Buproprion and diazepam? Two great tastes that taste great together?
September 23, 2016 6:22 AM   Subscribe

Has anyone here combined a regimen of buproprion and diazepam to treat depression and anxiety?

First, in big bold letters, YANMD!

've been a more-or-less lifelong user of buproprion (Wellbutrin) with fairly acceptable results. It takes the edge off and makes the roller coaster more into a livably bumpy ride. Plus, it's been the only antidepressant that has never hit me with side-effects. That, alone, is a huge plus. That said, while I was maintaining, I was still under the dark, heavy shroud of daily depression. I'm currently at 300Mg/day.

Last week, owing to a medical need entirely unrelated to my depression, my PCP wrote me a temporary script for 5Mg/day of diazepam (aka, good old valium) Oddly, I have never in my life taken valium, and I was utterly unprepared for what happened next. While it seems to be doing a good job at its intended use, the psychological effect has been miraculous. It's as if a veil has been lifted. I simply feel...open and clear. My therapist noticed right away something was different at our session this week. My posture was completely different...open, positive, unguarded. My wife is amazed at how different I am now. In just a short week, we're closer and communicating more than we have in years. I dare say I'm actually...happy? Honestly, I've not felt this connected and alive in my roughly 50 years of depression, so you can understand my giddiness and sense of "Holy shit! Is this what I've been missing all this time?"

Now, don't get me wrong. I've done quite a lot of drug experimentation over my long life, so i definitley know the difference between a big, druggy "happy" and what has been going on this week.

But, of course, there are questions. Has anyone here utilized this combination over an extended period of time? From what I can determine, this is not a common drug combo, and I'm unclear what long-term use of diazepam will do to me. Of course, long-term use of Wellbutrin isn't exactly harmless either, so, I guess it's always a game of trade-offs.

Anyway, I'd love to hear from anyone who might have incorporated diazepam into their antidepressant regimen, successfully or not. Or, form med pros with any definite opinions about this combo.

posted by Thorzdad to Health & Fitness (18 answers total) 5 users marked this as a favorite
I did buproprion and clonazepam. Of the two, I have ditched the buproprion. This was because the buproprion induced a mixed state.

Long term therapy with benzodiazepines is generally contraindicated. This is because of the association with benzodiazepines and Alzheimers and other memory/dementia issues. In my case, since I have bipolar 2 disorder and I'm already at increased risk, I figure I might as well take advantage of the therapeutic effects of this class of drug. As you experienced, they are real.

If you don't want to go the route of benzo use, you might consider lowering dose of buproprion. If needed you could augment or switch to another antidepressant.
posted by crazycanuck at 6:41 AM on September 23, 2016 [1 favorite]

I struggle with anxiety and depression and was prescribed Cipralex, which managed everything for about 5 years, until a significant event in 2014 led my family physician to add Wellbutrin to the mix to pick up my mood.

I took it for 2 years and recently stopped because I was feeling a lot of grar-anger and I wanted to see if it made a difference. Stopping wellbutrin has reduced my anxiety DRAMATICALLY. My mood is pretty stable at low (but not impossibly low).

My opinion is that the marketed "happy, skinny, horny" drug has more drawbacks to benefits to me personally.
posted by Dressed to Kill at 7:00 AM on September 23, 2016 [3 favorites]

According to this interaction checker, valium + bupropion may lead to a moderate risk of seizures - but check with a pharmacist.

(I've been offered bupropion for smoking cessation and attentional issues but rejected it, because it often exacerbates anxiety, and I'm anxiety-prone, and have had anxiety disorders in the past. [Have been primarily anxious; depressive episodes I've experienced have been secondary to it.] Benzodiazepines alone have made me feel pretty great - they take the edge right off, and just the edge... I've been hesitant about taking it, though, because of the effects crazycanuck describes, and because one epidemiological study found an increased, dose-dependent risk of mortality with benzodiazepines and/or hypnotics; this has been supported by other studies, but some have questioned whether the identified risk was related to possible [unanalyzed] confounds (like comorbidities, especially substance abuse; socioeconomic status; or use of the drug in association with terminal illness. Some have linked the identified mortality to pneumonia [which makes sense in that respiratory functions can be depressed with benzodiazepines].)

