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Sertraline or Bupropion for Depression?

sertraline bupropion

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#1 stan08

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Posted 29 July 2015 - 06:55 PM


I saw my family physician today concerning the depression issues I've had for the last few years.  It's not really a major sad and mopey depression...it's more that I just don't seem to feel anything.  My wife has been concerned because I don't even enjoy any of my previous hobbies anymore (reading, exercising, sports, etc.).  My days are pretty much the same with working during the day and spending time with my family in the evening before going to bed.  I just seem to lack motivation or enjoyment for other activities.  I also find myself just spacing out at work (no focus) and not really having any motivation to get anything done (all while still stressing some about my project deadlines).  

 

I've tried many supplements and nootropics over the years to try and fix the problem.  They help some but haven't really had much of an impact.  My doctor recommended I try an antidepressant.  He said that his patients have had the most luck with either sertraline (SSRI) or bupropion (DNRI).  He left it up to me to decide which I'd rather try first.  On the surface, bupropion seems like it would be more appropriate since I lack motivation/drive, focus and enjoyment in activities.  However, I also have anxiety issues and I've read that bupropion can make that worse.  

 

So, I'm looking to get opinions from others that have tried (or at least know a lot about) either of these antidepressants as to which seems most appropriate in my case.  Thank you.



#2 Major Legend

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Posted 29 July 2015 - 09:28 PM

It sounds like symptoms of depression more than an innate problem in focus.

 

SSRI seems the right way to go, and just have him prescribe you both, because bupropion works pretty quickly like within a few days - you would be able to tell whether it works for you or not fairly quickly, and a lot of people stack bupropion on top of SSRI's. 

 

On the other hand SSRI's take a LONG TIME to work, so really give it at least 1.5 months before deciding its not for you.

 

If you are worried about the increase in anxiety from bupropion, I would suggest propranolol or olive leaf extract to lower norepinephrine, which is what causes the anxiety.

 

Personally I like the anxiety, as it actually pushes me to do things, so to me a little anxiety can be helpful and normal.

 

I don't like sertraline, it makes me feel like a zombie. Lexapro has less side effects. Also I don't know why Prozac is not mentioned more often, it has a really good record.

 

Also Tianeptine is definitely worth a shot and extremely cheap.

 


Edited by Major Legend, 29 July 2015 - 09:30 PM.


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#3 registered

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Posted 30 July 2015 - 08:02 AM

i've been on most of SSRI out there and none has helped me with symptoms that are very similar to yours

(apathy anhedonia inactivity etc)

some of them did made me feel... hmm... (unreasonably) better psychologically and more content

however that comes with emotional dulling and thats not what i was going for

i came to hate that feeling

 

bupropion on the other hand... :))))

on just 150mg xr im feeling more active

and im enjoying things more

i actually look forward to doing things i have to do

they fulfill me

also emotions are back since im off SSRIs

(but that might be due to the abrupt cesation of paroxetine)

 

so if i were you i would go with wellbutrin

and dont worry about more anxiety

im anxious and this ad didnt exacerbate that



#4 stan08

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Posted 30 July 2015 - 04:00 PM

It sounds like symptoms of depression more than an innate problem in focus.

 

SSRI seems the right way to go, and just have him prescribe you both, because bupropion works pretty quickly like within a few days - you would be able to tell whether it works for you or not fairly quickly, and a lot of people stack bupropion on top of SSRI's. 

 

On the other hand SSRI's take a LONG TIME to work, so really give it at least 1.5 months before deciding its not for you.

 

If you are worried about the increase in anxiety from bupropion, I would suggest propranolol or olive leaf extract to lower norepinephrine, which is what causes the anxiety.

 

Personally I like the anxiety, as it actually pushes me to do things, so to me a little anxiety can be helpful and normal.

 

I don't like sertraline, it makes me feel like a zombie. Lexapro has less side effects. Also I don't know why Prozac is not mentioned more often, it has a really good record.

 

Also Tianeptine is definitely worth a shot and extremely cheap.

