- Treating Menopause: Beyond Hormone Replacement Therapy
- Antidepressant may have Role in Treating Menopause Symptoms
- Antidepressant Dressed Up for Menopause
- What is Prozac?
- Important information
- Before taking this medicine
- How should I take Prozac?
- What happens if I miss a dose?
- What happens if I overdose?
- What should I avoid while taking Prozac?
- Prozac side effects
- What other drugs will affect Prozac?
- Further information
- More about Prozac (fluoxetine)
- Perimenopause, hormones, and midlife health
- When menopause ‘comes roaring,’ what do you do?
- Study Shows ADHD Drugs Could Help Treat Menopause
Treating Menopause: Beyond Hormone Replacement Therapy
Ever since results from the Women’s Health Initiative study raised safety concerns about the side effects of estrogen and combination hormone replacement therapy (HRT), many women have been looking for alternative ways to treat their menopause symptoms.
The good news is that a lot of women are finding some relief with non-HRT menopause treatments for symptoms such as hot flashes, problems sleeping, vaginal dryness, depression, and mood swings.
Beyond Estrogen: Other Options for Menopause Symptom Relief
Simple changes like eating right, getting enough sleep, and exercising regularly are probably the best non-hormonal treatments for keeping menopause symptoms at a manageable level. However, when lifestyle changes aren’t enough, some prescription medications such as antidepressants, anti-seizure medications, and blood pressure medications have shown promise as menopause treatments for symptoms such as mood swings and hot flashes, says Wendy Klein, MD, director of education at the Virginia Commonwealth University Institute for Women’s Health and associate professor emeritus of internal medicine, obstetrics, and gynecology at VCU School of Medicine.
Here’s a look at common menopause symptoms and non-hormonal therapies that may work to alleviate them.
Help for Hot Flashes
Some women find that they experience hot flashes after eating or drinking hot or spicy foods or drinking alcohol or caffeine. The simplest solution may be to just avoid these triggers, says Linda Barron, RN, MS, a women’s health nurse practitioner in Lynbrook, N.Y. Try keeping a journal of your symptoms to help identify your triggers. If that ounce of prevention isn’t enough, some non-hormonal treatments include:
- Antidepressants. Studies show that they can help relieve hot flashes in some women, Dr. Klein says. Options include the selective serotonin reuptake inhibitor (SSRI) antidepressants Prozac (fluoxetine) and Zoloft (sertraline) and the serotonin norepinephrine reuptake inhibitors (SNRIs) Cymbalta (duloxetine ) and Effexor (venlafaxine ).
- Gabapentin. The anti-seizure medication Neurontin (gabapentin) also has been shown to reduce hot flashes. The thinking is that it works by dampening chemical activity in certain areas of the brain, including the area connected to the one that causes hot flashes, Klein says. “This is probably the best medication available even though it, too, has side effects,” she says.
- Antihypertensives. Certain high blood pressure medications, such as Catapres (clonidine ) are another option, Klein says. However, studies have suggested that clonidine’s effects may be minimal, especially in women who have severe hot flashes.
- Soy. Some studies show soy can help with mild hot flashes. Soy is rich in phytoestrogens that have estrogen-like qualities. You can get more soy in your diet by eating tofu, tempeh, soy milk, and soy nuts. Soy is safe for the most part, but could potentially lead to problems if used very long term or in excessive amounts.
- Black cohosh. Studies of its effectiveness on hot flashes and night sweats have had mixed results. Women should avoid black cohosh if they have liver disorders or develop symptoms of liver trouble.
Easing Vaginal Dryness
If your vaginal dryness is severe, HRT may be the only treatment that can really help. However, some over-the-counter vaginal lubricants and moisturizers can help keep vaginal tissues moist.
It’s also important, Barron says, to remain sexually active to combat vaginal dryness. Klein says women shouldn’t be as concerned about using topical estrogen creams for vaginal dryness because the estrogen is not absorbed through the body as it is with oral medications.
Promoting Better Sleep
Certain lifestyle adjustments can help you to sleep better during menopause, Barron says. These include exercising, though not close to bedtime; avoiding stimulants such as caffeine and alcohol past lunchtime; and sipping a warm beverage before bed such as caffeine-free herbal tea or warm milk.
Also, keep your bedroom dark, quiet, and cool. Avoid naps and try to go to sleep and wake up the same time every day, even on weekends.
Other options to try include:
- Melatonin supplements, available as tablets, capsules, cream, and lozenges, have been shown to help some women with sleep problems associated with menopause. It’s best to start with low doses in case you experience side effects.
- Ginseng can be helpful with mood symptoms and sleep disturbances associated with menopause in some women.
You may also find that acupuncture and relaxation techniques such as yoga, tai chi, or medication can help you relax and sleep better at night, Barron says.
Relief for Depression and Mood Swings
These menopause symptoms may improve if you get enough sleep and exercise regularly, Barron says.
Antidepressants also have been shown to control mood changes associated with menopause, Klein says. Antidepressants that may be helpful in boosting menopause-related depression include paroxetine (Paxil), venlafaxine (Effexor), bupropion (Wellbutrin), and fluoxetine (Prozac).
The Bottom Line on Hormone-Free Menopause Treatment
The National Center for Complementary and Alternative Medicine, a branch of the National Institutes of Health, says the jury is still out on whether herbs and dietary supplements are safe and effective treatments for menopause symptoms. It continues to fund scientific studies to gather evidence on their effectiveness as an alternative to HRT.
Some women have had success in controlling hot flashes and mood swings with antidepressants, anti-seizure medications, and high blood pressure drugs although they do have potential side effects of their own. Meanwhile, lifestyle changes are worth trying as a menopause treatment. They are safe and have other benefits when it comes to your overall health and well-being.
Antidepressant may have Role in Treating Menopause Symptoms
When menopausal women cannot or do not want to take estrogen to combat bothersome hot flashes and night sweats, antidepressants may serve as an effective alternative.