All that said... It's wonderful to hear that something is actually working for you. I've seen you talk about the impact of depression on your life many times. I wonder if careful monitoring - of the valium use, and of any medical conditions - might offset the risk enough to make it feel acceptable...

(Alternatively - this is how valium works; if you are worried, maybe you can talk to your doc about alternatives that function in a similar way?)

(I am definitely not a doctor.)
posted by cotton dress sock at 7:14 AM on September 23, 2016 [3 favorites]

Frequent use of Valium will lead to tolerance. Best to save it for when you really need it and find a non-benzodiazepine anxiety medication.
posted by arrmatie at 7:20 AM on September 23, 2016 [7 favorites]

(Another non-doctor here): I take 300 mg of Buproprion a day, and I save my benzos for acute episodes, because I am very paranoid about developing a tolerance for them and/or displaying "drug-seeking behavior" if I go through them too quickly. I did have a lot of success managing anxiety long-term with an SSRI (Zoloft), concurrently with the Buproprion. Once the Zoloft kicked in, I had the profound feeling of "normal." Like, this thing that would normally ruin my day with anxiety? I see it, and I remember my past reaction, but I don't feel like making a big deal about it. And then I could actually move right on without obsessive thoughts and worry.

My psychiatrist is unconcerned with long-term effects; her opinion is generally that if it increases my quality of life and helps me make healthy choices (lower cortisol levels, less neurotic behavior around food, less self-medication via alcohol) it's worth it.

I stopped taking the Zoloft because I gained a bunch of weight--and I'm still not sure if the SSRI is to blame--but there seems to be a lasting effect where certain stimuli no longer cause me angst. It's nice.
posted by witchen at 7:53 AM on September 23, 2016 [1 favorite]

Bupuprion + benzos has been fine for me, FWIW. Standard caveats apply: you really don't want to be on a daily benzo regimen, because you'll develop tolerance and stopping taking it is viciously terrible. But I have not experienced any difficulties from occasional combining of these two.
posted by Mayor West at 7:56 AM on September 23, 2016 [2 favorites]

As a potential alternative if you haven't tried it: some people take Buspar (buspirone) with bupropion to help with anxiety. Buspar's an odd drug and doesn't help everyone but it helps some people and it is not dependency-inducing.
posted by needs more cowbell at 8:12 AM on September 23, 2016

Tolerance in and of itself is not a bad thing. It is possible to stay on a lower dose for a long time. It is possible to cut back your dose or withdraw with careful planning, a lot of time, a pill splitter, and a steady hand.

The practical implications of tolerance are things like:
- under no circumstances must you be separated from your medication while traveling
- you have to worry about your refill calendar when trip planning
- you must stay on top of doctors appointments and refills. In Canada this is cheap, in the US more expensive
- If you're not a regular at an expensive retail pharmacy, they wont spot you and phone it in (though your regular pharmacist may do this if they know you)
- you will have to manage transitions with your prescribing physician carefully. If you go this road, hope your doc stays in business for a few years so the next guy doesn't come along and screw it up (after a long time you can switch, they'll take the if it ain't broke don't fix it approach )
posted by crazycanuck at 8:34 AM on September 23, 2016

I think a lot of people actually do combine an antidepressant with a benzo for occasional use. The long-term risks of routine (daily) benzo use have been touched on above (and they are considerably greater than long-term use of bupropion, at least from what we know now). The fact that you're getting such relief from Valium suggests to me that your prior drug regimen was not adequately managing your anxiety. Perhaps you might benefit from adding the anti-anxiety drug Buspar and saving the Valium for breakthrough anxiety, or trying a different antidepressant, if you haven't already been through all of them? Bupropion increases anxiety in some people, though certainly not all.
posted by praemunire at 8:55 AM on September 23, 2016 [1 favorite]

I've been taking a daily benzo along with my antidepressant for about four months now. I'm meant to take it twice a day, but my sleep improved as my anxiety decreased, so I only take the morning dose. Mentally, this is the best I've felt for as long as I can remember. And what's great about that is now I am emotionally able to build up my coping skills with the ultimate goal of weaning off the benzo.
posted by Ruki at 10:20 AM on September 23, 2016

I found clonidine (a non benzo med used for high blood pressure that also helps with anxiety) to be very helpful. I used to take wellbutrin, but it made me so anxious. For awhile, I actually used a clonidine patch to make the anxiety tolerable. I've since gone off of Wellbutrin, but I do still take clonidine to help me sleep.

