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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by Kathie on April 20, 2000, at 21:21:32
I have heard Wellbutrin mentioned many many times and was hoping someone could explain how they work. I understand how the SSRI's work...but I don't think Wellbutrin is an SSRI. Thanks for your time.
Kathie
Posted by Cam W. on April 20, 2000, at 23:26:45
In reply to Cam or anyone...please explain Wellbutrin, posted by Kathie on April 20, 2000, at 21:21:32
Kathie - How does Wellbutrin really work? I don't know, but it did relieve the symptoms of my depression, where SSRIs did not really help.The manufacturer says that it inhibits the reuptake of norepinephrine and dopamine, but receptor binding studies show that these actions are not significant until you are taking about 600mg daily (twice the recommended daily dose).
I do know that it modulates norepinephrine in the locus cereuleus, the main site of norepinephrine neurons in the brain. It kinda evens out the flow of norepinephrine between the neurons in this brain area. Whether this is it's mechanism of action or just artifact, I don't know. The improved norepinephrine neurotransmission may affect other neurotransmitter systems (eg serotonin, dopamine, etc.) and help to modulate them as well. I am not certain on these points, though.
It also raises dopamine levels in the nucleus accumbens (part of the brain's pleasure centers), but probably not to an appreciable extent. I would like to see if Wellbutrin would work in some non-substance abuse addictions (eg gambling), but I haven't seen any studies.
All that I do know is that it does resolve depressive symptoms in some people. It is also energizing, so the last dose of the day should not be taken after 5:00pm (I take my last dose at 3:00) to avoid problems with falling asleep.
With the SR version of Wellbutrin the doses must be taken at least 8 hours apart to decrease the risk of seizures. I did not think that the risk of seizures was that significant until I saw one person actually have a seizure (no previous history of them) in a doctor's office. He was also taking a low dose of chlorpromazine (50mg daily) which does reduce seizure threshold. At that low dose you would not expect someone with no previous history of seizures to have one. I have also heard of other people having seizures with Wellbutrin, but almost always when in combination with drugs that do reduce seizure threshold.
The risk of seizures in people not susceptible to them is (I think) 0.4% at 300mg daily, 1% at 450mg daily and 4% at 600mg daily. So the risk is not that large.
When starting Wellbutrin, they will build your dose slowly. The books say to start at 150mg Wellbutrin SR in the morning for 3 days, then increase it to 150mg teice daily. I tell people to take 150mg in the morning for at least a week or they end up vibrating all day (too activating). You must let your body adjust to the drug.
Also, as a side effect, I quit smoking while taking it, without even trying. I forgot to buy cigarettes one day when filling up with gas and never bought another pack (except for the pack I smoked while drunk at my 20th high school reunion - man, my throat hurt for 2 days).
If you have any specific questions I will be glad to answer them.
P.S. - I will be away at the inlaws in Calgary for Easter, but will be back Monday, so I may not get to answer it for a while. - Cam W.
Posted by CarolAnn on April 21, 2000, at 9:09:15
In reply to Re: Cam or anyone...please explain Wellbutrin, posted by Cam W. on April 20, 2000, at 23:26:45
Cam, how much Wellbutrin do you take? I am currently on 200mgs.SR twice a day. It has never really done anything for me, but I'm thinking that a dosage increase might help. The problem is, my Pdoc, says that I am already on the highest dose. I'm in the USA, do you think a pharmacist would have info on the higher doses? Thank you for all your help! Have a great Easter! CarolAnn
Posted by Cam W. on April 21, 2000, at 10:18:11
In reply to Re: Cam Wellbutrin questions, posted by CarolAnn on April 21, 2000, at 9:09:15
CarolAnn - I take 150mg twice daily since last August (same dosage as the time before). It has worked both times. I think 300mg twice daily is maximum dose (in Canada) unless you are taking other meds that could reduce seizure threshold. Ask you pharmacist about the local rules.I should also mention that, at around 2 to 3 weeks into the therapy, I turned into a bear. I would lash out for no reason and even look for things to get angry about. This seemed to last about 2 weeks and then went away. I have also heard this happen in others, but they usually stopped the med. It seems you do get over the angriness (sp?). Eat lots of chocolate! - Cam W.
Posted by Rick on April 23, 2000, at 19:54:21
In reply to Re: Cam Wellbutrin questions, posted by Cam W. on April 21, 2000, at 10:18:11
>
> CarolAnn - I take 150mg twice daily since last August (same dosage as the time before). It has worked both times. I think 300mg twice daily is maximum dose (in Canada) unless you are taking other meds that could reduce seizure threshold. Ask you pharmacist about the local rules.
>
> I should also mention that, at around 2 to 3 weeks into the therapy, I turned into a bear. I would lash out for no reason and even look for things to get angry about. This seemed to last about 2 weeks and then went away. I have also heard this happen in others, but they usually stopped the med. It seems you do get over the angriness (sp?). Eat lots of chocolate! - Cam W.Cam, even though Klonopin has helped sooooo much for my non-depressive social anxiety, I have still (greedily?) been seeking augmentation which might get me to that "home run". I added Celexa about 9 weeks ago. At about week 7 (still at 20 mg) it started filling in some anxiety gaps very nicely. Now while most Celexa side effects were long gone (it actually WORSENED anxiety at first), I was finding my motivation on the low side, and occasional bouts of fatigue which -- at least for me -- worsen social anxiety. So four days ago my pdoc added a low dose of Wellbutrin SR -- 50 mg. Much to my surprise -- given that even BuSpar and selegiline (and those initial weeks of Celexa) made me somewhat more anxious -- I have had NO negative effects from the Wellbutrin, and I'm already feeling more "up" and sociable. Even if the latter is a placebo effect, I'm stil amazed that there has been no downside given my history with other "activating" agents (those doses of BuSpar and selegiline that made me nervous were very low-dose as well).
