Wellbutrin pill. Wellbutrin: Uses, Side Effects, and Essential Information for Safe Usage

01.07.202317.07.2023 by alexxlab

How does Wellbutrin work. What are the main uses of Wellbutrin. What are the potential side effects of Wellbutrin. How should Wellbutrin be taken properly. What precautions should be considered when using Wellbutrin. Can Wellbutrin interact with other medications. How effective is Wellbutrin for treating depression and other conditions.

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Understanding Wellbutrin: An Overview of the Antidepressant

Wellbutrin, also known by its generic name bupropion, is a widely prescribed antidepressant medication used to treat various mental health conditions. It belongs to a class of drugs called norepinephrine-dopamine reuptake inhibitors (NDRIs), which work by affecting the balance of certain neurotransmitters in the brain.

Is Wellbutrin different from other antidepressants. Unlike many other antidepressants, which primarily target serotonin, Wellbutrin focuses on norepinephrine and dopamine. This unique mechanism of action can make it effective for patients who haven’t responded well to other antidepressants or who experience certain side effects with selective serotonin reuptake inhibitors (SSRIs).

Primary Uses of Wellbutrin: More Than Just Depression

While Wellbutrin is primarily known as an antidepressant, its uses extend beyond treating major depressive disorder. Healthcare providers may prescribe Wellbutrin for various conditions:

Major depressive disorder
Seasonal affective disorder (SAD)
Smoking cessation (under the brand name Zyban)
Attention deficit hyperactivity disorder (ADHD) in some cases
Bipolar depression (in combination with mood stabilizers)

Can Wellbutrin help with weight loss. Some studies suggest that Wellbutrin may have a modest effect on weight, potentially helping some patients avoid the weight gain often associated with other antidepressants. However, it’s not approved as a weight loss medication, and any weight-related effects should be discussed with a healthcare provider.

Wellbutrin’s Mechanism of Action: How It Works in the Brain

Understanding how Wellbutrin works can help patients appreciate its effects and potential benefits. The medication’s primary mechanism involves inhibiting the reuptake of norepinephrine and dopamine in the brain.

What does inhibiting neurotransmitter reuptake mean. When Wellbutrin blocks the reuptake of these neurotransmitters, it effectively increases their availability in the brain. This can lead to improved mood, increased energy, and better focus for many patients.

The unique action on dopamine and norepinephrine, rather than serotonin, sets Wellbutrin apart from SSRIs and may contribute to its effectiveness in treating certain symptoms of depression, such as fatigue and lack of motivation.

Neurotransmitter Balance and Mental Health

The balance of neurotransmitters in the brain plays a crucial role in regulating mood, energy levels, and cognitive function. By modulating norepinephrine and dopamine levels, Wellbutrin can help restore this balance in individuals with depression or other mental health conditions.

Does Wellbutrin work immediately. Like most antidepressants, Wellbutrin typically takes several weeks to reach its full therapeutic effect. Patients may start noticing improvements in energy levels and concentration before mood changes become apparent.

Proper Usage and Dosing Guidelines for Wellbutrin

Adhering to proper usage and dosing guidelines is crucial for the safe and effective use of Wellbutrin. The medication is available in different formulations, including immediate-release, sustained-release (SR), and extended-release (XL) tablets.

Immediate-release tablets are typically taken three times daily, at least 6 hours apart.
Sustained-release (SR) tablets are usually taken twice daily, morning and evening.
Extended-release (XL) tablets are taken once daily, preferably in the morning.

How should Wellbutrin be taken. Wellbutrin can be taken with or without food. If stomach upset occurs, taking it with food may help alleviate this side effect. It’s important not to crush, chew, or split extended-release tablets, as this can alter the drug’s release profile and potentially increase the risk of side effects.

The typical starting dose for Wellbutrin varies depending on the formulation and the condition being treated. Healthcare providers will often start with a lower dose and gradually increase it to minimize side effects and determine the most effective dosage for each patient.

