What is the safest way to switch from Lexapro (escitalopram) to Wellbutrin (bupropion)?

Safely Switching from Lexapro (Escitalopram) to Wellbutrin (Bupropion)

The safest way to switch from Lexapro to Wellbutrin is through a cross-taper approach, gradually reducing Lexapro while simultaneously introducing Wellbutrin SR at 150 mg once daily for 3 days, then increasing to 150 mg twice daily. 1

Cross-Tapering Approach

• Begin Wellbutrin SR at 150 mg once daily while maintaining your current Lexapro dose 1
• After 3 days, increase Wellbutrin to the target dose of 150 mg twice daily (300 mg total daily) 1
• Once Wellbutrin is at target dose, begin gradually tapering Lexapro over 2-4 weeks to minimize withdrawal symptoms 2
• Complete discontinuation of Lexapro should occur only after Wellbutrin has reached therapeutic levels 2

Special Considerations

• Monitor closely for both withdrawal symptoms from Lexapro and side effects from Wellbutrin during the transition 2
• Lexapro withdrawal symptoms may include dizziness, nausea, headache, and irritability 2
• Common Wellbutrin side effects include insomnia, dry mouth, headache, and nausea 3
• Take the second Wellbutrin dose before 3 PM to minimize risk of insomnia 1

Dosing Adjustments for Special Populations

• For older adults: Start Wellbutrin at a lower dose (approximately 50% of standard dose) 1
• For patients with moderate to severe hepatic impairment: Total daily Wellbutrin dose should not exceed 150 mg 1
• For patients with moderate to severe renal impairment: Reduce total daily Wellbutrin dose by half 1

Contraindications and Precautions

• Avoid this switch if you have a seizure disorder, as Wellbutrin lowers seizure threshold 1
• Do not combine with monoamine oxidase inhibitors (MAOIs) or within 14 days of discontinuing MAOIs 1
• Use caution if you have uncontrolled hypertension, as Wellbutrin can raise blood pressure 1

Monitoring During Transition

• Schedule follow-up within 2 weeks of initiating the switch to assess efficacy and side effects 3
• Monitor for neuropsychiatric adverse effects, especially in individuals younger than 24 years 1
• Check vital signs, particularly blood pressure, during follow-up visits 1
• Assess for improvement in depressive symptoms after 4-6 weeks on the target dose of Wellbutrin 3

Efficacy Considerations

• Wellbutrin has shown similar efficacy to SSRIs like Lexapro in treating major depressive disorder 4
• In patients who don't respond to SSRIs like Lexapro, approximately 60% may experience full or partial response to Wellbutrin 5
• If no response is seen after 6-8 weeks at an adequate Wellbutrin dose, consider alternative treatment 1

Common Pitfalls to Avoid

• Abrupt discontinuation of Lexapro can lead to withdrawal symptoms and potential relapse of depression 2
• Taking Wellbutrin late in the day increases risk of insomnia 1
• Exceeding recommended Wellbutrin doses increases seizure risk 1
• Failing to monitor for both withdrawal symptoms and new medication side effects during transition 2, 6