Transcription
Hey everybody, it's Dr. Dave Psychiatry. Thanks for joining me in my new and rebuilt YouTube studio.
So, as you can see, I've got pretty much everything out except my special book that I have from Dr. Romano. That's in a box someplace. I have to find it, but I'll get that later. Thank you for all of your well wishes uh as we recover from the fire and get into the new office. Appreciate your comments and both on the internet and personally. So, thanks a lot.
Today I'm going to do a product specific video about a medicine called bupropion which you know typically as Wellbutrin. There's other brand names for wellbutrin. Um I think one of them is um a plenin which I don't use cuz it's brand name in 4550 which is the 450 milligram once a day. But basically wellbutrin is a medicine that we've used since the 1980s late 1980s. It's a great medicine. It works for a lot of people. And so we're going to talk about how I think about it, what it's used for, and hopefully that if you're taking it or thinking about taking it or you have friends who are taking it, you will understand more about wellbutrin, which is what I'm going to call the the brand name of generic buproprion. Bupropion. One of the problems with it is it's hard to say. Bupropion is the right way to say it. Sometimes I mess it up. So I'm just going to stay within even though that's the trade name. That's what I'm typically when I'm talking to patients I talk about. about wellbutrin and then I write for the generics.
So what is wellbutrin? Well, it is a norepinephrine booster. So I look at it in that way in the research literature. It is known more typically as a norepinephrine dopamine reuptake inhibitor which is listed as an NDRI. One of the confusing aspects of this is that when it first came out, it was referred to as a selective NRI, a selective norepinephrine reuptake inhibitor. Well, then they came out with so that was called an SNRI. Then they came out with duloxitine subalta, which was termed an SNRI, which meant serotonin norepinephrine reuptake inhibitor. So there's a lot of confusion about the SSRI, SNRI, SDRI, I think, or NDRI. Yeah, that's it. Lots of D's and Rs and I's that are confusing. So in my mind when I'm teaching to patients, I typically typically just talk about it as a norepinephrine booster.
Now, technically that's not actually true. Uh we know that willbutrin in works differently in different parts of the brain. So in the parts of the brain that uh dopamine is relevant then there is increased activity in dopamine activity due to wellbutrin but in my world typically I'm using norepinephrine boosting as the tool that is um intended to increase concentration attention focus but also treat symptoms of anxiety and depression. So really anything that is caused by low norepinephrine I use as a I use wellbutrin as a norepinephrine booster and it's really my lead tool for that. So very simply if your norepine activity should be in this normal range and if I believe you're low and we talk about that then I'm using willbutrin as your norepinephrine booster. So I sort of just want to bypass all those S's and D's and N's and Rs and I's and just talk about norepinephrine boosting.
Norepinephrine is made in a tiny little gland called the locus ceruius about less than half of an inch long and a um about a less than a quarter of an inch wide and it sits at the base of your brain and all it does your entire life is it makes this chemical norepinephrine and it's supposed to distribute it in the places that you need it in your brain and if you have low norepinephrine activity a lot of times that can cause problems with depression anxiety and also attention deficit disorder and so wellran is a medicine that treats all those conditions. So for people that have depression symptoms, depressed mood, low anxious, low energy, hopeless helpless, kind of concentrate thoughts of being dead that are driven by serotonin shortage, well norepinephrine isn't going to help. Alternatively, if their symptoms are caused by norepinephrine shortage, absolutely it's going to help. So a lot of times we only figure that out because we use two or three trials of serotonin boosters such as Prozac, Zolaf, Paxel and if we get failure failure failure then sometimes that indicates that might indicate that serotonin shortage is not the problem. You have something else norepinephrine shortage. So if we believe you have an oropinephrine shortage that causes depression then a trial of willbutrin a lot of times will prove that that's the case and willbutrin helps a lot of people that have sort of almost been pre-screened by treatment with the serotonin boosters what you call the SSRIs.
We also use wellbutrin when we have the uh situation of attention deficit disorder because it was really determined a long time ago that if low norepinephrine is your problem that's what causes us that's what causes attention deficit and ADD ADHD symptoms difficulty concentrating focusing paying attention and so the release agents that we've talked about in previous videos that cause release of norepinephrine from from the brain cells um those medicines like aderall and rtoolin well that that production or increase of activity of norepinephrine really doesn't have to do with production so the way I look at and the way I teach use of wellbutrin is that wellbutrin doesn't work right away it's it doesn't cause quick release of norepinephrine but there's something about it that increases that activity of the locoserius over time to help norepinephrine activity so really when we're using wellbutrin for the treatment of ADHD D the the downside of that is that it doesn't work right away. It takes several weeks to work. The upside of the of using Wellbutrin for attention deficit disorder is once it's in your system, you don't have to take it at an exact time during the day. So a lot of people that take a rolin, the timing of when they take their medicine is really critical. If they don't take it at the right time or if they forget a dose, that can cause a problem. But with Wellbutrin, once it's in your system for 5 days and and beyond that, then typically it stays in your system. And so you don't have to worry so much of the timing of the of the medicine. You could take it at 6:00 in the morning or 8 in the morning or 10 in the morning. As long as you're taking it once a day, then it should get the job done.
Also, the fact is because it does boost nor epinephrine. We almost always tell people to take Wellbutrin in the morning. Now, sometimes people say, "Hey doc, that medicine makes me sleepy." That's pretty rare. Um the most common side effect of Wellbutrin is that people feel sort of amped up. So, as in terms of side effects, it's often uh the the most common side effects, not that often, but the most common side effects are jittery, jumpy, nervous, sweaty, sweaty palms, some feeling feeling like you've had too much coffee, things of that nature. So, really overactivation is a picture of the major side effects. Of course, any any medicine can have any side effects, rash, you know, um allergic things like that. But the most common thing that we hear with Wellbutrin is really not gut issues or or anything like that. it's it's more um it's more related to overactivation.
