An atypical antidepressant for atypical depression: Consider Wellbutrin if SSRIs have failed

Major depressive disorder affects approximately 15 million American adults in the U.S. in a given year, and a first pharmacological line of defense is often a prescription for an SSRI such as Prozac, Celexa, or Zoloft. (These drugs have been favored since the late 1980s for the treatment of depression as they are generally well tolerated, have fewer side effects than their predecessors the MAOIs, and help a great many people.)

However, people suffering from atypical depression (characterized by hunger and sleepiness, rather than loss of appetite and insomnia) may have different needs in an antidepressant and should discuss with their doctor options such as Bupropion (familiarly known by its GlaxoSmithKline trade name, Wellbutrin), which could help where popular SSRIs might fail.

That is because SSRIs (Selective Serotonin Reuptake Inhibitors)  work on the neurotransmitter Serotonin, while Wellbutrin, an NDRI is a Norepinephrine and Dopamine Reuptake Inhibitor. This change of focus in the affected neurotransmitter may make all the difference for those individuals who suffer depression in an atypical manner.

Atypical depression differs from regular, melancholic depression primarily in energy and appetite. It is often characterized by reversed vegetative symptoms such as over-eating (regular depressives have little appetite) and/or over-sleeping (regular depression is usually characterized by sleeplessness).It is estimated that up to 40% of people suffering from depression have atypical symptoms.

Wellbutrin reportedly has a more enlivening affect than the SSRIs, so it is often considered for those who are sleeping abnormally long amounts. (For this reason, it is not advised for those suffering anxiety or agitation.) It is also one of the only antidepressants that is not associated with weight gain, and for this reason is also suitable for atypical depressives who may be overeating.

Even successful users of SSRIs have reason to consider Wellbutrin. SSRIs have widely-known sexual side effects that trouble some patients, even if the SSRI is curing their depression. This may make them turn to their physician for refinement of the prescription. Says Ray Sahelian, M.D.:

Since bupropion raises dopamine levels, it actually can enhance sexuality rather than depress libido as do many SSRIs. Bupropion has been shown to have a favorable effect on sexual dysfunction. Several reports and small, short-term trials have examined bupropion as an adjunct or substitute for other antidepressants in sexually dysfunctional patients. This means that Wellbutrin is often prescribed for sufferers of atypical depression, but it is also prescribed as an add-on for people using SSRIs who would like to try to combat the sexual side effects of SSRIs.

In other words, Wellbutrin is often prescribed as an add-on to an SSRI for the express purpose of relieving some of the SSRI’s sexual side effects (usually loss of libido or functioning).

Depression is not the only condition that Bupropion has been approved to treat. In 1997, it was approved by the FDA as a smoking cessation aid under the name Zyban. And in 2006, Wellbutrin XL was approved as a treatment for Seasonal Affective Disorder. Because both Wellbutrin (prescribed for depression) and Zyban (prescribed for smoking cessation) are essentially Bupropion, patients should not take both at the same time; they would be doubling their dose.

Caution: The most well-known side effect of Bupropion is that it lowers seizure thresholds. Doctors have worked around this with lower dosages (it is highly dose-dependent) and controlled-release formulations. Still, those with seizure disorders should avoid Bupropion. Other common side effects are nervousness/ agitation and insomnia. As with any antidepressant, people suffering from increased depressive symptoms or thoughts of suicide should contact their doctor immediately.

Some formulations of Bupropion are available as generics in the United States and Canada.

U.S. Brand Names

• Budeprion
• Budeprion XL
• Buproban
• Wellbutrin SR
• Wellbutrin XL
• Wellbutrin
• Zyban

Canadian Brand Names

• Novo-Bupropion SR
• PMS-Bupropion SR
• RATIO-Bupropion SR
• SANDOZ-Bupropion SR
• Wellbutrin XL
• Wellbutrin
• Zyban