Same situation as you. SSRIs seemed mostly ineffective, or sometimes had crazy side effects (will never forget Effexor-induced zaps despite tapering off following the directions to the letter). Bupropion has been fantastic for me since I started and I wished I'd found it 20 years ago.

That’s great! Bupropion caused a psychotic episode for me maybe ten years ago. Most terrifying day of my life, when the razor blades were calling out to me telling me to cut myself. To be clear, I’ve never had anything like that happen before or since. My daughter spent 9 months in the NICU and got genetic testing for various drugs, with 1 being the baseline expected (I’m going off memory here) and 9 or 10 being “wtf this is super weird”. She got a 9 for bupropion. I’m assuming she got that from her father.

> My daughter spent 9 months in the NICU and got genetic testing for various drugs, with 1 being the baseline expected (I’m going off memory here) and 9 or 10 being “wtf this is super weird”. She got a 9 for bupropion.

I've never heard of that. Why would they be testing an infant for their reaction to an antidepressant drug? Just curious.

The genetic tests use genotypes to make statistical inferences about efficacy and metabolism for certain drugs. Wellbutrin is a common medicine, and the testing company probably had it as part of their panel.

Wow, sorry. Bupropion is an SNRI, not SSRI. SSRIs are 'dangerous' IMHO, except for the special cases mention here (suicide ideation, extreme non-functioning).

I would have hoped clinicians would start at the lowest possible dose, and titrate up. I've certainly heard of the "you need about xx mg, use this dose" first doses, tho.

To me, this is Yet Another reason one should never receive medical advice alone, especially when thinking is impaired. That trusted friend / partner needs to ask the hard questions of the prescribing clinician; but rules make any 3rd party except spouse difficult for adults.

It's an NDRI, not an SNRI.

Do these work for panic attacks ? I think anxiety and depression are related. I was prescribed SSRI for anxiety.

> I think anxiety and depression are related. I was prescribed SSRI for anxiety.

They often accompany one another. I've had panic attacks in the past, and was diagnosed with generalized anxiety disorder. I can't claim that bupropion fixes panic attacks proper, and I'm not a doctor, but it does help me with my depression. (I haven't had a panic attack in a long time.)

It's not a silver bullet; you can still find yourself in mentally stuck states, the difference is the physical side of things seems to be 'gated' at the low end so that your spiraling down isn't as deep as it is before. There's still a lot of work to do to recognize + slow that descent, but it is a tool to help with that.

Mirtazapine can help with depression, anxiety and panic, and it isn't an SSRI. There are also newer drugs that are marketed as SMS drugs instead of SSRIs, like vilazodone and vortioxetine. Buspirone binds to 5HT1A directly, instead of inhibiting the serotonin transporter like other drugs.

Wellbutrin and NDRIs typically aren't that great for anxiety, but they can help.

Not available in the UK because reasons.

Not available directly from a GP, but if one gets referred to a clinical psychiatrist they can permit a prescription.

True. But it won't be easy. You will mostly likely be put on combination therapies first. Then onto combo SSRIs and Antipsychotics, then maybe you might get something that ups dopamine, maybe. If you look a bit bipolar though you'd likely go onto a mood stabiliser (i.e. calm the f down you over-active neurons, have some more gabba/ block those calcium channels etc). and personally that's what worked best for me, over active mind induced perpetual exhaustion -> anhedonia from the stress of a mind that never stops.