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Why Would Wellbutrin And Rispderdal Be Prescribed Together If They Have Opposite Effects On Dopamine?

dopamine Risperdal

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#1 jendaizbee

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Posted 27 October 2011 - 09:48 AM

I was reading the Dopamine 101 thread, and I'm curious about this:

I take Wellbutrin, which apparently is increasing Dopamine? This has always been helpful to me (this med) for depression, and I believe, to some extent, with concentration (though that gets to be problematic because the negative symptoms of psychosis can come up and cause more concentration problems with which Wellbutrin at 450 mgs doesn't seem to help).

Simultaneously, I take Risperdal Consta injections for psychosis. This works for me, except for the fact that I have had some symptoms recently requiring the addition of Latuda. (I thought the Latuda was making we worse, went off if for a week and came to the conclusion that my pdoc was correct and my dosage was just actually too low, so now I'm on 80 mgs of Latuda since two days ago).

I have also, when I was younger, and before I was psychotic, been told that I probably had ADD, and I was put on Ritalin for that. I don't recall it helping much, other than to make me more alert and awake. My pdoc told me that drugs like Ritalin (and this is obviously true from what I read here), basically do the opposite to Dopamine of what AAP's do.

So I am wondering if it is actually sensible for me to be on Wellbutrin and Risperdal at the same time? Is anyone else on this combo? I'm not going to change it just because it seems odd, since the meds work for me so that's all that really matters. But I'm curious if one might be counter-acting the other to a degree, leading them to not be as effective as they would be without the other.

Can anyone explain why a person might benefit from Wellbutrin, plus Risperdal and Latuda?

I do not know if it is true that I ever actually had ADD. I did identify with a lot of the symptoms, but the psychosis is by far my more prominent problem now, along with depression at times.

I have been on Wellbutrin the majority of the time, at different dosages since 1999. I have been on Risperdal Consta for three years, and before that for another couple years, with a break in between. I have been on Latuda for a couple months.

Thanks!
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"Its Latin name may come from bellis, meaning beautiful, so Bellis Perennis can be translated to perennial beauty, as the daisy flowers for so long. Or bellis may come from bellum, Latin for war, because it grew in fields of battle, and can staunch bleeding and reduce bruising and shock. One of the daisy's old names is bruisewort.

The cheerful little daisy is a symbol of innocence because of its association with children, and of survival.
Daisies adapt to almost any landscape and soil type, and will survive being trodden underfoot and all the indignities of the hoe and the lawnmower."
-Anne McIntyre, Flower Power

http://www.suicidalnomore.com

Dx: Schizoaffective Disorder, Bipolar Type

Current Meds: Trilafon, Clozaril (going off now), Prozac, Valium, Vistaril, Melatonin, Ambien, and non-psych meds for thyroid and Lupus

Past Meds: APs - Seroquel, Risperdone, Geodon, Abilify, Haldol and Thorazine (those 2 in hospitals)
Antidepressants: Prozac, Paxil, Effexxor, Anafranil, Elavil, Tofranil, Remeron 
 Prozac 50 mgs, Latuda 80 mgs, Clonazepam 1.5 mgs, Vistaril 100 mgs, Ambien 10 mgs, Risperdal Consta injections - 50 mgs biweekly, Melatonin for additional sleep help, other non-psych meds and other SSRI's I can't recall

Mood Stabilizers: Neurontin, Lithium, Lamictal, Depakote, perhaps others
Others: Luvox, Ritalin, Cogentin and others like it, Restoril, Trazadone plus more I cannot remember




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#2 Rockie

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Posted 28 October 2011 - 05:01 PM

I think two things might come into play here, if not more.

The first has to do with receptor occupancy. Occupancy is the proportion of receptors to which a drug is bound. D2 receptor occupancy for Risperidone 3mg/day is around 72%, and 6mg/day is around 82% (here).

We already know that Risperidone is, among other things, a D2 antagonist. So, and this is my wild guess, even though bupropion increases the amount of dopamine available since it reuptakes dopamine, it only has roughly 28% of the dopamine receptors left to bind to. Thus, you're getting much more action from risperidone's antagonism of D2 than from bupropion's dopamine reuptake.

