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Wellbutrin vs Elavil
Introduction
For individuals dealing with major depressive disorder (MDD) or other types of depression, certain medications that influence the amounts of brain compounds related to mood, known as neurotransmitters, can be beneficial in stabilizing depressive lows and managing symptoms. Wellbutrin and Elavil are two such drugs often prescribed for depression. Both impact different neurotransmitters in the brain but have similar effects on mood stabilization in patients suffering from depression. Wellbutrin is classified as a norepinephrine-dopamine reuptake inhibitor (NDRI), primarily affecting levels of norepinephrine and dopamine. On the contrary, Elavil is a tricyclic antidepressant (TCA) which increases the levels of serotonin and norepinephrine in the brain by slowing their rate of re-absorption into nerve cells.
Wellbutrin vs Elavil Side By Side
| Attribute | Wellbutrin | Elavil |
|---|---|---|
| Brand Name | Wellbutrin | Elavil |
| Contraindications | Should not be taken with or have recently taken monoamine oxidase (MAO) inhibitors. | Should not be taken with or have recently taken monoamine oxidase (MAO) inhibitors. |
| Cost | For brand name: around $500 for 60 tablets of 100 mg. For generic bupropion: between $0.25 to $0.80 per day at dosages of 100mg, up to $1-$3 per day for 200mg to 450mg. | For brand name: around $150 for 30 tablets of 50 mg. For generic amitriptyline: starts as low as roughly $0.04 per day, typically does not exceed about $1/day. |
| Generic Name | Bupropion | Amitriptyline |
| Most Serious Side Effect | Increased suicidal thoughts or actions | Signs of an allergic reaction such as hives; difficulty breathing; swelling of your face, lips, tongue, or throat. |
| Severe Drug Interactions | MAO inhibitors | MAO inhibitors |
| Typical Dose | 200 mg/day, divided into two doses, up to a maximum of 450 mg/day. For SAD, 150–300 mg/day. | 25–50 mg/day, can be increased to 150 mg/day, maximum prescribed dosage usually capped at 300 mg/day. |
What is Wellbutrin?
Bupropion (the generic name for Wellbutrin) is an antidepressant that belongs to the class of drugs known as aminoketones. It was first approved by the FDA in 1985. Unlike other common antidepressants, which are often SSRIs or TCAs, bupropion affects norepinephrine and dopamine, rather than serotonin. This unique impact on neurotransmitters makes it beneficial for patients who have not responded well to other treatments.
In contrast, Amitriptyline (Elavil) is one of the first generation tricyclic antidepressants (TCAs), available since the late 1960s. Elavil works primarily by preventing reabsorption of two neurotransmitters — norepinephrine and serotonin — effectively increasing their levels in the brain. While this can help alleviate symptoms of depression, its influence on multiple receptors can lead to more side effects compared to selective options like bupropion.
Both medications are often used in treating different forms of depression but choosing between them depends greatly on individual patient factors including symptom profile, potential side effects and response to previous treatments.
What conditions is Wellbutrin approved to treat?
Wellbutrin is approved for the treatment of various forms of depression and mental conditions:
- Major depressive disorder (MDD)
- Seasonal affective disorder (SAD), a type of depression that occurs at the same time every year, usually in winter
- As an adjunct in cessation of smoking, to reduce nicotine withdrawal symptoms
How does Wellbutrin help with these illnesses?
Wellbutrin, also known as bupropion, manages depression by increasing the levels of dopamine and norepinephrine in the brain. It does this by inhibiting their reuptake into the neurons which allows these neurotransmitters to remain longer within brain synapses. Dopamine is a neurotransmitter that plays an important role in mood regulation, motivation, reward and attention while norepinephrine influences attention, emotions and sleep patterns among other things. Some individuals with depression have been found to have lower levels of these two chemicals thus Wellbutrin can help manage depressive symptoms by effectively raising their concentrations.
