From: dyer@spdcc.com (Steve Dyer)
Subject: Re: Need info on Wellbutrin and Somatostatin
Organization: S.P. Dyer Computer Consulting, Cambridge MA
Date: Sat, 10 Oct 1992 21:56:45 GMT

In article <ldeecmINNd9u@news.bbn.com> cjross@bbn.com (Chris Ross) writes:
>These have been recommended to me by a gastroenterologist attempting
>to treat a condition which has resisted conventional approaches.  (In
>brief, I'm starving to death because of a continuously upset stomach.)

"Continuously upset stomach" is a rather vague term.  What are your
symptoms?  (I recall your posting this before, but my memory is failing
me over the details.  Email if you like.)

>For Wellbutrin: what reasons exist for choosing it over the tricyclics
>or MAO inhibitors, besides adverse reactions to the latter two?  Does
>anyone have experience with long-term use?

Both tricyclics and MAO inhibitors can tend to cause weight gain.  MAO
inhibitors, especially phenelzine (Nardil), seem to be particularly potent
in this regard.  And both of these cause a variety of other side effects
which may or may not occur in any individual.  For tricyclics, dry mouth
is not uncommon.  MAO inhibitors impose very inconvenient dietary/drug
restrictions and can cause sweating/heat intolerance and occasionally
orthostatic hypotension (low blood pressure when rising.)  Bupropion
(Wellbutrin) has little intrinsic effect on body weight, though it
resembles the amphetamines chemically; some people might lose some weight
while on it.  It has been used in bulemics with inconsistent results.
Bupropion seems to be pretty well tolerated.  Most people report absolutely
no side effects at all.

I have no comments to make on its use in your particular problem.
I plead ignorance.

>For Somatostatin: what is it, and what are its side effects?  My PDR
>doesn't list it, and my pharmacist couldn't dig up anything on it.

Somatostatin is a natural hormone which suppresses growth hormone
production, as well has having a wide variety of other physiological
effects.  It's unlikely that you'd be administered that.  However,
there is a synthetic polypeptide analogue of the hormone which is longer
acting known as octreotide (Sandostatin) which is sometimes used
to control the adverse gastrointestinal side effects of certain
tumors, such as carcinoid tumors and tumors which produce VIP
(vasoactive intestinal peptide).  Speaking very generally, octreotide
slows your entire gut down and reduces the secretion of digestive
enzymes and bile.  In the treatment of these disorders, the drug can
actually counter the effects or reduce the secretion of endogenous
substances which are causing many of the symptoms.  Aside from its
primary FDA-approved indications, it has been used to control severe
HIV-associated diarrhea.  Somewhat paradoxically (not really), individuals
with somatostatin-secreting tumors can suffer from malabsorption and
malnutrition _themselves_ because of the hormone's effect on reducing
the secretion of digestive enzymes and bile.  When octreotide is used,
the most frequent side effect is GI "bloating" (not at all unexpected)
and there are indications that its negative effect on gall bladder motility
can facilitate the development of bile acid "sludge" and gallstones.

Both drugs are relatively safe enough (as far as I know) that they
can't hurt much to try one or the other.  But I'd wait for further
comments from one of the MDs.  This sounds like you have a rather
knotty, treatment-resistant problem which has been poorly characterized.

-- 
Steve Dyer
dyer@ursa-major.spdcc.com aka {ima,harvard,rayssd,linus,m2c}!spdcc!dyer