Antidepressants #2: Norepinephrine-Dopamine Reuptake Inhibitors

Depression is, in a word, complicated––especially when considered medically. While you may already be familiar with clinical depression, the condition is far from singular and not so easily diagnosed. No one depressive disorder is the same as the next, and this is seen in the diagnostic models, with specifications in the medical community made for persistent depression, bipolar depression, seasonal depression, and more.

Accordingly, psychiatric treatments for depressive disorders are also complex and varied among patients, necessitating a treatment plan personalized for each patient. Should you choose to talk with a medical professional about psychiatric treatment for depression, there is a laundry list of medications to consider.

SSRIs like fluoxetine and escitalopram (known in the US as Prozac and Lexapro, respectively) are the most common starters for drug therapy, but if symptoms persist, your doctor—with your consent—may choose to prescribe an additional medicine, such as an NDRI like bupropion (known in the US as Wellbutrin).

Originally approved by the FDA as a smoking cessation drug, bupropion has proven effective as an antidepressant as well, working as a norepinephrine–dopamine reuptake inhibitor (hence the acronym NDRI).

To simplify: Norepinephrine is a neurotransmitter largely associated with alertness and focus, while dopamine is a neurotransmitter associated with pleasure and reward. These chemicals pulse between neurons in the brain across gaps called synapses, sending a signal to the receiving neuron that creates an emotional response (among many other things) to a stimulus.

In a typical brain, excess norepinephrine, dopamine, and other such neurotransmitters left over in the synaptic gap are often taken back by the transmitting neuron and made unavailable for further use in a process called reuptake.

Reuptake is usually a healthy process, as an excess of any neurotransmitter can lead to adverse symptoms. However, in atypical brains, neurotransmitters like norepinephrine and dopamine can be made so unavailable that psychiatric disorders like depression emerge. Bupropion thus works to inhibit excessive reuptake and stabilize mood.

Bupropion can work as a great secondary medication, often paired with an SSRI for patients with persistent mood disorders.

Mood disorders are a category of illnesses that describe a serious change in mood. Illness under mood disorders include: major depressive disorder, bipolar disorder (mania – euphoric, hyperactive, over inflated ego, unrealistic optimism), persistent depressive disorder (long lasting low grade depression), cyclothymia (a mild form of bipolar disorder), and SAD (seasonal affective disorder)

Of course, it is not without its risk of side-effects, including (but not limited to) nausea, insomnia, and rarely, but significantly, seizures. It is thus advised to avoid alcohol when taking bupropion, which increases risk of seizure when combined with the drug.

All of this considered, bupropion is a viable option for patients who find their existing antidepressants to be ineffective, but also for newer patients who may not be as familiar with drug regimens as others. As always, be sure to discuss the risks and benefits with a medical professional before taking bupropion, as well as any personal concerns about the drug.

Your treatment is, in the end, your treatment; knowing the facts can make it a better one.

By Casey Dalrymple

Edited by Christine Yan

Photos by Susan Im

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