r/Nootropics • u/Outrageous_Maybe1954 • 1d ago
Seeking Advice Would a med more selective to dopamine suit my symptom profile better?
So I've been on Wellbutrin for many years, almost five years mainly for my SCT and executive dysfunction and because it used to be so extremely helpful for my mood, apathy, avolition and anhedonia in the past. In the beginning it gave me increased motivation, anticipation and just a great feeling of overall wellbeing all the time. At first it was amazing and worked very well for me.
Unfortunately last year and this year I've noticed it has lost a lot of its effectivness and later on it changed completely and became a killer anxiety provoker instead of a motivation and mood enhancer like it used to be in the past. Particularly this year I've noticed that it has started to give me a lot of strange side effects I never used to have from it before and those seem to related to its noradrenergic effects. And those side effects are frequent thirst, frequent urination, dry mouth, blurry vision that comes and goes, tingling sensations in my head, headaches, dizziness, vertigo, hot flashes, burning sensations, balance issues, insomnia and sleep disturbances, facial twitches, muscle stiffness and weakness etc. And I've also noticed now that it just makes me feel wired, tired, anxious, confused + with a scattered mind, but without any of the mood or motivation benefits it used to give me in the past. Now when I take it, it just makes me anxious, wired and on edge, but with none of the happiness and great feeling of overall wellbeing like it used to give me in the past.
Now I'm wondering if this is just tolerance or is it that my response to it changed over time? Because the anxiety and panic attacks that it gives me nowadays is starting to interfere with my life and it's starting to take a tool on my mental health. I honestly don't think the norepinephrine of this med helps my depression at all. I just think the norepinephrine makes me anxious, wired, tired and confused + with a scattered mind and does no good for me at all. I think it was the weak dopaminergic effects that helped my depression in the first place.
So do you think a med more selective to dopamine would suit my symptom profile better based on everything I've told you now?
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u/justaregulargod 1d ago
Wellbutrin is an NDRI, limiting the reuptake of both dopamine and noradrenaline. This increases the levels of each within the brain. When levels are artificially elevated in this way, the brain tries to restore homeostasis by decreasing the number of receptors for them. The problem is that the dopamine receptors decrease much faster than the noradrenaline receptors, so you'll lose the motivation/salience/hedonic benefits of the elevated dopamine, while retaining the HPA-triggering effects of the noradrenaline. So you end up with just the fight-or-flight "adrenaline rush" of the elevated adrenergic signaling. A medication more selective for dopamine may help initially, but it's likely to eventually get you back into this same situation, as your receptor density will continue to plumet.
Rather than focusing on NDRIs, I'd suggest an MAOB-inhibitor such as selegiline or rasagiline instead.
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u/neuralek 1d ago
Wellbutrin did me well but would burn me out quite quickly. My psych advised me to use it on and off, or, to take a break after a few days. Took it for a few months, it helped me out of a rut being a stimulant, didn't use it for years. Then about a year ago I was prescribed Concerta, it felt much more "controllable", mental, less chaotic in a way. But it's more intense. So I can't really say which was better, but if I had to choose one I'd choose C. But I also took that very sparsly, it actually had an aftereffect for a day or two.
But as the other poster said, dopaminergic system is like it is and it will never be as consistent as we want it to be.
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u/Linero_Hans38 1d ago
have you had your thyroid and cortisol checked recently? a lot of those symptoms overlap with hormonal stuff that can shift over time, and it might not be the med itself thats changed but your baseline physiology
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u/Ok_Channel_9078 1d ago
Wellbutrin's norepinephrine reuptake is way stronger than people give it credit for, and what you're describing sounds textbook for when that side of it starts outweighing the dopamine. The thirst, the twitching, that wired-but-useless feeling, all points toward too much NE activity.
Five years is a long run and sometimes your neurochemistry just shifts, especially if you've been under more stress or your sleep's been off. It's not necessarily tolerance in the classic sense, more like your baseline changed and now the same drug hits different receptors harder.
A more dopaminergic option could make sense if the initial benefits you remember were the motivation and anticipatory pleasure. Problem is most things that lean heavily into dopamine come with their own baggage or are harder to get prescribed. Might be worth digging into what specifically helped before and working backward from there.