Wellbutrin (Bupropion) for Bipolar Disorder and Borderline Personality Disorder
Wellbutrin (bupropion) is not FDA-approved for either bipolar disorder or borderline personality disorder. In bipolar disorder, it poses a significant risk of triggering manic episodes, even when combined with mood stabilizers. 1, 2
Use in Bipolar Disorder
Risks and Contraindications
- Bupropion carries a specific warning that it may precipitate manic, mixed, or hypomanic episodes, with increased risk in patients with bipolar disorder 2
- The FDA label explicitly states that bupropion is not approved for the treatment of bipolar depression 2
- The risk of switching from depression to mania/hypomania is significant, with studies showing 6 out of 11 patients experiencing manic episodes even when stabilized on mood stabilizers 3
Evidence Against Use
- Practice guidelines for bipolar disorder recommend lithium, valproate, and/or atypical antipsychotics as standard therapy for bipolar disorder, with no mention of bupropion as a first-line agent 1
- A meta-analysis found that despite previous beliefs, bupropion's rate of phase shifting (triggering mania) was not significantly lower than other antidepressants in bipolar patients 4
- Case reports document manic shifts occurring when bupropion was added to ongoing mood stabilizer treatment in bipolar patients 5
Dose Considerations
- Higher doses of bupropion (>450 mg/day) appear to increase the risk of triggering mania in bipolar patients 6
- Even at standard doses, caution is warranted as manic episodes have been reported 5
Use in Borderline Personality Disorder
- There are no guidelines or substantial evidence supporting the use of bupropion specifically for borderline personality disorder in any of the provided references [1-6]
- The FDA label does not mention borderline personality disorder as an indication 2
Approved Indications for Bupropion
- Bupropion is FDA-approved for major depressive disorder 1
- It is also approved for smoking cessation 1
- Bupropion may be considered for weight management as part of combination therapy (naltrexone-bupropion) 1
Clinical Considerations
- Bupropion has a unique mechanism as a selective norepinephrine and dopamine reuptake inhibitor 7
- It has a lower rate of sexual adverse effects compared to SSRIs like fluoxetine and sertraline 1
- Common side effects include nausea, headache, dry mouth, insomnia, anxiety, and constipation 1
- Bupropion lowers the seizure threshold and should be avoided in patients with seizure disorders 1
Alternative Treatments for Bipolar Depression
- FDA-approved treatments for bipolar depression include the combination of olanzapine and fluoxetine 1
- Lamotrigine is approved for maintenance therapy in bipolar disorder 1
- Lithium is approved for acute mania and maintenance therapy in bipolar disorder (down to age 12) 1
In conclusion, while bupropion may have some efficacy in treating depressive symptoms, its use in bipolar disorder carries significant risks of triggering mania, and there is insufficient evidence supporting its use in borderline personality disorder.