Problems with Trintellix added to 150mg Wellbutrin treatment for Depression- HELP

I have been medicated for 10 years plus for major depression, which has been present since early adolescence. Now 32, I have had both great success and frustration at various points trying to shuffle my medication. Citalopram was my first med, and it never worked terribly well even at max dosage. I was quickly changed to Effexor and this pretty much changed my life almost overnight. I remained on effexor for 8 years, only sometimes upping and decreasing my dosage. about two years ago it...very quickly stopped working. I remember weaning off of it to a lower dose years before and it was certainly no walk in the park

Fast forward to earlier this year. My psychiatrist had added 150mg Welbutrin to my now maximum ever effexor dose at 225mg. Little seemed to change, I never had significant side effects from either med...but no change after months. I suggested to my shrink that after 8 plus years of continuous treatment with Effexor, I felt it wasn't doing anything anymore. He discouraged me from weaning myself off, all the while suggesting a third medication: Trintellix. He said it would help me with my focus, motivation and concentration (I am in graduate school) which have been serious issues.

I was prescribed 5mg to increase to 10.I kept waiting for a benefit. My sleep deteriorated rapidly and has not recovered after 8 months. I became restless, irritable, sporadic and sudden vomiting (very unusual for me), upset stomach, poor appetite, and often feel kind of out of it and on edge at the same time. My concentration has deteriorated, along with my motivation, and my physical symptoms of depression are perhaps worse now. After 6 months of treatment I learned that Wellbutrin can have a magnifying effect on Trintellix, and that any combo of the two should be supervised very closely by a psychiatrist. Not only did this not happen, but when I started to have suicidal thoughts in a big way a month ago, and called my shrink, I was informed that he could not longer see me due to change in the focus/nature of his practice to a short term model of care. This is completely unethical...no notice, no concern for transfer of care, no referral etc. I have spoken with several pharmacists and my doctor who have advised I taper off immediately.

I guess I am wondering if anyone has had similar experiences of Effexor working so well, until it doesn't, and then trying to find the right meds or med combos to fill in what worked for so long. I obviously need a better psychiatrist, but in the meantime I really would appreciate hearing any SUCCESS stories following Effexor becoming ineffective. I don't know where to turn but find hearing the specifics of what works for others very helpful.

I also know Trintellix is quite new, and docs are prescribing it to folks on Wellbutrin quite irresponsibly without explaining the dangers of interactions between the drugs. I have been on 10mg of Trintellix per day...but my blood levels of Trintellix are actually more in the realm of what would be expected of a dose that is double or tripple this amount,...in short, there is a "therapeutic window" for dosage of meds, and blood concentration is a related metric...I was prescribed a standard dose of Trintellix...but it makes complete sense I've been experiencing nothing but side effects because this dose is retained in my blood at concentrations that far exceed standard or "therapeutic" dosing. All drugs have a therapeutic window...if used above or below in dosage they are by definition counter-therapeutic.

FYI, no need to worry about suicide risk for me. I just had a lot of distressing intrusive thoughts for many weeks...came out hte other side and weaning off Trintellix has made these rapidly dissipate. I frankly am angry wiht my shrink for being so irresponsible as to prescribe me a combo of meds that is counter-indictated and poorly understood...and when I try to see him again about it, I am informed I'm no longer a patient. This is ethically so unacceptable. If others find themselves in this position I would encourage you to familiarize with the ethical guidelines around termination of care relative to the appropriate medical licensing body in your state or province...there are basic, minimum standards for termination of care and they are there with good reason, to prevent docs causing harm to folks because they are ethically lazy or incompetent.

Please BEWARE being prescribed poly drug therapy that includes these two medications because we know enough to know they really shouldn't be used together. It is right in the Trintellix instructions in each box. Trintellix has been marketed quite aggressively to psychiatrists as a way to improve concentration and focus in particular...that isn't a reason to prescribe it so recklessly...its being marketed as such and that's exactly why I was given it, even thought I was requesting an evaluation for ADHD.

As someone training in the mental health field...I encourage ALL folks to consult with a trusted pharmacists with every medication change. Many psychiatrists (especially older generation ones) don't have half the knowledge of the new meds in particular that many decent pharmacists do.

ANY help, sharing of stories, welcome. ESPECIALLY in terms of meds that may or tend to make an appropriate replacement for Effexor when it has worked so well in the past. After getting on effexor...I became functional for the first time in years. I was able to go back to school while working full time, and then started graduate school...somewhere in grad school Effexor just stopped working and I miss having energy, being able to actually live my life like I did before.

