Talk:Bupropion

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Contents 1 Supposed Banning 2 References 3 Sustained and Extended Release 4 Psychic energy 5 Bupropion vs. modafinil 6 Wellbutrin + Pot 7 The Pill? 8 Side Effects 9 Snorting Bupropion Good/Bad 10 Methylphenidate Hydrochloride and wellbutrin sr ?????? high usage 11 Risks in tobacco withdrawal 12 Bupropion and insomnia 13 This pages looks too POV 14 Suicidal Thoughts 15 My experiences with the drug and some questions 16 My experience with Welbutrin. 17 Dosage? 18 Bupropion and MDMA 19 Budeprion SR Merge 20 Eating Disorders? 21 SR Bupropion and Seizures

[edit] Supposed Banning

http://www.antidepressantsfacts.com/Bupropion-not-prescribed-in-France.htm Sentence I'm removing: Wellbutrin is also banned or restricted from use in several countries. This is the only reference I have found to Wellbutrin/Zyban being banned.. anywhere. And that's not a ban. That's France recommending it not be prescribed as an anti-smoking agent. Not only is a reference needed to make that claim, but the only hint of a reference seems to suggest otherwise. A great many sites -claim- that it is banned, but no reputable sources do, nor can I find a list of countries to suggest such. Until I see something legal and/or legitimate, I am removing this sentence. AltonBrownFTW 04:35, 10 March 2007 (UTC)

[edit] References

Seriously. For example, where does it say that Bupropion has been shown to increase suicidal tendencies of kids? I'm looking for information on this and haven't found anything yet. It's my perception (MAY BE WRONG!) that the warning that gets dumped onto Wellbutrin about suicides is just coming from SSRI's being implicated (even though they are very different drugs). On the other hand, a friend started taking the drug and is having more suicidal visions than before. Anyway, I'm on a tangent. PLEASE GIVE REFERENCES PEOPLE! 129.215.16.12 20:15, 20 June 2006 (UTC)

Much of this seems to be taken verbatim from the instructions included with the drug which includes a special insert for using Bupropion with children and teenagers. There are numerous warnings in there about increased suicidal thoughts. Anyway, shouldn't the source of the entire article be cited?

The actual wardning states that nine antidepressants were studied, and describes them as SSRIs and others.4.234.120.220 02:30, 9 August 2006 (UTC)

Khan et al found no statistically significant difference between SSRIs, active control, placebo or other antidepressants (including buproprion) in terms of suicide attempts or suicidal ideation in their metastudy. Sample population slightly over 48.000 subjects.

Typically, the sources that cite an increase in suicidal ideation, suicidal behaviour and suicide attempts, cite a moderate increase (say 4% vs 2% for placebo) in suicidal ideation. For buproprion, there was a <1% incidence of treatment-emergent suicidal ideation in the profile I read.

HTH. Zuiram 02:07, 27 October 2006 (UTC)

[edit] Sustained and Extended Release

What's the difference between sustained release and extended release? --Galaxiaad 20:00, 24 August 2005 (UTC)

Nil. JFW | T@lk 21:22, 24 August 2005 (UTC)

False. SR is sustained release, usually taken twice daily. XL -- extended release -- is a reformulation designed for once-daily dosing.

[edit] Psychic energy

This sentance is a little suspect; "psychic energy"?:

Because patients with suicidal thoughts suffering from depression may experience a serious increase of psychic energy before remission of depression is encountered, these patients are at high risk of attempting suicide. If one decides to treat these patients with Bupropion, sedative drugs (benzodiazepines or Chlorprothixene) should be given additionally until remission of depressive disorder occurs.

24.31.191.41

I'll have a look. JFW | T@lk 19:38, 6 November 2005 (UTC)

It means you get the energy to get things done, yet your thinking still has not changed, so you are having negative thoughts and can act upon them. Unlike when you have negative thoughts and are depressed and do nothing at all because you have no energy for anything.

[edit] Bupropion vs. modafinil

Does anyone know whether the chemical structures of buproprion and modafinil have any similarities that would suggest similar behavioral/psychoactive effects? We are trying to determine if modafinil effects dopamine and/or norepinephrine systems in a manner similar to drugs like bupropion. Tribeguy13 16:35, 9 November 2005 (UTC)

Who is "we"? What is the hypothesis? JFW | T@lk 17:30, 9 November 2005 (UTC)

Buproprion is not really closely related to modafinil, and the behavioural and psychoactive effects are different. Modafinil affects DA and NE with a much higher Ki, and also affects histamine, oxytocin and others. Trying to determine the effects of a drug by examining its chemical structure is futile, unless you have a very good understanding of the structure of the receptor. AFAIK, none of the receptors have had their structure fully analyzed yet.

