MyDoorsAreOpen
Bluelight Crew
- Joined
- Aug 20, 2003
- Messages
- 8,549
TL;DR: Just started bupropion, pleasantly surprised to discover it took the joy out of alcohol entirely. If it works for nicotine and food addiction, at least for some people, why not all addictions?
Bupropion is one of the most fascinating psychoactive chemicals I've come across, second maybe only to clonidine. Both have a vast array of effects on many systems and tissues around the body and many therapeutic applications, but surprisingly no recreational merit for most people.
I prescribe bupropion rather liberally for tobacco cessation, which as I'm sure I don't need to mention is one of its USFDA approved uses (branded as Zyban). I find it follows a rule of thirds: One third lose all taste for nicotine on bupropion, and drop the habit without looking back. One third cut down noticeably but aren't able to fully give it up. And another third find it no help at all.
I was very intrigued when the FDA approved Contrave for weight loss, which is a time-release combo of bupropion and naltexone. Being the frugal and hopelessly liberal-progressive physician I am, I was quick to file Contrave in my mind under the category of patent-whoring gimmicks, right up there with Nuedexta and Vytorin. I figured much of the efficacy of contrave came from the naltrexone, in blocking the pleasure pathways which are stimulated by eating, while the bupropion was there merely as an antidepressant (to balance out the well-known effect of opiate antagonists for blocking all joy), and/or as a mild non-habit-forming stimulant to suppress appetite and keep energy levels up. Nevertheless, I started prescribing bupropion 150mg sustained release every 12h off-label for weight loss, especially for patients who clearly had a food addiction. Much to my surprise, more than half of the obese patients who've stayed compliant on the bupropion have succeeded in staying away from their comfort food of choice, and actually started to lose weight, feel healthier, and feel just all-over better about themselves. A lot of them have offered to me, "I just don't feel like scarfing a whole pizza anymore" or "I got halfway through my usual tub of ice cream, and just suddenly threw the rest away. I just don't have the itch it used to scratch." Clearly the bupropion was doing a lot more for the addiction than I'd given it credit for, and without the (cruel, IMHO) addition of naltrexone.
I have a strong family history of mental illness, especially severe depression and ADHD, but also no small amount of alcoholism, gambling addiction, OCD, and pathological emotional sensitivity and self-confidence issues, particularly among the males. Through some reading I've done on genetic medicine, I have a strong hunch that all of the mental health problems I just listed are different epigenetic manifestations of a single maladaptive gene or set of genes involved with the architecture of reward and motivation pathways in the CNS. I've met people unrelated to me, both in clinical settings and day to day life, who have this exact same cluster of mental health problems in their personal and family history.
I have an on-again-off-again, love-hate relationship with alcohol. I remember first trying it in junior high school, and thinking, "Oh man, I could get used to this!" I abused it recklessly from ages 18-23. Then I quit it for 2 years completely. I hated how much I liked it. I hated how unhealthy it made me feel long term. And I hated others judging me for my thirst for it. I'm a wanderer by nature who has spent a lot of time with people from other cultures. By pure chance, this has tended to include peoples who have fairly "dry" cultures, where most people are light or non-drinkers, and people who really like to drink are not looked upon favorably. This has definitely been a positive influence on me. Still, ever since age 25, my alcohol use has tended to go in phases lasting months at a time. I'll go several months with absolutely no interest in alcohol, and have no trouble abstaining from it. Then with no rhyme or reason, I'll pick up social drinking for a few months, having a couple beers a week in social settings, but no more than that. Then there are large chunks of time when my itch for alcohol is back full force, and I'll find myself drinking 2-4 drinks most days, and really enjoying it. I should add that while this sounds like a light habit to some folks, it definitely qualifies as problem use because I do it mostly alone and hide it from my family. Then one day, out of nowhere, the thought of buying a beer just nauseates me, and I'll go dry for the next few months. Like I said, there seems to be no rhyme or reason to when I switch drinking patterns. It really feels like a 3-setting switch in my head, that I don't have full control over.
