What is the usage and dosage of Wellbutrin (bupropion) for treating major depressive disorder and smoking cessation?

From the Guidelines

Wellbutrin (bupropion) is typically prescribed at an initial dose of 150 mg once daily in the morning for major depressive disorder, usually increased to 150 mg twice daily after 3-4 days if tolerated, and for smoking cessation, treatment begins at 150 mg once daily for 3 days, then increases to 150 mg twice daily for 7-12 weeks, as recommended by the most recent guidelines 1. The medication works by inhibiting the reuptake of dopamine and norepinephrine in the brain, which helps regulate mood and reduce nicotine cravings. Some key points to consider when prescribing Wellbutrin include:

• The maximum recommended dose is 450 mg daily, taken in divided doses of no more than 150 mg each.
• Patients should avoid taking doses too close to bedtime as this can cause insomnia.
• Common side effects include dry mouth, insomnia, headache, and nausea.
• Wellbutrin should not be used in patients with seizure disorders, eating disorders, or those undergoing abrupt discontinuation of alcohol or sedatives due to increased seizure risk.
• The medication typically takes 4-6 weeks to reach full effectiveness for depression, though smoking cessation effects may be noticed sooner. It's also important to note that bupropion has been associated with a small increased incidence of seizures, particularly among those whose medical history suggests increased risk, such as any prior seizure or structural brain lesion from previous stroke or tumor 1. Additionally, bupropion may be particularly beneficial as a smoking cessation agent for persons with depression, and longer duration of bupropion treatment may help prevent relapse in those who have successfully quit 1.

From the FDA Drug Label

HIGHLIGHTS OF PRESCRIBING INFORMATION BUPROPION HYDROCHLORIDE EXTENDED-RELEASE TABLETS (XL) ... 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) ... DOSAGE AND ADMINISTRATION General • Increase dose gradually to reduce seizure risk. (2.1,5. 3) • Periodically reassess the dose and need for maintenance treatment. ( 2.2) Major Depressive Disorder • Starting dose: 150 mg once daily. Usual target dose: 300 mg once daily ( 2.2) • After 4 days, may increase the dose to 300 mg once daily. ( 2.2)

The usage and dosage of Wellbutrin (bupropion) for treating major depressive disorder is as follows:

• The starting dose is 150 mg once daily.
• The usual target dose is 300 mg once daily.
• The dose can be increased to 300 mg once daily after 4 days.
• The dosage should be increased gradually to reduce the risk of seizures.
• The dose and need for maintenance treatment should be periodically reassessed.

For smoking cessation, the dosage is not explicitly stated in the provided text, but it is mentioned that neuropsychiatric adverse events can occur during smoking cessation with bupropion hydrochloride extended-release tablets (XL) 2.

According to the clinical studies, the efficacy of bupropion in the treatment of major depressive disorder was established with the immediate-release formulation of bupropion hydrochloride in two 4-week, placebo-controlled trials in adult inpatients with MDD and in one 6-week, placebo-controlled trial in adult outpatients with MDD 2.

From the Research

Usage of Wellbutrin (Bupropion)

• Wellbutrin (bupropion) is an effective antidepressant used to treat major depressive disorder (MDD) and smoking cessation 3, 4, 5.
• It is available in three oral formulations: immediate release (IR), sustained release (SR), and extended/modified release (XR) 3, 4.
• All three formulations are bioequivalent in terms of systemic exposure to bupropion 3, 4.

Dosage of Wellbutrin (Bupropion)

• The dosage of Wellbutrin (bupropion) varies depending on the formulation and the condition being treated 3, 4.
• For MDD, the typical dosage is:
  • Immediate release (IR): 100-150 mg three times daily 3, 4.
  • Sustained release (SR): 100-150 mg twice daily 3, 4.
  • Extended/modified release (XR): 150-300 mg once daily 3, 4.
• For smoking cessation, the typical dosage is 150-300 mg once daily 5, 6.

Efficacy of Wellbutrin (Bupropion)

• Wellbutrin (bupropion) has been shown to be effective in treating MDD, with efficacy similar to selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs) 3, 4, 5.
• It has also been shown to be effective in aiding smoking cessation, with a significant increase in quit rates compared to placebo 5, 6.
• The efficacy of Wellbutrin (bupropion) in treating seasonal affective disorder (SAD) is also supported by some evidence, with bupropion appearing to have the strongest evidence supporting long-term use 7.

Safety and Side Effects of Wellbutrin (Bupropion)

• Wellbutrin (bupropion) is generally well tolerated, with common side effects including headache, dry mouth, and insomnia 3, 4, 5.
• It has a risk of seizures, with an estimated risk of 1 in 1000 6.
• Concerns about an increased risk of suicide with bupropion are currently unproven 6.