From the Guidelines
Wellbutrin (bupropion) may be considered as an adjunctive treatment for certain eating disorders, particularly binge eating disorder, but its use should be carefully evaluated and monitored by a healthcare provider specializing in eating disorders. The American Psychiatric Association practice guideline for the treatment of patients with eating disorders, published in 2023 1, recommends a comprehensive approach to treating eating disorders, including psychotherapy, nutritional counseling, and sometimes medication. While Wellbutrin is not FDA-approved specifically for eating disorders, some studies suggest it may help reduce binge eating episodes and purging behaviors, likely due to its effects on dopamine and norepinephrine, which influence appetite regulation and reward pathways in the brain.
Key considerations for using Wellbutrin in eating disorders include:
- Typical dosages range from 150-300mg daily, often starting at a lower dose and gradually increasing
- Contraindications for individuals with a history of seizures, anorexia nervosa, or bulimia nervosa with purging behaviors, as it can increase seizure risk, especially in underweight individuals or those with purging behaviors
- Importance of a comprehensive treatment plan that incorporates medical, psychiatric, psychological, and nutritional expertise, commonly via a coordinated multidisciplinary team, as recommended by the APA guideline 1
- Need for careful monitoring of side effects and adjustment of treatment as necessary, particularly in patients with restrictive eating disorders, severe purging behavior, or those taking medications that prolong QTc intervals, as recommended by the APA guideline 1
Ultimately, the decision to use Wellbutrin for eating disorder symptoms should be made in consultation with a healthcare provider who specializes in eating disorders, taking into account the individual's specific situation, medical history, and potential risks and benefits.
From the FDA Drug Label
Do not take bupropion hydrochloride extended-release tablets (XL) if you: • have or had an eating disorder such as anorexia nervosa or bulimia.
Tell your healthcare provider about your other medical conditions, including if you: o have, or have had, an eating disorder such as anorexia nervosa or bulimia.
Bupropion is not indicated for the treatment of eating disorders. In fact, the drug label advises against taking bupropion if you have or have had an eating disorder, such as anorexia nervosa or bulimia 2.
From the Research
Bupropion and Eating Disorders
- Bupropion, also known as Wellbutrin, is not typically used to treat eating disorders such as anorexia nervosa (AN) or bulimia nervosa (BN) due to contraindications 3.
- In fact, AN and BN are listed as contraindications for bupropion, suggesting that it may not be a suitable treatment option for these conditions 3.
- However, bupropion may be considered for the treatment of comorbid unipolar depression in patients with eating disorders, although its use in this context is not well-established 3.
Alternative Treatment Options
- Other medications, such as fluoxetine, lisdexamfetamine, and olanzapine, have been shown to be effective in treating certain eating disorders, including bulimia nervosa and binge eating disorder 3, 4.
- Cognitive-behavioral therapy (CBT) is also a commonly used treatment for eating disorders, and has been shown to be effective in reducing symptoms of bulimia nervosa and binge eating disorder 5, 6, 7.
- A combination of medication and CBT may be the most effective treatment approach for some patients with eating disorders, particularly those with bulimia nervosa 7.