Editorial: a recent email to RxISK on the topic of antidepressant withdrawal brings out the fact that bupropion withdrawal is very different from SSRI withdrawal and both are very different to mirtazapine withdrawal.
For all RxISK posts on withdrawal see Here
Email from Edge
My name is A. I’m 28. I was prescribed to Wellbutrin 3 years ago, and took it for 18 months. I had never taken any type of psychiatric medication previous to this. I was prescribed to Wellbutrin by a physician that insisted it would help with the depressive symptoms that I was experiencing due to a generalized anxiety disorder (GAD). My primary disorder at the time was GAD, and the only reason that I was experiencing depressive symptoms, is because of the change in my demeanor since becoming constantly worried about the possibility of having an anxiety attack in any social situation.
The first time that I went to see a general practitioner about my general anxiety disorder, she immediately wrote me a prescription for Prozac, I took the medication a grand total of three days before having a bad accident.
I went back to the doctor and she decided that it would be better if I tried going the antidepressant route. At the time I started Wellbutrin I was in my first semester of graduate school and the effects of Wellbutrin were welcome. I was able to concentrate better than ever before, and was getting all A’s in school. It went this way for a little over a year, until I started seeing a return of my panic attacks.
I went back to the doctor and she told me that it sounded like I was building up a resistance to the dosage of medication that I was taking. I was taking a once daily immediate release dosage of 75 mg of Wellbutrin at the time and she decided it would be a good idea to up my dosage to 100 mg of sustained release in order to get me back to a base line.
I went home with the medication and thought about what the up dosage meant. I had a lot to consider… I didn’t want to be dependent on the medication for the rest of my life. Especially since I was taking an antidepressant medication when I didn’t even actually have depression. That day I decided that I was going to quit the medication altogether.. without my doctor’s consent… I had NO IDEA how bad of an idea that would turn out to be.
Fast forward to a week and a half after trying to quit wellbutrin cold turkey and I was a COMPLETE DISASTER. I was experiencing suicidal ideation (the first time I’d ever had ANY thoughts like this), MAJOR anhedonia, memory issues and extreme fatigue. I went back to my doctor to get help, because I was scared of what I was going to do.
Long story short, she ended up putting me on the Wellbutrin SR 100 mg anyways so that I could level out before I started my taper process. I took the 100 mg SR every day for about 2 weeks and was having some really uncomfortable side effects. So I decided it was time for me to start weening myself off of it. I took the 100 mg SR every other day for two weeks and then every two days for another two weeks, so all in all I tapered off of the medication over a month. I know now that this was WAY too fast, but it’s too late for me to try to go back on it for a slower taper.
I’m just wondering if anyone else has a similar story to mine, that can tell me what kind of recovery timeline I’m looking at. I’m experiencing some pretty severe depression, anxiety, anhedonia, depersonalization, derealization and memory/concentration issues.
I’m terrified that I might have permanently destabilized my nervous system. I’m also very concerned because of what you mentioned about there not being many reports from individuals who had issues with discontinuing Wellbutrin. I’m having significant issues with it, and haven’t seen any deviation in my withdrawal symptoms since discontinuing cold turkey 9 months ago (I hardly constitute my three week “taper” as being adequate).
I’m a regular subscriber to the Surviving Antidepressants and benzobuddies forums and I’ve found a wealth of valuable information from individuals that have gone through withdrawal before and recovered. But I’m concerned that I’m so far into withdrawal and haven’t seen ANY improvement. An individual I was conversing with on Benzo buddies told me that I might be able to get more information about the kind of trajectory I’m looking at for recovery by checking with RxISK.
I know that recovery is very subjective depending on the individual, but I just need to know that there will be eventual recovery and that I haven’t permanently damaged myself with these drugs.
Antidepressant withdrawal
Bupropion is labelled as an antidepressant and this makes it sound like Zoloft and Prozac and Efexor but its not. It was first suggested as an antidepressant by Fridolin Sulser in the 1970s. Everyone including Sulser got vague when asked about how it worked. Funny thing strategic vagueness.
Its chemical background is interesting. When launched as an antidepressant, there was talk about Bupropion being a noradrenaline reuptake inhibitor which it may be too but it primarily acts on dopamine systems. There is tons of evidence that stimulants like methylphenidate can do just as well for the kinds of cases that respond to an SSRI as the SSRI can.
But just because you call a drug an antidepressant doesn’t mean that the withdrawal syndrome is going to look like the withdrawal problems from an SSRI for instance. Bupropion doesn’t cause PSSD or many of the problems SSRIs cause. It’s striking reading A’s account above that the problems are much less about peripheral problems and much more about motivation and related problems.
