Is this all there is to Wellbutrin?
September 2, 2014 5:48 AM   Subscribe

I've been taking Wellbutrin for depression for about 5 months now. It helps, but not as much as I hoped. Is this a common experience?

I have dysthymia, i.e. chronic low level depression. In April I decided to go on antidepressants for the first time in my life (I'm in my thirties). I was on 150mg Wellbutrin for the first month, then my therapist upped the dose to 300mg, which I've been taking ever since. It's the brand name, not a generic. I'm feeling better, but not as much better as I would like.

What Wellbutrin has done, which I'm extremely grateful for, is take away the lowest lows. I no longer wake up in the middle of the night and start crying, and I rarely have days when I feel like I just can't get out of bed. This is awesome. But, my mood is still pretty glum most of the time. If before Wellbutrin it used to swing between about 2 and 5 on a 10-point scale, now it just stays more or less around 4-5, with an occasional shortlived uptick to 6 or 7 (usually caused by caffeine or other stimulants). I want to actually feel happy, not just not terrible.

I know that a lot of my depression has to do with life circumstances, which are pretty stressful right now: I'm likely to be unemployed in a few months and my long-term career prospects are dim. I'm also very isolated -- I have one or two friends, not very close ones, I've had sex a total of five times in the past year, and I've never been in a serious romantic relationship in my life. I tend to avoid social activities out of a mixture of anxiety and anhedonia. I've been in therapy for a couple of years now, but it hasn't helped much.

All these are problems I could take active steps about, but I'm trapped in a cycle where low mood saps my willpower and optimism and makes nothing feel worth doing, so I do nothing, which feeds my depression. I was hoping that Wellbutrin would jump-start my reward centers, help me get a little more enjoyment out of life and give me a positive reason to get out there, do things and talk to people, but it hasn't had that effect.

I have an appointment with my psychiatrist in a couple of weeks and will bring all this up. I'm very reluctant to go on a different antidepressant because of possible side effects (especially loss of libido and insomnia), but maybe adding an anxiolytic of some kind would make sense? I don't know. If you've been on Wellbutrin or other antidepressants, how does my experience compare with yours?

(I don't want this to be another general "How do I get less depressed" thread -- please avoid well-meaning "exercise more"-type suggestions and stick to the meds topic. Thanks.)
posted by anonymous to Health & Fitness (26 answers total) 7 users marked this as a favorite
Wellbutrin works for me the way you described. I started taking it in addition to Celexa because the Celexa alone just wasn't cutting it.

I'm also on Adderall for ADD and I think that's what helps me actually get motivated. I've read that it's also sometimes prescribed for treatment-resistant depression, so maybe your doctor will let you try that in addition to the Wellbutrin?
posted by Jacqueline at 5:55 AM on September 2, 2014

You cannot fix mood problems caused by life stresses with chemicals. You can take things that help your brain cope, but it's never going to do the whole job for problems like that. If it's helping but hasn't solved things completely, you're probably not going to have more than minor improvements on other drugs
posted by Sequence at 6:02 AM on September 2, 2014 [6 favorites]

I have taken Welbutrin for a few years now. It doesn't totally cure my depression. Like you, it just takes away the big lows. I don't have "cry days" as I call them anywhere near as often. It just eases it enough for me to be able to cope and work on other skills to manage my depression.
posted by PuppetMcSockerson at 6:08 AM on September 2, 2014

Wellbutrin was absolute shit for me and completely ramped up my anxiety to can't-leave-the-house levels. I'm also on generic Ritalin to help boost my current meds, sort of what Jacqueline mentioned. And it helps me get up and go do things because super sleep is a huge symptom of my particular kind of crazy.
posted by sperose at 6:13 AM on September 2, 2014 [2 favorites]

I have dysthymia, i.e. chronic low level depression.[...]I no longer wake up in the middle of the night and start crying, and I rarely have days when I feel like I just can't get out of bed.

I am a therapist, but not your therapist, and I can diagnose people with mental disorders although I feel pretty strongly that this is not really possible over AskMe.

What you have written does not describe dysthymia, and seems, on its face, much more consistent with a major depressive disorder. This may not ultimately matter, but your expectations for how good you will feel how quickly may be related to thinking you have low level depression. (There are other issues with describing dysthymia this way, but let's leave those aside for now.)

