Can Buproprion (Wellbutrin) help people with IBD?
The frontline drugs for moderate to severe Inflammatory Bowel Disease can demonstrate high efficacy and in many cases can be life-saving to people with IBD.
These drugs unfortunately also come with side effects ranging from mild to quite serious.
For example, I took a drug called azathioprine (brand name Imuran) for many years. The drug works by interfering with DNA synthesis and suppressing the bone marrow’s production of white blood cells and thus modulates the immune response. I was sick all the time, I had many sinus infections, and once contracted a serious bacterial infection that landed me in the hospital for a few days because I was violently throwing up and could not keep fluids down. The drug is now almost never used in young males given the risk of a certain but near 100% fatal type of blood cancer called hepatosplenic T-cell lymphoma (HSTCL). Am I a little upset that I was prescribed this drug for 6 years? Yes, a little for sure.
Mid and newer generation biological-based drugs like Remicade, Humira, Entyvio, and Stelara can work extremely well in many cases but similarly present issues associated with immunosuppression, cancer, and other side effects. Risks of serious side effects increase when these drugs are combined
Many people with IBD and other disorders for which these drugs are prescribed are understandably uncomfortable with these side effects and feel as though there are not options out there.
When you dive deep enough into the world of IBD or frankly start to study anything so intensely, interesting discoveries are uncovered, and I’d like to share one with you today.
There is a commonly prescribed anti-depressant medication called bupropion (brand name Wellbutrin) which is an atypical antidepressant thought to be a norepinephrine dopamine reuptake inhibitor (NDRI).
In 2001, psychiatrists at the University of Vermont and UC San Diego penned an academic open letter to the Journal of Gastroenterology. They noted how two of their patients experienced complete resolution of symptoms and sustained remission after taking Wellbutrin.
They hypothesized that bupropion works to modulate IBD and possibly other inflammatory conditions by indirectly lowering concentrations of TNF through reducing intracellular cAMP a signaling molecule in the inflammatory cascade associated with IBD.
Later studies have demonstrated bupropion’s anti-inflammatory properties and the case reports from people I have spoken with and read about seem quite promising.
Why has this not been studied further?
Yes, you guessed it: the drug has been around too long in order of a profit to be made so again the science is lacking.
I’d like to end by pointing out that the fact that a psychoactive medication modulates the immune system is not surprising to me.
I believe this further adds to the developing narrative of how IBD, other inflammatory conditions, and especially those involving the gut are deeply tied to the state of our brain, mind, and emotional state.
Let us not underestimate the striking relationship between the gastrointestinal system, immune system, and nervous system.