From the Research
Bupropion may be considered for patients with irritability, particularly when irritability is associated with depression, ADHD, or smoking cessation efforts, as it has been shown to be effective in reducing symptoms of depression and anxiety, with a relatively favorable side effect profile compared to other antidepressants 1.
Key Considerations
- The typical starting dose is 150 mg once daily of the extended-release formulation (Wellbutrin XL or SR), which can be increased to 300 mg daily after several days if tolerated.
- For immediate-release formulations, 100 mg twice daily is common, potentially increasing to 150 mg twice daily.
- Treatment duration depends on the underlying condition, with depression typically requiring at least 6-12 months of therapy after symptom resolution.
- Bupropion works by inhibiting the reuptake of dopamine and norepinephrine, which can help regulate mood and reduce irritability.
Important Side Effects and Contraindications
- Patients should be monitored for side effects including insomnia, headache, dry mouth, and rarely seizures (dose-dependent risk) 2.
- Bupropion is contraindicated in patients with seizure disorders, current or prior diagnosis of bulimia or anorexia nervosa, or during abrupt discontinuation of alcohol or sedatives.
- A gradual titration approach and regular follow-up appointments are recommended to assess effectiveness and manage any side effects.
Comparison with Other Antidepressants
- Bupropion has been shown to be as effective as selective serotonin reuptake inhibitors (SSRIs) in the treatment of major depressive disorder, with a lower risk of sexual dysfunction and weight gain 3, 1.
- However, in patients with anxious depression, SSRIs may have a modest advantage over bupropion in terms of response rates and reduction in symptoms of anxiety 4.