There is no need to attempt to determine the effects of modafinil on DA and NE, as it has been fairly well studied already. Have a look at the Ki-database for the constants of inhibition, and look up some of the studies for the receptor subtype specific information if that is relevant.

Zuiram 02:17, 27 October 2006 (UTC)

[edit] Wellbutrin + Pot

I've been on Wellbutrin XL 300mg for severe depression for over a year now. It seems to have an altering effect on what happens after I smoke pot. It enhances the euphoric feeling (described best as "floating") but occasionally gives me a rush of several mixed feelings all at once (happiness, saddness, agitation, the desire for tranquility, and fear [rarely]). My high also seems to be drawn out longer than smoking when I wasn't on Wellbutrin.

I've also had moments where I would be looking at something (such as a trail in a forest I was walking in) and it would trigger whole dreams to be replayed crystal-clear in my mind. The "something" also had a significant role in the dream, which is why I think it triggered these relapses. The dreams weren't even from recent times, either. All of the dreams I've had relapses of were from my childhood (like second grade) that had long since been forgotten. I usually feel overjoyed after remembering this or that dream.

I remember one time I even had auditory hallucinations right after smoking of a cat meowing and a dog barking from far away in my right ear and indoor laughter in my left ear, which lasted for about 10 minutes. It was strange because I was out at a park and nobody else was in the park aside from the two friends I had been walking with.

The only bad experience I've had has only occured a few times. It's a barrage of ideas, memories, and feelings all at once for about an hour or two. This is basically like an overload of my mind, and the only way I've delt with it is just to ride it through until my high is over.

A few people I know who have/had also been on Wellbutrin seem to describe the same types of things, but everything is subjective and varies a little from person to person.

The resulting psychological effect of mixing Wellbutrin with pot is now referred to by myself and my friends as "Wellbutripping." We hope this will catch on sooner or later :)

I didn't know where I could enter all of this on the article since it's subjective. Just thought I'd add my two cents to the discussion.

Kokekane9 19:17, 11 January 2006 (UTC)

Interesting experience. Perhaps submit to erowid.org ? --Pfh 01:59, 21 January 2006 (UTC)

Hookah smoking is much more pleasurable I've found since I've been on this.J. M. 21:04, 5 April 2006 (UTC)

How is the pot smoking affecting your depression? Does it make you more or less depressed?

I find it has a negative affect if the meds are actually working and making you feel better. I love smoking but when I can think clearly by myself (well with the meds) I feel like supressing that feeling makes me really anxious and aggrivated.

--> Um, I don't know if you should smoke pot while taking this drug. I mean who knows what can happen when they interact. Wellbutrin is a very powerful drug and so is THC and its family metabolites. Also, no one has done any studies on THC-budeprion interaction.

[edit] The Pill?

Anyone know if Wellbutrin interacts with The Pill In All Her Forms? (BCP)

[edit] Side Effects

It might be better if the side effects are listed in an order of prevalence. I know that dry mouth and insomnia are two of the more common side effects, but they're listed first and last in the list.

Are the dangers Zyban/Tobacco Withdrawl only or anti-depressant usage also?

What "dangers" are you referring to? The side-effect profile should be comparable, but both smoking and depression are associated with higher morbidity and mortality than zyban/bupropion is. Zuiram 09:00, 14 November 2006 (UTC)

This site lists common and uncommon side effects: http://www.something-fishy.org/doctors/medications.php#wellbutrin --Lewie 06:54, 30 June 2006 (UTC)

Sorry but that source is worthless for this article, as it does not list the relative incidence of these side effects. A better alternative would be:

[1]

I'll put that on my todo-list. Zuiram 09:00, 14 November 2006 (UTC)

[edit] Snorting Bupropion Good/Bad

I DID A LOT OF RESEARCH ABOUT BUPROPION. I FOUND IT TO BE A PSYCHOSTIMULANT. I HAVE ALWAYS BEEN LAZY UNMOTAVATED. THE FIRST BOTTLE I SUCKED THE COVERING OFF IT. I THEN CRUSHED IT UP AND SNORTED LIKE COKE I GOT A RUSH AND I WAS UP AND MOVING. BUT THE PROBLEM WAS INSTED OF TAKING 2 A DAY I WOULD SNORT 5 OR 6 A DAY OF THE 150MG. AT WHICH POINT I RAN OUT 3 WEEKS BEFORE MY REFILL.