Importance of Consistent Medication Use

For optimal results, it’s crucial to take Wellbutrin consistently as prescribed. Skipping doses or stopping the medication abruptly can lead to discontinuation symptoms and potentially worsen the underlying condition.

What happens if a dose is missed. If a dose is missed, it should be taken as soon as remembered, unless it’s close to the time for the next scheduled dose. In that case, skip the missed dose and resume the regular dosing schedule. Never take a double dose to make up for a missed one.

Potential Side Effects and Risks Associated with Wellbutrin

Like all medications, Wellbutrin can cause side effects. While not everyone experiences side effects, it’s important to be aware of potential adverse reactions. Common side effects of Wellbutrin include:

Dry mouth
Nausea
Insomnia or sleep disturbances
Agitation or anxiety
Headache
Constipation
Dizziness
Increased sweating

Are there any serious side effects to be aware of. While less common, some patients may experience more serious side effects that require immediate medical attention:

Seizures (risk is dose-dependent)
Severe allergic reactions
Changes in heart rhythm
Unusual changes in mood or behavior
Suicidal thoughts or behaviors, especially in young adults

The risk of seizures is a particular concern with Wellbutrin, especially at higher doses. This risk is higher in patients with a history of seizures, eating disorders, or those taking other medications that lower the seizure threshold.

Managing Side Effects

Many side effects of Wellbutrin are mild and may improve over time as the body adjusts to the medication. However, if side effects persist or worsen, it’s important to consult with a healthcare provider. They may adjust the dosage or recommend strategies to manage side effects.

Can lifestyle changes help minimize side effects. In some cases, simple adjustments like taking the medication with food, staying hydrated, or adjusting the timing of doses can help alleviate certain side effects. However, any changes should be discussed with a healthcare provider first.

Wellbutrin Interactions: Medications and Substances to Avoid

Wellbutrin can interact with various medications and substances, potentially altering its effectiveness or increasing the risk of side effects. It’s crucial to inform healthcare providers about all medications, supplements, and substances being used before starting Wellbutrin.

Which medications can interact with Wellbutrin. Some notable interactions include:

Monoamine oxidase inhibitors (MAOIs)
Other antidepressants, especially those affecting serotonin
Antipsychotics
Certain anti-arrhythmic medications
Some antiseizure medications
Stimulants used for ADHD

Wellbutrin can also interact with alcohol, potentially increasing the risk of seizures and other adverse effects. Patients are typically advised to avoid or limit alcohol consumption while taking Wellbutrin.

The Role of CYP2B6 Enzyme

Wellbutrin is metabolized primarily by the CYP2B6 enzyme in the liver. Medications that inhibit or induce this enzyme can affect Wellbutrin’s metabolism and potentially its effectiveness or side effect profile.

How does genetic variation affect Wellbutrin metabolism. Some individuals may have genetic variations that affect CYP2B6 function, potentially altering how they respond to Wellbutrin. In some cases, genetic testing may be recommended to guide dosing decisions.

Special Considerations: Pregnancy, Breastfeeding, and Elderly Patients

Certain patient populations require special consideration when it comes to Wellbutrin use. These include pregnant women, breastfeeding mothers, and elderly patients.

Is Wellbutrin safe during pregnancy. The use of Wellbutrin during pregnancy is a decision that should be made carefully, weighing the potential benefits against the risks. Some studies suggest a slight increase in the risk of certain birth defects with first-trimester use, while untreated depression during pregnancy also carries risks.

For breastfeeding mothers, small amounts of Wellbutrin and its metabolites can pass into breast milk. The potential effects on nursing infants are not fully known, and the decision to use Wellbutrin while breastfeeding should be made in consultation with a healthcare provider.

Elderly patients may be more sensitive to the effects of Wellbutrin and may require lower doses. They may also be at increased risk for certain side effects, such as confusion or falls. Close monitoring is important in this population.

