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Glenn Yank, MD is a Psychiatrist located in Tennessee.


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Question #1:
Do you know if Wellbutrin XL and Topamax taken together cause problems? Thank you, Anita

Answer #1:

The most likely problem that someone could encounter from taking Wellbutrin and Topamax together is significant loss of appetite, because both drugs can suppress appetite, but do so by different mechanisms.

To answer this question more fully, it would be necessary to know the specific disorders for which you are being treated. This is particularly important because Topamax is sometimes prescribed for people diagnosed with forms of Bipolar Disorder, even though there is very little evidence that Topamax is an effective mood stabilizer. Evidence for Topamax helping Bipolar Disorder is limited to one modest-sized study comparing Topamax to Wellbutrin in patients with Bipolar Depression (and who were not that severely ill), which showed that Topamax may have some benefit for this condition. However, the data on treatment of Bipolar Disorders show better demonstrated efficacy, both in the depressed phase of the illness and long-term, for several other medications, including Lamictal, Lithium, and Symbiax. If, in fact, you are being treated for Bipolar Depression with only Wellbutrin and Topamax, you should be aware that neither is protecting you from a swing into mania or hypomania.

Topamax has shown to be an effective drug for epilepsy, migraine headaches, and some forms of neuropathic pain. It may also be helpful to decrease alcohol craving and to decrease self-injury in some patients. However, it is not currently considered a first-line treatment for any psychiatric disorder.

Because of the effect of Wellbutrin to lower seizure threshold, if someone were taking Topamax for epilepsy, Wellbutrin would be considered contraindicated for that person.

Question #2:
I ‘d like to know your opinion in using Mirtazepine and Bupropion at the same time. Joaquim

Answer #2:

Mirtazepine (Remeron) and Buproprion (Wellbutrin) can be a very useful combination of antidepressants, particularly for people who have experienced sexual side effects with other types of antidepressants, can’t tolerate other antidepressants because of other side effects, or for whom other antidepressants haven’t worked. Mirtazepine and bupropion are each unique in their activities on neurotransmitters and receptors, and do not overlap each other in their mechanisms of actions. Their typical side effects are also quite different: buproprion is generally activating and tends to decrease appetite, whereas mirtazepine is often sedating and increases appetite. For these reasons, they can make an effective combination, which I have used successfully with many patients.

Question #3:
I am currently on Wellbutrin XL 300 mg a day, but it is not enough for me. I was previously on Prozac and Wellbutrin together and felt good. Then, I felt the Prozac lost its efficacy. I just stopped taking 10 mg of Lexapro. I am bipolar with anxiety and some compulsive behavior. I have been hospitalized twice for mania. Also, I am afraid of weight gain, since I am a recovering anorexic who has made friends with food but subsequently packed on pounds because my body was not used to food. Any suggestions would be welcomed. I also have Fibro and Lupus. Thanks for any help. Kathleen

Answer #3:

Based on your comment that your current dose of the antidepressant Wellbutrin is “not enough,” I will assume that your current symptoms are primarily those of depression. Wellbutrin can be dosed as high as 450 mg/day for most adults to treat depression. However, before commenting on your treatment options I would like to say again that it is critical to establish an accurate diagnosis in order to comment on treatment options. If you have been hospitalized twice for mania, then you would meet the criteria for Bipolar Disorder, Type I, and your treatment should address preventing future manic episodes and decreasing mood cycling in addition to treating depression. Just increasing the dose of Wellbutrin, if it is your only medication, would not accomplish these goals, and might increase the risk of future manic episodes. Adding to this situation that you have anxiety symptoms and “some compulsive behavior” complicates your treatment, because adding a second antidepressant that is effective for anxiety and compulsivity (e.g., a serotonin reuptake inhibitor or a serotonin-norepinephrine reuptake inhibitor) increases the risk of cycling into mania. Further, restricting your choices to agents that do not significantly increase appetite limits your choices considerably.

However, there are a few drugs that may fit this rather narrow profile (help bipolar depression, low risk of causing mania, likely to reduce risk of future mania, unlikely to cause weight gain), and these include the anticonvulsants Lamictal, Carbamazepine, and Trileptal; and the atypical antipsychotics Abilify and Geodon. Of these, Lamictal has the most data for helping Bipolar Depression, followed by carbamazepine. Unfortunately, carbamazepine has a lot of other side effects and interactions with other drugs, which can limit its usefulness, although I have prescribed it frequently over the years. Trileptal has not been studied specifically in bipolar depression, but is an effective mood stabilizer. None of these anticonvulsants will particularly help with anxiety, but may decrease impulsive (rather than compulsive) behavior. On the other hand, the atypical antipsychotics are more likely to help with anxiety, as well as preventing mania, but have not been specifically studied in bipolar depression, although there are theoretical reasons to suggest they will be helpful in this condition.

Other drugs that might be useful, but could cause some weight gain, would be Lithium, Depakote, and the atypical antipsychotics Seroquel, Risperdal, and Zyprexa. Of these drugs, Lithium has a long track record of helping bipolar depression and Seroquel has recently shown to be specifically useful in this condition. Compared to Seroquel, Zyprexa more weight gain, and Risperdal has more effect on sex hormone levels in women.

None of the foregoing comments are meant to suggest that a particular drug would or would not be of benefit to you, and whether you would tolerate it well or experience problematic side effects with it. I am just attempting to indicate how likely it is that a particular drug will be helpful for a specific disorder or have particular side effects.

Comment: Buproprion (Wellbutrin) is a useful antidepressant with unique actions among antidepressants available in the United States. It is the only antidepressant that blocks the reuptake of both dopamine and norepinephrine, making these two neurotransmitters more available. It is generally alerting rather than sedating, and has been shown to increase attention span in patients with Attention Deficit Disorder. It also usually decreases nicotine craving and has been marketed as Zyban to help people stop smoking. Its side effect profile is different than most other antidepressants: it is usually weight neutral and doesn’t cause sexual side effects, but it can cause nausea, dry mouth, insomnia, headaches, insomnia, and a “wired” or jittery feeling. It is seldom prescribed as a first antidepressant for patients who also have post traumatic stress disorder, panic attacks, or generalized anxiety disorder, because it is not effective in these conditions, whereas a variety of other antidepressants can treat depression and these anxiety disorders. Because abuse survivors often have symptoms of post traumatic stress disorder or other significant anxiety symptoms more than are accounted for by depression, buproprion is usually not the first drug that will be recommended for them. However, it may be useful in combination with other medications for people who have these anxiety disorders in addition to depression by further helping depression or attention deficit symptoms, or by counteracting the sexual side effects of other antidepressants. It should be avoided by patients who have seizures because it can make seizures worse, and is usually avoided in patients with anorexia because it can decrease appetite. The use of buproprion or other antidepressants in bipolar disorder is complicated, and I have touched on this in my answer to the first question. If you would like further information about buproprion, you can find the package insert and a patient information flyer at:

Anyone wishing to see a more detailed review of buproprion compared to other antidepressants can find one at: **pdf reader required**


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Disclaimer: The information contained here is not intended nor implied to be a substitute for professional advice relative to your specific medical or mental health condition or question. ALWAYS seek the advice of your physician or other health provider for any questions you may have regarding your medical or mental health condition. Information provided here DOES NOT constitute a doctor-patient relationship between you and the column author.

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