Bupropion Review: A Versatile Antidepressant
Does depression make it impossible for you to accomplish daily tasks? Do you want to do well in school or excel at work but struggle to find the motivation? Do you worry about taking medication to manage your mental health because of the weight gain associated with most medications? Bupropion, or Wellbutrin, is a versatile option for people seeking to treat depression and many other mental health concerns, especially if low energy and lack of motivation are their primary concerns.
Its versatility doesn’t mean bupropion is without adverse effects, and at Levelheaded Mind, we believe educating patients is the best way to ensure proper mental health care. This blog gives you all the details about bupropion you need, to have an effective conversation with your mental health provider and decide whether Wellbutrin is right for you. Continue reading to learn about uses, side effects, and drug interactions.
What is bupropion?
Bupropion is an atypical antidepressant because it does not directly influence serotonin levels like SSRIs such as Prozac (fluoxetine). Instead, Bupropion is a norepinephrine and dopamine receptor reuptake inhibitor (NDRI) and can have stimulating effects. These stimulating effects are why it works well for the types of depression that cause a lack of motivation or low energy.
The effects of bupropion vary based on dosage and how often you take it. Bupropion hydrochloride (Wellbutrin) comes in immediate release (IR), extended-release tablets (Wellbutrin XL), and sustained release (Wellbutrin SR). People taking the immediate release form will take it every 4-6 hours, SR is taken once- twice a day, and XL, the other form, is taken once daily. Bupropion hydrobromide (brand name Aplenzin) is taken once daily, usually in the morning. The dose of bupropion varies depending on your individual needs, so you’ll need to discuss dosing with your healthcare provider.
FDA-approved uses for bupropion
Bupropion is approved by the Food and Drug Administration (FDA) for many mental health conditions and uses outside of mental health. The dose you take, and the type of bupropion that’s best for you will depend on your diagnosis, so it's vital to have this information when speaking with your medical provider.
Major depressive disorder, or MDD, is characterized by persistent, recurring bouts of overwhelming sadness, irritability, and loss of interest. Bupropion is especially effective if loss of interest and low energy are your primary symptoms.
Seasonal affective disorder, or SAD, is bouts of depression that occur in different seasons. It’s most common in winter, especially when sunlight is scarce, but it can also occur in summer. Bupropion treats acute SAD and can also act as a preventative treatment.
Smoking cessation is another FDA-approved use for bupropion since its effect on dopamine reduces cravings.
Off-label uses for bupropion
Bupropion treats several other conditions, even though they aren’t FDA-approved. You can learn more about FDA approval here.
Wellbutrin treats ADHD by improving executive function skills, which allows people to start and complete tasks, use time effectively, etc. The way bupropion influences dopamine levels in your body makes it an effective ADHD treatment without the addictive qualities of many amphetamines and stimulants.
Bupropion also treats sexual dysfunction, whether it’s primary sexual dysfunction or caused by taking antidepressants. Often people add bupropion to another antidepressant that works well to counteract the low libido their medication causes. Some people switch altogether because bupropion doesn’t impact sexual function.
When mood stabilizers aren’t enough to treat the depressive symptoms of bipolar disorder, bupropion can help. It’s less likely to induce mania in people with bipolar than other antidepressants.
Sometimes depression persists despite treatment with other medications. Bupropion is effective in treatment-resistant depression, especially when combined with Zoloft if lack of motivation and low energy are still problematic.
When combined with Naltrexone, bupropion is used as a weight loss drug. This combination affects the brain's reward pathways to reduce food intake and cravings.
Common side effects of bupropion
All medications have side effects, and if you are considering bupropion to treat mental health issues, you likely have questions about what side effects you can expect and how long they will last.
Bupropion has stimulating effects, which is why it works so well for low energy and motivation. This stimulation can cause agitation, trouble sleeping, rapid heart rate, and tremors. Like other antidepressants, bupropion can cause headaches, nausea/vomiting, and dry mouth. All side effects should lessen or disappear after a week or so of taking bupropion. If you have serious side effects, or they last longer, talk to your healthcare provider. They may want to change the dosage or switch medication.
