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Paxil vs Wellbutrin
Introduction
For patients with major depressive disorder (MDD) or other types of depression, certain medications that alter the levels of compounds in the brain tied to mood - neurotransmitters - can assist in stabilizing depressive lows and managing symptoms. Paxil and Wellbutrin are two such drugs that are often prescribed for depression. They each influence different neurotransmitters in the brain, but both have mood-stabilizing effects on patients suffering from depression. Paxil is a selective serotonin reuptake inhibitor (SSRI), primarily affecting levels of serotonin, while Wellbutrin is classified as a norepinephrine-dopamine reuptake inhibitor (NDRI) and nicotinic acetylcholine receptor antagonist, mainly influencing levels of norepinephrine and dopamine.
Paxil vs Wellbutrin Side By Side
| Attribute | Paxil | Wellbutrin |
|---|---|---|
| Brand Name | Paxil | Wellbutrin |
| Contraindications | Should not be taken with or have recently used monoamine oxidase inhibitors (MAOIs). | Should not be taken with or have recently used monoamine oxidase inhibitors (MAOIs). |
| Cost | For brand name, approximately $4.3/day. For generic (paroxetine), costs can range from $.10 to $.90 per day. | For brand name, averages around $16–33/day depending on dose. For generic (bupropion), costs range from $0.25 to $1.50 per day for typical dosages. |
| Generic Name | Paroxetine | Bupropion |
| Most Serious Side Effect | Increased thoughts about suicide or self-harm, severe allergic reactions, changes in vision, heart-related issues, hyponatremia, neurological problems. | Signs of an allergic reaction, increased suicidal thoughts or actions, severe skin reactions, a seizure, unusual changes in mood or behavior, blurred vision, rapid heartbeats, signs of a manic episode. |
| Severe Drug Interactions | Monoamine oxidase inhibitors (MAOIs). | Monoamine oxidase inhibitors (MAOIs). |
| Typical Dose | 20-60 mg/day for adults, starting dose of 20 mg/day. Maximum daily dosage is 60 mg for adults and 40 mg for adolescents. | 100–200 mg/day initially, can be raised to 300 mg/day, split into two doses. Maximum recommended dose is 450 mg per day. |
What is Paxil?
Paroxetine (the generic name for Paxil) is an antidepressant that belongs to the SSRI class, similarly to fluoxetine. Paroxetine was first approved by the FDA in 1992 and works primarily by increasing levels of available serotonin in the brain just like Prozac does. It is commonly prescribed for conditions such as depression, anxiety disorders, obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), and premenstrual dysphoric disorder (PMDD). Bupropion on other hand known commercially as Wellbutrin, falls under a different class of antidepressants called norepinephrine-dopamine reuptake inhibitors(NDRI). It received its approval from FDA slightly earlier in 1985. Unlike Paxil it majorly influences dopamine and norepinephrine neurotransmitters rather than focusing on serotonin which results in a completely different side effect profile compared to SSRIs like Paxil or Prozac.
What conditions is Paxil approved to treat?
Paxil is approved for the treatment of various mental health conditions, including:
- Unipolar depression, also known as major depressive disorder (MDD)
- Panic disorder with or without agoraphobia
- Generalized anxiety disorder (GAD)
- Post-traumatic stress disorder (PTSD)
- Obsessive-compulsive Disorder (OCD)
- Social Anxiety Disorder/Social Phobia
How does Paxil help with these illnesses?
Paxil, like Prozac, works to manage depression by increasing the amount of serotonin available in the brain's synapses. It achieves this by preventing its reuptake into neurons, thereby allowing levels to remain elevated for longer periods. Serotonin is a neurotransmitter that plays a pivotal role in varying functions such as mood regulation, cognition, memory retention, sleep patterns and appetite among others. Individuals with depression are believed to have comparatively lower levels of serotonin; thus increasing these levels can mitigate depressive symptoms and help patients better manage their condition.
On the other hand, Wellbutrin operates differently from Paxil. Instead of focusing on serotonin activity primarily, it increases both dopamine and norepinephrine; two neurotransmitters that also play crucial roles in mood regulation amongst other things. This unique mechanism makes Wellbutrin an appealing alternative for those who do not respond well to or experience side effects with selective serotonin reuptake inhibitors (SSRIs) like Paxil.