On the other hand, Elavil or amitriptyline works primarily as a serotonin-noradrenaline reuptake inhibitor (SNRI). This means it increases both serotonin and noradrenalin levels but primarily affects serotonin reuptake more than norepinephrine’s. Serotonin has functions similar to those mentioned earlier including playing a crucial role in mood stabilization. Thus by boosting its availability along with noradrenalin's presence in neural synapses helps alleviate depressive symptoms.
What is Elavil?
Elavil is a brand name for amitriptyline, which is a tricyclic antidepressant (TCA). Its mechanism of action involves reuptake inhibition of both norepinephrine and serotonin neurotransmitters in the brain. It also has antihistamine effects, leading to its sedative properties. Elavil was first approved by the FDA in 1983 and is commonly used as an off-label treatment for chronic pain conditions, especially when such conditions disrupt sleep.
Contrary to bupropion (Wellbutrin), Elavil does inhibit the reuptake of serotonin along with that of norepinephrine. This dual action can make it more effective at treating certain types of depression than NDRI drugs like Wellbutrin, particularly those where anxiety or insomnia are significant symptoms. However, this also means that its side effect profile includes common SSRI-related side effects such as weight gain and sexual dysfunction - alongside other TCA-specific side effects like dry mouth and constipation due to their broader receptor activity.
What conditions is Elavil approved to treat?
Elavil, also known as amitriptyline, is approved by the FDA for the treatment of:
- Major depressive disorder (MDD)
- Neuropathic pain In addition to these conditions, it's often used off-label for insomnia and migraine prevention. Please note that while Elavil can be very effective, its use should be closely monitored due to potential side effects.
How does Elavil help with these illnesses?
Elavil, also known as amitriptyline, is a tricyclic antidepressant that can be used to treat symptoms of depression. It works primarily by preventing the reuptake of certain neurotransmitters in the brain, namely norepinephrine and serotonin. This action increases the levels of these chemicals in the brain and helps maintain mental balance. Unlike Wellbutrin which does not significantly affect serotonin levels, Elavil has a potent effect on this important mood-regulating neurotransmitter. For patients who do not respond well to medications like Wellbutrin or typical SSRI antidepressants (such as Prozac), Elavil might be an effective alternative due to its different mechanism of action.
How effective are both Wellbutrin and Elavil?
Both bupropion (Wellbutrin) and amitriptyline (Elavil) have long-established histories of treating depression, having been approved by the FDA in 1985 and 1961 respectively. They operate on different neurotransmitters; hence they may be prescribed under varying circumstances. The effectiveness of Wellbutrin and Elavil in alleviating depressive symptoms was directly studied in a double-blind clinical trial conducted in 1998, demonstrating similar efficacy levels for both drugs in managing depression-related symptoms as well as promising safety profiles. None of the metrics used to measure treatment efficiency differed significantly between patients receiving Wellbutrin or those taking Elavil.
A meta-analysis review published in 2006 emphasized that bupropion is effective from the first week of treatment at relieving depressive symptoms, has a favorable side effect profile compared to many other antidepressants, is well-tolerated even among elderly populations. Research indicates that it's less likely to cause sexual side effects like reduced libido or orgasmic dysfunction - common adverse outcomes associated with SSRIs.
On the other hand, a comprehensive analysis carried out in 2011 indicated that amitriptyline seemed more efficacious than placebo at treating depression while being comparable to most commonly used antidepressants regarding its overall impact on depressive symptomatology. Amitriptyline is typically considered an alternative therapy option due to its significant anticholinergic side effects such as dry mouth, constipation, urinary retention which can lead to discontinuation amongst certain patient groups especially geriatric population who might be intolerant towards these side-effects.
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At what dose is Wellbutrin typically prescribed?
Oral dosages of Wellbutrin for depression begin at 200 mg/day, divided into two doses, and can be increased to a maximum of 450 mg/day. However, studies suggest that most patients respond well to a dose of 300 mg/day. For those dealing with seasonal affective disorder (SAD), the dosage ranges from 150–300 mg/day. Children and adolescents should only use Wellbutrin under strict medical supervision.
