In 2000, sales representatives from the big pharma company GlaxoSmithKline gathered in Las Vegas to party and to learn how to promote “the sexy, horny, happy drug” called Wellbutrin. Unlike competing antidepressants, Wellbutrin does not cause a decrease in libido. In fact, patients were providing anecdotal evidence that they were having better sex than ever on the drug — one middle-aged woman reported having an orgasm that lasted on and off for two hours. Not only were people happier and sexier on Wellbutrin, the drug could also help some patients lose weight. The sales reps went home to promote “the sexy, horny, happy drug,” with a little help from TV’s “Dr. Drew.”
Twelve years later GlaxoSmithKline paid a fine of about one billion dollars for the fraudulent marketing of Wellbutrin, which by that time had generated more than $6.6 billion in sales. Wellbutrin had been approved by the United States Food and Drug Administration in 1989 for major depressive disorder and later for Seasonal Affective Disorder, but not for weight loss, drug addiction and sexual dysfunction. GlaxoSmithKline had allegedly bribed doctors to prescribe the drug off-label for these purposes, offering them expensive vacations and spa treatments. Dr. Drew apparently received $275,000 to promote the drug without appearing to be a paid spokesman for the company.
It was not the first time GlaxoSmithKline got in trouble with authorities over Wellbutrin. Just two years earlier, the company paid out $400 million to defend itself for allegedly marketing and falsely promoting the drug as a weight loss product.
Wellbutrin has frequently ranked in the top five of all sales of antidepressants, and some years doctors wrote out over 20 million prescriptions for Wellbutrin. Antidepressants are the most popular category of drugs, and almost 11% of all Americans are on them. These drugs — sometimes called “cosmetic pharmaceuticals”– are promoted as ways to improve personality the way cosmetic surgery can improve appearance. Since young people are using antidepressants in record numbers, their sales will probably keep increasing, even though many experts believe that these antidepressants are probably ineffective for the majority of people.
What Is Wellbutrin?
Wellbutrin is the trademarked name of a drug whose active ingredient is bupropion. The two most frequently prescribed bupropion products are Wellbutrin and Zyban, which are manufactured by GlaxoSmithKline. In 2010 the FDA withdrew a generic version of bupropion after the agency’s own study found that it was not as effective as the trademarked Wellbutrin.
Bupropion does not work the way other depressants do. Monoamine oxidase inhibitors, such as Nardil and Parnate, were the first type of antidepressant. They work by changing the levels of an enzyme called monoamine oxidase, which in turn inhibits the reuptake of serotonin and dopamine, brain neurotransmitters associated with feelings of pleasure . Selective Serotonin Reuptake Inhibitors (SSRIs) such as Prozac, Zoloft, Paxil and Lexapro stop serotonin from going back into its cells of origin, and therefore increase its level in the brain. Serotonin–Norepinephrine Reuptake Inhibitors (SNRIs) such as Cymbalta, Effexor and Pristiq prevent the absorption of serotonin and norepinephrine, which are brain chemicals that affect how nerve cells communicate with each other. The latest research is indicating that depression may not be just a matter of having a shortage of these two chemicals, as previously believed.
Bupropion does not affect serotonin, but it does increase levels of norepinephrine and dopamine, although no one is exactly sure how. Its chemical formula is C13H18ClNO•
Besides Zyban and Wellbutrin, other trademarked names for bupropion products are Aplenzin, Budeprion, Forfivo, and Zyban.
The U.S. Department of Justice does not classify bupropion as a controlled, addictive substance.
What Are the Medical Uses of Wellbutrin?
The U. S. Food and Drug Administration has approved Wellbutrin for major depressive disorders and Seasonal Affective Disorder. A 2010 study published in the Journal of the American Medical Association found that antidepressants such as Wellbutrin are probably ineffective for patients with only mild depression.
