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Susan Ivy
Susan Ivy, Nurse (RN)
Category: Health
Satisfied Customers: 4058
Experience:  BSN, MSN, CNS
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I have major depressive disorder. I was originally put on

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I have major depressive disorder. I was originally put on venlafaxine (effexor) and it was helpful but it made me too tired and caused a decrease in libido. I am now on Bupropion (Wellbutrin) which has also been helpful and keeping me awake through the day. I feel like these two together in a combination therapy would offer a more complete resolution to my disorder, as well as possibly cancelling out the fatigue brought on by the velafaxine.
Is this a safe combination?
Is there any way to have a prescription like this changed by calling a doctor or going with an online pharmacy? I have no time to take off work and I work during normal business hours.

I am a psychiatric nurse and am very familiar with these medications and their use.

Typically, they are not used together... there are several reasons for this.

I am wondering how long you were on the Venlafaxine? This is actually one of the most 'stimulating' antidepressants, other than Wellbutrin. ( The problem with Wellbutrin is that it does not treat the anxiety and nervousness that often come along with depression very well.) With Venlafaxine, which is an antidepressant that works on two neuro transmitters that are often low in depression, it must be taken for a period of at least 3 months to get an idea of the true effects that you will have long term (this is really true with all antidepressants. You may be able to see an effect pretty quickly .. but these drugs actually change the structure of the brain -- causing growth in certain areas of the brain - so the true long term effect may take much longer to be complete). Also, if it was making you drowsy after you took it, for example, it might have been that you could have tried taking it at a different time... so that the period of drowsiness corresponded with the time you needed to be sleeping anyway... (individuals are effected differently by these medications to a certain degree... some people find it stimulating, with an after effect of drowsiness, some find it causes drowsiness, then stimulation) But, importantly, in either case the side effects, such as drowsiness, over time tend to decrease (the side effects are always more obvious in the beginning of initiating treatment, and sometimes completely go away over time)

Although I understand about the hassle of getting into a doctor it really sounds like you need to be seeing a psychiatrist on a monthly basis in order to find the best combination or therapy for you. Depression can be quite complicated to treat since it does not respond to medications in the same way in each individual. Some people need a mood stabilizer along with the antidepressant. In rare cases a single action antidepressant might be prescribed along with Wellbutrin, such as Paxil or Zoloft... but even if this were done, then there would need to be close monitoring of your response... there are potential side effects from combining different classes of antidepressants -- and they are not necessarily something that the individual taking them will notice (seretonin syndrome is one, induction of mania is another, suicidal ideation another)

Besides the fact that monitoring is needed when prescribing these powerful mood altering medications, especially in combination... at least in the beginning.. then it is possible of course to decrease monitoring visits, they can't be prescribed over the phone or internet safely. Most doctors simply will not prescribe without meeting the patient (there are things that cannot be assessed over the phone such as certain physical symptoms) and because of this, a doctor could lose their license if they prescribe without thouroughly assessing and monitoring their patient.

We have a new rating system at JustAnswer that I'd like to explain to you being that you appear to be a new user of the site. When I send you this answer you will then be asked to rate my service. Please postpone rating my service until we are finished (in other words, if you have any questions what so every, please hit the reply button so that I can answer them fully) I am doing my best to provide you information that is accurate and honest here, but probably not want you had hoped to hear. I hope that you will be considerate and not rate my service poorly because of me being a 'messenger of bad news". (This reflects poorly on my status as an expert if I get a bad rating.) So again... if you still have questions or need clarification about anything please reply first, so that I can respond to you and further answer any questions you might have.
Customer: replied 4 years ago.

Don't worry for a depressed person I take bad news fairly well I am interested in the combination therapy mainly because both my dopamine and seretonin levels were both messed up by past drug use. Inhibiting the reuptake of one or the other is good but feels incomplete. I will definately try to get the time to see a doctor as soon as possible. I'm not sure if you can answer this because I assume you're not local to my location in Az...but do you know of any clinics or facilites that can see people on weekends or evenings?

Thank you for being understanding!

Sometimes you can find psychiatrist that will see you in the evenings or weekends. Typically younger ones that are just starting out and that don't have a large patient base yet. If you live in a city with a medical school and a department of psychiatry, that may be a good place to look for a doctor with flexible hours. If you want to give me your city, I could probably provide you with some numbers to try.
Customer: replied 4 years ago.

That would be awesome :) I'm in Gilbert, Arizona. Also, I have one question on Zoloft. I have heard that many SSRI antidepressants contain fluoride or fluorine. I try to avoid too much fluoride (weird tick for someone of my background) lol But I think I have heard that Zoloft does not contain any. If you're able to confirm that I'd appreciate it. That's all the questions, I promise!

Not a problem. I have not heard that Zoloft contains any type of fluoride, but I will be happy to check it out. I will also get you some Psychiatrist numbers. I'll get back with you later today if that is ok? I have to be away from the computer for just a bit, but I will def. be back and want to take time to get you the good information you deserve. (You don't need to reply to me now, if you are ok with waiting a few hours for the details.)
Hi, and thank you for your patience!

I looked up and read about the issue with Fluoride in antidepressants. It seems there is a lot of misinformation on the internet about this topic (this is pretty common with a lot of medical issues, one reason that it is better to go through a professional with training in the particular area.... otherwise you can scare yourself to death.) Awareness is good, but always check for references, and who/what the information is coming from. In the case of Zoloft, it has no relation to Fluoride. Here is Sertraline's chemical name:


It seems that some people think that Prozac contains Fluoride. It has a fluoride molecule combined with another molecule:


but the fluoride does not become available when you take it. And if it did (it doesn't ) it would not be in an amount beyond what is in the natural environment (not even as much as what is put in water in some areas) But again, the fluoride molecule does not become 'free' even in Prozac and isn't even part of sertraline (Zoloft) at all.

I found some contacts for you to hopefully find a flexible doctor. It might take a couple of phone calls, but it will be worth it in the long run:

The University of Arizona in Tuscon has a Medical school with a Psychiatry department. On their web page they have also a phone number listed for appointments. I realize that it appears that doctors affiliated with this school may be too far away from you, but you could still call in case some of the doctors that are doing their residency (see patients) closer to you or they might be able to refer you doctors who have finished residency in the last few years that are in a location more convenient. Residents/interns have completed medical school, and some clinical and theoretical studies in psychiatry and see patients but are supervised by another psychiatrist – this is actually a good thing – they will be up to date on the most current treatments, plus are being monitored and they discuss their cases, esp. difficult cases and get input from several doctors).

Next, I found the psychiatry department of St. Josephs Hospital which is in Phoenix, AZ and it is University based, so this may be better for you as far as location and getting a doctor to see you that is flexible and up to date on treatments for depression. They have pics of the docs, and they all look young. (of course not all older docs are bad... but at least at a university based center you will know that they are up to date on things:

Also, here is a link to just a general list of Psychiatrist near Gilbert, AZ. I know nothing about these doctors, but most have their years of experience and a few other details. If the above doesn't work out to be convenient, you could use this list to call some doctors in your area to see if you can find one with flexible hours that will work with you.

When you call, just mention what you told us, that you are working, so they will understand that you are trying to keep your job while getting help for your depression and need someone that can see you after hours or on weekends. I think they will have compassion with the fact that you are trying to maintain your ability to function. But don't give up if your first few calls don't result in what you need.

I hope to hear from you that this works out. You can find my profile by clicking on my name in this question to request me anytime (or you can put "for Susan Ivy" in the title of a new post if you would like to update or ask anything of me in the future.). this way no one else will answer it but me. And of course, you can ask questions of other experts too if you would like.

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