 

 

i've been on most of SSRI out there and none has helped me with symptoms that are very similar to yours

(apathy anhedonia inactivity etc)

some of them did made me feel... hmm... (unreasonably) better psychologically and more content

however that comes with emotional dulling and thats not what i was going for

i came to hate that feeling

 

bupropion on the other hand... :))))

on just 150mg xr im feeling more active

and im enjoying things more

i actually look forward to doing things i have to do

they fulfill me

also emotions are back since im off SSRIs

(but that might be due to the abrupt cesation of paroxetine)

 

so if i were you i would go with wellbutrin

and dont worry about more anxiety

im anxious and this ad didnt exacerbate that

 

Thank you both for your responses.  It sounds like bupropion is the way to go.  Am I correct in assuming that sertraline would be better if my depression was more related to sadness but since mine seems more related to apathy, anhedonia and lack of motivation bupropion is more appropriate?  So, in my case I need something that increases dopamine and norepinephrine?  I wonder if that's why caffeine improves my mood and motivation...while also increasing my anxiety (to the point that I end up with voice modulation issues).  For the last year I've been taking low dose stimulants to actually feel something.  By low dose I mean no more 150 mg/day of caffeine because any more than that is too bad on my anxiety and causes sleep problems.  



#5 registered

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Posted 30 July 2015 - 07:10 PM

good luck with bup

hoping it wont mess with your brain too much :D

i dont have that kind of anxiety that i cant take caffeine in larger doses

however i was given xanax for my anxiety (im familiar with voice modulation)

which i dont take btw

 

and yeah bup starts working rather quickly so you will know soon is it good for you

like in a week or two

and you might see immediately is it gonna raise anxiety

 

 

 

 



#6 Dichotohmy

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Posted 30 July 2015 - 09:39 PM

Might want to be careful of bupropion if you're hoping to cure apathy and anhedonia

 

These results indicate that bupropion, unlike 5-HT reuptake inhibitors, promptly increased 5-HT neuronal activity, due to early desensitization of the 5-HT1A autoreceptor. The gradual recovery of neuronal firing of NE neurons, due to the desensitization of α2-adrenoceptors, in the presence of the sustained increase in 5-HT neuronal firing, may explain in part the delayed onset of action of bupropion in major depression.

http://www.sciencedi...028390808003110

 

Desensitizing the 5-HT1A autoreceptor even more, leading to more 5-ht release, is possibly the last thing you want if you already have anhedonia. Contrary to its supposed NDRI MoA, bupropion also has little if any affinity for dopamine reuptake or increasing dopaminergic activity.

 

 

Bupropion is really good at NE release and is a potent reuptake inhibitor of NE once you reach the onset of action, though, if what you're looking for is energy, alertness, and focus. My baseline brain is NE biased as a rule, so 150mg of it at the one month mark gave me heart palpitations, 170/120 BP, and wicked energy, which wasn't what I was looking for. Sustained use of 75mg wasn't benefitial for me, probably due to the serotonergic reasons. SSRIs I've tried lead to bad agitation and malaise at startup, with zombiness after a few months, but are worth a try at low doses.



#7 stan08

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Posted 30 July 2015 - 09:54 PM

good luck with bup

hoping it wont mess with your brain too much :D

i dont have that kind of anxiety that i cant take caffeine in larger doses

however i was given xanax for my anxiety (im familiar with voice modulation)

which i dont take btw

 

and yeah bup starts working rather quickly so you will know soon is it good for you

like in a week or two

and you might see immediately is it gonna raise anxiety

 

The whole increasing anxiety issue is what worries me the most.  I already avoid most social situations because I get overly nervous and blush, sweat and have voice modulation issues (especially if I've had any caffeine to help improve my mood).

 

Might want to be careful of bupropion if you're hoping to cure apathy and anhedonia

 

 

 

These results indicate that bupropion, unlike 5-HT reuptake inhibitors, promptly increased 5-HT neuronal activity, due to early desensitization of the 5-HT1A autoreceptor. The gradual recovery of neuronal firing of NE neurons, due to the desensitization of α2-adrenoceptors, in the presence of the sustained increase in 5-HT neuronal firing, may explain in part the delayed onset of action of bupropion in major depression.

http://www.sciencedi...028390808003110

 

Desensitizing the 5-HT1A autoreceptor even more, leading to more 5-ht release, is possibly the last thing you want if you already have anhedonia. Contrary to its supposed NDRI MoA, bupropion also has little if any affinity for dopamine reuptake or increasing dopaminergic activity.

