Abrupt Discontinuation of Wellbutrin and Starting Zoloft
Abruptly stopping Wellbutrin (bupropion) and starting Zoloft (sertraline) is not recommended due to the risk of withdrawal symptoms and potential serotonin syndrome.
Risks of Abrupt Discontinuation
Withdrawal symptoms: Abruptly stopping antidepressants, including Wellbutrin, can lead to withdrawal symptoms that may include:
- Dizziness
- Headache
- Irritability
- Anxiety
- Sleep disturbances
- Mood fluctuations 1
Serotonin syndrome risk: The combination of bupropion and sertraline has been associated with serotonin syndrome, a potentially life-threatening condition characterized by:
- Confusion
- Agitation
- Muscle twitching
- Autonomic instability
- Altered consciousness 2
Recommended Approach for Medication Transition
Step 1: Gradual Tapering of Wellbutrin
- Implement a hyperbolic tapering schedule over several weeks rather than abrupt discontinuation 3
- Reduce the dose by approximately 10% of the original dose per week 4
- For long-term users, consider an even slower taper (10% per month) 4
Step 2: Monitoring During Taper
- Weekly monitoring for withdrawal symptoms is essential during the active tapering period 4
- Watch for:
- Changes in mood
- Anxiety
- Suicidal ideation
- Sleep disturbances
- Physical symptoms like headache or dizziness
Step 3: Introduction of Zoloft
- Begin Zoloft at a low dose only after Wellbutrin has been tapered to a lower dose
- Start with the lowest effective dose of Zoloft (typically 25-50mg)
- Gradually increase the Zoloft dose while continuing to taper Wellbutrin
Step 4: Complete Transition
- Complete the transition to Zoloft only after Wellbutrin has been fully tapered off
- Continue monitoring for at least 2-4 weeks after completing the transition
Special Considerations
High-risk patients who may need more careful monitoring include:
- Elderly patients
- Those with history of seizures
- Patients with concurrent substance use
- Those with liver or kidney disease 4
Symptom management: If withdrawal symptoms emerge during the taper:
- Return to the previous dose
- Resume tapering at a slower rate 4
- Consider non-pharmacological interventions like cognitive behavioral therapy and relaxation techniques
Important Cautions
The combination of bupropion and sertraline has been documented to cause serotonin syndrome in some cases, highlighting the importance of not having both medications at full therapeutic doses simultaneously 2
While some treatment-resistant depression cases have benefited from the combination of bupropion and sertraline 5, this should only be implemented under close medical supervision, not as a self-directed transition strategy
Abrupt discontinuation of antidepressants is associated with a significantly higher rate of discontinuation-emergent adverse events compared to gradual tapering 6
Remember that any medication changes should be done under the supervision of a healthcare provider who can monitor for adverse effects and adjust the tapering schedule as needed.