Are the described neurotransmitter actions of Qelbree (viloxazine), Wellbutrin (bupropion), and Atomoxetine correct, and can you provide a chart summarizing their effects on norepinephrine, dopamine, and serotonin?

Neurotransmitter Effects of Qelbree, Wellbutrin, and Atomoxetine

Your understanding is partially correct but needs important clarifications, particularly regarding Qelbree's mechanism and Wellbutrin's dopamine effects.

Corrected Neurotransmitter Profile Chart

Medication	Norepinephrine	Dopamine	Serotonin
Qelbree (Viloxazine)	↑↑ Moderate increase via NET inhibition [1,2]	↑ Moderate increase (indirect) [1,2]	↑↑↑ Significant increase via 5-HT2C agonism and 5-HT2B antagonism [3,4,1]
Wellbutrin (Bupropion)	↑↑ Increase via reuptake inhibition [5,6]	↑↑ Increase via reuptake inhibition (NOT decrease) [5,6]	No effect [6]
Atomoxetine	↑↑↑ Selective increase via NET inhibition [3]	Minimal direct effect	No effect [3]

Key Corrections to Your Understanding

Qelbree (Viloxazine) - You Were Partially Correct

• Viloxazine significantly increases serotonin in the prefrontal cortex, which is actually its predominant mechanism, not just a secondary effect 1, 2
• The serotonin increase occurs through 5-HT2C receptor agonism and 5-HT2B receptor antagonism, not through serotonin reuptake inhibition 2
• Norepinephrine is moderately increased through NET inhibition 1, 2
• Dopamine is also moderately increased in the prefrontal cortex, contrary to your statement of "no real effect" 1, 2
• The American Academy of Child and Adolescent Psychiatry classifies viloxazine as a "serotonin norepinephrine modulating agent" (SNMA), emphasizing its dual mechanism 3, 4

Wellbutrin (Bupropion) - You Were Incorrect About Dopamine

• Bupropion increases (not decreases) dopamine through dual norepinephrine and dopamine reuptake inhibition 5, 6
• It has no clinically significant serotonergic effects 6
• The dual norepinephrine-dopamine mechanism is what distinguishes bupropion from SSRIs and contributes to its lack of sexual dysfunction and weight gain side effects 6

Atomoxetine - You Were Mostly Correct

• Atomoxetine is a pure norepinephrine reuptake inhibitor with selective NET inhibition 3
• It has no direct serotonergic activity, which distinguishes it from viloxazine 3

Clinical Implications of These Mechanisms

The serotonergic activity of viloxazine creates important clinical considerations:

• The American Academy of Child and Adolescent Psychiatry recommends caution when combining viloxazine with other serotonergic agents due to serotonin syndrome risk, particularly in the first 24-48 hours after initiation 3, 4
• This risk does not apply to atomoxetine or bupropion monotherapy 3, 6

Bupropion's dopaminergic activity explains its unique profile:

• The dual norepinephrine-dopamine mechanism is associated with lower rates of sexual dysfunction, weight gain, and sedation compared to serotonergic antidepressants 6
• However, rare cases of serotonin syndrome have been reported when bupropion is combined with SSRIs, likely through cytochrome P450 2D6 inhibition increasing SSRI levels 7

Atomoxetine's selective norepinephrine mechanism:

• Represents the most selective NET inhibition among these three medications 3
• Does not carry the serotonin syndrome risk that viloxazine does 3