Although estrogen has long been the gold standard for treating the hot flashes and night sweats of menopause, some women are unable or unwilling to use it because of associated risks. Consequently, SSRI or SNRI antidepressants—particularly the SNRI antidepressant venlafaxine—are often prescribed as a treatment for these vasomotor symptoms.
However, while SSRI and SNRI antidepressants have been found to be more effective than placebo in countering hot flashes and night sweats, their effectiveness compared with estrogen has not been studied. Hadine Joffe, M.D., an associate professor of psychiatry at Harvard Medical School, and her colleagues conducted a study to evaluate the two types of medications, using venlafaxine as the test antidepressant.
As they reported May 26 in JAMA Internal Medicine, both estrogen and venlafaxine were significantly more effective than a placebo, but estrogen was slightly more effective than venlafaxine.A total of 339 perimenopausal and postmenopausal women with at least two bothersome vasomotor symptoms a day—on average, eight a day—took part in the study. The researchers excluded candidates who had experienced major depressive episodes within the previous year.
The subjects were randomized to receive either low-dose oral estradiol (0.5 mg/d), low-dose venlafaxine extended release (75 mg/d), or a placebo for eight weeks. The researchers used low-dose rather than high-dose estradiol, they explained, “because of recommendations to use the lowest effective estrogen therapy dosage.”Throughout treatment, and on a daily basis, the subjects recorded in diaries how often they experienced vasomotor symptoms.By the end of treatment, the estradiol group was experiencing 3.9 vasomotor episodes a day on average, the venlafaxine group 4.4., and the placebo group 5.5. Estrogen reduced the frequency of vasomotor episodes by 53 percent, venlafaxine by 48 percent, and placebo by 29 percent. The differences between the estradiol group and the placebo group, as well as between the venlafaxine group and placebo group, were statistically significant. The differences between the venlafaxine group and the estradiol group were not
Tolerability of both estradiol and venlafaxine was high. Discontinuation because of adverse events was uncommon and did not differ significantly between treatments.The researchers also found that the treatment responses were not influenced by subjects’ mood symptoms, sleep quality, or race. A third of the subjects were African American.
“It is nice to see this head-to-head study comparing estradiol and venlafaxine in the treatment of menopausal hot flashes,” Claudia Reardon, M.D., an assistant professor of psychiatry at the University of Wisconsin and an expert on women’s health issues, said in an interview with Psychiatric News. “While venlafaxine may not be quite as effective as estradiol in the treatment of these symptoms, it does appear to work notably better than placebo. Our women patients often talk to us as their mental health providers about their bothersome menopausal symptoms, and this study helps us to be able to discuss the likely relative efficacy of their options with them.”
“The results of this carefully conducted study provide women and their physicians with critical data to guide treatment for vasomotor symptoms . . . , which affect the lives of the majority of midlife women,” Katherine Wisner, M.D., a professor of psychiatry and obstetrics and gynecology at Northwestern University, told Psychiatric News.
“Although a number of studies have demonstrated the efficacy of venlafaxine and other serotonergic antidepressants for treating vasomotor symptoms, this study advances our knowledge by comparing estradiol and venlafaxine to placebo within the same study,” Laura Miller, M.D., medical director of women’s mental health at the Edward Hines Jr. VA Hospital in Illinois, said. “The findings confirm that both estradiol and venlafaxine reduce the frequency, severity, and interference of menopausal hot flashes. While supporting prior impressions that the impact of estradiol on vasomotor symptoms is greater than that of venlafaxine, it shows that the magnitude of difference is relatively small. Caveats are that this study is not a direct comparison between estradiol and venlafaxine (both were compared with placebo) and that medroxyprogesterone was not given during the study as it would be with clinical use of estrogen (it was given only after unblinding). overall, the study adds valuable information about an alternative to estrogen for the treatment of bothersome menopausal vasomotor symptoms.”
The study was funded by the National Institutes of Health. ■
An abstract of “Low-Dose Estradiol and the Serotonin-Norepinephrine Reuptake Inhibitor Venlafaxine for Vasomotor Symptoms” can be accessed here.
Copyright ©2014 American Psychiatric Association
Volume 49 Number 14 page 1
Antidepressant Dressed Up for Menopause
This article is a collaboration between MedPage Today and:
One pharmaceutical company can now brag about a nonhormonal option to treat hot flashes during menopause.
Noven Therapeutics knows that’s welcome news to scores of women who’ve developed a fear of hormone therapy following the increased risk of heart disease and breast cancer seen in the Women’s Health Initiative (WHI).
But Brisdelle is just an old medication dressed up in a new feminine name and packaging – it’s the antidepressant paroxetine, better known by its brand name, Paxil.
“Some women won’t even know it is an antidepressant,” says Diana Zuckerman, PhD, president of the National Center for Women & Families, a women’s health advocacy group, explaining that few may look at the generic name, and of those who do, paroxetine will be much less recognizable than Paxil.
Using antidepressants in menopause is not new. Gynecologists have long been using them off-label to treat hot flashes, particularly in women who can’t tolerate hormone therapy – including those with a history of heart disease, blood clots, deep vein thrombosis, and stroke.
In theory, selective serotonin reuptake inhibitors (SSRIs) like paroxetine work for hot flashes because serotonin is thought to play a role in regulating body temperature.
But the question remains as to whether antidepressants are actually effective in this condition. There are no large studies of their off-label use in hot flashes, and efficacy findings in the Brisdelle studies were questionable — so much so that the FDA’s own advisory committee recommended against approving the drug for hot flashes.
FDA Panel Votes Against Brisdelle
In March, that panel voted 10 to 4 against approval because it was concerned that the drug’s benefits didn’t appear to outweigh its risks. Members said there was little difference in hot flash frequency whether patients were on the drug or on placebo. Some panelists also expressed concerns about the risk of suicidal thinking, for which the antidepressant formulation carries a black box warning.
The overall incidence of these adverse events didn’t differ much between the two groups during the trial, but Zuckerman noted that patients with a history of depression or suicidal ideation were excluded from the trials.
