Bupropion - most commonly used AD in US/Canada, yet N/A in Europe...?

ElectroTechno

[font=Verdana, Arial, Helvetica, sans-serif]Some people attribute this to "a marketing ploy", their side of the pond.[/font]

[font=Verdana, Arial, Helvetica, sans-serif]A lot of anecdotal reports are floating around that seemingly it induced horrific nightmares.[/font]
[font=Verdana, Arial, Helvetica, sans-serif]That being said, there were clinical trials conducted that demonstrated significant inferiority of the generic versions to the brand names (Wellbutrin/Zyban), and that generics sometimes did have this effect, so perhaps there was some mix up there.[/font]

[font=Verdana, Arial, Helvetica, sans-serif]All that being said, the reality is, Bupropion acts on a different set of neuroreceptors than SSRI's, so, when they prove ineffective, it would be logical next step.[/font]
[font=Verdana, Arial, Helvetica, sans-serif]A lot of doctors will alternatively prescribe Venlafaxine (Effexor), which is basically just another SSRI anyways, but with a 1/30th effect on noradrenaline, in comparison to its effect on serotonin.[/font]
[font=Verdana, Arial, Helvetica, sans-serif]Apparently it does have a very mild effect, "downstream" (what exactly that means I don't know), on the mu opioid receptor, which you would imagine enhances its AD properties, so there is that.[/font]

[font=Verdana, Arial, Helvetica, sans-serif]Still and all, in terms of varying the therapeutic approach and coming from a different angle, the logical next step would be a to implicate a different set of receptors.[/font]
[font=Verdana, Arial, Helvetica, sans-serif]But, due to Bupropion being unavailable in Ireland/UK and europe in general, the options are then limited to the likes of Straterra, which is intended for use to treat ADHD.[/font]
[font=Verdana, Arial, Helvetica, sans-serif]Or perhaps some tricyclics, with all their side effects - and that being said, even the more prominent noradrenaline based tricyclics are also completely unavailable in Europe - such as desipramine.[/font]

[font=Verdana, Arial, Helvetica, sans-serif]Baffling.[/font]

[font=Verdana, Arial, Helvetica, sans-serif]On top of that, there has been clinical trials conducted which clearly highlight the benefits of using noradrenergics when treating depression associated with cognitive impairment, which concurrently prove that serotonergics are a futile application in these circumstances, due to their lack of affinity with "executive function".[/font]
[font=Verdana, Arial, Helvetica, sans-serif]Noradrenaline seems to be the key player in this capacity.[/font]

[font=Verdana, Arial, Helvetica, sans-serif]Link to said clinical trial[/font]

[font=Verdana, Arial, Helvetica, sans-serif]clinicaltrials.gov/ct2/show/NCT00125957?term=bupropion&rslt=With&rank=5[/font]

[font=Verdana, Arial, Helvetica, sans-serif]I know there can be some bureaucracy surrounding "big pharma" and ultimately what can keep these pharmaceutical companies income nice and high, but a proven effective medication such as bupropion remaining unlicensed, whilst a relatively benign AD like Valdoxan (agomelatine), which has proven to carry significant risk of hepatoxicity, being marketed as a forerunner....
I mean, that doesn't really make much sense, does it?[/font]

[font=Verdana, Arial, Helvetica, sans-serif]As an after thought, the company responsible for the synthesis of valdoxan, also produced an tricyclic based med in the 80's called Tianeptine, which implicates more so the opioid receptors, which, due to the 10 year patent having expired, i.e. not being a position to net the pharmaceutical much in the way of profit, yet proven to be a highly effective AD whilst carrying little to no side effects - has pretty much faded into oblivion.[/font]


[font=Verdana, Arial, Helvetica, sans-serif]Just curious - but the overall point being, the situation regarding the licensing of bupropion, appears to me at least, to be a straight up oversight.[/font]

angeldelight

Zyban has been licensed in Ireland for many years for smoking cessation. I have seen it used off-label for depression

ElectroTechno

angeldelight wrote: »

Zyban has been licensed in Ireland for many years for smoking cessation. I have seen it used off-label for depression

You have seen ti off license used for depression??

May I ask, where?
Because, basically, everyone (no exaggeration) that I spoke to in the medical industry, including pharmacists, have said they haven't seen it given out in years, for smoking cessation, let alone depression.

Is Zyban exactly the same product as Wellbutrin??
Can anyone definitively answer that?


And - and here's a real wake up call - on the review of multiple clinical trials, Bupropion came in with efficacy similar to Prozac, Setraline, Lexapro and Venlafaxine, and here's the punch line, significantly outperformed venlafaxine, the second line and widely considered the more potent agent, in terms of actual remission acheived.

