Posted by pedr on February 4, 2002, at 8:15:50
In reply to Re: Intense biological depression on Wellbutrin, posted by Bekka H. on February 4, 2002, at 3:14:12
> Hello, Pete!
>
> I had the same problem on Wellbutrin. I was feeling suicidal on it and I had to stop. My negative thoughts were relentless and obsessional, like an endless tape or broken record. The odd thing is, I had taken Wellbutrin about 5 or 6 years ago, and I didn't have that problem, but I had it this past year when I tried it. This was quite a shock and disappointment to me because, in the past, it was the only antidepressant I could tolerate, and it gave me energy and drive, both of which were numbed on all the other antidepressants. For some reason, my body just can't tolerate it now. I have a thought, and I wonder whether you've checked with your doctor about this. . .I don't know too much about Reboxetine since it's not available in the U.S., but after reading your post, it occurred to me that Reboxetine and Wellbutrin might compete for some of the same liver enzymes and, therefore, might be rendering each other less effective. Do you know about the cytochrome P450 enzymes? Nearly every drug requires some metabolism by the cytochrome P450 enzymes. The problem is, some drugs are substrates of the enzymes, some drugs are inhibitors of the enzymes and some drugs are inducers of the enzymes. If you take one drug that inhibits an enzyme (let's call it enzyme IID6, for example), and you take a second drug that is a substrate of IID6, then that second drug won't be properly broken down because the first drug inhibited the enzyme that was needed for the second drug's metabolism. As I said, I don't know much about reboxetine, but I do know that Wellbutrin metabolites affect some of the cytochrome P450 enzymes. If I'm not mistaken, I believe that hydroxy-bupropion, the major metabolite of Wellbutrin, inhibitis cytochrome P450 IID6.
>
> Another thing to consider is the half-lives of the various drugs. Bupropion itself has a fairly short half life of about 14 hours or so; however, its metabolites have half lives of 2-3 days, so I wonder how that might be interacting with reboxetine. I wish I knew more about reboxetine so I could help you. Also, I wonder how you would be responding to Wellbutrin if you weren't on reboxetine. How long have you been on reboxetine? Have you ever taken Wellbutrin without reboxetine and, if so, did you have the same reaction?Wow,
much thanks for the reply Bekka. Just to clarify something - you seem to have had the *opposite* reaction to Wellbutrin than I did i.e. increased very negative distorted thinking. I just *feel* depressed, my thoughts and outlook are overall improved. Weird.Thanks for the suggestions about the P450 enzymes. I know pretty much zilch about this sort of stuff, I never know where to start learning about it. I shall print out this post and see what my pdoc thinks. So far I've not been too impressed with his knowledge, for example, he says that Wellbutrin affects only dopamine which I know not to be the case.
The best info I've found on reboxetine is at:
http://www.smart-drugs.net/reboxetine/reboxetine-articles.htm
http://www.mentalhealth.com/drug/p30-r06.html
http://www.ijmt.net/3_4/3_4_26.htmlIf you have the time [and desire] to look into the possible interactions I'd love to hear your findings and don't worry, I won't go changing dose/drug/whatever without consulting my pdoc :-]
To answer your latter questions:
How long have you been on reboxetine? - I've been on it for 4 months now. Incidentally I was plagued with constant suicidal thoughts for the first 2 weeks - just like you when you started wellbutrin the second time.Have you ever taken Wellbutrin without reboxetine and, if so, did you have the same reaction? - no. I wonder what it'd be like without it.
Thanks for your time and for sharing your knowledge,
pete.
poster:pedr
thread:92694
URL: http://www.dr-bob.org/babble/20020131/msgs/92806.html