“Some doctors might assume that’s not a big deal, and if a woman starts feeling depressed or suicidal, she can stop taking the drug,” Zuckerman said. “But when a person feels depressed or suicidal, they don’t think clearly. They may not fully realize it is caused by the drug, because they start to feel bad about themselves or their lives.”
If they do realize the effects, she said, stopping the medication quickly can be dangerous: “There’s a rebound effect that can be very harmful. So, it’s not a simple matter to try it and stop if it isn’t working,” she said.
Although it often takes the advice of its advisory committees, the FDA isn’t bound by their decisions. So in June, it went ahead and gave Brisdelle the green light anyway, potentially because it saw a dearth of options for hot flash treatment.
Gynecologic Indications for Antidepressants
This certainly isn’t the first time an antidepressant drug maker has tried to seek a gynecologic indication for its drug. In the early 2000’s, Eli Lilly won an indication for its antidepressant fluoxetine – better known as Prozac – in severe premenstrual syndrome — now called premenstrual dysphoric disorder (PMDD).
The drug was given a trade name of Sarafem, and the green and white capsules of Paxil became pink and purple.
When Sarafem was approved, PMDD wasn’t listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM), the psychiatrist’s bible of diagnoses. It was relegated to a back-of-book index for conditions that need further study. (As of May 2013, the condition is now listed in the main book of the DSM-5).
Many antidepressants at the time were facing patent loss, and the gynecologic indication gave them an additional measure of exclusivity. Several other antidepressants, including sertraline (Zoloft) and paroxetine (Paxil), won approvals for PMDD around that time.
As with Paxil in hot flashes, clinicians had already been using antidepressants off label for their severe PMS cases, according to Holly Thacker, MD, of the Cleveland Clinic. But it was attractive that the drugs had been specifically studied for PMS, she said.
Having studies makes use of Brisdelle attractive too, she said.
“It’s nice to be able to now give a prescription for a therapy that’s been specifically studied and approved, and is in lower doses than typical antidepressants,” Thacker told MedPage Today.
The evidence is also reassuring to patients: “We’ve had to use antidepressants off-label and it’s somewhat disconcerting to women who are not depressed who have bad menopausal symptoms to be told, here, have an antidepressant,” she said.
Diana Bitner, MD, of Spectrum Health in Grand Rapids, Mich., said she’s been using escitalopram (Lexapro) off-label for certain hot flash patients. But she recognizes that “some women are more comfortable with a formal indication, and Brisdelle gives me one more such option.”
Zuckerman said that’s what the drug maker is counting on to tap into this potentially very lucrative market.
“The company knows that many women will pay full price for the ‘new’ product instead of buying the old generic product,” Zuckerman said.
It remains to be seen whether insurers will pay for the brand-name drug, since the off-label option is significantly cheaper. And the dose, although not an exact match, is comparable: Brisdelle is approved for 7.5 mg, while the lowest dose of Paxil is 10 mg.
Its uptake also depends on patients, who may be more concerned about medication pricing.
“If someone is determined to try it,” Zuckerman said, “they should take generic Paxil off label instead, because it is equally ineffective and unsafe and costs less.”
Generic Name: fluoxetine (floo OX e teen)
Brand Names: PROzac, PROzac Weekly, Sarafem, Rapiflux, Selfemra, PROzac Pulvules
Medically reviewed by Sophia Entringer, PharmD Last updated on Jan 2, 2019.
- Side Effects
What is Prozac?
Prozac (fluoxetine) is a selective serotonin reuptake inhibitor (SSRI) antidepressant. Fluoxetine affects chemicals in the brain that may be unbalanced in people with depression, panic, anxiety, or obsessive-compulsive symptoms.
Prozac is used to treat major depressive disorder, bulimia nervosa (an eating disorder), obsessive-compulsive disorder, and panic disorder.
Prozac is sometimes used together with another medication called olanzapine (Zyprexa) to treat manic depression caused by bipolar disorder. This combination is also used to treat depression after at least 2 other medications have been tried without successful treatment of symptoms.
If you also take olanzapine (Zyprexa), read the Zyprexa medication guide and all patient warnings and instructions provided with that medication.
Prozac may also be used for purposes not listed in this medication guide.
You should not use Prozac if you also take pimozide or thioridazine, or if you are being treated with methylene blue injection.
Do not use Prozac if you have used an MAO inhibitor in the past 14 days, such as isocarboxazid, linezolid, methylene blue injection, phenelzine, rasagiline, selegiline, or tranylcypromine unless instructed by a doctor.
You must wait at least 14 days after stopping an MAO inhibitor before you can take Prozac. You must wait 5 weeks after stopping fluoxetine before you can take thioridazine or an MAOI.
Some young people have thoughts about suicide when first taking an antidepressant. Stay alert to changes in your mood or symptoms.
Report any new or worsening symptoms to your doctor, such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself.
Before taking this medicine
Do not use Prozac if you have taken an MAO inhibitor in the past 14 days. A dangerous drug interaction could occur. MAO inhibitors include isocarboxazid, linezolid, phenelzine, rasagiline, selegiline, and tranylcypromine. You must wait at least 14 days after stopping an MAO inhibitor before you can take Prozac. You must wait 5 weeks after stopping fluoxetine before you can take thioridazine or an MAOI.
You should not use Prozac if you are allergic to fluoxetine, if you also take pimozide or thioridazine, or if you are being treated with methylene blue injection.
Tell your doctor about all other antidepressants you take, especially Celexa, Cymbalta, Desyrel, Effexor, Lexapro, Luvox, Oleptro, Paxil, Pexeva, Symbyax, Viibryd, or Zoloft.
Some medicines can interact with Prozac and cause a serious condition called serotonin syndrome. Be sure your doctor knows about all other medicines you use. Ask your doctor before making any changes in how or when you take your medications.
To make sure Prozac is safe for you, tell your doctor if you have:
cirrhosis of the liver;
seizures or epilepsy;
bipolar disorder (manic depression);
a history of drug abuse or suicidal thoughts; or
if you are being treated with electroconvulsive therapy (ECT).
