Originally Posted by Guide 4 Dummies
If you picked SNRI, then which one?
If you picked 'SSRI + Wellbutrin', then which SSRI?
My Pdoc gave me these options and I don't know which to pick. My biggest enemy is fatigue, and I heard that Cymbalta causes fatigue. Effexor XR is an interesting option.
If you were me what would you pick?
if fatigue is your problem, then SSRI+Wellbutrin is a more reliable and predictable combo. Wellbutrin has predictable stimulating and antidepressant effects in many people....but SNRIs can vary greatly in their effects. Effexor made me tired, really tired. It was more stimulating than SSRIs (by themselves). Effexor and Cymbalta do have weak effects on dopamine, and strong effects on norepinephrine....but these are sometimes not enough to offset the fatigue caused by the SRI properties of both medications. I noticed very strong pro-Dopaminergic effects from Wellbutrin, this may have been augmented by the fact that Zoloft (which i was also taking) is a DRI* (dopamine reuptake inhibitor).
if i had to choose, id go with Zoloft and Wellbutrin (this combo may be more stimulating, and can have stronger effects on both Serotonin and Dopamine, as compared to an SNRI, which would be more selectively serotonergic and sedating.)
*Zoloft is an SSRI, but it also has significant DRI properties, which may positively effect its overall efficacy as an antidepressant
**some SSRIs, including Zoloft, inhibit the metabolism of Wellbutrin, leading to increased effects from Wellbutrin--this can be either a good or bad thing, (very stimulating, ....but can cause more anxiety and insomnia.)