Combining Wellbutrin and Vyvanse: A Patient‘s In-Depth Perspective
As an adult struggling for years with depression, attention issues and lack of motivation, finding an effective treatment has been a major challenge. Like many with similar issues, I’ve tried various antidepressants and stimulants over the past decade with mixed results. Most recently, my doctor had me trial Vyvanse (lisdexamfetamine) for attentional symptoms along with Wellbutrin (bupropion) which I was already taking for depression.
In this detailed article, I’ll provide background on each medication and their neurological mechanisms, share my experience and research on potential pros and cons of combining them, offer lifestyle optimization tips, and suggestions for working with your doctor to determine if this regimen might be right for you or a loved one fighting similar battles.
How Wellbutrin and Vyvanse Work in the Brain
Wellbutrin, an atypical antidepressant, acts primarily as a dopamine and norepinephrine reuptake inhibitor. This means it prevents these "feel good" neurotransmitters from being reabsorbed too quickly, leaving more available in the synaptic cleft to bind neurons and enhance signaling related to motivation, pleasure, and energy.
Research indicates Wellbutrin also lightly stimulates nicotinic acetylcholine receptors, and may modulate serotonin indirectly. Unlike SSRIs which directly influence serotonin, Wellbutrin works via different pathways that for some like myself, lead to fewer side effects.
Vyvanse, meanwhile, is a stimulant prodrug consisting of the amino acid lysine linked to dextroamphetamine. After oral ingestion, enzymes in red blood cells detach the lysine, slowly converting it pure active amphetamine which then enters the brain. Hence Vyvanse is considered extended release, without harsh peaks and valleys.
In the central nervous system, dextroamphetamine induces the release of dopamine, norepinephrine and to a lesser extent serotonin into synapses. It does this mainly by triggering storage vesicles containing these neurotransmitters to fuse with neurons and dump content into the synaptic cleft. It also partially blocks reuptake of dopamine and norepinephrine via their transporters, similar to Wellbutrin.
Potential Synergistic Effects
As you can see, both medications ultimately act to elevate levels of dopamine and norepinephrine signaling responsible for concentration, motivation, energy and mood regulation.
Research on co-administration is still limited, but some studies along with anecdotal patient reports indicate that for some individuals, combining Vyvanse and Wellbutrin in a carefully monitored regimen results in:
- Augmented perceived energy, productivity, motivation and feelings of well-being
- Enhanced ability to ignore distractions and sustain attention for longer periods
- Possible antidepressant boost – increased pleasure and engagement in hobbies for example
- Apparent safe option for avoiding SSRI interactions with amphetamines that provoke serotonin toxicity
A 2018 study published in CNS Spectrums evaluated effects of Vyvanse combined with either an SSRI, SNRI or bupropion in adults with ADHD plus a mood disorder. 60.7% of the Wellbutrin co-administration group experienced a clinical response versus roughly 48% for those on Zoloft or Effexor with Vyvanse.
While not a huge difference, it does suggest possible advantages for some patients. Researchers believe enhanced norepinephrine and dopamine signaling drive uplifted mood and motivation levels.
Of course, individual physiology plays a major role. Outcomes run the gamut from remarkable improvements, to no noticeable change, to new intolerable side effects. Synergies that benefit some may overstimulate others – close monitoring is key. But given the mechanistic overlap Wellbutrin has with stimulants like Vyvanse, cautious co-administration seems a reasonable option worth considering.
Risks and Side Effects to Weigh
That said – drastically altering brain chemistry via two psychotropics does not come without risks. Possible concerning reactions include:
- Insomnia, restlessness, agitation
- Tachycardia, hypertension, arrhythmia
- Exacerbation of psychiatric symptoms
- Serotonin toxicity reactions in vulnerable individuals
I fortunately did not experience the above to excess. But it‘s critical people consider their personal and family history before opting to combine agents that increase monoamines.
For example, if you have bipolar disorder, adding a stimulant may trigger mania. Those with heart conditions need to discuss cardiac impacts – both medications may increase blood pressure and heart rate. People currently taking antidepressants that influence serotonin like SSRIs should be especially cautious and start with an extremely low dose of Vyvanse if trying the combo.
