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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by linkadge on June 8, 2004, at 10:07:27
I was just wondering what distinguises wellbutrin from ritalin as an antidepressant.
Don't they work similarly?? What makes wellbutrin special in that it can be classified as an antidepressant??
Linkadge
Posted by Sad Panda on June 8, 2004, at 11:17:41
In reply to how is wellbutrin an AD, and Ritalin not, posted by linkadge on June 8, 2004, at 10:07:27
> I was just wondering what distinguises wellbutrin from ritalin as an antidepressant.
>
> Don't they work similarly?? What makes wellbutrin special in that it can be classified as an antidepressant??
>
> Linkadge
>Hi Linkadge,
I would think that the sales section of a drug company determines what to sell it as. :) Ritalin is probably the better antidepressant & likely a much more usefull drug.
Cheers,
Panda.
Posted by King Vultan on June 8, 2004, at 12:29:48
In reply to how is wellbutrin an AD, and Ritalin not, posted by linkadge on June 8, 2004, at 10:07:27
> I was just wondering what distinguises wellbutrin from ritalin as an antidepressant.
>
> Don't they work similarly?? What makes wellbutrin special in that it can be classified as an antidepressant??
>
> Linkadge
Ritalin is classified as a Schedule II stimulant because of its abuse/tolerance potential, while Wellbutrin lacks the stimulatory effects of Ritalin and is classified as an antidepressant. In general, stimulating drugs that are problematic enough to be classified as controlled substances (amphetamines, Provigil, etc.) are considered to be stimulants rather than antidepressants.While both Wellbutrin and Ritalin act on dopamine (and norepinephrine), the critical difference is in the manner that they increase dopaminergic transmission. My doctor said that you can think of stimulants more or less as hammers in releasing dopamine (with the analogy taken to its extreme, cocaine would be a sledgehammer), while Wellbutrin is much milder, as if the dopaminergic pleasure centers of the brain were being gently brushed or caressed.
Wellbutrin is kind of a fluke antidepressant, as it is a dopaminergic drug with a pharmacology that winds up giving it antidepressant abilities without the typical tolerance and abuse problems of the stimulants. The only other dopaminergic antidepressant--that's available in the US, anyway--is the MAOI Parnate. While much less powerful than than the amphetamines and Ritalin, this drug does have some real stimulant character to it; although, it's apparently not enough to warrant classification as a controlled substance. Therefore, it is still considered an antidepressant.
Todd
Posted by Keith Talent on June 9, 2004, at 8:30:22
In reply to Re: how is wellbutrin an AD, and Ritalin not, posted by King Vultan on June 8, 2004, at 12:29:48
It is known that methylphenidate works by inhibiting dopamine reuptake and, at high concentrations, causing dopamine release. Bupropion's mechanism of action, on the other hand, is a bit of a mystery. Some papers say that its potency at inhibiting dopamine reuptake is far too low for THAT to be the mechanism of action. Some papers say that it causes release of noradrenaline. Who knows? From the complaints here at Psycho-Babble, it seems that bupropion increases anxiety without providing a useful energy boost (i.e. stimulation) nor much of an antidepressant effect.
So, I guess my answer is that bupropion is really NOT an antidepressant (very little anyway), but that methylphenidate is very commonly used to augment antidepressants, and can be used alone as an antidepressant (such as in medically ill patients).
Posted by King Vultan on June 9, 2004, at 17:11:22
In reply to Re: how is wellbutrin an AD, and Ritalin not, posted by Keith Talent on June 9, 2004, at 8:30:22
> It is known that methylphenidate works by inhibiting dopamine reuptake and, at high concentrations, causing dopamine release. Bupropion's mechanism of action, on the other hand, is a bit of a mystery. Some papers say that its potency at inhibiting dopamine reuptake is far too low for THAT to be the mechanism of action. Some papers say that it causes release of noradrenaline. Who knows? From the complaints here at Psycho-Babble, it seems that bupropion increases anxiety without providing a useful energy boost (i.e. stimulation) nor much of an antidepressant effect.
>
> So, I guess my answer is that bupropion is really NOT an antidepressant (very little anyway), but that methylphenidate is very commonly used to augment antidepressants, and can be used alone as an antidepressant (such as in medically ill patients).
>I tend to subscribe to the view that the metabolites of bupropion are what really need to be focused on, as they build up to enormous concentrations relative to the parent drug. In any case, it appears that bupropion's net effect is as a combined norepinephrine/dopamine reuptake inhibitor and might almost be looked at as a weak, weak version of the stimulants.
It also appears that it unfortunately winds up not being a terribly effective antidepressant because of a number of factors, including a relatively narrow therapeutic window and its tendency to cause agitation in patients who oftentimes have concomitant anxiety disorders. My own experience was that the agitation and insomnia were quite transitory and went away within a few weeks, but I really needed 300 mg/day to get an antidepressant effect, and this dosage induced extreme irritability after a few months on the drug. I found 150 mg/day to be completely worthless and 225 mg/day to not do much at all.
So in essence, I agree with you that it winds up not being much of an antidepressant, but it does have some applicability in certain situations. A co-worker with ADD is taking 2 x 200 mg/day of Wellbutrin SR and 2 x 15 mg/day of methylphenidate and finds that this combination works extremely well. There are apparently some people who can tolerate a high enough dose of Wellbutrin to get an antidepressant effect, but judging from this board, a lot of people seem to have problems with it.
Todd
Posted by Chairman_MAO on June 9, 2004, at 19:06:09
In reply to Re: how is wellbutrin an AD, and Ritalin not » Keith Talent, posted by King Vultan on June 9, 2004, at 17:11:22
My position on Wellbutrin is identical to King Vultan's. I'd like to add, however, that in the original clinical investigations of bupropion as an antidepressant, the dosage range used was 450mg-900mg (or perhaps it was 600mg-900mg, I do not remember). Now, in the Wellbutrin monograph, they note that it has CNS stimulant effects at 400mg and above. Coincidence? I believe that, at doses of 450mg and above, Wellbutrin probably is a much more robust antidepressant because it's essentially a dysphoric stimulant. That is, it makes you feel crappy if you take "too much" instead of elated, as the "stimulants" often do. This highlights an important point: the predominant ethos among misguided biopsychiatrists is that an antidepressant should only be capable of making people in the deepest depths of unending clinical depression feel less terrible; it shouldn't be capable of actually elevating mood. This view deprives many depressives of the medication they need to actually feel well.
This is the end of the thread.
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