Zyban is the same drug as Wellbutrin, but Zyban is been approved only for people who are trying to quit smoking. Zyban and Wellbutrin are often used interchangeably because some insurance policies will cover antidepressants like Wellbutrin but not medications for smoking cessation, and other insurance policies will cover Zyban but not Wellbutrin. Therefore, some people are actually taking Wellbutrin to quit smoking or Zyban for depression.
Wellbutrin is sometimes prescribed off label for attention deficit disorder/hyperactivity and for the depressive stage in bipolar disorder. Some doctors prescribe it as an “add on” drug to enhance the effects of an antidepressant like Zoloft, for example, or because Wellbutrin can counteract the unwanted sexual side effects of certain antidepressants.
Wellbutrin comes in tablet form. The most common dosage is one 100mg tablet taken twice a day, which can be increased to 100mg three times a day or even up to 450mg a day. Wellbutrin SR tablets are taken twice a day, and the extended release ones can once a day.
It can take up to six weeks for Wellbutrin to be effective in some people with depression; however, this is not true of Zyban.
Does Wellbutrin show up on urine tests?
Bupropion like most antidepressants will not show up on routine urine tests given at work or schools. However, specialized urine tests and blood tests do exist that will detect the drug. The blood tests are used most commonly when you are showing signs of a drug overdose and go to an emergency room. Bupropion has a half-life in the body of nine to 21 hours, depending on which form of the drug you were taking. The extended release version takes longer to metabolize and therefore has a longer half-life.
What Are the Side Effects of Wellbutrin?
The side effects of Wellbutrin can depend on how much you take. After the drug was approved as an anti-depressants in 1985, the FDA withdrew it from the market because too many patients were experiencing seizures. Subsequent studies found that you were more likely to have seizures if you took Wellbutrin at 400mg or 600mg. The drug was reintroduced into the marketplace to be sold at lower dosages in 1989.
One study found that 14% of those taking the 400mg dose and 9% of those on 300mg discontinued Wellbutrin because of severe side effects.
At 300mg, people are more likely to experience loss of appetite, dry mouth, rashes, sweating, ringing in the ears, and tremors. At 400mg, side effects can also include agitation, anxiety, dizziness, muscle pains, heart palpitations, sore throat, and more frequent urination. Not everybody gets the same side effects. For example, studies of patients taking bupropion at 400mg found that the following percentages experienced the following side effects: headache (26%), dry mouth (24%), insomnia (16%), dizziness (11%), and agitation, weakness and abdominal pain (9%). Between five and six percent had sweating, heart palpitations, weakness, frequency of urination, anxiety, tremors, nervousness, constipation, and ringing in their ears.
Some people have rare but serious side effects such as hallucinations, psychosis, paranoia, extreme hostility, inability to sit still, excitement, irrational fears, and other problems. They usually have to stop using bupropion.
What Are the Risks and Dangers of Taking Wellbutrin?
ellbutrin and Zyban can activate mania and cause weight loss or weight gain, hypertension that needs treatment, and hepatic and/or renal impairment.
A 2006 study from Duke University that lasted three years found that men with coronary artery problems were slightly more likely to have fatal heart attacks if they were taking antidepressants.
Wellbutrin and Zyban can cause birth defects if used during pregnancy.
Some people are allergic to Wellbutrin and Zyban, and may experience a life-threatening reaction the first time they take these drugs. Their symptoms might include shortness of breath, rashes, hives, itching, swelling of the throat, lips and face, difficulty breathing, changes in heart rate, and so forth. The person requires immediate emergency treatment.
About 20% of people who take bupropion drugs will experience a withdrawal syndrome that can last several weeks and produce unpleasant symptoms.
What Drugs Interact with Wellbutrin?
Wellbutrin and Zyban should never be combined with monoamine oxidase inhibitors (MAOIs) because of a potentially fatal reaction. In fact, these drugs should not be taken within 14 days of one another. Some brand names of MAO antidepressants are Marplan, Nardil, Emsam, Eldepryl, Zelapar and Parnate.
