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.
poster:Cam W.
thread:30772
URL: http://www.dr-bob.org/babble/20000420/msgs/30780.html