Some young people have thoughts about suicide when first taking an antidepressant. Your doctor should check your progress at regular visits. Your family or other caregivers should also be alert to changes in your mood or symptoms.
Taking Prozac during pregnancy may cause serious lung problems or other complications in the baby. However, you may have a relapse of depression if you stop taking your antidepressant. Tell your doctor right away if you become pregnant. Do not start or stop taking this medicine during pregnancy without your doctor’s advice.
Fluoxetine can pass into breast milk and may harm a nursing baby. Tell your doctor if you are breast-feeding a baby.
How should I take Prozac?
Take Prozac exactly as prescribed by your doctor. Follow all directions on your prescription label. Your doctor may occasionally change your dose. Do not take this medicine in larger or smaller amounts or for longer than recommended.
Do not crush, chew, break, or open a delayed-release Prozac Weekly capsule. Swallow the capsule whole.
It may take up to 4 weeks before your symptoms improve. Keep using the medication as directed and tell your doctor if your symptoms do not improve.
Do not stop using Prozac suddenly, or you could have unpleasant withdrawal symptoms. Ask your doctor how to safely stop using this medicine.
Store at room temperature away from moisture and heat.
What happens if I miss a dose?
Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.
If you miss a dose of Prozac Weekly, take the missed dose as soon as you remember and take the next dose 7 days later. However, if it is almost time for the next regularly scheduled weekly dose, skip the missed dose and take the next one as directed. Do not take extra medicine to make up the missed dose.
What happens if I overdose?
Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.
What should I avoid while taking Prozac?
Drinking alcohol can increase certain side effects of Prozac.
Ask your doctor before taking any medications that effect blood clotting, such as warfarin, other anticoagulants, or nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs include aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), celecoxib (Celebrex), diclofenac, indomethacin, meloxicam, and others. Using any of these medications with Prozac may cause you to bruise or bleed easily.
This medication may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert.
Prozac side effects
Get emergency medical help if you have signs of an allergic reaction to Prozac: skin rash or hives; difficulty breathing; swelling of your face, lips, tongue, or throat.
Report any new or worsening symptoms to your doctor, such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself.
Call your doctor at once if you have:
blurred vision, tunnel vision, eye pain or swelling, or seeing halos around lights;
high levels of serotonin in the body–agitation, hallucinations, fever, fast heart rate, overactive reflexes, nausea, vomiting, diarrhea, loss of coordination, fainting;
low levels of sodium in the body–headache, confusion, slurred speech, severe weakness, vomiting, loss of coordination, feeling unsteady;
severe nervous system reaction–very stiff (rigid) muscles, high fever, sweating, confusion, fast or uneven heartbeats, tremors, feeling like you might pass out; or
severe skin reaction–fever, sore throat, swelling in your face or tongue, burning in your eyes, skin pain, followed by a red or purple skin rash that spreads (especially in the face or upper body) and causes blistering and peeling.
Common Prozac side effects may include:
sleep problems (insomnia), strange dreams;
headache, dizziness, vision changes;
tremors or shaking, feeling anxious or nervous;
pain, weakness, yawning, tired feeling;
upset stomach, loss of appetite, nausea, vomiting, diarrhea;
dry mouth, sweating, hot flashes;
changes in weight or appetite;
stuffy nose, sinus pain, sore throat, flu symptoms; or
decreased sex drive, impotence, or difficulty having an orgasm.
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
What other drugs will affect Prozac?
Taking Prozac with other drugs that make you sleepy or slow your breathing can cause dangerous side effects or death. Ask your doctor before taking a sleeping pill, narcotic pain medicine, prescription cough medicine, a muscle relaxer, or medicine for anxiety, depression, or seizures.
Many drugs can interact with fluoxetine. Not all possible interactions are listed here. Tell your doctor about all your current medicines and any you start or stop using, especially:
any other antidepressant;
St. John’s Wort;
tryptophan (sometimes called L-tryptophan);
a blood thinner – warfarin, Coumadin, Jantoven;
medicine to treat anxiety, mood disorders, thought disorders, or mental illness – amitriptyline, buspirone, desipramine, lithium, nortriptyline, and many others;
medicine to treat ADHD or narcolepsy – Adderall, Concerta, Ritalin, Vyvanse, Zenzedi, and others;
migraine headache medicine – rizatriptan, sumatriptan, zolmitriptan, and others; or
narcotic pain medicine – fentanyl, tramadol.
This list is not complete and many other drugs can interact with fluoxetine. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Give a list of all your medicines to any healthcare provider who treats you.
Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use Prozac only for the indication prescribed.
Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.
Copyright 1996-2020 Cerner Multum, Inc. Version: 24.01.
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- Segraves RT, Croft H, Kavousis R, et al. Bupropion sustained release (SR) for the treatment of hypoactive sexual desire disorder (HSDD) in nondepressed women. J Sex Marital Ther. 2001;27:303–316.
- Emmanuel NP, Brawman-Mintzer O, Morton WA. Bupropion SR in treatment of social phobia. Depress Anxiety. 2000;12:111–113.
- Canive JM, Clark RD, Calais LA, et al. Bupropion treatment in veterans with posttraumatic stress disorder: an open study. J Clin Psychopharmacol. 1998;18:379–383.
- Almai AM, Brouette TE, and Goddard AW. Bupropion treatment of civilian PTSD. In: New Research Abstracts of the 153rd Annual Meeting of the American Psychiatric Association; May 15, 2000; Chicago, Ill. Abstract NR17:61.
- Murphy K, Barkley RA. Prevalence of DSM-IV symptoms of ADHD in adult licensed drivers: implications for clinical diagnosis. J Atten Disord. 1996;1:147–161.
- Wender PH, Reimherr FW. Bupropion treatment of attention-deficit hyperactivity disorder in adults. Am J Psychiatry. 1990;147:1018–1020.
