it was the only thing in months that actually got me to sleep. It gave me a wicked sleep hangover though. No way I would take it when not about to sleep. Also it made me eat like crazy and crave sweets constantly.

I gained about 15-20 pounds and was in an overweight BMI for the first time ever.

All that said it did its job, but it really was in my experience and according to doctors i've spoken with about it, a "last resort, nothing is working" type thing.
posted by sweetkid at 5:44 PM on February 21, 2014

I've never considered taking an SSRI with the Wellbutrin. I wonder if that would help with the anxiety/muscle tension but let me keep the libido.
posted by BuddyBoo at 5:53 PM on February 21, 2014

IANAD but my first thought when reading your question was whether you had tried the Wellbutrin+SSRI combo. I believe Wellbutrin is commonly used as an adjunct to other antidepressants when weight gain and/or sexual side effects are an issue. It definitely seems like a good thing to talk to your doctor about, especially since you know that you respond well to zoloft and lexapro.

That would be the first place I would want to start before beginning to experiment with non-SSRI meds. With that being said, Lamictal tends to have pretty minimal side effects if you're not one of the unlucky few who gets the skin rash (but that is a very rare side effect).

You may also be interested in checking out the crazy medsweb site. They have a lot of information about various psych medications.
posted by litera scripta manet at 6:22 PM on February 21, 2014

Agree on combining Wellbutrin with something else.

During my first few months on Celexa I was having libido issues and my doctor recommended adding Wellbutrin - he said Wellbutrin is pretty shitty on its own as an anti-anxiety med (which may explain why it's not working for you in that regard) but that combined with Celexa/Lexapro it works well and is known to help with libido.
posted by joan_holloway at 6:54 PM on February 21, 2014

You're in a stage of medication management (trying more than two meds, thinking about mixing meds) that should absolutely involve a psychiatrist, not just a PCP/internist.
posted by jaguar at 6:55 PM on February 21, 2014 [2 favorites]

Effexor did this for me and I take it in combination with wellbutrin now. It's the same family of drugs as Cymbalta, IIRC.
posted by NoraReed at 12:20 AM on February 22, 2014

Are you taking brand version of Wellbutrin or a generic? Our son had the same amplified anxiety issues when on one of the generics.
posted by Thorzdad at 6:08 AM on February 22, 2014

Thinking back to my starting on Wellbutrin... I started with the 150 XL but wasn't seeing enough effect, so eventually went up to the 300 XL Wellbutrin. It took a while for the effect to settle, a couple of months I think. I remember finding it hard to sleep for a while, and feeling kind of wired generally for a couple of months. Then my doc added 400 mg Gabapentin (Neurontin) for anxiety. 600 mg was too much for me. It's an off-label usage, but it works for me.
posted by the big lizard at 6:46 PM on February 22, 2014

The problem you describe is very familiar to me. Since about 1989 starting with Prozac, I have been on a variety of SSRIs, SNRIs, tricyclics, and also Wellbutrin, Lamictal, Neurontin, Valium, and a few more, with varying degrees of success. Among other side effects, the SSRIs/SNRIs all caused anorgasmia and low libido, with the exception of Pristiq. With Pristiq I had some sexual side effects at first but they eventually went away after about 6 weeks. Wellbutrin has the same effect on my body as you mention, with extremely tight upper back and shoulders, jaw clenching, etc. and this never went away (I've been on it for as long as 4 years at a time.) I am prone to physical manifestations of anxiety anyway and Wellbutrin just seemed to ratchet me up another few turns, even at a low dose and no matter what else I took with it. Feel free to message me for more info.
posted by miaou at 1:04 PM on March 6, 2014

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