I'm not sure if affinities and contention also play into this. I also wasn't able to find specifics of receptor occupancy for buproprion, but I did find a study that was completed, but the findings weren't published.

Second, buproprion may increase blood plasma levels of risperidone (here) so you get more for less. Since receptor occupancy is greater as you increase the dosage, you'll get even higher receptor occupancy with the same dosage of risperidone. You'll also have a higher chance of EP side effects so this should be/is considered when determining the dosage.

Also, in terms of AD action, by having both on board you get the benefits of both norepinephrine reuptake inhibition (from bupropion) and 5-HT2A antagonism (from risperidone, here), though perhaps not so much from dopamine reuptake inhibition due to the above.

Re: bupropion + risperidone + lurasidone, I'm guessing that your pdoc is betting on both more AD and AP action by combining the three.

I'm sure it's much more complicated than this, but that's my layman's understanding from the sources I found.

Edited by Rockie, 28 October 2011 - 05:43 PM.

  • 1

Previous Meds
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AED's: Topomax, Trileptal, Klonopin, Ativan, Lamictal, Oxazepam, Triazolam
AP/AAP's: Seroquel
Other: Buspar, Ambien, Nadolol, Propranolol, Pramipexole, Hydroxyzine

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#3 In-Between

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Posted 31 March 2012 - 08:10 AM

Hey there! I realize this is an old thread, but I was researching a question I had about Bupropian and Risperadone and their interactions. Came across this thread but am still left a little confused and was hoping someone could clarify for me. I read the above post as saying that the two do in fact contradict one another in the dopamine area. My wife read it a little different than that and said we dont know how many receptors are in play which effects the outcome. My question is this- do the two play nice together? I was recently prescribed Wellbutrin and am feeling nothing from it- good or bad, well, except my ears ring now. I started to look at my other meds to see how Welly would play with them and came across these questions. I also read that Welly will increase the effects of the Risperdal.

Thanks, look forward to figuring this out.
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#4 Rockie

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Posted 31 March 2012 - 11:55 AM

To add to the above, I did find the receptor occupancy of therapeutic dosages of bupropion, which is, at most, 20-30% of striatal DAT. So this meshes with:

The first has to do with receptor occupancy. Occupancy is the proportion of receptors to which a drug is bound. D2 receptor occupancy for Risperidone 3mg/day is around 72%, and 6mg/day is around 82% (here).

We already know that Risperidone is, among other things, a D2 antagonist. So, and this is my wild guess, even though bupropion increases the amount of dopamine available since it reuptakes dopamine, it only has roughly 28% of the dopamine receptors left to bind to. Thus, you're getting much more action from risperidone's antagonism of D2 than from bupropion's dopamine reuptake.


So unless you're on a tiny dosage of risperidone, DAT occupancy by risperidone would be much higher than bupropion and possibly increased (as mentioned above) by adding it to an AAP.

But how does bupropion help depression if it's occupying such a small percentage of DAT? It's thought that high occupancy of DAT -- as an agonist (or partial agonist in certain cases) rather than as an antagonist -- is not required to produce therapeutic effect. This is also true of NET occupancy, which is only 50% vs 80-90% of SERT at therapeutic dosages of SNRI's. Another example - 50% DAT occupancy is enough for a med to elicit stimulant effects. I should also mention that higher D2 occupancy by an antagonist is required to elicit AP effects. Don't ask me why.

In addition, adding in bupropion may also help with EP side effects since it's increasing dopamine receptor activity, rather than decreasing it at D2 like risperidone. So, adding in bupropion may produce either positive or negative results depending on how skillfully it's administered.

(Paraphrased from Stahl's Depression and Bipolar Disorder)

Edited by Rockie, 31 March 2012 - 11:58 AM.

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AED's: Topomax, Trileptal, Klonopin, Ativan, Lamictal, Oxazepam, Triazolam
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#5 In-Between

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Posted 01 April 2012 - 07:47 AM

Can someone explain this to me like I was a 5yr old?