On the other hand, Elavil is typically started at lower doses due to its potent nature—around 25-50mg per day—and can gradually increase depending on patient response up to a max of 150mg per day. Like Wellbutrin it's also used off-label in children and adolescents under close medical guidance due to potential side effects.
At what dose is Elavil typically prescribed?
Elavil treatment is typically initiated at a dosage of 25–50 mg/day, which can be taken as an evening dose or divided into two doses. If necessary, the dose can subsequently be increased to 150 mg/day, split into three doses of 50 mg each and spaced approximately 8 hours apart. The maximum prescribed dosage is usually capped at 300 mg/day divided into multiple doses throughout the day; however, this higher limit may only be tested if there's no significant response to treatment using smaller dosages after several weeks. As with any medication regimen, it's crucial that adjustments are made under the guidance of a healthcare professional.
What are the most common side effects for Wellbutrin?
Some common side effects of Elavil include:
- Drowsiness, dizziness
- Dry mouth, blurred vision
- Constipation, weight gain
- Difficulty urinating or an enlarged prostate
- Changes in sexual desire or ability
- Excessive sweating
- Nausea and vomiting
- Unusual taste in the mouth
- Rash, itching or hives on the skin
Remember to seek medical help if any of these symptoms persist. It's also important to note that abruptly stopping Elavil can cause withdrawal symptoms such as nausea, headache and malaise.
Are there any potential serious side effects for Wellbutrin?
While both Wellbutrin and Elavil are used to treat depression, they can have different side effects. For instance, with Elavil there's a risk of:
- Increased suicidal thoughts or actions
- Allergic reactions: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing
- Changes in vision such as blurred vision or seeing halos around lights
- Rapid or irregular heartbeat
- Unusual weight gain/loss, changes in appetite
- Low sodium levels which may present themselves with symptoms like headache, confusion, slurred speech or unsteady feeling
- Severe nervous system reaction - rigid muscles, high fever, sweating and confusion.
Remember that an overdose can lead to serotonin syndrome which is characterized by agitation hallucinations fever sweating shivering fast heart rate muscle stiffness twitching loss of coordination nausea vomiting diarrhea. If you experience any of these serious symptoms while taking Elavil consult your healthcare provider immediately.
What are the most common side effects for Elavil?
Elavil, also known as Amitriptyline, can be associated with a variety of side effects including:
- Dry mouth, sore throat
- Blurred vision and increased sensitivity to light
- Nausea, vomiting, stomach cramps or loss of appetite
- Constipation
- Sleep disturbances such as insomnia or excessive tiredness
- Sweating more than usual
- Weight gain
- Urinary retention
- Feeling confused or disoriented -Unusual thoughts or behavior (including thoughts of suicide) -Dizziness upon standing up suddenly due to low blood pressure (orthostatic hypotension) -Muscle weakness or unexpected muscle pain.
Remember that not everyone will experience these side effects and many people tolerate Elavil well. However, if you notice any unusual symptoms while taking this medication, it's important to consult your healthcare provider immediately.
Are there any potential serious side effects for Elavil?
While Elavil is an effective medication for many, it does have potential side effects that require attention. Some of the symptoms that may suggest a severe reaction to Elavil include:
- Signs of an allergic reaction such as hives; difficulty breathing; swelling of your face, lips, tongue or throat
- Unusual bleeding (nosebleeds, bleeding gums), or any kind of unusual bruising
- A lightheaded feeling like you might pass out
- Chest pain spreading to your jaw or shoulder with sudden numbness or weakness on one side of your body
- Rapid and irregular heartbeats
- Vision changes including blurred vision and seeing halos around lights
- Confusion, hallucinations and unusual thoughts or behavior
If you experience these signs while taking Elavil, immediately seek medical help. It's crucial not to ignore these symptoms as they could indicate a serious problem requiring immediate attention.
Contraindications for Wellbutrin and Elavil?
