What Can Be Done For Prozac Poop-Out?

QUESTION:

Hello Dr. Heller,

I very much enjoy your Website.  I have spent hours reading thru it.

To keep my question short, I have self diagnosed myself with GAD along with "fractured enjoyment".  Ludiomil worked miracles but I gained weight from 190-220 lbs.  For that reason, I switched to Prozac and took it for 15 years, lost the weight and the depression lifted.

For about the last 2 years, I got chronic fatigue with Prozac and the depression ("fractured enjoyment") returned.  I went up to 80mg of Prozac with no relief.  I've read that Prozac can quit working, i.e.  "poop out".  Do you subscribe to that?  Anyhow, I am taking 30mg/day of BuSpar (for 2 months).  My depression has lifted but now I am extremely agitated and can't sleep.  I know you seem to recommend Remeron (I think).  I can't handle another weight gain problem.

What would you recommend?  Remeron would probably work because Ludiomil worked so well.  Would Serzone work?  I appreciate any help you can give me.

Thank you!!

ANSWER:

Assuming the BPD isn't present, the usual reason is an imbalance between serotonin and noradrenaline plus dopamine.  The addition of Wellbutrin can stop this phenomenon.  Generally people like you need Prozac, so the addition of Wellbutrin would be necessary.

If the BPD is present, the addition of Tegretol should stop the symptoms in just hours.