Discontinuing Wellbutrin (Bupropion) 159 mg Daily
For patients discontinuing bupropion 159 mg daily, taper to 150 mg once daily for at least 7 days before complete discontinuation to minimize withdrawal symptoms and ensure safe cessation. 1
Recommended Tapering Protocol
The FDA-approved approach involves a single-step taper: reduce from your current dose to 150 mg once daily, maintain this for at least one week, then discontinue. 1 This is the manufacturer's recommended strategy specifically for patients on doses above 150 mg daily.
Step-by-Step Discontinuation Plan
- Week 1-2: Reduce from 159 mg to 150 mg once daily (taken in the morning) 1
- Week 3: Discontinue completely after maintaining 150 mg for at least 7 days 1
This conservative approach is particularly important because bupropion, unlike SSRIs, has a relatively lower risk of severe discontinuation syndrome, but withdrawal symptoms can still occur. 2, 3
Expected Withdrawal Symptoms and Timeline
Bupropion discontinuation symptoms are generally milder than with SSRIs but can include:
- Mood disturbances (irritability, anxiety, low mood) 2
- Sleep disturbances (insomnia or changes in sleep patterns) 2, 3
- Flu-like symptoms (fatigue, headache, body aches) 2, 3
- Dizziness or equilibrium disturbances 2, 3
Symptoms typically emerge within 1-4 days after dose reduction or discontinuation and may last days to weeks. 2, 3 The relatively short half-life of bupropion means symptoms can appear quickly if the medication is stopped abruptly.
Critical Monitoring Points
During the taper period, monitor closely for:
- Return of depressive symptoms - distinguish this from withdrawal effects, as true relapse typically develops more gradually over weeks rather than days 3
- Increased suicidal ideation - particularly important in patients under 24 years old, though this risk applies during treatment rather than discontinuation 4
- Energy level changes - since bupropion has activating properties, patients may experience fatigue during withdrawal 4
When to Slow the Taper
If significant withdrawal symptoms emerge during the taper:
- Resume the previous dose that was tolerated 2
- Wait until symptoms resolve completely (typically 5-7 days) 2
- Then taper even more slowly, potentially splitting the 150 mg dose or extending the duration at each step 2
Research suggests that hyperbolic (exponential) tapering may be superior to linear tapering for psychiatric medications, though specific data for bupropion is limited. 5 If standard tapering proves difficult, consider extending the 150 mg phase to 2-4 weeks before discontinuation.
Important Clinical Caveats
The dose of 159 mg is unusual - this is not a standard manufactured strength. If this represents a compounded formulation or split tablets, ensure you have access to the 150 mg dose for tapering. Standard available doses are 150 mg and 300 mg for extended-release formulations. 1
Distinguish withdrawal from relapse: Withdrawal symptoms appear within days of dose reduction and include physical symptoms (dizziness, flu-like symptoms), while relapse of depression develops more gradually over weeks and primarily involves mood symptoms. 3
Do not abruptly discontinue - while some patients tolerate abrupt cessation, research shows only 8.9% of patients receive evidence of deliberate tapering in clinical practice, yet this approach minimizes risk for all patients. 6 The "first decrement is key" - if the initial dose reduction is tolerated well, the remainder of the taper typically proceeds smoothly. 6
Alternative Approach for High-Risk Patients
For patients with history of severe withdrawal from other antidepressants or significant anxiety about discontinuation:
- Consider a more gradual taper over 4-8 weeks rather than 2-3 weeks 2
- Some patients may benefit from tapering over months, though this is typically unnecessary for bupropion 2, 5
- Symptomatic management with temporary use of sleep aids or anti-anxiety medications may be appropriate if withdrawal symptoms are distressing 2
The key principle: slower is safer, but unnecessarily prolonged tapers can become the focus of patient anxiety. 7 For bupropion at this relatively low dose, a 2-3 week taper is appropriate for most patients, with flexibility to extend if needed.