- Wilens TE, Spencer TJ, Bierderman J, et al. A controlled clinical trial of bupropion for attention deficit hyperactivity disorder in adults. Am J Psychiatry. 2001;158:282–288.
- Kuperman S, Perry PJ, Gaffney GR, et al. Bupropion SR versus methylphenidate versus placebo for attention deficit hyperactivity in adults. Ann Clin Psychiatry. 2001;13:129–134.
- Perry PJ, Kuperman S, Gaffney GR, and et al. Bupropion sustained release versus methylphenidate versus placebo in the treatment of adult ADHD. In: New Research Abstracts of the 153rd Annual Meeting of the American Psychiatric Association; May 17, 2000; Chicago, Ill. Abstract NR568:211.
- Reimherr FW, Strong RE, Marchant B, and et al. Six-week, double-blind, placebo-controlled trial of bupropion sustained release in the treatment of adults with ADHD. In: New Research Abstracts of the 153rd Annual Meeting of the American Psychiatric Association; May 18, 2000; Chicago, Ill. Abstract NR718:252.
- Wilens TE, Prince JD, Spencer T, and et al. Bupropion SR for attention deficit hyperactivity (ADHD) in adults with bipolar disorder (BPD) and ADHD . Presented at the 40th annual meeting of the New Clinical Drug Evaluation Unit; May 30–June 2, 2000; Boca Raton, Fla.
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What is Wellbutrin?
Wellbutrin is an antidepressant and brand name of the drug bupropion. The medication has been approved for treating depression and seasonal affective disorder in adults. The medication is sometimes used to treat symptoms of hyperactivity and impulsivity in patients with attention deficit hyperactivity disorder (ADHD) when traditional medications are ineffective. More commonly, the drug is prescribed to treat symptoms of depression which can co-occur with ADHD.
Is there a generic version of Wellbutrin available?
Yes, the generic version of Wellbutrin is called bupropion and is available for purchase.
When did the U.S. Food and Drug Administration (FDA) approve the medication?
Bupropion was first approved by the FDA in 1985.
What are the major differences between Wellbutrin and other medications used to treat ADHD?
Most traditional ADHD medications are stimulants. They can be very effective in treating symptoms, but they can be habit-forming. When stimulants are not effective, antidepressants like Wellbutrin are sometimes prescribed. However, there is limited data which supports Wellbutrin as an effective treatment for ADHD. Depression commonly co-occurs with ADHD, and antidepressants can prove effect in treating these symptoms. However, because it an antidepressant, it takes several weeks for the drug to reach maximum efficacy.
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Can children take Wellbutrin?
The safety and effectiveness of Wellbutrin in children has not been established. Children and teens who take antidepressants are at risk for developing suicidal thoughts.
Are there potential interaction issues for people taking Wellbutrin and any other drugs?
Do not take Wellbutrin if you have taken an MAO inhibitor in the past two weeks, benzodiazepines, or sedatives. There are also hundreds of drugs which are known to interact with Wellbutrin in major, moderate, or mild ways, so let your doctor know what other medications you are taking before you begin taking the medication.
Are there any other medical conditions that would make someone ineligible for Wellbutrin therapy?
You should not take Wellbutrin if you have had an eating disorder, seizures, or drink a lot of alcohol. Talk to your doctor if you have liver or kidney problems, heart problems, high blood pressure, diabetes, a history of mental illness, or a history of suicidal thoughts.
What is the typical dose that would be prescribed to someone taking Wellbutrin?
No single dose of Wellbutrin should be more than 150 mg. A typical dose for adults is 300mg a day, divided into three times (i.e. 100 mg each).
What do I do if I miss a dose?
Wait until it is the next time to take the tablet. Do not take an extra dose to make up for the missed dose. Taking too much Wellbutrin can increase the risk of seizures.
What are Wellbutrin’s common side effects?
Common side effects of Wellbutrin can include:
- trouble sleeping
- dry mouth.
If you experience major side effects, report them to your doctor immediately and stop using the medication. Major side effects can include but are not limited to seizures, manic episodes, high blood pressure, delusions, hallucinations, eye pain, swelling or redness around the eye, and severe allergic reactions. You can report side effects to the FDA at 1-800-FDA-1088 or online.
Are there any possible psychiatric side effects that come from taking Wellbutrin?
Wellbutrin can cause or increase suicidal thoughts in children or adults. Psychiatric side effects of the medication can also include nervousness, anxiety, agitation, panic attacks, irritability, manic episodes, aggression, hallucinations, and delusions. Talk to your doctor if you have a history of bipolar disorder or a family history.
Is it safe for a woman who is pregnant, about to become pregnant, or nursing to take Wellbutrin?
There have been no controlled human pregnancy studies on the effects of Wellbutrin. The drug can be transferred via breast milk, but it is unknown whether it can harm a baby. Therefore, talk to your doctor if you are pregnant, planning to become pregnant, or are nursing before you take Wellbutrin.
Can symptoms occur if Wellbutrin is discontinued?
Withdrawal symptoms of Wellbutrin can include but are not limited to anxiety, body aches, crying, depression, dizziness, lack of energy, headaches, changes in appetite, irritability, decrease in sexual interest, seizures, lack of coordination, vomiting, and weight gain. Talk to your doctor before you discontinue use and seek medical attention if necessary.
What should I do if I overdose on Wellbutrin?
An overdose of Wellbutrin could be fatal, so seek immediately help or call the Poison Help Line at 1-800-222-1222 if you overdose. Overdose symptoms can include seizures, fever, muscle rigidity, respiratory failure, hallucinations, hypotension, stupor, loss of consciousness, sinus tachycardia, arrhythmia, and coma.
Is Wellbutrin habit-forming?
Wellbutrin is not habit-forming, but withdrawal symptoms can occur, so talk to your doctor before you discontinue use.
How much does Wellbutrin cost?
Sixty tablets of 75 mg Wellbutrin cost approximately $160. The cost of the generic version bupropion is around $30.
Are there any disadvantages to Wellbutrin?
