Question regarding "Bupropion" (or "Wellbutrin") for Neuropathic pain
 

Hi Gang:

Over the years, I have used Cymbalta with moderate success for Neuropathic pain (especially Small Fiber).

The only side effect that I have encountered is delayed orgasm, which is very frustrating.

I recently read online that "Bupropion" (or "Wellbutrin") was shown in a number of studies to be effective for neuropathic pain relief without the sexual side effects of Cymbalta.

It was also shown to be useful in weight loss as a nice side effect.

Can anyone who is knowledgable about this drug share their knowledge. Could this drug actually be an effective replacement for Cymbalta without the sexual side effects?

I know that it is not an "SNRI" like Cymbalta, so I was surprised to read that it may be effective for treating neuropathic pain as opposed to depression alone.

Many thanks!

David

Some people find Wellbutrin works for PN pain. It works on dopamine primarily which does not have the well known connection for the serotonin central system the brain uses in pain perception. Increasing dopamine may improve attitude and confidence and make pain issues less prominent for some people.

But it is true that Wellbutrin does not affect sexual functioning as much as the other types do. Some people with sensitive cardiac functions may get a type of palpitations from Wellbutrin... but not all. Dopamine is a stimulant for the heart under some circumstances.

You'll just have to try it and see.

Many thanks for your insights!

If Wellbutrin is going to work for neuropathic pain, then how long would you expect it would take to work?

Cymbalta seems to take two weeks or so after you begin taking the full-strength 60mg dose before seeing an effect (I always taper-up with the first week at 30mg to avoid side effects).

I would give the Wellbutrin a month.

Watch for increased heart rate...that is the most common reason people discontinue.

That actual antidepressant actions will be slow to appear though like with other antidepessants.

People with low dopamine levels will feel energized and more confident as first changes. People with high dopamine already, may get the palpitations.( I saw many people complain of this heart rate effect over the years).

Some people believe Wellbutrin has mixed actions. These drugs can get pretty complicated to understand.

http://en.wikipedia.org/wiki/Bupropion

The anti-inflammatory actions mentioned in this article are fairly new.
If your PN has an inflammatory component...you may see improvement.

I was taking Wellbutrin for a short while and mentioned to the neurologist and gp that it was helping with my pain levels in my feet especially at night with throbbing, burning, stabbing etc. This was before studies were done showing it helped with nerve pain and they just looked at me and said we never heard that before. I used to call it the poor man's viagara. It worked pretty well for me for a while, until the type of pain i had morphed into deep bone pain.

... many thanks for the feedback!

David

Dopamine increases sensation. Increasing sensation, instead of blunting it with Serotonin enhancing drugs would seem more preferable to rebuilding nerves. In experimenting with both sides of the spectrum, I found that my neuropathy was worse on medications that were too pro-Serotonin as I was blind to my pain triggers(like laying a certain way for instance).

On the flipside, too much dopamine may cause anxiety and inability to relax. Finding your middle ground is the best solution and tipping the scales a little in the Dopamine direction. You can even do this by adding Blueberry, Pomegranate, and other fruit extracts to your regimen. Vitamin D or Methyl B-12 are serotonin enhancing and can cover those bases. You can enhance Serotonin levels with Vitamin D and Methyl B-12 amongst other routes.

I do take the Methy B-12 5000 mcg and also Vitamin D-3 2000 IU per day. Many thanks for your imput!

David

Apollo,

I was prescribed Bupropian along with other medications this past fall and winter for neuropathic pain in my feet. These included nuerontin, celebrex, lexapro, lyrica, indomethacin, amitryptilene and desipramine. I consequently developed undesirable side effects and discontinued all.

In retrospect I feel like the lyrica and the tricyclics were the root cause of the bad side effects, but I felt it was best to stop all the medications just to make sure.

I plan to start taking Bupropian again next week. It DID seem to help me with my stress and pain levels before I discontinued it.

I think that I will try the Wellbutrin XL (the once daily time-release version), and I read that 300 mg once per day seems to be the suggested dose. Does this dose level sound correct for neuropathic pain?

Mrs D?

Most people start lower and titrate up. This way, the palpitations side effects seem to be less likely.