The question is whether the withdrawal syndrome it does cause is more like stimulant or dopamine agonist withdrawal than SSRI withdrawal. So RxISK consulted its stimulant-dopamine agonist withdrawal expert – Johanna Ryan – who’s response is here. But we need more input from anyone who has been through bupropion or stimulant issues. What do you make of A’s account above?
RxISK view
It’s well-known enough that many of the young adults on Quitting Adderall have used Wellbutrin to get off Adderall. This is usually their own idea — their doctors are just glad they are willing to take an “Antidepressant,” because their doctors have often considered their irregular behavior on Adderall to be “bipolar” and any troubles stopping Adderall to be “depression.”
The problems people have stopping Wellbutrin seem very similar to going off Adderall or other amphetamines. (DAWS is a similar syndrome according to at least one neurologist.) Some of the best (and most worrisome) descriptions of this Speed Withdrawal Process are found in the literature on methamphetamine addicts. It’s said their anhedonia/depression takes about a year to clear, and the cognitive effects may take longer to go away completely. There seems to be a definite dose-response relationship: the higher the dose of speed you have been on, the longer and more difficult the recovery.
A can take consolation that 100 mg of Wellbutrin is a fairly small dose: the “standard adult dose” of bupropion for anti-depressant purposes is supposed to be 300 mg. I’d guess she’s been taking much less speed than the average Adderall user, and about one-tenth of what the average meth head consumes.
Most of the Wellbutrin takers on Quitting Adderall either planned to stay on it, or had not started tapering off yet. I think quitting may be harder for older people. Menopause, andropause or what-have-you, or maybe just a slower metabolism. That’s a consolation for A: she’s stopping while still young, and as hard as it is, it’s much better done now than 20 years from now.
I am no chemist, so I often rely on drug names to spot similarities. A drug called diethylpropion was one of the stimulant “diet pills” that got people in trouble in the 1960s. It is still on the market for weight loss as “Tenuate,” although not much used anymore.
Another random clue: Bupropion is the only “antidepressant” I know of that people are known to take for strictly recreational purposes. Except for Parnate, which is fairly regularly abused in Germany.
A might like to take a look at Quitting Adderall, and/or my blog post on “punding“, which has links to the QA crowd.
Given her age and the fact she’s been in college, she probably knows a bit about Adderall Problems. I’d be curious to know how the feelings and behaviors people describe while taking Adderall stack up against her own experience.
annie says
What’s in a name?
David Healy
1 hr
What’s in a name? Bupropion is an Antidepressant (Wellbutrin) in the US, though only a stop-smoking pill in UK. Patients trying to stop face different problems than with SSRIs. https://t.co/CB2EXXpYpF https://t.co/mhcvwMrfkg
David Carmichael
6 hrs
In less than 10 minutes, this Know Your Drugs video presentation explains why it’s so important for people to be knowledgeable about any prescription drugs they consume. “Adverse drug reactions are a leading cause of death largely because pharmaceutical companies hide the truth about potentially deadly side effects.”
https://knowyourdrugs.org/video/
Know your drugs .. know their names ..
Johanna says
As I’ve said before, I’m no chemist … but bupropion appears to be part of the extended family of amphetamines and amphetamine-type drugs. Amphetamines were openly prescribed to relieve depression in the mid-twentieth century (and still are, though doctors don’t like to discuss it). They were also used as weight-loss pills, which helped to fuel a real epidemic of both recreational abuse, and medically-caused addiction.
So it shouldn’t surprise anyone that Wellbutrin has not only been used as a sort of step-down tool for people who find themselves addicted to Adderall. It’s also getting a reputation for “recreational abuse” in its own right. This article from the Canadian Medical Assn journal gives the basics:
http://www.cmaj.ca/content/186/13/1015
A joke making the rounds over here is that cocaine could become a big hit with millenials by re-branding it as “Adderall Xtreme.” As for the weight-loss market, bupropion has been re-packaged with a dash of naltrexone and approved as an “anti-obesity” pill called Contrave. Yep, those godawful diet pills that nearly killed your mom’s sorority sisters in college are now Evidence Based Medicine again!
