From the Guidelines
For a patient experiencing evening crying and emotional issues while taking bupropion (Wellbutrin) 150mg, changing the medication is recommended, as increasing the dose may exacerbate the symptoms. The patient's evening emotional symptoms could indicate that bupropion is not adequately addressing their depression or may be contributing to activation symptoms, as it has stimulant-like properties that can worsen anxiety or cause agitation in some patients 1. Before making changes, evaluate the timing of medication administration, as taking bupropion later in the day can disrupt sleep and worsen evening mood. Consider moving the dose to morning if currently taken later.
Some key points to consider when managing this patient's symptoms include:
- Bupropion's common adverse effects, such as dry mouth and insomnia, are dose-related, but the patient's symptoms of evening crying and emotional issues are not typically listed as common side effects 1.
- The medication's stimulant-like properties may be contributing to the patient's symptoms, and increasing the dose could worsen these symptoms.
- Alternative medications, such as SSRIs like sertraline (50-200mg daily) or escitalopram (10-20mg daily), may be more appropriate, especially if anxiety is prominent.
- Adding a small dose of mirtazapine (7.5-15mg) at bedtime could help with evening symptoms while maintaining the bupropion for daytime energy, as mirtazapine promotes sleep, appetite, and weight gain 2.
- Any medication change should be done gradually with close monitoring for side effects and symptom improvement over 2-4 weeks.
From the FDA Drug Label
To minimize the risk of seizure, increase the dose gradually [see Warnings and Precautions (5.3)]. The recommended starting dose for MDD is 150 mg once daily in the morning. After 4 days of dosing, the dose may be increased to the target dose of 300 mg once daily in the morning.
The patient is experiencing evening crying and emotional issues while taking bupropion 150mg. Increasing the dose may not be the best option, as the patient is already experiencing emotional issues, and increasing the dose may worsen these symptoms. Changing the medication may be a better option, as the current medication may not be suitable for the patient. It is recommended to monitor the patient closely and consider alternative treatment options. 3
From the Research
Bupropion and Emotional Issues
- Bupropion is known to cause psychiatric adverse events, including depression and anxiety, as reported in a study published in 2020 4.
- The study found that participants randomized to bupropion were more likely to report psychiatric adverse events compared with those randomized to placebo.
- However, another study published in 2009 found that combination therapy with varenicline and bupropion sustained-release did not increase depressive symptoms, and no subjects reported suicidal ideation 5.
Dose Increase or Medication Change
- There is no clear evidence to suggest that increasing the dose of bupropion would alleviate evening crying and emotional issues.
- A study published in 2015 found that combination therapy with varenicline and bupropion sustained-release was associated with increases in self-reported depressive symptoms, particularly in patients with a history of depression 6.
- Another study published in 2013 found that varenicline use was associated with a generalized suppression of depression and reduced smoking reward compared with bupropion and placebo 7.
Alternative Treatment Options
- Varenicline may be a viable alternative treatment option for patients experiencing emotional issues with bupropion, as it has been shown to be effective in maintaining abstinence and reducing craving 8.
- A study published in 2024 found that varenicline seems to be more effective in maintaining abstinence and reducing craving than bupropion and nicotine replacement therapy 8.
Monitoring and Counseling
- Patients experiencing evening crying and emotional issues while taking bupropion should be closely monitored and counseled to manage their symptoms.
- Intensive smoking cessation counseling has been shown to be effective in combination with pharmacotherapy, including varenicline and bupropion, in achieving prolonged abstinence from smoking 7.