The biggest disadvantage of Wellbutrin is that it can cause suicidal thoughts in people taking the medication. Patients are also advised not to drink alcohol while taking the medication. Unlike many other medications used to treat ADHD, the drug takes several weeks for the effects to be felt, and data supporting the drug’s efficacy in treating ADHD is very limited. Also, common side effects of the medication may outweigh the benefits.
DISCLAIMER: The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. This article mentions drugs that were FDA-approved and available at the time of publication and may not include all possible drug interactions or all FDA warnings or alerts. The author of this page explicitly does not endorse this drug or any specific treatment method. If you have health questions or concerns about interactions, please check with your physician or go to the FDA site for a comprehensive list of warnings.
Article Sources Last Updated: Nov 25, 2018
Before taking bupropion,
- tell your doctor and pharmacist if you are allergic to bupropion, any other medications, or any of the ingredients in bupropion tablets. Ask your pharmacist or check the Medication Guide for a list of the ingredients.
- tell your doctor if you are taking a monoamine oxidase (MAO) inhibitor such as isocarboxazid (Marplan), linezolid (Zyvox), methylene blue, phenelzine (Nardil), selegiline (Eldepryl, Emsam, Zelapar), and tranylcypromine (Parnate), or if you have stopped taking an MAO inhibitor within the past 14 days. Your doctor will probably tell you not to take bupropion.
- do not take more than one product containing bupropion at a time. You could receive too much medication and experience severe side effects.
- tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the following: amantadine (Symmetrel); beta blockers such as atenolol (Tenormin), labetalol (Normodyne), metoprolol (Lopressor, Toprol XL), nadolol (Corgard), and propranolol (Inderal); cimetidine (Tagamet); clopidogrel (Plavix); cyclophosphamide (Cytoxan, Neosar); efavirenz (Sustiva, in Atripla); insulin or oral medications for diabetes; medications for irregular heartbeat such as flecainide (Tambocor) and propafenone (Rythmol); medications for mental illness such as haloperidol (Haldol), risperidone (Risperdal), and thioridazine (Mellaril); medications for seizures such as carbamazepine (Tegretol), phenobarbital (Luminal, Solfoton), and phenytoin (Dilantin); levodopa (Sinemet, Larodopa); lopinavir and ritonavir (Kaletra); nelfinavir (Viracept); nicotine patch; oral steroids such as dexamethasone (Decadron, Dexone), methylprednisolone (Medrol), and prednisone (Deltasone); orphenadrine (Norflex); other antidepressants such as citalopram (Celexa), desipramine (Norpramin), fluoxetine (Prozac, Sarafem, in Symbyax), fluvoxamine (Luvox), imipramine (Tofranil), nortriptyline (Aventyl, Pamelor), paroxetine (Paxil) and sertraline (Zoloft); ritonavir (Norvir); sedatives; sleeping pills; tamoxifen (Nolvadex, Soltamox); theophylline (Theobid, Theo-Dur, others); thiotepa; and ticlopidine (Ticlid). Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
- tell your doctor if you have or have ever had seizures, anorexia nervosa (an eating disorder) or bulimia (an eating disorder). Also tell your doctor if you drink large amounts of alcohol but expect to suddenly stop drinking or you take sedatives but expect to suddenly stop taking them. Your doctor will probably tell you not to take bupropion.
- tell your doctor if you drink large amounts of alcohol, use street drugs, or overuse prescription medications and if you have ever had a heart attack; a head injury; a tumor in your brain or spine; high blood pressure; diabetes; or liver, kidney, or heart disease.
- tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking bupropion, call your doctor.
- you should know that bupropion may make you drowsy. Do not drive a car or operate machinery until you know how this medication affects you.
- talk to your doctor about the safe use of alcoholic beverages while you are taking bupropion. Alcohol can make the side effects from bupropion worse.
- you should know that bupropion may cause an increase in your blood pressure. Your doctor may check your blood pressure before starting treatment and regularly while you are taking this medication, especially if you also are using nicotine replacement therapy.
- you should know that bupropion may cause angle-closure glaucoma (a condition where the fluid is suddenly blocked and unable to flow out of the eye causing a quick, severe increase in eye pressure which may lead to a loss of vision). Talk to your doctor about having an eye examination before you start taking this medication. If you have nausea, eye pain, changes in vision, such as seeing colored rings around lights, and swelling or redness in or around the eye, call your doctor or get emergency medical treatment right away.
- you should know that some people have reported symptoms such as changes in behavior, hostility, agitation, depressed mood, and suicidal thoughts (thinking about harming or killing oneself or planning or trying to do so) while taking bupropion to stop smoking. The role of bupropion in causing these mood changes is unclear since people who quit smoking with or without medication may experience changes in their mental health due to nicotine withdrawal. However, some of these symptoms occurred in people who were taking bupropion and continued to smoke. Some people had these symptoms when they began taking bupropion, and others developed them after several weeks of treatment or after stopping bupropion. These symptoms have occurred in people without a history of mental illness and have worsened in people who already had a mental illness. Tell your doctor if you have or have ever had depression, bipolar disorder (mood that changes from depressed to abnormally excited), schizophrenia (a mental illness that causes disturbed or unusual thinking, loss of interest in life, and strong or inappropriate emotions), or other mental illnesses. If you experience any of the following symptoms, stop taking bupropion (Zyban) and call your doctor immediately: suicidal thoughts or actions; new or worsening depression, anxiety, or panic attacks; agitation; restlessness; angry or violent behavior; acting dangerously; mania (frenzied, abnormally excited or irritated mood); abnormal thoughts or sensations; hallucinations (seeing things or hearing voices that do not exist); feeling that people are against you; feeling confused; or any other sudden or unusual changes in behavior. Be sure that your family or caregiver knows which symptoms may be serious so they can call the doctor if you are unable to seek treatment on your own. Your doctor will monitor you closely until your symptoms get better.
Perimenopause, hormones, and midlife health
Published: November, 2006
Hormone researchers are shifting some of their attention from menopause to the years that precede it.
