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Bupropion XL & Pristiq

Hello,

I have been on Bupropion XL for a year now for my generalized anxiety disorder...I started out on lexapro, but the unfortunate sexual side effects were far too terrible..So my doc switched me to bupropion. That worked out great for me, I was having the best sex of my life with my fiancé, except I was losing way too much weight on it. I have always been thin, 5'5 & when I started out I was 123 pounds....last check up I was all the way down to 108 pounds, which I am not okay with. I've always been self-conscious about being thin, and when people began to comment on it on my wedding day of all days (I got married almost 2 months ago) I had to complain about it to my doc.

She gave me some samples of Pristiq and told me to immediately start taking half of one a day and to quit the bupropion all together. Its been a month now, i've gained almost 10 pounds back which I'm extremely happy about! But those sexual side effects are back once again....Mentioned it to my doc, and now she wants me to still continue on half a Pristiq a day, but add on half of my bupropion XLs to it as well.... I am afraid I will begin to lost weight on it. Anyone have any experience with this at all? I feel like I'm going to have to chose between a great sex life or being comfortable in my body & fitting into my clothes again...
7 Responses
Avatar universal
Is this a psychiatrist or a general doc?  And is your problem depression or anxiety, as both meds you're using are stimulating meds not usually used for primary anxiety.  Doesn't mean they won't work, but it sounds as if you're being treated for primary depression, which may be the case.  The ssris would normally be used first for primary anxiety, and they also tend to be more likely to promote weight gain as they're not as stimulating.
Avatar universal
It is my general doctor, as i don't go to a psychiatrist. I was diagnosed with anxiety, not depression. I also have a prescription for ativan to take as needed, which i never normally have to use. Either medicine (bupropion or pristiq) works for me for my anxiety, its just the side effects are the issue here. My doctor told me with pristiq, most people don't have issues with side effects.
Avatar universal
Your general doc is wrong, of course.  This is why you see a psychiatrist.  And my guess is, if these drugs are working, your problem very well may be depression, especially if wellbutrin worked -- it's one of the most stimulating of the antidepressants which is why it doesn't cause the weight gain that most antidepressants cause.  Pristiq, an snri, targets serotonin as the ssris do but also targets norepinephrine, which is basically adrenalin, which is why these aren't usually first choices for anxiety.  If it's working, that's great.  All of these drugs come with many side effects -- some suffer more, some less, but all drugs have side effects.  They are very powerful and alter the way the body functions naturally, so naturally they throw some things out of balance.  How much depends on the person.  General docs just don't know this stuff that well as they don't receive specialized training in it.  Now, you do what you feel is best -- some general docs are just great at this -- but I'd venture to say most would say wellbutrin is known for having fewer side effects than any snri (Pristiq is basically a newer form of Effexor).  But again, as to your original question, the ssris are known for weight gain because they tend to be more sedating since they only target serotonin.  But do what your instinct tells you is right, I'm just explaining some stuff your doc didn't as I've been taking these meds, unfortunately, for a long long time now.
1 Comments
This comment is dead on
Avatar universal
Oh, I should add, wellbutrin is best for not producing the sexual side effects.  Pristiq, since it largely targets serotonin, might have these effects, but ssris are most known for this problem.
11589391 tn?1419644443
I just started taking 150 wellbutrin SR , I was taking paxil . . . I had been taking an ssri for about 8 years now and I was always SO tired, never no energy, and the sexual side effects were something I decided I no longer wanted to deal with, not to mention no energy and I felt emotionally numb. Long story short right after the switch i noticed a HUGE change for the good of course. It was like someone had flipped a switch on and I began to live again. about 10 days after the switch i began to have severe sweating episodes....called my dr and she said to quit taking the wellbutrin....she thinks the sweating is a side effect from no paxil.....i am still having the sweating i have been off for about a week and I started back on the wellbutrin last night on my own accord....my dr is out of the office until after the first....but I HAD to have something....IF this is the paxil causing this how long will this sweating last.....looking for answers
Avatar universal
I started off on 150 mg generic Wellbutrin XL which was not doing much...so I was upped to 300 mg.  The sweating is unbelievable! I wake up in the morning drenched. My doc and pharmacist both say it is a side effect of the Wellbutrin and that it should go away. It's been 3 weeks now and I am still sweating a lot! I take mine at night because I don't want it to affect my sleep. Although I see a lot of people take it morning...so I don't if I should be taking it at night .
Avatar universal
I have been on many different antidepressants over the last 25 years. Cymbalta was the worst experience of all, Prozac, paxil Effexor, all worked for a while but after about 7 to 10 years they just didn't help much and I would switch to another one. My psychiatrist finally put me on Wellbutrin about 7 years ago. OMG it was a life saver, literally. I felt great, I lost 72 lbs in about a year and a half ( I was overweight, so they weight loss was great, I felt so much better in so many ways), and my sex life was wonderful. Well we are to the 7 year mark, and it just seems it isn't working anymore. I have gained 50 of the 72 lbs back, and my sex drive has left the building.  My general doctor ( I moved so I don't have my psychiatrist anymore) has decided to ADD Pristiq to my Wellbutrin, and in 3 months wants to wean me off my klonopin. She seems to really be against  the klonopin, she has attempted to take me off that before with Seroquel, but the Seroquel had side affects I didn't like so stopped it, and stayed on the klonopin.  