Bupropion products should not be taken with other antidepressants, beta blockers, drugs to prevent blood clots, sleeping pills, antihistamines, sedatives or medications for diabetes, mental illness, seizures, or irregular heartbeat. Do not take bupropion with SSRIs like Prozac or Zoloft or tricyclic antidepressants, such as amitriptyline. Do not combine these drugs with illegal narcotics like heroin or prescription narcotic pain killers, such as OxyContin. Do not use them with stimulants, such as cocaine, coffee, energy drinks, methamphetamine, or Sudafed.
Wellbutrin enhances the effects of alcohol, and alcohol enhances the effects of Wellbutrin. People who try to combine the two can experience blackouts, confusion, paranoia, dizziness, drowsiness, suicidal ideation, and they are at high risk for seizures.
What People Should Not Take Wellbutrin?
Wellbutrin is not usually prescribed to people with bipolar disorder, suicidal ideation, anorexia, bulimia, seizure disorders, histories of alcoholism or drug addiction, diabetes, or problems with their hearts, livers and/or kidneys. It is not for people with brain tumors, high blood pressure, histories of stroke, schizophrenia or mania, or those who have low levels of sugar, sodium or oxygen in their blood. Because bupropion can increase drowsiness and therefore the risk for falling, it is not always prescribed to the elderly.
A 2010 study of 13,000 pregnant women who had taken Wellbutrin or Zyban or similar drugs during pregnancy concluded their babies had double the risk for a certain heart defect and other problems.
In 2009 the FDA put a black box warning on Wellbutrin, advising parents and physicians that the drug can increase the risk of suicide in some patients, particularly those under 24 years old. The FDA has not approved Zyban or Wellbutrin for children, adolescents or young adults.
What Is a Wellbutrin Overdose?
A Wellbutrin overdose occurs when a person takes the drug in amounts not medically recommended — commonly, more than 450mg. Fatal overdoses can occur if you take 5.4 to 9 grams of bupropion. Symptoms are difficulty breathing, dizziness, fainting, sweating, confusion, blurred vision, seizures, hallucinations, loss of consciousness, rapid or pounding heartbeat, shakiness, lack of energy, upset stomach, lightheadedness, and jitteriness. Sometimes people will collapse and stop breathing. Wellbutrin overdoses should be treated by physician specializing in emergency medicine.
What is more common than Wellbutrin overdoses are severe reactions to combinations of bupropion products and other drugs or alcohol. These reactions can also be life-threatening.
What Is Wellbutrin Withdrawal or Discontinuation Syndrome?
About 20% to 30% of people who take bupropion drugs develop “discontinuation” or withdrawal symptoms when they stop taking them. Whether you develop the syndrome depends on individual factors. Some people have a biological vulnerability to bupropion that makes them more susceptible to discontinuation syndrome. You are more likely to develop the syndrome if you were taking the drug for a long period of time and in large amounts.
The symptoms may begin eight hours after the last dosage, and can last two to six weeks. Most people experience it as having the flu along with psychological symptoms such as crying spells, depression, confusion, anxiety, loss of concentration, and mood swings. After 24 to 72 hours have passed since the last dosage of Wellbutrin or Zyban, some people will have seizures and experience severe emotional problems. During the first week they may feel more tired, sleep more often, and complain about being in a “mental fog.” People in Wellbutrin withdrawal have reported some 50 different symptoms, but the most common are headaches, muscle aches, insomnia, nausea, vomiting, trembling, tiredness, and other flu symptoms. Some people grind their teeth, cough, feel short of breath, develop acne, and so forth.
In one study, a 32-year-old man who had been taking Zyban for two months for smoking cessation developed a severe withdrawal syndrome that his doctor diagnosed as flu. When he started taking bupropion again, his “flu” went away. His doctor gradually had him take 150mg a day, then 150mg every other day for eight days, then 150mg every three days for four days, 150mg every other day for a week, and finally 150mg every three days for six weeks until he was completely withdrawn from the drug.