One of the interesting side effects that you don't see with uh wellbutrin buproprion is the sexual side effects. When when we're talking about treating depression symptoms a lot of times when we use medicines like prozac zolaf paxol selelexapro then sexual side effects can be a problem. There's other videos on that that you can watch. And one of the things about wellbutrin is that we know that it typically does not cause sexual side effects. Furthermore, and we think this is related to the dopamine related uh boosting a aspects of wellbutrin. Sometimes we add wellbutrin to the medicines like prozac solopax seleapro the serotonin boosting agents. Sometimes we add wellbutrin to those to try to reduce the sexual side effects of those medicines. That doesn't always work. A lot of times we simply just have to change those other medicines. But sometimes if you add wellbutrin to the picture that helps sexual side effects.
Now, who shouldn't be taking Wellbutrin? Wellbutrin is pretty well tolerated by most people. It turns out that early early on in the in the investigation of whether or not Wellbutrin would be helpful, a group of people that had seizures was identified. And so, Wellbutrin is actually now contraindicated people that have a history of seizure disorder. The people that were noted to have problems with seizures during the investigation phase of wellbutrin were people that had bad eating disorders. That is to say bulimia or anorexia. So officially wellbutrin is contraindicated that is to say should not be used in patients that have a history of seizures or a history of eating disorders specifically bulimia or anorexia.
Now how often do people admit to that? Sometimes people don't talk about their eating disorders. People very uh often will talk about have seizure disorder and so I shouldn't be taking the mbutrin and that's absolutely true. Even though all of our medicines that we use in psychiatry typically increase the likelihood of seizures slightly except for the anti-epileptic drugs that we use for mood stabilization. But if you just talk about the big groups of the serotonin boosters and the norepinephrine boosters, those all tend to slightly increase the risk of seizures. But because of the original uh investigational findings when we when the approval for wellbutrin was being um developed, that was when this group of de of people who were having seizures was discovered. And so that's why we specifically have a contraindication for people that have eating disorders and taking wellbutrin. So if you have that question, if you have a history of eating disorder, if you have a history of seizure disorder, you should tell your doctor, you should tell me and we will just say, "Okay, fine. We need to try something else."
Do I believe that that Wellbutrin is more likely to cause seizures in the average patient in my practice? I typically don't. So if someone has a seizure when they're taking Wellbutrin, my first question is really not did the Wellbutrin cause it. My first question is something else cause it. And obviously that that was beyond stopping the wellbutrin what we want to do is make sure that that person gets into the hands of a neurologist so they can do investigations to see why somebody might be have a seizure. The most important one being some type of um abnormal mass in your brain which would be like a brain tumor or something of that nature. So it's not enough just to stop the wellbutrin. It's probably the next step is to make sure that that patient is evaluated by a neurologist.
It's important to say that anytime you have uh a medicine that responds or causes a positive response that we look at the chemical response as opposed to just the predicted response. What I'm really getting to is that there are a lot of patients that have terrible anxiety and wellbutrin treats those patients successfully. So we typically don't look at low norepinephrine as the reason for anxiety. But if we try multiple medicines, you know, Prozac, Selelex, Lexapro, Symbalta or the benzoazipines like Xanax, clamp and Adavan and patients still have anxiety. Well, a certain proportion of those people, they get better on wellbutrin. So why is that? Does that mean that Wellbutrin is an anti-anxiety medicine? Actually, I would not be the guy to say that, but I would say that in typical troubleshooting fashion, if you get better with a medicine that boosts norepinephrine and your symptom is anxiety and panic, that means that your anxiety and panic was caused by low norinephrine. So, if if if this is what's causing your anxiety and wellbutrin helps it, well, that's because that's what the medicine does. It typically it proves to us when we do that trial. though when patients have failed with the other quote anti-anxiety medicines as long as patients know that we're doing it in sort of just a research type fashion one-on-one with them then it's absolutely uh appropriate to try that and when they benefit from it well they're not going to argue and tell me that it's not an anti-anxiety medicine they're going to say hey doc thanks for helping my anxiety so again to summarize wellbutrin is a good once a day easy to take relatively low side effect nor epinephrine booster so any condition that is caused by low norinephrine here is likely to improve with a norepinephrine booster whether that's a depressive type scenario whether that's um an anxiety type scenario or whether that's an ADHD type scenario.
One last thing I would want to say is that um Zyan is one of the names that Wellbutrin was marketed as uh in order to treat smoking sessation. My personal experience with people taking Wellbutrin for smoking sessation is it didn't work long term. uh Zyban Wellbutrin was prescribed a lot a lot there was a lot of hope that it would help people not smoke it for some people they say that it it did decrease their desire for cigarettes but in general in my opinion Zyban did not prove itself to be really very useful in people quitting smoking so I'm not I'm not one of those people that recommends that that be that that be done if you've seen my video on on smoking sensation pretty much that technique the vape technique is the only one that I've seen long-term people get away from cigarettes. So, even though bupropran zyban was tried for that, even though if you tried it helps you, hey man, keep doing it. If it helps you, not no argument there. But in my experience with large groups of patients, it really did not prove itself to be very useful.
Okay, that's about all I'm going to say about Wellbutrin today. Cyban uh wellbutrin alensen um 4550 all the other names but generic buproprion little difficult to say but that's the one of the main norepinephrine boosters that I use in my practice every day I hope those insights are helpful obviously go to the university of the internet and read a lot of stuff but those are my insights and that's how I think about well be in my practice so I'm Dr. day of psychiatry. I hope that's helpful. Thanks for coming to see me today.