Initial Dosing for Wellbutrin (Bupropion) and Zoloft (Sertraline) in Depression
For patients with depression, the recommended initial dose of Wellbutrin (bupropion) is 37.5 mg every morning, gradually increasing to 150 mg twice daily, while Zoloft (sertraline) should be started at 50 mg once daily. 1, 2
Wellbutrin (Bupropion) Initial Dosing
Starting Dose and Titration
- Initial dose: 37.5 mg every morning 1
- Titration: Increase by 37.5 mg every 3 days 1
- Target dose: 150 mg twice daily 1, 3
- Maximum dose: 400 mg daily (SR formulation) 1, 3
Administration Timing
- To minimize insomnia risk, give second dose before 3 p.m. 1
- Can be administered as once-daily dosing with SR formulation (150 mg daily) 3
Important Considerations
- Activating medication - may improve energy levels rapidly 1
- Should not be used in patients with:
- Dosage should be gradually titrated to minimize seizure risk 4
Zoloft (Sertraline) Initial Dosing
Starting Dose and Titration
- Initial dose: 50 mg once daily 1, 2
- 50 mg is the usually effective therapeutic dose for most patients 2
- Can be increased in 50 mg increments at intervals of no less than one week 2
- Maximum dose: 200 mg daily 1, 2
Administration Timing
- Can be administered as a single daily dose at any time of day 2
- No specific timing requirements (unlike bupropion) 2
Important Considerations
- No need for dose adjustment in elderly patients (unlike some other SSRIs) 2
- May cause side effects including sweating, tremors, nervousness, insomnia or somnolence, dizziness, and gastrointestinal and sexual disturbances 1
Monitoring and Follow-up
- Evaluate response after 4-8 weeks of treatment (full therapeutic trial) 1
- If inadequate response to sertraline within 2-4 weeks, consider dose increase 2, 5
- For bupropion, improvement in energy may be seen quickly, but full antidepressant effect may take 4 weeks 4
- After 9 months, consider dosage reduction to reassess medication need 1
Special Considerations
- Bupropion has a lower risk of sexual side effects compared to SSRIs 4
- Bupropion may cause weight loss (0.5-1.0 kg), while SSRIs may cause weight gain 3
- Common side effects of bupropion include agitation, dry mouth, insomnia, headaches, nausea, constipation, and tremor 4
- Sertraline efficacy increases with dosage, while adverse effects slightly decrease between 50-150 mg and increase above 150 mg 5
Clinical Pitfalls to Avoid
- Do not start bupropion at high doses due to seizure risk; gradual titration is essential 1, 4
- Do not increase sertraline dose more frequently than weekly intervals 2
- Avoid abrupt discontinuation of either medication; taper over 10-14 days to limit withdrawal symptoms 1
- Remember that patients with depression and psychosis require concomitant antipsychotic medication 1
Both medications are effective options for depression treatment, with approximately one in four patients achieving remission after switching to either medication when an initial SSRI fails 6.