What is the proper dosage and usage of Wellbutrin (bupropion) for treating depression and seasonal affective disorder?

Wellbutrin (Bupropion) Dosage and Usage for Depression and Seasonal Affective Disorder

For depression and seasonal affective disorder, Wellbutrin (bupropion) should be started at 150 mg once daily in the morning for the first 4-7 days, then increased to the target dose of 300 mg once daily if tolerated. 1

Dosing Regimen for Major Depressive Disorder (MDD)

• Starting dose: 150 mg once daily in the morning
• Titration: After 4 days, increase to target dose of 300 mg once daily
• Administration: Take in the morning with or without food
• Formulation: Extended-release tablets should be swallowed whole, not crushed, divided, or chewed 1

Dosing Regimen for Seasonal Affective Disorder (SAD)

• Starting dose: 150 mg once daily in the morning
• Titration: After 7 days, increase to target dose of 300 mg once daily
• Timing of treatment: Begin in autumn prior to onset of depressive symptoms
• Duration: Continue through winter season
• Discontinuation: Taper in early spring by reducing to 150 mg daily before stopping 1

Monitoring and Efficacy Assessment

• Assess response after 8-12 weeks of treatment at therapeutic dose 2
• Periodically reassess the need for maintenance treatment 1
• Monitor for common side effects:
  • Nervousness and insomnia (most common)
  • Headache
  • Dry mouth
  • Nausea (less common than with SSRIs) 3

Special Dosing Considerations

Hepatic Impairment

• Moderate to severe impairment: Maximum 150 mg every other day
• Mild impairment: Consider reducing dose or frequency 1

Renal Impairment

• Consider reducing dose and/or frequency in patients with glomerular filtration rate less than 90 mL/min 1

Safety Precautions

Seizure Risk

• Increase dose gradually to minimize seizure risk (approximately 0.1% at therapeutic doses) 2, 1
• Contraindicated in:
  • Seizure disorders
  • Eating disorders (anorexia, bulimia)
  • Abrupt discontinuation of alcohol or sedatives 2

Drug Interactions

• Allow at least 14 days between discontinuing MAOIs and starting bupropion
• Allow at least 14 days after stopping bupropion before starting an MAOI 1
• Bupropion inhibits CYP2D6, which may affect metabolism of other medications 3

Cardiovascular Considerations

• Monitor blood pressure, especially in patients with pre-existing hypertension 2
• Use with caution in patients with cardiovascular disease 2

Practical Tips for Optimal Use

• To minimize insomnia, take the second daily dose (if applicable) before 3 PM 2
• For patients with depression and tobacco use, bupropion can help with both conditions 3
• Bupropion is less likely to cause sexual dysfunction compared to other antidepressants 3
• For prevention of seasonal episodes, timing of initiation should be based on the patient's historical pattern of SAD episodes 1, 4

When to Discontinue

• Immediately discontinue if:
  • Seizure occurs
  • Severe allergic reactions develop
  • Suicidal ideation emerges (particularly in patients under 24) 2
• If discontinuing after successful treatment, taper the dose by reducing to 150 mg once daily prior to complete discontinuation 1

Bupropion has demonstrated efficacy for both major depressive disorder and seasonal affective disorder, with evidence supporting its long-term use for prevention of seasonal episodes 4, 5. Its unique mechanism of action targeting dopamine and norepinephrine (rather than serotonin) makes it particularly useful for depression characterized by decreased energy, pleasure, and interest 5.