Thanks
:mad:
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#6 Rockie

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Posted 01 April 2012 - 12:27 PM

The Dr. Seuss or Lil Wayne translation:

One day you were caught while in a psychosis
So your doctor gave you a schizoaffective diagnosis

Risperdal you take so a scene you don't create
And Wellbutrin lifts your mood and helps you to concentrate

But still you wonder about this dopamine stuff
Will taking Risperdal with Wellbutrin make your life rough?

You know that too much dopamine activity can be a mistake
But too little can cause your head and heart to ache

Risperdal is an antagonist at the dopamine receptor
Which basically means it slows down dopamine receptor activity. thus, making mania and psychosis better

But doesn't Wellbutrin inhibit dopamine reuptake in the brain
Which, in bipolars, can make you act insane?

Turns out that Risperdal effects dopamine receptors much more
So adding in Wellbutrin will help to even the score

Wellbutrin the side effects can ease
Caused by Risperal, no EPS, please

But keep in mind that it can also increase Risperdal levels in your blood
So add it in carefully, lest you end up speaking like Elmer Fudd

While it may sound like they don't play nice
Listen to your doctor, he's giving you good advice

Edit: Forgot to mention the norepinephrine reuptake inhibition that Wellbutrin adds to the mix
Your mood and concentration it can also help fix.

Edited by Rockie, 01 April 2012 - 01:39 PM.

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Previous Meds
AD's: Prozac, Zoloft, Paxil, Luvox, Celexa, Cymbalta, Effexor, Lexapro, Wellbutrin, Remeron, Emsam, Imipramine, Nortriptyline,Trazodone, Viibryd, Nefazadone
AED's: Topomax, Trileptal, Klonopin, Ativan, Lamictal, Oxazepam, Triazolam
AP/AAP's: Seroquel
Other: Buspar, Ambien, Nadolol, Propranolol, Pramipexole, Hydroxyzine

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#7 fairymonkey

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Posted 02 April 2012 - 12:24 PM

Rockie you're the only person that made sense to me. Thank you. Some people just don't understand these things and need it to be EXTREMELY simplefied. I'm on Wellbutrin (100mg, due to stomach side effects so its a bit low) and risperdal (at .5, because I use it for anxiety. I got all sorts of worried due to drug interactions but I do find it common among most people they have contradictory meds that actually help them.
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#8 In-Between

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Posted 03 April 2012 - 05:56 AM

That's pretty great, Rockie, thanks much!
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#9 jendaizbee

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Posted 18 April 2012 - 11:52 AM

Haha, I'm no longer on Wellbutrin, but I love this explanation in your last post, Rockie! The other posts were a little over my head.
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"Its Latin name may come from bellis, meaning beautiful, so Bellis Perennis can be translated to perennial beauty, as the daisy flowers for so long. Or bellis may come from bellum, Latin for war, because it grew in fields of battle, and can staunch bleeding and reduce bruising and shock. One of the daisy's old names is bruisewort.

The cheerful little daisy is a symbol of innocence because of its association with children, and of survival.
Daisies adapt to almost any landscape and soil type, and will survive being trodden underfoot and all the indignities of the hoe and the lawnmower."
-Anne McIntyre, Flower Power

http://www.suicidalnomore.com

Dx: Schizoaffective Disorder, Bipolar Type

Current Meds: Trilafon, Clozaril (going off now), Prozac, Valium, Vistaril, Melatonin, Ambien, and non-psych meds for thyroid and Lupus

Past Meds: APs - Seroquel, Risperdone, Geodon, Abilify, Haldol and Thorazine (those 2 in hospitals)
Antidepressants: Prozac, Paxil, Effexxor, Anafranil, Elavil, Tofranil, Remeron 
 Prozac 50 mgs, Latuda 80 mgs, Clonazepam 1.5 mgs, Vistaril 100 mgs, Ambien 10 mgs, Risperdal Consta injections - 50 mgs biweekly, Melatonin for additional sleep help, other non-psych meds and other SSRI's I can't recall

