Wellbutrin long term effects

[Misguided_Angel]

10

Carcinogenesis, Mutagenesis, Impairment of Fertility: Lifetime carcinogenicity studies were

performed in rats and mice at doses up to 300 and 150 mg/kg per day, respectively. These doses are

approximately seven and two times the maximum recommended human dose (MRHD),

respectively, on a mg/m2 basis. In the rat study there was an increase in nodular proliferative lesions

of the liver at doses of 100 to 300 mg/kg per day (approximately two to seven times the MRHD on a

mg/m2 basis); lower doses were not tested. The question of whether or not such lesions may be

precursors of neoplasms of the liver is currently unresolved. Similar liver lesions were not seen in

the mouse study, and no increase in malignant tumors of the liver and other organs was seen in

either study.

WELLBUTRIN SR

[AirMarshall]

The Ames test is benign. It involves using several strains of Salmonella bacteria that are placed in petri dishes with the compound being tested. Each strain is engineered with various DNA changes that make it sensitive to different effects. Investigators look for changes to the bacteria DNA in order to detect possible mutagenic compounds in the tested drug. The test was developed by Mr. Ames at UC Berkely in the early 1970's.

Unfortunately for most of the drugs we use, there will be no decades long effects data until we have used them for decades. The results you quote are not alarming to me as a biologist. First the dosages tested were many times higher than humans would take. The nodular growths were NOT cancerous. Mice did NOT experience the same type of growths, so this may have been an effect unique in rats that won't occur in humans. No other growths were found in other internal organs.

I have pretty good trust in the the scientists and doctors who develop our medicines and test them. They don't want people to use meds that will harm them either.

Finally we must consider the risk benefit ratio. Presently there is no evidence that your med causes cancer or other dangerous condition. The evidence for growths in unsure. On the other hand, what is the danger of people dying from suicide or accidents, or from other illnesses due to lack of personal care? Hundreds of thousands of people are taking this medication. We should have good warning if it develops that there are problems. If that happens you can change to another medication.

Hope that eases some of your fears. a.m.

[null0trooper]

Unfortunately for most of the drugs we use, there will be no decades long effects data until we have used them for decades. The results you quote are not alarming to me as a biologist. First the dosages tested were many times higher than humans would take. The nodular growths were NOT cancerous. Mice did NOT experience the same type of growths, so this may have been an effect unique in rats that won't occur in humans. No other growths were found in other internal organs.

With bupropion, the manufacturer and most printed material are fairly emphatic about NOT exceeding the known therapeutic

range. So you've got an out-of-range high data point that indicates a minimal risk, and nothing else to bracket it on the low end except the side effects profiles.

If you ARE still worried though, maybe your GP can schedule an annual liver enzyme test - to establish a baseline now and give an early warning if your liver ever starts getting too old to be taking as much as you do. But to be brutally honest about the risks: you're liver is far safer with your depression under control with Wellbutrin than out-of-control and soaked in alcohol.

[Thorzdad]

I'm in the same boat as you, Angel. I've been taking Wellbutrin ever since it was new. I can't imagine being off it since, like you, it's the only med that has ever worked for me.

I guess it's a trade-off. A med that works, but with a slight chance of liver damage.

[KRS]

it seems as though by now there should be information available on its long term effects (as in decades.) didnt WB first come out in the 80's?

[resonance]

Yes. But, in order to find out about long-range effects you have to look at people who've been on WB for long periods of time. A lot of people aren't on a given medication that long. It's also much more difficult and expensive to do long-range studies, because it's hard to keep track of people and people drop out and people stop taking the medication and eventually you don't have anyone still on it in your sample, unless you had a huge initial sample. Finding the people right now who have been on it for years won't tell you what happened to the people who stopped using it after, say, five days or months or years, and you need to know why they stopped taking it because they might have done so because of long-range effects. And finding people who used to take it and stopped is tricky, partly due to privacy reasons.

I think it would be great if we just automatically funded long-term studies of medications, but afaik it's still up to individual researchers to secure funding for stuff like that. I don't know this, but I'm willing to bet that drug companies want to put their money into their newer drugs, rather than older ones that already have an established market, so that would make long-term studies even less likely.

