Wellbutrin + Lamictal= awesome?
February 17, 2018 12:22 PM   Subscribe

YANMMD etc. I’m suffering from a pretty severe and frustratingly long lasting case of Post Partum Depression. I am currently taking 200mg of Lamictal. It definitely helps but things are still pretty tough on the homefront. I’m thinking about asking my psychiatrist about adding Wellbutrin. Would love to hear from others who take those two medications in combination.

The PPD was sudden onset and severe. I had not previously taken any medication for mood or depression, but after a terrible, terrifying initial experience on Zoloft and a family history of bi-polar disorder (I had not previously had any symptoms) I have been on a very slowly escalating dose of Lamictal reaching 200mg about two weeks ago.

I definitely notice a difference, especially at work where I am finding great satisfaction. But I still have intense and debilitating spells of sadness anger and panic directed largely at my (lovely and supportive) spouse.

Based on some reading, I’m wondering if a small dose of Wellbutrin might help me round this final corner. My prescribing psychiatrist seemed reluctant when I mentioned it and I didn’t push the issue— I’ll ask again when I see her in two weeks. But before that conversation I was wondering 1) Have any of you taken Lamictal and Wellbutrin in tandem? Particularly if you’re not taking any additional medication? If so, was the combination effective? 2) Have you taken Lamictal in combination with any other a-typical antidepressants and if so was it effective? 3) Anyone else our there who experienced complicated PPD and found a combination of medication that worked for them? Any insights are welcome but I’m particularly curious about folks who were not previously on medication.

Please know I am safe, well-supported, in therapy, love and am able to care for my children etc. I just wish so much that I could get a better handle on this.
posted by jeszac to Health & Fitness (10 answers total) 1 user marked this as a favorite
Never been pregnant and don't have bipolar, but I have been on Lamictal for years (200 mg) and I just started Wellbutrin about two months ago. I had tried other antidepressants (Prozac, Zoloft, Cymbalta) and they were ineffective or the side effects were too severe. I tried Wellbutrin a few years ago (while already on Lamictal) and the anxiety was too much so I stopped, but I was going through a traumatic experience at the same time so it's hard to tell how much was the medication.

My current experience: the first week or two was amazing, I had a lot of energy and motivation. It was like drinking a bunch of coffee without the jitters. That's since plateaued but I do not have the crushing despair I had before WB. I do notice greater mood swings and the insomnia was a problem at first. I'd imagine that sleeping is difficult for anyone with a baby and if I were you I'd seriously consider that aspect. I have to be very conscious of sleep hygiene or I'll be up until 2 ruminating about something.

Wellbutrin gives me a jumpstart that Lamictal does not, but I still have to direct that energy appropriately, or I can spend six hours reading about South American bats on Wikipedia. I don't find it helpful at all for panic or anger and that may be why your prescriber balked. I feel things more intensely on Wellbutrin. For me that's better than not feeling anything at all and waiting for death, but I don't have a partner or anyone to yell at. Other things I've noticed: increased sex drive, decreased appetite. (Mild but long lasting) headaches may or may not be related.
posted by AFABulous at 2:10 PM on February 17, 2018 [1 favorite]

If you have anxiety and panic, Wellbutrin can really spike those. I’m on Lamitcal now and it’s a good fit for me. I have been on Wellbutrin in the past and it really exacerbated my panic attacks. If that’s not a huge part of your experience, maybe try it? But I would also ask for other recommendations from your doctor if increased anxiety is a big concern.
posted by ananci at 3:19 PM on February 17, 2018 [2 favorites]

All I can say is that response to psych meds vary so widely from person to person! When the doctor added Wellbutrin to a family member's anti-depressant, three days later she had her first psychotic break. Since then I've met many people happily taking Wellbutrin (I have a job where I know people's prescriptions) so I know our experience is not typical but trying to predict side effects seems to be a very strange and uncertain task.

Bottom line: If you trust your doctor, be clear that you are feeling the need for something more, ask about Wellbutrin but then be prepared to really listen to her response.
posted by metahawk at 3:40 PM on February 17, 2018 [2 favorites]

Wellbutrin plus lamictal = hallucinations for me. YMMV. :(
posted by Hermione Granger at 5:54 PM on February 17, 2018

Wellbutrin and Lamictal gave me a mixed episode featuring irritability. It did lift the depression though, so there’s that.

Lamictal can go up to 400mg so give it a try. If Zoloft didn’t work try another, low dose. SSRI are classic for anxiety. I flunked Celexa but passed Zoloft, who knew?
posted by crazycanuck at 6:52 PM on February 17, 2018 [1 favorite]

With the caveat that anecdata doesn't equal data; everyone responds differently to psych meds; IANAD/IANYD/etc...

