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Wellbutrin+Ssri=Serotonin Syndrome..?

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#1 UNS


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Posted 13 September 2012 - 12:08 AM

( first sorry for the bad english cuz im an african arabian..)
yeah i know it's weird ..
let's say that i'm asking if using wellbutrin with an SSRI increased risk of serotonin syndrome..??
when i google about SS i saw in some articles they put wellbutrin as drug that maybe cause SS
...now we all know that wellbutrin is norepinephrine-dopamine reuptake inhibitior..how can effect serotonon meds..
even mayo clinic put wellbutrin in the causes of SS

Now to my experience..
6 or7 years ago when the first time i tried Psychiatry i were in some different combos of medicines like
prozac+favrene + tofranil
if i wasn't mistaken the side effect that i had is increase appetite ..consumption..and sleepiness..
after years 2 or 3 years i lost hop in Psychiatry..but i went back 2 years ago..then it's when wellbutrin was in the market of my country..the med give me energy to certain level better than any any depressant before it if i wasn't mistaken ..i was in zoloft 50 alone for a month then i bought wellbutrin ..as i said this med gives me energy (loss of energy was from my depression symptoms so it's was a fixed medicine on my cocktails..) but it didn't help with my OCD and panic disorder so I needed serotonin to fix that..
and then that when i started to hate SSRI''s ...zolofT even 25 cause the SS prozac a couldn't tolerate any dose above 20 also it happened with any dose above 10 with lexapro....i thought that i have a sensitive to serotonin med's

the SS symptoms happened to me:
1- feeling agitated or angry
2- restless
3-some pain in the chest
4- depression became worse
5- nocturnal awaking ..

now i want to play safe..because wellbutrin is an important medicine for me and i want to be sure before stoping taking it..
dose he really effect serotonin when it used with SSRI...??
the link between wellbutrin ans SS i just knew it today in the morning and thus when i recalled my experience with it+zoloft and other SSRI medicines..

Edited by UNS, 13 September 2012 - 12:14 AM.

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#2 Finding 51

Finding 51

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Posted 13 September 2012 - 01:10 AM

I am sure someone else here with more knowledge on this will give you a better answer. I was on wellbutrin a short while and we did not get along, but in my research I read is it does increase serotonergic firing. I am not sure what that means exactly. It could mean it increases serotonin activity. Reactions to all drugs are individual, and it could be you just do not do well on ssri's. This is something you should call your doctor and tell them about. There are other non-ssri medications you can try. One I like is mirtazapine. It has quite a unique mechanism. Good luck.
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#3 CuriosityGrover


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Posted 13 September 2012 - 03:26 AM

Hopefully someone else can confirm, but from what I can gather, Wellbutrin and an SSRI ought to increase the likelihood of Serotonin Syndrome. Although I would say it would be a function of your dose of each.

The reason for this is that Serotonin syndrome can be caused by taking a stimulant (coffee, amphetamines etc) along with an SSRI. Stimulants prominent effects are the increase of norepinephrine and or dopamine. (source of all of this: Wikipedia). Wellbutrin is a reuptake inhibitor of both epinephrine and dopamine so ought to give a similar effect.

You might have to adjust your dose of Wellbutrin relative to your SSRI - either the SSRI down or Wellbutrin down.

Either that or you may need a bit of a downer to take the edge off those symptoms you listed - I know I got some mileage out of a bit of a downer when I was getting something similar from taking Effexor and having a bit too much coffee - certainly took the edge off it.
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2001-2006: Citalopram 20mg
2007-2009: Effexor XR 150mg

2010-2012: generally no medication apart from:
2010: Escitalopram 10mg for >=12weeks - no response
2011: Megavitamins (Pfieffer treatment) - no response
2012: Mirtazapine 15mg-30mg for >60 days - some response
Seroquel 100mg 8 days - no response
Effexor XR 75mg + Mirtazapine 15mg for 22 days - nothing of note.
Citalopram 10mg-40mg over 75 days - no response.
Bupropion SR 150mg 24/11 -> 300mg 6/12 -> 450mg 18/12->22/12 300mg

#4 Velthir


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Posted 13 September 2012 - 07:10 AM

Those 5 symptoms can't possibly conclusively diagnose serotonin syndrome, statiscially they're incredibly more likely to be just a bad reaction to antidepressants and/or your depression turning into more agitated depression. Antidepressants for me always end up increasing depression, causing agitation/restlessness, and messing with my sleep.

Especially unlikely that bupropion and a small dose of an SSRI would cause you problems when you were previously on med combos with incredible serotonin action vs bupropion (which probably has no/little clinically significant serotonin action) and low dose SSRIs.

Trying to self diagnose serotonin syndrome on one report that isn't very useful (starting both meds at the same time it could've even just been the sertraline alone) isn't a good idea.

