Wellbutrin - What is it?

[Andrew]

Informative sites on Wellbutrin:
http://www.rxlist.com/cgi/generic/buprop.htm
http://www.mentalhealth.com/drug/p30-b04.html
http://www.psyweb.com/Drughtm/buprop.html

My experience with this drug: I was put on it originally for depression about 6 years ago....and was the one drug after a long trial of drugs for me that worked and did not have hurrendous side effects....at first it even curbed my appetite. I believe I started at 200 mg per day, SR. Then another doctor continued me on it at an even higher dosage as he said at the time that I was getting an ADD diagnosis that Wellbutrin was also used to treat ADD....and so I've been on it ever since....and it is known to treat both depression and ADD....The exact mechanism, i.e. the exact neurotransmittor of the brain it targets is as yet unknown...dopamine, seratonin or epinephrine...but I know many people whom this drug has worked for whether alone or with other meds....Under the name zyban it also is used to help nictotine cravings in smokers....

Joan

[atomx]

Wellbutrin specifically focuses on dopamine (or at least that's what my psych told me).

Wellbutrin was also the only drug I ever got on that treated my depression. No (negative) side effects -- it seemed to increase my sex drive a bit, but that's hardly unwelcome.

And dopamine is the primary neurotransmitter involved in most addictions, so it's not surprising that Wellbutrin (buproprion -- marketed as Zyban for smoking) is effective at reducing smoking cravings.

Unfortunately, Wellbutrin hasn't done anything (or hasn't done much) for my AD(H)D. It's possible that it's doing SOMETHING but not eliminating it completely. I'm considering asking the doc to put me on a higher dose (I'm on 300mg/daily -- two 150mg Wellbutrin SR tablets... I think you can go to 400 or higher).

Incidentally, the literature mentions something about seizures and Wellbutrin. There's a bit of medical folklore involved in this... The OLD format of buproprion... the non-SR format (SR stands for sustained release, I believe) DID trigger seizures in a small percentage of patients. The percentage was small, but the effect was considered serious enough that warnings were put on all the meds, and I believe that eventually the non-SR formulation was taken off the market (someone correct me if I'm wrong). After a few years, the maker reformulated it as a sustained release version, and retested it. This version had a seizure side effect of something like 4%. I believe that the incidence of seizures in the original (non-SR) Wellbutrin was something like 8% (so the SR version has half that risk). But if someone tries to tell you that Wellbutrin can trigger seizures... well, it can, but consider that the seizure incidence of the SSRI's (Prozac, Paxil, etc.) is about 5%. SO the seizure incidence for Wellbutrin SR (the SR is the crucial part) is actually LOWER than some of these other "safe" anti-depressants.

Just something to consider. All in all, I think that from my experience and what I've read, Wellbutrin is an extremely safe and (especially for AD(H)D people) effective psych med.

I've been on it for about 4 years now, I think.

-- Tom

[atomx]

By the way, the 150mg Wellbutrin SR tablets are a nice soothing shade of purple

Tom: Thanks for writing....you took the words out of my last psychiatrist's mouth...(the one I had in Florida before moving here to California)...he said the exact same thing about the seizure warning...IN FACT...I was on the maximum dosage that he would allow me to be on....450 mg....(3 of those soothing purple colored pills)....as he was concerned with seizures...now I'm on 400 (2 pink pills each has 200 mg)....

But didn't know seizure risk had to do with SR or non SR....I was always on SR...

I'm sorry your Wellbutrin is not helping your ADD although it is helping your sex drive...(good!) Perhaps a higher dosage would help....OR perhaps another med in addition to the Wellbutrin?? One specific for ADD? In the past I have been on Luvox (for OCD AND ADD) with Wellbutrin...which worked well treating depression and ADD

and at another time was on Wellbutrin and Cylert which worked well treating depression and ADD...those are my only experiences....

Didn't know Dopamine was the neurotransmittor Wellbutrin acted upon.....okay.....addictions??? I have many....not smoking....nor drugs nor alcohol...but a SEVERE one to sugar....but Wellbutrin only helped that for awhile....anyway...good luck....keep us posted....maybe a higher dosage of Wellbutrin or an additional med?

Joan O.

[atomx]

Joan -- thanks for writing.

My memory of the exact effects of Wellbutrin was hazy, so I looked it up:

http://www.rxlist.com/cgi/generic/buprop_cp.htm

Incidentally I was wrong about the immediate release format being no longer available, apparently. According to rxlist (a source I trust a LOT for pharmacological information), the immediate release formulation is still available...