Rob Purssey says
“… though doctors don’t like to discuss it.” You might be surprised. See this astonishing article from Australian & New Zealand Journal of Psychiatry 2016, lead author editor-in-chief of that journal among other KOLs – see disclosures. “Stimulants for depression: On the up and up?” Mind-blowing for disconnect from simple humanity, awareness of history and the human condition, and bioneurotransmitter babble and chicanery – and curiously seems “full free online”:
Conclusion
The continued clinical use of stimulants for the treatment of depression reflects in part the desperation that both clinicians and patients feel when faced with this illness, especially when conventional therapies fail or produce only a partial response. In practice, psychostimulants are inherently ‘satisfying’ to prescribe because patients experience almost immediate benefits (BECAUSE IT’S SPEED) and clinicians observe this clinical improvement in their patients. This is understandably gratifying for all those involved, and even though the effects are usually short-lived (BECAUSE IT’S SPEED) the positive responses reinforce the future use of psychostimulants (BECAUSE IT’S SPEED – AND THE CUSTOMERS, SORRY PATIENTS, COME BACK FOR MORE). However, the dearth of research supporting the use of psychostimulants in the treatment of depression means that clinicians have to make difficult treatment decisions based on clinical experience alone and this burdens them with unnecessary additional risk. (POOR CLINICIANS, WHAT A BURDEN – no matter those suffering now with a speed addiction / worsened anxiety / etc etc to boot) Really remarkable… http://journals.sagepub.com/doi/full/10.1177/0004867416634208
Johanna says
Thanks so much for the plain talk, Rob! BECAUSE IT’S SPEED. Oh yes indeed.
There’s actually been quite a bit of research done on the combo of SSRI antidepressants plus speed, for people who have not managed to “get their life back” on SSRIs. Trouble is, most of it was negative. Have a look:
https://clinicaltrials.gov/ct2/results?term=lisdexamfetamine&cond=Depression
Most of the recent studies were done with Vyvanse (lis-dex-amphetamine) since Shire still has a patent on the stuff. In one of the biggest studies the first phase went well, but the six-month followup was apparently so bad it was terminated early. I’d suspect the Vyvanse either stopped working, or people needed increasing doses to get the same effect. (And a few became so rapidly and obviously addicted, it embarrassed even the psychiatrists …) One of the biggest crimes of market-based medicine is that studies like this don’t get published! They have at least as much to teach us as most of the “successful” studies.
One more thing driving the increasing use of this stuff in adults: Doctors are using it to offset the grogginess produced by the other meds they prescribe — mainly antipsychotics and opioids. Andrew Kolodny of PROP is one of the few who have spoken publicly about this practice in the pain clinics. But I’ve seen it several times in the world of Midwestern workers’ compensation.
Damian says
https://www.theguardian.com/society/2018/may/01/report-finds-serious-issues-with-use-of-mental-health-act
“People with the most severe forms of mental illness have the greatest needs and continue to be the most neglected and discriminated against”, said Prof Sir Simon Wessely, who chaired the review.
What about the neglect and discrimination of those wrecked by psychotropics.
annie says
Aye ..
Since you brought this up, Damian, Akiko, seems to have a handle on it and does not mince her words in her appraisal but does so in a very acceptable manner which can make us all think about the importance of ‘acts’ and how they can relate to you and me ..
The Interim Report on the Independent Review of the Mental Health Act: A Response
https://www.madinamerica.com/2018/05/interim-report-independent-review-mental-health-act-response/
Akiko Hart
Akiko Hart is the Chair of ISPS UK, a Committee Member of the English Hearing Voices Network and the Hearing Voices Project Manager at Mind in Camden. She has previously worked as the Director of Mental Health Europe. Her research interests include critical suicidology, psychosis and dissociation.
Peter J. Gordon May 3, 2018 at 1:33 am
Dear Akiko,
What a very thoughtful and wise perspective you offer on the Interim Report of the Mental Health Act. I share your every concern. I am not at all sure how this review came to be labelled as “Independent”!
I should say I work in NHS Scotland and Scotland has its own Mental health legislation. I have been a psychiatrist for more than 20 years and I am coming now to the end of my career.
Thank you for writing this Akiko.
aye Peter
Bridge of Allan
annie says
Antidepressant Withdrawal: What’s in a Name
READ and MO(O)RE ..
On March 9, 2018, a group of thirty academics, psychiatrists and people with lived experience wrote to the UK Royal College of Psychiatrists to challenge public statements about antidepressant withdrawal made in The Times newspaper.
Royal College of Psychiatrists Dig Deep Abyss
https://fiddaman.blogspot.co.uk/2018/05/royal-college-of-psychiatrists-dig-deep.html#.WulHrUxFw2x
UK Royal College Dismisses Complaint
https://www.madinamerica.com/2018/05/royal-college-dismisses-complaint/
Today on MIA Radio we have a special episode which is devoted to recent developments in the UK involving a formal complaint lodged with the UK Royal College of Psychiatrists.
