What conditions is Wellbutrin (bupropion) used to treat?

Conditions Treated by Wellbutrin (Bupropion)

Wellbutrin (bupropion) is primarily FDA-approved for treating major depressive disorder (MDD) and seasonal affective disorder (SAD), and is also effective for smoking cessation. 1, 2

Primary Indications

Major Depressive Disorder (MDD)

• FDA-approved for acute treatment and maintenance therapy of MDD 2
• Efficacy established through multiple clinical trials showing improvements in:
  • Hamilton Depression Rating Scale (HAMD) scores
  • Clinical Global Impressions-Severity Scale (CGI-S)
  • Montgomery-Asberg Depression Rating Scale (MADRS) 2
• Particularly useful for depression presentations with:
  • Low energy/fatigue
  • Decreased motivation
  • Hypersomnia
  • Weight gain concerns 1

Seasonal Affective Disorder (SAD)

• FDA-approved for prevention of seasonal major depressive episodes 2
• Treatment typically initiated in autumn (September-November) before symptom onset
• Continued through winter with gradual taper in early spring 2, 3
• Efficacy demonstrated in three randomized, double-blind, placebo-controlled trials 2

Smoking Cessation

• Effective aid for smoking cessation under the brand name Zyban 4
• Reduces withdrawal symptoms and improves abstinence rates 4, 5
• Lowers negative affect and urges to smoke on quit day 5
• Effective for relapse prevention in smokers with and without history of major depression 6

Advantages in Specific Clinical Scenarios

• Depression with sexual dysfunction concerns: Causes less sexual dysfunction than SSRIs 1, 7
• Depression with weight gain concerns: Associated with less weight gain than some other antidepressants 1, 7
• Depression with fatigue/low energy: Has stimulating properties that can increase energy levels 1
• Depression without significant anxiety: Preferred in patients without prominent anxiety symptoms 1

Important Contraindications and Precautions

• Avoid in patients with:

  • Seizure disorders or conditions lowering seizure threshold
  • Uncontrolled hypertension
  • Current use of MAO inhibitors
  • Eating disorders (anorexia/bulimia)
  • Brain metastases
  • Closed-angle glaucoma 1

• Use with caution in:

  • Patients with pre-existing anxiety (may worsen anxiety symptoms)
  • Patients with agitation
  • Patients with history of stimulant sensitivity 1
  • Moderate to severe renal or hepatic impairment (dose reduction needed) 1

Common Side Effects

• Insomnia
• Dry mouth
• Anxiety/jitteriness
• Decreased appetite
• Headache
• Potential for increased blood pressure and heart rate 1

Clinical Pearls

• Bupropion has a unique mechanism as a dopamine-norepinephrine reuptake inhibitor, different from SSRIs 8, 7
• Available in three formulations: immediate release (IR), sustained release (SR), and extended release (XL/XR) 7
• Carries a black box warning for increased risk of suicidal thoughts in young adults 1
• Requires gradual dose titration to minimize side effects 1
• Avoid evening dosing to reduce insomnia risk 1
• Drug interactions occur via CYP2D6 inhibition; use caution when combining with medications metabolized by this pathway 2

Bupropion offers a valuable alternative to SSRIs and SNRIs, particularly when sexual dysfunction, weight gain, or sedation are concerns, but requires careful patient selection due to its stimulating properties and contraindications.