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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 17 of 17. This is the beginning of the thread.
Posted by samantha on May 13, 2000, at 8:36:40
Anyone on Wellbutrin?
Posted by Andre Allard on May 13, 2000, at 14:20:47
In reply to wellbutrin, posted by samantha on May 13, 2000, at 8:36:40
Wellbutrin effects primarily norepinephrine. It tends not to be a potent AD either. The only reason I would give Wellbutrin a trial is for it's inability to cause sexual disfunction, which is a problem with most ADs. Even though I experience anorgasmia at times, personally, I would not try Wellbutrin. Like I said, and most pdocs would agree, Wellbutrin is not an effective AD in treating severe depression. Other ADs that do not impair one's sex life are Remeron and Serzone. The thing is they can be sedating. If sex is that important to you, other ADs have given you a problem in this area, and your depression is not making you run to your nearest gun dealer, then Wellbutrin might be for you. Good luck!
Posted by Cam W. on May 14, 2000, at 0:50:42
In reply to Re: wellbutrin, posted by Andre Allard on May 13, 2000, at 14:20:47
Samantha - Wellbutrin is working wonders on my depression. I have had failures on both Zoloft and Paxil (actually with the Zoloft, I may have not given it time to work, but I didn't like the side effects). I had reached 60mg of Paxil daily over 6 months without improvement (and a possible worsening).As for Wellbutrin's mechanism of action (MOA), I am almost sure it has little to do with norepinephrine or dopamine reuptake, as is the common theory. Even the manufacturer admits that the blockade of norepinephrine reuptake and dopamine reuptake occurs at much higher doses than are taken for depression. These effects really are not significant until a person is taking 600mg daily (increased risk of seizure at this level - >4%)
Possible mechanism of action of Wellbutrin (•caution - for HPA axis purists only•):
Modulation (or smoothing out the flow) of norepinephrine through the locus ceruleus (contains about 50% of the body's norepinephrine fibers), makes the norepinephrine signaling less erratic. This may improve norepinephrine flow through the body and may downregulate ß-adrenergic receptors, leading to decreased CRH gene expression. Less CRH release (from the hypothalamus) which causes less ACTH release (from the pituitary) which leads to a downregulation of ACTH receptors (and improves the blunted adrenal response to ACTH; but actually decreases ACTH activity), thus leading to decreased cortisol release from the adrenals. This decrease in cortisol release may allow the downregulation of the glucocrticoid receptors in the hypothalamus and pituitary and restore the feedback mechanism that turns off cortisol release from the adrenals. This may restore the functioning of the HPA axis (body's main stress response system), thus ameliorating the symptoms of depression.
I believe the above to be an intriguing theory.
Or - All antidepressants (all classes) seem to have action at the body's corticosteroid receptors in the hypothalamus and pituitary. Most downregulate glucocorticoid receptors (citalopram downregulates mineralocorticoid receptors - extended theory upon request). Does this kickstart the cascade I mentioned above? (Kinda a chicken/egg thing). This would explain why antidepressants that don't act on norepinephrine (eg SSRIs) work.
I am going to go out on a limb here and hypothesize that the reason SSRIs (eg fluoxetine, paroxetine) work for some people, NRIs (eg reboxetine, desipramine) and mixed SNRI TCAs (eg amitriptyline, nortriptyline) work for other people, is that some have a breakdown of the HPA axis that requires serotonin to resolve depression (responders to SSRIs) or a breakdown requires norepinephrine to resolve depression (responders to NRIs). This may also be why many European psychiatrists believe that the TCAs are still the best pharmaceutical antidepressants we have, because they have both SRI and NRI activity. It's just that the TCAs' effects on muscarinic/cholinergic and œ-adrenergic receptors cause too many side effects (some of them life threatening or at least interfering with daily functioning).
Wellbutrin has worked for me (on 2 occations) where SSRIs haven't and I do not believe that it is placebo effect.
Geez, I gotta stop this thinking out loud - Cam
Posted by Andre Allard on May 14, 2000, at 1:39:06
In reply to Re: wellbutrin, posted by Cam W. on May 14, 2000, at 0:50:42
Hey Samantha, just ignore us. Cam, a panel of 11 experts were convened for a conference to discuss wellbutrin's mechanism of antidepressant activity. They concluded that wellbutrin's mechanism of action appears to have an unusual, not fully understood, noradrenergic link. The wellbutrin metabolite hydroxybupropion probably plays a critical role in the antidepressant activity, which appears to be predominantly associated with long term noradrenergic effects. The mild central nervous system activating effects of wellbutrin appear to be due to weak dopaminergic mechanisms. There is some evidence that dopamine may contribute to wellbutrin's antidepressant properties. Antidepressant effects of wellbutrin are not serotonergically mediated. I am glad to hear that wellbutrin (no matter what it's mechanism is) is working for you.
