EndGameNYC

You rang? You ask an excellent question, Nuudawn, and I have no ready or even satisfying answer.

My thoughts on this are informed by the history of psychopharmacology, economics, politics, experience, training, opinion, and what I've garnered from the few people in the field who make the time to consider this issue. But when have I ever allowed all that keep me from posting a good comment?

Wellbutrin was introduced in 1986, but was found to precipitate a high incidence of epileptic seizures at the originally recommended dosage, and was eventually removed from the market. It was re-introduced in 1989, and was immediately classified as an "atypical antidepressant," due to its dopaminergic properties. The modifier 'atypical' carries surplus meaning that tends to make some psychiatrists squirrely about prescribing it, but there are others reasons that have made them cautious, not the least of which was it's earlier history.

With the advent of Prozac in 1987, and then later SSRIs, psychiatrists and those treating depression believed they had reached The Promised Land. As some may recall, there was a great deal of hype around Prozac, what with an apparent abundance of stories from previously depressed people who claimed it changed their lives. And the side effects were not nearly as daunting as those associated with the earlier ADs. So the big pharmaceutical companies followed the money. Billions of dollars worth of research on SSRIs became the norm, and everyone was interested in finding "the next big thing." Relative to Prozac, the search was narrowed down to finding a "Prozac Lite," an AD that would have all the benefits of Prozac but without the nasty side effects, including but not limited to sexual dysfunction in men.

The earlier antidepressants, TCAs (tricyclic antidepressants) and MAOIs (monoamine oxidase inhibitors) carried many unwanted side effects. In the case of MAOIs, there were dietary concerns, among them red wine and cheese (of all things) identified as being extremely toxic, potentially leading to death, in addition to other adverse food and chemical interactions. Regular blood work was also required for safety concerns, including hypertensive effects. The MAOIs were the atypical ADs of their day, though there is evidence that they increased dopamine availability.

So Wellbutrin got a bad rap which it never fully shed, and things tended to get worse rather than better. As we all know, it's not easy to change first impressions. By increasing dopamine availability, we run the risk of triggering manic states that did not previously exist, sometimes causing patients to develop bipolar depression. An excess of dopamine is also implicated in schizophrenia, something that has been well-known and well-researched for decades.

Then came the increasing incidence of suicidal ideation and attempts associated with Wellbutrin, and the research dollars, never amounting to much in the first place, all but dried up. There was also the risk of successful suicide via overdose with Wellbutrin that further separated it from the SSRIs. Many of these events and conditions were greatly overstated, if only because they were so dramatic. Wellbutrin continues to have a relatively mild side-effect profile, and many people have tolerated it extremely well and will swear by it the way those in the early days of Prozac swore by that drug. One final oddity that I know about Wellbutrin is that there have been many reports that people often experience a tremendous sense of well being while drinking and using Wellbutrin, which is generally not considered to be a good thing. Some have described this state as similar to what happens when they've used cocaine, but without the edge.

Finally, controlled studies (some of which I've reviewed and can personally endorse) demonstrated that Wellbutrin had better success than the SSRIs for certain types of depression. Yet in the ever-competitive realm of psychopharmaceuticals, other studies demonstrated that Wellbutrin was only equally or less effective than SSRIs.

My personal experience with Wellbutrin was not a good one. As I've noted before, Wellbutrin eventually became marketed as Zyban for smoking cessation when controlled studies indicated that depressed people who were also smokers lost their cravings for smoking with relative ease. (More people with clinical depression tend to smoke as compared to the general population.) Though I wasn't smoking at the time, I abruptly lost my taste for coffee, which I'd been drinking for most of my adult life. I also found that I started craving leafy greens, carrots, and other healthy foods, in stark contrast to the high-carb, high-sugar snacks that depressed people crave, and in which we/they typically overindulge. I also experienced cravings for things I either rarely or never ate before. I imagine that what happens with some smokers on Zyban is that the taste and smell of burning tobacco becomes repellent and merely disgusts them.

I also had racing thoughts, hyperactivity, and anxiety while on Wellbutrin, so I thought it was best to try something different. (There are, also, at least two SSRIs that positively affect dopamine availability, Prozac being one of them, now that I think of it).

Though Wellbutrin has stood the test of time and experience as an effective AD, is considered to be extremely safe, and has a very mild side-effect profile (with no sexual side effects), it was never able to overcome its early struggles, making it increasingly difficult for serious researchers to further explore its benefits, one of which is weight loss and a generally not-unhealthy decrease in appetite.

silentrun

I was prescribed celexa after months of complaining to my doc about mood swings esp before my cycle. It works really well for me. They gave me welburtin once to quit smoking and I got incredibly paranoid on that one.

EndGameNYC

The same things that happen when you drink and you're not on SSRIs.

Mcribb

I take lexipro it seems pretty cheap and I didn't wake up with tons of anxiety like I was doing.

Pondlady

My doctor switched me to lexapro this Spring, from another anti d I'd been taking for around 13 years. It has helped my depression. I do suffer from mild anxiety..... so try to listen to calming music etc. at bed time.

Nuudawn

Thank you Endgame!! Very interesting indeed.

I couldn't help chuckling to your response to AO's question re alcohol whilst using SSRI's..

I chuckled because on my way home from my 3rd AA meeting of this sobriety, I pondered my over 15 year penchant for self help materials. And with that thought, I thought about how they warn to not drink whilst using anti-depressants...as they simply do not work.

I suddenly thought...why the hell did I read all that stuff whilst still drinking? I couldn't transform any of it into application really. I had all the theory but no application. I once read that information is not transformation without execution. How true.

Like anti depressants and drinking, self help books and drinking just doesn't work. I believe one cancels the other out really.

EndGameNYC

Yeah, before I got sober for the first time, many years ago, I was reading books on transcendental mediation, relationships, and self-confidence. Not self-help books, but books that I hoped nonetheless would help me in some ways, perhaps even allow me to continue drinking and smoking weed virtually every day, once I was able to master some of life's other difficulties. I probably tried meditating no more than two or three times, all the while of thinking about my next joint or drink, and with my eyes closed with little effort given to emptying my mind or focusing on my breathing. I was no better with relationships than before I read the books, and my self-confidence hit an all-time low, in part due to my "failure" to put into practice anything I was reading about. So I continued to drink and smoke while my life slipped farther away from me.

Next!

Nuudawn

There's the pearl right there. It has only been in the last couple days where I have been able to consciously, happily note the enlargement in my life that is sobriety. It that feeling of "it's all coming back to me now".

Sobriety, as passage, IS that dome car through the breathtaking Canadian rockies I took as a child (self indulgent Via Rail reference).

I do not want to get off the train again. Alrighty AO....sorry.

I have no experience with Lexapro. When I first entered this thread, I wanted to make some joke that my experience with Lexapro made me skinny, wrinkle free, upped my IQ and curiously, gave me new dance moves... just to make ya laugh.

I hope you are able to accept whatever is best for you...and find peace with whatever that choice is.

Needinghelp82

I take citalopram and have done, on and off, for nine yeas.

Due a review on meds but it did help a lot.