Is tapering necessary when discontinuing Wellbutrin (bupropion)?

Tapering Wellbutrin (Bupropion): FDA-Recommended Approach

Yes, you should taper Wellbutrin when discontinuing, particularly if you're on the 300 mg dose—the FDA label explicitly recommends decreasing from 300 mg to 150 mg once daily before complete discontinuation. 1

FDA-Mandated Tapering Protocol

For patients on 300 mg daily:

• Reduce to 150 mg once daily before stopping completely 1
• This is the only specific tapering instruction provided in the FDA labeling

For patients on 150 mg daily:

• The FDA label does not specify whether tapering is required, but does not recommend abrupt discontinuation either 1

Why Tapering Matters

While bupropion has a different mechanism than SSRIs (it's a norepinephrine-dopamine reuptake inhibitor), drugs acting on the central nervous system are known to cause withdrawal symptoms when stopped abruptly 2. The general principle for antidepressants is that gradual tapering over weeks to months minimizes discontinuation symptoms 3.

Common discontinuation symptoms from antidepressants include:

• Insomnia and sleep disturbances 4, 3
• Flu-like symptoms (fatigue, myalgia, chills) 4
• Dizziness and light-headedness 4
• Mood disturbances (anxiety, irritability, crying spells) 4
• Nausea 4
• These symptoms can last days to months and may be mistaken for depression relapse 3

Practical Tapering Approach

Based on the FDA guidance and general antidepressant discontinuation principles:

1. If on 300 mg: Decrease to 150 mg once daily and maintain for at least 1-2 weeks before considering complete discontinuation 1, 3

2. If on 150 mg: Consider maintaining this dose for 1-2 weeks, then either stopping or reducing frequency (e.g., every other day) for another week before complete cessation 3

3. Tapering duration: The process should occur over weeks, not days—antidepressant tapers should be carried out over weeks to months 3

Managing Discontinuation Symptoms

If withdrawal symptoms emerge:

• Restart the prior dose and taper even more slowly 3
• Provide symptomatic management as needed 3
• Reassure patients that mild symptoms are usually transient 4

Do not confuse discontinuation symptoms with depression relapse—this misdiagnosis can lead to unnecessary testing and treatment 4.

Critical Exceptions

Never taper during pregnancy without specialist consultation if the medication is being used for depression, as the risks of untreated depression must be weighed against medication risks 1.

For Seasonal Affective Disorder specifically: The FDA recommends tapering in early spring when discontinuing after winter treatment 1.

Key Pitfall to Avoid

The most common error is stopping too abruptly, which can precipitate discontinuation symptoms that are distressing enough to cause missed work and decreased productivity 4. While bupropion may have less severe discontinuation symptoms than SSRIs (particularly paroxetine and venlafaxine, which have shorter half-lives) 4, the FDA's explicit tapering recommendation for the 300 mg dose indicates this is a necessary precaution.