Question:
Dear Doctor Heller,
I found your web site to be very
informative as I am currently
undergoing psychological treatment. I
am being treated for panic/anxiety
co-morbid with low/moderate depression.
I am on 50 mg of Zoloft for the past 2
weeks. The panic/anxiety has subsided
substantially and to a certain extent
depression. My biggest issues are lack
of motivation and/or persistence to
stay on top of things, general
enjoyment in life other than highly
stimulating things such as sex, and
staying focused. I was treated for
anxiety/panic about a year ago with
Lexapro but it also left me "apathetic"
so I came off it. Slowly but surely, the
same problems began again: loss of
interest, anxiety, etc. I want to work
on getting the best possible treatment.
Zoloft is great with my anxiety/panic
and the "sorrows and guilt of
depression" but I struggle with a lot
of tiredness that SSRI's seem to
contribute to and it's not energizing me
enough to actually do things. Do you
suggest I take the Effexor approach or
sticking to the Zoloft and adding
Wellbutrin? Or any other suggestions?
Thank you.
Dr. Heller's Answer:
SSRI's can cause a neurotransmitter
imbalance with dopamine and
noradrenaline which creates "the
blahs." This can include apathy, lack
of interest in life, etc. The addition
of Wellbutrin (buproprion) usually
solves this problem. My patients
generally take it for a month, and then
resume it when "the blahs" return.
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