Should I stop taking bupropion (Wellbutrin)

Should You Discontinue Bupropion?

No, you should not discontinue bupropion abruptly without first consulting your healthcare provider, as sudden discontinuation can cause withdrawal symptoms including irritability, anxiety, insomnia, headache, and generalized aches and pains. 1, 2

Critical Safety Situations Requiring Immediate Discontinuation

You must stop bupropion immediately and contact your healthcare provider if you experience any of the following:

• Seizure activity - If you have a seizure while taking bupropion, stop the medication immediately and do not restart it 1
• New or worsening suicidal thoughts or behavior - Including thoughts about suicide, attempts to commit suicide, or severe worsening of depression 1
• Severe neuropsychiatric symptoms - Such as hallucinations (seeing or hearing things that aren't there), delusions (believing you are someone else), paranoia, or severe confusion 1
• Manic episodes - Including greatly increased energy, severe insomnia, racing thoughts, reckless behavior, or excessive happiness alternating with irritability 1
• Severe allergic reactions - Though rare, these require immediate discontinuation 3

When Continuation is Appropriate

Bupropion should be continued if you are tolerating it well and achieving therapeutic benefit, as continuation treatment for up to 44 weeks significantly decreases the risk of depression relapse compared to discontinuation. 4

• For major depression, bupropion has demonstrated efficacy comparable to other antidepressants and is particularly beneficial for patients with low energy, apathy, or hypersomnia 5, 6
• For smoking cessation, treatment duration is typically 7-12 weeks, with therapy potentially extended to 6 months to 1 year to promote continued cessation 3
• Longer duration treatment helps prevent relapse in those who have successfully quit smoking 3

Contraindications That Would Require Discontinuation

You should discontinue bupropion if any of these conditions apply:

• Seizure disorders or history of seizures - Bupropion lowers the seizure threshold with a 0.1% documented seizure risk 3, 7
• Brain metastases or structural brain lesions - These significantly increase seizure risk 3
• Eating disorders (bulimia or anorexia nervosa) - These conditions substantially increase seizure risk 5, 8
• Concurrent MAOI use or within 14 days of stopping MAOIs - This combination can cause hypertensive crisis 3, 5, 8
• Abrupt alcohol, benzodiazepine, barbiturate, or antiepileptic drug withdrawal - This is an absolute contraindication due to increased seizure risk 5
• Uncontrolled hypertension - Bupropion can cause blood pressure elevations 5, 1

Proper Discontinuation Protocol

If discontinuation is medically appropriate, follow this approach:

• Never stop bupropion suddenly - Gradual tapering is recommended to minimize withdrawal symptoms 1, 2
• Taper slowly under medical supervision - Reduce the dose incrementally over several weeks rather than stopping abruptly 2
• Monitor for withdrawal symptoms - Watch for irritability, anxiety, insomnia, headache, and body aches during the taper 2
• Continue monitoring after discontinuation - Some neuropsychiatric symptoms may persist after stopping and require follow-up until they resolve 1

Special Monitoring Considerations

If continuing bupropion, ensure appropriate monitoring:

• Blood pressure checks - Regular monitoring is required as bupropion can elevate blood pressure, especially when combined with nicotine replacement therapy 5, 1
• Neuropsychiatric symptoms - Watch for worsening depression, increased agitation (as bupropion is activating), or mood changes 3, 5
• Dose adjustments for organ impairment - Maximum 150 mg daily for moderate-to-severe hepatic impairment; reduce dose by 50% for moderate-to-severe renal impairment 3, 5

Common Pitfalls to Avoid

• Do not discontinue without medical guidance - Even if you feel better, premature discontinuation increases relapse risk 4
• Do not exceed maximum dosing - Keep total daily dose at or below 300 mg for smoking cessation and 450 mg for depression to minimize seizure risk 3, 5
• Do not take the second dose late in the day - Administer before 3 PM to minimize insomnia risk 5
• Do not combine with medications that lower seizure threshold - This includes tramadol and certain other agents 8