Tapering Off 150mg Wellbutrin (Bupropion)
For a patient currently taking 150mg of Wellbutrin daily, discontinue directly without tapering, as this represents a sub-therapeutic dose that does not require gradual reduction. 1
Rationale for Direct Discontinuation at 150mg
- 150mg daily is below the standard therapeutic dose of 300mg for depression, making it an appropriate stopping point without further tapering 1
- The National Comprehensive Cancer Network guidelines demonstrate that bupropion can be initiated at 150mg and increased to 300mg after just 3 days, indicating the medication has relatively forgiving dose transitions 1
- Bupropion requires less aggressive tapering than SSRIs because its dopamine/norepinephrine reuptake inhibition mechanism produces less severe withdrawal compared to serotonergic agents 1
If Patient Were on Higher Doses (Context for Understanding)
For patients on 450mg or 300mg who need to reach 150mg before stopping:
- Reduce from 450mg XL to 300mg XL and maintain for 1-2 weeks 1
- Then reduce to 150mg XL and maintain for 2-3 weeks to assess for withdrawal symptoms 1
- For patients experiencing withdrawal symptoms at 150mg, consider extending this phase to 4-6 weeks or alternating 150mg daily with 150mg every other day for 1-2 weeks before complete discontinuation 1
Monitoring During Discontinuation
- Monitor for neuropsychiatric symptoms including depression and suicidal ideation, though these are uncommon with bupropion discontinuation 1
- Watch for potential withdrawal symptoms including irritable mood, anxiety, sleeplessness, headache, and generalized aches and pains, though these are rare with bupropion 2
- General antidepressant discontinuation guidelines recommend 10-14 days for tapering to limit withdrawal symptoms, but bupropion's unique mechanism makes it less prone to withdrawal syndromes 3
Important Clinical Context
Bupropion differs fundamentally from SSRIs in withdrawal risk. While SSRIs require hyperbolic tapering to very low doses over months to minimize withdrawal 4, bupropion's dopaminergic/noradrenergic mechanism creates substantially lower withdrawal risk 1. The evidence supporting aggressive SSRI tapering strategies 4, 5 does not apply to bupropion.