Anti-depressants work differently, and different ones work differently, for different people. If you think anti-depressants can be helpful to you, you may need to try others in order to see if you can find more relief. I tend to agree that it's hard to deal with poor life circumstances through medication alone.

MeMail me if you have any other questions.
posted by OmieWise at 6:14 AM on September 2, 2014 [17 favorites]

I took Wellbutrin for a few months, had to admit that it wasn't really doing much for me, and was put on Prozac instead. Like you, I was worried about possible side effects, and I had been hoping so much that Wellbutrin would work for me because it seemed like the 'best' of the antidepressants.

But the best one is the one that works for you, and switching from Wellbutrin to Prozac was one of the best decisions I've ever made.
posted by showbiz_liz at 6:32 AM on September 2, 2014

FWIW I went through just about every antidepressant on the market trying to address my low-level depression, until I moved and my new doctor diagnosed me with ADHD (inattentive) and prescribed Focalin.

Overnight I got my motivation and interest in living back. I haven't taken an antidepressant since, because I wasn't actually depressed. It was just a side effect of living with untreated ADHD.

What you describe sounds similar. IANAD but maybe pursue a second opinion?
posted by annekate at 6:36 AM on September 2, 2014

I've been on generic Wellbutrin for a while now, and I have basically experienced the same thing you are reporting. The drug doesn't make me happy, or make me less stressed out, it just lets me deal with those negative feelings in a more positive way, in the way I used to deal with those problems before my depression really kicked in.
posted by Rock Steady at 6:37 AM on September 2, 2014 [1 favorite]

Wellbutrin doesn't work (or work sufficiently) for everyone. I've trialed Wellbutrin twice and even though the second time I was up to a horse-pill dosage of 450 mg plus an Abilify chaser, it just wasn't doing enough. I've had better luck with Zoloft and Lexapro (current 'script). In retrospect I regret spending most of 2013 trying all kinds of alternatives trying to avoid SSRIs out of fear of side effects. Not everyone experiences sexual side effects or insomnia from SSRIs--"common" doesn't mean universal; it might be worth the effort to find out which camp you fall into.
posted by drlith at 6:37 AM on September 2, 2014

Finding the right antidepressant is like a series of shots in the dark.
posted by The Underpants Monster at 6:37 AM on September 2, 2014 [5 favorites]

To elaborate, what works well for one person isn't necessarily going to do the same thing (or even anything) for another.
posted by The Underpants Monster at 6:38 AM on September 2, 2014

I agree with OmieWise that what you describe sounds like major depression, not dysthymia. Dysthymia as I understand it doesn't seriously impede your functioning. You kind of live with it. Your mood is a little low most of the time, but you're able to function. It sounds like your mood is seriously impeding your functioning; it's preventing you from doing the things that can build a happier life for you. Antidepressants for most people do only what you've described they do to you, which is just take away the bad lows and give a more consistent, middle-ground mood. They're used as a springboard to making the kinds of life changes that will lead to long-term improvement in your mood and happiness. They give you the energy and the hope to do the work that that requires. For many/most people, that's all they can ask of antidepressants. But you have lots of options re the meds. You can stay on Welbutrin and add another drug from a different "family." Welbutrin is actually kind of an oddball drug and kind of its own family. Ask your psychiatrist about that.
posted by early one morning at 6:53 AM on September 2, 2014 [1 favorite]

What you describe sounds to me like the ramp-up phase of my experience on Prozac - just better enough to be vaguely functional. That was around the point where my doctor went, "Yay, this is a good sign that this is starting to work, so we're going to up your dosage some more." And then we did that a few times until I got to a place several notches above that, where life was still not all sunshine and puppies, but my baseline was at a place where I had the energy and coping ability to make other positive changes.

In your place I think I'd be asking about either increasing dosage (if that makes sense on Wellbutrin, I don't know that medication well) or switching/adding meds.
posted by Stacey at 6:56 AM on September 2, 2014

I had the same experience with Wellbutrin. Felt like it was "helping" but didn't feel like it was doing "all that it should." I had originally asked my psych for something not-SSRI because of a previous experience with SSRIs and their libido-destroying side effects. After 4 or 5 months on Wellbutrin, I went back to the doctor and said it wasn't working, could we try an SSRI. I'm on Lexapro now and it is night-and-day different. Yes the sexual side effects are still there, but after the first couple months they've diminished quite a bit (still there, frustratingly sometimes, but not insurmountably so).

