Switching from Wellbutrin 150mg to Celexa 40mg
You can perform a direct cross-taper switch from bupropion 150mg to citalopram 40mg without a washout period, as these medications have different mechanisms of action and no significant pharmacokinetic interactions. 1, 2
Recommended Switching Strategy
Week 1-2: Initiate Cross-Taper
- Start citalopram at 10mg daily while continuing bupropion 150mg 1
- Monitor for tolerability and early side effects 2
- This conservative approach minimizes risk of symptom exacerbation during the transition 2
Week 2-3: Increase Citalopram, Begin Bupropion Taper
- Increase citalopram to 20mg daily 1
- Reduce bupropion to 75mg daily (50% reduction) 2, 3
- Gradual tapering of bupropion reduces risk of discontinuation symptoms, though bupropion has relatively low withdrawal risk compared to SSRIs 3, 4
Week 3-4: Complete Transition
- Increase citalopram to target dose of 40mg daily 1
- Discontinue bupropion completely 2
- The total transition period of 3-4 weeks balances minimizing untreated symptoms against withdrawal risks 2, 3
Key Clinical Considerations
Why This Switch is Safe
- No pharmacokinetic interactions exist between bupropion and citalopram that would require extended washout 1
- Both medications can be safely co-administered during cross-taper 1
- Evidence from the American College of Physicians shows switching between these second-generation antidepressants (SGAs) carries low risk of adverse events 1
Monitoring During Transition
- Watch for SSRI initiation side effects: nausea, sleep disturbances, sweating, tremors 1
- Monitor for bupropion discontinuation symptoms (though uncommon): irritability, anxiety, mild mood changes 3
- Assess depressive symptoms weekly to ensure no clinical deterioration during switch 1, 2
Expected Outcomes
- Moderate-quality evidence shows no difference in response rates when switching between SGAs like bupropion and citalopram 1
- Low-quality evidence demonstrates no difference in remission rates between these agents 1
- Discontinuation due to adverse events is comparable between switching strategies 1
Common Pitfalls to Avoid
Do not abruptly stop bupropion - even though it has lower withdrawal risk than SSRIs, gradual tapering over 2-3 weeks is recommended to minimize any discontinuation symptoms 2, 3
Do not use an extended washout period - this unnecessarily prolongs time with suboptimal treatment and increases risk of depressive symptom exacerbation 2
Do not start citalopram at full 40mg dose immediately - titration from 10mg to 40mg over 3-4 weeks improves tolerability and reduces early discontinuation 1