What is the use of Wellbutrin (Bupropion)?

From the Guidelines

Wellbutrin (bupropion) is an antidepressant medication primarily used to treat major depressive disorder and seasonal affective disorder, and as a smoking cessation aid. The typical starting dose is 150 mg once daily, often increased to 300 mg daily after several days, taken as either immediate-release (three times daily), sustained-release (twice daily), or extended-release (once daily) formulations. Treatment duration for depression is usually long-term, often 6-12 months or longer after symptom improvement, while for smoking cessation it's typically prescribed for 7-12 weeks. Wellbutrin works differently from most antidepressants by inhibiting the reuptake of dopamine and norepinephrine rather than serotonin, making it beneficial for patients who experience fatigue, low motivation, or sexual side effects with other antidepressants. Common side effects include insomnia, headache, dry mouth, and agitation. Importantly, Wellbutrin carries a seizure risk, especially at higher doses, and should be avoided in patients with seizure disorders, eating disorders, or those abruptly stopping alcohol or sedatives. Unlike many antidepressants, it typically doesn't cause weight gain or sexual dysfunction, which makes it a preferred option for some patients.

Some key points to consider when prescribing Wellbutrin include:

• Monitoring for adverse effects, particularly seizure risk and neuropsychiatric effects 1
• Avoiding use in patients with certain medical conditions, such as seizure disorders or eating disorders 1
• Discussing the potential benefits and risks of treatment with patients, including the risk of sexual side effects and the potential for weight loss 1
• Considering alternative treatments, such as cognitive behavioral therapy, for patients who may not respond to or tolerate Wellbutrin 1

Overall, Wellbutrin is a useful medication for the treatment of major depressive disorder and seasonal affective disorder, and as a smoking cessation aid, but it should be used with caution and under close monitoring due to its potential side effects. As noted in a recent study 1, naltrexone-bupropion ER is available in tablets, each containing 8 mg of naltrexone and 90 mg of bupropion in a sustained-release formulation, and the recommended titration schedule begins with 1 tablet daily in the morning, followed by weekly escalation to 1 tablet twice per day. Additionally, a study published in the Journal of the National Comprehensive Cancer Network 1 found that bupropion reduces the seizure threshold and meta-analyses of trial data have found a 0.1% seizure risk among those receiving the drug for smoking cessation. It's also worth noting that, as stated in a study published in the Annals of Internal Medicine 1, bupropion is associated with a lower rate of sexual adverse events than fluoxetine and sertraline. In terms of treatment duration, a study published in the journal Gastroenterology 1 recommends that the medication should be discontinued if a patient has not lost 5% of their total body weight after 12 weeks of therapy on the maintenance dose. Finally, as noted in a study published in the Mayo Clinic Proceedings 1, bupropion SR has been associated with a small increased incidence of seizures, particularly among those whose medical history suggests increased risk.

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 use of Wellbutrin (Bupropion) is for the:

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

From the Research

Uses of Wellbutrin (Bupropion)

• Wellbutrin, also known as bupropion, is used for the treatment of major depressive disorder 3, 4, 5, 6.
• It is also approved for use in seasonal affective disorder 3, 4, 5, 6.
• Bupropion is used as an aid to smoking cessation treatment 3, 4, 6.
• It has demonstrated efficacy for attenuation of symptoms of attention deficit hyperactivity disorder 3, 6.
• Bupropion may have anti-inflammatory action against proinflammatory cytokines such as tumor necrosis factor-alpha (TNF-alpha) 3, 4.
• It is used to treat nicotine cravings and depression 5.
• Bupropion has been used off-label for numerous conditions including obesity and hypoactive sexual desire disorder 6.

Mechanism of Action

• The main mechanism of action of bupropion is believed to be via dopamine and noradrenalin reuptake inhibition 3.
• Bupropion undergoes metabolic transformation to an active metabolite, 4-hydroxybupropion, through hepatic cytochrome P450-2B6 (CYP2B6) 4.
• It has inhibitory effects on cytochrome P450-2D6 (CYP2D6), thus raising concern for clinically-relevant drug interactions 3, 4.

Side Effects

• Common side effects of bupropion include nervousness, insomnia, nausea, headache, dry mouth, dizziness, and nausea 3, 4, 5, 7.
• Bupropion can cause delayed hypersensitivity reactions, including delayed pruritis and urticaria 7.
• The risk of delayed hypersensitivity reactions may be highest in males aged 17 to 40 years and those with a history of allergic reactions 7.