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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by SheilaC on January 16, 2011, at 17:09:04
I took Wellbutrin in the past (before I was on a mood stabilizer) and it made me manic.
I've been afraid of trying it again now that I am stable, but I have some residual depression I am trying to get rid of.
I have been using Adderall for my ADD and depression, but even at very low doses it messes up my moods. Just not good - very de-stabilizing.
My doc keeps suggesting Wellbutrin to me for my depression. But I am afraid it may be just as de-stabilizing as Adderall.
Is Wellbutrin more mild than Adderall? Now that I am on Geodon and stable, can I still become hypomanic on Wellbutrin?
I don't want to trade one form of speed for another and mess up my moods.
Posted by Phillipa on January 16, 2011, at 18:00:12
In reply to Wellbutrin milder than Adderall?, posted by SheilaC on January 16, 2011, at 17:09:04
Sheila only my personal experience. Was on wellbutrin for week and when saw the doc he felt I was hypomanic and put me in the hospital. And they took me off and it went away. Many others do quite well with wellbutrin. I was on benzos with it at the time. But seroquel is a lot stronger. Good luck with your decision. Phillipa
Posted by ed_uk2010 on January 19, 2011, at 16:14:40
In reply to Wellbutrin milder than Adderall?, posted by SheilaC on January 16, 2011, at 17:09:04
>Is Wellbutrin more mild than Adderall?
It's not possible to make that comparison I'm afraid - they are different drugs with different mechanisms of action.
Posted by MissThang on January 21, 2011, at 0:36:43
In reply to Wellbutrin milder than Adderall?, posted by SheilaC on January 16, 2011, at 17:09:04
I would imagine the wellbutrin would have a more stabilizing effect on your mood than adderall, especially taken in the xl version. Also, as the last poster noted, it's not really a speed type drug, it's just one of the more stimulating antidepressants that can cause mania in BP patients.
Adderall is more likely, imho, to cause spikes and crashes than wellbutrin by far. If it were me, I'd give it a month's trial anyway.
Posted by bearfan on January 25, 2011, at 16:16:26
In reply to Wellbutrin milder than Adderall?, posted by SheilaC on January 16, 2011, at 17:09:04
If you can tolerate it well, (Wellbutrin is known to have a rough start up), then it should 'theoretically' be similar in effect to a stimulant like adderall after about a months time. If taken consistently, there would be less of a crash as well.
Posted by gritslad on January 26, 2011, at 20:14:26
In reply to Wellbutrin milder than Adderall?, posted by SheilaC on January 16, 2011, at 17:09:04
Funny my doc and I just talked about many of these drugs today. Since I just came off of some kind of episode when we tried replacing Prozac with Luvox, I'm not trying anything now. BUT in the future we talked about Wellbutrin or Abilify.
Right now I take Prozac and Lamictal daily and Adderral when I have to focus, and Ambien or whatever sleep stuff she wants me to try as needed.
She thinks my previous diagnosis of Bipolar D is really just anxiety to the extreme, so when I'm brave enough to experiment again, we'll try the Abilify or Wellbutrin.
Posted by Chairman_MAO on February 3, 2011, at 14:52:44
In reply to Wellbutrin milder than Adderall?, posted by SheilaC on January 16, 2011, at 17:09:04
What are we treating here?
Cholinergic drugs like galantamine (Reminyl) are antimanic and enhance cognition. You might be able to take Adderall with the addition of e.g. galantamine. Tread with caution, though, because they can also induce [agitated] depression (not mania usually, AFAIK). Roughly speaking, acetylcholine and dopamine counterbalance each other. This is why anticholinergic drugs are given for dyskinesias, etc. Worth talking about.
Have you tried Ritalin?
Posted by bodhisattva_guy on February 6, 2011, at 4:14:19
In reply to Re: Wellbutrin milder than Adderall? » SheilaC, posted by Chairman_MAO on February 3, 2011, at 14:52:44
Bupropion cannot be milder or stronger than adderall because these two medications work on different receptors. Furthermore, bupropion can become as stimulating as adderall if the dose is large enough. I've experienced psychosis-like paranoia while on bupropion. This can also happen on adderall, so it is hard to say which is milder. They belong to different group of medications.
[doc] type
http://www.unc.edu/~novick/bupropion.docexcerpt from:
"Chemically Correct: Bupropion
By
Andrew Novick"Hopes this helps:
wellbutrin chemical formula: http://upload.wikimedia.org/wikipedia/commons/0/03/Bupropion_numbered.png
dextroamphetamine: http://cerhr.niehs.nih.gov/evals/stimulants/amphetamines/amphetamine.gifDopamine
Bupropion has relatively weak yet selective affinity for the dopamine re-uptake pump (4). Its much weaker than cocaine as an inhibitor of dopamine re-uptake (5), and even sertraline (which is considered a Selective Serotonin Re-uptake Inhibitor) has a stronger in vitro affinity for the dopamine transporter (4). Yet, despite bupropions lack of potency, meaningful dopaminergic activity appears to take place, as bupropion can effectively substitute in rats for a plethora of dopaminergic stimulants from cocaine to methamphetamine (6,7). In vivo, bupropion increases interstitial dopamine concentrations (8), can prevent dopamine depletion from the neurotoxic effects of 6-hydroxydopamine (9,10), and increases dopamine transporter mRNA expression (11).