Research about midlife health and hormones has produced some apparently confusing results. The best-known example involves hormone therapy and the heart. Many large studies like the Nurses’ Health Study had suggested that it protected against heart disease. But in 2002, the Women’s Health Initiative (WHI) came to the opposite conclusion. Since then, however, new analyses of these data indicate that hormone therapy used in perimenopause and for 10 years after menopause may benefit the heart, but if used later than this increases the risk of heart disease.
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When menopause ‘comes roaring,’ what do you do?
Doctors continue to recommend hormone replacement therapy, but it may carry risks. STORY HIGHLIGHTS
- Menopausal symptoms include mood swings, hot flashes, sleep disruption, changes in libido
- Hormone replacement therapy is the only treatment that targets all of those symptoms
- An alternative to hormone replacement therapy for some women is antidepressants
- Hormone Therapies
- Mental Health
- Women’s Health
(CNN) — Just after she’d gotten a divorce and gone back to work, Alice Thornton would feel cold one minute and hot the next, and her temper was shorter than usual.
“It was irritating because when it comes, it comes roaring through,” said Thornton, 61, of Huntington, West Virginia, whose symptoms began around age 49 or 50. She wrote about the experience in her iReport.
A deficiency in the hormone estrogen is responsible for the symptoms of menopause, which include mood swings, hot flashes, sleep disruption and changes in libido.
As baby boomers continue to go through menopause in record numbers, questions about how to curb these symptoms, especially those that interrupt daily life, are all the more relevant. At the same time, research on hormone replacement therapy keeps emerging without hard conclusions, leading doctors to recommend the lowest dose for the shortest duration.
Not every woman feels troublesome effects from menopause; in fact, 30 percent don’t report any significant symptoms. But that means up to 70 percent of women have moderate to severe symptoms that can cause changes in daily living, said women’s health expert Dr. Donnica Moore.
For 80 percent of women, symptoms generally resolve within five years, but it’s not known how long the unpleasantness lasts beyond that for the remaining 20 percent of women, Moore said. Because every woman is different, there is no certain quick fix for menopausal symptoms.
“This is why medicine is an art and not a science,” she said. “We don’t have the tools to be able to make these decisions by computer or a checklist.”
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The HRT controversy
Marilyn Grounds, 51, of Springboro, Ohio, hasn’t slept well in years. She feels exhausted all the time, and is also going through hot flashes. Recently she decided it’s time to look into hormone replacement therapy, she said in her iReport.
Hormone replacement therapy too risky? HRT and risk of breast cancer death
Hormone replacement therapy is the only treatment that would target all of the potential symptoms of menopause at once, Moore said. It comes in forms such as pills and patches, and is designed to replace estrogen.
Women taking estrogen who have not had their uterus removed also need to take progesterone, as this helps reduce the risk of uterine cancer.
Hormone replacement therapy, also called HRT, has generated much debate in recent years because of concerns about elevated risks of breast cancer and cardiovascular events.
A recent study in the Journal of the American Medical Association found that women who took a specific hormone therapy that included estrogen and progestin were twice as likely to die from breast cancer as women who took a placebo. This was part of a large government study called the Women’s Health Initiative, which stopped a study on the topic in 2002 due to concerns about heart health, breast cancer and other health problems. The latest results are from the same women who participated in that, after 11 years of follow-up.
Moore and other doctors caution that the Women’s Health Initiative study has numerous flaws — for instance, it looked at only one particular drug: Pfizer’s Prempro. There are all kinds of formulations and varieties of hormone replacement therapy, with estrogen and progestin in combination in different amounts, Moore said. It’s hard to know whether it is one or both hormones, or the dosing, or something else entirely, that may have contributed to negative outcomes, she said.
There are some women who should not consider hormone replacement therapy because of underlying conditions such as liver problems and gallstones, Moore said.
But in appropriate situations, Moore continues to recommend it. So does Dr. Camelia Davtyan, director of Women’s Health at the Comprehensive Health Program at the University of California, Los Angeles.
Davtyan said she’s not as “generous” with recommending hormone replacement therapy as she used to be, given the research on risks. Of the available options, she prefers prescribing a hormone-releasing patch, as there has been some suggestion that it causes fewer blood clots, she said.
Virginia Olander of New Orleans, Louisiana, remembers feeling like an 85-year-old at age 52. She had to have a complete hysterectomy, which threw her body out of whack in severe menopausal symptoms. Her brain was in a fog, her energy had dropped, and she felt generally miserable, she said in her iReport.
Traditional hormone replacement therapy didn’t relieve any of her symptoms. She thought, “I cannot continue to work full time and take care of my family if I’m going to continue to feel this way.”
Long-lasting relief came from pellets containing “bioidenticals,” which are chemical equivalents of the hormones that the body produces naturally, but are derived from plants. Synthetic estrogen, on the other hand, is made in a laboratory, but functions the same. Grounds, like Olander, has also opted to try the bioidenticals, but hasn’t gone to her first appointment yet.
The specific treatment Olander chose and others like it are controversial because they are not approved by the U.S. Food and Drug Administration, and therefore have not undergone the same level of scrutiny in terms of dosing. But Olander doesn’t care, as long as it works.
There are some hormone replacement therapies on the market that are approved by the FDA, and also use plant-derived hormones, such as Estrace, Climara patch, Vivelle-Dot patch, and Prometrium natural progesterone, according to the Mayo Clinic’s Dr. Mary Gallenberg.
Still, bioidentical treatments carry the same risks of breast cancer and cardiovascular risks as other forms of hormone replacement therapy, Davtyan said.
Olander’s pellets have a combination of estradiol — the chemical that synthetic estrogen mimics — and testosterone. They are like grains of rice inserted into the hip, in an outpatient procedure that takes about 30 minutes, Olander said.
Olander said she’ll have to be on the pellets for life, but doesn’t mind, since they give her relief. That’s contrary to the current philosophy of major medical organizations: to administer the minimum dose for the shortest period of time, Davtyan said.
An alternative to hormone replacement therapy for some women is antidepressants.
