What is the recommended tapering strategy for a 22-year-old male with moderate depression, as indicated by a Patient Health Questionnaire-9 (PHQ-9) score of 9, and moderate anxiety, as indicated by a Generalized Anxiety Disorder 7-item scale (GAD-7) score of 11, who is currently taking bupropion (Wellbutrin) XL 300mg?

From the FDA Drug Label

1. 5 To Discontinue Bupropion Hydrochloride Extended-Release Tablets (XL), Taper the Dose When discontinuing treatment in patients treated with bupropion hydrochloride extended-release tablets (XL) 300 mg once daily, decrease the dose to 150 mg once daily prior to discontinuation. The patient should taper off bupropion XL 300mg by decreasing the dose to 150 mg once daily before discontinuing the medication 1.

From the Research

I strongly recommend against tapering off bupropion XL 300mg for this 22-year-old male with moderate depression (PHQ-9 score of 9) and moderate anxiety (GAD-7 score of 11) without considering the potential risks of worsening symptoms, as suggested by a recent study 2. Given the patient's current symptoms, as indicated by the PHQ-9 and GAD-7 scores, it is crucial to prioritize maintaining mental health stability. The PHQ-9 and GAD-7 are well-validated measures for detecting and monitoring depression and anxiety, respectively 3, 4. Some key points to consider:

• The patient's PHQ-9 score of 9 and GAD-7 score of 11 indicate moderate depression and anxiety, which may worsen if the medication is abruptly discontinued.
• A gradual tapering approach may be considered, but it should be done under close supervision, and the patient should be monitored for worsening symptoms.
• Non-medication strategies, such as regular exercise, adequate sleep, stress management techniques, and possibly psychotherapy, can be implemented to help maintain mental health stability during and after the medication taper.
• The patient should be aware of the potential risks and benefits of tapering off bupropion XL 300mg and should be closely monitored by a healthcare provider. It is essential to weigh the potential benefits of tapering off the medication against the potential risks of worsening symptoms, as highlighted by a study that found mild anxiety and depressive symptoms were threefold more likely to worsen rather than improve with treatment 2. Therefore, a cautious approach is recommended, prioritizing the patient's mental health stability and closely monitoring their symptoms during any medication adjustments, as supported by the most recent and highest quality study 2.