While bupropion has a lower risk of withdrawal than many other antidepressants, missing a dose may cause you to feel slightly off. Symptoms of a missed dose include excessive sweating, digestive problems, insomnia, and neurological effects like numbness or tremors. You might also experience mood changes or irritability if you miss a dose.
People taking bupropion and other antidepressants, especially adolescents or young adults, can have an increased risk of suicidal ideation. If your doctor prescribes bupropion, they’ve weighed the adverse effects against potential benefits and decided it’s the best option for you. If you experience worsening symptoms of depression or suicidal thoughts after starting bupropion, please contact your healthcare professional.
Bupropion and risk of seizures
When bupropion was first Approved in 1985 by US Food and Drug Administration (FDA) as a major depressive disorder treatment, there was some concern about seizure risk that caused the FDA to pull it from the market.
After more research, they determined that the seizure risk was dose-dependent, and bupropion was reintroduced in the market with a maximum dose of 450 mg/d. Bupropion is also contraindicated for patients with an increased risk of seizures from a head injury, anorexia nervosa, bulimia or other eating disorders, alcohol or benzodiazepine withdrawal, and seizure disorders. Be sure to discuss any of these conditions with your doctor before taking bupropion.
Drug interactions
Due to the risk of seizures with higher doses of bupropion, you shouldn’t take it with any medication that decreases the seizure threshold, such as antidepressants, antipsychotics, and the pain medication tramadol. Like any medication, it’s best to discuss any medications, including over-the-counter ones or supplements you regularly take, with your provider so they can check for interactions.
Is bupropion right for you?
After reading this review, you may wonder if treating depression with bupropion is right for you. Maybe you’ve never taken medication for depression before and worry about side effects. Maybe you have treatment-resistant depression or other complications and want more detailed advice.
Since patient education is our priority, we invite you to schedule an initial mental health coaching session so we can learn more about your mental health care needs and help get you unstuck. You’ll meet with Jezel Rosa, our psychiatric nurse practitioner expert, to discuss your symptoms and treatment needs. We want you to feel empowered to create the best treatment plan for you.
Disclaimer: All the information on this channel is for educational purposes and not intended to be specific/personal medical advice or a substitute for the diagnosis and treatment of any conditions discussed herein. Furthermore, watching these videos or getting answers to comments/questions does not establish a provider-patient relationship. Please consult with your healthcare provider for proper diagnosis and treatment.
References:
Carlat, D. & Puzantian, T. (2020). Medication Fact Book for Psychiatric Practice, 5th ed.
Costa, R., Oliveira, N. G., & Dinis-Oliveira, R. J. (2019). Pharmacokinetic and pharmacodynamic of bupropion: integrative overview of relevant clinical and forensic aspects. Drug Metabolism Reviews, 51(3), 293–313. https://doi-org.libproxy.eku.edu/10.1080/03602532.2019.1620763
Finkelstein, Y., Macdonald, E. M., Li, P., Mamdani, M. M., Gomes, T., & Juurlink, D. N. (2018). Second-generation anti-depressants and risk of new-onset seizures in the elderly. Clinical Toxicology (15563650), 56(12), 1179–1184. https://doi-org.libproxy.eku.edu/10.1080/15563650.2018.1483025
Stahl,S. (2017). Stahl’s Essential Psychopharmacology: Prescriber’s Guide, 6th Ed.
Stahl, S. (2021). Stahl’s Essential Psychopharmacology: Neuroscientific Basis and Practical Applications, 5th Ed.
Verbeeck, W., Bekkering, G. E., Van den Noortgate, W., & Kramers, C. (2017). Bupropion for attention deficit hyperactivity disorder (ADHD) in adults. The Cochrane database of systematic reviews, 10(10), CD009504.
