January 26, 2023

Wellbutrin, more commonly prescribed as the generic Bupropion, remains a widely prescribed therapy for depression. Popular in part because it may lead to less weight gain and sexual dysfunction compared to other antidepressants, it probably lacks significant major therapeutic advantages versus its competitors. While Bupropion may provide some relief, it neither cures depression nor completely eliminates the symptoms.

Hello i’m dr. ken land thanks for watching let’s talk about treatment of depression with wellbutrin that’s the trade name the brand name or bupropion that’s the generic name depression affects about fourteen million people in the united states and we don’t know what causes depression is it an environmental condition a developmental condition is it a genetic

Condition or is it as things are getting popularized in an epigenetic condition and what chemicals are involved in depression is it the serotonin or is it the noradrenaline or is it dopamine or what other kind of monoamine is involved in this condition i’m not exactly sure popularly people talk about how they’re depressed but in medicine you have to have symptoms

Basically every day for most of the day and you have to have at least five of nine symptoms and those symptoms include feeling depressed having a low loulou feeling tearful maybe having a decreased interest or pleasure and most activities sometimes there’s significant weight change go up or down change in your sleep pattern change in your level of activity maybe

You have fatigue or loss of energy feelings of guilt or worthlessness a decreased ability to concentrate or the feeling you want to commit suicide those symptoms you have to have at least five of nine of those and one of them has to be either depressed mood or a loss of interest now if you see the family doctor with those kind of symptoms chances are only 50/50

That you’ll have that diagnosis so the treatment is among other things wellbutrin or bupropion remember it is not the same thing as buprenorphine that’s to help get you off of the opioids when we’re talking about the antidepressant the wellbutrin or the bupropion it’s one of the most frequently used antidepressants in the united states and in canada it’s used

By itself or as an add-on medicine to one of the ssris selective serotonin reuptake inhibitors drugs like lexapro prozac zoloft it’s actually not sanctioned for that but frequently used it’s sold as wellbutrin to treat depression but the exact same thing is sold as iban to help get you off cigarettes doesn’t seem to work very well for that by the way the drug

Was initially discovered 1969 synthesized 1969 by a chemist at burroughs wellcome and then it went through a series of different owners now it happens to be owned by valeant pharmaceuticals the food and drug administration approved it as an antidepressant in 1989 in nineteen in 2003 it came out as the extended release form in 2006 it was approved for treatment

Of the seasonal affective disorder syndrome now the winter time depression it became very popular because it was thought that compared to the other antidepressants there was less weight gain taking this pill taking the wellbutrin or the appropriate that’s probably not actually true over the course of a year you lose about five pounds more than you lose with the

Placebo it was thought to make you less sleepy it was cause thought to cause less sexual dysfunction than the ssris actually that got him into a lot of trouble it was being promoted off-label and actually ended up with the owners of the drug at the time glaxosmithkline gsk ended up paying a three billion dollar fine because they were paying doctors and moving in

Dr. drew pinsky was involved in all of that there was a problem that they ended up getting their hands left well which of the antidepressants is best is it better if you take effexor or zoloft or lexapro or remeron or paxil prozac wellbutrin actually overall there seems to be relatively little difference it’s a trial and error approach it’s an equal opportunity

Disease affects people less than age 20 and more than age 60 affects women about three times more off than men and 10% of the people who take the drug take the wellbutrin or the appropriate you’re going to end up stopping it because of side effects adverse reactions to the drug seems to help with different aspects of cognition and mood and behavior so if you

Happen to have depression and sleepiness and fatigue maybe you would opt for bupropion rather than an ssri but if you have depression with some anxiety maybe the ssri drug like lexapro would be a better choice well we talked about response so if you happen to have a pneumonia you take penicillin you get better well if you happen to have depression and you take

An antidepressant whether it’s wellbutrin you proprio know one of the other drugs chances are you’ll have about 50% symptom reduction in about half of the people – maybe three-quarters of the people you’ll have remission in only about 1/3 of the people now compare that to sasebo where you have significant symptom reduction in somewhere between a quarter and a

Half of the people and we’re mission in somewhere between one in three and one in six now oftentimes people don’t get better with first antidepressant they take what the second antidepressant that they take question is the add-on or do you substitute for there’s no good data even today about this we rate depression on the hamilton depression score that’s a test