Mood Stabilizers: Neurontin, Lithium, Lamictal, Depakote, perhaps others
Others: Luvox, Ritalin, Cogentin and others like it, Restoril, Trazadone plus more I cannot remember


#10 Claire

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Posted 18 April 2012 - 12:03 PM

The Dr. Seuss or Lil Wayne translation:

One day you were caught while in a psychosis
So your doctor gave you a schizoaffective diagnosis

Risperdal you take so a scene you don't create
And Wellbutrin lifts your mood and helps you to concentrate

But still you wonder about this dopamine stuff
Will taking Risperdal with Wellbutrin make your life rough?

You know that too much dopamine activity can be a mistake
But too little can cause your head and heart to ache

Risperdal is an antagonist at the dopamine receptor
Which basically means it slows down dopamine receptor activity. thus, making mania and psychosis better

But doesn't Wellbutrin inhibit dopamine reuptake in the brain
Which, in bipolars, can make you act insane?

Turns out that Risperdal effects dopamine receptors much more
So adding in Wellbutrin will help to even the score

Wellbutrin the side effects can ease
Caused by Risperal, no EPS, please

But keep in mind that it can also increase Risperdal levels in your blood
So add it in carefully, lest you end up speaking like Elmer Fudd

While it may sound like they don't play nice
Listen to your doctor, he's giving you good advice

Edit: Forgot to mention the norepinephrine reuptake inhibition that Wellbutrin adds to the mix
Your mood and concentration it can also help fix.


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Previously Rx'd
Moclobemide - Pooped out on second attempt.
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Prozac/Fluoxetine - Mania
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Lofepramine - Ridiculous sweating, but did work Pdoc says all tricyclics will have same effect
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#11 Eli

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Posted 21 April 2012 - 12:03 PM

The Dr. Seuss or Lil Wayne translation:

One day you were caught while in a psychosis
So your doctor gave you a schizoaffective diagnosis

Risperdal you take so a scene you don't create
And Wellbutrin lifts your mood and helps you to concentrate

But still you wonder about this dopamine stuff
Will taking Risperdal with Wellbutrin make your life rough?

You know that too much dopamine activity can be a mistake
But too little can cause your head and heart to ache

Risperdal is an antagonist at the dopamine receptor
Which basically means it slows down dopamine receptor activity. thus, making mania and psychosis better

But doesn't Wellbutrin inhibit dopamine reuptake in the brain
Which, in bipolars, can make you act insane?

Turns out that Risperdal effects dopamine receptors much more
So adding in Wellbutrin will help to even the score

Wellbutrin the side effects can ease
Caused by Risperal, no EPS, please

But keep in mind that it can also increase Risperdal levels in your blood
So add it in carefully, lest you end up speaking like Elmer Fudd

While it may sound like they don't play nice
Listen to your doctor, he's giving you good advice

Edit: Forgot to mention the norepinephrine reuptake inhibition that Wellbutrin adds to the mix
Your mood and concentration it can also help fix.


lol, yeah it makes some sense!

Was researching risperdal+welbutrin.

Still confused though, I must me a dummy.
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Also known as the crazy rapid-cycling, mixed episodes and treatment-refractory patient. Did I mention debilitating anxiety? Yeah. Doctors hate me.

Edit: my current doc disputes the above. I think, he's right. Or lamictal saved my life. Or both.

#12 Rockie

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Posted 22 April 2012 - 06:00 PM

Just wanted to add that some of the AAP's (e.g. Zyprexa, Seroquel, Geodon) also indirectly release NE and DA. This is thought to contribute to their AD effect and perhaps also with EPS.

Edited by Rockie, 22 April 2012 - 06:02 PM.

