What is Wellbutrin (bupropion) given for?

Indications for Wellbutrin (Bupropion)

Wellbutrin (bupropion) is primarily indicated for the treatment of major depressive disorder (MDD) and seasonal affective disorder (SAD), and is also effective as a smoking cessation aid. 1

Primary FDA-Approved Indications

• Major Depressive Disorder (MDD)

  • First-line antidepressant option
  • Available in three formulations: immediate-release (IR), sustained-release (SR), and extended-release (XL) 1, 2
  • Dosing typically starts at 150 mg daily and may be increased to 300 mg daily 1

• Seasonal Affective Disorder (SAD)

  • Specifically for prevention of seasonal major depressive episodes
  • Typically initiated in autumn before onset of symptoms
  • Continued through winter and tapered in early spring 1

• Smoking Cessation

  • Marketed as Zyban for this indication
  • Shown to be effective in promoting smoking reduction and cessation 3
  • Efficacy similar to nicotine patch but less than varenicline 3

Mechanism of Action and Unique Properties

Bupropion works differently from most other antidepressants:

• Acts as a norepinephrine and dopamine reuptake inhibitor 4, 5
• Does not significantly affect serotonin, unlike SSRIs
• May increase activity of vesicular monoamine transporter-2 4
• Has stimulating properties that can increase energy levels 6

Clinical Advantages in Specific Populations

• Patients with decreased energy, pleasure, and interest

  • Particularly effective due to its dopaminergic effects 5

• Patients concerned about sexual dysfunction

  • Associated with less sexual dysfunction than SSRIs 4, 7
  • May be used for hypoactive sexual desire disorder 5

• Patients with treatment-resistant depression

  • Effective as augmentation therapy with SSRIs 4
  • Can be combined with other antidepressants (except MAOIs) 6, 4

• Patients with depression and nicotine dependence

  • Addresses both conditions simultaneously 3, 4

• Patients with depression and ADHD

  • Shows efficacy for both conditions 5

Important Contraindications and Precautions

• Seizure risk

  • Contraindicated in patients with seizure disorders 6
  • Risk increases with higher doses; gradual dose increases recommended 1
  • Avoid in patients with brain metastases 3

• Neuropsychiatric effects

  • Carries black box warning for increased risk of suicidal thoughts in young adults 1
  • Monitor for anxiety, agitation, and insomnia 6

• Drug interactions

  • Contraindicated with MAOIs 6, 4
  • Inhibits CYP2D6, potentially affecting metabolism of other medications 4, 2
  • Metabolized by CYP2B6 2

• Other contraindications

  • Uncontrolled hypertension 6
  • Closed-angle glaucoma 6
  • Caution in moderate to severe renal or hepatic impairment 6

Common Side Effects

• Insomnia and nervousness 4
• Dry mouth 6
• Anxiety/jitteriness 6
• Decreased appetite 6
• Headache 6
• Potential for increased blood pressure and heart rate 6

Clinical Pearls

• Bupropion may be particularly beneficial for patients with depression who also have fatigue or low energy 5
• For highly nicotine-dependent smokers, bupropion can decrease depressive symptoms during active treatment 8
• When discontinuing, gradual tapering is recommended to minimize withdrawal symptoms 6
• Regular monitoring of blood pressure and heart rate is necessary, especially during the first 12 weeks 6