[font=arial, helvetica, clean, sans-serif]"remission rates were significantly higher among those treated with bupropion XL (46%) versus venlafaxine XR (33%) (odds ratio, 1.93; 95% confidence interval, 1.07-3.46)"[/font]

Link:

ncbi.nlm.nih.gov/pubmed/16974189

ElectroTechno

ElectroTechno wrote: »

You have seen ti off license used for depression??

May I ask, where?
Because, basically, everyone (no exaggeration) that I spoke to in the medical industry, including pharmacists, have said they haven't seen it given out in years, for smoking cessation, let alone depression.

Is Zyban exactly the same product as Wellbutrin??
Can anyone definitively answer that?


And - and here's a real wake up call - on the review of multiple clinical trials, Bupropion came in with efficacy similar to Prozac, Setraline, Lexapro and Venlafaxine, and here's the punch line, significantly outperformed venlafaxine, the second line and widely considered the more potent agent, in terms of actual remission acheived.

[font=arial, helvetica, clean, sans-serif]"remission rates were significantly higher among those treated with bupropion XL (46%) versus venlafaxine XR (33%) (odds ratio, 1.93; 95% confidence interval, 1.07-3.46)"[/font]

Link:

ncbi.nlm.nih.gov/pubmed/16974189

From my understanding, it is not as effective for depression/anxiety and most people suffer from anxiety with depression. I would always recommend an SSRI for first line treatment of depression due to evidence of safety and efficacy.

ElectroTechno

Yes, that seems to be the go-to approach.
And given it's activating nature, it would make sense that, it does not really alleviate anxiety, as more sedative agents are normally used in these circumstances.
For depression/low mood specifically though - the clinical trial statistics are what they are.

SSRI's seem always to be first line, and in the Netherlands, which I consider the gold standard for mental health care in Europe, Wellbutrin is approved for use, specifically as a second line agent, if first lines have been unsuccessful.

So I said Bupropion NA in europe, but it is available in the Netherlands.
That being said, UK and Ireland still regard it as an NA drug.

Curiously though, Netherlands mental health care will often use TCA's as first line agents.

ElectroTechno

ElectroTechno wrote: »

Yes, that seems to be the go-to approach.
And given it's activating nature, it would make sense that, it does not really alleviate anxiety, as more sedative agents are normally used in these circumstances.
For depression/low mood specifically though - the clinical trial statistics are what they are.

SSRI's seem always to be first line, and in the Netherlands, which I consider the gold standard for mental health care in Europe, Wellbutrin is approved for use, specifically as a second line agent, if first lines have been unsuccessful.

So I said Bupropion NA in europe, but it is available in the Netherlands.
That being said, UK and Ireland still regard it as an NA drug.

Curiously though, Netherlands mental health care will often use TCA's as first line agents.

That is unusual. Never seen anybody been started on a tricyclic for depression in the time I've been a pharmacist. I think if you are just suffering from low mood, there are better options than an antidepressant such as counselling therapy. From my experience, most cases of depression are stemming from an event that happened in the patient's life and long term, they would benefit more from counselling/CBT.

ElectroTechno

Deleted User wrote: »

ElectroTechno wrote: »

Yes, that seems to be the go-to approach.
And given it's activating nature, it would make sense that, it does not really alleviate anxiety, as more sedative agents are normally used in these circumstances.
For depression/low mood specifically though - the clinical trial statistics are what they are.

SSRI's seem always to be first line, and in the Netherlands, which I consider the gold standard for mental health care in Europe, Wellbutrin is approved for use, specifically as a second line agent, if first lines have been unsuccessful.

So I said Bupropion NA in europe, but it is available in the Netherlands.
That being said, UK and Ireland still regard it as an NA drug.

Curiously though, Netherlands mental health care will often use TCA's as first line agents.

That is unusual. Never seen anybody been started on a tricyclic for depression in the time I've been a pharmacist. I think if you are just suffering from low mood, there are better options than an antidepressant such as counselling therapy. From my experience, most cases of depression are stemming from an event that happened in the patient's life and long term, they would benefit more from counselling/CBT.

Again, this is typical protocol, and I assume you're a pharmacist in Ireland/UK.

Yes, I'm aware starting with a tricyclic would be unheard of under the NHS.
But like I said, I consider the Dutch system to be the gold standard.

Like I said, typical protocol and, often times doctors will jump and administer these measures without indepth analysis and correct diagnosis being made.
You walk into a shrinks office, and he's already writing a script for an SSRI before you've even exchanged a word with him/her/

About 25% of depressive cases comprise of endogenous depression, to 75% reactional - that would be, as you describe, a life event or long term behavioral pattern.

Endogenous or refracted depression to not respond to psychotherapy.
Granted, this makes up the minority of cases, but can be overlooked due to the typical protocol which has been established, and which you describe.