 

 

Bupropion is really good at NE release and is a potent reuptake inhibitor of NE once you reach the onset of action, though, if what you're looking for is energy, alertness, and focus. My baseline brain is NE biased as a rule, so 150mg of it at the one month mark gave me heart palpitations, 170/120 BP, and wicked energy, which wasn't what I was looking for. Sustained use of 75mg wasn't benefitial for me, probably due to the serotonergic reasons. SSRIs I've tried lead to bad agitation and malaise at startup, with zombiness after a few months, but are worth a try at low doses.

 

Thank you for that information.  That definitely worries me a bit.  If it mostly effects NE, then maybe it isn't the best option for me.  A little energy and focus would be nice but the last thing I want is to make my heart palpitations (and other anxiety issues) worse in social situations.  My anxiety is already impacting my job in a negative manner enough as it is.  Do you know of any other options that might work better?  



#8 drg

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Posted 30 July 2015 - 10:16 PM

I would say try sertraline, it is a first line treatment option for depression. No point looking at mechanism of action or overcomplicating things. Sertaline is more commonly used and you can make the assumption that it has a higher likelyhood of working with less side effects. You haven't tried another SSRI until you do I wouldn't suggest any other type of antidepressant.  



#9 registered

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Posted 30 July 2015 - 11:50 PM

sertralin is also weak dopamin reuptake inhibitor

a lot of people combine sertralin and bupropion

but bup is also first line ad and is prescribed on its own

it was 10th most prescribed ad in 2010 (sertraline was first)

 

also

if you go SSRI route you can expect problems with libido

 

i read that DRI action of bupropion is not significant

but it led me into acute psychosis back than when i wasnt taking any antipsychotic

and i would def not be taking bup today if im not on aripiprazole

it does something to dopaminergic system

 

i feel on bup almost like i felt on methylphenidate

started readings books again for example

in my experience best ad so far

and i have come a looooong way in finding the cocktail that helps

(i also take mirtazapin another great ad without sexual side effects)

 

it might not be the right med for you however

your mileage may vary as they say

truth is

you will never know how one of crazy meds is gonna infulence you unless you take it

but you are gonna survive whatever happens dont be afraid to pop those pills



#10 drg

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Posted 31 July 2015 - 12:10 AM

your mileage may vary as they say

truth is

you will never know how one of crazy meds is gonna infulence you unless you take it

but you are gonna survive whatever happens dont be afraid to pop those pills

 

I 100% agree with this.

However calling bupropion the 10th most commonly prescribed antidepressant really takes things out of perspective. Because there are many different SSRIs being commonly prescribed that are all high on the list and for the most part they substitute for one another. But there is no substitute for bupropion so because of its uniqueness everyone looking for NDRI antidepressants will be taking only bupropion making it appear higher on the list than if their were alternatives.
.

 



#11 nowayout

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Posted 31 July 2015 - 10:14 AM

Vilazodone is another newer non-SSRI antidepressant that I could actually tolerate, whereas I can't tolerate SSRIs or Bupropion, and I tried preety much everything else over the years.

 

My long-standing depression and anxiety finally resolved itself when I started dating someone who would drag me (kicking and screaming on the inside) into a social situation once a week or so.  Or maybe it was the weed I started vaping periodically aroud the same time.


Edited by nowayout, 31 July 2015 - 10:15 AM.


#12 stan08

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Posted 31 July 2015 - 10:56 AM

I would say try sertraline, it is a first line treatment option for depression. No point looking at mechanism of action or overcomplicating things. Sertaline is more commonly used and you can make the assumption that it has a higher likelyhood of working with less side effects. You haven't tried another SSRI until you do I wouldn't suggest any other type of antidepressant.  

 

That's pretty much what my doctor said to (that sertraline was the first option usually tried and it tended to be the most successful).  I'm just a little worried about some of the common side effects experienced by SSRIs (especially with regard to libido).

