Posted by michael on February 15, 2007, at 9:54:26
In reply to Re: Abilify + Wellbutrin Combo?, posted by med_empowered on February 15, 2007, at 4:26:55
Hi-
Thanks for the reply. No, no Psychosis. I've been trying cymbalta, parnate, and a couple of tca's over the last 18 months or so... Now I'm going back to wellbutrin, which seems to be the best "base" antidepressant for me - keeps me from smoking too. (tried ssri's & effexor in the past too)
I had added sulpiride (50-150mg) and found that to be somewhat helpful - lifted my mood a bit, whereas the wellbutrin does more for energy & cognition, and generally feeling kind of flu-ish. (actually my basic combo was wellbutrin & dexedrine - I had added the sulpiride to those two) My dx is dysthymia.
Sulpiride's not FDA apporved, so my current pdoc doesn't feel comfortable with my using it (I had purchased it from Canada). Scott here at PB (a.k.a. SLS) had suggested that I might find abilify useful... and my pdoc thought that it might be worth a try, since another antipsychotic (sulpiride) had been helpful to me.
I am hopeful that it targets receptors that will be helpful for me (i.e.: I think it's a partial agonist at D2 & 5HT1a receptors, and I think an antagonist at 5HT2a receptors)
So, I'm kind of hoping that the abilify might be able to replace the stimulant in my cocktail. If it doesn't work out that way, I guess I go back to Dexedrine or Ritalin...
I found one or two posts here that mentioned both wellbutrin & abilify. However, they seemed to be taking regular doses of both, which I think might be why they didn't seem to like the combo.
I just looked up wellbutrin & abilify at rxlist.com, and found the following:
For Abilify:
-Both CYP3A4 and CYP2D6 are responsible for aripiprazole metabolism. Agents that induce CYP3A4 (eg, carbamazepine) could cause an increase in aripiprazole clearance and lower blood levels. Inhibitors of CYP3A4 (eg, ketoconazole) or CYP2D6 (eg, quinidine, fluoxetine, or paroxetine) can inhibit aripiprazole elimination and cause increased blood levels.For Wellbutrin:
-Drugs Metabolized by Cytochrome P450IID6 (CYP2D6): Many drugs, including most antidepressants (SSRIs, many tricyclics), beta-blockers, antiarrhythmics, and antipsychotics are metabolized by the CYP2D6 isoenzyme. Although bupropion is not metabolized by this isoenzyme, bupropion and hydroxybupropion are inhibitors of the CYP2D6 isoenzyme in vitro.-Therefore, co-administration of bupropion with drugs that are metabolized by CYP2D6 isoenzyme including certain antidepressants (e.g., nortriptyline, imipramine, desipramine, paroxetine, fluoxetine, sertraline), antipsychotics (e.g., haloperidol, risperidone, thioridazine), beta-blockers (e.g., metoprolol), and Type 1C antiarrhythmics (e.g., propafenone, flecainide), should be approached with caution and should be initiated at the lower end of the dose range of the concomitant medication.
That's what I was trying to get at in my first post, when I referred to how they're metabolized... And wondering if anyone else had tried this combo out yet.I have 5mg tablets, but the plan at the moment is to use a pill cutter so that my starting dose will be just 2.5 mg. I expect to go up to 300 mg wellbutrin XL.
...so, I'll definitely be going with the "start low, go slow" approach with the abilify, as you suggested.
I was just hoping that there might be some others out there who have either already tried this, or might be able to tell me if I'm doing something that's riskier than I think it is...
In any case, that's the longer version of my first post in this thread...
Anyone have any comments/thoughts, now that I've rambled on... and on...
Thanks for any feedback.
michael
> hey! I personally couldn't find any info on dosage adjustments. Are you experiencing psychosis? The combo could be really effective--reboxetine, for instance, helps negative symptoms when combined w/ neuroleptics. Even if there isn't an interaction, you might need less Abilify since Wellbutrin reduces dopamine release. You might just want to try the "start low, go slow" approach and see what happens...I think there's a 2mgs Abilify pill out now, and it goes up to 30mgs/day, so you have lots of room for adjustments.
poster:michael
thread:732999
URL: http://www.dr-bob.org/babble/20070213/msgs/733027.html