A Noob's Guide to Wellbutrin
May 14, 2007 9:40 PM   Subscribe

I have just started taking Wellbutrin. What should I be feeling?

I began taking 150mg of the Welbutrin generic (Bupropion) for anxiety once a day on Friday morning. I have never taken this kind of drug before, ever.

I am male and 36. I have what I think are typical anxiety symptoms: stress, feelings of worthlessness, feeling like a failure, being an asshole to my family, shortness of breath, depression, tinitus, some body tics, hopelessness, etc.

I have had no bad side effects at all, except for a slightly dry mouth. However, I wonder what the good stuff should feel like. What I have noticed so far has been the following:

Before, my mind felt like a box with a bunch of ping pong balls bouncing around in it. Now the box seems smaller (my mind seems less hyper).

Concentration seems easier.

The feelings of failure used to feel like they were coming from Marilyn Manson ("YOU FUCKING SUCK! YOU ARE SUCH A FAILURE! I FUCKING HATE YOOOOU!!!"). Now they are still there, but they are less often and they feel like they are coming from Mr. Rogers ("You fucking suck. You are a failure. Can you say failure? I thought you could, because you suck.").

Is this what I should expect? Because I really don't know what I should look for, I find myself wondering if it is possible that this medicine is actually Tic Tacs and I am just pulling myself up by my bootstraps, ignoring negative thoughts, because I the medicine has some powerful placebo effect.
posted by anonymous to Health & Fitness (30 answers total) 19 users marked this as a favorite
Reaction to antidepressants varies drastically from person to person. There is no "standard" or "expected" response.

For many antipressants, it can take as long as 6 weeks for clinical effect. There might be some effect immediately (especially side effects), but it often takes a very long time for the drug to begin to affect depression. Sometimes it doesn't work at all.

That's why psychiatric treatment of depression with drugs is more art than science.

If you're expecting some sort of instant and miraculous change, you're bound to be disappointed. Tune your expectations down about five notches. Don't worry too much about it.
posted by Steven C. Den Beste at 9:50 PM on May 14, 2007

Be careful accepting general advice on antidepressants. Wellbutrin affects people very differently than do other drugs in its class (SSRI).

In my opinion, the placebo effect deserves respect and distanced awe. If Wellbutrin works for you, leave a good thing alone.

One side effect that's been reported widely involves Peter Jonathan McWilly. That's right, you could be loving it up real nice soon. So pronounced are the effects that some doctors prescribe Wellbutrin off-label for sexual dysfunction.
At Case Western Reserve University School of Medicine, a team led by R. Taylor Seagraves, M.D., a professor of psychiatry, gave Wellbutrin to 66 women, ages 23 to 65, who had experienced low or no libido for an average of six years. All 66 took a placebo for six weeks, then the drug for eight weeks. At the end of the placebo phase of the study, the group averaged 0.9 sexual encounters. But by the end of treatment with Wellbutrin, the figure had more than doubled to 2.3. Extent of sexual arousal also increased significantly, and number of sexual fantasies more than doubled (0.7 to 1.8). "Before starting treatment," Seagraves says, "100 percent of the women were dissatisfied with their level of sexual desire, but by the end of the [Wellbutrin] treatment phase, 40 percent reported feeling satisfied." The drug's only signficant side effects were insomnia (18 percent), tremor (6 percent) and rash (6 percent). - Salon.com, 2000
posted by nilihm at 9:53 PM on May 14, 2007

I've been taking 100mg for a couple of months now. I can't point out a difference. I might have a bit more affect now, but it's tough to say. Supposedly you get a little something with concentration a couple of days after you start and mood changes develop slowly over the next few weeks. It's a strange drug that's prescribed for all sorts of things, increase libido, depression, stop smoking, and help with ADD.

While I wouldn't argue if given a diagnosis of depression like dysthymia, I take it to make the amphetamines work. Without the amphetamines I notice no difference in my ability to concentrate, but without Buproprion I get very little from the amphetamines. Weird stuff.

When I was prescribed my directions were to wait at least two weeks before changing the dosage. Also, pay attention to the tics and whether they change in frequency or intensity over the course of medication. Perhaps keep a daily record.

