side effects, dosage, reviews, how to take & discontinue, uses, pros & cons, and more
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Brand & Generic Names; Drug Class
|US brand name: Wellbutrin|
|Generic name: bupropion|
|Drug Class: Antidepressants|
|More on Generic & Worldwide Availability|
Wellbutrin’s Approved & Off-Label Uses (Indications)
US FDA Approved Treatment(s)Major depressive disorder. The extended release (XL) flavor is also approved for seasonal affective disorder (SAD)
Popular Off-Label UsesWeight loss, Bipolar depression, ADD/ADHD, Crohn’s disease, Restless leg syndrome (RLS), Pathological gambling, Treating SSRI/SNRI-induced sexual dysfunction.
Wellbutrin’s Usual Onset of Action (when it starts working)Usually two-three weeks. Like all antidepressants, especially reuptake inhibitors, you should give it up to a month, maybe six weeks, before giving up, barring any really nasty side effects or you can tell nothing positive is happening at all. Meds that work on dopamine tend to act quickly, so it could start having positive results in a few days.
Likelihood of WorkingPretty freaking good. The side effects or something else may make it suck too much to keep taking it, or there’s too much potential for trouble in the first place, but Wellbutrin is one of those meds that usually work. Sometimes a little too well.
How to Take Wellbutrin
Manufacturer’s RecommendationsGlaxo-Smith Kline (GSK) says this for the Sustained Release (SR) form:
Initial Treatment: The usual adult target dose is 300 mg/day, given as 150 mg twice daily. Dosing should begin at 150 mg/day given as a single daily dose in the morning. If the 150-mg initial dose is adequately tolerated, an increase to the 300-mg/day target dose, given as 150 mg twice daily, may be made as early as day 4 of dosing.
Increasing the Dosage Above 300 mg/day: As with other antidepressants, the full antidepressant effect 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, may be considered for patients in whom no clinical improvement is noted after several weeks of treatment at 300 mg/day. --the Wellbutrin PI sheet
The XL form has the same dosages, but with just one dose a day.
The only thing I don’t like is raising the dosage after three days. I really think you should wait at least five, preferably seven-eight days (see steady state below) before going up to the next higher dosage.
How to Stop Taking Wellbutrin (discontinue / withdrawal)
Based on its complex pharmacokinetics, your doctor should be recommending that you reduce your dosage by 100–150mg a day (for the more popular SR and XL forms, 75mg for the immediate release form), every 5–7 days (a week is just easiest way to keep track of things) if you need to stop taking it. There have been reports of more than the usual problems that come from stopping any crazy med abruptly, or just too quickly. These include mania (not uncommon when you stop taking antidepressants cold turkey), dystonia (painful muscle contractions & spasms).
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Pros and Cons
Low chance of sexual side effects, unless you consider making you hornier with or without premature/spontaneous orgasms sexual side effects. None of the weight gain associated with SSRIs & SNRIs. Often a very effective and relatively fast-acting antidepressant, as dopamine and norepinephrine reuptake inhibition are frequently part of, if not the answer for a lot of people.
Anything used recreationally, so it can be abused and has to be avoided by anyone with an eating disorder or other addictive behaviors. The abuse potential is a serious problem, as Wellbutrin is one of the few modern antidepressants that can kill you if you take too much.
Interesting Stuff your Doctor Probably didn’t Tell YouBupropion is also the active ingredient in Zyban, a drug used to quit smoking. Depending on your HMO schedule or your health insurance, you may want to get a prescription for Zyban. Why? Sometimes it’s cheaper. While mental health coverage is now supposed to be treated like everything else by health insurance providers, the pervasive anti-crazy bigotry guarantees that won’t be the case. While smokers are treated like second-class citizens, non-crazy smokers are still considered human and don’t get anywhere near as much shit as we do for taking drugs to quit smoking. And some insurance companies have a points system like car insurance. If you get too crazy, your rates go way up, but if you do something positive like try to quit smoking, your rates go down. So check with the person who works in your doctor’s office about the rates and the system, and see if you need to game the system with a prescription for the same drug with a different name and lower maximum dosage.
Best Known forRight now: Being marketed by Glaxo sales reps, and Dr. Drew, as the “happy, horny, skinny pill.”
Wellbutrin’s Side Effects
Typical Side EffectsAgitation, anxiety, insomnia, weight loss (it’s undergone trials both as, and part of, a weight loss medication), headache, dry mouth, nausea, constipation, dizziness. Most of these are transitory, but the weight loss, agitation and insomnia tend to stick around.
