From the Guidelines
Wellbutrin (bupropion) is warranted primarily for treating major depressive disorder and as an aid for smoking cessation, particularly when patients have not responded well to other antidepressants or experience fatigue, low energy, or decreased motivation as prominent symptoms of their depression. It's typically prescribed when patients cannot tolerate the sexual side effects or weight gain associated with SSRIs 1. The usual starting dose is 150 mg once daily for 3-4 days, often increasing to 150 mg twice daily, with a maximum dose of 450 mg daily divided into multiple doses. For smoking cessation (under the brand name Zyban), treatment typically begins 1-2 weeks before the quit date at 150 mg daily for 3 days, then 150 mg twice daily for 7-12 weeks. Wellbutrin works differently from most antidepressants by primarily affecting dopamine and norepinephrine rather than serotonin, which explains its energizing effects and lower impact on sexual function 1.
Key Considerations
- Bupropion is associated with a lower rate of sexual adverse events than fluoxetine or sertraline, whereas paroxetine has higher rates of sexual dysfunction than fluoxetine, fluvoxamine, nefazodone, or sertraline 1.
- SSRIs are associated with an increased risk for suicide attempts compared with placebo, and patients should be monitored for rare but serious side effects including agitation, insomnia, and potential suicidal thoughts, particularly when starting treatment 1.
- It should be avoided in patients with seizure disorders, eating disorders, or those undergoing abrupt alcohol or sedative withdrawal due to a slightly increased seizure risk 1.
Monitoring and Follow-Up
- Clinicians should assess patient status, therapeutic response, and adverse effects of antidepressant therapy on a regular basis beginning within 1 to 2 weeks of initiation of therapy 1.
- The U.S. Food and Drug Administration advises that all patients receiving antidepressants be closely monitored on a regular basis for increases in suicidal thoughts and behaviors, particularly during the first 1 to 2 months of treatment 1.
From the FDA Drug Label
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 The efficacy of bupropion hydrochloride extended-release tablets (XL) in the prevention of seasonal major depressive episodes associated with SAD was established in 3 randomized, double-blind, placebo-controlled trials in adult outpatients with a history of MDD with an autumn-winter seasonal pattern (as defined by DSM-IV criteria)
Wellbutrin (bupropion) is warranted for the treatment of:
- Major Depressive Disorder (MDD): as established by two 4-week and one 6-week placebo-controlled trials in adult inpatients and outpatients with MDD 2
- Seasonal Affective Disorder (SAD): as established by three randomized, double-blind, placebo-controlled trials in adult outpatients with a history of MDD with an autumn-winter seasonal pattern 2
From the Research
Indications for Wellbutrin (Bupropion)
Wellbutrin (bupropion) is warranted for the treatment of:
- Major depressive disorder (MDD) 3, 4, 5
- Seasonal affective disorder (SAD) 3, 4, 5
- Smoking cessation 3, 5
- Attention deficit hyperactivity disorder (ADHD) 3, 6
Off-Label Uses
Wellbutrin (bupropion) may also be used off-label for:
- Augmenting a partial response to selective serotonin reuptake inhibitor antidepressants 5
- Helping people quit tobacco smoking 3, 5
- Reducing fatigue in cancer 5
- Reducing concentration problems 5
Important Considerations
When prescribing Wellbutrin (bupropion), it is essential to consider the following: