Berigan, 1999 Bupropion-Associated Withdrawal Symptoms: A Case Report

[Phil]

This mentions SSRI withdrawal, I thought it might be worth posting:

 

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC181057/

 

Full text at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC181057/

 

Quote

It is known that sudden and even tapered withdrawal from antidepressants can cause a variety of somatic and psychological symptoms.6 Although the exact mechanism is not known, it is postulated that the discontinuation phenomena may be due to decreased availability of synaptic serotonin and that other neurotransmitters such as dopamine, norepinephrine, and γ-aminobutyric acid (GABA) may be involved, as well as cholinergic rebound.7 Although bupropion has no effect on the serotonin system and lacks anticholinergic activity, its mechanism of action, mediated through the dopaminergic and noradrenergic systems,8 may have contributed to our patient's discontinuation symptoms. Pollock1 states that all SSRIs should be gradually tapered to minimize the possibility of discontinuation symptoms. On the basis of our experience, until the discontinuation or withdrawal syndrome is more clearly defined, we recommend a slow taper of the antidepressant during discontinuation, regardless of the half-life or mechanism of action. As more physicians prescribe antidepressants for a myriad of clinical entities, they need to remain alert for withdrawal symptoms and work in educating patients to the possibility of discontinuation symptoms. This type of education will not only increase compliance but also decrease the abrupt discontinuation of antidepressants by patients.

Edited January 16, 2019 by Altostrata
added link to full text

[compsports]

This mentions SSRI withdrawal, I thought it might be worth posting:

 

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC181057/

 

It is known that sudden and even tapered withdrawal from antidepressants can cause a variety of somatic and psychological symptoms.6 Although the exact mechanism is not known, it is postulated that the discontinuation phenomena may be due to decreased availability of synaptic serotonin and that other neurotransmitters such as dopamine, norepinephrine, and γ-aminobutyric acid (GABA) may be involved, as well as cholinergic rebound.7 Although bupropion has no effect on the serotonin system and lacks anticholinergic activity, its mechanism of action, mediated through the dopaminergic and noradrenergic systems,8 may have contributed to our patient's discontinuation symptoms. Pollock1 states that all SSRIs should be gradually tapered to minimize the possibility of discontinuation symptoms. On the basis of our experience, until the discontinuation or withdrawal syndrome is more clearly defined, we recommend a slow taper of the antidepressant during discontinuation, regardless of the half-life or mechanism of action. As more physicians prescribe antidepressants for a myriad of clinical entities, they need to remain alert for withdrawal symptoms and work in educating patients to the possibility of discontinuation symptoms. This type of education will not only increase compliance but also decrease the abrupt discontinuation of antidepressants by patients.

Thanks Phil for providing the link to this article.

 

I found his Wellbutrin tapering schedule interesting which caused no problems:

 

"By 36 hours, the patient's symptoms had resolved and he tapered off bupropion SR, taking 150 mg/day for 4 days followed by 150 mg every other day for 8 days (4 total doses) and 150 mg every third day for 6 days (2 total doses) without further complications."

 

Of course, he wasn't on the drug for too many weeks but I am surprised the every other day and every third day schedule didn't greatly affect him.

 

Then again, I was able to cold turkey off of 270mg after being on it for 3 years with the help of Chlorella and Spirulina. I decided to do it as an experiment as I fully expected this to fail. Much to my great surprise, the only symptom I had was minor fatigue.

 

CS

[Barbarannamated]

I thought he was on for 2 years w 3 failed attempts to DC attributed to stress or anxiety (or, could it be w/d symptoms?).

I hadn't thought about the people taking bupropion for smoking cessation prior to this posting.

 

Q: which ADs have strongest cholinergic (or anti-) effects? I've seen charts of antipsychotic profiles, but never ADs.

[compsports]

I thought he was on for 2 years w 3 failed attempts to DC attributed to stress or anxiety (or, could it be w/d symptoms?).

I hadn't thought about the people taking bupropion for smoking cessation prior to this posting.

 

Q: which ADs have strongest cholinergic (or anti-) effects? I've seen charts of antipsychotic profiles, but never ADs.

 

Hi Barbara,

 

You are totally correct as I misread the article. I am interpreting the failures to quit as WD issues.

 

Wow, he is lucky his tapering schedule didn't cause problems but then again, Wellbutrin has a reputation (fairly or unfairly) for being easier to get off of.

 

Sorry, I don't know the answer to your question.

 

CS

[Barbarannamated]

CS, I think you were right! After rereading, I believe it says he made 4 attempts to quit CT, meaning smoking, not ADs.

[Altostrata]

Maybe that short taper was enough for him, compared to cold turkey.

 

Nice that his doctor was concerned enough to write it up.

 

Bar, the antidepressant with significant cholinergic action is Paxil (paroxetine). This anticholinergic reasoning shows up in papers about withdrawal because the early documentation of withdrawal syndrome was about TCAs, which are anticholinergic. It is a red herring.

[Barbarannamated]

Am I understanding that Paxil is CHOLINERGIC as opposed to TCAs?

[Altostrata]

No, Paxil is the most anticholinergic of all the SSRIs. The others supposedly have insignificant cholinergic action. Sorry for the misunderstanding.