This article is about drugs that can help work with Fecal Transplants to make them more effective for Ulcerative Colitis. It grew out of several responses I have written to emails from people who have visited this site.
What dramatically tipped the illness in my favor was when I started taking the anti-depressant drugs Bupropion (brand names Wellbutrin, Zyban) and Silenor (6 mg of Doxepin) for sleep maintenance along with going back on Apriso and mesalamine suppositories. The next day after starting this new mixture of medicine my symptoms completely went away. I was able to rapidly taper off of Prednisone and I believe that it can be effective as an anti-inflammatory drug.
Why did I think anti-depressant drugs would help? How can I say that my sudden, sustained remission within two days of starting this combination of drugs was not due to also taking mesalamine? In truth I can’t really say if any single treatment approach was effective. By itself mesalamine by itself did not help in the peak of a flare in the past, nor had it consistently been effective at keeping me in remission. However it stands to reason that this drug also helped me continue to heal. I had also taken Bupropion in the past, however never looked for any link between that and the course of my Ulcerative Colitis illness. Of course I also think the fecal transplants were still the single biggest contributing factor, however those by themselves were not the full solution, perhaps in part because of the many years of widespread and deep inflammation in my colon.
I asked my psychiatrist who has treated me for ADHD and occasionally for depression for many years after reading some encouraging stories and studies. This included a discussion thread on an internet forum Bupropion as a treatment for Ulcerative Colitis after doing a Google search for Bupropion and Crohn’s Disease. I then found several discussion threads where it had been used to successfully treat Crohn’s Disease. In addition to its use for Irritable Bowel Syndrome (IBS) there also is some evidence that it inhibits TNF-a similar to “biologic drugs” like Remicade and Humira, except without side effects which include secondary infections and even cancer in rare cases. I found a study A Clinical Trial of Wellbutrin to Treat Crohn’s Disease, however despite completing stage 3 trials the results of that study were not published for unknown reasons. I also saw some information that Bupropion is a tnf-a inhibitor in mice, similar to Remicade but without many of the harmful side effects. So I thought it was worth trying.
At the same time I got a prescription for Bupropion I also got a prescription for Silenor after the psychiatrist recommended it to help deal with sleep difficulties related to Prednisone and urgency related to a flare of Ulcerative Colitis. This drug is an anti-spasmodic drug which can calm urgency and diarrhea. Calming the gut is helpful because with less diarrhea the newly “transplanted” bacteria can reproduce and spread up the colon much more easily. I later learned that Silenor is a low dose (3 or 6 mg) of the tri-cyclic anti-depressant drug Doxepin which has been off-patent for many years. I ended up getting the generic 10 mg capsules and taking one half each day which saved me over $100 over the brand name Silenor. In fact tri-cyclic anti-depressant drugs like Doxepin have long been prescribed for a similar but less severe condition, Irritable Bowel Syndrome (IBS,) often in lower doses than those used to treat clinical depression.
While many treatments including Fecal Transplant for Ulcerative Colitis are not readily accepted at this point, the side effects of anti-depressant drugs including Bupropion are generally a lot less harmful, if at all, than the effects of the illness, surgery or drugs which suppress the immune system. Therefore giving drugs like Bupropion a try would actually seem to be a reasonably safe option compared to other treatment options that are currently considered by GI doctors. In fact my side effects included increased self-confidence and energy, not too bad.
Another consideration for treatment is the form of Bupropion that you take. I have read some patient stories saying that the immediate release form (taken 3 times a day) was more effective for them than Sustained Release (SR) form taken twice a day and the extended release (XL) form taken once a day. For this reason I initially tried the immediate release form, which I had to ask for specifically since the once a day extended release form is currently the most widely prescribed drug since it only has to be taken once a day.
Why would the immediate release form be the most effective? What is the difference since we are talking about the same parent drug – Bupropion? The reason might be that the anti-inflammatory / TNF inhibiting benefits come from the period of time where blood plasma levels are increasing. In he figure on the left which is taken from 15 years of Clinical Experience with Bupropion HCL: From Bupropion to Bupropion SR to Bupropion XL notice how the original Bupropion has a much more rapid time to peak and that since it is taken 3 times a day that there are 3 peaks.
Also if Bupropion were so effective, why is it not widely used as a treatment for Ulcerative Colitis or Crohn’s Disease? Without data from a study in people it is hard to say how many people it could be effective for Also in my experience none of my Gastroenterologists ever considered prescribing psychiatric drugs to help my condition even though my psychiatrist knew that antidepressants were prescribed to treat Irritable Bowel Syndrome (IBS.) I think the degree of overlap between IBS and IBD was not considered by my GI doctors. I also don’t think they ever considered how treating “symptoms” of Colitis like urgent diarrhea could also help heal the colon heal in the absence of these aggravating factors.