 

sertralin is also weak dopamin reuptake inhibitor

a lot of people combine sertralin and bupropion

but bup is also first line ad and is prescribed on its own

it was 10th most prescribed ad in 2010 (sertraline was first)

 

also

if you go SSRI route you can expect problems with libido

 

i read that DRI action of bupropion is not significant

but it led me into acute psychosis back than when i wasnt taking any antipsychotic

and i would def not be taking bup today if im not on aripiprazole

it does something to dopaminergic system

 

i feel on bup almost like i felt on methylphenidate

started readings books again for example

in my experience best ad so far

and i have come a looooong way in finding the cocktail that helps

(i also take mirtazapin another great ad without sexual side effects)

 

it might not be the right med for you however

your mileage may vary as they say

truth is

you will never know how one of crazy meds is gonna infulence you unless you take it

but you are gonna survive whatever happens dont be afraid to pop those pills

 

The libido issue with sertraline is one of my main concerns with trying it.  My wife and I are trying for a child and lack of libido would definitely have a negative impact on that.

 

 

your mileage may vary as they say

truth is

you will never know how one of crazy meds is gonna infulence you unless you take it

but you are gonna survive whatever happens dont be afraid to pop those pills

 

I 100% agree with this.

However calling bupropion the 10th most commonly prescribed antidepressant really takes things out of perspective. Because there are many different SSRIs being commonly prescribed that are all high on the list and for the most part they substitute for one another. But there is no substitute for bupropion so because of its uniqueness everyone looking for NDRI antidepressants will be taking only bupropion making it appear higher on the list than if their were alternatives.
.

 

 

 

That's a good point.

 

Vilazodone is another newer non-SSRI antidepressant that I could actually tolerate, whereas I can't tolerate SSRIs or Bupropion, and I tried preety much everything else over the years.

 

My long-standing depression and anxiety finally resolved itself when I started dating someone who would drag me (kicking and screaming on the inside) into a social situation once a week or so.  Or maybe it was the weed I started vaping periodically aroud the same time.

 

Thank you for providing another option.  I'll look into that one and discuss it with my doctor if it looks like a good option.

 

With regard to your second point, my wife already does that to me.  I have no problem going out and doing some "low key" social activities but even then I never feel comfortable no matter how often I go out.  I just wish I could fix some of my anxiety/depression/self-esteem issues such that I could handle doing some of the other things she wants to do (like dancing).



#13 nowayout

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Posted 31 July 2015 - 02:51 PM

Vilazodone is another newer non-SSRI antidepressant that I could actually tolerate, whereas I can't tolerate SSRIs or Bupropion, and I tried preety much everything else over the years.

 

My long-standing depression and anxiety finally resolved itself when I started dating someone who would drag me (kicking and screaming on the inside) into a social situation once a week or so.  Or maybe it was the weed I started vaping periodically aroud the same time.

 

With regard to your second point, my wife already does that to me.  I have no problem going out and doing some "low key" social activities but even then I never feel comfortable no matter how often I go out.

 

I didn't say I feel comfortable and being forced to interact with semi-strangers (to me).  I don't feel comfortable at all.  But it seems to have cured my depression.  Probably exactly because it forces me out of my comfort zone.  Hanging out with my old friends with whom I feel comfortable never helped for my depression. 

 


Edited by nowayout, 31 July 2015 - 02:52 PM.


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#14 IndyX

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Posted 02 August 2015 - 10:38 PM

Both would probably worsen your symptoms long term. These drugs have potential do destroy your whole neurohormonal balance, including testosterone and thyroid hormones. I believe sertraline triggered my Hashimoto thyroiditis (as it f*cks big time with TSH). Should I mention PSSD? Impaired cognition? There's no need for alien invasion to turn one into "vessel". Rx doesn't mean safe.

 

Magic pill is a bogus. Until dawn of artificial intelligence, quantum computing and first Nobel Prize in digital biology you should stay away from psydrugs.

 

Only lifestyle (changes), long (short) term goals, physical activity, meditation, healthy diet and supplementation compounded with pinch of mumbo jumbo really matters.

 

 


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