Many thanks for reading and any responses to come.

Thanks for the reply RobLee. I was in early recovery from addiction when I was first put on Celexa 11 years ago...I have been continuously medicated with antidepressants since. I have a history of what I will call "active" and also "resolved" PTSD, and have personally found EMDR treatment by an experienced clinician over a 6 month period to be more helpful than any medication for my PTSD. The only "re-experiencing" symptoms I've had since this treatment have emerged in response to trauma experienced since treatment, and I plan to resume EMDR treatment shortly. I can't emphasize enough how important it is to work with an EMDR practitioner who has real training in trauma well beyond EMDR...usually a well rounded clinician who takes their EMDR training and practice very seriously (eg: has been supervised in the development of their EMDR competencies). EMDR can be done very badly or very well.
Back to meds:
While on celexa in early recovery I went up to 60 or 70 mg...I gained some weight which wasn't unwelcome but it wasn't helping me to get off the floor (physically and emotionally), let alone function. I advocated to be put on effexor because I had met others further along the path who had similar combinations of struggles who found it to be a lifesaver. They tapered me up to 150mg over 3 days...I honestly felt like I was on some kind of ecstacy for about 3 days, but not in a bad way;) Then my mood and anxiety just...levelled right out...I could function. Within a few weeks I was a totally different person. I remember not being able to cry easily once I got up on Effexor...that wore off, but it took at least a year or two. Sexual side effects were minimal and non-existent in the long term. Over those 8 years I would see my family doc if I felt like I was starting to go dark again, and a small dosage increase always seemed to help.

I have a friend who has sadly passed away. He was on Effexor for almost 10 years. I remember him telling me it had stopped working, but I didn't understand what that really meant or what it could feel like until I hit the same wall a few years later. In hindsight I really wish I had offered to advocate for him...because I don't think he ever felt good again, I don't think he found an alternative that worked. Personally in my experience of trying to talk to my psychiatrist about my Effexor not working he has been exceedingly skeptical, warned me it is probably doing "something" I just don't realize it, and advised me to remain on it while also on Wellbutrin, and then Trintellix also. I explained I had known others who had similar experiences with Effexor and he wasn't terribly interested. I told him I was coming off the effexor and that if I had withdrawal symptoms that would tell me that its doing something...he cautioned me not to do this but was aware I was doing this. I had NO withdrawal symptoms whatsoever...and I KNOW what they feel like for effexor, just from weaning my dose down in the past. Withdrawal symptoms for Effexor are considered especially challenging because the drug has an extremely short half-life...in other words it leaves the system rather quickly, rather than over time after taking the last dose, within 24 hours you can have some pretty uncomfortable symptoms (headaches, sleeplessness, confusion etc.). One can often physically feel the brain kind of pining for it...hard to describe.

My advice for anyone on effexor is to understand that because it has such a short half-life, one needs to consider alternatives to simply coming down one standard pill-sized increment to the next. If weaning off or down, I can't express how much pain and discomfort you can avoid by getting your prescription filled by a "compounding pharmacist" who can convert the effexor into a liquid suspension...this way one can literally taper down by as little as a one mg ever day or two. Most/many docs are not well aware of this alternative but it's the way to go in coming off or down from effexor. That is unless it is no longer working!

Trintellix is so new and it scares me how widely and easily it is being prescribed. Half the psychiatrists don't seem to know about it, the other half have samples waiting from pharma reps. I met with a prescribing pharmacist (they can do that where I live) recently who had a lot to say about the messed up prescribing practices of many psychiatrists. As consumer I believe we have to educate ourselves as much as possible, ask questions, read instructions in great detail, and not be afraid to ask a second opinion. Pharmacology in psychiatry is very far from a precise science...if you don't ask good questions, you get what you get. Good psychiatric care involves supervision through med changes, follow up, and a high level of ethical competency. It also requires psychiatrists to educate clients about potentially serious side effects. Good psychiatric care should begin with appropriate suggestions for medication with the SMALLEST side effect profiles, and should only work towards medication with more substantial side effect profiles if less invasive treatment is unsuccessful. I say this because I have seen so many people prescribed antipsychotics (neuroleptics) for SLEEP, which is frankly insane.

Thanks for responding to my thread. Hopefully we will get more folks in on this