What is Wellbutrin?
Wellbutrin, known generically as bupropion, is a unique antidepressant that acts as a norepinephrine-dopamine reuptake inhibitor (NDRI). This means it enhances the levels of the neurotransmitters norepinephrine and dopamine in the brain by decreasing their absorption. It also moderately inhibits the action of another neurotransmitter, acetylcholine, at nicotinic acetylcholine receptors. The FDA first approved Wellbutrin in 1986.
Of note is that Wellbutrin isn't an SSRI (selective serotonin reuptake inhibitor) like Paxil; therefore, it doesn't inhibit serotonin reuptake. This distinction leads to a different side-effect profile compared to SSRIs: specifically, it's less likely to cause sedation or lead to weight gain and sexual dysfunction – common adverse effects associated with SSRIs such as Paxil.
The influence on dopamine and norepinephrine can be beneficial for treating depression - especially for those who haven't responded well to typical SSRI antidepressants like Paxil. Therefore, if you've experienced unwanted side-effects from taking an SSRI or haven’t had much success with them in managing your symptoms of depression, then considering something like Wellbutrin could be worthwhile.
What conditions is Wellbutrin approved to treat?
Wellbutrin is acknowledged as a viable treatment option for:
- Major Depressive Disorder (MDD), providing relief from persistent feelings of sadness, loss of interest or pleasure in activities and other symptoms associated with depression.
- Seasonal Affective Disorder (SAD), commonly known as "winter blues," helping to alleviate mood changes and energy shifts that come with shorter daylight hours during winter.
How does Wellbutrin help with these illnesses?
Dopamine, a neurotransmitter that plays several vital roles in the brain and body, is known to affect mood regulation, memory recall, and focus. Its deficiency has been linked with depressive symptoms. Wellbutrin works by increasing the levels of dopamine available in the brain which can help alleviate some signs of depression. It also influences norepinephrine and acetylcholine but doesn’t significantly alter serotonin levels like most traditional SSRIs such as Paxil do. This makes Wellbutrin an attractive option for patients who may not respond favorably to typical SSRI antidepressants or it could be utilized in combination with these drugs to enhance therapeutic effect.
How effective are both Paxil and Wellbutrin?
Both paroxetine (Paxil) and bupropion (Wellbutrin) have established histories of success in treating patients with depression, with Paxil being approved by the FDA in 1992 and Wellbutrin a few years earlier in 1985. Since they act on different neurotransmitters, they may be prescribed under different circumstances. The effectiveness of paroxetine and bupropion in alleviating depression was directly studied; both drugs exhibited substantial efficacy in managing symptoms of depression along with similar safety profiles.
A review reported that paroxetine is effective from the first week of treatment for many patients, offering relief from depressive symptoms. Its side effect profile is generally favorable over several other antidepressants but it can lead to sexual dysfunction including decreased libido, erectile dysfunction, or anorgasmia. Despite these challenges, paroxetine remains widely prescribed due to its proven efficiency against depressive disorders.
On the other hand, according to a meta-analysis carried out recently, Wellbutrin seems equally effective as placebo when used for treating depression and has been found comparable to several common antidepressants like SSRIs or SNRIs regarding efficacy. Nevertheless, it's often considered as a second- or third-line treatment option which means it's usually chosen after other first-line treatments have been tried. In contrast to Paxil though - one unique advantage Wellbutrin holds is that it doesn’t tend to induce sexual side effects making it preferable for individuals who wish to avoid such issues.
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At what dose is Paxil typically prescribed?
Oral dosages of Paxil range from 20-60 mg/day, but studies have highlighted that a starting dose of 20 mg/day is typically adequate for treating major depressive disorder in most individuals. Adolescents may be started on 10 mg/day. In either population, the dosage can be increased after several weeks if there is no improvement in symptoms. The maximum daily dosage that should not be exceeded under any circumstances is 60 mg for adults and 40 mg for adolescents.
At what dose is Wellbutrin typically prescribed?
Wellbutrin therapy typically begins at a dosage of 100–200 mg/day. If necessary, this dose can be raised to 300 mg/day, split into two doses which should be taken roughly eight hours apart. The maximum recommended dose is 450 mg per day divided into three separate doses of 150 mg each and spaced six hours apart. This higher dosage may be considered if the patient shows no response to treatment at the lower daily dose of 300mg after sufficient time has passed.
