Q:  Worse on Wellbutrin

I have been on Trileptal since August.  The side effect profile is excellent and it seemed to have a calming affect. This fall I got very depressed again. AFter going up on my Trileptal my pdoc and I decided to cautiously add Wellbutrin since I"ve had bad affects from the SSRI meds.  I did very well the first two weeks. It calmed me down.But now I'm more depressed and have extreme dark moods with suicidal thoughts. They change very rapidily. What is going on?  I'm afraid to tell my doctor. I don't want to get put away.  I want to find an antidepressent that works.  

Sharon


Dear Sharon -- 
That could have been the very thing that makes me so reluctant to use antidepressants in anybody with bipolar disorder: they make the depression better but the make the "big picture" worse: in not too long, you begin to see "rapid cycling" and "mixed states".  Your "extreme dark moods and suicidal thoughts" could be that.  

Of course I can't make a certain diagnosis here on this much info'.  You should definitely tell your doc' and look for another way to address the depression.  Usually when this kind of thing happens, in retrospect we can see that the depression was not "pure", but had mixed state elements: insomnia, irritability, agitation, difficulty concentrating.  If that's the case, I avoid antidepressants and look for more mood stablilizer -- either increasing one or adding another.  Check out some recent experience with thyroid hormone for that role.  

In any case, do tell your doctor, as you'll need to change what you're doing (as you've already figured out...).  I hope you find something more satisfactory soon.

Dr. Phelps

Published November, 2001