You may also find that you don't need the high dose. I think it is always a good idea with drugs that affect neurotransmitters to titrate up. (once there you may have to titrate down, if you decide to quit. Tapering off drugs that affected neurotransmitters is typically needed if you have been on them for months or years).

For example, TCAs which were the first antidepressants, work in very low doses. The Wellbutrin may be the same.

Thank you for your thoughts, Mrs. D!

Based on what you said, what would be your suggested recommended dosage then, and is the one a day "XR" version available in your lower suggested dosage?

David

100SR or -150 XL daily to start.

Wellbutrin goes up to 450 daily I think. You probably won't need that much.

In the old days, they used the immediate release 50mg.. etc.

But that was because of the "seizure warning"...which didn't turn out to be a significant thing in the field. So 100 SR or 150mgXL to start for a month may be a way to start.

Apollo
My personal experience with Wellbutrin........started taking it for depression, took a low dose to start (can't remember exactly what it was). Within 5 days or so I was becoming more and more depressed and by about day 8 I was suicial. I can confirm that it works well for weight lose, I couldn't eat at all while taking it. I quit taking once I realized what was happening to me. I realize I am probably not the "norm" but thought you should hear from someone that had a bad reaction.

... thank you for your feedback.

Mrs. D, why would Cymbalta cause sexual issues whereas Wellbutrin does not, when they are both "SNRI" type antidepressants?

Wellbutrin works mostly on the dopamine system.

Cymbalta works on norepi and serotonin.

The serotonin actions are the ones that affect sexual functions.

When Wellbutrin was discovered, it took a long while to understand how it works. In fact the SSRIs like Prozac are still creating confusion! They are not as "simple" as serotonin affecting.

All the the drugs affecting neurotransmitters, are complex in fact and were allowed on the market LONG before they were understood. The general public became a huge experiment IMO.

Example: a new atypical antipsychotic: Abilify:
from http://www.rxlist.com/abilify-drug.htm
In general antipsychotics were labeled as reducing dopamine in the past. But you can see this one is really complex.

This is why when a person has been on a drug that impacts neurotransmitters for a long time, it is best to taper off. Many receptors "adjust" and change with the presence of these centrally acting drugs, and the person goes thru a withdrawal when the drug is removed. Often unpleasant.

Drugs are really quite complicated and both doctors and the public do not respect that factor at all.

Wellbutrin:
from http://www.rxlist.com/wellbutrin-xl-drug.htm

Wellbutrin for periphral neuropathy
 

I was taking Wellbutrin for my PN and had great success almost immediately. But I did experience the heart issues and Dr told me to stop taking it, almost immediately the swelling and pain/burning came back - I want to start taking it again B/C I feel so terrible again.
Are there alternatives for me?
I tried the serotonin type meds but they make me feel terrible and I don't feel any relief.

I am soooo frustrated and sad.

wellbutrin is the poor mans viagara.

i took 150 xl. i would use it again if i had to. Mrs.D is correct in my experience, use as little of something as you need to and still get the desired effect and take your time going up and down in dose.

This is old, but my observation may help someone.

Wellbutrin did this for me...I could taste things fully for the first time in forever. It made a HUGE difference in how much I could taste. Without it, I can barely detect some flavors. They are "muffled" at best.

I lost my habit eating? It controlled urges. The things that I would impulsively do, I had more control over. That covered, snacks, and sunflower seeds (my drug of choice).

It's like the highways to the taste buds weren't clogged anymore, the nudges from impulses was manageable, and it has helped with mental acuity somewhat to, which is the big hope for me with it.

It's sometimes used for weight loss and stop smoking, I understand. I can see why that would work, lessen the urge to smoke as an "urge", same with weight loss.

bye.

I have PN in my feet and I use cymbalta, and I was wondering why this was happening to me. Forget a delayed orgasm, it's more like none at all. I thought it was the neurontin, because it kept the nerves from firing, and it was possibly doing it to my sex organ too. But it's probably the cymbalta. Brutal. How about losing an erection in the middle of the act - I almost got smacked because of that happening. Frustrating is right. Makes you wonder whether you should keep asking females out at all. :o