Why Choose Wellbutrin (Bupropion)
Wellbutrin (bupropion) is recommended for its unique mechanism as a norepinephrine-dopamine reuptake inhibitor that offers antidepressant efficacy with advantages of lower sexual dysfunction, weight neutrality or weight loss potential, and utility across multiple conditions including depression, ADHD, and smoking cessation. 1, 2
Key Advantages of Bupropion
Unique Mechanism of Action
- Functions as a norepinephrine and dopamine reuptake inhibitor (NDRI) 2
- Different mechanism than SSRIs and SNRIs, providing an alternative for patients who don't respond to or can't tolerate these medications
Favorable Side Effect Profile
- Lower sexual dysfunction rates compared to SSRIs and other antidepressants 1
- Weight neutral or associated with weight loss unlike many other antidepressants that cause weight gain 1
- Less sedation than many other antidepressants 2
Multiple Formulations for Dosing Flexibility
- Available in three formulations:
- All formulations are bioequivalent in terms of systemic exposure 4
Clinical Applications
Major Depressive Disorder
- FDA-approved for treatment of major depressive disorder 3
- Comparable efficacy to SSRIs and SNRIs in treating depression 2
- Particularly useful for patients with:
- Sexual dysfunction from other antidepressants
- Concerns about weight gain
- Fatigue or low energy as predominant symptoms 1
Attention-Deficit/Hyperactivity Disorder (ADHD)
- Used off-label for ADHD in adults 5
- Low-quality evidence shows bupropion decreases ADHD symptom severity and increases the proportion of patients achieving clinical improvement 5
- May be considered as an alternative when stimulants are contraindicated or not tolerated 1
Smoking Cessation
- Effective aid for smoking cessation 1
- Improves 12-month sustained abstinence rates and reduces withdrawal symptom severity 1
- Standard dose is 300 mg per day for smoking cessation 1
Weight Management
- Part of combination therapy (with naltrexone) for chronic weight management 1
- May help with weight loss by suppressing appetite and reducing food cravings 1
Dosing Considerations
Standard Dosing
- Major Depressive Disorder:
Special Populations
- Hepatic Impairment:
- Moderate to severe impairment: 150 mg every other day
- Mild impairment: Consider reducing dose/frequency 3
- Renal Impairment:
- Consider reducing dose/frequency 3
Safety Considerations
Contraindications
- Seizure disorder
- Current or prior diagnosis of bulimia or anorexia nervosa
- Abrupt discontinuation of alcohol, benzodiazepines, barbiturates, antiepileptic drugs
- Concomitant use of MAOIs
- Known hypersensitivity to bupropion 3
Important Warnings
- Seizure risk: Dose-related (1 in 1000, similar to other antidepressants) 1
- Suicidal thoughts: Increased risk in children, adolescents, and young adults 3
- Hypertension: Can increase blood pressure 3
- Activation of mania/hypomania: Screen for bipolar disorder before initiating 3
- Angle-closure glaucoma: Risk in patients with untreated anatomically narrow angles 3
Common Pitfalls and Caveats
- Formulation differences: Patients may experience different side effects with different formulations (SR vs XL); switching formulations may help manage side effects 6
- Seizure threshold: Avoid in patients with seizure disorders or factors that lower seizure threshold 3
- Drug interactions: Inhibits CYP2D6 and may reduce clearance of agents metabolized by this enzyme 4
- Pregnancy considerations: Limited data suggests bupropion does not appear to be associated with major congenital malformations, though there is a possible small increased risk for certain cardiovascular malformations 1
- Breastfeeding: Present in human milk at very low levels; generally no adverse events reported, but two case reports of seizures in breastfed infants exist 1
By understanding these aspects of bupropion, clinicians can make informed decisions about when to select this medication over other antidepressants or treatments for the conditions it addresses.