Here's some unasked for advice. Don't expect the medication to do it all. You do your part too.
posted by BigSky at 10:23 PM on May 14, 2007

I took Welbutrin in its "Zyban" form for smoking cessation.. It was like a miracle for me.. It gave me a general sense of well-being... But, once I quit taking it, I ended up smoking again (ugh)... I desperately wish to get back on it again, (as soon as I can work up the courage to call my doctor)... I'm not familiar with it as a strictly anti-depressant drug (although I imagine that the smoking-cessation effects work as an anti-depressant too)... But, for me, it was wonderful.
posted by amyms at 10:25 PM on May 14, 2007

Very important: watch out for dry mouth, it can lead to seriously bad breath and poor oral health. Drink plenty of water, step up your brushing and perhaps ask a close friend about whether they've noticed changes in your breath.

As they say, it affects everyone differently -- though I'm surprised that you're on it for anxiety + etc. Wellbutrin is a bit of a stimulant, and I've found that it increases anxiety and nervousness to some degree. In fact, anxiety and agitation are two of the most common side-effects of Wellbutrin. I've noticed that I am more active, more anxious, but thankfully more positive about it. I wasn't anxious to begin with, so the change has been somewhat positive for me.

I noticed sleep disturbances in the form of waking up too early in the morning. I find this to be helpful as opposed to hindering, as the start of my day is generally positive and productive.

Negative sexual side-effects have been nil, but the ramp up period for Wellbutrin left me feeling very in season. This was not a bad thing, per se, but might've been if I were single.

I can assure you that the medicine isn't bootstraps. This is not a placebo. I had to step up to 300mg before I got the results I was looking for, but who knows what will work for you.

For more info, I really like crazymeds.org. Not the best moniker, but a great site about firsthand experiences on various drugs associated with mental health issues. Their write-ups on various forms of Wellbutrin were helpful to me.
posted by cior at 10:33 PM on May 14, 2007 [2 favorites]

Wellbutrin may make you hornier.
posted by loiseau at 10:54 PM on May 14, 2007

I haven't taken it personally but know a friend that has, and in her case the depression is replaced with anxiety. Wellbutrin is a norepinephrine reuptake inhibitor, which is actually part of the design of the drug as studies have shown a link between norepinephrine and depression.

So it is possible you may see anxiety symptoms and may have insomnia. Maybe not, as others have pointed out about the effects varying between people. If the symptoms crop up, though, now you'll know why and can decide whether depression or anxiety is the greater of two evils.
posted by rolypolyman at 11:07 PM on May 14, 2007

I should add that the few times my friend has started a course of Wellbutrin, she's quit it after only 1-2 weeks because of the anxiety/sleep problems. But often this is enough to snap her out of the depression rut, so it all works out ok.
posted by rolypolyman at 11:09 PM on May 14, 2007

I took it under the Zyban label as well, also for smoking cessation.

I didn't like it. I had trouble sleeping, felt keyed up and antsy all the time, and generally felt like the top of my head was about to come off.

I did manage to quit smoking for a few months, but now I'm back to a pack a day or so.
posted by trip and a half at 11:25 PM on May 14, 2007

I'm taking it as an aid to quitting smoking. 150mg every morning around 8am. (So far, so good by the way. Not smoking is awesome)

I'd say the most obvious thing I noticed about Wellbutrin was that around 11am, things got really speedy ... a kind of "oh shit, I'm at work and ON DRUGS!" speedy that makes you want to seek out a nice dark place to chill out in, maybe with some vitamins and the Allman Brothers. It went away after about half an hour, and only lasted for a week or so. Now (5 weeks into a 2 month supply) I don't even notice the elevenses any more.

And yes, dry mouth. I drank a LOT of tea and water in the first few weeks.
posted by mumkin at 11:50 PM on May 14, 2007

I have to agree with clor, Wellbutrin made my pre-existing anxiety worse, and I ended up on a lower dosage than originally prescribed (on the full dosage I basically felt like I had butterflies in my stomach ALL the time). Weight loss was also an unexpected side effect for me, and I think that was at least partly due to the anxiety.

