effexor poopout: augmentation v switching medication

hello,

last december i was hospitalized for a major depressive episode and prescribed effexor xr -- now at 300mgs. i also take 25mg seroquel for sleep and rivotril prn. i improved on effexor, but had to keep jacking up the dose because depressive symptoms would return (i.e. cognitive impairment, psychomotor retardation, confusion, suicidal ideation, etc). now, after only 2-3 months, i feel like i have completely relapsed into depression again. i had tried wellbutrin a few weeks ago (75mg) but found it made me ultra-jittery -- though it DID clear my brain and amp-up my mood and energy.

i'm wondering now, should i stay on the effexor and give the wellbutrin another shot and hope the jittery/headachey stuff will dissipate, or go with another form of augmenation, like lithium or another ssri? my psyche-doc wants to use thyroid hormone, but i'm concerned that this will mess up my thyriod (which is currently functioning well).

is 3 months with 50-60% improvement enough to legitimize staying on effex and augmenting? or should i consider it a failure and swap drugs altogether? if aumentation is indicated, would you choose another shot at wellbutrin, or perhaps buspar--or go ahead with the thyroid hormone?

my main objective is to stay cognitively acute, as i'm a professor and need my brain to function sharply.

thanks for your help,

kw

[Roger Gould, M.D.]

These are all experiments, and since you have already experimented with Wellbutrin, it makes sense to give it another try and work on calibrating the dose so it doesn't create those side effects.  A little of the stimulant effect is good. You should also be involved in therapy,its a good place to use your brain and your intelligence, and not have to blindly put all your hope in these biological mechanisms.