THIS TIME I AM GOING TO TRY AND TAKE IT AS PERSCRIBED. I AM TRYING TO GET THAT FAST HIGH INSTED OF TAKING IT AS TOLD AND FEELING GOOD ALL THE TIME. PLUS MY NOSE WILL STOP HURTING.

PLEASE GIVE ME FEED BACK ON THIS!!!!!!!!
I HONESTLY THINK CANIBAS(WEED)IS THE BEST THING FOR ALOT OF MY PROBLEMS AND MANY OTHERS.
-- Master Chriztopher 09:21, 18 May 2006 (UTC)

Uhh... well, it is generally best to take medicines in the manner intended by your doctor. Snorting pills is generally of more recreational value than it is of any real medical value. As to the medicinal value of cannabis, I would direct you to that article and it's sub-articles (particularly the Medical cannabis article). Cheers AP

It's a great idea to snort bupropion if you want to have seizures. --Anon. 129.215.16.12 20:12, 20 June 2006 (UTC)

There are better things to snort.

That said, insufflation of prescribed medicines can have its (non-recreational) uses as well, e.g. to achieve a local effect from an otherwise systemic medicine. I wouldn't suggest experimenting with it, though, and your doctor will positively kill you if you ask him/her. ;) —The preceding unsigned comment was added by Zuiram (talk • contribs) 02:23, 27 October 2006 (UTC).

[edit] Methylphenidate Hydrochloride and wellbutrin sr ?????? high usage

judging by the other entries, this site is not used as a tool to assist foreign police forces, is this the case, I do not live in a Western nation. will information raised here be treated confidentially.

No, information here will not be treated confidentially by any stretch of the imagination.

Zuiram 02:24, 27 October 2006 (UTC)

[edit] Risks in tobacco withdrawal

When commenting on the references, please keep commentary to the actual findings reported in the references. In the study on sudden death and bupropion: The conclusion of the general practice case series study states: “bupropion is probably associated with a small increase in seizure rate, which is similar to that seen with most other antidepressants when used to treat depression, but there is no evidence to suggest that the drug is associated with an increased risk of sudden death, and our findings suggest that a hesitancy to use the drug on these grounds is unfounded.” It does not comment on risk of suicide - with a series of 9329 patients it would be notable if any had taken their own life whether using the drug at the time or not. ie The study was not designed to determine risk of suicide - so it cannot say there was an increased risk of suicide (just as it cannot say there was no increase ). Nogwa 13:37, 20 August 2006 (UTC)

[edit] Bupropion and insomnia

Has anyone any idea, whether this substance is being used for insomnia treatment? May-be in cases of depression-induced insomnia?Constanz - Talk 17:15, 18 September 2006 (UTC)

The use of stimulant medications in the treatment of insomnia is not exactly routine. Benzos, barbiturates, antihistamines and neuroleptics are the most common, depending on what else you have going on in your head, how long you've had insomnia, and how long the treatment is expected to last.

There are a substantial number of anecdotal reports of stimulants aiding sleep, though, and some doctors prescribe it.

Personally, when I was being treated with tranylcypromine and dexedrine (treatment refractory depression), I would usually take the last dose an hour or two before bed-time if I needed to sleep well. Dexedrine helps me fall asleep, and I wake up well-rested. YMMV.

When asking questions like these, it'd be great if people would include the reason why they are asking, as most people asking these questions are asking the wrong question. Not saying you are, but it'd be a great help in providing the right answer. Do you want to add something about it to the article, are you or someone you know suffering from insomnia, etc?

Zuiram 02:32, 27 October 2006 (UTC)

[edit] This pages looks too POV

I know it is the typical thing that people say when they first read an article that they dont like, but I have just viewed a BBC Horizon documentary "we love cigarettes" where they comment that trials of this drug have shown that it can increase the success in quitting smoking from 5% to 55%. It also seems that more thorough tests have shown that it is not so overwhelming but significant enough to gain FDA approval as a medicin to quit smoking.

