My anxiety disorder is now under control with neurontin. Sadly my depression has not lifted with the lexapro 20mg.

That makes perfect sense - I completely understand your concern with beginning an SNRI because of the Wellbutrin. It's a valid concern. Though I've seen many patients do horribly on Wellbutrin, but do fine on an SNRI. In my experience, Wellbutrin is much worse for anxiety (it can cause bad jitters/trembling, etc; I rarely see that with an SNRI). However, there's no way to know how you'll react without a trial, unfortunately. Though I'm hopeful that an SNRI will be better because of the Serotonin effects (which should mellow the Norepinephrine effect a bit). And, Lexapro is routinely used at 30mg/day, though some docs won't prescribe a higher dose.

That said, I wonder if you'd qualify for Celexa? It's another formulation of the same drug that's in Lexapro and works better for some people. And, Viibryd is an interesting possibility too. I have less experience with it, but it appears promising because it blockades the serotonin into the synapse and is a partial agonist (stimulating agent) for serotonin as well. It also doesn't tend to suppress the norepinephrine like some SSRIs can...

Overall, I'd listen to your feelings on this. If you're worried about an SNRI, try exploring other options first. If you try another SSRI, or the Viibryd, if they don't work, you don't need to taper down (at least not much, in the case of Viibryd) to switch. On an SNRI, you will need to taper gradually in order to avoid the side effects. So, it might be worth exploring the others before going to something you can't easily walk away from, if that makes sense.

Another benefit to the Viibryd is that you know it worked for you and it doesn't come in time-released dosages (yet). So, you could potentially cut a pill in half to extend your prescription (with your doc's consent) if you find that a smaller dose is effective for you (which, if you're sensitive to medications, it might be!). If you could get by with 5mg a day by cutting the pills in half, it would cut the cost substantially!

Lexapro has no impact on Norepinephrine as it is only affects the Serotonin receptors. Viibryd has a small effect on Norepinephrine, but it is negligible at best. If you want to stay on the Neurontin (Gabapentin) you can, as it is not an addictive medication, and try the Prozac, Viibryd, or Lamictal for your depression. Or if you really want to try the Pristiq, or if it is pushed to you by your medical team, I would recommend holding at only 50mg/day for your depression and continuing with the Neurontin to manage your anxiety, and any increase in anxiety from the Pristiq. I know this is definitely a struggle for you and there are not many other options in terms of medications. Another thing I want to mention outside of the medications is the use of Transcranial Magnetic Stimulation (TMS); this is used to treat resistant cases of depression and anxiety where they do not respond well to medication or multiple medications have been tried without success. Also TMS has been shown in pilot studies to treat chronic pain as well, so this may be an option for you. Treatment with TMS is usually expensive, but if you can show to your insurance that it may be cheaper to use a few weeks of TMS instead of long-term medication changes and doctor visits, the insurance may cover a significant portion of it.

Please let me know if you have any questions or concerns as I am happy to assist and support you regarding this issue.

Neurontin would not have caused this all of a sudden nor interacted with your Lexapro to cause this as Neurontin is primarily used to treat neuropathic pain, so it actually may prevent muscle aches or at least lessen them to a degree. Lexapro on the other hand can cause muscle aches as a side effect, but because you have only been using the medication for 5 weeks there is a chance by the 8th week the muscle aches would disappear as your body adapts to the medication...this is called an initial adverse effect and usually are temporary in the first few weeks of any psychotropic medication as your body adapts to said medication. So there is a chance if you continue with the Lexapro these muscle aches will go away, but of course I cannot be certain of that as I cannot predict the future.

900mg to 1800mg/day is considered in the moderate to moderate-high range for Neurontin so yes your doctor can increase the dose if he/she and you feel that it is necessary. As of right now you are in the moderate-low range so there is no harm in increasing the dose.

You are most welcome. I wish you all the best and I hope your depression and anxiety lessens very soon for you.

The cross tapering you described appears to be appropriate as it does not appear to be rushed and the Neurontin helps to lessen any SSRI withdrawal symptoms too. Perhaps you were just very sensitive to the medication and your cross tapering plan should have been more gradual, but there was no way to predict that beforehand.

Also Viibryd is so far only approved for treating depressive symptoms. Its use of treating anxiety has had mixed results so that could also be a reason why your anxiety is bad today.

You may need the augmentation again if it helped before.

I think that would be best. I wish you all the best and I hope your anxiety lessens very soon.

Typically 100-400mg is considered a therapeutic dose, but it varies from person to person and how you respond.