It is safer to withdraw from bupropion under a doctor’s care, not only because medical professionals know how to ease your discomfort, but also because of the danger of seizures and severe mental problems during withdrawal. Many people have told their doctors they thought they were “going crazy.”
What Is Wellbutrin Abuse?
Wellbutrin is not usually prescribed to people with addictions, alcohol, or compulsive behavioral disorders such as anorexia because it has some potential for physical dependency. Nevertheless, the federal government classifies the drug as “non-abusable.” Since this drug affects the same pleasure circuits in the brain the same way that alcohol, cocaine and other addictive drugs do, some experts question whether it is non-addictive. Primates will self-administer bupropion, and rats show responses to this drug similar to their responses to cocaine and amphetamine. However, in studies of humans, most subjects found bupropion to be only a mild stimulant comparable to caffeine, and they did not particularly “like” the drug or develop cravings for it.
People who abuse drugs have tried to crush bupropion tablets and then snort or inject them in order to get a “high.” They often experience seizures instead. Wellbutrin is sometimes abused by bodybuilders and others who want to lose weight or by those who think it will enhance their sexual experiences. Bupropion is sold illegally over the Internet for those purposes.
While bupropion is not widely abused and diverted for recreational uses, many people find it difficult to stop taking the drug because they enter withdrawal syndromes. This is especially difficult if they received their original prescription from a family doctor or their college counseling center, where they never underwent a complete psychological work-up to determine if they were actually suffering from a major depressive disorder. Once they enter the discontinuation syndrome, one of their main symptoms is usually depression. This depression may be “rebound depression” which means it is a return to the original psychiatric problem that made them take the drug in the first place. Or it can be depression generated by stopping the drug. After all, many of those who take bupropion for smoking cessation also experience depression when they stop taking bupropion.
This is why it is so important to be evaluated and monitored by a medical profession when you stop taking Wellbutrin for depression. You should not just stop “cold turkey” on your own because of the danger of seizures. You also need to be evaluated to found out if you need to stay on your medication to treat your ongoing depression.
If you decide that you want to stop taking Wellbutrin for a while or just to see if you can function without it, you should consult a psychiatrist or other mental health professional to help you with this problem. If you can answer yes to any of the following questions, it may be time to get help.
- Were you prescribed Wellbutrin by a family physician or college counselor?
- Were you prescribed Wellbutrin during a crisis, such as losing your job, death of a loved one, etc?
- Have you tried to quit taking Wellbutrin on your own but failed?
- Do you believe that Wellbutrin is not helping you?
- Are you experiencing side effects from Wellbutrin that are very bothersome?
- Have you been taking Wellbutrin for more than a year?
- If money were no object, would you find a counselor to help you with your mental health issues?
- Are you having problems in your family relationships that you just tolerate rather than try to solve?
- Are you using Wellbutrin to lose weight or feel better about sex?
- Have you been using Wellbutrin since you were a young adult?
Some people are abusing Wellbutrin along with other drugs and/or alcohol. If you can answer yes to any of the following questions, you may want to consider entering residential treatment for your drug abuse or alcohol problem.
Do you have trouble going for more than a day or two without drugs or alcohol?
- Have you tried to crush or snort Wellbutrin for a high?
- Do your family members or friends criticize you for your drug use?
- Do you have to take sleeping pills at night because you are using drugs in the day?
- Do you feel that the stress in your life is contributing to your drug use, but you can’t figure out a way to change your lifestyle?
- Do you think you could benefit by breaking away from your current lifestyle and your substance-using friends?
- Do you feel guilty or ashamed about your drug use?
- Do you feel out of control about your use of drugs and alcohol?
- Have you tried to cut down on drinking and drug use but failed?
- Have you endangered yourself or others by driving under the influence of drugs or alcohol?
- Do you use drugs or alcohol when you are alone?
- Do you think you solve your problems and avoid your emotions by using drugs and alcohol?
- If money were no object, would you enter a residential treatment center?