I have taken wellbutrin and lamictal together. It sounds like I ended up on lamictal in a similar situation to you: I was put on an SSRI (celexa, in my case), and ended up having bipolar-ish episodes where previously I had never had any of those symptoms. So, I got off of the SSRI, and I titrated up to a dose of 200 mg of Lamictal. I later added in Wellbutrin, both to help with depressive symptoms and also ADHD symptoms. (None of this was in any way related to PPD, so not sure how directly applicable this is to your situation.)

I was on this combo for several years. I did take a couple other meds during this time, but none of them were antidepressant types. (Clonidine, a blood pressure med that I used for insomnia/anxiety; also naltrexone, which helps with alcohol cravings.)

The good news is that for me, the lamictal plus wellbutrin combo did not cause me to revert back to any of those bipolar symptoms I got on SSRIs. I definitely noticed the wellbutrin helped with energy and focus and that kind of thing. (Also helped me quit smoking.)

However, the bad news for me is that ultimately the anxiety on wellbutrin was just not worth the other benefits. In retrospect, I should have gotten off wellbutrin way sooner, but I didn't initially attribute my intense anxiety/hypervigilance/irritability to wellbutrin.

To be fair, I think my own psych history contributed to the intensity of these symptoms, but I would not say that anxiety is a primary diagnosis for me, and when I got off wellbutrin, it got way better. Although I tried going on a lower dose of wellbutrin, when I got low enough for the anxiety symptoms to abate, I stopped seeing any benefit.

Anxiety is one of the side effects of wellbutrin because it can be a more activating antidepressant, but I know not everyone has a problem with it the way I did. But if you do try out wellbutrin, definitely watch out for that. I can't really speak to affect on sleep, as I've always had major sleep problems; I did take wellbutrin in the am.

Although I do think I should have gotten off wellbutrin sooner, I don't regret trying it out, so it could be worth exploring with your doctor, but as others have noted, this is definitely ymmv territory.
posted by litera scripta manet at 9:11 AM on February 18, 2018

Just wanted to say thank you to all of you who’ve responded. In a difficult and somewhat isolating period of my life the context you’re providing is so helpful.
posted by jeszac at 10:15 AM on February 18, 2018 [1 favorite]

I'm in a slightly different situation from you- I was on Zoloft and when it plateaued, we added Lamictal as a supplement. The combo for me has been magical. I have a few side effects, mainly restless leg and some memory issues, but the overall mood stability has been totally worth it. It's my understanding that Lamictal usually works best in combination with other drugs so adding Wellbutrin may work really well for you. Sorry to mostly give anecdata, but I do want to advocate for combining Lamictal with other medications!
posted by Polyhymnia at 12:43 PM on February 18, 2018

I currently am prescribed both meds and have taken them both, along with unrelated other meds for unrelated health needs, for years. Others have already given you good information, and I have only one other additional thought.

Dosage matters. Wellbutrin, prescribed many many years ago to me wrapped in a smoking-cessation label, made me psychotic nearly immediately. I did not sleep for several days in a row, I saw/heard things that nobody else could see/hear ...it was frightening. Wellbutrin was again prescribed years later for a treatment-resistant MH need, and I agreed to try it starting with a teeny tiny dose, titrating up v.v. slowly, and have had no problems with it at all this time. You're probably already aware of small, incremental titration since Lamictal is usually handled that way too, but just in case...

Most of all, I sure do hope you'll feel better soon.
posted by mcbeth at 9:23 AM on February 19, 2018

You can feel better than this, and deserve to feel better. It may take time, however. Months or even years, not weeks. I have bipolar II. I've been on Lamictal since I was diagnosed a decade ago, and it has never been enough. The best for me has been to take Citalopram with it. We added Wellbutrin in the last two years as well. So those three together plus Clonazepam are my regime right now.

I can see why your doctor is reluctant to add an SSRI if you had such a bad experience with Zoloft, but the way my doctor has talked about it is that the Lamictal stabilizes mood and if it has stabilized at a point lower than we would like, then we can *carefully* add an SSRI to try to lift it a bit higher. I am able to tolerate SSRIs but I guess not everyone can? Also, your doctor may just want you to be on the Lamictal for a while without adding anything else yet so that it's very clear what the Lamictal does and doesn't achieve for you.

Anyhow, there is more out there than SSRIs. At one point I was on an MAOI instead. It's an older type of antidepressant. It worked. I can't remember why I went off. A few years ago the doctor wanted me to go off the SSRI and try Abilify instead. That was a disaster. Then, Latuda. That didn't work either. So after that it was back to the SSRIs. YMMV. Good luck, and feel free to memail me if you have questions!
posted by kitcat at 2:25 PM on February 20, 2018

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