I am concerned about  the Pristiq. Is it going to cause sexual side affects? I really liked the sex drive I had early on with the Wellbutrin, but it doesn't seem to be around anymore. I know that Wellbutrin and Pristiq are both considered stimulants(not sure if that's the correct word to use) , I am hoping the combo might help me to lose the weight I have put back on.  How I wish the Wellbutrin worked as well now as it did when I first started taking it. Why is it these antidepressants seem to stop working after a period of time?
2 Comments
They don't always, but they often do.  My advice is to get a different psychiatrist before making any new moves.  GPs just don't get the same amount of study of this stuff as psychiatrists do, and although some do fine with them, when you have a complicated case like yours I'd see the specialist, not the generalist.  I would also be very suspicious of a doctor who just didn't like a particular drug.  Why?  Seroquel doesn't do what clonazepam does, at all.  It has been used for an unwanted side effect of causing sedation that its manufacturer got caught illegally marketing it for despite never doing any studies on it for that use.  Doctors are allowed to use any approved drug for any purpose they want, but this drug has a very fraught history.  I get the dislike of taking benzos every day, but stopping Klonopin can be very very hard to do and if you feel it's helping you, why stop it?  All the bad things about it you're already suffering, and it's mostly that it's an addictive drug and very very hard to stop taking.  You already have that problem, so your doc isn't preventing anything here.  I doubt it has anything at all to do with either your sex drive problem or your weight problem, and Seroquel, as a very sedating drug, would be much more likely to have both of those as side effects as it's an anti-psychotic and you aren't psychotic and it has because of that very profound effects on the brain.  Now, nobody can tell you if Pristiq will cause sexual side effects.  You've already been on Effexor, and this is basically going back on Effexor but with a slightly better record of being a bit easier to stop taking, but it's just the next generation of Effexor that was created because Effexor was losing it's patent protection at the time.  They aren't exactly the same, but pretty close.  Given how often you've changed meds it doesn't appear you have had a huge withdrawal problem, but benzos can be hard.  So again, if you like what it does for you or you just don't want to deal with a withdrawal problem while you're trying to deal with these other problems right now, it's hard to see the gain here.  Which is why I recommend highly that you wait until you get a new psychiatrist.  You obviously don't have a lot of trust in this doc and from what you say I think you're right not to.  As for combining two drugs, I also have a hard time seeing how that helps you, either.  If the Wellbutrin has been increased in dosage as much as is recommended and it still isn't working, why would taking a second antidepressant make it work any better?  It seems it would be better to taper off the Wellbutrin until you've successfully stopped it and then try something else.  Now, that's just me, you might engage in a deep discussion of this with either your current doc or a new psychiatrist and see if they have a good explanation how any of this will help you.  But there is one problem I have with this.  Wellbutrin is considered one of the best drugs out there for not having sexual side effects or weight problems, but it's also highly stimulating for most people and so it's not usually for anxiety sufferers, it's for those who have depression as their primary problem.  It can cause anxiety in some people.  The stimulating part is because of its action on norepinephrine, and the SNRI class that includes Pristiq and effexor also affects that neurotransmitter.  Many find that adding Wellbutrin in a small dose to their SSRI helps with the weight and sexual problems, but it has to work for that to happen, and to add it to Pristiq, assuming again the Wellbutrin was working, is to double the effects on norepinephrine.  Could help some, but maybe too much stimulation for others.  But the weight gain and sexual problem is hard to see being attributed to a drug that isn't working anymore for you, unless it's still working as an antidepressant and just not working for the weight gain and sexual problems.  But again, assuming it's burnt out, why would you be having sexual problems and weight gain?  That's a side effect of an antidepressant that is working, right?  Is it possible something else is going on that would be more a therapy situation than a side effect of a drug that has stopped working and didn't have this side effect?  Just asking.   If you've burnt out on it, it won't have that effect, at least logically.  Can't tell you what to do, but hope I've at least provided some ways to think about this situation.  
By the way, sometimes going back on a drug that worked for you but burned out you haven't been on for awhile might start working again.
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