[cdsmafp]

After more than 12 years on Celexa (citalopram) 25mg, Ativan (lorazepam) 2 mg, and Wellbutrin SR (bupropion SR) 450 mg, I made the decision to come off these meds. When I began taking them, I was in deep depression with panic attacks and needed the relief they gave me. But in the interim, the panic attacks stopped (actually they stopped for the most part around the time I divorced - I wonder if there was a connection?!) and the depression has been much better. In the past 4 years I was diagnosed with hypothyroidism and asthma - both of which can be effected by psychotropic meds. That was another reason I wanted to come off. It is hard to know if illness is contributed to by drugs if the drugs have been part of your body chemistry for such a long time. I also felt I needed to know if the drugs were still working.

I want to preface all this by saying that I am well aware that everyone has different reactions to different meds and different cocktails. I also want to say that although my experience has on the whole been a positive one, this is not something I recommend to anyone without serious research and medical monitoring.

Since there are no clinical studies on the long-term effects of these drugs, there is no way to know if they work after an extended period. Lorazepam, for example, is addictive. This is something I was aware of from the beginning - I had a very good psychiatrist who was current and kept current on meds, and was a believer in honest, direct communication with patients. He was a gem. So, I knew I was addicted to the lorazepam from the first few months of taking it. Over time there is no evidence that any benzodiazepine keeps its effectiveness. There is evidence however, that patients keep taking the drug (keep having the drug prescribed) because coming off it can be dangerous as well as extremely unpleasant. In other words, I continued to take the drug because I was addicted to it not because it was effectively controlling my anxiety. I was not aware of the long-term contraindications of lorazepam until earlier this year, when I was already considering coming off my meds.

Both the doc who initially tried me on meds, and the one who fine-tuned my cocktail, are no longer available to me. The former has moved to the other coast, and the latter was tragically killed some years ago. The current doc I have been seeing was not a fan of my plan of titration. Nonetheless, I was determined because I felt it was important to my overall health, and was imperative to know how these drugs were working, if in fact they still were.

I started with Celexa since it was the smallest dosage and had been originally added as a booster for the Wellbutrin, not the primary anti-depressant. I designed a plan which I discussed with both my primary care doc and my therapist (PhD doc). Celexa turned out to be easy to withdraw from with no discernable side effects and no discernable difference to my mood. I came off it very slowly, staying three weeks at each stage of the titration. The first week for my body to adjust to the change, the second week to weather any withdrawal symptoms, and the third to make sure I was all right before stepping down further.

I then moved to the lorazepam. I must admit I was extremely nervous about this one. After much research, I found that the most common way to come off is to replace the dosage with a similar dosage of Valium (diazepam). Valium apparently has a much smaller half-life than lorazepam, so the addiction factor is minimized and withdrawal from it after taking it for a relatively short period is easier.

Since my psychiatrist was not supporting this endeavor, and since my primary care doc would not prescribe psychotropics (which I am grateful for - I appreciate knowing that he practices within his own purview and does not try to be all things to me), I did not feel using Valium was the way to go. So, I began the titration without any replacement drug. I did it very slowly allowing 4 weeks for each step instead of three, and monitoring myself closely. I have had withdrawal symptoms - severe nausea, headache, anxiety - at every step down. The first one was the most significant since I had a panic attack during the second week. Frankly, I am not certain if the panic attack was brought on by the chemical reaction in my body or the psychological reaction to getting rid of this crutch. Either way, the attack was real and awful; however, it was the only one I have had. I am happy to report I am in the last stages of withdrawal and expect to be through this within a week, although I will monitor for another three weeks.

I feel I must once again caution anyone else to considered hard and long before trying to withdraw from any benzodiazepine. These are serious, hard-core, addictive drugs that can very profoundly mess with your brain and central nervous system. I am a psychologist who has had a great deal of experience with individuals on a multitude of psychotropics and have monitored side-effects and withdrawal symptoms on many of them. In addition, I did weeks, months of research on the topic, had no seizure history or obvious brain damage/complications, AND did have some medical monitoring. This is absolutely not something that should be done by anyone without careful consideration.

Wellbutrin SR (actually buproprion SR, since it is considered the generic form of Wellbutrin and what my insurance will pay for) is my last drug. My current non-supporting doc handed me a prescription for Cymbalta 30 mg, but would not tell me how to take it with the Wellbutrin or in place of it. I believe I do need an antidepressant, and Cymbalta seems like a good drug for me to take. It will in fact replace all of my previous cocktail since it is an SSNRI and helps control anxiety. My question now - and the reason for this long tale - is, how to make the transition. I have noticed on this and other sites than many people are taking both Wellbutrin and Cymbalta, but have not seen any one who has come off the Wellbutrin and begun Cymbalta. I have also noticed that of those who gave a diagnosis, most were bipolar not MDD, which would of course make a difference in the effectiveness of the drug(s).