Like The Underpants Monster says above, antidepressants are a shot in the dark. Talk to your doctor about a different one.
posted by ish__ at 7:09 AM on September 2, 2014

Dysthymia as I understand it doesn't seriously impede your functioning. You kind of live with it.

I don't want to derail, but dysthymia absolutely does impede functioning. Many people have a very very hard time living with it. This is part of why I objected above to characterizing it as "low level depression." In my clinical experience, that phrase vastly understates dysthymia's effects. The specifics here, however, make me question whether that diagnosis is appropriate.
posted by OmieWise at 8:02 AM on September 2, 2014 [1 favorite]

"Double depression" is possible, i.e. a major depressive episode on top of the chronic grayness of dysthymia.

I've been taking Wellbutrin for years now, and it works quite well for me, but there are a few things I should mention that might be relevant. First, I take 450 mg - lower doses didn't seem to work. Second, it doesn't really beat crappy circumstances; it makes them feel less catastrophic and keeps me from derailing into a fog of misery and self-hatred, but it doesn't prevent them from getting to me. Finally, Wellbutrin (as well as the other antidepressant I've tried, Cymbalta) doesn't jump-start my motivation. It keeps me out of bed, but most of the steps I need to take to improve myself professionally, socially, or physically are still daunting and potentially useless - I just have to make myself do them. This was my biggest disappointment when I first tried antidepressants: I thought I'd become more productive and proactive, but I was still my cynical Cheeto-eating self, just a more pleasant version.

I think it's worth trying a higher dose or a different med (especially if you have anxiety, since Wellbutrin can amplify that), but you may also need to manage your expectations a little bit. Antidepressants may not make you happy by themselves; sometimes they just get you to the point where you're better able to make yourself happy.
posted by Metroid Baby at 8:07 AM on September 2, 2014 [7 favorites]

Not to sound trite, but pills don't teach skills. There is no drug that you can take that will make you happy; what they do, when effective, is undo or loosen the shackles holding you in place. It's then up to you to learn coping strategies (CBT is good) to gain the confidence and energy necessary to start changing environmental issues.

The next time you speak to your prescribing doctor, talk about drugs that work synergistically with Wellbutrin to amplify its effects. One of my psychiatrists said that Abilify is the standard. Lamictal may also be good, but IIRC requires regular blood testing. (IANAD, at all, repeating information given to me.)

The next time you see your therapist, talk about specific coping strategies and plans of action to address specific problems in your life. Start small. Once you overcome one thing, the rest look a lot less scary.

FWIW, Wellbutrin has--minus one extremely bad episode that was the result of ugly external factors--worked extremely well for me. Like you, it's removed the lowest lows (again, absent external stressors, which I should have avoided in the first place), but I see that as a good thing: I'm now physically safe, which means I can get on with the business of living.

Best of luck.
posted by feckless fecal fear mongering at 8:43 AM on September 2, 2014 [3 favorites]

Wellbutrin was like taking sugar pills for me. (My sadness is also due to unchangeable extetnal circumstances.)
I have yet to find anything that does shit. Neither therapy no drugs has helped.
posted by Violet Hour at 9:04 AM on September 2, 2014

In addition to having an antidepressant effect, Wellbutrin frequently acts as a stimulant for many of those who take it. That stimulant effect helps people not only improve their moods on its own but also enables people to actively work to improve their moods. But some people still need a little kick. Wellbutrin has been good for me but since I also have sleep issues, I need a prescription stimulant. The stimulant + Wellbutrin have set me up for success. I now have the drive to do what I need to do to improve my own life. The drugs don't do the work for me. It's still hard to get out of bed in the morning because bed is great and pajamas are comfortable and I have an A/C window unit so it's very pleasant in my bedroom. But drugs make me feel like I am not fighting my depression with one hand tied behind my back.