That's the background, but my question is this: Do Celexa and/or Klonopin lower the seizure threshold? While I'll probably have no need to add much more (if any) Wellbutrin SR, what is a safe maximum in tandem with the other meds? I have no seizure history, although during my short-lived
Posted by Cam W. on April 23, 2000, at 21:06:26
In reply to Re: Cam Wellbutrin questions, posted by Rick on April 23, 2000, at 19:54:21
Rick - SSRIs in general, including Celexa, can lower seizure threshold, but not usually to an appreciable extent and they also do make anxiety worse for the first couple of weeks until your body adjusts to the drug. I have seen Celexa and Wellbutrin used together with no problem. This is still a generalization and Celexa may induce seizures when taken with Wellbutrin, but, unless you are predisposed to seizures, the risk is slight.Further reducing the seizure risk is the fact that Klonopin is an anticonvulsant and raises seizure threshold. You are also taking a low dose of Wellbutrin, so this further reduces the risk of seizure. Ask your doctor for a second opinion on this, as he will know your medical history and I don't.
Hope this helps - Cam W.
Posted by Danielle on April 25, 2000, at 21:32:05
In reply to Re: Cam Wellbutrin questions, posted by Cam W. on April 23, 2000, at 21:06:26
>
Cam,
This is very interesting! My husband had been hospitalized several months ago. He was diagnosed with GAD and suicial thoughts. The doc started him on Zyprexa, Seroquel, Celexa and Zanax. He continued down hill. We had a miserable time trying to contact this doc, he was always out of town or simply wouldn't return our calls. Needless to say we have found another doctor closer to home and at a university hospital. He has placed my dh on 40mg Celexa and Klonopin. I can see a slight improvement, however he seems more anxious. Can this be caused by the Celexa? and how long should it last? All he does is sleep, pace the floor and cry! Also, how can I encourage him not to quit his job? He says he would be fine if he didn't have to go back. His management position requires about one to two hours of light work a day, the rest of the day is spent sitting with NOTHING to do. Thanks and sorry it is so long.
Posted by Cam W. on April 25, 2000, at 22:22:21
In reply to Re: Cam Wellbutrin questions, posted by Danielle on April 25, 2000, at 21:32:05
Danielle - I really cannot give full advice here, as I have not seen your husband's chart. Couple things to consider. Perhaps the Celexa dose is too high. Perhaps he should try an antidepressant with anxiolytic (anti-anxiety) properties (eg Paxil or Effexor). Maybe he is getting the weepiness from the Klonopin. Maybe he needs a mood stabilizer. Ask these questions of his doctor.The side effects of Celexa (except for weight gain and sexual dysfunction) usually disappear 2 to 4 weeks after starting the drug, as the body adjusts to it.
Good luck and keep us posted. - Cam W.
Posted by Danielle on April 25, 2000, at 22:43:41
In reply to Re: Wellbutrin questions - Danielle, posted by Cam W. on April 25, 2000, at 22:22:21
>
Cam, thanks for answering so quickly. The weepiness has been around much longer than the Klonopin. At first, I blamed it on the Zanax. It is almost a lose/lose situation. Whatever he takes for the anxiety increases his depression. He did try Paxil once last year, but he said it made him worse so he quit. About one and a half years ago he tried Celexa and it worked great. He felt so good he stopped! It was the beginning of the nightmare. Any suggestions on a support site for a tired wife and mom?
Posted by Cam W. on April 25, 2000, at 23:54:41
In reply to Re: Wellbutrin questions - Danielle, posted by Danielle on April 25, 2000, at 22:43:41
Any suggestions on a support site for a tired wife and mom?
Danielle - I don't know of online support groups, but I am sure that there are plenty. Start a new thread and ask this question. I am sure many of the moms out there will tell you which are the best. The people in this group are incredible. Good luck - Cam W.
Posted by newcomer331 on April 12, 2005, at 21:05:03
In reply to Cam or anyone...please explain Wellbutrin, posted by Kathie on April 20, 2000, at 21:21:32
Does anyone know if Wellbutrin is available in Europe?
Posted by ed_uk on April 14, 2005, at 8:03:52
In reply to Re: Cam or anyone...please explain Wellbutrin, posted by newcomer331 on April 12, 2005, at 21:05:03
Hi!
>Does anyone know if Wellbutrin is available in Europe?
What country do you live in?
Wellbutrin is a brand name for the drug bupropion. Bupropion is also sold under the brand name Zyban. When bupropion is used for the treatment of depression, the brand name Wellbutrin is used. When bupropion is used as an aid to smoking cessation the brand name Zyban is used.
In the UK (where I live), bupropion is available under the brand name Zyban. The Wellbutrin brand is not available. Although bupropion is only approved as an aid to smoking cessation in the UK, doctors can still prescribe Zyban for depression if they want to. Zyban is only rarely prescribed for depression in the UK, most doctors here are probably unaware that it is an antidepressant.
In some European countries, bupropion is available as Zyban AND Wellbutrin.
Ed.
This is the end of the thread.
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