Uncommon Side EffectsStrange body odor, sweating, nervousness and tremor. Basically it could make you look like the guilty party, so you better have a damn good alibi at all times in case some big, unsolved crime goes down. Also: seizures.
Freaky Rare Side EffectsChange in hair color. They swore Lady Clairol wasn’t involved! There was also new hair, possibly in unusual places. Painful erections, unusual ejaculations, ballism, and outright impotence. You know you’re the butt of one of God’s little jokes if you become impotent or get one or more of the dick-pain side effects and hornier.
Side Effect Details.
TMI at times
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What You Really Need to be Careful About
Seizures, especially if you’ve either had seizures before (thank you Dr. Obvious), an eating disorder, or have recently stopped drinking a shitload of booze every day.
Half-Life & Clearance
Bupropion itself: 12–30 hours, each of its metabolites:15–25, 23–43 and 24–50 hours. Clearance: 4–12 days.
Pharmacokinetics Information Overload
Half-life is the average time it takes for you to process half of the drug’s active ingredient. If a drug has a half-life of around 24 hours and you take a dose of 100mg, you’ll have roughly the equivalent a 50mg dose after one day, a 25mg dose after two days, and so on. The rule of thumb is: multiply the half-life by five and you get how long it is for the dose you took to be cleared from your bloodstream, so there’s nothing swimming around to attach itself to your brain and start doing stuff1. That’s called “plasma clearance.” Complete clearance is a complex equation based on a lot of factors which may or may not: be published in the PI sheet, include personal data like your weight, or even completely figured out by corporate and independent researchers. It usually winds up being 2–5 days after plasma clearance no matter what2, but can take weeks. Sometimes a drug will clear from your brain and other organs before it clears from your blood. If we’ve found the complete clearance, or how to calculate it if it requires things like your weight and what your piss looks like, you’ll find that on the pharmacokinetics page.
How bupropion Works
the current best guess at any rateBased upon the Communications Interference Hypothesis of psychiatric and neurological conditions, bupropion effectively raises the norepinephrine and dopamine levels in your brain by letting your synapses soak in those tasty brain juices for longer than usual by slowing (inhibiting) the mechanism of norepinephrine and dopamine transmission deeper into the neurons (reuptake).
More than You Probably Ever Wanted to Know about How a Drug Works
AKA mechanism/method of action, pharmacodynamics
Ratings, Reviews, Comments, PI Sheet, and More
While Wellbutrin has the potential make you happy, horny, skinny, and quit smoking, it is only consistent at making you not depressed - which probably counts as happy so long as you don’t end up all irritable, anxious, and pissed off3 - and helping you to stop smoking, while being unlikely to make you gain weight or affect your libido. Weight loss and treating sexual dysfunction are off-label uses of Wellbutrin and, like most off-label uses, you only want to try it if the regular treatments don’t work, because the odds aren’t as good or the side effects are worse. Or both.
Really, Dr. Drew… oh, wait, Dr. Drew just took GSK’s money and told everyone the facts as they were known - like it is less likely to cause weight gain or sexual side effects than SSRIs - except for that part about taking a shitload of money from GSK. It was another doctor, who wasn’t as famous, who was repeating what the pharm reps were telling him about the happy, horny, skinny pill. Maybe. If you don’t need it to keep from falling to the floor in a fetal position and sobbing for hours if the newspaper reprinted yesterday’s sudoku. They should have known better than that.
There’s more news. The FDA pulled the approval of Teva/Impax 300 mg Budeprion XL.4 I have more information about that on the Generic Availability page, the Expanded Comments page, and in a topic about this on the Crazy Talk forum.
As if I didn’t go on long enough already.
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If you’re still feeling judgmental as well as just mental5, please boost or destroy my self-confidence by honestly (and anonymously) rating this article on a scale of 0 to 5. The more value-judgments the better, even if you can criticize my work only once.
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It’s always a good idea to check for drug-drug interactions yourself. Just because most people in the crazy meds business know about really important interactions (e.g. MAOIs and a lot of stuff, warfarin and everything on the planet) doesn’t mean the person who prescribed your meds told you about them, or the pharmacist has all the meds you take at their fingertips like they’re supposed to. Or they have the time to do their jobs properly when not dealing with complete idiots or playing Angry Farmers on the Faecesbooks.
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2 For crazy meds. I have no idea what the average complete clearance is for other types of medications. For all I know there are drugs that utterly vanish from your system in under five passes, and others that won't let go of your squishy bits for years after you stop taking them.