Posted by ChrisK on May 14, 2000, at 6:04:38
In reply to wellbutrin, posted by samantha on May 13, 2000, at 8:36:40
Samantha,
To get back to plain Eonglish for a minute. I didn't respond to the SSRI's at all. I then switched to a TCA and got some benefit from that. After a while and reading people's opinions here I asked my pdoc about trying Wellbutrin because it was supposed to have a stimulating effect. After a couple of months of using it with my TCA I have recently tried it alone. So far things have gone very well. At one point I was taking 6 meds and now I am down to 3.
In short, Wellbutrin has worked well for me. I take 300 mg/day of the SR version. I am definitely not ready to give up on it anytime soon.
I think almost anything is worth a try if you react to it but Wellbutrin has done good things for me.
Chris
Posted by Cam W. on May 14, 2000, at 11:43:12
In reply to Re: wellbutrin, posted by Andre Allard on May 14, 2000, at 1:39:06
> Hey Samantha, just ignore us. Cam, a panel of 11 experts were convened for a conference to discuss wellbutrin's mechanism of antidepressant activity. They concluded that wellbutrin's mechanism of action appears to have an unusual, not fully understood, noradrenergic link. The wellbutrin metabolite hydroxybupropion probably plays a critical role in the antidepressant activity, which appears to be predominantly associated with long term noradrenergic effects. The mild central nervous system activating effects of wellbutrin appear to be due to weak dopaminergic mechanisms. There is some evidence that dopamine may contribute to wellbutrin's antidepressant properties. Antidepressant effects of wellbutrin are not serotonergically mediated. I am glad to hear that wellbutrin (no matter what it's mechanism is) is working for you.
Andre - Thanks for the info. I too, think that norepinephrine is involved in bupropion MOA, but not norepinephrine reuptake blockade. There is a definite action on noradrenergic neurons in the locus ceruleus, but it may be direct (agonist activity) rather than indirect (reuptake blockade).
Also, another thing I have noticed in the hospital studies of reboxetine, here in Canada, that responders to reboxetine had had some response to bupropion.
Didn't they try hydroxybupropion in animal models (tail-pinch studies) and found little activity? I know it is a long way (in some instances) from animals to humans; especially when extrapolating something as subjective as depressive symptoms. I believe these extrapolations have slowed science in many instances.
Thanks again for the input. Are the consensus group's results published anywhere? - Cam
Posted by allisonm on May 14, 2000, at 20:28:36
In reply to Re: wellbutrin, posted by Cam W. on May 14, 2000, at 0:50:42
Cam, one more question, probably not the last:
Have you ever experienced stomach problems on Wellbutrin? I am noticing an increasingly painful gnawing/cramping in my stomach if I haven't eaten in awhile. And after I eat, sometimes it feels even worse.This evening it was paired with nausea and vomiting, but I think that might be related to something else (the weather is changing, my allergies are making my head pound and sometimes that leads to nausea). Anyway, it hasn't been a fun evening.
Thanks.
Posted by Cam W. on May 14, 2000, at 21:13:03
In reply to Re: wellbutrin, Cam?, posted by allisonm on May 14, 2000, at 20:28:36
> Cam, one more question, probably not the last:
> Have you ever experienced stomach problems on Wellbutrin? I am noticing an increasingly painful gnawing/cramping in my stomach if I haven't eaten in awhile. And after I eat, sometimes it feels even worse.Allison - I've never really experienced a cramping or gnawing, but then again, my stomach is never empty. I think I do know what you mean in a milder sense. Driving home from work, espcially if I have not eaten lunch, I think I do have more "hunger pangs" than I did when not taking Wellbutrin. My pangs do go away after I've eaten, though.