Taking into account the horrendous statistics around smoking and its health risk, i.e. today 90.000 children tried their first cigarette, 50% of smokers will die as a result of the habit, or smokers die 10years younger. It does seem to me that far more information should be included.

As it stands, and at first glance, it seems to cast a highly negative view, as if it was another "bad" drug: Chronic hepatotoxicity in animals, Contraindications, Side effects, Abuse liability, Additional warnings,increase the incidence of suicidal thoughts, Potential indications of bipolar and schizoaffective disorder, Alleged Risks with certain treatments...

I do not question the encyclopedic value of all this information, but I think that ultimately we are about giving VALUABLE Information and this drug could help thousands of millions of people quit smoking and we should contribute by providing all the possible information to how it works and its success, in addition to discussing its side effects.

If I was the director of a Tobacco company I would be very pleased with the way the article is currently written. Im sure we can do better. 88.15.59.243 17:11, 21 October 2006 (UTC)

If you want to quit smoking, and can't do it on your own, ask your doctor for help. If you don't trust your doctor, you sure shouldn't trust any of the psychopharmacology articles on Wikipedia.

There are a zillion drugs that have some effect or other that is useful in conjunction with smoking cessation, notably MAOIs, stimulants, cholinergics and so forth.

Selecting the right one, working out supportive measures, planning the timetable for quitting, screening for possible interactions and adverse reactions, etc. is a lot more work than the average reader can reasonably cope with.

Bupropion is a great help for some people, both as an antidepressant, and as a smoking cessation aid. But WP is not, and with its current editorbase, cannot be, a guide to selecting drugs.

If you want to help people quit smoking (or, in my case, using snus), you'll want to make a cessation article, and link to it from pages such as nicotine and smoking. This page does a fair job of summarizing some important reference material, and to add anything substantial about its use for a particular purpose would mean a lot of text and tons of sources.

Zuiram 02:41, 27 October 2006 (UTC)

[edit] Suicidal Thoughts

The following under Side Effects is uncited:

Suicidal thoughts and attempts have been reported in children and adolescents.[citation needed] Reports of increasing suicidal thoughts have occurred.[citation needed]

It should probably removed unless there is some research to back it up. Suicidal thoughts are a symptom of the disease it treats, thus it would have to be heavily documented to make it a legitamite side effect of the drug.--Twintone 16:37, 30 October 2006 (UTC)

Suicidal ideation and attempted suicides have a greater incidence with drugs than with placebo for the initial phase of psychopharmacological treatment, at least with SSRIs and SNRIs (the ones that have been studied for this effect).

Based on this, a blanket warning has been issued by the FDA and other countries' counterparts, and this article is merely repeating that. This has been widely publicized, and there is no need to cite it. I'm not sure there is any need to keep it in there either, though.

The net suicidality during such treatment is generally low anyway, with one study citing 2% for placebo and 4% for the SSRI being tested. Significant? Yes. Alarming? Hardly.

Yes, suicidal ideation and behaviour is often a response to the disease, but these drugs sometimes bring it to the surface in people that have previously been perceived as not having such thoughts. The potential reasons for this are many, and the industry is generally content to leave it at providing the actual numbers. One fairly benign interpretation would be that twice as many people actually tell their doctors how they really feel once the treatment starts "opening them up", whereas one fairly malign interpretation would be that the drugs cause twice as many people to feel like killing themselves. Until we have some more solid data to base a conclusion on, these two interpretations, and the ones in between, are simply speculation, and we're stuck reporting the effect-statistics rather than anything about the cause.

Some have even implicated antidepressants in recent high school shootings and people going "postal", etc. Personally, I think they're just searching for someone to blame to make themselves feel better and to soothe the cognitive dissonance of "it won't happen to me" meets "it just happened", though I would venture that 5HT is perhaps not the best receptor to be messing with, especially since the effects are mediated further downstream by all accounts (D₂-upregulation and β-downregulation, mostly).

You could make a case that getting your hopes up, then having them torn down further, is a significant cause of these problems. Many describe being met by doctors that appear to not care about you, who calmly put you through the motions of their rx-list in a seemingly endless procession of switch-increase-increase-switch. That was my experience, and it almost cost one or more lives. Still, an anecdote does not demonstrate universal causality.

