Wellbutrin Sr Once A Day?

March 17, 2022 9:01 AM

I was prescribed bupropion SR 100mg once a day to start for depression, which seemed to have SOME positive effect, but we determined it wasn't enough at the last visit. She increased the dose to 150mg SR once a day. But I think the issue is maybe coverage, is this normal?

I know YANMD, but I am looking for experience and questions to take back to the psychiatric np that is treating me because I just don't know if taking bupropion sr once a day is the correct step outside of first starting. My limited understanding of the drug is that I should either be taking SR twice a day, or switch to XL to be able to take once a day.

I did as why, as well as asking about XL instead of SR. Her concern was that it could worsen sleep issues. She also said that the higher dose should mean that there is more circulating for longer. But that doesn't seem right, it seems like the higher dose would just mean that I would get a higher peak during the 12 hours, and crash more during the times I'm not treated.

But, neurotransmitters are weird, right? Is it more that over time, the higher dose will just make more of the changes to neurotransmitters in brain that 1x is okay?

I've noticed outside the effective times, I am crashing in terms of my mood. If I get up before I get up and take it, its less noticable in the morning, but still there. Same thing at night, I'd say more like 14 hours, not 12. But something is happening where my mood just spirals down.

I do generally have some difficulties with sleep, and the first couple weeks were rough. There were a few days that were really bad where I just could not sleep/was wide awake. But those have past, I still have some difficulty, but it seems as though its getting better every day.

I'm also only about 4 weeks into treatment, I know thats not necessarily enough time to know the full effect of treatment, but she thought since I had gotten some initial benefit and it is back sliding, that its the right drug, just not the right dose yet.

posted by [insert clever name here] to Health & Fitness (7 answers total)

You both could be right and that's why both versions of the drug exist. I'm on XL 300 right now and it doesn't cause me sleep issues but everyone is different. If it does seem like your mood changes a lot around when it it expires that does seem like a good indication you might be better on XL. Increasing the dosage to 150 definitely will increase the effective time for the drug so this could also work. I'm at the point where I can skip a day on XL and not really notice it, but I've been on it for years at this point. Either way I think it's fine to try this for a month and then report back to your doctor, you have an obvious thing to try next.

Broadly, the reason we can't predict how any individual person will react to an antidepressant is that most of the positive effects aren't due to the immediate impact of the neurotransmitter changes, but are due to the more subtle changes your brain makes in response to the changed neurotransmitter level. This is why these drugs take so long to start working, why the side effects are so confusing, and why very similar drugs can cause very different effects on different patients. There have been some improvements to understanding what types of drugs will work on what patients, but we still need to experiment with each patient to find the right dosage. But it sounds promising from what you say so far
posted by JZig at 9:18 AM on March 17, 2022 [5 favorites]

I'm not a healthcare provider of any kind, but I had the exact same problem on Wellbutrin SR and it's way better on XL. I have primarily been on 150 mg Wellbutrin XL for years (with some fluctuations in Wellbutrin doses, partially to accommodate other meds and issues).

Because XL will persist longer into the night and possibly worsen sleep disruption, I'd give yourself 2-4 weeks to adjust to the 150mg SR, even if you keep "crashing" (i.e. mood/energy dropping in the 12-14 hour time frame).

I am more likely to "crash" even on XL if I've recently changed/increased dose, or if I've done a poor job of feeding and hydrating through the day, so you might also try buying some snacks and giving yourself one at "crash" time.
posted by All Might Be Well at 9:26 AM on March 17, 2022

I'm on 150mg x3 bupropion extended release once daily. It, along with most of the other psychotropics I've been prescribed, have had effects on my sleep. I currently have a prescription for Trazodone 50mg that I can take 1-4 of to sleep at night, which helps (so long as you time it correctly). This may not be the correct time to go down that route (you and your doctor should talk through all the issues you're seeing), but for n=1, it's the approach that worked here.
posted by isauteikisa at 9:56 AM on March 17, 2022

i would definitely ask for the XR/XL formulation.

bupropion makes me sleepy, so i take it at night, even though everyone says to take it in the morning. everyone's different, and it does take some time to figure out what works for you.
posted by misanthropicsarah at 11:50 AM on March 17, 2022

It's also possible to mix XL and SR. I started on Wellbutrin about two months ago, and am taking 150XL + 75SR in the morning and another 75SR at noon in an attempt to keep me awake longer (I'm still sleeping too much). 300XL made me jittery, but the 150XL + 150SR is okay.
posted by wherestheeraser at 11:55 AM on March 17, 2022

The frustrating thing about antidepressants is their unpredictability. It's quite possible you may end up having to actually try the higher dose of SR once a day, some dose of the SR twice a day, AND the XL before you can get any idea of which is going to work best for you. Four weeks is really no time at all.
posted by The Underpants Monster at 3:47 PM on March 17, 2022 [1 favorite]

Im on the SR version in the mornings, started at 150mg then 300mg before settling on 450mg. I tried each for 2-3 months before increasing the dose. As I understand it that's the standard way in our health system.
But how knows what the best path is, it is complicated =/
posted by skaggig at 8:23 AM on March 18, 2022