Both Wellbutrin and Elavil, along with many other antidepressant medications, may exacerbate symptoms of depression in certain individuals. If you observe your depression intensifying or find an increase in suicidal ideation, thoughts or behavior emerging, please seek immediate medical attention.
Neither Wellbutrin nor Elavil should be taken if you are currently taking or have recently taken monoamine oxidase (MAO) inhibitors. It's crucial that your physician is aware of all the medications you're taking; MAOIs require about 5 weeks to completely exit the system to avert hazardous interactions with both Wellbutrin and Elavil. Furthermore, due to potential side effects such as drowsiness and dry mouth associated with both drugs, it’s important to discuss any health concerns with your doctor prior to starting these medications.
How much do Wellbutrin and Elavil cost?
For the brand name versions of these drugs:
- The price for 60 tablets of Wellbutrin SR (100 mg) averages around $500, which works out to approximately $16–32/day, depending on your dose.
- The price for 30 tablets of Elavil (50 mg) averages around $150, working out to about $5/day.
Thus, if you are in the higher dosage range for Wellbutrin (i.e., 300 mg/day or higher), then brand-name Elavil 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 generic versions of Wellbutrin (bupropion) and Elavil (amitriptyline):
-
Bupropion (100mg tablets) are available in packs from 30 capsules upwards, with costs averaging between $0.25 to $0.80 per day at dosages of 100mg daily or between $1 and$3 per day if taking typical doses between 200mg to up to potentially450mg daily.
-
Amitriptyline comes in packs ranging from15 up to several hundred pills(10 -150mg each). Costs can start as low as roughly$0.04per day(for purchasing larger quantities upfront), but typically do not exceed about$1/daily even when buying smaller amounts.
Popularity of Wellbutrin and Elavil
Bupropion, both in its generic form and under brand names such as Wellbutrin, was reportedly prescribed to around 5.8 million people in the US in 2020. It accounted for just over 12% of antidepressant prescriptions nationwide. The drug is often referred to as an "atypical" antidepressant because it doesn't fall neatly into any broad class of antidepressants like SSRIs or SNRIs. Since 2013, the prevalence of bupropion has been on a general upward trend.
On the other hand, amitriptyline (commonly known by its brand name Elavil), is one of the older tricyclic antidepressants that have been widely replaced by newer classes due to their more favorable side effect profiles. Despite this, amitriptyline still retains some usage today for nerve pain and certain types of chronic pain conditions along with off-label use as a sleep aid and migraine prophylactic therapy. In terms of overall prescriptions within the USA during 2020, Elavil was prescribed less frequently than Wellbutrin - around half a million times - accounting for about 1% of all antidepressant prescriptions given out that year.
Conclusion
Both Wellbutrin (bupropion) and Elavil (amitriptyline) have a long-standing track record of use in patients with depression, and are supported by numerous clinical studies indicating that they are more effective than placebo treatments. In some instances, these drugs may be used together under careful consideration by your physician due to potential drug interactions. Their mechanisms of action differ: Wellbutrin primarily acts on norepinephrine and dopamine while Elavil is a tricyclic antidepressant that influences serotonin and noradrenaline levels, leading to their usage under different circumstances.
Wellbutrin is commonly considered as an initial treatment option or added therapy for those who do not respond well to first-line SSRI antidepressants or need to avoid common side-effects like sexual dysfunction associated with many SSRIs. Elavil is often reserved for cases resistant to other treatments due to its potential for more severe side effects.
Both medications are available in generic form providing considerable cost savings especially if you're paying out-of-pocket. Both Wellbutrin and Elavil might require an adjustment period; it can take several weeks before the full therapeutic effect becomes noticeable.
The side-effect profile varies between the two drugs: both are generally well-tolerated but Wellbutrin has less propensity for weight gain and sedation compared with Elavil. It's crucial for patients starting either medication to closely monitor their moods, seeking immediate medical help if they notice worsening depression or begin having suicidal thoughts or thinking about self-harm.
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Refrences
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