Wellbutrin
Wellbutrin (generic name: Bupropion) is an antidepressant medication that affects chemicals within the brain that nerves use to send messages to each other. These chemical messengers are called neurotransmitters. Many experts believe that depression is caused by an imbalance among the amounts of neurotransmitters that are released. Nerves, in a process referred to as reuptake, may recycle released neurotransmitters. Bupropion works by inhibiting the reuptake of dopamine, serotonin, and norepinephrine; an action that results in more dopamine, serotonin, and norepinephrine to transmit messages to other nerves. Bupropion is unique and unlike other antidepressants in that its major effect is on dopamine, an effect that is not shared by the selective serotonin reuptake inhibitors or SSRIs [for example, paroxetine (Paxil), fluoxetine (Prozac), sertraline (Zoloft)] or the tricyclic antidepressants or TCAs [for example, amitriptyline (Elavil), imipramine (Tofranil), desipramine (Norpramin)]. The FDA approved bupropion in December 1985. This medication is also manufactured under brand names Wellbutrin SR, Wellbutrin XL and Zyban.
Wellbutrin should be used cautiously in patients receiving drugs that reduce the threshold for seizures. Such drugs include prochlorperazine (Compazine), chlorpromazine (Thorazine), and other antipsychotic medications of the phenothiazine class. Additionally, persons who are withdrawing from benzodiazepines [for example, diazepam (Valium), alprazolam (Xanax)] are at increased risk for seizures.
Carbamazepine (Tegretol) may reduce the effect of bupropion by reducing the blood concentration of bupropion. Monamine oxidase inhibitors should not be combined with bupropion because of the risk of severe reactions. At least 14 days should elapse between discontinuation of an MAOI and initiation of bupropion. Bupropion may affect the action of warfarin (Coumadin).
Wellbutrin side effects
The most common side effects associated with bupropion are agitation, dry mouth, insomnia, headache, nausea, constipation, and tremor. In some people, the agitation or insomnia is most marked shortly after starting therapy. Some patients may experience weight loss. Uncommonly, patients may experience manic episodes or hallucinations. Four of every 1000 persons who receive bupropion in doses less than 450 mg/day experience seizures. When doses exceed 450 mg/day, the risk increases ten-fold. Other risk factors for seizures include past injury to the head and medications which can lower the threshold for seizures. (See drug interactions.)
Antidepressants increased the risk of suicidal thinking and behavior (suicidality) in short-term studies in children and adolescents with depression and other psychiatric disorders. Anyone considering the use of bupropion or any other antidepressant in a child or adolescent must balance this risk with the clinical need. Patients who are started on therapy should be closely observed for clinical worsening, suicidality, or unusual changes in behavior.