If you want to clear the text up, just replace it with something to the effect of the usual "The FDA has issued a warning that..." statement used in antidepressant PI sheets. Zuiram 20:18, 30 October 2006 (UTC)

I added a citation for the first statement from a NIH page. It is not original research, but it is a least a reliable source indicating the issue does exist in children. I also removed the second statement as it is totally unclear. Does it refer to adults? If it refers to children how is it different then the first statement? Master shepherd 20:06, 12 December 2006 (UTC)

[edit] My experiences with the drug and some questions

Im currently taking Wellbutrin XL 150mg and have been doing so for about 3 months. Im also taking Lexapro as well and have been on that for about 4 years. I was wondering what the interactions between these two drugs might be? I had each one prescribed by a different doctor because I moved off to college last year.

I was wondering where I could find out about the interactions of the two drugs. I was taking Lexapro for Depression and Anxiety and Wellbutrin seems to cause Anixiety(based on info from this article) so Im not sure its it being used as it should.

Ok, now for my side effects:

I can vouch for the insomnia. I am up all night every night. Even when I am dead tired. Of course I do have Afternoon classes and wake up at 11am, but Im often up from 2pm til 7am on a regular basis. My sleeping schedule has become very sporatic. Like today, for example, I was up last night from 9pm until 3pm. Then I slept until 1am. And now I am up and it is 3am EST right now. The sweating definitely happens as well. I occasionally(maybe 3-4 times a week) wake up in the middle of the night with sweats. And after I wake up my hands become covered with perspiration to the point that it can (and will) actually drip from my hands. I also have a tendency to feel dizzy and have fainting spells (possibly as a result of Lexapro; its page is not very informative) and I dont know if this is increased by this combination of drugs or not.

I occasionally take Excedrin or Advil for headaches and for the last ten days Ive been taking Sudafed and Amoxiclav for a Sinus/Ear infection. There have been no other drugs used by myself since starting Wellbutrin XL.

Yes, but I was wondering where I might find information about these two drugs and their relations because I have failed to find it through google and am once again coming to Wikipedia for rescuing.

Thanks,

Lamentingvampire09 08:18, 4 November 2006 (UTC)

Lamentingvampire, mail me, and I'll try to give you a good answer. Wikipedia is not the appropriate place for this discussion, as it is an encyclopedia, not a forum or community in that sense. Zuiram 23:41, 4 November 2006 (UTC)

[edit] My experience with Welbutrin.

I just wanted to chime in, that while I was taking this evil (imho) drug for depression (under the care of a doctor), I experienced extremely psychotic dreams, to the point of shooting, without emotion, 2 of my closest friends in said dreams.

I may also mention, that a friend of mine, taking the same drug at the same time, with the intention of quitting smoking (under a different doctor's care also) did litterally attempt to strangle his wife (fully conscious event).

And then, I ran out of money, 2 months into using this drug, and the co-pay didn't pan out. I was unable to obtain a refill, and thus forced to stop "cold-turkey". The effect of this, for me personally, was EXTREME depression, with suicidal thoughts. To sum up my feelings, it felt like every atom of the universe harbored a strong hatred of me, and wished me to become non-existant. Perhaps this sudden removal is what triggers the suicidal tendencies of other patients, especially in the case of juveniles who fake taking the drug as a rebellious action against authority (I know I did the same with the Obatan Forte (now banned, alike adverse side effects) that was being foisted on me as a child for hyperactivity, some 25-30 years ago). Then again there may be other reasons.

I just hope anyone who is considering using Welbutrin/Bupropion reads this, and considers their lot first, and may ask their doctor for an alternative. And to those of you who are facing sudden withdrawl, or are now worried about withdrawl... well, the vile effects are extreme for the first day, and are gone in three days (at least for me they were). Just hold on, it's not going to be fun, and cling to your logic.

Zaphod http://zaphodb.dyndns.org —The preceding unsigned comment was added by 69.145.40.116 (talk • contribs) 12:28, 3 December 2006 (UTC).

Quite honestly, what you've said here sounds no more than trying to scare people into not taking Wellbutrin without realising obvious things like: Not all drugs are for all people. I believe that my HMO generally puts people on Prozac as the first try for anti-depressants if there's no reason not to. Prozac did not work for me, but I'm never going to tell anyone that they shouldn't take it because they "will" have trouble with the side effects I had trouble with (no sex drive, insomnia/horrible sleeping patterns). However, I then learned that my family has a good history with Wellbutrin, although my father had experienced an unacceptable level of feeling cotton-headed and thus no longer takes it, while my grandmother continues to take 300mg daily. I switched to Wellbutrin as soon as I possibly could and I've enjoyed some of the more positive side effects (quitting smoking was damn easy and sexual activity is far more entertaining), as well as working very well for its prescribed usage.