I asked my primary care provider recently if I could try bupropion, as an adjunct to my amphetamine and sertraline for ADHD and depression, respectively, because it's shown efficacy for both. I just started 150mg XR daily 3 days ago, and the biggest effect I've noticed is that I feel more focused, but calmer. I'd almost describe the drug as a mood stabilizer -- fewer valleys but also fewer peaks. And most interestingly, I'm okay with that! I do not feel flat, emotionally blunted, or bored at all. I daresay it takes the edge off the amphetamine.
But here's the most surprising thing. Last night I picked up a pint of beer 6% ABV just for the hell of it. This is the first time I've taken any alcohol since starting bupropion. I drank it over the course of 20-30min, with some light snacks in my belly. I typically find the first 45-90min of alcohol has a stimulating euphoric edge to it, which synergizes very well with my amphetamine, and makes me very motivated to surf the net or do other intellectually-stimulating forms of entertainment, like writing. But this time, I felt shitty. My mental state was what I imagine dementia or haloperidol must feel like -- mentally slow, lazy, annoyed for feeling so lazy, and utterly joyless. I also felt physically poisoned, with waves of gooseflesh lasting through the next morning. My face felt like I was on the verge of a mild cold too. No headaches or shakes the next morning, but boy was it not an experience I cared to repeat! If I stay on the bupropion, I could care less if I ever drink again.
So this got me wondering: I wonder if, for certain people with a certain genotype, bupropion is universally anti-addictive. If I could identify those patients, I could see myself prescribing them bupropion for any unhealthy habit they were having a hard time resisting. Has there been any research done on this, in either animal or human test subjects? Has anyone here personally found bupropion helpful for quitting an addiction other than nicotine? I say some people because I've found that as an antidepressant, bupropion is a love-it-or-hate-it drug. Again, there seems to be a rule of thirds: For one third it's just the ticket, one third are unimpressed with it, and the final third hate the way it makes them feel so much that they flush it after 2-3 days.
My understanding of the pharmacodynamics of bupropion is pretty basic. I know it's an "enhancer", in some way, of DA, 5HT, and NE. Can any of my fellow pharmacology nerds expand on this a bit more?
Bupropion is one of the most fascinating psychoactive chemicals I've come across, second maybe only to clonidine. Both have a vast array of effects on many systems and tissues around the body and many therapeutic applications, but surprisingly no recreational merit for most people.
I prescribe bupropion rather liberally for tobacco cessation, which as I'm sure I don't need to mention is one of its USFDA approved uses (branded as Zyban). I find it follows a rule of thirds: One third lose all taste for nicotine on bupropion, and drop the habit without looking back. One third cut down noticeably but aren't able to fully give it up. And another third find it no help at all.
I was very intrigued when the FDA approved Contrave for weight loss, which is a time-release combo of bupropion and naltexone. Being the frugal and hopelessly liberal-progressive physician I am, I was quick to file Contrave in my mind under the category of patent-whoring gimmicks, right up there with Nuedexta and Vytorin. I figured much of the efficacy of contrave came from the naltrexone, in blocking the pleasure pathways which are stimulated by eating, while the bupropion was there merely as an antidepressant (to balance out the well-known effect of opiate antagonists for blocking all joy), and/or as a mild non-habit-forming stimulant to suppress appetite and keep energy levels up. Nevertheless, I started prescribing bupropion 150mg sustained release every 12h off-label for weight loss, especially for patients who clearly had a food addiction. Much to my surprise, more than half of the obese patients who've stayed compliant on the bupropion have succeeded in staying away from their comfort food of choice, and actually started to lose weight, feel healthier, and feel just all-over better about themselves. A lot of them have offered to me, "I just don't feel like scarfing a whole pizza anymore" or "I got halfway through my usual tub of ice cream, and just suddenly threw the rest away. I just don't have the itch it used to scratch." Clearly the bupropion was doing a lot more for the addiction than I'd given it credit for, and without the (cruel, IMHO) addition of naltrexone.