Wellbutrin and Smoking Cessation

Wellbutrin, under the brand name Zyban, is FDA-approved as an aid for smoking cessation. It can help reduce cravings and withdrawal symptoms associated with quitting smoking.

How effective is Wellbutrin for quitting smoking. Studies have shown that Wellbutrin can significantly increase the chances of successfully quitting smoking compared to placebo. It’s often used as part of a comprehensive smoking cessation program that includes counseling and support.

Monitoring and Follow-up: Ensuring Safe and Effective Treatment

Regular monitoring and follow-up are essential components of Wellbutrin treatment. Healthcare providers typically schedule follow-up appointments to assess the medication’s effectiveness, monitor for side effects, and make any necessary adjustments to the treatment plan.

What should be monitored during Wellbutrin treatment. Key aspects of monitoring include:

Changes in mood and depressive symptoms
Emergence of side effects
Changes in weight or appetite
Sleep patterns
Blood pressure and heart rate
Any unusual changes in behavior or thoughts

Patients should be encouraged to keep a journal of their symptoms and any side effects they experience. This information can be valuable during follow-up appointments and help guide treatment decisions.

Long-term Use and Discontinuation

For many patients, long-term use of Wellbutrin may be necessary to maintain symptom improvement and prevent relapse. The decision to continue or discontinue treatment should be made in consultation with a healthcare provider.

How should Wellbutrin be discontinued. If discontinuation is deemed appropriate, it’s typically done through a gradual tapering of the dose to minimize the risk of discontinuation symptoms. Abrupt discontinuation can lead to symptoms such as irritability, anxiety, dizziness, and flu-like symptoms.

In conclusion, Wellbutrin is a versatile antidepressant with a unique mechanism of action that can be effective for various mental health conditions. While it offers many benefits, it’s crucial to use it under close medical supervision, adhere to proper dosing guidelines, and be aware of potential side effects and interactions. Regular monitoring and open communication with healthcare providers are key to ensuring safe and effective treatment with Wellbutrin.

Wellbutrin Oral: Uses, Side Effects, Interactions, Pictures, Warnings & Dosing

Warnings:

Bupropion is an antidepressant used to treat a variety of conditions, including depression, other mental/mood disorders, and smoking cessation. Antidepressants can help prevent suicidal thoughts/attempts and provide other important benefits. However, studies have shown that a small number of people (especially people younger than 25) who take antidepressants for any condition may experience new or worsening depression, other mental/mood symptoms, or suicidal thoughts/attempts. It is very important to talk with the doctor about the risks and benefits of antidepressant medication, even if treatment is not for a mental/mood condition.

Tell the doctor right away if you notice new or worsening depression/other psychiatric conditions, unusual behavior changes (including possible suicidal thoughts/attempts), or other mental/mood changes (including new/worsening anxiety, panic attacks, trouble sleeping, irritability, hostile/angry feelings, impulsive actions, severe restlessness, very rapid speech). Be especially watchful for these symptoms when a new antidepressant is started or when the dose is changed.

If you are using bupropion to quit smoking, stop taking bupropion and contact your doctor right away if you experience any of the symptoms listed above. Tell your doctor right away if you have any of these symptoms after stopping treatment.

Warnings:

Uses

Bupropion is used to treat depression. It can improve your mood and feelings of well-being. It may work by helping to restore the balance of certain natural chemicals (neurotransmitters) in your brain.

How to use Wellbutrin 75 Mg Tablet

Read the Patient Information Leaflet and Medication Guide available from your pharmacist before you start using bupropion and each time you get a refill. Consult your doctor or pharmacist if you have any questions.

Take this medication by mouth with or without food as directed by your doctor, usually three times daily. If stomach upset occurs, you may take this drug with food. It is important to take your doses at least 6 hours apart or as directed by your doctor to decrease your risk of having a seizure.

The manufacturer directs not to crush, cut, or chew the tablet before taking it. However, many similar drugs (immediate-release tablets) can be crushed, cut, or chewed. Follow your doctor’s directions on how to take this medication.

