Expert: Ivan Goldberg, M.D. - 3/10/2009

Question
Good day,
I am a 34yr old women who was diagnosed with Depression 8yrs ago and started taking Zoloft, eventually tapering out at 150mgs. I moved from AZ to OH in 2005 and my episodes increased and became more intense so I started seeing a new Dr. who diagnosed me as BP; he decreased my Zoloft to 100mg and added Lamictal 100mg, Zyprexa 5mg and Remeron 30mg. After about 2 weeks of this treatment I became irritable, VICIOUS, homicidal and anti-social; as a result I stopped taking everything except the Zoloft (which I knew was beneficial). I did okay for a couple of years and had a MAJOR break in late 2008 and started seeing a new Dr. I am happy thus far with my new treatment of Lamictal 100mgs and Lexapro 10mg; with the exception of still "not feeling quite right". After discussing this with my Dr. he added Welbutrin 150mg to my treatment (long story, but I had tried Welbutrin before and it did not work well for me), I explained to him that I did not like Welbutrin but he put me on it anyway. After a few weeks on the Welbutrin my menstrual cycle became erratic and I started bleeding sooner, longer, and heavier; as well as a huge increase in my irritability (bordering on homicidal) and I was becoming disoriented (example: I would find myself putting the milk away in the pantry instead of the fridge or I would end up in a room and not remember how I had gotten there or why I had gone there in the first place). When I told my Dr. of these changes and of my concerns, he said that the Welbutrin would not cause these events, however I took myself off the Welbutrin and my confusion and irritability returned to "normal"; I told my Dr. on my next visit. I suggested that if he thought I needed to be on something in addition to the Lexapro and Lamictal that the Zoloft had worked wonders for me for several years. He said that I could not take Zoloft in combination with the Lexapro and Lamictal because of some drug interaction. Since he was not honest with me or not educated on the whole Welbutrin side effects, I just wanted to confirm that this information is accurate; Can I actually take Zoloft with a combination of Lexapro and Lamictal? And if not, are there any other drugs that have been used in combination with them that have had good results? I am still "not quite right" and feel I need additional help.
Thank you for your time, have a lovely day.

Answer
Hi Louise . . .

While I cannot give you personal advice I can talk about people with a story such as yours.

Wellbutrin often causes peculiar experiences including confusion and memory problems. People who become irritable, and angry when taking antidepressants, most always have some form of bipolar disorder.

People with bipolar disorder often feel the best on a combination of an antidepressant and a mood stabilizer. When lecturing I often say "M&Ms are great but L&L is better" L&L refers to the combination of lithium and Lamictal . . . the best combination in my experience for people with bipolar disorder.

Best regards . . .

Ivan
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