Edited by Velthir, 13 September 2012 - 07:14 AM.

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Dx: Dysthymia, recurrent treatment resistant depression, Bipolar  II/III (antidepressant induced mixed states/hypomania)
Daily Rx: 400 mg lamotrigine, 800 mg carbamazepine (Tegretol XR), selegiline 5mg
Failed meds: Citalopram (Celexa), agomelatine (Valdoxan), lofepramine, mirtazapine (Remeron), sertraline (Zoloft), quetiapine (Seroquel), trimipramine (Surmontil)
Partial-success: bupropion (Wellbutrin),nortriptyline, moclobemide, aripiprazole (Abilify), reboxetine

#5 Demento


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Posted 13 September 2012 - 09:35 AM

True serotonin syndrome is relatively rare and is unlikely from an SSRI + Wellbutrin. If you were taking an SSRI with an MAOI, well, that's a different story.

The symptoms that you described look a lot like the symptoms that I have when I first start taking an antidepressant, that is to say, typical known side effects of antidepressants. Remember that serotonin syndrome is a medical emergency that can be fatal and must be distinguished from typical antidepressant side effects.

Edited by Demento, 13 September 2012 - 09:43 AM.

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#6 jpcwon


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Posted 13 September 2012 - 12:00 PM

The thing is, Wellbutrin doesn't work on Serotonin; instead it works on Norepinephrine and Dopamine. So I wouldn't worry too much about it causing Ser. Syndrome as it doesn't directly manipulate Serotonin like an SSRI does.

I am currently on 150mg Effexor (an SNRI) and 300mg Wellbutrin XL together (AND Remeron) and have never had a problem with Serotonin Syndrome.

Edited by jpcwon, 13 September 2012 - 12:01 PM.

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"Just because the monkey's off your back does not mean that the circus has left town!" -George Carlin

-Past meds: Prozac, Paxil (made me suicidal!), Zoloft, Celexa, Lexapro (twice), Wellbutrin (twice), Zyprexa, Seroquel, Trazadone, Lamictal, Trileptal, Neurontin, Propranolol, Adderall, Dexidrine, Methadone, Every Benzo In The Book...

#7 notfred


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Posted 13 September 2012 - 12:28 PM

You lack 2-3 signs, sweating, fever and changed deep tendon reflexes and other rexlexes . Plus Welly can't cause Syndrome.

You need one from each category:

Cognitive effects: headache, agitation, hypomania, mental confusion, hallucinations, coma
Autonomic effects: shivering, sweating, hyperthermia, hypertension, tachycardia, nausea, diarrhea.
Somatic effects: myoclonus (muscle twitching), hyperreflexia (manifested by clonus), tremor.

The expert on SS, Dr Ken Gilman, is here:

Edited by notfred, 13 September 2012 - 12:41 PM.

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I am in full remission (DSM IV 296.36) from Depression. Insomnia, ADHD-PI, Epilepsy, and the Pseudoparkinsonian tremor are well controlled.


Psyc Meds: Forfivo XL 450 mg (Wellbutrin XL), Aripiprazole 15 mg (Abilify), Eszopiclone 6 mg (Lunesta), Belsomra 20 mg (Suvorexant), Vyvanse 70 mg (Lisdexamfetamine), Levetiracetam 2,000 mg (Keppra), Propranolol ER 60 mg (Inderal), Clonazepam 1 mg (Klonopin),
PRN: Lorazepam 1-4 mg (Ativan), Alprazolam 1-2 mg (Xanax), Dextroamphetamine 10-40 mg (Dexedrine), Propranolol 20-40 mg (Inderal), Ondansetron 8-16 mg (Zofran)

Supps: Multi-vitamin/mineral, Vitamin D-3 2,000 IU, Omega-3-acid ethyl esters 4 g (Lovaza), Hemp seed oil 2 g (ALA), CoQ10 100 mg, L-Glutathione 200 mg, Iron 65 mg (Ferrous Sulfide)

Dx: Depression, Insomnia, ADHD-PI, Temporal Lobe Epilepsy, Dyspraxia, Tremor, Iron and Vitamin D deficient 

I also take allergy and diabetes + it's complications meds, Truvada

All doses are a daily total.

#8 Artemisia


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Posted 13 September 2012 - 01:28 PM

While possibly theoretically possible, serotonin syndrome from combining Wellbutrin with an SSRI is very unlikely. It gets prescribed to augment SSRI meds all the time. Care should be taken when prescribing Wellbutrin with Zoloft (sertraline), though, because the concentration of Zoloft will increase due to a liver enzyme interaction.

Edited by Artemisia, 13 September 2012 - 01:28 PM.

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Current meds: sertraline 100mg, cetirizine 5mg, zolpidem 2.5 mg

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