Unless you have super low blood pressure, clonidine is a pretty low side effect med, and I've taken the same dose for years now without developing a tolerance. (I no longer take it during the day because my anxiety stopped being an issue when I got off wellbutrin, but I do still take it to help me sleep.)

IANAD/IANYD, this is just anecdata. I know there are some people who use benzos daily, but tolerance can be a problem, and you may not be able to find a doctor willing to prescribe it to you in this way. However, even if daily benzos aren't the solution, it definitely sounds like you need to work with your doctor to find an alternative to just taking wellbutrin.
posted by litera scripta manet at 10:29 AM on September 23, 2016 [1 favorite]

I had to jump off the buproprion train because it eventually exacerbated my anxiety way too much.

I'm wondering if you're having a similar reaction as mdma assisted therapy. So while I'd agree there are good reasons not to use it for the long term, it might let down your boundaries enough to handle emotionally difficult situations.
posted by politikitty at 10:34 AM on September 23, 2016

I'm on buproprion, escitalopram and diazepam, though the diazepam is not for anxiety, but to counteract the tooth-grinding side effect from the buproprion at night. I didn't notice much difference in mood, just stopped cracking crowns quite as often.
posted by Karmakaze at 10:51 AM on September 23, 2016

Thanks all! Just for the record, buproprion has been my trusty friend since it was brand spanking new, so no worries there.

(There was a period from the early 00's through about 2012 where there was a specific brand of generic buproprion on the market that did, in fact, drive people over the edge with severe anxiety and even suicidal ideation, and I know a lot of people who got caught up in that mess. I had to shop my own prescription around based on which pharmacy was stocking the "ok" manufacturer that month. It was nuts. Luckily, it's off the market now.)

I am a bit concerned about long-term benzo use, so I'm definitely going to talk with my doc and see what we can do to keep me at this amazing level without too many potential problems.
posted by Thorzdad at 1:13 PM on September 23, 2016 [2 favorites]

Thanks all! Just for the record, buproprion has been my trusty friend since it was brand spanking new, so no worries there.

>That said, while I was maintaining, I was still under the dark, heavy shroud of daily depression.

Those statements don't go together. It sounds like Wellbutrin is not managing your depression and anxiety adequately. If I were you, I'd consult with a psychiatrist for a med adjustment.

I have found that a lot of psychiatrists dismiss or ignore anxiety. You might be better served if you make sure to bring it up as an ongoing problem. People with depression and anxiety sometimes think the entire problem is depression, while anxiety is often the more disabling half of the equation.
posted by lazuli at 7:29 PM on September 23, 2016 [1 favorite]

Personally, as someone who prescribes benzos on an almost daily basis, if it were for myself, I'd make sure I had tried every other option for a non-addictive medication for my anxiety before using any benzo on a daily basis.
posted by treehorn+bunny at 7:58 PM on September 23, 2016

I am on bupuprion & clonazapam. I'm fairly miserable, but I am still alive. The bupropion is too speedy for me really, I am so, so anxious. But it's the only antidepressant that doesn't make me gain 80 pounds in a week, or sleep at all times. I take a high dose of clonazapam daily; before my PTSD I used it PRN. If you've got a winning combination, stick with it and count your lucky stars.
posted by The Noble Goofy Elk at 12:43 AM on September 25, 2016

>~That said, while I was maintaining, I was still under the dark, heavy shroud of daily depression.

~Those statements don't go together. It sounds like Wellbutrin is not managing your depression and anxiety adequately. If I were you, I'd consult with a psychiatrist for a med adjustment.

Well, they kind of do, if you knew me on and off Wellbutrin and my life history of depression. I am a lifelong (i.e. 50+ years), unrelenting depressive. It will and forever be there and a part of me. The Wellbutrin makes it possible for me to tolerate daily life without any noticeable side-effects. In the past, I have been on enormous levels of the stuff (like, triple the usual daily dosage.)

I agree, though, that it may be time for an adjustment in conjunction with the benzos.
posted by Thorzdad at 3:52 AM on October 22, 2016

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