As for positive results, after a few weeks I felt different in a good way. As best as I can describe it, everything delighted me, and I got back my joy in the little things (although at the same time, some of the things going on in my life that caused me to decide to try medication were changing, and that probably had at least something to do with it). I never tried an SSRI, but this seems to contrast with the numbness effect I've heard some people get on them.
posted by someone else at 12:16 AM on May 15, 2007

I too am surprised you got Wellbutrin if anxiety was a symptom, my "SO" and I both found it kinda stimulating. It made me feel pretty good and helped keep my weight down, but taking only Wellbutrin interfered with my sleep and in stressful times I tended to get crankier than usual. Of course that's worse at higher doses; I don't think anybody under say 200 pounds needs 450 mgs/day.

I'd recommend the slow-dissolving XL form though, it is easier on your stomach than the SR and it's a longer smoother "ride" without that quick rise, short plateau and hard THUNK that I just hate in drug experiences; as others have noted high doses of Wellbutrin alone can be speedlike. Through trial and error I found that what worked best was a lower dose supplemented by a low dose of an SSRI (in my case Lexapro), and in fact I'd recommend asking your doctor about that as one good thing about SSRIs is they often reduce obsessive-compulsiveness as well (such as the YOU SUCKY FAILURE "tape loop").

But what really bugged me was that no matter what, even one low dose per day of the slow-dissolving XL form, Wellbutrin crucified my stomach. Even with a big meal AND three Tums. After a couple years I gave up on it this past winter (and promptly put on 10 pounds, damn damn damn). But then I'm so "delicate" anyway.
posted by davy at 12:27 AM on May 15, 2007

When I was taking a fairly high dose of Venlafaxine (where the norepinephrine reuptake inhibitor bits of it start to kick in), I asked my doctor for a series of beta blockers to help manage the anxiety. They seemed to help quite a bit.

I did try to get on Bupropion at one point, but apparantly it's only available if you're trying to stop smoking here in the UK, *mutter*.
posted by Freaky at 1:16 AM on May 15, 2007

If you were feeling 'cured' by now then you might as well have been taking tic tacs. The lift some people get in the first few days taking antidepressants is purely placebo. They take several weeks to work at all and usually 4-6 weeks to have enough build up in your system to have the full effect of the drug.
Anti depressants are not a miracle drug, they take time. I have read of something that works instantly, but its still in the experimental phases.
Another unfortunate problem with drug therapy for depression is there isnt 1 guarenteed drug that will work for everyone, so you may spend a month on this one and if it doesnt work, a month on something else etc until they either give up or find something that works.

If you're being given Wellbutrin it sounds like you are being treated for depression rather than anxiety - probably rightly so given your list of symptoms. IANAD/P but it seems to me like your anxiety is a symptom of your depression and not the other way around.
posted by missmagenta at 1:27 AM on May 15, 2007

My anxiety went through the roof and I had to counter that problem with increasing amounts of Xanax. When my shrink refused to supply me more Xanax than what was needed to ween me off of it, I started freaking out.

Probably due to my experiences with Adderall, I felt the Welbutrin wasn't doing much for me. Sure it made everything feel great (sex and food included,) but I felt any impulse to focus on task was like having a gun to my head. I refused to drive a car for months and I stopped worry about important things out of fear I might drive myself nuts.

Eventually, I got off Wellbutrin. As the withdrawl symptoms started rolling in, I was either yelling like I was posessed during arguments and throwing stuff or narcoleptic (13 hours sleep a night, thank god I'm senior in college with a week left.) I was fucking scared of what I had become, worse than the perpetually cranky Adderall junkie from last year.

I trust that Wellbutrin actually works for a lot of people. I'll admit I dodged a terrible Seasonal Affective Disorder winter because of it, but I think I'll stick to a sunlamp.
posted by portisfreak at 2:03 AM on May 15, 2007

Welbutrin has been the only anti-depressant I've taken that, for me, was unique in its marked lack of any undue side-effects. YMMV, of course.

/anecdotal story begins/
I definitely advise you be wary of any of the generic Bupropion formulations your doc or insurance company may try to move you onto. Anthem moved me from the brand-name Welbutrin onto a generic version some time ago (large pink or white pills, as opposed to the familiar little blue pills) The difference was like night-and-day. The generic was best described as a anti-anti-depressant, as my depression, anxiety and anger went through the roof. It took a lot of back-and-forth between myself, my doc, and Anthem to get me back onto the tried-and-true Welbutrin.
I have since found a different generic that seems to work just as well as the name-brand.
/anecdotal story ends/
posted by Thorzdad at 4:56 AM on May 15, 2007

Some people do respond to antidepressants right away, and it's not just a placebo effect. The full antidepressant/antianxiety effect will likely not be clear for another couple of months, though. What your are feeling now is probably just your initial response.