Professor John Read from the University of East London took time out to bring us up to date on the response to the complaint which was lodged on behalf of a group of thirty academics, psychiatrists and people with lived experience.
By
James Moore
May 1, 2018
https://www.madinamerica.com/2018/05/professor-john-read-uk-royal-college-psychiatry-dismisses-complaint/
John Read Retweeted
James Moore @jf_moore 10h
On the @Mad_In_America #podcast, Professor John Read @ReadReadj talks about the UK College of Psychiatrists attempt to dismiss a complaint about misleading the public
John Read Retweeted
Mad In America @Mad_In_America 11h
The UK Royal College of Psychiatrists has dismissed a formal complaint of misleading the public on a matter of public safety against its President and Chair of its Psychopharmacology Committee. Professor John Read and colleagues respond to the dismissal
Fiona French @benzosarebad
https://holeousia.com/2018/05/01/rsm-health-matters-podcast-episode-1-antidepressants/
Transcript of RSM interview by Dr Peter Gordon. I am deeply troubled by the comments as is the rest of the online patient community. Deeply troubled.
susanne says
The college of psychiatrists reveals it’s contempt for it’s members as well as the public and anybody who uses the services controlled by them, They cannot be trusted to behave decently or ethically or even with the knowledge and skills needed to treat mental illness when it is obvious they are not understanding or ignoring the scientific literature.. it is frightening that such a bunch of people can have so much control over vulnerable peoples’ lives. As they are withholding information which has been requested by John Reid and signatories of the petition – could a Freedom of Information request be used?
tim says
Very deeply troubled.
Intolerant dogma and well rehearsed propaganda.
For an entire professional lifetime I have afforded the Royal Society of Medicine the highest resect.
Now: – No longer possible. This was not medicine.
Fiona Smith says
I see in this symptoms I have experienced trying to come off anti-psychotics like memory loss and extreme fatigue. As hard as my present situation is I see signs of hope that it is not me it is the drugs. I have struggled with acute withdrawal symptoms and agrivation of physical and mental problems because of drugs. I got off anti-depressants and mood stabilisers and if I can live without them – no one needs them. After recently watching crazywise i see hope that psychotic symptoms do eventually abate with patience and support. Thank you for your wonderful writing and for providing an increasingly robust space of resistance.
Damian says
https://www.theguardian.com/world/2018/may/03/montreal-brainwashing-allan-memorial-institute
With honourable exceptions I see psychiatry as a curse on mankind.
susanne says
Simon and Clare Wesseley were both interviewed o BBC R4 1/05./18 Midday News (although I could only bring up S W’s part on the pod cast) so they made sure both colleges were represented but no ‘user groups’ . Incredibly S W stated that he had been out of the loop doing other things for so long that he was surprised to find things were so bad – especially highlighting the situation regarding ‘black’ men and incarceration. Despite his ignorance of the situation and that there are other more suitable candidates SW accepted the appointment as Chair. It was given by Theresa May UK P.M – at a time when there are two national scandals in UK ie how the Windrush generation have/are being treated and the Grenfell Tower disaster – both effecting mainly non white British people. So it was useful to her for publicity to be concentrating on changing things for Black’ people when it has been known discrimination has been rampant in psychiatry for decades. She included concerns about the treatment of ‘Black’ people in part in a speech she made referring to the Act. Many have been campaigning themselves for at least 50 years and one group recently has set up an independant support and advice drop in in Lambeth ie the borough where Clare works because of the discriminatory way they are still treated. C W did unusually admit that she does know there are are serious issues around prescribed drugs but then quite slyly stated that people ‘claim’ to be having problems caused by psychiatric drugs. She is an experienced media presenter and knows how to skew information by the use of words such as ‘claim’..S W is flagging up that more ‘interventions’ designed to prevent hospitalisation are the way forward – both he and his wife ,despite Clare at least being a trained therapist herself.. strongly promote and defend use of drug treatments. There was much anguish and fear the last time compulsory treatment in the community orders were brought in – and found not to work after the harm had been caused to so many – and led to the apology from Tom Burns who no longer practices clinically ,he strongly advocated bringing them in as the government adviser of the time. So now the UK has another political appointment of a psychiatrist who does not engender trust and who has admitted he was not even aware of how dire the psychiatric services are in UK –
Damian says
My submission to the Scottish Parliament has now been returned to the petition webpage. Very strange.