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Nortriptyline to Wellbutrin because of anger, negativity

My son has signs of depression/anxiety and has tried meds for such for the last couple of years.  The SSRI meds made him beyond crazy hyper.  So he was put on Nortiptyline and we’ve been on that for almost a year.  However, the last few months I’ve noticed he is negative, angry, aggressive- and if not acting one of those ways- he’s blah, disinterested in anything. 
Took him into the doc and she wants to try Wellbutrin to replace the Nortriptyline. 
Anyone else see these behaviors in your kiddo and was a new anti-d/anxiety med helpful?

Thanks

Replies

Is he taking only the antidepressants & nothing for ADHD?

Posted by BC on Jun 15, 2014 at 8:20am

I have a friend whose son has ODD and nothing worked for them. Once they put him on Wellbutrin it helped a great deal. He became much less defiant and more accommodating. His psychologist believes that the related anxiety/depression he was suffering hadn’t been addressed and once it was his situation improved. It doesn’t have a lot of the side effects of SSRIs and I believe is tolerated a lot better. He still needed the ADHD treated too however as the previous post mentioned. But Wellbutrin helped.

Depending on your son’s age however it could also be age related changes that are very stressful for an ADHD child. My son is a teenager now and he is no fun at all. It was a lot simpler when he was younger in terms of dealing with the symptoms. You can’t fix the symptom of being a teenager, although I’d pay good money for it if you could.

Posted by Havebeenthere on Jun 15, 2014 at 9:45am

Sorry! Yes he is on focalin for ADHD and has been for years. He is 9.5 y/o. I’m hoping this helps him a bit. He’s also been incessantly picking at his nails.

Posted by 2boys4me on Jun 15, 2014 at 8:07pm

The advantage of Wellbutrin as an antidepressant over all others is that it is also a second-line treatment for ADHD.  It is an “activating” antidepressant, so for some the activating part will be indistinguishable from “hyper.”  Knowing that, it’s usually best to take it in the AM, and during the first few weeks of taking it be prepared for it potentially causing sleep problems & that “activating” kind of behavior.  For those who are not bothered by those side effects it can be much more helpful than the other antidepressants tried.  IMO summer is the best time to try something new, especially if it might take a number of weeks to iron out any wrinkles.  I would say jump on the idea of switching to Wellbutrin because it might work out much better than what you’ve tried thus far.

Posted by BC on Jun 15, 2014 at 11:12pm

To give you feedback on this option, I would first want to know how old your son is. I read this very helpful journal article last summer. It was called “Attention Deficit/Hyperactivity disorder across the lifespan.” In it, they talked about pharmaco treatments for kids and adults. I have tried to pull up the article, but I can’t seem to find it. I will keep your link on my email and see if I can’t send it on later. Anyway, two adult treatment options discussed in this article were norimpramine and Welbutrin. I’m not sure if I would give Welbutrin to a child under the age of 16, but I know my husband gets pretty good results from it. He is very sensitive to this med. If he takes too much, he becomes agitated and very cranky. Like other antidepressants, this med can cause mania. So, he takes a very low dose, just 50 mgs per day. If your child is older, I don’t think it would hurt to try the Welbutrin. I would ask to start on a very low dose and monitor him closely. You could also consider gabapentin and Lamictil. These are two other non-SSRIs that are used for treating depression. However, I haven’t read about them being used specifically for people with ADHD.

I will see if I can find a link to that journal article and post it to you.

I hope this is helpful.
Sue H in PC, Ohio

Posted by SueH on Jun 16, 2014 at 6:55am

I took wellbutrin when it first came out and it caused me to have sleep apnea and a hyperactive bladder. Now that being said everyone responds differently to medication.

Posted by jameskellum on Jun 16, 2014 at 7:00pm

RE: the advice to try gabapentin (Neurontin) or lamotrigine (Lamictal)—these are anti-convulsants that are used to treat bipolar depression, not unipolar depression or depression secondary to ADHD.  They have no place in this discussion at all.

[http://www.psychiatrictimes.com/major-depressive-disorder/lamotrigine-major-depressive-disorder-inappropriate]

Posted by BC on Jun 17, 2014 at 9:23am

RE: medications that are “approved” for use in children vs “off-label” usage.  Wellbutrin, like many antidepressants, is not “approved by the FDA” for usage in children.  When drugs are first marketed and are still under patent, if there is a really good chance they will be used in kids (and especially if there’s a good chance they’ll be used more often in kids) drug companies will do the studies which are necessary to establish “safety” in kids. 

Wellbutrin was initially marketed as an antidepressant.  However it was later found to help people quit smoking (and tests to establish safety & efficacy were done for that specific indication early on)...and they even gave it a new name for when it was used for that indication—Zyban.  Later, it was found that Wellbutrin also helped with ADHD symptoms (and some studies followed…)

Wellbutrin (generic name bupropion) lost it’s patent or was going to lose it soon…so there was never any financial reason to conduct studies to determine it’s “safety” and efficacy in children for the indication of treating ADHD.  Regardless, because treating ADHD with non-scheduled, non-stimulant drugs has lots of advantages, plenty of researchers have conducted studies on it’s usage in kids over the years…just not the kind of studies that will get it “approved for the treatment of X in patients under the age of Y.” 

[http://www.m.webmd.com/a-to-z-guides/drug-combinations-to-treat-adhd-in-children?page=1]

It has been used by lots of psychiatrists “off-label” and in formal research studies for a while now.  Compare that with Prozac, one of the few SSRIs that is actually “approved” for use in kids…yet Prozac has lots of issues I won’t even go into.  In the Final Analysis I’d give my kid Wellbutrin sooner than I’d give him Prozac.  In fact I gave my kid Wellbutrin because he was depressed & had ADHD (and Wellbutrin help my husband).  Wellbutrin didn’t help my kid’s ADHD or his depression…

NutShell: I don’t know why the topic of whether your kid is 16 or above (cuz in pharmacokinetics there’s nothing too magical about the number 16 years old…) came up.  Just thought I should try to address it somehow.

Hope I didn’t just create more confusion instead. wink

If you have any questions about the fact that all the SSRIs and Wellbutrin (& others) can “cause mania,” I should perhaps touch on that one as well.  All of the antidepressants which treat unipolar depression have been found to induce “manic or hypomanic conversion” in patients who unknowingly have bipolar depression instead of unipolar depression (or depression secondary to ADHD).  The “hyper” that kids often get from SSRIs and others when they are first started & when dosage is increased should not be confused with manic conversion. 

The Climbing The Walls kind of thing that lots of adults & children alike get from Wellbutrin (because it is an activating antidepressant—doesn’t only effect serotonin but increases norepinephrine levels, etc) also should not be confused with manic conversion.  People who can only tolerate Wellbutrin at low doses (like 50 mg) are highly sensitive to that very unique property of Wellbutrin—the norepinephrine (or adrenaline) component.  Hope that helps clear up some of the confusion!

Posted by BC on Jun 17, 2014 at 10:38am

Oh…the other little factoid I wanted to mention—very few of the ADHD meds that we adults take are actually “approved for the treatment of ADHD in adults” but they are “approved” in kids.

Posted by BC on Jun 17, 2014 at 10:42am

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