Do you have to taper Wellbutrin (bupropion)?

Wellbutrin (Bupropion) Tapering

Yes, you should taper Wellbutrin (bupropion) when discontinuing it—the FDA label explicitly states "To Discontinue Bupropion Hydrochloride Extended-Release Tablets (XL), Taper the Dose" as a specific dosage administration instruction. 1

Why Tapering Is Necessary

While bupropion has a different mechanism than SSRIs (it affects dopamine and norepinephrine rather than serotonin), antidepressant discontinuation can produce withdrawal symptoms that are often mistaken for relapse of depression or physical illness. 2 These symptoms include:

• Somatic symptoms: dizziness, nausea, fatigue, myalgia, flu-like symptoms, sensory disturbances 2
• Psychological symptoms: anxiety, agitation, crying spells, irritability 2

The key clinical challenge is distinguishing withdrawal symptoms from actual relapse of depression—withdrawal symptoms typically emerge within days of discontinuation and are self-limiting, whereas relapse develops more gradually over weeks. 2

Recommended Tapering Approach

Use a hyperbolic (percentage-based) tapering schedule where you reduce by a percentage of the current dose, not the original dose. 3 This approach maintains a consistent reduction in the drug's biological effect at receptors throughout the taper.

Practical Tapering Protocol:

• Initial reduction: Start with 25% reduction of the current dose every 1-2 weeks 4
• For long-term users (>1 year): Extend to 10% reductions per month rather than the faster schedule 5
• Duration: Plan for a minimum of 6-12 months for the complete taper 5
• The taper rate must be determined by patient tolerance, not a rigid schedule—pauses are acceptable and often necessary when withdrawal symptoms emerge 5

Critical First Step:

The first dose reduction is key for all patients—it must go well. 6 If the patient tolerates the first reduction without significant withdrawal symptoms, you can proceed. If withdrawal symptoms emerge, slow the taper immediately.

Monitoring Requirements

• Follow up at least monthly during the taper, with more frequent contact during difficult phases 5
• Monitor specifically for: return of depressive symptoms, withdrawal symptoms, mood changes, and suicidal ideation 5
• Distinguish withdrawal from relapse: Withdrawal symptoms typically appear within days and include physical symptoms; relapse develops over weeks and primarily involves mood symptoms 2

Managing Withdrawal Symptoms

If mild withdrawal symptoms occur:

• Reassure the patient that symptoms are usually transient and self-limiting 2

If moderate to severe symptoms develop:

• Reinstitute the previous dose and slow the rate of taper 2
• Do not push through severe symptoms—this leads to treatment failure and patient distress 2

Common Pitfalls to Avoid

1. Tapering too quickly: Most traditional "2-4 week tapers" show minimal benefit over abrupt discontinuation and are often not tolerated 3
2. Stopping at therapeutic minimum doses: Taper to doses much lower than minimum therapeutic doses to minimize withdrawal 3
3. Misdiagnosing withdrawal as relapse: This leads to unnecessary reinitiation of treatment or costly medical workups 2
4. Abandoning the patient: Even if tapering is unsuccessful, maintain the therapeutic relationship 5

Special Considerations

• Pregnant patients: Do not taper without specialist consultation due to potential risks 5
• Patients with history of recurrent depression: May require slower tapers and closer monitoring 7
• Abrupt discontinuation is never appropriate and significantly increases relapse risk (HR 2.09-2.97) 7

The Reality of Current Practice

Only 8.9% of patients receive evidence of deliberate tapering in routine practice, though this has increased from 4.9% in 2014 to approximately 10% in recent years. 6 While some patients can discontinue without formal tapering, it's impossible to predict who will struggle—therefore, a universal tapering approach is recommended for all patients to prevent the minority who will experience severe withdrawal. 6