Bupropions dopamine controversy comes into focus when we see that when given to humans at actual clinical dosages, bupropion fails to significantly occupy the dopamine transporter compared to placebo (12). Also, unlike other dopaminergic drugs, bupropion doesnt affect prolactin and growth-hormone levels in humans at clinical dosages (13). Furthermore, if bupropion did have pronounced dopaminergic and stimulant qualities, it might be expected to appeal to stimulant abusers. However, at therapeutic dosages, experienced stimulant users have a hard time distinguishing bupropion from placebo (14). Yet at dosages slightly above the usual therapeutic level, bupropion does produce mild amphetamine and liking effects in test subjects (15).
Probably the best conclusion that can be drawn from this conflicting research is that because of bupropions weak affinity for the dopamine re-uptake pump, pronounced dopaminergic activity doesnt kick in until the higher dosages.
Noradrenaline
Bupropions affinity for the noradrenaline re-uptake pump is approximately half that of its affinity for the dopamine pump (16). Despite being less potent at inhibiting noradrenaline re-uptake, most of bupropions antidepressant action is attributed to its noradrenergic mechanisms (17). How can this be? Bupropions active metabolite, hydroxybupropion has almost equal affinity for the NA re-uptake pump as bupropion yet its concentrations during clinical treatment reach 6-fold that of the parent drug (17). This increase in concentration would make up for the lack of affinity and thus cause meaningful inhibition of NA re-uptake, even at therapeutic dosages. Hydroxybupropion has been said to be more antidepressant and less stimulant due its noradrengeric mechanism with lack of dopaminergic action (18). But well talk more about hydroxybupropion and other metabolites later.
Bupropion downregulates beta-adrenergic receptors (a trademark of most antidepressants with NA activity) and decreases NA stimulation of adenylate cyclase (19). It also reduces the firing rate of NA neurons, a phenomenon which can be reversed by the administration of adrenergic antagonists (16,20). There is also evidence that bupropion increases the release of NA from the synapse (20).
Serotonin
Traditionally, bupropion was thought to have no action on serotonin, being that its affinity for the serotonin re-uptake pump is negligible (21). However, a more recent study has demonstrated that bupropion increased the firing rate of serotonergic neurons, possibly by an NA facilitated mechanism (20).
Also of interest might be the synergistic role that serotonin itself can play with other neurotransmitters and how this could apply to bupropion. Fluoxetine (better known as Prozac, a serotonin re-uptake inhibitor) can greatly potentiate bupropions extracellular increases of dopamine and serotonin (22). There is some evidence that fluoxetine itself can be used for weight loss (23), and a bupropion-fluoxetine combination would resemble the once popular noradrenergic-serotonergic combination Phen-fen.
Nicotinic
Bupropions efficacy as an anti-smoking aid can be attributed to two reasons: 1) bupropion acts as a nicotine substitute (24,25) and 2) bupropion acts as a nicotinic antagonist (26). Besides sharing similar stimulant properties with nicotine, bupropion has modest selectivity for neuronal nicotinic receptors, particularly blocking activation of alpha(3)beta(2), alpha(4)beta(2) and alpha(7) neuronal acetylcholine nicotinic receptors, thus blunting the effects of nicotine. (26)
Pharmacokinetics (15)
When administered orally, peak concentrations of bupropion occur within 1-3 hours and 84% of it is bound to plasma protein. The half-life of bupropion is anywhere from 10-21 hours. It is metabolized in the liver to form three active metabolites: hydroxybupropion, threohydrobupropion and erythrohydrobupropion. Hydroxybupropion is the most potent of the metabolites and has a half-life of 20-25 hours. As stated earlier, hydroxybupropion concentrations reach several times that of the parent drug. Elimination occurs mainly through the urine.
Posted by jjjaspar on February 6, 2011, at 11:57:48
In reply to Re: Wellbutrin milder than Adderall?, posted by bodhisattva_guy on February 6, 2011, at 4:14:19
For attentional difficulties in psychotic or potentially psychotic illnesses, Wellbutrin is considered "safer" than a stimulant such as Ritalin and Aderall. Wellbutrin still has the potential for some side-effects such as potentially causing anxiety or causing mania, but the stimulants are contra-indicated in psychotic illnesses and in families with psychotic illnesses as they can cause psychosis.
Another alternative for attentional difficulties is the use of medications such as Provigil and Nuvigil. They, too have potential for bad side-effects such as anxiety and even psychosis, but more rarely than the amphetamine-like stimulants (Ritalin and Adderall).
There are also non-prescription supplements that may help - fish oil, rhodiola, and such, but of course there are contyra-indications for each and any choice should be in conjunction with a physician.
Consider books such as "Fix the Broken Brain" by Hyman and "It's Not Mental" by Wolfson.
Here:
http://www.lef.org/magazine/mag2009/mar2009_Mark-Hyman-Healing-Broken-Brain-Syndrome_01.htm
http://itsnotmental.blogspot.com/So the bottom-line answer is yes, Wellbutrin is considered "milder" for something like ADHD (or attentional difficulties caused by psychosis, lack of sleep or the underlying cause of the mental illness) than Adderall, and safer especially if there is a possibility of psychosis. But that does not mean it is "right" for everybody.
This is the end of the thread.
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