Further, you make changes in your life when you become less disabled with anxiety/depression. You will likely feel different about yourself in a year because of these changes. This is the bootstrap effect, which is very real. It's completely normal to have both a medication and a bootstrap effect at the same time. You feel less disabled, you get out more, you get more exercise, you spend more time with friends, you eat better, you sleep better, you're more productive at work, you complain less. All of these things make you feel better.

Exercise is something that is pretty much guaranteed to make you feel better. For me, though, it's hard for me to get out of the house and face the world enough to get the exercise without the antidepressant support. So I do both.
posted by kika at 5:12 AM on May 15, 2007 [1 favorite]

It will take a few weeks for the Wellbutrin to build up to a therapeutic dose, although the side effects (dry mouth, tremor, cigarette repulsion) should kick in right away.

If you are feeling better, it's probably placebo. Some people don't much care for the placebo effect, think it's not as good or as 'real' as what can be done by the drug. But I ADORE placebo. It implies on some level that I can improve my own situation -- not through bootstraps or willpower, but through some hidden power of my own mind, which is a mysterious but exciting idea, and certainly more fun than thinking that I need little white wellbutrin crystals adhering to my brain to make everything sparkly again.

Of course, medications don't actually do that. Drugs are kind, yes, very kind. They restore functionality. They will help you stay awake for eight hours at a time. They will help you make it to class. They will make people and crowds more manageable. Drugs do not solve problems, but they put you in a place where you can deal with them. They put you in a place where your mind is clear enough that you can make rational decisions. The really hard work -- reordering the way you think about yourself and the world -- is not something drugs will significantly aid you with.

But if Wellbutrin does not give you back functionality, try something else. No medication is going to make you happy, but some of them definitely will leave you more competent and (appropriately) emotionally responsive than others. It's fine, even kind of fun, to play around in the pharmaceutical fruitbasket, so feel free to move onto something else if life isn't easier next month.
posted by bluenausea at 5:34 AM on May 15, 2007 [1 favorite]

Well, there's no real answer to that question, but if it helps this is what if feels like when an anti-depressant doesnt work:

1. You are angry for no reason at all, all the time.
2. You feel terrible and contemplate suicide.
3. You feel randomly goofy.
4. You have incredible anxiety, must worse than usual.
5. You get little electric shocks now and then.
6. You wander around in a haze and generally feel like a zombie.

To me, it sounds like you are getting a theraputic effect from this drug, which is pretty good luck considering its the first anti-depressant you've tried.

All this placebo talk is simply wrong. Many people don't need to wait 2 weeks for the effect of the drug. They might have to wait 2 weeks for the full effect or a very noticable normalizing effect.
posted by damn dirty ape at 6:54 AM on May 15, 2007

PS -- Perhaps what I exalt as placebo is actually the drug, then. I periodically, like every couple of months, take 60-80 mg of Prozac for a few days, to pull myself out of a hole that bootstraps, alchy, and reason can't get into. (Yes, I know Prozac is not supposed to be taken this way). And wonders of wonders, it totally works. 24 hours later and I feel much better. I stop crying, stop eating, get out of bed, go running, and take simple steps to address complicated problems. I always assumed my newfound ability to cope was due to the placebo effect since I've had endless admonishing fingers waved at me prozac doesn't work so fast...

I'm kind of sad to think that maybe it does...
posted by bluenausea at 7:26 AM on May 15, 2007

There's some nonsense in this thread. Welbutrin is NOT an SSRI, to begin with. It is used for anxiety, usually, as a symptom of depression, not usually for anxiety as a standalone diagnosis (that's why God invented benzodiazepams). It's an alternative to SSRIs for people who shouldn't take them, or don't tolerate them, or don't respond to them, or hate the sexual and other side effects of SSRIs. In my own experience, Welbutrin is a wonderful antidepressant. But everyone is different and you need to be working on this with a doctor.

I've never heard of tinnitus as a diagnostic criterion for anxiety. You should get that checked out. It doesn't sound right.