What are the most common side effects for Paxil?
The common side effects of Paxil and Wellbutrin can vary, but may include:
- Anxiety
- Restlessness or nervousness
- Difficulty sleeping (insomnia) or too much sleeping (hypersomnia)
- Drowsiness or fatigue
- Tremors
- Decreased appetite
- Nausea or vomiting
- Indigestion, discomfort in the abdomen
- Diarrhea or constipation
- Dry mouth
- Changes in sexual desire or ability
- Excessive sweating
-Unusual dreams
-Influenza-like symptoms such as fever, aches, and chills
-Throat inflammation causing a sore throat
-Inflammation within sinuses leading to sinusitis
-Frequent yawning
Remember that these medications affect individuals differently. It's always best to consult with your healthcare provider for personalized advice.
Are there any potential serious side effects for Paxil?
While both Paxil and Wellbutrin are used to treat depression, they do have different side effects. In rare cases, some people taking Paxil might experience:
- Increased thoughts about suicide or self-harm
- Severe allergic reactions: hives, difficulty breathing, swelling in your face or throat
- Changes in vision such as blurred vision or tunnel vision
- Heart-related issues: rapid heartbeats, feeling like you might pass out
- Hyponatremia (low sodium levels): headache, confusion, slurred speech, severe weakness
- Neurological problems: rigid muscles, sweating, fast or uneven heartbeats
On the other hand with Wellbutrin:
- Allergic reactions can occur: skin rash/hives/itching/swelling especially of the face/tongue/throat
- Mood changes such as anxiety and agitation along with increased risk of suicidal thoughts
- Vision changes such as blurred/double vision; eye pain/swelling/redness
- Cardiovascular symptoms including chest pain/palpitations/unusual heartbeat patterns/breathlessness at rest
It's important to note that these are not comprehensive lists of potential side effects and individuals should consult their healthcare provider for personalized advice.
What are the most common side effects for Wellbutrin?
Common side effects of Wellbutrin can include:
- Dry mouth, sore throat
- Ringing in the ears or tinnitus
- Blurred vision or difficulty focusing
- Nausea, stomach pain, loss of appetite
- Sleep problems like insomnia and frequent awakenings
- Tremors, sweating excessively
- A feeling of anxiety or restlessness
- Rapid heartbeat which may feel uncomfortable
- Confusion or agitation
-Skin rash on rare occasions
-Unintended weight loss due to reduced appetite -Increased frequency of urination
-Recurring headache or dizziness
-Muscle aches and joint pains.
It's important to note that these side effects are not experienced by everyone who takes this medication. However, if they do occur they may need medical attention.
Are there any potential serious side effects for Wellbutrin?
Wellbutrin, while generally safe and effective for many patients, can cause some serious side effects. These could include:
- Signs of an allergic reaction such as hives, difficulty breathing, swelling in your face or throat
- Increased suicidal thoughts or actions
- Severe skin reactions: rash with blistering and peeling
- A seizure (convulsions)
- Unusual changes in mood or behavior like confusion or irritability
- Blurred vision, eye pain or swelling, seeing halos around lights
- Rapid heartbeats; or even signs of a manic episode: racing thoughts increased energy, reckless behavior feeling extremely happy talking more than usual severe problems with sleep.
If you experience any of these symptoms after starting Wellbutrin it is crucial that you seek immediate medical attention.
Contraindications for Paxil and Wellbutrin?
Both Paxil and Wellbutrin, like many antidepressants, might exacerbate depression symptoms in some individuals. If you notice your depression intensifying or an increase in suicidal thoughts or behaviors, please seek immediate medical help.
Neither Paxil nor Wellbutrin should be taken if you are currently using or have recently used monoamine oxidase inhibitors (MAOIs). It is essential to inform your doctor about any medications you're taking; MAOIs will need approximately 5 weeks to clear out of your system so as to avoid harmful interactions with both Paxil and Wellbutrin.
How much do Paxil and Wellbutrin cost?
For the brand name versions of these drugs:
- The price of 60 tablets of Wellbutrin SR (150 mg) averages around $500, which works out to $16–33/day, depending on your dose.
- The price of 30 capsules of Paxil (20 mg) is about $130, working out to approximately $4.3/day.
