bupropion
Article
bupropion is a recurring brand in the Astral Codex Ten archive, appearing 3 times across 3 issues between April 14, 2021 and August 20, 2021. The archive places it in contexts such as “bupropion (“Wellbutrin”), the fourth-most prescribed antidepressant in the US”; “Most patients will want either escitalopram or bupropion as first-line treatment”; “Advantages of bupropion: it gives you more energy and makes it easier to do things”. It most often appears alongside FDA, US, COVID.
Metadata
- Category: Brands
- Mention count: 3
- Issue count: 3
- First seen: April 14, 2021
- Last seen: August 20, 2021
Appears In
Related Pages
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- FDA (3 shared issues)
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- US (3 shared issues)
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- COVID (2 shared issues)
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- 2002 meta-analysis by Cochrane Collaboration (1 shared issues)
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- 5-HTP (1 shared issues)
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- 5-HTP (1 shared issues)
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- SSC (1 shared issues)
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- aducanumab (1 shared issues)
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- aducanumab (1 shared issues)
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- Aduhelm (1 shared issues)
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- Adumbrations Of Aducanumab (1 shared issues)
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- Al Capone (1 shared issues)
External Links
Source Context
Recovered passages from the original issue text. When the raw archive preserved outbound links inside the source passage, they are listed directly under the quote.
Likewise, Próspera has 100% drug approval reciprocity. If a drug has been approved in an OECD country (eg by the FDA), it’s approved in Próspera. Again, close to my heart. Amisulpride is a great antipsychotic, probably better then most of the ones we use here. It’s approved in Europe, the UK, Australia, Israel, etc, where many studies have shown it’s safe and effective. Because none of those studies were done in the US, the FDA refuses to approve it here, and has demanded several hundred million dollars worth of more studies, which the company involved has chosen not to do (an injectable version was recently approved for nausea, but can’t be easily used for psychosis). Meanwhile, bupropion (“Wellbutrin”), the fourth-most prescribed antidepressant in the US, isn’t approved for depression in Britain; the subset of patients who respond to this medication and nothing else are out of luck. Próspera will be one of the only places in the world where patients will have access to amisulpride, bupropion, and all the other medications that one country or another is restricting because “it wasn’t invented here”.
The short version: Depression has a combination of biological, psychological, and social causes. You can address the social causes by changing your life circumstances (and research suggests people underestimate the potential benefits of making major life changes). You can address the psychological causes with therapy; possible therapies are diverse and complicated but I especially recommend “behavioral activation” therapy (where you try to keep a schedule and also do new, interesting things) and David Burns’ book Feeling Good. You can address the biological causes with a combination of lifestyle changes, medications, and supplements. Consider exercising more and adapting a modified Mediterranean diet. Consider taking antidepressants like escitalopram and bupropion, and supplements like l-methylfolate. Other non-chemical biological options include light therapy (safe and easy), transcranial magnetic stimulation (more complicated), and electroconvulsive therapy (difficult but extremely effective last-ditch solution). If something treats your depression, continue it for some length of time depending on the type of intervention, then consider withdrawing it to see if you can maintain your mood without it.
Most patients will want either escitalopram or bupropion as first-line treatment. These medications are easy to use and have fewer side effects than most others.
Advantages of bupropion: it gives you more energy and makes it easier to do things. It sometimes makes you lose weight. Disadvantages of bupropion: it sometimes makes anxiety worse, although some studies have challenged this. It can sometimes stimulate you too much and make it hard to sleep.
You see, Axsome thought they were in a good place, as did the stock market. Axome had a drug, bupropion-dextromethorphan, which had done well in their phase 3 trials for major depressive disorder. The next step after that is to submit the drug for approval to the FDA, which, when there are such clear indications of improvement, is usually a layup. An annoying layup, filled with lots of paperwork, but a layup.
Bupropion-dextromethorphan is an interesting case, because both bupropion and dextromethorphan alone are FDA-approved medications (bupropion as an antidepressant, DXM as a cough syrup). Then someone (maybe Axsome) did some preliminary studies suggesting that both of them together worked much better for depression than bupropion alone.
It’s actually weirder than that, because probably Axsome will have to charge really high prices for their combo drug to recoup the cost of the FDA approval process. Doctors will still have the alternative option of prescribing (very cheap) bupropion and dextromethorphan separately and telling the patient to take one of each. And yet Axsome is full of smart businesspeople who have assured their CEO that nobody will do this, and I’m sure those businesspeople are right. Why make patients take two cheap pills instead of one convenient super-expensive pill, when Yagmuk is paying the bills either way?