Welbutrin needs to build to a certain concentration in the bloodstream, so it takes beteen 3 and 10 days to really kick in on at 150mg/day.

Welbutrin is also a stimulant for most people (which is why it is used in place of an SSRI in some cases, but also why it is NOT indicated in some cases, and also why you are noticing an improvement in concentration, probably). You won't notice anything dramatic at 150mg (are you using the XL or the regular 150s? If you haven't tried the XL extended release, I recommend giving it a go).

But you *should* notice a gradual improvement (nopt a black and white transformation) in all of the mood symptoms of depression, including both "anxiety" symptoms and the feelings or worthlessness and self-loathing you describe, which don't sound like "anxiety" to me, but do sound a lot like major depression, of which "anxiety" is often a phase or a component. Or you should work with your doctor on changing dosage or trying something else.

All of these, however, are questions for your psychiatrist. If you had Welbutrin prescribed by a GP and not a shrink, I'd consider finding a good psychiatrist to really work on getting on the right meds and dosages systematically. You can waste a lot of time trying this and that with a doctor not experienced in working on this stuff every day with lots of patients, certainly if your depression/anxiety is as serious as it sounds from your post.

Welbutrin is not normally associated with any direct sexual side effects. It does have some risks, mostly of seizures, and should never be taken by anyone with a seizure disorder without asking this specific question of a doctor.

But to disclaim, although I have experience on which to base these statements, I am not a doctor. You need to talk to a doctor. Soon. Again. And it should be a psychiatrist who cares about getting your neurochemistry in order, systematically, and carefully, and intensively, and while answering exactly these sorts of questions with knowledge not many people on AskMe have.

Good luck. There's a better time on the other side of this. You'll be OK if you stick to it and have the support of your family and a good doctor.
posted by spitbull at 7:45 AM on May 15, 2007 [3 favorites]

I will add that in my experience, the non-placebo real effects of Welbutrin begin to happen within 3 days or so. But it can take up to 2 weeks. Everyone is different.
posted by spitbull at 8:19 AM on May 15, 2007

Go ahead and mark what spitbull just told you as best answer, I was going to say pretty much everything that is up there.

I just wanted to share that I didn't notice that the wellbutrin was having an effect on me (other than side effects) until months later when it just hit me that a lot of things had changed in my life. That was fun, things are good now, and good luck to you!
posted by echo0720 at 8:53 AM on May 15, 2007

Clor absolutely nailed it on this one.

I take Wellbutrin and Cymbalta (SSRI), and gosh, yes, I AM fun to be around.

If I mess up (or, really, if I procrastinate and don't get it refilled right away) and miss some of my Cymbalta, I get more anxious. They have a totally different effect. Cymbalta makes me want to get out and do the things I should be doing. Wellbutrin makes me able to have a great sex life despite the Cymbalta, and also takes that negative feedback (YOU SUCK) and allows me to be more objective ( YOU SUCK well, no, not all the time, just this once and I don't need to lose sleep over it).
posted by misha at 9:56 AM on May 15, 2007

I made a significant mistake. Wellbutrin is an NRI/DRI. Not an SSRI.
posted by nilihm at 11:14 AM on May 15, 2007

So did I. After taking it for years, I still think it's spelled with one "L" when it's really 2, as in "Well," hmmm. Love that pharma marketing stuff.

Gotta say I've never had dry mouth from it, or any urge to quit smoking. No side effects whatsoever. I just feel better.
posted by spitbull at 2:30 PM on May 15, 2007

There probably is a placebo effect but it's not all that's going on.

Relax and give it time, 4 weeks or so. You do not want to compare 1 hour before your first dose to 1 hour after your first dose; it makes more sense to compare the 8 weeks before you started taking the drug to the 8 weeks immediately after the 4-week run-in period.

That way you're comparing epoch to epoch and you can say, yeah, in this time period I generally felt better about myself and ruminated on negative depressive feelings less.
posted by ikkyu2 at 9:38 PM on May 15, 2007

Well this is timely. I started Wellbutrin this morning, 150mg XL, for depression, obsessive thinking, and attention deficit. I am moving from Celexa which I stopped taking a week ago because of severely delayed orgasm which is fun for about an hour. I already have notes:

I am manic. Got a huge amount done today, racing from task to task and switching contexts without much loss of "flow", and feel at quarter of one AM that I could work all night. I can focus for the first time in many months, and I feel almost like I did on modafinil (but without the weird side effects).

