What is the use of Wellbutrin (Bupropion)?

From the Guidelines

Wellbutrin (bupropion) is a recommended medication for smoking cessation and treatment of major depressive disorder, with a typical starting dose of 150 mg once daily, often increased to 150 mg twice daily after several days if tolerated, as supported by the most recent evidence 1.

Key Considerations

• The medication works by inhibiting the reuptake of dopamine and norepinephrine, making it less likely to cause sexual side effects or weight gain compared to other antidepressants 1.
• Common side effects include insomnia, headache, dry mouth, and nausea, and it should be taken with caution by those with seizure disorders, eating disorders, or those taking other medications that lower seizure threshold, as it can increase seizure risk 1.
• For smoking cessation, the regimen usually begins at 150 mg daily for 3 days, then increases to 150 mg twice daily for 7-12 weeks, with some evidence suggesting that bupropion may be particularly beneficial as a smoking cessation agent for persons with depression 1.
• The medication has also been shown to be effective for the long-term treatment of recurrent major depression, and it is reasonable to prioritize it for appropriate patients with depressed mood 1.

Special Clinical Considerations

• Patients with moderate to severe renal impairment should have their total daily dose reduced by one-half, and those with moderate to severe hepatic impairment should not exceed 1 tablet daily 1.
• The medication should be avoided in patients that require short-term or long-term opiate therapy, and it should be discontinued before procedures that require the use of opiates 1.
• Vital signs should be monitored in patients treated with bupropion, and it should be avoided in patients with uncontrolled hypertension or those treated with, or within 14 days of, monoamine oxidase inhibitors 1.
• Patients should be observed for neuropsychiatric adverse effects, including suicidal thoughts and behaviors, especially in individuals younger than 24 years, and patients and their families should be counseled for the emergence of these reactions 1.

From the FDA Drug Label

INDICATIONS AND USAGE Bupropion hydrochloride extended-release tablets (XL) are an aminoketone antidepressant, indicated for: • treatment of major depressive disorder (MDD) ( 1.1) • prevention of seasonal affective disorder (SAD) ( 1.2)

The drug is indicated for treatment of major depressive disorder (MDD) and prevention of seasonal affective disorder (SAD). Wellbutrin is another name for bupropion. 2

From the Research

Wellbutrin Overview

• Wellbutrin, also known as bupropion, is a medication used to treat major depressive disorder, seasonal affective disorder, and as an aid to smoking cessation 3, 4, 5, 6, 7.
• It is available in three oral formulations: immediate release, sustained release, and extended/modified release, all of which are bioequivalent in terms of systemic exposure to bupropion 4, 5.

Mechanism of Action and Efficacy

• Bupropion is presumed to be a dopamine-norepinephrine reuptake inhibitor, which contributes to its effectiveness as an antidepressant 3, 4, 5.
• It has been shown to be effective in the treatment of major depressive disorder, with efficacy comparable to some tricyclic antidepressants and selective serotonin reuptake inhibitors 4, 5.
• Bupropion has also demonstrated efficacy in the prevention of seasonal major depressive episodes in patients with seasonal affective disorder 3, 6.

Safety and Tolerability

• Bupropion is generally well tolerated, with common side effects including insomnia, headache, dry mouth, dizziness, and nausea 3, 4, 5.
• It is a cytochrome P450 2D6 inhibitor, and care must be taken when coprescribing with drugs cleared by this enzyme or with drugs that lower seizure threshold 3.
• The risk of treatment-emergent neuropsychiatric adverse events does not differ by medication for individuals with major depressive disorder 7.

Smoking Cessation

• Bupropion has been shown to be effective as an aid to smoking cessation, with continuous smoking abstinence rates at one year of around 20% across many clinical groups 3.
• A randomized clinical trial found that varenicline, bupropion, and nicotine patch were all effective in promoting smoking cessation among smokers with major depression, with varenicline showing the largest effect size 7.