These extra "hungries" could also be a change in my body metabolism due to the exercise I now get, as opposed to being a couch slug until about four years ago. ('couch slug' came from an old roommate that said I wasn't a couch potato because every now and then I would reach for a beer). - Cam
Posted by PeterJ on May 15, 2000, at 2:09:46
In reply to Re: wellbutrin, Cam?, posted by allisonm on May 14, 2000, at 20:28:36
> Cam, one more question, probably not the last:
> Have you ever experienced stomach problems on Wellbutrin? I am noticing an increasingly painful gnawing/cramping in my stomach if I haven't eaten in awhile. And after I eat, sometimes it feels even worse.
>
> This evening it was paired with nausea and vomiting, but I think that might be related to something else (the weather is changing, my allergies are making my head pound and sometimes that leads to nausea). Anyway, it hasn't been a fun evening.Nausea is a common side effect of bupropion. However, if you continue to have severe nausea to the point of vomiting, I would suggest contacting your physician to discuss a temporary decrease in dose.
I don't want to worry you unecessarily but it is possible that repeated vomiting and not eating may increase the risk of seizures from bupropion. A study of bupropion in bulimia found increased rates of seizures, which is why the drug is contraindicated in bulimia. (I'm not saying you have bulimia, just that the vomiting may be a bad sign.)
Most people get past the nausea just fine. But I have read of one case in which sudden onset of severe nausea and insomnia preceeded a seizure.
The chance of seizures with bupropion is usually very low, so there is no reason to panic. But do talk to your doctor if the vomiting continues. Better safe than sorry.
Peter
Posted by allisonm on May 15, 2000, at 8:36:46
In reply to Re: wellbutrin, Allison., posted by Cam W. on May 14, 2000, at 21:13:03
>> These extra "hungries" could also be a change in my body metabolism due to the exercise I now get, as opposed to being a couch slug until about four years ago. ('couch slug' came from an old roommate that said I wasn't a couch potato because every now and then I would reach for a beer). - Cam<<
LOL. I probably have my old-fashioned gardening remedies mixed up, but I thought I heard once that putting a saucer of beer in the garden attracted, then killed/drowned slugs. No doubt they were happy in their last moments. Or maybe it was beer and flies. Or maybe that's flies and sugar water ... or is that sugar water and wasps? Or is it salt on slugs? I thought it was beer. Geez, I dunno anymore.
Posted by Arias on May 16, 2000, at 21:34:07
In reply to Slugs. Off the subject. Cam, posted by allisonm on May 15, 2000, at 8:36:46
Alison,
I was on Wellbutrin otherwise known as Zyban for a time, 150 mg 2x/day, sustained-release. In a word, it was a dream. I'd tried the SSRI's with the consequent sedation, anorgasmia without effect on the depression itself. Officially, it's a norepinephrine and dopamine reuptake inhibitor but from these prior posts, I don't think so anymore :) It did however work for the depression.
However, there is the issue of anorexia as it suppresses the appetitite and the not-insignificant issue of seizures which occurs at a higher frequency in those with a history of eating disorders and those with a history of seizures. Something like 1.2%. I frankly don't understand this however, mechanism-wise, and there is a spectrum of eating disorders but anyway.
However, this can be mitigated with the following measures: take the medicine regularly, and separated by 8 hours apart. Don't take it after 4-5 p.m., also because wellbutrin tends to adversely affect sleep. Seizures tend to occur at higher dosages, 450 mg/day and higher. Additionally, drop the alcohol with Wellbutrin. And of course, if you have a history of an eating disorder or a seizure disorder, consider another drug.
Despite my hearty thumbs-up concerning wellbutrin, I did have one episode of a seizure with it; but I did not always follow these precautions and additionally, it may have something to do with the individual's body's metabolizing system, the cytochromes etc.
Best of luck to you my friend.
Posted by allisonm on May 16, 2000, at 21:48:54
In reply to Re: Slugs. Off the subject. Cam, posted by Arias on May 16, 2000, at 21:34:07
Arias,
Thanks for writing. I've been on Wellbutrin SR for almost a year now. Most recently on 400mg. I am not anorexic. I have been overweight most of my life, so the weight loss has been a welcome side effect after rather troubling weight gain with Remeron and lithium.The nausea the other night was new. I have not had it since. The stomach pains have subsided. I have pretty much eliminated alcohol from my diet (as well as all caffeine and meat -- the former because I cannot tolerate it, the latter because it doesn't appeal anymore). I had had a small amount of alcohol that evening of the cramps and vomiting, although I have had the stomach cramps on other occasions w/o alcohol and cannot find a correlation. I will completely avoid alcohol from now on, too, as it is the only thing I can think of that may have caused it that evening. Thanks for the info.