Therefore, I am asking for your help. Has anyone moved from Wellbutrin to Cymbalta, then stopped taking the Wellbutrin, and if so, what kinds of side effects/withdrawal did you experience? Also, has anyone diagnosed with major depressive disorder used these drugs and what was your experience?

[cdsmafp]

I don't know this, but I'm willing to bet that drug companies want to put their money into their newer drugs, rather than older ones that already have an established market, so that would make long-term studies even less likely.

You are absolutely right about this. Long-term studies are labor intensive and expensive, and drug companies are definitely in the moment. Once they have done the required testing and received FDA approval, they rarely do any more research on a drug. That is one of the reasons that potentially fatal side effects are not monitored very carefully. The initial research generally shows that these effects are rare, so other than including the research info in the drug insert, the drug companies do not do much with currently marketed drugs.

[olga]

I wouldn't go off the Wellbutrin at all, and switch to Cymbalta. Why don't you titrate down to 300 mg of Wellbutrin, which is the therapeutic dose recommended by the manufacturer? If you feel well, and not anxious at that level, why go off it?

Cymbalta is much newer, so if you're concerned about long-term effects, you're safer on Wellbutrin. It's so much older that people would have been reporting serious long-term effects---if they exist. I think it is perfectly possible to take drugs for many years and NOT have any serious side effects.

I did the opposite switch--from Cymbalta to Wellbutrin. My doctor made me titrate down on the Cymbalta and take nothing for 3 weeks, and then I started with 150 mg of Wellbutrin. I didn't feel great during that time, but it wasn't awful either.

YMMV!

olga

[cdsmafp]

I think it is perfectly possible to take drugs for many years and NOT have any serious side effects.

I did the opposite switch--from Cymbalta to Wellbutrin. My doctor made me titrate down on the Cymbalta and take nothing for 3 weeks, and then I started with 150 mg of Wellbutrin. I didn't feel great during that time, but it wasn't awful either.

YMMV!

I also think it is possible to not have serious side effects on long-term meds. My major concern I guess was being on these drugs for so many years, and having other organic illnesses diagnosed in the interim. Both illnesses - hypothyroidism and asthma - are worsened by stress, anxiety and depression, so I wanted to find out if the drugs were helping that situation or hurting it. It may be that the drugs had no effect whatsoever, except to do their chemistry thing which of course was the reason for taking them in the first place.

Maybe I was spoiled by the docs I had before, but I just feel like a psychiatrist should actually monitor a patient not just saying "How are you doing?" then writing a prescription while you say how you are doing, then shaking your hand and oh-by-the-way-don't-let-the-door-hit-you-on-your-way-out.

I am a believer in better living through pharmaceuticals. I have seen them work wonders on people who were lost. I am also a believer in not taking drugs you do not have to. I think I have just wanted to be sure I still had to, and that the drugs were still working.

Thanks for the advice!

olga

[olga]

Boy, I hear ya on the bum's rush with the doctor. My Wellbutrin is prescribed by my GP, who factors in the other drugs I take for glaucoma, cholesterol and high blood pressure. He has blood work done on me every 3 months, and the big ones (liver function, thyroid, etc) at least once a year. I can talk to him as long as I need to, and he never rushes me out.

And the best part is that he knows I check all the drugs and interactions on the internet, and he's always interested in hearing what I've discovered. He just diagnosed me with hypothyroidism---but he gave me a month to research it so we can decide together what I'll do. He's a really terrific doc.

Keep doing your research and asking questions---the best patient is an informed patient.

olga

[JenB]

There's lack of information about long-term side effects of drugs because clinical studies are usually short-term. Two years was the maximum term of the study that struck my eye. Wellbutrin is pretty old drug, it's on the market since 1985 (despite it was discovered in 1966). Twenty two years is long enough to reveal possible serious complications that can be caused by long-term use.

[Misguided_Angel]

Hmm, A few years later...and Im on it still. My liver has still been fine. Going to new doc in a few days and asking about increasing to 450mg tho. Which I hear is not out of the norm anymore.

Thank you btw to all the ppl who responded. My internet access is limited so I am sometimes gone for long periods. Cheers