Is Wellbutrin (bupropion) safe during lactation for treating postpartum depression?

Bupropion Safety During Lactation for Postpartum Depression

Bupropion (Wellbutrin) can be used during lactation for postpartum depression, but requires careful monitoring as there have been rare reports of seizures in breastfed infants despite generally low transfer into breast milk. 1, 2

Safety Profile During Breastfeeding

• Bupropion is present in human milk and has been detected in the serum of breastfed infants, though typically at very low or sometimes undetectable levels 1, 3
• Limited data (21 documented cases) generally show no adverse events in breastfed infants 1, 3
• However, there have been two case reports of seizures in breastfed infants whose mothers were taking bupropion 1, 4
• In one documented case, seizure-like symptoms occurred in a 6.5-month-old breastfed infant whose mother was taking both bupropion and escitalopram 4

Efficacy for Postpartum Depression

• Bupropion has shown efficacy in treating postpartum depression in pilot studies 5
• In one small study (n=8), median Hamilton Depression Rating Scale scores declined significantly from 20.5 to 10.0 after 8 weeks of treatment with bupropion SR 5
• Six out of eight subjects demonstrated at least 50% decrease in depression scores, and three achieved remission 5

Clinical Recommendations

• If bupropion is needed for treating postpartum depression during breastfeeding:

  • Maintain the therapeutic dose while breastfeeding 1
  • Monitor the infant carefully for potential adverse effects, particularly:
    • Vomiting, diarrhea, jitteriness, sedation, and/or seizures 1
    • Ensure appropriate weight gain and developmental milestones 1

• Consider bupropion as an alternative to stimulants in the perinatal period, particularly for individuals requiring treatment for co-occurring depression 1

Important Caveats

• The FDA drug label notes that limited data from postmarketing reports have not identified a clear association of adverse reactions in breastfed infants 2
• In a lactation study of ten women, the average daily infant exposure to bupropion and its active metabolites was only 2% of the maternal weight-adjusted dose 2
• The relationship between bupropion exposure through breast milk and reported seizures is unclear 2
• Bupropion may have drug interactions with other medications that could potentially increase risk 4

Alternative Options

• If there are concerns about using bupropion during lactation, paroxetine and sertraline are considered suitable first-line antidepressants for breastfeeding mothers 6
• The benefits of treating maternal depression must be weighed against potential risks, as untreated postpartum depression can have adverse effects on maternal wellbeing, infant development, and family functioning 7, 8

Always perform an individual risk-benefit assessment when considering bupropion for a breastfeeding mother with postpartum depression, taking into account the severity of depression, response to previous treatments, and the mother's preference regarding breastfeeding 3, 8.