September 25, 2017

Bupropion as a treatment for Ulcerative Colitis

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.

Bupropion peak plasma levels compared

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.

Comments

  1. Mauricio says:

    Dear Michael,
    I have bought your book and have been in touch with Sky. I will start doing the infusions in a week and also have a prescription for Doxepin (5 mg) and Bupropion (150 mg). What do you think would be a good dosage / times per day to take?
    I will appreciate if you could reply to me.
    Thank you,
    Rgds.,
    Mauricio

    • Hi Mauricio,

      I used Bupropion 100 mg 3 times a day using the immediate release form since I read that was more effective than the sustained release (SR, twice a day) or the Extended Release (XL, once a day.) The immediate release form is usually not prescribed these days unless someone specifically requests it. After about 3 months I ended up switching to the XL version, however this was well after my Colitis symptoms were well under control.

      I’m interested you found a prescription for 5 mg of Doxepin, it looks like they just introduced that dosage level in generic form in April. I guess this is because of the release of brand name Silenor patented in 3 and 6 mg dosage levels for sleep maintenance. When I discovered that I took 10 mg capsules of Doxepin and used half each time. Take Doxepin at night since it will make you drowsy. You may also want to switch to Valerian root extract later for sleep and to help limit diarrhea and enhance stool quality.

      Have you started doing them yet? Feel free to ask me any questions you have, congratulations on getting going. You are on your way to being done with this illness!

  2. I was interested in reading your taking the buproprion. I assume it did NOT make you nauseaus. I had taken it at much lower doses and it appeared to increase anxiety so I didnn’t take it. Have you tried ldn to keep you in remmission. It comes in capusles as well as a cream. The capsules caused diarrhea and I called the compounding phrarmacy who informed me this med comes in a cream and does not cause gastro side effects. I am currently waiting for it to arrive. I did FT for 3 1/2 weeks-donor was tested etc. ONe of my last treatements resulted in severe diarrhea-I learned my donor had had hot peppers, and raw onions. Did you ever experience server cramps etc. based on donor’s diet?? Thank you!

    • Michael Hurst says:

      Ok, there are a few things on here. I think instead of Bupropion you are referring to Low Dose Naltrexone (LDN) since the anti-depressant drug Bupropion only comes in tablets and does not come in a cream. I briefly tried LDN after Bupropion and FMT had gotten my symptoms under control, however I don’t really think it helped much for Colitis symptoms, although taking it at night caused terrible insomnia.

      If your donor has eaten foods which could cause irritation it is very possible that those foods could cause problems when administered by enema to your colon. I did have some severe cramps and bloating at times which I treated by taking Gas-x. I don’t know how much of this was caused by my donor’s diet or my diet. I think competing bacteria can cause lots of gas as well as a loss of elasticity from having had prolonged inflammation in the colon.

      • No, I WAS referring to Buproprion as well as LDN. I took low doses of the Welbutrin (Buproprion) and was experiencing nausea as well as anxiety. My doctor told me that indeed the Buproprion could increase the anxiety so I got off of it. In the meantime I had a cheek swab done to measure my tolerance for antidepressants. Out of 20 supposedly I can tolerate only 4 of them!! Buproprion was one that was strongly recommended I not take. So unfortunately I can’t use it to help with my UC.

        I thank you for your help regarding diet of donor!! I finished about 30 FT and am in remission. However, I plan to continue doing them from time to time for maintenance. I had let about 3 weeks lap and then did one night before last. I awakened during the night with a feeling of spasms and a bit of cramping. And since that time, am stll a bit gurgley. Is it possible that perhaps I needed “a tune up” and my body is again reacting to new healthy bacteria?? I hope that is what it is. Now that you are in remission do you still do an FT from time to time?

        Also, I am curious if you or any of your followers has experience feelings of nausea. I had these feelings off and on when I was dealing with a flare as well as when i was comig off Prednisone. I was tested for Gall Bladdder problems and tests were negative. I went for 2 1/2 week with NO nausea. Last week tried a low dose of ENSAM patch (maoi) and the next day I was extremely nauseas. I got off the med,but since that time the nausea has continued. Have you or any of your followers had this symptom? And if so what is the cause and treatment?

  3. Just want to throw this out there – has anyone ever tried preparing the fecal sample with saline solution and then injecting the sample into an empty gel pill, freezing and then swallowing the pill? If anyone has experience with this method would love to hear from you.

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