That you can take this test that has 21 items 17 of them are graded and you get a different kind of score score of those from very severe depression to severe depression moderate depression mild depression or normal it’s rated on depression your symptoms the type of symptoms you have so the same sort of symptoms that i spoke about a moment ago well that tells

Us how bad your depression is if you take wellbutrin and you have very severe depression statistically you’re going to end up with moderate depression if you take a placebo you’ll still have severe depression not very severe depression but severe depression that was done in several tests and we’ve come up with the same answer all the time symptoms do not go away

They just seem to get better now if you happen to have sad seasonal affective disorder syndrome and you know it’s going to come because it’s going to get to be wintertime you take the pills in advance you take them in the morning take it for several months and you take it throughout wintertime some people even take it forever now the mechanism of action we don’t

Know it prevents the reuptake of norepinephrine and dopamine so there’s more of that floating around the cell so we call it an atypical antidepressant also works on the nicotine receptor nicotinic receptor doesn’t seem to change the serotonin or the histamine or the acetylcholine actually it appears that this drug is altered inside the body to at least three

Metabolites and the metabolites are actually even more effective than the drug itself well how do you take it well you can take wellbutrin be appropriate in the regular immediate louise the sr and you take 100 milligrams twice a day then you go up to 103 times a day you can go up to 450 milligrams total takes about four weeks for the full antidepressant activity

Or if you’re taking the extended-release the xl version you take 150 milligrams then after four days you can bump it up to 300 milligrams its maximum dose again 450 milligrams caution if you have liver or kidney abnormalities should take it only if it’s absolutely necessary if you’re pregnant or bread feeding if you’re taking the drug you better not suddenly

Discontinue taking alcohol or a seizure medicine or a sedative because if you do then you might have a seizure the drug is the same thing as zyban so you shouldn’t combine the two and if you happen to take an mao inhibitor a drug like nardo or parney so allegedly and even then you shouldn’t take wellbutrin for at least two weeks on either side of it what are some

Of the side effects will more than one in ten people who take the drug going to suffer from dry mouth or nausea and saam near dizziness weight loss or some constipation other side effects include agitation or rash ringing in the ears third vision feeling tired changing your taste more urination than normal you don’t feel well you get restless or you have anxiety

It can increase your blood pressure it can activate the manic phase of bipolar disease so absolutely we used to call manic depressive disorder well if you take the drug it might increase the manic portion of the disease tell you about that at the moment also can cause a cute angle closure of glaucoma and people who have narrow angles the likelihood of a serious

Allergic reaction to the pill is relatively small but since we know it can cause seizures have to be very careful we know it can cause mania so if you have racing thoughts or excessive energy or you’re reckless in your behavior and pulse of you know take risks that you didn’t take the floor that might be a sign that you’re developing mania or hypomania obviously

Go see your doctor right away if you have any third vision tunnel vision you see halos around lights mm then you might be having that glaucoma part we talked about and certainly some people who take the drug can develop agitation or they can develop hostility or paranoia confusion interestingly the drug can cause a false positive test for methamphetamine major

Problem with the drug is the potential for suicide or suicide thoughts especially if you’re under age 25 when the drug originally came on the market back in the late 1980s there seemed to be an increased incidence of seizures associated with the drug but only with the immediate release form and only at a relatively high dose so it’s taken off the market for a short

Period of time now it’s back obviously there’s a problem with the epilepsy so anything that predisposes to epilepsy should mean that you shouldn’t take this pill so if you have the inner exci or bulimia if you have a brain tumor if you drink too much alcohol you’ve used benzodiazepines or if you’re withdrawing from alcohol or a benzodiazepine probably shouldn’t

Be taking these kinds of drugs you know it can lower the threshold seizure especially if you happen to be taking drugs that you wouldn’t even think could be associated with epilepsy so for instance if pro or corticosteroids or the tricyclic antidepressants or drugs like theophylline maybe for asthma or alcohol or again the abrupt withdrawal from alcohol or the

Benzodiazepine take this is not a drug for you to take so there is benzo i’m sorry a blue pro peon induced psychosis that’s where you can develop delusions or hallucinations or paranoia or confusions seem to be certain people who are at high risk so people taking a high dose people have bipolar disease people are taking lithium people who are older people who