I am horny. Not just horny for sex, but in the mood for romance. I gave two women my card today, made a date with a girlfriend for 8 AM tomorrow morning, and dinner dates for tomorrow and Thursday nights. Now, I live in the middle of the NYU campus, and today was over 80 degrees, so this may be largely situational. And my depression is romantic in origin, so there may be a psychological overcompensation compulsion thing happening.

I am garrulous. I am a normally fast-talking New Yorker but I have been talking people's ears off. I have a huge amount going on this week and next (starting a company!), and I seem to need to give everyone I talk to all the details. See, you didn't need to know that I'm starting a company. But I needed to tell you! This posting is a good example - look over my posting history and you'll find that I'm generally pretty to-the-point - this is probably the longest non-technical message I've ever posted.

I am, centrally, much less sad. For the last week or so, I was literally in tears a few times each day, from the most random things. That endpiece in the Sunday NYT magazine about picking up an old lady hitchhiking and discovering that she doesn't know where she lives? I bawled. And I am not normally lachrymose. Today, no such impulse. I have a sense of great excitement about each of my projects, work and personal. I'm eager to get to the gym. I got a new stereo amp and I can't wait to teach my TiVo remote to operate it.

Now, I am a big believer in the placebo effect, but this seems like a lot all at once. And I can still make myself very sad if I think about her. But yesterday, those depressing thoughts were unavoidable, and today my desire to read our old IMs and look at our vacation pictures is negligable, and I just want to do new women things.

So, anonymous, I'm few years older than you and my depression was different but it sounds like we're doing this at the same time and getting the same kinds of effects - if you'd like to get in touch, ask Jessamyn to forward a message to me.
posted by anonymous response at 10:35 PM on May 15, 2007 [3 favorites]

Cymbalta will do all of that. The problem for me was it wouldn't let me sleep....never slept more than 3.5 hours at one time, or 5.5 hours a night while on it. I told the Dr. that it had to be working on my mood tremendously well, because I otherwise would be extremely miffed sleeping only 5 hours a night for 6 weeks! It was the second reason I stopped it, after severe dry mouth & dehydration.

So, if you are still able to sleep, it sounds promising so far......the "high" should normalize. Remember you were depressed in all things before, so it seems like a bigger change than it actually is from your "normal". Good too you realize the meds aren't taking the depression away; it makes you able to do the things that help you deal with it. I'd slow down a bit on all the "socializing" unless you were like that before, and even then I'd take a good look at it to see if the reprocussions from that kind of behavior was what helped get you into your situation...but that's just me.

My very best to you for your recovery!
posted by mattfn at 9:57 AM on May 18, 2007

Here's what I experienced with Bupropion when I took it for over a year (now I have stopped taking it because I don't feel I need it).

For the first few days I had some ringing in my ears, so I went down to 100 mg instead of 150 mg. I only took 100 per day, not two doses. It made me very interested in everthing I was reading, excited to be alive, much more social, and sex was much better because I was more aroused than ever. I experience multiple orgasms a few times while I was taking it, but never before that and none since I stopped. Sex became a mind blowing experience for me and my husband who was taking it also. It went on for hours and it was not boring in the least (20 years of marriage).

On the negative side, I noticed I was less tolerant of what I began to think of as "bad people doing bad things". I would confront people right away. It started to scare me because in my job people are always at their worst and it's my job to hold their hand. I wasn't very patient with people. I was nicer to my kids and my husband though. Things didn't bother me at home as much. With all the stimulation I felt I had Adrenal Fatigue.

It was too much sex, too much to learn about, and too many opportunities that I wanted to take advantage of. I did some impulsive things too, like I bought another house to fix up and sell, only it was a 7 bedroom house and it needed to be completely redone! I did it though, but it almost killed me.

I had no desire to smoke or drink, which was nice, and now I still don't smoke or drink but sometimes I want to. I think it's a good drug to get over a trauma, like in my case losing my mom, which was very hard. A trauma can deplete the dopamine in the brain and bupropion takes care of that.

Oh, one last thing, I had to take Melatonin to be able to sleep at first. It did tend to keep me awake.
posted by dela at 9:55 PM on June 8, 2007

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