Implementing Lifestyle Support Strategies
In addition to close medical monitoring, I found essential to structure daily habits to support mental health and effective functioning of both Wellbutrin and Vyvanse:
- 7+ hours sleep nightly
- Low-glycemic nutrition – complex carbs, protein at each meal
- Daily exercise 30+ minutes
- Stress management via meditation, yoga, nature
- Avoiding alcohol which can worsen side effects
Carving out time for proper self-care allows me to optimize the therapeutic effects of this medication regimen. Healthy homeostasis enhances both mood stability and neurological signaling.
Dietary protein and complex carbs provide amino acid precursors for neurotransmitters like dopamine that medications augment. Cardio exercise supports circulation and may boost BDNF production enabling neuroplasticity underlying the brain’s ability to adapt. Activities like yoga lower stress hormones that can otherwise inhibit optimal neuronal communication.
In essence, cleaning up aspects of daily living establishes the biological foundations for psychoactive meds to work best. It’s about consciously engineering an internal milieu conducive to enhanced concentration and wellbeing.
Finding Your Minimum Effective Dose Combo
When it comes to potentially synergizing Vyvanse and Wellbutrin or any other psych meds, finding the “goldilocks zone” with your doctor is key – the minimum doses that provide therapeutic effects without intolerable side effects.
Many practitioners agree that if combining a stimulant like Vyvanse with Wellbutrin, it’s smart to start with lower doses of both drugs, and increase gradually while tracking effects vs side effects. Doing so allows the body to adapt slowly. It also aids in determining which impacts stem from which medication, to harness any synergies while avoiding overstimulation.
For example, I already took 300mg Wellbutrin XL daily for depression. When adding Vyvanse, my psychiatrist Dr. Johnson had me start with just 20mg (half the typical starting dose) for a week along with my usual Wellbutrin dose. We agreed I’d journal any new positive or negative changes, then meet to discuss either maintaining or increasing the Vyvanse after a week.
The goal was finding where benefits tapered off relative to increased side effects. This process of weekly check-ins assessing quantitative metrics and qualitative experiences continued over a month until arriving at my minimum effective combo: 300mg bupropion and 40mg Vyvanse daily.
Tracking Metrics Like Sleep, HRV to Dial In Dosing
To further identify optimal dosing with my doctor, I quantified key biomarkers using tracking tools:
- Sleep quality and duration via sleep cycle app and wearable
- Heart rate variability with chest strap monitor
- Blood pressure 2x daily
- Body weight tracking for appetite changes
- ADHD self-assessment tests
Monitoring metrics like heart rate variability day-to-day and pre vs post-exercise indicated changes in autonomic tone reflective of health reactions to the medications. Declining HRV for example might signal rising inflammation or stress hormones necessitating an adjustment. Tracking sleep quality and appetite are also hugely telling re stimulation levels.
All of these datapoints helped educate both myself and my doctor on how my physiology responded as we tuned the regimen. Used wisely, biofeedback tools provide incredible insight!
Developing Open Dialogue with Your Treatment Team
While apps and wearables proved invaluable for monitoring my biomarker responses, nothing can replace an experienced, caring psychiatrist and therapist when venturing into complex medication combinations. Communicating benefits and side effects open and often was essential to the process.
Fortunately over the years, I’ve found a fantastic treatment team I fully trust. Both Dr. Johnson and my therapist Brenda have been caring, non-judgemental listeners helping me navigate tricky diagnostic and medication dilemmas. I cannot overstate how vital establishing rapport, mutual understanding and accountability with professionals managing such a sensitive process is!
Final Thoughts – Give It a Shot?
Unfortunately those with dual diagnoses like ADHD plus depression may need to trial various medical and lifestyle interventions to experience substantial improvement day-to-day. For some like myself, cautiously combining targeted medications like Vyvanse and Wellbutrin alongside daily movement, stress and sleep hygieneOptimizationhas proven to be life-changing. My motivation, moods and general zest for life has improved markedly on this regimen.
That said, this prescription mix certainly won’t be right for everyone. In fact both drugs on their own don’t work for many. We all respond differently based on unique physiology and lifestyles. You have to put in time communicating with a practitioner and listening inwardly to find what works then optimize around it.
If struggling with similar issues however, perhaps give rational stimulant/antidepressant polypharmacy a try. But I urge developing a solid working relationship with your doctor, being radically honest about all symptoms and tracking biomarkers daily to help calibrate dosing. With trust and patience, a synergistic combo effect may await discovery!
I hope detailing my journey offers some guidance and sparks optimism. Please let me know in comments any other questions!