Does Wellbutrin Require a Taper?
Yes, Wellbutrin (bupropion) should be tapered when discontinuing, particularly for patients on the 300 mg dose, to minimize withdrawal symptoms and prevent adverse outcomes. 1
FDA-Mandated Tapering Protocol
The FDA drug label explicitly states that when discontinuing bupropion extended-release 300 mg once daily, the dose must be decreased to 150 mg once daily prior to complete discontinuation. 1 This is the only antidepressant-specific tapering guidance provided in the evidence, making it the clearest directive available.
Rationale for Tapering
While bupropion has a different mechanism of action than SSRIs (it affects norepinephrine and dopamine rather than serotonin), antidepressant discontinuation syndrome can still occur:
- All classes of antidepressants are associated with withdrawal syndromes, including those affecting different neurotransmitter systems. 2
- Discontinuation symptoms commonly include insomnia, flu-like symptoms, mood disturbances, dizziness, anxiety, agitation, and irritability. 3, 4
- Symptoms can last days to months and may be mistaken for relapse of depression or physical illness, leading to unnecessary testing and treatment. 3, 4
Recommended Tapering Approach
For patients on 300 mg daily:
- Reduce to 150 mg once daily and maintain this dose for at least 1-2 weeks before complete discontinuation. 1
- Monitor closely for withdrawal symptoms during this period. 3
For patients on 150 mg daily:
- While the FDA label doesn't mandate tapering from 150 mg, general antidepressant principles suggest gradual discontinuation over weeks is prudent. 3, 4
- Consider extending the interval between doses before complete cessation. 5
Tapering timeline:
- Tapers should be carried out over weeks to months, not days. 3
- Gradual tapering is necessary to minimize discontinuation symptoms. 4
- The first dose reduction is critical—it must go well to predict tolerance of further reductions. 6
Managing Withdrawal Symptoms
If discontinuation symptoms emerge during tapering:
- Restart the prior dose of bupropion that was well-tolerated. 3
- Slow the taper further, using smaller decrements or longer intervals between reductions. 3, 4
- Provide symptomatic management as needed for specific withdrawal symptoms. 3
- Reassure patients that mild symptoms are usually transient and self-limiting. 4
Common Pitfalls to Avoid
- Never abruptly discontinue bupropion, especially from the 300 mg dose, as this violates FDA guidance and increases withdrawal risk. 1
- Don't mistake withdrawal symptoms for depression relapse—this can lead to unnecessary long-term medication continuation. 2, 3
- Don't use overly rapid tapers (less than 2 weeks)—these show minimal benefit over abrupt discontinuation. 2
- Don't dismiss patient concerns about withdrawal—validate their experience and adjust the taper accordingly. 3
Special Populations
Patients with hepatic impairment:
- Maximum dose is 150 mg every other day for moderate-to-severe impairment, so tapering may require even more gradual dose reductions. 1
Patients with renal impairment:
- Consider reducing dose and/or frequency, which may necessitate a more conservative tapering approach. 1