Maybe you could use a prescription stimulant. Maybe Wellbutrin + something else will work for you. Maybe something else + something else + something else will work for you. Talk to your doctors. I think the right combination of stuff is out there for you and I've got to tell you, when you find it, it's really great. It's not perfect but I really did have a feeling one day where I realized that the stuff I was taking was doing what it was supposed to do. It was like all of the road blocks had moved out of my way. I still have to figure out how to get where I'm going but it has really improved my life and I hope it does the same for you. Good luck.
posted by kat518 at 9:59 AM on September 2, 2014

I was on Wellbutrin for several years and it worked pretty much as you describe. It sort-of evened-out the peaks and valleys to where is was more of a gently rolling landscape. Honestly, I think a lot of people seem to expect anti-depressants to change you into a happy person. They don't.

Are you on the brand-name version of Wellbutrin or generics. My experience with the drug is that the brand-name works really well, while the generics vary greatly in effect.
posted by Thorzdad at 10:27 AM on September 2, 2014

300mg did as you describe for me too. My psych upped the dose to 450mg and holy hell was it like night and day. So it might be dose-related.
posted by zug at 3:54 PM on September 2, 2014

I was at one time on Celexa + Wellbutrin. At times I would stop taking the Celexa and only take the Wellbutrin, which made me irritable as f*ck and slightly manic. While this is not exactly what you are describing, I think Wellbrutrin was made to be an "add on" antidepressant, i.e., you should also be taking some kind of SSRI as a base. I'd recommend asking your psychiatrist about that.
posted by ttkx at 4:50 PM on September 2, 2014

Lamictal doesn't require blood tests - that's lithium. And that wouldn't be appropriate anyway in this circumstance because this isn't bipolar and isn't yet treatment resistant depression. Also it's not cheap. I would count this out for now.

Augmentation is a reasonable strategy and it can go many ways.

There's the stimulant route - in addition to the others mentioned up thread, dexedrine is another option.

There's also an examination of your sleep pattern to see if you're getting quality sleep. This can be corrected in many ways, I am currently on a trazodone trial with Wellbutrin. Trazodone, being an old school SARI antidepressant, also does a bit to help with the anxiety associated with Wellbutrin.

There are also the benzos, which you might have been thinking about when talking about anxiolytics. Benzos won't give you the get up and go that you seem to need. Long term benzo therapy is not something to be undertaken lightly and I wouldn't start this in your shoes.

Then there is augmentation with a second antidepressant. In an augmentation situation you can take less of the drug with a problematic side effect profile and hopefully avoid the side effect altogether. Wellbutrin works well at counteracting sexual side effects of the SSRI.

You have responded to Wellbutrin so I wouldn't toss it just yet. Itemize to your doctor the problems that you wish you fix and the side effects that you will/will not tolerate, you should be able to find a solution together. Don't dismiss the entire SSRI class of drugs, ask how you can mitigate side effects if your doctor concludes that is the best course of action.
posted by crazycanuck at 7:16 PM on September 2, 2014

Wellbutrin changed my life. It did nothing for my brother or sister.
posted by jessca84 at 8:21 PM on September 2, 2014

Wellbutrin sent my anxiety through the roof. I was a mess and had to stop it quickly.

Anyway, what I mostly want to say is that I have read that people have a really vast array of experiences depending on whether they take the generic or name brand and if they take SR or XR. I am not a psychiatrist and don't know exactly how that plays out, but that could be one other factor to mention.

Plus, it's not uncommon to take Wellbutrin in addition to another antidepressant in order to combat the sexual side effects.
posted by mermaidcafe at 11:04 PM on September 2, 2014

Wellbutrin is often prescribed in addition to another antidepressant. So, if you think it isn't doing enough, it isn't necessary to stop the Wellbutrin, but perhaps to add something else.

I can't find it right now, but I recall reading something online years ago outlining how different antidepressants target different neurotransmitters (dopamine, serotonin, and norepinephrine). Wellbutrin apparently inhibits norepinephrine and dopamine reuptake, but not serotonin reuptake. This might account for the fact that when I was on Wellbutrin alone, I had an improvement in energy and motivation (e.g. my body went zooming around getting more things accomplished than usual), but not in subjective mood (the way I felt inside myself no longer matched my behavior). The SSRI's, of course, do inhibit the serotonin reuptake. You might need both.

Here's something I just found on pubmed: "The preclinical and clinical data show that bupropion acts via dual inhibition of norepinephrine and dopamine reuptake and is devoid of clinically significant serotonergic effects."
posted by mysterious_stranger at 1:48 PM on January 14, 2015

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