Posted by Gladys on April 2, 2001, at 20:46:10
In reply to wellbutrin, posted by allisonm on May 16, 2000, at 21:48:54
Has anyone else had such a response when drinking alcohol while on welbutrin? I am not a heavy heavy drinker but do go out on occasion with friends and have wine with dinner sometimes and am about to start welbutrin. I hate to think I can never enjoy a night out or some wine without stomach cramps. Has anyone else been able to drink while on welbutrin? thanks.
Posted by moonman on May 9, 2001, at 20:43:10
In reply to Re: wellbutrin, posted by Andre Allard on May 13, 2000, at 14:20:47
Have had anxiety for over a year with a lot of facial flushing and some muscle weakness. My doctor has had me on all the SSRI's .. most recently Celexa. They all give me the creeps and don't help my anxiety (diazapam and beta blockers help). I asked for Wellbutrin and was told it's too stimulating. I argued and won and it appears to have helped some of my symptoms. Any theories?
Posted by bella007 on May 10, 2001, at 12:19:15
In reply to wellbutrin vs. anxiety, posted by moonman on May 9, 2001, at 20:43:10
> Have had anxiety for over a year with a lot of facial flushing and some muscle weakness. My doctor has had me on all the SSRI's .. most recently Celexa. They all give me the creeps and don't help my anxiety (diazapam and beta blockers help). I asked for Wellbutrin and was told it's too stimulating. I argued and won and it appears to have helped some of my symptoms. Any theories?
Wellbutrin is usually used to treat depression, but sometimes it is prescribed for ADHD, due to the fact that it effects norepinphrine in the brain, and can calm a hyperactive person down. If some of your anxiety stems from you being hyperactive, then maybe this is why you feel more calm. I have seen Wellbutrin work this way for others also. I am currently taking Celexa at 5mg, and I have only been on it for a week and a half, but it has helped me tremendously with my social anxiety and depression. I asked my doctor if I could take Wellbutrin for anxiety, too, but he said it wouldn't help at all and that it might make it worse. But, I am glad it is working out for you!! Good luck! Oh, and I have one question: Why did you stop taking Celexa?
Posted by sl on May 11, 2001, at 20:34:04
In reply to Re: Slugs. Off the subject. Cam, posted by Arias on May 16, 2000, at 21:34:07
What Dr's say so they don't get sued:
>Additionally, drop the alcohol with Wellbutrin.
A Rare case:
> Despite my hearty thumbs-up concerning wellbutrin, I did have one episode of a seizure with it; but I did not always follow these precautions and additionally, it may have something to do with the individual's body's metabolizing system, the cytochromes etc.
> Best of luck to you my friend.
I was on it for YEARS, I was a DRUNK, and I never had so much as a twitch, let alone a seizure. I think it might be more likely to bring them on if you've already got a genetic predisposition, but if you don't it won't force your body into some horrible reaction.So don't freak out, was my point.
*plinkplink*
sl
Posted by moonman on May 28, 2001, at 20:47:10
In reply to Re: wellbutrin vs. anxiety, posted by bella007 on May 10, 2001, at 12:19:15
> > Have had anxiety for over a year with a lot of facial flushing and some muscle weakness. My doctor has had me on all the SSRI's .. most recently Celexa. They all give me the creeps and don't help my anxiety (diazapam and beta blockers help). I asked for Wellbutrin and was told it's too stimulating. I argued and won and it appears to have helped some of my symptoms. Any theories?
>
> Wellbutrin is usually used to treat depression, but sometimes it is prescribed for ADHD, due to the fact that it effects norepinphrine in the brain, and can calm a hyperactive person down. If some of your anxiety stems from you being hyperactive, then maybe this is why you feel more calm. I have seen Wellbutrin work this way for others also. I am currently taking Celexa at 5mg, and I have only been on it for a week and a half, but it has helped me tremendously with my social anxiety and depression. I asked my doctor if I could take Wellbutrin for anxiety, too, but he said it wouldn't help at all and that it might make it worse. But, I am glad it is working out for you!! Good luck! Oh, and I have one question: Why did you stop taking Celexa?Stopped taking Celexa as almost al SSRI's give me flushing and creeps. Withdrew from Celexa in about 5 days ... uncomfprtable but not terrible. Hope it works for you
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