Can I stop taking venlafaxine (Effexor) and switch to Wellbutrin (bupropion) after a recent relapse into binge drinking while on venlafaxine?

Switching from Venlafaxine to Bupropion After Binge Drinking Relapse

Yes, you can switch from venlafaxine to bupropion (Wellbutrin) after a recent binge drinking relapse, but this requires careful tapering of venlafaxine to avoid discontinuation syndrome while gradually introducing bupropion. This medication change is appropriate given your history of binging and may help address both depression and substance use concerns.

Rationale for Switching

Bupropion offers several advantages in your situation:

• Bupropion has a different mechanism of action than venlafaxine, working primarily as a dopamine/norepinephrine reuptake inhibitor 1
• Unlike venlafaxine, bupropion has not been associated with dependence in patients with alcohol misuse history 2
• Venlafaxine has been documented to cause dependence in patients with history of alcohol misuse 2
• Moderate-quality evidence shows no difference in response rates when switching from one antidepressant to bupropion 3

Tapering Protocol for Venlafaxine

Venlafaxine requires careful discontinuation due to risk of withdrawal symptoms:

• Venlafaxine has been associated with discontinuation symptoms 3
• Implement a slow taper schedule to minimize discontinuation syndrome
• For patients on higher doses, reduce by 75mg increments weekly
• For patients on lower doses, reduce by 37.5mg increments weekly
• Continue the slowest taper at the end (from 37.5mg to zero)

Bupropion Initiation Protocol

Start bupropion during the venlafaxine taper:

1. Begin with 150mg once daily in the morning 1
2. After 4 days, if tolerated, increase to the target dose of 300mg once daily 1
3. Take in the morning with or without food 1
4. Swallow tablets whole; do not crush, divide or chew 1

Monitoring Parameters

During the transition period, monitor for:

• Discontinuation symptoms from venlafaxine (dizziness, headache, nausea, irritability)
• Emergence of side effects from bupropion (dry mouth, insomnia, headache)
• Changes in alcohol cravings or consumption
• Blood pressure and heart rate (both medications can affect these)
• Seizure risk (bupropion lowers seizure threshold, especially important with alcohol use)

Special Considerations for Binge Drinking History

Your history of binge drinking makes this switch particularly appropriate:

• Venlafaxine may be problematic in patients with alcohol misuse history 2
• Bupropion has been used successfully in treating depression with comorbid substance use
• Bupropion does not appear to increase alcohol cravings and may help with impulse control
• The gradual dosing approach helps minimize side effects that might trigger drinking

Potential Pitfalls and How to Avoid Them

1. Discontinuation syndrome: Never stop venlafaxine abruptly; always taper
2. Seizure risk: Bupropion lowers seizure threshold, which is particularly concerning with alcohol use
3. Medication timing: Take bupropion in the morning to minimize insomnia
4. Drug interactions: Ensure no contraindicated medications (especially MAOIs, which require 14-day washout) 1
5. Monitoring mood: Watch for activation or worsening depression during transition

This medication switch addresses both your depression and may help with binge drinking behaviors by transitioning to a medication with less dependence potential and different neurotransmitter effects that may better support recovery.