Expert: Dr Alan Galbraith - 10/2/2006

Question
You did not provide an answer to my question and you did not previously respond, as this is the first time I have used this service.
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Followup To

Question -
I have a longstanding history of lowgrade depression and anxiety, peaking during PMS times. (Maternal family hx of this...we're all on Zoloft...I think we may have seratonin deficiency syndrome although we've never been officially tested)

I've been taking Zoloft 50 mg for 5 years & recently went into my PMD because of feeling "snappier", overwhelmed/stressed by my responsibilities at home and work & fatigue. (My mind races and I have a hard time prioritizing tasks.) My labs were normal & my PMD decided to have me stop Zoloft and try Lexapro.  Lexapro made my sxs worse so I went back in and she put me back on Zoloft 50 mg and recommended I start Wellbutrin 150 mg. She thought that once my depression is under control, sxs of "hypomania" surface and the Wellbutrin will help those sxs.  

I'm nervous about taking 2 drugs and am considering asking her if I could simply increase my Zoloft to 75 mg to see if it helps before adding a drug.  I don't know a lot about Wellbutrin.

My question is:  what symptoms is Zoloft best for and what symptoms is Wellbutrin best for?  Is the combination okay or is there high risk for me to feel like a "zombie"?  Is it reasonable to try and increase Zoloft first or will that not really impact my symptoms?

Thank you for your time.

Answer -
Dear Jennifer

Answer
Dear Jennifer

I do not know what happened but here is my answer as written on 1st October, but spelling now corrected. I keep a record of all my answers as Word Docs hence the corrections.

Regards

Alan Galbraith

Dear Jennifer

I would be inclined to increase the dose of the Zoloft first, I always think that one
drug for the same thing is often (but not always) better than two. You would have to discuss
this with your doctor or only a psychiatrist can decide on this. .

However, I am a great believer in the use of the old fashioned antidepressants such as
the tricyclics or MAOIs, although they can have more problems in their use, especially
the latter, they still have an important place in the treatment of depression. I would
discuss your problems and concerns with a psychiatrist, an older one as they will be more
familiar with the use of the older antidepressants. The younger ones have been brought up
on
a diet of SSRIs etc and tend to dismiss the older ones as being to problematic. Try to
convince him/her to try a non-sedating tricyclic or a more stimulating MOAI and see how
you
get on. I may sound a bit cynical but I can assure I am not just realistic and I still
see the older types being used very successfully in Australia.

Regards

Dr Alan Galbraith