Do not take more or less medication or take it more often than prescribed. Taking more than the recommended dose of bupropion may increase your risk of having a seizure.

The dosage is based on your medical condition and response to treatment. Your dose may be slowly increased to limit side effects such as sleeplessness, and to decrease the risk of seizures. To avoid trouble sleeping, do not take this medication too close to bedtime. Let your doctor know if sleeplessness becomes a problem.

Use this medication regularly in order to get the most benefit from it. To help you remember, use it at the same times each day.

Do not stop taking this medication without consulting your doctor. Some conditions may become worse when the drug is suddenly stopped. Your dose may need to be gradually decreased.

It may take 4 or more weeks before you notice the full benefit of this drug. Continue to take this medication as directed by your doctor even after you feel better. Talk to your doctor if your condition does not improve or if it worsens.

Side Effects

Precautions

Before taking bupropion, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.

Before using this medication, tell your doctor or pharmacist your medical history, especially of: seizures or conditions that increase your risk of seizures (including brain/head injury, brain tumors, arteriovenous malformation, eating disorders such as bulimia/anorexia nervosa), alcohol/drug dependence (including benzodiazepines, opioid pain medicines, cocaine and stimulants), diabetes, heart disease (such as congestive heart failure, high blood pressure, recent heart attack), kidney problems, liver problems (such as cirrhosis), personal or family history of psychiatric disorder (such as bipolar/manic-depressive disorder), personal or family history of suicide thoughts/attempts, personal or family history of glaucoma (angle-closure type).

This medication should not be used if you are suddenly stopping regular use of sedatives (including benzodiazepines such as lorazepam), drugs used to treat seizures, or alcohol. Doing so may increase your risk of seizures.

This drug may make you dizzy or affect your coordination. Alcohol or marijuana (cannabis) can make you more dizzy or affect your coordination. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Avoid alcoholic beverages. Alcohol can also increase your risk of seizures. Talk to your doctor if you are using marijuana (cannabis).

Older adults may be more sensitive to the side effects of this drug, especially dizziness and memory loss. Dizziness can increase the risk of falling.

During pregnancy, this medication should be used only when clearly needed. Since untreated mental/mood problems (such as depression, seasonal affective disorder, bipolar disorder) can be a serious condition, do not stop taking this medication unless directed by your doctor. If you are planning pregnancy, become pregnant, or think you may be pregnant, immediately discuss with your doctor the benefits and risks of using this medication during pregnancy.

This drug passes into breast milk and may have undesirable effects on a nursing infant. Consult your doctor before breast-feeding.

Interactions

Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor’s approval.

Some products that may interact with this drug include: codeine, pimozide, tamoxifen, thioridazine.

Taking MAO inhibitors with this medication may cause a serious (possibly fatal) drug interaction. Avoid taking MAO inhibitors (isocarboxazid, linezolid, metaxalone, methylene blue, moclobemide, phenelzine, procarbazine, rasagiline, safinamide, selegiline, tranylcypromine) during treatment with this medication. Most MAO inhibitors should also not be taken for two weeks before and after treatment with this medication. Ask your doctor when to start or stop taking this medication.

This medication may interfere with certain medical/lab tests (such as brain scan for Parkinson’s disease, urine screening for amphetamines), possibly causing false test results. Make sure lab personnel and all your doctors know you use this drug.

Does Wellbutrin 75 Mg Tablet interact with other drugs you are taking?

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Overdose

If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: seizures, hallucinations, fast or slow heart rate, loss of consciousness.

Do not share this medication with others.

Psychiatric/medical checkups or tests such as blood pressure monitoring may be performed periodically to monitor your progress or check for side effects. Consult your doctor for more details.

If you miss a dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.

Store at room temperature away from light and moisture. Bupropion tablets may have a strange odor. This is normal and the medication is still okay to use. Do not store in the bathroom. Keep all medications away from children and pets.

Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

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CONDITIONS OF USE: The information in this database is intended to supplement, not substitute for, the expertise and judgment of healthcare professionals. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or anyone else. A healthcare professional should be consulted before taking any drug, changing any diet or commencing or discontinuing any course of treatment.

Wellbutrin Dosage Guide – Drugs.com

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Generic name: BUPROPION HYDROCHLORIDE 75mg
Dosage form: tablet, film coated
Drug class: Miscellaneous antidepressants

Medically reviewed by Drugs. com. Last updated on Apr 17, 2023.

General Instructions for Use

To minimize the risk of seizure, increase the dose gradually [see Warnings and Precautions (5.3)]. Increases in dose should not exceed 100 mg per day in a 3‑day period. WELLBUTRIN Tablets should be swallowed whole and not crushed, divided, or chewed. WELLBUTRIN may be taken with or without food.

The recommended starting dose is 200 mg per day, given as 100 mg twice daily. After 3 days of dosing, the dose may be increased to 300 mg per day, given as 100 mg 3 times daily, with at least 6 hours between successive doses. Dosing above 300 mg per day may be accomplished using the 75- or 100-mg tablets.

A maximum of 450 mg per day, given in divided doses of not more than 150 mg each, may be considered for patients who show no clinical improvement after several weeks of treatment at 300 mg per day. Administer the 100‑mg tablet 4 times daily to not exceed the limit of 150 mg in a single dose.

It is generally agreed that acute episodes of depression require several months or longer of antidepressant drug treatment beyond the response in the acute episode. It is unknown whether the dose of WELLBUTRIN needed for maintenance treatment is identical to the dose that provided an initial response. Periodically reassess the need for maintenance treatment and the appropriate dose for such treatment.

Dose Adjustment in Patients with Hepatic Impairment

In patients with moderate to severe hepatic impairment (Child-Pugh score: 7 to 15), the maximum dose of WELLBUTRIN is 75 mg per day. In patients with mild hepatic impairment (Child-Pugh score: 5 to 6), consider reducing the dose and/or frequency of dosing [see Use in Specific Populations (8.7), Clinical Pharmacology (12.3)].

Dose Adjustment in Patients with Renal Impairment

Consider reducing the dose and/or frequency of WELLBUTRIN in patients with renal impairment (Glomerular Filtration Rate less than 90 mL per min) [see Use in Specific Populations (8.6), Clinical Pharmacology (12.3)].

Switching a Patient to or from a Monoamine Oxidase Inhibitor (MAOI) Antidepressant

At least 14 days should elapse between discontinuation of an MAOI intended to treat depression and initiation of therapy with WELLBUTRIN. Conversely, at least 14 days should be allowed after stopping WELLBUTRIN before starting an MAOI antidepressant [see Contraindications (4), Drug Interactions (7.6)].

Use of WELLBUTRIN with Reversible MAOIs Such as Linezolid or Methylene Blue

Do not start WELLBUTRIN in a patient who is being treated with a reversible MAOI such as linezolid or intravenous methylene blue. Drug interactions can increase the risk of hypertensive reactions. In a patient who requires more urgent treatment of a psychiatric condition, non-pharmacological interventions, including hospitalization, should be considered [see Contraindications (4), Drug Interactions (7.6)].

In some cases, a patient already receiving therapy with WELLBUTRIN may require urgent treatment with linezolid or intravenous methylene blue. If acceptable alternatives to linezolid or intravenous methylene blue treatment are not available and the potential benefits of linezolid or intravenous methylene blue treatment are judged to outweigh the risks of hypertensive reactions in a particular patient, WELLBUTRIN should be stopped promptly, and linezolid or intravenous methylene blue can be administered. The patient should be monitored for 2 weeks or until 24 hours after the last dose of linezolid or intravenous methylene blue, whichever comes first. Therapy with WELLBUTRIN may be resumed 24 hours after the last dose of linezolid or intravenous methylene blue.