3 Along with other symptoms of a dysphoric mania. Not all manias are happy-happy joy-joy, kids.
4 Technically the FDA asked Teva & Impax to voluntarily remove Budeprion XL from the market, much like the way the IRS assists us in voluntary compliance with tax code. Go ahead, search irs.gov for the phrase "promote voluntary compliance", with or without quotes. I feel so much better about myself knowing I've been volunteering for my country.
5 Thank you! I'll be here all weak. Be sure to tip your content provider. And don't try the veal, it's cruelicious!
6 These include: Canada's Product Monographs (PM), New Zealand's Medicine Data Sheets (MDS), the EU's European Public Assessment Reports (EPAR), and the Summary of Product Characteristics (SPC) used in Britain, Ireland, and many other places.
If you have any questions not answered here, please see the Crazymeds Wellbutrin discussion board. I welcome criticisms of the articles, notifications of bad links, site problems, consumer experiences with medications, etc. I’m not always able to write back. Hence I never answer questions about meds via e-mail that are answered by this or other articles. Especially if they have been repeatedly asked on the forum. That’s why I write these damn things. I’m frustrated enough as it is. Questions about which meds are best for your condition should also be asked on the forum; because this is a free site, so the price of admission is making things easier for somebody else searching for the same answer. We don’t deal with children on the forum or in private because after doing this for ten years I don’t have the emotional stamina to deal with kids who have brain cooties. How to contact Crazymeds.
|Last modified on Friday, 28 March, 2014 at 03:02:38 by SomeMedCritic||Page Author: JerodPoore||Date created 27 March 2011 at 14:50:23|
Wellbutrin, and all other drug names on this page and use throughout the site, are a trademark of someone else. Look on the the PI sheet or ask Google who the owner is. The way pharmaceutical companies buy each other and swap products like Monopoly™ real estate, the ownership of the trademark may have changed without my noticing.
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Almost all of the material on this site is by Jerod Poore and is copyright © 2004, 2005, 2006, 2007, 2008, 2009, 2010, 2011, 2012, 2013, and 2014 Jerod Poore. Except, of course, the PI sheets - those are the property of the drug companies who developed the drugs the sheets are about - and any documents that are written by other people which may be posted to this site will remain the property of the original authors. You cannot reproduce this page or any other material on this site outside of the boundaries of fair use copying without the express permission of the copyright holder. That’s usually me, so just ask first. That means if want to print out a few pages to take to your doctor, therapist, counselor, support group, non-understanding family members or something like that - then that’s OK to just do. Go for it! Please. As long as you include this copyright notice and something along the lines of following disclaimer, I’m usually cool with it.
All rights reserved. No warranty is expressed or implied in this information. Consult one or more doctors and/or pharmacists before taking, or changing how you take any neurological and/or psychiatric medication. Your mileage may vary. What happened to us won’t necessarily happen to you. If you still have questions about a medication or condition that were not answered on any of the pages you read, please ask them on Crazy Talk: the Crazymeds Forum.
The information on Crazymeds pertains to and is intended for adults. While some information about children and adolescents is occasionally presented (e.g. US FDA approvals), pediatric-specific data such as dosages, side effects, off-label applications, etc. are rarely included in the articles on drugs or discussed on the forum. If you are looking for information regarding meds for children you’ll have to go somewhere else.
Know your sources!
Nobody on this site is a doctor, a therapist, or a pharmacist. We don’t portray them either here or on TV. Only doctors can diagnose and treat an illness. While it’s not as bad as it used to be, some doctors still get pissed off by patients who know too much about medications, so tread lightly when and where appropriate. Diagnosing yourself from a website is like defending yourself in court, you suddenly have a fool for a doctor. Don’t be a cyberchondriac, thinking you have every disease you see a website about, or that you’ll get every side effect from every medication1. Self-prescribing is as dangerous as buying meds from fraudulent online pharmacies that promise you medications without prescriptions.
All information on this site has been obtained through our personal experience and the experiences family, friends, what people have reported on various reputable sites all over teh intergoogles, the medications’ product information / summary of product characteristic (PI/SPC) sheets, and from sources that are referenced throughout the site. As such the information presented here is not intended as a substitute for real medical advice from your real doctor, just a compliment to it. You should never, ever, replace what a real doctor tells you with something from a website on the Internet. The farthest you should ever take it is getting a second opinion from another real doctor. Educate yourself - always read the PI/SPC sheet or patient information leaflet (PIL) that comes with your medications and never ever throw them away.