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Previous Meds
AD's: Prozac, Zoloft, Paxil, Luvox, Celexa, Cymbalta, Effexor, Lexapro, Wellbutrin, Remeron, Emsam, Imipramine, Nortriptyline,Trazodone, Viibryd, Nefazadone
AED's: Topomax, Trileptal, Klonopin, Ativan, Lamictal, Oxazepam, Triazolam
AP/AAP's: Seroquel
Other: Buspar, Ambien, Nadolol, Propranolol, Pramipexole, Hydroxyzine

"The pink ones keep you from screaming".
- Grandpa Simpson


#13 Elisabet_Fluffy

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Posted 23 October 2013 - 09:20 AM

Sorry to be reviving this old thread, but I am taking both Wellbutrin and Abilify.  I know that Abilify is a D2 antagonist, but that it also stimulates some ofthe D2 receptors a bit at the same time (Is that right?).  Does that combo mean...bad stuff?  I'm not specifically using the Abilify to augment the Wellbutrin.


Edited by Elisabet_Fluffy, 23 October 2013 - 09:21 AM.

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Non-crazy meds and supplements:  Gildess FE, loratadine, fish oil, turmeric, Vitamin D, Calcium, pantothenic acid, iron, fiber and probiotic supplements (my meds make me full of shit,) magnesium (traz gives me bruxism,) and sometimes melatonin.
 
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#14 neuropharm

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Posted 23 October 2013 - 01:31 PM

Abilify is both a dopamine antagonist and I believe a partial agonist. I think it affects dopamine differently in different areas of the brain. It's not bad, if anything it's good.
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Currently dealing with the sudden death of my psychiatrist/therapist, who was closer to me than a mother. 

current meds: sertraline 200 mg, bupropion xl 450 mg, clonazepam 3 mg, zolpidem 20 mg (that's the actual prescription from my doctor)

Dx: major depression, borderline personality

past meds: alprazolam, chlorpromazine, clonidine, desvenlafaxine, duloxetine, escitalopram, fluoxetine, gabapentin, haloperidol, hydroxyzine, lamotragine, levetiracetam, lorazepam, oxcarbazepine, paroxetine, perphenazine, pregabalin, propranolol, risperidone, thiothixene, topiramate, trazodone 

#15 GetOffMyLawn

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Posted 23 October 2013 - 02:00 PM

I'm doing BPR for mood elevation and RIS to take the edge off my panic attacks and blunt my rages


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Current Meds: Lamotrigine 300mg, Buproprion XL 450mg, Topiramate 300mg, Citalopram 40mg, Risperidone prn .25mg+ at my discretion
Past Meds: Paroxetine, Escitalopram, Sertraline
Current Non-Psych: Lovastatin, Baby Aspirin
 
 
Tomorrow and tomorrow and tomorrow
Creeps in this petty pace from day to day
Til the last syllable of recorded time.
And all our yesterdays light fools the way to dusty death.
Out, out, brief candle!
Life is but a walking shadow,
A poor player who struts and frets his hour upon the stage
Then is heard no more.
It is a tale told by an idiot,
Full of sound and fury,
Signifying nothing.


#16 Elisabet_Fluffy

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Posted 23 October 2013 - 02:55 PM

 

Abilify is both a dopamine antagonist and I believe a partial agonist. I think it affects dopamine differently in different areas of the brain. It's not bad, if anything it's good.

Is blocking the D2 in the mesolimbic pathway all that really matters for antipsychotics, then (even if it only partially blocks them)?  So as long as that's happening dopamine everywhere else is groovy?  That would make sense, now that I think of it.  Bipolar depression, negative symptoms of schizophrenia, etc. still need to be treated.  I'm taking the Abilify to stabilize my moods (they don't know what the hell is wrong with me,) but I'm on a low dose because I'm a scrawny lady and I wasn't fully up the wall or anything.  But I'm still having issues.

 

 

I'm doing BPR for mood elevation and RIS to take the edge off my panic attacks and blunt my rages

 

That is the exact reaction I'm hoping for with the Abilify and bupropion.  As well as helping me not start sobbing over random stupid shit. 


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Non-crazy meds and supplements:  Gildess FE, loratadine, fish oil, turmeric, Vitamin D, Calcium, pantothenic acid, iron, fiber and probiotic supplements (my meds make me full of shit,) magnesium (traz gives me bruxism,) and sometimes melatonin.
 