Although depression is not itself a symptom of menopause, doctors have found that antidepressant drugs called selective serotonin reuptake inhibitors (SSRIs) can be effective for some women in reducing mood swings and hot flashes. These drugs can also help with sleep disturbances.
“This does not mean the doctor thinks you are depressed or that it’s all in your head,” Moore said. “That’s a huge point of confusion.”
Alice Thornton had been taking Zoloft, an SSRI, since long before menopause, and speculates it may have helped stave off menopause’s more severe symptoms.
The natural way
Grounds has reached the point where she feels she needs a new medical option, but she has found some relief in yoga, meditation and hiking.
Small interventions such as keeping a fan at your desk, carrying ice packs, sleeping naked, keeping the room temperature lower and wearing athletic clothing can all help with hot flashes, Moore said. Some women with mild symptoms also feel better with drinking soy milk, exercising and taking herbal remedies, such as black cohosh.
Thornton’s doctor put her on hormone replacement therapy, but she only lasted about 30 days on it. She didn’t like the weight gain or the idea that she was messing with nature.
For the rest of her four years of menopausal symptoms, Thornton braved it without additional medical assistance: taking off layers of clothing during sweats and locking herself in the bathroom with a glass of wine when she felt her temper acting up.
“Deal with the discomfort as it is what we must do; compared to childbirth and abdominal surgery, this was a breeze!” she wrote in her iReport.
Study Shows ADHD Drugs Could Help Treat Menopause
Along with hot flashes and mood swings, up to two-thirds of menopausal women report suffering from “brain fog,” a frustrating condition marked by forgetfulness and an inability to concentrate. Now, a new therapy might have these women filling up the same prescriptions as their hyperactive grandchildren.
Stimulants traditionally used to treat ADHD in children could also be used to treat several cognitive and mood complaints in menopausal women, according to new research from the University of Pennsylvania. Dr. C. Neil Epperson, director of the Penn Center for Women’s Behavioral Wellness, presented the findings of an unpublished study during the American Psychiatric Association’s annual meeting. The research shows that the drug lisdexamfetamine (PDF) (LDX)—the third-most popular ADHD medication, similar to Adderall but with a lower potential for abuse—can aid post-menopausal women by improving attention and concentration, organization, and memory.
Epperson, a clinician, tells The Daily Beast that she began her research after noticing that more women were coming to her practice with worries about the early onset of dementia. As it turned out, their problems with memory, concentration and ability to focus at work usually weren’t actual dementia, but side effects of low estrogen levels associated with menopause.
Most menopausal women are treated with hormones but they aren’t effective for all women and aren’t even an option for those with certain medical conditions. That’s where Epperson says stimulants might be able to step in.
“ decline during the menopausal years, we believe, can play a role in the simultaneous decline in executive function that many women experience during the menopause transition. More specifically, estrogen plays a role in dopamine levels and the brain’s normal dopaminergic tone. We theorize that this process can result in symptoms similar to those experienced by people with attention deficit hyperactivity disorder,” Epperson said in statement released before the presentation.
Epperson conducted the double-blind crossover study of 32 “successful” women (participants had an average of 16 years of education and an IQ of 113) between the ages of 48 and 60 with no history of ADHD, who reported diminished ability to focus and multi-task in their early post-menopausal years. Over four weeks, half of the women were given LDX and the other half a placebo, then measured on self-reports of functioning in five areas: organization and motivation for work; concentration and attention; alertness, effort and processing speed; managing affective interference (letting emotions inhibit performance); and working memory and recall. The women who received LDX treatment, the preliminary evidence shows, had a significant reduction in the severity of all symptoms but one (the over-attention to emotion, which wasn’t a major complaint to begin with), but especially in the domain of organization and motivation for work. The women with the most severe symptoms experienced the most striking improvement; still others showed no improvement al all.
Though Epperson says this is the first study to link ADHD treatment for the ADHD-like symptoms of menopause, stimulants have historically been used to treat those women who failed to meet certain societal expectations, and despite their initial effectiveness, some experts warn against a return to potential overprescription.
“When I hear about this type of approach—taking common life changes where one might feel a little more distractible, or having trouble with memory when one gets older—and applying amphetamines, it makes me have a flashback,” Pieter Cohen, an assistant professor of medicine at Harvard Medical School, tells The Daily Beast.
“When amphetamines were introduced, it was to help stay-at-home women who were feeling down about themselves and their lives,” Cohen says.
As Cohen recounts and Nicolas Rasmussen details in his book On Speed: The Many Lives of Amphetamine, since their initial release in 1937, amphetamines have been used to improve the performance of American soldiers in WWII, stave off depression and weight gain in 1950s housewives, and eventually to treat narcolepsy and Hyperkinetic Reaction of Childhood (or ADHD as we now know it).
Pharmaceutical companies pushed these drugs—promising to put the pep back in your step—but prescriptions fell after the addictive potential of the stimulants became clear, and they were added to the Drug Enforcement Administration’s list of “controlled substances” as a Schedule II, meaning they have a high potential for abuse and dependence.
“Once you stop taking it you feel like something’s missing,” Cohen says.“It might not be an addiction where you’re racing around trying to find your next hit, but it can cause dependence, and in some cases, addiction.”
As for the UPenn study, though it hasn’t been released yet, Cohen is dubious.
“It’s absurd to draw any conclusions from a few dozen women who self-report being more productive after taking speed. That’s what this drug does, it makes people feel better, so of course your self-assessment of your capabilities would increase,” he says.
Epperson also suggested caution in her presentation: “This is with only four weeks of treatment. We don’t know what would happen if they took this for a longer period of time,” she said.
The prescription of stimulants would also be inappropriate for women with hypertension (stimulants can increase blood pressure, heart rate, and body temperature) or a history of addiction, Epperson told The Daily Beast. She also noted that LDX maker, Shire—a company that has provided grant and/or research support, according to her disclosure—said the study wasn’t large enough to say the drug is a suitable treatment for all menopausal women, just these menopausal women in the study.