The risk of administering methylene blue by non-intravenous routes (such as oral tablets or by local injection) or in intravenous doses much lower than 1 mg per kg with WELLBUTRIN is unclear. The clinician should, nevertheless, be aware of the possibility of a drug interaction with such use [see Contraindications (4), Drug Interactions (7.6)].

Frequently asked questions

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Medical Disclaimer

Wellbutrin instructions for use price reviews Kiev, Kharkov 150 mg (60 tablets)

for medical use of the drug

WELLBUTRIN SR

Composition:

90 002 1 tablet contains bupropion hydrochloride 150 mg.

Release form.

Coated tablets, prolonged release.

Pharmacotherapeutic group.

Antidepressants.

Reading.

Treatment of major depression.

Wellbutrin: how to take the drug

Dosage and administration.

The drug begins to act no earlier than 14 days after the start of therapy. As with other antidepressants, the full effect of the drug is observed only after a few weeks of treatment.

Wellbutrin tablets should be swallowed whole and not divided, crushed or chewed as this may increase the risk of side effects, including convulsions.

The maximum single dose should not exceed 150 mg. Use Wellbutrin tablets in 2 doses per day with an interval between doses of at least 8 hours.

Wellbutrin – contraindications, side effects

Contraindications.

Wellbutrin is contraindicated in patients with hypersensitivity to bupropion or to any of the components of the drug.

Wellbutrin is contraindicated in patients with seizures.

Wellbutrin is contraindicated in patients who are currently abruptly discontinued from alcohol or sedatives.

Wellbutrin tablets contain bupropion and therefore should not be given to patients receiving any other drug containing bupropion because the incidence of seizures is dose dependent.

Wellbutrin is contraindicated in patients with current or history of bulimia nervosa or anorexia nervosa, because in this group of patients there was a greater incidence of seizures when prescribing the rapid release form of bupropion.

Co-administration of Wellbutrin and monoamine oxidase inhibitors is contraindicated. Between the abolition of irreversible MAO inhibitors and the start of treatment with Wellbutrin, at least 14 days should elapse.

Adverse reactions.

From the immune system: hypersensitivity reactions such as urticaria, more severe hypersensitivity reactions including angioedema, dyspnea/bronchospasm or anaphylactic shock.

From the side of metabolism and digestive disorders: anorexia, weight loss, impaired blood glucose levels.

Mental disorders: insomnia, sleep disturbance, agitation, anxiety, depression, dysphoria, disorientation, aggressiveness, hostility, irritability, restlessness, hallucinations, unusual dreams, depersonalization, delusions, paranoid thinking, suicidal thoughts and suicidal behavior, psychosis , euphoria, mania, hypomania, changes in mental state.

From the side of the central nervous system: headache, tremor, dizziness, taste disturbances, memory disturbances, anxiety, myoclonus, dystonia, migraine, attention disorders, vertigo, akathisia, dysarthria, convulsions, EEG disturbances, dystonia, ataxia, parkinsonism, disorder of coordination of movements, memory impairment, paresthesia, fainting, coma, delirium, sensory disturbances, dyskinesia.

On the part of the organs of vision: visual disturbance, diplopia, mydriasis, increased eye pressure.

From the hearing organs: ringing in the ears.

From the side of the heart: tachycardia, cardiac arrhythmias, ECG changes, myocardial infarction, increased blood pressure, edema, palpitations.

Vascular: increased blood pressure (in some cases significant), redness, vasodilation, postural hypotension.

From the digestive tract: dry mouth, gastrointestinal disorders, including nausea and vomiting, abdominal pain, constipation, dyspepsia, toothache, gum irritation, intestinal perforation.

From the hepatobiliary system: increased levels of liver enzymes, jaundice, hepatitis.

From the side of the skin and subcutaneous tissue: rash, itching, sweating, polymorphic erythema and Stevens-Johnson syndrome, exacerbation of psoriasis, alopecia.

