Welcome to the Frontier Psychiatrists. It’s a newsletter. Today, you will learn things about science. There is a paywall. It’s an experiment. Plenty of good stuff before it! I have “get past the paywall for sharing” turned on, so it doesn’t have to cost you money. Other excellent (if weird) reviews in the series include:
Effexor, Buspar, Risperdal, Zyprexa, Neurontin, Xanax, Klonopin, Paxil, Prozac, Clozaril, Lamictal, Lithium, Latuda, Ambien, and generally Benzos, specifically maybe Benzos leading to death by suicide, Geodon, Zoloft, Auvelity, and over 500 articles total in this newsletter thus far. You should subscribe!
Bupropion — the most renamed antidepressant. I could go back and check that claim, but I'm not going to. Because it's a waste of everyone's time. Here are the different ways in which you can get that medication as brand name pill, alone or combined with other medicines:
Wellbutrin — depression
Wellbutrin, sustained release (SR)
Wellbutrin, extended-release (XL)
Zyban — smoking cessation.
Contrave (in combination with naltrexone) — weight loss.
Auvelity (in combination with Dextromethorphan) — depression
Aplenzin (the hydrobromide salt instead of the hydrochloride salt for Wellbutrin) — depression and smoking cessation…and a super-cringe-worthy sponsored Google ad when I searched just now).
Forfivo XL (this is the 450 mg version of the hydrochloride salts in one pill…instead of different pills). — depression
The original FDA approval was in 1985. “On-label?” The drug is FDA-approved for (adult) depression, seasonal affective disorder, and smoking cessation. Common Off-label, non-FDA-approved uses include anti-depressant-induced sexual dysfunction—this “use case” was promoted illegally and led to $3,000,000,000 in fines in 2002, attention-deficit/hyperactivity disorder (ADHD), depression associated with bipolar disorder, and obesity. In pediatrics, bupropion has data for ADHD.
The original patent for this odd duck of a drug was issued in 1974 to what was at the time Burroughs Wellcome—that is where the Wellbutrin must have come from!?— which is now a part of the (massive) GlaxoSmithKline1.
I call it an odd duck because unlike most antidepressant meds, which include the serotonin system in their mechanism of action, Wellbutrin does not. It predominantly leads to more dopamine and, to a lesser extent, norepinephrine, hanging out in synapses thanks to the prevention of “reuptake” by the presynaptic terminal. This means no sexual side effects.2. There may be a risk of increased libido, which matters when treating sex offenders or paraphilias in the wrong direction.3
This “reuptake inhibitor” mechanism has been a goldmine for pharma and a lame class of meds (according to me) since Eli Lilly leaned into it…HARD…with Prozac and its “selective” serotonin reuptake mechanism of action branding, which, as I’ve addressed previously, is nonsense4. The “missing” documentation of these medicines' impacts on suicidality is also an issue of some importance that I will touch on.5
Instead of just doing my standard drug review, I will use the bupropion data on depression to teach you. It's time for “how anyone can do a meta-analysis analysis.”
Bupropion is better than placebo in more than one study:
Welcome to the forest plot …for those not reading science all day! The way to read these (which are used in meta-analysis papers on the regular) is as follows:
Each study is usually listed on the left by author and year….
The 95% interval indicates where we are at the actual answer, which is where the square is. The wider those error bars, the less confident we are about the real underlying value compared to what the Study found.
Also, I will use a different font to make this point hit home: