The depressive phase includes these symptoms:

• Feelings of sadness, emptiness and tearfulness throughout the day.
• Significantly lower interest and pleasure in any activity.
• Marked weight loss without dieting, or weight gain. Increase or decrease in appetite almost everyday.
• Hypersomina or insomnia mostly each day.
• Feelings of fatigue or exhaustion.
• Lack of feelings of self worthiness, and excessive as well as inappropriate feelings of guilt.
• Indecisiveness and loss of concentration along with inability to think logically.
• Suicidal thoughts, regular suicidal ideation and even suicide attempts.

A patient suffering from bipolar disorder goes through these depressive episodes in varying degrees.

Wellbutrin is often considered to be the best antidepressant in the treatment of bipolar disorder. It is the brand name for bupropion that was developed by Nariman B.Mehta belonging to Burroughs Wellcome (currently GlaxoSmithkline) in 1969. The United States FDA approved its use as an antidepressant in 1985 marketing bupropion in the name of Wellbutrin.

Wellbutrin, as an antidepressant plays the role of a dopamine reuptake blocker and norepinephrine. It also acts as a nicotinic antagonist. Bupropion (Wellbutrin) is a part of the group of chemicals known as aminoketones. Structurally bupropion resembles cathinone which is a stimulant, anorectic diethylpropion, as well as to phenethylamines. In the year 2007, it ranked fourth in the U.S. retail market amongst the most prescribed drugs for treating depression.

Wellbutrin, by itself effectively works on depression. However it is most commonly used as a supplementary medication in conditions where there is incomplete response to the selective serotonin reuptake inhibitors like citalopram, fluoxetine, and paroxetine to name a few. Clinical studies with Placebo have proved bupropion’s efficacy with regard to treating clinical depression.

Similar comparative studies were conducted between bupropion and other antidepressants like fluoxetine (Prozac), sertraline (Zoloft), escitalopram (Lexapro), and paroxetine (Paxil). In a recent observation, a markedly greater remission rate was observed with treatment through bupropion in comparison to the use of venlafaxine (Effexor). Unlike most categories of antidepressants, with the exception of mirtazapine, maprotiline and tianeptine, the use of bupropion did not lead to sexual dysfunction.

Similarly in contrast to the use of most other antidepressants, bupropion also did not result in weight gain. Symptoms like hypersomnia and excessive exhaustion also were reduced significantly as compared to SSRIs (selective serotonin reuptake inhibitors) in patients with depression.

However bupropion is mostly effective in treating patients suffering from moderate to low level anxiety, while the SSRIs are better in treating depression patients with high levels of anxiety. Most of the clinical studies have proved that the ideal strategy followed in case of patients not responding to sole SSRI therapy is the enhancement of a recommended SSRI with bupropion.

The effective combination of citalopram (Celexa) and bupropion is a better step taken than switching over to some other antidepressant. Mood improvement, higher levels of energy and improvement in sexual and cognitive functions were noticed in patients treated with the dual combination of citalopram (Celexa) and bupropion (Wellbutrin). Among the other antidepressants, Wellbutrin also has less likelihood of precipitating rapid cycling, manic episodes, and mixed episodes that characterize bipolar disorder.

Wellbutrin is available in the following forms:

• Wellbutrin (immediate release)
• Wellbutrin SR (sustained release). Dosing is twice daily.
• Wellbutrin XL or XR (extended release). This is to be taken once daily.

The makers of Wellbutrin, GlaxoSmithkline have advised against the usage of the medicine in patients with epileptic conditions or such conditions which reduce the threshold of seizure. These include benzodiazepine discontinuation, bulimia, or anorexia nervosa and brain tumors. Individuals having MAO inhibitors should also abstain from taking Wellbutrin. In case of switching over from MAOIs to Wellbutrin, a period of washout of close to two weeks is recommended.

Wellbutrin should be used with extreme caution in patients with kidney disease, and hypertension. Similarly caution should be exercised in the use of Wellbutrin in adolescents as well as young adults belonging to the 18 – 24 age groups as this medication is known to increase the risks of suicidal ideation in this category. Some of the commonest side effects associated with Wellbutrin 12 hour sustained release (Wellbutrin SR) are nausea, dry mouth, tremor, insomnia, excess sweating, as well as tinnitus.

In a nut shell, Wellbutrin’s efficacy with regard to treating depression in patients with bipolar disorder remains unquestionable. However, it is always advisable to seek a doctor’s guidance for the final choice with regard to antidepressants.