From the respiratory system: pulmonary embolism, bronchitis.

From the musculoskeletal system and connective tissues: muscle twitching, arthritis, rhabdomyolysis.

From the side of the kidneys, urinary and reproductive system: infections of the urinary system: decreased libido, increased frequency of urination and / or delay, erectile dysfunction, menstrual disorders, gynecomastia, testicular edema, glucosuria, nocturia.

General disorders: fever, chest pain, asthenia.

On the part of the blood system: leukocytosis, leukopenia, thrombocytopenia.

Bupropion gave criminal complications – Kommersant

“Kommersant” became aware of a new criminal case related to the drug bupropion – we recall that the police and customs of the Russian Federation call it a “derivative of a narcotic substance”, and psychiatrists consider it a legal antidepressant. Astrakhan customs opened a large-scale drug smuggling case against Olga Kalinovskaya, suffering from a psychiatric illness, who received pills in the mail. The woman claims that she did not even order the medicine – the package was allegedly a New Year’s gift from a friend who advised her on treatment. Experts point out that bupropion is not banned in Russia, but this does not interfere with judging for its purchase.

Photo: Sergey Mikheev, Kommersant / buy photo

Olga Kalinovskaya lived in Ukraine since 2008, where she was diagnosed with a depressive personality disorder. In 2012, an acquaintance of hers, a teacher who works with special children, suggested that the woman might also have attention deficit hyperactivity disorder (ADHD). She advised me to contact a friend from Norway who lives with ADHD himself and consults other patients remotely. He confirmed the diagnosis of Olga Kalinovskaya and recommended bupropion for treatment; she several times ordered the drug to Ukraine from an Indian pharmaceutical company without any problems.

Abroad Bupropion is completely legal and prescribed by doctors as an antidepressant or to help quit smoking. Foreign pharmaceutical companies produce bupropion tablets under different names: Zyban, Elontril, Wellbutrin. Until 2016, it was also sold in Russia, and the Ministry of Health even included it in the standards for the provision of medical care. But then the manufacturer left the Russian market and withdrew the license from the State Register of Medicines. By law, such drugs without a license can be bought and sold as dietary supplements.

In 2017, Olga Kalinovskaya returned to Volgograd with her husband and child to take care of her elderly mother. The woman passed a psychiatric commission, but Russian doctors did not confirm ADHD. She was given a different diagnosis (she asked not to disclose it to the media) and prescribed treatment. Ivan Martynikhin, a member of the executive committee of the Russian Society of Psychiatrists, told Kommersant that ADHD is poorly diagnosed in Russia: “Doctors do not know that it persists in adults. I see patients who come in with a depressive disorder, and ADHD is at the root.”

At the same time, the psychiatrist emphasized that one should not engage in self-examination: “Only in half of the patients who came to see me and complained of ADHD, the syndrome was actually confirmed.”

At the end of December 2019, Kalinovskaya received a notification about the delivery of an unknown package from India. She was detained at the post office – it turned out that the package contained 300 bupropion tablets. According to Mrs. Kalinovskaya, this was a complete surprise for her. Later, the woman found out that the same patient-consultant from Norway had sent the drug. “He didn’t warn me, he sent me pills for his money. He explained that he knew about my problem and just wanted to help,” said Olga Kalinovskaya. As a result, the Astrakhan customs opened a criminal case against Ms. Kalinovskaya under Part 3 of Art. 229.1 of the Criminal Code of the Russian Federation (drug smuggling on an especially large scale, the maximum penalty is up to 20 years in prison). Customs experts considered that the tablets contained “derivatives” of the illegal drug ephedron.