Sustained Release Tablets: Bupropion is a relatively weak inhibitor of the neuronal uptake of norepinephrine, serotonin, and dopamine, and does not inhibit monoamine oxidase. The mechanism of action of bupropion, as with other antidepressants, is unknown and the mechanism by which bupropion enhances the ability of patients to abstain from smoking is also unknown. However, it is presumed that this action is also mediated by nonadrenergic and/or dopaminergic mechanisms.

This is interesting -- it's not known why it's an antidepressant! But I guess that I was sort of right about the dopamine pathways -- also it appears to affect the norepinepherine pathways. This is pretty interesting since norepinepherine is also hypothesized to be involved in AD/HD. Since you have a drug that (probably) increases levels of both dopamine AND norepinepherine (and to a smaller extent, serotonin), you have a very specific AD/HD drug (assuming that the dopamine/norepinepherine theories are right).

Anyway, the article indicates that the max dosage for Wellbutrin SR is 400mg/day:

Increasing the Dosage Above 300 mg/day: As with other antidepressants, the full antidepressant effect of bupropion HCl may not be evident until 4 weeks of treatment or longer. An increase in dosage to the maximum of 400 mg/day, given as 200 mg twice daily, (450 mg/day for the immediate release, given as in doses not more than 150 mg each) may be considered for patients in whom no clinical improvement is noted after several weeks of treatment at 300 mg/day. For the Immediate Release Tablets Only: Dosing above 300 mg/day may be accomplished using the 75 or 100 mg tablets. The 100 mg tablet must be administered 4 times daily with at least 4 hours between successive doses, in order to not exceed the limit of 150 mg in a single dose. Bupropion HCl should be discontinued in patients who do not demonstrate an adequate response after an appropriate period of treatment at 450 mg/day.

...although in the clinical trials, they had patients on up to 600mg/day, so 450mg/day of SR is probably okay.

The thing is, I'm on 300mg/day as it is. Increasing this to 400mg/day... I don't know. I'm not a psychiatrist, but I can't see how upping the dosage by 33% is going to have a dramatic effect on my ADD.

I suspect that your other suggestion is going to be the kicker -- I may need another drug. A brief trial of Adderall really opened my eyes to the potential, and I'm going to see if my doc will prescribe me the XR (extended release) version of Adderall today Incidentally, the stimulants' primary method of action is the release of -- you guessed it -- dopamine!

And there's lots and LOTS of research showing the interactions between addictions and dopamine. Dopamine is one of the primary neurotransmitters involved in the feelings of pleasure and reward, so folks with depressed dopamine levels are likely to be frantic to find some way to "feel good." Normal people don't realize what this chronic "blah" feeling is like -- it's not sad and weepy like a low-serotonin phase, it's just... "blah" like life is sort of grey. You go through the motions. This causes an intense need to add some color -- through risky (but stimulating) activities, through substance abused, through whatever. This isn't "wrong" -- it's our own attempts to adjust the dopamine levels.

For details of dopamine and addiction, try a search on PubMed:

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi

You'll get a lot of very scholarly papers on the subject. Be warned -- have your medical dictionary close at hand

-- Tom

PS: Am I the only one who finds this stuff fascinating -- above and beyond my own personal stake in the matter, I just think it's amazing and fascinating how the brain works!

[atomx]

Oh incidentally, the reason I think Adderall and Wellbutrin might be good together is that I think the two will be synergic -- the effect of the two together will be greater than the sum of the two separately. The reason is that Wellbutrin blocks the reuptake/absorption of dopamine, and Adderall increasese the overall amount of dopamine available. The net effect should be significant.

Just my pet theory. We shall see...

-- Tom

Tom -- you sound very bright...and I'm sure that the people who sit in the rooms of Alchoholics Anonymous and Narcotics Anoymous -- and there are many -- worldwide -- are all suffering from low Dopamine levels....ya think??....they need that something to feel better......me too -- I'm fascinated by the brain....sounds good about the Wellbutrin and Adderal...your theory about the two working together and being better than either of them separately....hey you may be onto something...I don't often hear people talking about "these two meds" for example worked well together for me...etc. I only hear people talking about one med at a time....but I'm never convinced that just one med covers everyone's bases....just my opinion and experience.....I guess perhaps your living proof of that currently....I always did the best on two..and in fact, recently struggling with focus....I mean its okay but could be better, I know that.....have to be honest....even on 400 mg.....and so need to see my doctor about re-entering the Cylert thing...

So Dopamine wins...I also hear people talk about Concerta being another good one by the way...when do you see your doctor about Adderal??? Good luck....Stay in touch....