Are abusing substances are at high risk now if you overdose on the medicine that’s a potential major problem because seizures can develop in a third of the people hallucinations loss of consciousness abnormal heart rate and then if you take another kind of medicines in addition you can develop fever muscle rigidity extreme fall and your blood pressure extreme

Elevation in your blood pressure stupor and coma and respiratory problems you can die from this stuff it’s metabolized to a series of other compounds that are actually active in the body and present and higher concentrations than the appropriate on and interestingly even though we’ve known about the drug for an awfully long time just in 2016 we found three new

Metabolites that also are very active in the body and they’re as important as the metabolites we knew about beforehand and interestingly the concentration in the body can range about fivefold different in different people so there’s a question about how the drug works how much of the drug is going to be in your system and if you happen to take certain kind of

Medicines that inhibit an enzyme used to metabolize the drug then you might end up with more drug in your system than you bargained for so if you happen to also be taking paxil or prozac or zoloft or you’re taking valium or even taking the appropriate on itself they all increase the concentration to be appropriate in the system on the other hand if you’re taking

Alcohol st. john’s wort if you’re taking dilantin or phenobarbital or even close i am is all because you have a yeast infection that can decrease the amount in the system well generic appropriate or wellbutrin came out in 2006 it was said to be bio equivalent but they only tested the 150 milligram pill they didn’t test the 300 loganville they just figured that

It was going to be the same thing just twice as much of it but unfortunately the delivery system was different it didn’t seem to be as effective it caused an increased incidence of seizures and people had headache and gastrointestinal disorders and fatigue and anxiety this was all reported in about 2007 vfb fda said now it’s just the natural variation of the

Disorder but actually they asked the drug companies to check to see if there was any problem drug companies didn’t do it so the fda took it upon itself it did it and by 2012 it found that oh my goodness the 300 milligram pill was not equivalent the generic wasn’t equivalent and the generic only by actually two different manufacturers out of 10 was not the

Same that problem has now been taken care of well some people say it helps for attention deficit disorder adhd teachers think it works the parents and the clinicians don’t think it works it’s not even a first or a second or third choice some people use it as an add-on treatment with the mood stabilizer and people who have bipolar disorder doesn’t seem to be

Any significant harm maybe benefit maybe not some people tried it for this continuation of cocaine use didn’t seem to work there’s very weak evidence that it’ll help you get off methamphetamine no evidence that it helps for low back pain no evidence that it really is good for neuropathies the cost of the medicine will however make you sick so if you want to

Take the brand name and you want the wellbutrin xl one month of therapy at 150 milligrams is going to cost you cash price $1400 and if you take the 300 milligram pill it will cost you cash about two thousand dollars now if you want to go get the generic product the generic product is going to cost you about with the coupon twenty two bucks or something like

That so valeant pharmaceuticals owns the brand name they charge almost $50 cash price for that pill the generic variety cost a dollar fifty now valeant pharmaceuticals has had some funny business that’s gone on they have the network of affiliated pharmacies that were using this drug selling this drug and there are quote unanswered questions related to some of

The business practices of valiant so the relationship has persisted even though they got in trouble several years ago because of a special relationship they had with philidor which was a specialty pharmacy that was selling some especially of their the logic products now even though valiant continues to raise the price of this drug that’s been available forever

Even though the number of prescriptions has fallen by about 50 percent over the past two years the revenue has risen by about a third just something because they keep jacking up the price not on the other hand if you want to take prozac with the coupon get that for between three and five dollars zoloft cost you that with the coupon nine bucks twelve bucks so in

Summary it seems that the antidepressants almost are a trial-and-error type drug you take one for a month or so if you have a depression you see if it helps if it doesn’t you can stop it start another one there’s nowhere near a hundred percent efficacy of any of these drugs and in fact if you have a 50% reduction in the symptoms you can consider yourself lucky

And that only happens in about half of the people who are taking the drug and unfortunately the symptoms are just reduced and if you stop the drug the symptoms tend to recur now fortunately there’s a lot of research being done in this area and hopefully we’re going to have some better therapies in the relatively near future thanks for watching i’m dr. ken landau you you

Transcribed from video
Wellbutrin By wellnowdoctor