These are the pills that keep me sane, or at least keep me in the world of the emotionally-vibrant. They consist of 300mg of bupropion (brand name: Wellbutrin) taken in two pills daily and 50mg of trazodone (brand name: Oleptro) taken at night about an hour before bed. Bupropion treats the symptoms of my dysthymia, the emotional dullness and tendency to lapse into major depression. The trazodone, while technically a very weak antidepressant, helps me sleep.
I was diagnosed with dysthymia by my primary care physician in 2012. It seems like people who receive disease diagnoses fall into one of two categories: glass half empty or half full. The former see the diagnosis as a tragedy, yet another misfortune they must tackle. You’d think, as someone with a depressive disorder, that I would fit squarely into that category. Strangely, I did not, nor do I now. Despite my condition, I’m relatively optimistic. Thus, my reaction was a half full one: now I know what the hell’s been wrong with me all of these years and can take steps to fix it. The diagnosis explained why felt like an emotionless golem. It explained why I often felt intensely sad for no apparent reason. It explained why my mood could be completely divorced from the wonderful things happening in my life. It explained that my emotional distance from the world was not a personality trait, but rather a disease.
Bupropion was the first antidepressant the doctor wanted me to try. There are various reasons for this. Most common depression drugs fit into one of two categories: Selective Serotonin Reuptake Inhibitors (SSRIs) and Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs). SSRIs include drugs such as Lexapro, Zoloft, Paxil, and Prozac, and SNRIs include drugs such as Cymbalta, Effexor, and Pristiq. The Mayo Clinic pages to which I link explain them far better, but briefly, these drugs work by adjusting the levels of neurotransmitters in the brain. Both SSRIs and SNRIs have many common side effects: nausea, decreased libido, insomnia, and more.
My antidepressant of choice fits into neither category. In fact, to make things more fun, researchers don’t really fully understand exactly how bupropion works, though they have a general idea. But before I get into bupropion and how it helped me, I should probably explain how I got to the point of getting the prescription in the first place. My doctor’s visit was precipitated by a terrible bout of major depression, one where I got the closest I ever had before to committing suicide. My friend encouraged me to go, and I am so glad that she did. The doctor said that my symptoms are consistent with dysthymia, a word I’d never heard before. She also said, because of the disconnect between my mood and what was happening in my life, that I was a good candidate for medication. She prescribed bupropion.
Before I started the bupropion, I had hardly any energy. After work, I’d come home, collapse, and just read random things on my phone until I gave in and decided to attempt to fall asleep, usually unsuccessfully. When I first started taking bupropion, I felt amazing. It was like I’d been seeing the world in greyscale and suddenly could see in color. These emotions that I’d experienced in full only periodically in my life came flooding in. I don’t think that I really understood the stunning beauty of the Columbia River Gorge, where I live, until I started taking medication. The vibrant green forests, sheer sculpture-like rock faces, and shining river hit me with a wave of emotion. I never really thought of beauty as an emotional attribute before, but that experience changed my view of it.
Most importantly, I had my energy back. Within three days of starting the drug, I not only had enough energy to mow the lawn of the house of was renting, but also the one of the house I was buying and my neighbor’s lawn. In one day. This was unheard of for me. I cleaned the house. Work tasks were dispensed with efficiently and effectively. I felt like a person again, with emotions, motivations, and energy. My initial experience with bupropion made me realize that so much of who I thought I was – that person I hated and criticized – was not actually a part of my personality, but rather an illness.
The honeymoon lasted a few months with bupropion. The first couple of weeks, it ran me through a cycle of side effects. Initially it was the nausea. Then it was the insomnia. Last it was the irritability. Little things would annoy me, things I’d brush off before. Once those few weeks past, it was pretty smooth sailing. Weirdly, though, after a few months, I started getting panic attacks. I would lie on the couch, shaking. They had no apparent cause, and it scared the shit out of me.
Given that strange side effect, my doctor thought it best to try me on other antidepressants. Initially it was escitalopram, an SSRI. Honestly, it didn’t really do much for me. I went back to my emotional dullness within weeks of starting it. Next up was venlafaxine, an SNRI. It seemed to do a reasonable job at elevating my mood, but I was tired constantly. I slept long stretches in an almost coma-like state, nine to ten hours a night, and woke up feeling like I hadn’t slept at all. I took three hour naps on my days off. So despite that my mood was decent, it was hard to notice due to constant exhaustion.
That’s when I decided to go back to the bupropion. This might seem like an odd decision, given the panic attacks, but I thought that 1) now that I knew they were coming, maybe I could predict and control the attacks better and 2) the bupropion’s side effects overall seemed better than the other two drugs. And the bupropion did work better when I began taking it again. The panic attacks never came back; I still don’t know ultimately why they happened. Eventually, the bupropion settled into giving me mild insomnia, for which the doctor prescribed trazodone. However, I didn’t pair my medications with other self-treatment measures. That lack of self-care, and my increasing forgetfulness at taking my medications, led me into major depression, the effects of which were brutal.
After I broke, I got more serious about my treatment. My doctor gave me the option to double my bupropion intake, to 300mg/day, which I decided to try. It made an amazing difference. This time, though, I took on other measures. I started eating better. I bought a rowing machine to exercise indoors during the cold, wet winter months. I improved my sleep habits. After doing some research and consulting with my doctor, I limited myself to one drink per day (bupropion interacts with alcohol even more poorly than other antidepressants), although I was never really a heavy drinker.
Probably my most interesting self-imposed treatment, though, is I require myself to have at least one in-person social interaction per day. Sometimes that interaction involves going out to listen to music or hanging out at the brewery. Sometimes it might just involve interacting with a clerk in a store. As an introvert, I can easily go through an entire day without interacting with anyone, thus further isolating me and exacerbating my issues. My social interaction rule, however, helps keep me connected. Already, that rule has brought some amazing new people into my life
Now that I’m on a positive path of treatment, it’s like I’m discovering the real me. I’m not sure that I’ve ever met him in his entirety, only glances. He’s optimistic. His mind is agile. He loves to hike. He enjoys musicals. He’s a devoted Whovian. Now, all of these things – and more – are coming to the fore. It’s pretty exciting to get a chance to revisit who you really are in adulthood. Chemistry is helping make that happen for me.