The suicidal tendencies in the younger set who are prescribed any anti-depressant, not just Wellbutrin, is generally attributed to the fact that the drug "fixes" them enough that they have energy to be active again, but that their way of thinking has not yet changed, thus they now have the energy to carry out suicidal plans.

Also, again you have spoken without researching: Quitting any anti-depressant cold-turkey is going to screw you over. Anti-depressants affect your brain's chemistry, which is why patients are started at low dosages and moved up to a full dosage and then the same is done in reverse when getting off of the drug. I can entirely relate that Wellbutrin withdrawal isn't fun (I've forgotten to take all of my doses or take it at all) and I'm hoping my refill arrives soon, before I run out, and that I can step back up to my normal dosage.

Taking any drug without being fully aware of the side effects is stupid and no doctor should prescribe any drug without fully discussing the side effects with the patient, including what to do if some of the drug's nastier side effects are encountered.

128.153.197.122 03:42, 13 December 2006 (UTC)

Forgive me for being devil's advocate, but why are people posting experiences? Isn't wikipedia not experience based?--69.251.145.233 00:23, 2 January 2007 (UTC)

The above comment was made by me, i forgot to login.--Neur0tikX ^.talk 00:24, 2 January 2007 (UTC)

[edit] Dosage?

I'm curious where the information on the dosage forms came from, because the Wellbutrin I was prescribed does not fall into any of what is mentioned (my prescription is Wellbutrin SR, 100mg, manufactured by Watson, imprint code WPI-858). Any reference/citation anywhere for that? 128.153.197.122 04:09, 13 December 2006 (UTC)

[edit] Bupropion and MDMA

I tried an average dose of what I knew to be pure MDMA. All my friends "Rolled" But I did not. I take 300mg of Welbutrin XL daily. PErhaps they bind to the same receptor sites. —The preceding unsigned comment was added by 72.94.6.82 (talk) 06:04, 20 December 2006 (UTC).

Most likely, no. It's unlikely as Wellbutrin focuses more on the catecholamine reuptake, not serotonin. Although, if you happen to take antipsychotics such as seroquel or rohypnol it's likely that they interfered with your 'roll', so to speak. Of course, the culprit could be something completely nonpharmaceutical, MDMA interacts with the brain in a very specific way, hence, a roll can be offset by a number of things, as well as a trip. The antipsychotics also interfere with most 'trips', I believe some antipsychotics/neuroleptics are even given to persons who experience a bad trip as they interfere with the many receptors that LSD decides to erratically act on.--Neur0tikX ^.talk 00:29, 2 January 2007 (UTC)

[edit] Budeprion SR Merge

I have marked that the page Budeprion SR should be merged here and a redirect set. Master shepherd 17:36, 25 December 2006 (UTC)

[edit] Eating Disorders?

My doctors have been talking about putting me on Wellbutrin to treat my anxiety and depression. I'm reluctant to try ANOTHER medication, but hopeful at the same time because it's a completely different class of drug than they've ever tried with me before.

I'm just confused about one thing: this page says that common side effects include anorexia and bulemia. Yet I've spoken with about 5 or 6 people who have been prescribed Wellbutrin and all but one of them told me they gained weight on it. The two different doctors I've been conferring with also warned me that if I started taking it, I might experience weight gain. Only one woman I spoke with about it told me that she not only stopped smoking, she stopped eating as well. She said, "It made everything taste bad. I felt like I could taste all the chemicals and preservatives in everything, even water. I just couldn't eat and I really didn't want to smoke."

Regardless of the fact that I refuse to take anything that will make me fat (not to mention that I LOVE smoking my Newports), I'm wondering why there hasn't been anything in this discussion about this particular issue. Is that because it's not a common issue, or is it just like all the other side effects: it varies greatly from person to person? Any additional information on this subject would be greatly appreciated, as I'm supposed to start taking this stuff tomorrow morning. Thanks!

Kryssi Bee 22:56, 21 February 2007 (UTC) kryssi_b@yahoo.com

Hello. Anorexia nervosa and bulimia are contraindications, meaning that bupropion shouldn't be prescribed to someone who has one of those disorders (because, as it says in the article, the patient may have a lower seizure threshold, and bupropion already carries a risk of seizures). Anorexia is also listed as a side effect, but in this case "anorexia" refers to the symptom anorexia, simply meaning decreased appetite (see anorexia (symptom)).