Non-crazy diagnoses:  BRCA 1 mutation, allergies, Raynaud's Syndrome (primary)

#17 neuropharm

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Posted 24 October 2013 - 07:50 AM

There are a number of pathways where dopamine is important in schizophrenia.
I haven't heard about studies of how APs effect dopamine in non-schizophrenics. The assumption is that they act in the same way, but I don't think we really know.
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Currently dealing with the sudden death of my psychiatrist/therapist, who was closer to me than a mother. 

current meds: sertraline 200 mg, bupropion xl 450 mg, clonazepam 3 mg, zolpidem 20 mg (that's the actual prescription from my doctor)

Dx: major depression, borderline personality

past meds: alprazolam, chlorpromazine, clonidine, desvenlafaxine, duloxetine, escitalopram, fluoxetine, gabapentin, haloperidol, hydroxyzine, lamotragine, levetiracetam, lorazepam, oxcarbazepine, paroxetine, perphenazine, pregabalin, propranolol, risperidone, thiothixene, topiramate, trazodone 

#18 forgetmenot

forgetmenot

    Amateur Psychopharmacologist

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Posted 24 October 2013 - 03:15 PM

The Dr. Seuss or Lil Wayne translation:

One day you were caught while in a psychosis
So your doctor gave you a schizoaffective diagnosis

Risperdal you take so a scene you don't create
And Wellbutrin lifts your mood and helps you to concentrate

But still you wonder about this dopamine stuff
Will taking Risperdal with Wellbutrin make your life rough?

You know that too much dopamine activity can be a mistake
But too little can cause your head and heart to ache

Risperdal is an antagonist at the dopamine receptor
Which basically means it slows down dopamine receptor activity. thus, making mania and psychosis better

But doesn't Wellbutrin inhibit dopamine reuptake in the brain
Which, in bipolars, can make you act insane?

Turns out that Risperdal effects dopamine receptors much more
So adding in Wellbutrin will help to even the score

Wellbutrin the side effects can ease
Caused by Risperal, no EPS, please

But keep in mind that it can also increase Risperdal levels in your blood
So add it in carefully, lest you end up speaking like Elmer Fudd

While it may sound like they don't play nice
Listen to your doctor, he's giving you good advice

Edit: Forgot to mention the norepinephrine reuptake inhibition that Wellbutrin adds to the mix
Your mood and concentration it can also help fix.

Genius..

 

I've done Abilify and Wellbutrin and Risperdal and Wellbutrin...and Haldol and Wellbutrin. Wellbutrin is my solid. Risperdal was just NOT for me. The combo of Abilify/Wellbutrin/whatever else, was great, now Haldol/Wellbutrin/Lamictal is awesome.


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current rx: wellbutrin xl 450 mg, lamictal 300 mg, Haldol 0.5 mg, Saphris 5 mg

 celexa, prozac, navane, xanax, klonopin, vistaril, effexor xr, lithium, abilify, benztropine, buspar, risperidone, trazadone, cogentin, latuda


#19 neuropharm

neuropharm

    Would-be Neurologist

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Posted 24 October 2013 - 04:38 PM

True, wellbutrin plus an AP is solid. Works for me, I just need an additional AD as well.

All the APs I've taken have been while I was on wellbutrin.

Edited by neuropharm, 24 October 2013 - 04:39 PM.

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Currently dealing with the sudden death of my psychiatrist/therapist, who was closer to me than a mother. 

current meds: sertraline 200 mg, bupropion xl 450 mg, clonazepam 3 mg, zolpidem 20 mg (that's the actual prescription from my doctor)

Dx: major depression, borderline personality

past meds: alprazolam, chlorpromazine, clonidine, desvenlafaxine, duloxetine, escitalopram, fluoxetine, gabapentin, haloperidol, hydroxyzine, lamotragine, levetiracetam, lorazepam, oxcarbazepine, paroxetine, perphenazine, pregabalin, propranolol, risperidone, thiothixene, topiramate, trazodone 



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