As Kommersant already said, at the beginning of 2019, Russian law enforcement agencies began to arrest citizens ordering drugs with bupropion in foreign online stores. The fact is that in Russian legislation since 2012 there is the concept of “derivatives of narcotic drugs” – this is the name of substances created by slightly changing the chemical formula of the drug. “Derivatives” are not listed as banned substances, but are still considered drugs. This wording appeared as part of the fight against new types of drugs, primarily “spice” – manufacturers quickly changed parts of the formula, which made it possible for some time to sell the drug without the threat of punishment. However, lawyers and narcologists already then criticized the idea of “derivatives” for legal uncertainty: they warned that sooner or later legal pharmaceuticals would fall under the ban.

There are already about ten criminal cases of bupropion smuggling, at least two people are in jail.

At the same time, the Russian Society of Psychiatrists (ROP) in August 2019 published an official conclusion that bupropion is not a drug and does not lead to dependence. Ivan Martynikhin, a member of the executive committee of the ROP, said that patients applied to the society with a request to include bupropion in clinical recommendations. The psychiatrist told Kommersant that the drug has practically no analogues and “kills two birds with one stone: bupropion is good in the treatment of depression and affects the cause – attention deficit hyperactivity disorder.” Ivan Martynikhin noted that bupropion does not have severe side effects, which is important for patients with bipolar depression. Moreover, the drug can be prescribed in addition to the main drugs to correct side effects.

Legal consultant on drug-related cases, expert of the Institute of Human Rights Arseniy Levinson draws attention to the fact that not a single Russian legal act prohibits bupropion from circulation in the Russian Federation, nowhere is it officially indicated that it is considered a drug. “If a person does not read the news, then there is no way for him to know that bupropion is recognized by the police as a derivative of ephedron,” says Mr. Levinson. “Obviously, such a person cannot commit smuggling, a crime involving direct intent. In other words, the person must know that he is committing a crime and desire it. How could Olga Kalinovskaya know that the medicine she freely bought in Ukraine suddenly turned out to be a drug in Russia?” According to him, “the authorities stubbornly ignore” the problem of criminal liability for “derivatives”. Mr. Levinson participates in the work of the Duma working group on improving anti-drug legislation; summer 2019years he spoke there about the situation with bupropion. “The representative of the Ministry of Internal Affairs said that they are aware of the problem, that the police are humanely sorry for those who are persecuted for purchasing medicine for medical reasons, but nothing needs to be changed,” said Arseniy Levinson.

“As a result, I face 20 years in prison for inaccuracies in the legislation,” says Olga Kalinovskaya.

Recall that the first criminal case on the smuggling of bupropion was initiated in April 2019 by the Ural customs against Daria Belyaeva, who ordered an antidepressant from Poland. As Irina Ruchko, the girl’s lawyer, told Kommersant, in January 2020 the case was returned for additional investigation for the third time – with the wording that the investigation “did not specify the circumstances of socially dangerous acts.” According to her, now the investigator intends to send several requests: “At least, to the medical institution where Daria was treated – to find out what drugs she was prescribed in connection with the disease. And to the Ministry of Health – to find out the attitude of the department towards bupropion.

The lawyer said that the investigator himself became the object of a departmental check: “Initially, the defense was acquainted with the decision on the appointment of an examination on bupropion, where the expert was asked five questions. And then the same decision appeared in the case file, only with three questions. In simple terms, this means that the investigator replaced one decision with another.” The lawyer sent a petition, after which the Investigative Committee checked the actions of the investigator. “The results are not yet known to me, but I very much doubt that a criminal case will be initiated,” she said.

During the investigation, Darya Belyaeva was ordered an additional psychiatric examination – the girl was declared insane. “If the court concludes that she is guilty, then she will be sent to compulsory outpatient treatment,” the lawyer explained. “That is, in any case, she is not threatened with a colony now. But this situation puts pressure on her – after all, she already had a serious illness. Of course, it is not easy for her to bear it. “Let’s hope that the case will be dismissed without trial on rehabilitative grounds,” says Arseniy Levinson. “It is absolutely obvious that there is no public danger in the actions of a patient who acquires a medicine legal all over the world for medical use.