As bupropion is a stimulant, I don't think it makes sense for it to cause weight gain or increased appetite, rather the opposite. In the prescribing information for Wellbutrin [2], it says that on 300 mg/day Wellbutrin SR, 3% of patients in the clinical trial gained more than 5 lbs. and 14% lost more than 5 lbs. I would presume that the reason people might associate weight gain with Wellbutrin is because the tricyclics and to some extent the SSRIs (i.e. almost all antidepressants) do have weight gain as a side effect (as well as weight loss... depends on the person). But I can't see how a stimulant would cause weight gain. People's weight changes regardless of what they're taking, and everything is required to be recorded in a clinical trial. That doesn't mean it's related to the medication (indeed, the percent who gained weight on Wellbutrin is not significantly different from that on placebo). So I don't think it should be added to the article.

As for smoking, like it says in the article bupropion is also used to help people quit smoking. I've never heard anyone talk about this as a negative thing though. ;)

For the article, maybe we need to clarify what "contraindications" means? --Galaxiaad 03:39, 22 February 2007 (UTC)

[edit] SR Bupropion and Seizures

I would argue for the removal of the part of the sentence stating that extended release formulations of bupropion were "intended to reduce the incidence of seizures".

Galaxiaad says that "it doesn't really make sense without saying the SR and XL formulations were intended to reduce incidence of seizures". I disagree for the following reasons.

The usual intent behind development of extended release formulation of drugs is to make life easier for patients, so that they have to take their medication once or twice a day instead of three times a day. This also helps to increase compliance.

The other reason for development of new formulations is so-called "brand life-time management". New formulations are intended to extend the exclusivity period for the drug on the market. They are often claimed to be better than the regular formulation, that is better than generic versions of the same drug. After the main drug patent expired, the patent for the new formulation would still be valid for several years.

This strategy worked beautifully for bupropion. The impression was created that Wellbutrin SR is not only more convenient, but also safer than the generic bupropion. As a result Wellbutrin SR was prescribed preferentially despite its much higher cost. However, the superior safety of Wellbutrin SR and XL in respect to seizures is nothing but drug representative spin. In their publications reputable Glaxo researchers are careful to state that decrease of the seizures incidence for extended release wellbutrin has never been proven clinically. ("Both the prolongation of Tmax and the decrease in the number of peak plasma levels may result in better tolerability, although this has not been formally evaluated." see Prim Care Companion J Clin Psychiatry 2005;7:106–113). I contend that this better tolerability will never be proven and it is impossible to prove, taking into consideration the pharmacokinetics of Wellbutrin SR and XL (see below).

It is generally accepted that peak concentration of the drug in the blood (Cmax) is responsible for the concentration-dependent side effects (as seizures in the case of bupropion). However, the Cmax of Wellbutrin XL (300 mg once a day) is only 3% lower than Cmax of immediate release formulation (100 mg, 3 times a day) and the difference is statistically insignificant (Prim Care Companion J Clin Psychiatry 2004;6:159–166). Glaxo released these numbers only recently, but of course they had known about them all along. And now you know too... Paul gene 00:12, 15 March 2007 (UTC)

Sorry, I misread the bit about immediate-release Wellbutrin. I didn't realize it was put back on the market. That's why I said it only makes sense if the sustained-release formulations were created to replace the IR with less risk of seizure. I was mistaken, though, so it's fine if you remove that bit.

However, I still have a couple questions. Did Glaxo actually claim that SR/XL were safer in their marketing, or just give a vague impression like it sounds like you're saying? If they did actually make that claim, and it's apparently not true, that may be worth saying in the article (especially the peak concentration thing; obviously "never been proven clinically" doesn't make it false).

And I don't know much about pharmacokinetics, but isn't it weird that there would be that little a difference in the peak concentration? (I mean, I guess 3 times a day would keep it pretty steady, but still...) I'm just curious. --Galaxiaad 00:41, 15 March 2007 (UTC)

Of course, Glaxo was careful to never claim outright that SR is safer only, that it "may be safer". Vague impression was sufficient in this case. It is usual tactics in pharmaceuticals sales, so it really does not deserve any mention in the article. Paul gene 09:55, 15 March 2007 (UTC)