I have a strong family history of mental illness, especially severe depression and ADHD, but also no small amount of alcoholism, gambling addiction, OCD, and pathological emotional sensitivity and self-confidence issues, particularly among the males. Through some reading I've done on genetic medicine, I have a strong hunch that all of the mental health problems I just listed are different epigenetic manifestations of a single maladaptive gene or set of genes involved with the architecture of reward and motivation pathways in the CNS. I've met people unrelated to me, both in clinical settings and day to day life, who have this exact same cluster of mental health problems in their personal and family history.
I have an on-again-off-again, love-hate relationship with alcohol. I remember first trying it in junior high school, and thinking, "Oh man, I could get used to this!" I abused it recklessly from ages 18-23. Then I quit it for 2 years completely. I hated how much I liked it. I hated how unhealthy it made me feel long term. And I hated others judging me for my thirst for it. I'm a wanderer by nature who has spent a lot of time with people from other cultures. By pure chance, this has tended to include peoples who have fairly "dry" cultures, where most people are light or non-drinkers, and people who really like to drink are not looked upon favorably. This has definitely been a positive influence on me. Still, ever since age 25, my alcohol use has tended to go in phases lasting months at a time. I'll go several months with absolutely no interest in alcohol, and have no trouble abstaining from it. Then with no rhyme or reason, I'll pick up social drinking for a few months, having a couple beers a week in social settings, but no more than that. Then there are large chunks of time when my itch for alcohol is back full force, and I'll find myself drinking 2-4 drinks most days, and really enjoying it. I should add that while this sounds like a light habit to some folks, it definitely qualifies as problem use because I do it mostly alone and hide it from my family. Then one day, out of nowhere, the thought of buying a beer just nauseates me, and I'll go dry for the next few months. Like I said, there seems to be no rhyme or reason to when I switch drinking patterns. It really feels like a 3-setting switch in my head, that I don't have full control over.
I asked my primary care provider recently if I could try bupropion, as an adjunct to my amphetamine and sertraline for ADHD and depression, respectively, because it's shown efficacy for both. I just started 150mg XR daily 3 days ago, and the biggest effect I've noticed is that I feel more focused, but calmer. I'd almost describe the drug as a mood stabilizer -- fewer valleys but also fewer peaks. And most interestingly, I'm okay with that! I do not feel flat, emotionally blunted, or bored at all. I daresay it takes the edge off the amphetamine.
But here's the most surprising thing. Last night I picked up a pint of beer 6% ABV just for the hell of it. This is the first time I've taken any alcohol since starting bupropion. I drank it over the course of 20-30min, with some light snacks in my belly. I typically find the first 45-90min of alcohol has a stimulating euphoric edge to it, which synergizes very well with my amphetamine, and makes me very motivated to surf the net or do other intellectually-stimulating forms of entertainment, like writing. But this time, I felt shitty. My mental state was what I imagine dementia or haloperidol must feel like -- mentally slow, lazy, annoyed for feeling so lazy, and utterly joyless. I also felt physically poisoned, with waves of gooseflesh lasting through the next morning. My face felt like I was on the verge of a mild cold too. No headaches or shakes the next morning, but boy was it not an experience I cared to repeat! If I stay on the bupropion, I could care less if I ever drink again.
So this got me wondering: I wonder if, for certain people with a certain genotype, bupropion is universally anti-addictive. If I could identify those patients, I could see myself prescribing them bupropion for any unhealthy habit they were having a hard time resisting. Has there been any research done on this, in either animal or human test subjects? Has anyone here personally found bupropion helpful for quitting an addiction other than nicotine? I say some people because I've found that as an antidepressant, bupropion is a love-it-or-hate-it drug. Again, there seems to be a rule of thirds: For one third it's just the ticket, one third are unimpressed with it, and the final third hate the way it makes them feel so much that they flush it after 2-3 days.
My understanding of the pharmacodynamics of bupropion is pretty basic. I know it's an "enhancer", in some way, of DA, 5HT, and NE. Can any of my fellow pharmacology nerds expand on this a bit more?
