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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by TomV on August 14, 2000, at 21:52:41
Anyone tried both? Is SR superior to immediate release Wellbutrin. I've tried immediate release in the past and had very limited success. Any info would be appreciated.
Posted by Sunnely on August 15, 2000, at 1:11:23
In reply to Wellbutrin vs Wellbutrin SR, posted by TomV on August 14, 2000, at 21:52:41
> Anyone tried both? Is SR superior to immediate release Wellbutrin. I've tried immediate release in the past and had very limited success. Any info would be appreciated.
TomV,
There are differences and similarities between the traditional immediate release (IR) and sustained release (SR) Wellbutrin (bupropion).
First, for the simlarities:[1,2]
1. The SR Wellbutrin is bioequivalent to the IR formulation and therefore, expected to have similar antidepressant effectiveness given in comparative doses.
2. As with the IR formulation, the SR formulation of Wellbutrin has minimal impact on sexual function. In fact, both formulations may have a "pro-sexual" effect.
3. Both the IR and the SR formulations are contraindicated in patients with seizure disorder, in patients with eating disorder (anorexia and bulimia), or in patients on monoamine oxidase inhibitors (MAOIs) such as phenelzine (Nardil), tranylcypromine (Parnate), and isocarboxazid (Marplan).
4. No matter what the formulation is (IR or SR), Wellbutrin may not be the best antidepressant for patients with anxiety. It is actually a very bad anti-anxiety drug - it has no anti-anxiety effect. If anything, it tends to increase anxiety symptoms.
5. Both formulations seem to work well for patients with atypical type of depression - those who are sleeping and eating too much. In fact, both formulations may decrease appetite and induce weight loss.
Now for the differences:[1,2]
1. Frequency of dosing: With the SR formulation, it only has to be taken twice a day, although one reknown psychopharmacologist would disagree with this, i.e., depending on the total daily dose.[2]
2. Side-effect profile: The SR formulation seems to have fewer negative side effects such as insomnia, restlessness, and gastrointestinal distress compared to the IR formulation. It was suggested that the degree of side effects with Wellbutrin is related to the (blood) peak levels. The SR formulation decreases those peak levels, so the negative side effects described above would be less. Similarly, lessening the peak levels of Wellbutrin (using SR) also lessens the chance of seizures.
3. You can substitute Wellbutrin SR for Zyban (smoking cessation), but not Wellbutrin IR for Zyban. Wellbutrin SR is the spitting image of Zyban. The manufacturer, Glaxo Wellcome, gave Zyban a different name than Wellbutrin SR to distinguish the two uses of the drug. Another reason for the name change is just because of the stigma of depression, unfortunately.
To lower the risk of seizures from Wellbutrin, as an antidepressant, the following guideline is recommended:
1. The dose should be carefully titrated (increased) to achieve the lowest effective dose.
2. Daily doses (except for starting doses) are to be divided into at least every 6 or 8 hours interval.
3. The dose should not exceed 450 mg/day.
4. The dose should not exceed 150 mg in any single dose.
5. The doses should not be given closer than every 6 hours.
6. Further dose increases should not occur any more frequently than every 3 days, and for no more than 100 mg.
References:
1. Benefits of new sustained-release bupropion: less-frequent dosing, fewer side effects. In: Psychopharmacology Update, November 1997.
2. Preskorn SH: Bupropion. Journal of Psychiatric Practice, January 2000.
Posted by Dr. Bob on August 15, 2000, at 20:27:22
In reply to Re: Wellbutrin vs Wellbutrin SR, posted by Sunnely on August 15, 2000, at 1:11:23
Sunnely,
Just wanted to thank you for staying. Despite that business up there...
Bob
Posted by Oddzilla on August 16, 2000, at 8:06:27
In reply to Re: thanks for staying » Sunnely, posted by Dr. Bob on August 15, 2000, at 20:27:22
Bob,
And what about everybody else who stayed????????
Oddzilla
> Sunnely,
>
> Just wanted to thank you for staying. Despite that business up there...
>
> Bob
Posted by Sunnely on August 20, 2000, at 21:25:10
In reply to Re: thanks for staying » Sunnely, posted by Dr. Bob on August 15, 2000, at 20:27:22
> Sunnely,
>
> Just wanted to thank you for staying. Despite that business up there...
>
> BobHi Dr. Bob,
Oh, that stuff above. Read some, skipped some.
IMHO, discussion and exchange of opinion is healthy and should be encouraged. That is the hallmark of democracy. That's what makes this country great. However, limits should be set, too. Opinion that are abusive, hurtful, destructive, discriminatory, profane, degrading, etc., should not be tolerated. When Voltaire said, "I disapprove of what you say, but I will defend to the death your right to say it," I don't believe he meant to include the kind of opinion I just mentioned. To borrow from a parliamentary parlance of rules and procedures, "You're out of order, sir!" (Your post ought to be deleted.)
I believe you are doing a marvelous job in keeping this community board a clean and enjoyable place to visit. (I don't envy your role, however.) Opinion as to what constitutes a "civil" post/response or not will abound, but in the end, only yours should prevail. Bottom line is: Your house, your rules. If some people can't stand it, the door is just a mouse-click away.
Dissenting ("civil") opinion welcome.
Posted by Dr. Bob on August 21, 2000, at 1:22:10
In reply to Re: thanks for staying » Dr. Bob, posted by Sunnely on August 20, 2000, at 21:25:10
> > Just wanted to thank you for staying. Despite that business up there...
>
> Oh, that stuff above. Read some, skipped some.
>
> IMHO, discussion and exchange of opinion is healthy and should be encouraged...Thanks. But actually I wasn't thinking of *that* stuff, but the "Medical Deities" stuff. :-)
Bob
This is the end of the thread.
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