Thus, if you are in the higher dosage range for Wellbutrin (i.e., 300 mg/day or higher), then brand-name Paxil is less expensive on a per-day treatment basis. Please note that cost should not be a primary consideration in determining which of these drugs is right for you.
For the generic versions of Paxil (paroxetine) and Wellbutrin (bupropion), costs are significantly lower:
-
Bupropion SR (150 mg tablets) is available in packs above 30 capsules with approximate costs ranging from $0.25 to $0.80 per day for dosages at 100mg/day. If taking more typical dosages between 200mg up to even 450mg daily, expect expenditures between roughly $0.50 and$1.50 each day.
-
Paroxetine can be found in quantities ranging from as few as just fifteen capsules all the way up to one thousand(20mg). The cost starts from as low as about $.10 a day when purchasing larger quantities upfront but generally does not exceed an average daily expense around $.90 when buying smaller amounts regularly.
Popularity of Paxil and Wellbutrin
Paroxetine, also known under the brand name Paxil, was estimated to have been prescribed to approximately 2.7 million people in the US in 2020. As a selective serotonin reuptake inhibitor (SSRI), paroxetine accounted for about 5% of SSRI prescriptions and nearly 3% of overall antidepressant prescriptions. The use of paroxetine has seen a decline over the years due to concerns about side effects and withdrawal symptoms.
Bupropion, available as generic or under brands such as Wellbutrin, was prescribed to around 5.8 million individuals in the US during the same period. Accounting for just over 12% of total antidepressant prescriptions, bupropion is noted as an "atypical" antidepressant - it does not fall into categories like SSRIs or other broad classes of these medications. Notably, since 2013 there's been an increase in bupropion usage likely because its unique mechanism can be beneficial for patients who don't respond well to more common types of antidepressants.
Conclusion
Both Paxil (paroxetine) and Wellbutrin (bupropion) have long-standing records of usage in patients with depression, and are backed by numerous clinical studies and meta-analyses indicating that they are more effective than placebo treatments. In some cases, the drugs may be combined, but this is subject to careful consideration by a physician as they also interact with one another. Due to their different mechanisms of action—Paxil acting primarily on serotonin while Wellbutrin acts mainly on norepinephrine and dopamine—they tend to be prescribed under different circumstances. Paxil is considered a first-line treatment option for anxiety disorders too, whereas Wellbutrin would usually be considered an adjuvant therapy or for those who did not respond well to SSRIs like Paxil or need to avoid common sexual side-effects associated with such medications.
Both drugs are available in generic form which represents significant cost savings especially for patients who must pay out-of-pocket. Both Paxil and Wellbutrin may require an adjustment period meaning effects might not be noticeable right away.
The side effect profiles differ between the two drugs; both being generally well-tolerated but with Wellbutrin less likely to cause weight gain or sexual dysfunction than Paxil. Patients taking either drug should closely monitor their moods, particularly when starting treatment, seeking medical help immediately if they notice their depression worsening or begin having suicidal thoughts or thinking about self-harm.
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Refrences
- El Mansari, M., Ghanbari, R., Janssen, S., & Blier, P. (2008, December). Sustained administration of bupropion alters the neuronal activity of serotonin, norepinephrine but not dopamine neurons in the rat brain. Neuropharmacology. Elsevier BV.http://doi.org/10.1016/j.neuropharm.2008.07.028
- Papakostas, G. I., & Montgomery, S. A. (2007, December 15). Comparing the Rapidity of Response During Treatment of Major Depressive Disorder With Bupropion and the SSRIs. The Journal of Clinical Psychiatry. Physicians Postgraduate Press, Inc.http://doi.org/10.4088/jcp.v68n1211
- Dunner, D., & Kumar, R. (1998, May). Paroxetine: a Review of Clinical Experience. Pharmacopsychiatry. Georg Thieme Verlag KG.http://doi.org/10.1055/s-2007-979307
- Stahl, S. M., Pradko, J., Haight, B. R., Modell, J. G., Rockett, C. B., & Learned-Coughlin, S. (2004, August 13). A Review of the Neuropharmacology of Bupropion, a Dual Norepinephrine and Dopamine Reuptake Inhibitor. The Primary Care Companion For CNS Disorders. Physicians Postgraduate Press, Inc.http://doi.org/10.4088/pcc.v06n0403