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Welbutrin (Bupropion) for the Treatment of Depression

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Welbutrin (Bupropion) is a dopamine-norepinephrine reuptake inhibitor; its occupancy at dopamine transporter (DAT) is 23%; whereas over 75% causes euphoria (ex. cocaine). dopamine reuptake inhibitor (DRI) is a class of drug which acts as a reuptake inhibitor of the monoamine neurotransmitter dopamine by blocking the action of the dopamine transporter (DAT). Reuptake inhibition is achieved when extracellular dopamine not absorbed by the postsynaptic neuron is blocked from re-entering the presynaptic neuron. This results in increased extracellular concentrations of dopamine and increase in dopaminergic neurotransmission.

 I am currently taking Abilify 400 mg every 3 weeks (~ 20 mg / day) and 300 mg of Welbutrin. 

I was complaining to my psychiatrist about the side effects of Abilify I was suffering from; depression (low mood),  sexual dysfunction, anhedonia, from a condition called "Neuroleptic Induced Deficit Syndrome" . I complained that I had totally lost my motivation, drive, and initiative and was experiencing anhedonia (lack of pleasure), emotional suppression, etc. It is like living in a mental restraint "straigthjacket". So my psychiatrist added Welbutrin. Abilify dampens down dopaminergic activity in three of the four dopaminergic pathways; It is the only Antipsychotic that I know of that can increase mesocortical dopaminergic activity. Other partial agonists like Brexiprazole and Cariprazine might do this also, whereas a silent antagonist cannot. Welbutrin has treated my low mood; I am euthymic now, but I am still anhedonic from Abilify being so frequent for such a dose; I am taking the daily equivalent of 20 mg: 400 mg per 3 weeks. At lower doses Abilify has a more stimulating effect. The Welbutrin he added certainly helps; but is unfortunately not enough. 

I am considering adding a dopamine full agonist such as Ropinirole, Rotigotine, Cabergoline and Pramipexole to my prescription meds. Some dopamine agonists are useful at treating depression resistant to SSRI-treatment. Dopamine agonists can be given to counteract the side effects of antipsychotics and serotonergic antidepressants. No doubt that dopamine antagonism has a negative effect on mood. In the mesolimbic pathway *(reward pathway)* Aripriprazole reduces dopaminergic activity; which reduces motivation - salience (liking, rewarding), which can be identified as a major source of anhedonia. Aripriprazole does not reduce dopamine transmission in the mesocortical pathway in people whose mesocortical pathway has .less than normal activity. The dopamine boost that Welbutrin provides keeps me stable; counterbalances some of the negative effects of Abilify. I just need more help in alleviating this zombified state of existence in which I am alienated from my own real self. and cannot enjoy the things I used to enjoy; food, drugs, sex. I live in anhedonia, a state of a loss of pleasure; due to the neurological inhibition caused by Abilify. Welbutrin works as a wakefullness promoting agent, a mild stimulant.

 

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