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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Have Anxiety, Depression, PTSD. Taken Effexor, Wellbutrin, Escitalopram. Lower Dosage?

Tried talk therapy in 2007, which gave me tools to calm down, but never relieved my actual anxiety/depression/ptsd. I'm 23 years old, female, was hospitalized for depression/anxiety and attempts at suicide. I was put on Effexor XR 150mg/ day in February 2010. Wellbutrin was added six months later in August 2010. This helped a lot, I felt great for awhile. I began to develop vivid dreams and a lot of stomach aches and headaches, so I stopped the Effexor XR a month ago. The dosage for each when I stopped was 150mg/day Wellbutrin, and 75mg/day Effexor XR. I completely stopped and replaced with Escitalopram (20mg) at this point. The physical side effects from the Effexor XR went away quickly, and I was okay for a few weeks, but I'm getting crazier dreams and way more anxiety/depression now, seven weeks in. I would like to stay on the Wellbutrin, I respond well to it, I think. But I haven't had anxiety like this for years. I don't know if I should switch or lower the dosage?
Fri, 6 Sep 2013
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Psychiatrist 's  Response
thank you for your query. From your history, it appears that you were best on wellbutrin 150mg/day. it however, is unclear if you stopped the medications by yourself or on some expert advice. If after 7 weeks of treatment with escitalopram you are still not much improved, I really doubt how far it will be effective for you. Moreover, the dreams and anxiety, depression appears to be related to your primary disease condition, rather than the side effects of medications.
i would advice you to consult your psychiatrist for adequate and appropriate titration of your medications as soon as possible. if a patient would have come to me with your symptoms, i would have tapered off and stopped escitalopram over a few weeks, while gradually building the dose of wellbutrin (bupropion, an antidepressant) to 150 mg, may be upto 225 or 300 mg per day, while observing for responses and side effects. I would also have prescribed some mild sedatives (like clonazepam ) for relief of your anxiety symptoms along with continuing you on the psychotherapy (talk therapy).
Hope i've been able to satisfy your query. please feel free to contact me for any further clarifications. best of luck.
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Have Anxiety, Depression, PTSD. Taken Effexor, Wellbutrin, Escitalopram. Lower Dosage?

thank you for your query. From your history, it appears that you were best on wellbutrin 150mg/day. it however, is unclear if you stopped the medications by yourself or on some expert advice. If after 7 weeks of treatment with escitalopram you are still not much improved, I really doubt how far it will be effective for you. Moreover, the dreams and anxiety, depression appears to be related to your primary disease condition, rather than the side effects of medications. i would advice you to consult your psychiatrist for adequate and appropriate titration of your medications as soon as possible. if a patient would have come to me with your symptoms, i would have tapered off and stopped escitalopram over a few weeks, while gradually building the dose of wellbutrin (bupropion, an antidepressant) to 150 mg, may be upto 225 or 300 mg per day, while observing for responses and side effects. I would also have prescribed some mild sedatives (like clonazepam ) for relief of your anxiety symptoms along with continuing you on the psychotherapy (talk therapy). Hope i ve been able to satisfy your query. please feel free to contact me for any further clarifications. best of luck.