Crazymeds is not responsible for the content of sites we provide links to. We like them, or they’re paid advertisements, or they’re something else we think you should read to help you make an informed decision about a particular med. Sometimes they’re more than one of those things. But what’s on those sites is their business, not ours.
All brand names of the drugs listed in this site are the trademarks of the companies named on the PI/SPC sheet associated with the medication, sometimes on the pages about the drugs, even though those companies may have been acquired by other companies who may or may not be listed in this site by the time you read this. Or the rights to the drug were sold to another company. And any or all of the companies involved may have changed their names.
Crazymeds is optimized for the browser you’re not using on the platform you wish you had. Between you and me, it all looks a lot cleaner using Safari or Chrome, although more than half of the visitors to this site use either Safari or Internet Explorer, so I’m doing my best to make things look nice for IE as well. I’m using Firefox and running Windows 72. On a computer that sits on top of my desk. With a 23 inch monitor. Hey, at least you can make the text larger or smaller by clicking on the + or - buttons in the upper right hand corner. If you have Java enabled. Like 99% of the websites on the planet, Crazymeds is hosted on domain running an open source operating system with a variety of open source applications, including the software used to display what you’ve been reading. As such Crazymeds is not responsible for whatever weird shit your browser does or does not do when you read this site3.
No neurologists, psychiatrists, therapists or pharmacists were harmed in the production of this website. Use only as directed. Void where prohibited. Contains nuts. Certain restrictions may apply. All data are subject to availability. Not available on all mobile devices, in the 12 Galaxies Guiltied to a Zegnatronic Rocket Society, or in all dimensions of reality. Hail Xenu!
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1 While there are plenty of books to help you with hypochondria, for some reason there’s not much in the way of websites. Then again, staying off of the Internet is a large part of curing/managing the disorder.
2 Remember kids, Microsloth operating systems are like TOS Star Trek movies with in that every other one sucks way, way more. With TOS Star Trek movies you don’t want to bother watching the odd-numbered ones. With Microsloth OS you don’t want to buy and install the even-numbered ones. Anyone who remembers ME and Vista knows what I mean.
3 Have I mentioned how open source operating systems for commercial applications is one of the dumbest ideas in the history of dumb ideas?
[begin rant] I rent a dedicated server for Crazymeds. It’s sitting on a rack somewhere in Southern California along with a bunch of other servers that other people have rented. The hardware is identical, but no two machines have exactly the same operating systems. I don’t even need to see what is on any of the others to know this. If somebody got their server at the exact same time, with the exact same features as I did, I’m confident that there would be noticeable differences in some aspects of the operating systems. So what does this mean? For one thing it means that no two computers in the same office of a single company have the same operating system, and the techs can spend hours figuring out what the fuck the problem could be based on that alone. It also means that application software like IP board that runs the forum here has to have so many fucking user-configurable bells and whistles that even when I read the manual I can’t find every setting, or every location that every flag needs to be set in order for a feature to run the way I want it to run. And in the real world it means you can get an MBA not only with an emphasis on resource planning, but with an emphasis on using SAP - a piece of software so complex there are now college programs on how to use it. You might think, “But don’t people learn how to use Photoshop or Adobe Illustrator in college?” Sure, in order to create stuff. And in a way you’re creating stuff with SAP. But do you get a Bachelor of Fine Arts degree with an emphasis on Photoshop?
Back in the Big Iron Age the operating systems were proprietary, and every computer that took up an entire room with a raised floor and HVAC system, and had less storage and processing power than an iPhone, had the same operating system as every other one, give or take a release level. But when a company bought application software like SAP, they also got the source code, which was usually documented and written in a way to make it easy to modify the hell out of it. Why? Because accounting principles may be the same the world over, and tax laws the same across each country and state, but no two companies have the same format for their reports, invoices, purchase orders and so forth. Standards existed and were universally ignored. If something went wrong it went wrong the same way for everyone, and was easy to track down. People didn’t need to take a college course to learn how to use a piece of software.
I’m not against the open source concept entirely. Back then all the programmers read the same magazines, so we all had the same homebrew utilities. We even had a forerunner of QR Code to scan the longer source code. Software vendors and computer manufacturers sponsored conventions so we could, among other things, swap recipes for such add-ons and utilities. While those things would make our lives easier, they had nothing to do with critical functions of the operating system. Unless badly implemented they would rarely cause key application software to crash and burn. Whereas today, with open source everything, who the hell knows what could be responsible some part of a system failing. [/end rant]