What are the indications for bupropion (Wellbutrin)?

From the Guidelines

Bupropion is primarily indicated for the treatment of major depressive disorder (MDD) and as an aid for smoking cessation, with its use also supported for weight management in combination with naltrexone, as seen in the most recent guidelines 1.

Indications for Bupropion

• Major depressive disorder (MDD): Bupropion is typically prescribed when patients haven't responded well to other antidepressants or experience sexual side effects from SSRIs, with dosing starting at 150 mg once daily for 3-4 days, then increasing to 150 mg twice daily, with a maximum dose of 450 mg daily divided into multiple doses 1.
• Smoking cessation: Treatment begins 1-2 weeks before the quit date at 150 mg daily for 3 days, then 150 mg twice daily for 7-12 weeks, with evidence showing its efficacy in aiding long-term smoking cessation 1.
• Weight management: In combination with naltrexone, bupropion is used for weight loss in adults with obesity, with a recommended titration schedule and specific dosing instructions 1.
• Off-label uses: Bupropion is also used off-label for attention deficit hyperactivity disorder (ADHD), seasonal affective disorder, and bipolar depression, due to its unique mechanism of action inhibiting the reuptake of dopamine and norepinephrine rather than serotonin 1.

Important Considerations

• Bupropion should be avoided in patients with seizure disorders, eating disorders, or those undergoing abrupt alcohol or sedative withdrawal due to its potential to lower seizure threshold 1.
• The medication can cause adverse effects such as dry mouth, insomnia, and increased risk of seizures, particularly in those with a history suggesting increased risk 1.
• Monitoring for neuropsychiatric adverse effects, including suicidal thoughts and behaviors, is crucial, especially in individuals younger than 24 years 1.

From the FDA Drug Label

INDICATIONS AND USAGE Bupropion hydrochloride extended-release tablets (XL) are an aminoketone antidepressant, indicated for: • treatment of major depressive disorder (MDD) ( 1.1) • prevention of seasonal affective disorder (SAD) ( 1.2)

The indications for bupropion (Wellbutrin) are:

• Treatment of major depressive disorder (MDD)
• Prevention of seasonal affective disorder (SAD) 2 2

From the Research

Indications for Bupropion

The indications for bupropion include:

• Major depressive disorder 3, 4, 5, 6
• Seasonal affective disorder 3, 4, 5
• Smoking cessation 3, 4, 6
• Attention deficit hyperactivity disorder (ADHD) 3, 5, 6
• Prevention of seasonal major depressive episodes in patients with seasonal affective disorder 3
• Obesity and hypoactive sexual desire disorder 5
• Bipolar depression 5

Off-Label Uses

Bupropion may also be used off-label for:

• Augmenting a partial response to selective serotonin reuptake inhibitor antidepressants 4
• Reducing fatigue in cancer patients 4
• Concentration problems 4
• Inflammatory diseases such as Crohn's disease 3

Mechanism of Action

The mechanism of action of bupropion is believed to be via dopamine and noradrenalin reuptake inhibition 3, and may also involve inhibition of presynaptic dopamine and norepinephrine reuptake transporters 4.