Joan

Thanks for websites referrals....I will write down....

[cobweb]

Hi,
Just to let you know about my short experience with wellbutrin and adderall.
Ii was put on serzone for depression and it did nothing for me so was switched to wellbutrin 9 months ago. I started at 150 once a day and in a week 2 times a day. It has worked extremely well for me exept that a few weeks ago I started feeling depressed and anxious and sick. Turned out it had built up in my system too much. Went back to 1 dose of 150 a day and it's working great again.
A couple of weeks ago I was diagnosed with ADD and started taking adderall 10mg. The Dr told me that this was the minimum dose and we would probably need to adjust it up. I haven't needed to adjust it at all. Just take one in the morning and one around noon.
Tom, I think you are right about the synergic effect of the two.I was actually thinking the same thing when I realized that i didn't need to increase the dosage on the adderall. At this low dose I have no side effects except dry mouth ,so far, and the transition is very smooth when I stop taking the adderall. It lasts for about 6 hrs for me, again I think because it boosts the effect of the wellbutrin, and I was told it would probably last 4- 5 hrs.
I have been extremely lucky to have gotten the drugs that work for me so quickly. Only one switch and I was set but my whole experience with getting diagnosed was very quick too. I'll tell you about it sometime lol.

Okay Cobweb: let me ask you this...(and Tom too, when you start taking the Adderall)...after you take the second dosage -- do you have any trouble sleeping??? (i.e. at night).. I would like to ask my doctor about another drug in addition to Wellbutrin...as I'd like to be able to focus a little better than I am...am in school trying to get a ton of work done...and it's hard sitting and doing all this stuff...and have never been on Adderall...but don't want to have the insomnia thing...ANY other side affects for you Cobweb besides the dry mouth? I mean dry mouth I can handle...I even have that on the Wellbutrin....But in any event am glad the Wellbutrin/Adderal combo is working so well for you and on such a low dose and also that you found something so quickly...that's all really great....

Joan

[atomx]

There's also the concept of the correct dosage "window" -- sometimes more isn't better. As the example of doing better on 150mg of Wellbutrin than on 300mg demonstrates...

Brains are complicated things. I can't wait for the day that medication prescription and dosing is a more exact science!

-- Tom

[atomx]

And one more thing The adult ADD specialist that I just recently went to was the one who suggested the synergic effect of Wellbutrin/Adderall etc. although I'd love to take credit for it. And, it's just a wild theory right now -- don't know if there's been any research done on the topic.

-- Tom

Tom -- oh my God -- you brought a chuckle to me...as one of my professors here at school would LOVE you if he could only here you say "if some is good, more isn't necessarily better" phrase...as he uses that in class ALL the time....when describing nutrients etc. He's really funny...an older guy, retiring in fact...and what he'll do in class is say, "ok class if some is good MORE is better RIGHT?" and the whole class will go "NO"..because we KNOW what HIS right answer is...which is no of course..more is NEVER necessarily better...anyway Tom..thanks...and you're right...400 mg of Wellbutrin is not necessarily than um 300..or whatever..there is something called what did you call it?? dosage range?? I forgot...sorry...and no I did not mean to give you ALL the credit for coming up with the wellbutrin/adderal combo but I sure willl give you the credit for presenting it here, okay?

And yes, science will come up with combos, dosage ranges, etc. just like with heart meds, cancer meds, etc. The amount medical doctors give of these meds is quite clear.....hmmmmmm.....YES...quite clear...and someday for mental illness meds it will be quite clear.....okay, enough said...

Joan

[mark]

Just another little tidbit about the anti-depressent effects of Wellbutrin (Buproprion) is that it is NOT one of the Tri-Cyclic class of anti-depressents The "tri-" means something about 3 rings of Benzine in the molecular structure. It is also not from the MAOI family of anti-depressents. But thats all that I recall, other than what everyone else here has already written.

Hi -- hi glad I caught this...from my standpoint, you are ABSOLUTELY right...NOT the tricyclics....i.e. elavil...which tend to cause an increase in appetite -- due to increased carboydrate cravings and hence weight gain among other symptoms and Wellbutrin is NOT an MAO inhibitor either...which if it were, everyone on it would have to be on a special diet -- a low tyramine diet...(cutting out cheese, wines, processed meats, and a few other things)...NO I think Wellbutrin if it had to be classified in ANY group would be an SSRI...working on increasing serotonin levels maybe -- at LEAST....but we (the researchers or whomever) from what I know -- don't even know that yet....??? Just my 2 cents...