Wellbutrin (Bupropion) and Resolved Eating Disorder History
Bupropion remains absolutely contraindicated in patients with any history of anorexia nervosa or bulimia nervosa, even if the eating disorder has resolved. This is an FDA black-box contraindication that does not have a time-based expiration. 1
FDA Contraindication
The FDA drug label explicitly states that bupropion is contraindicated in patients with "a current or prior diagnosis of bulimia or anorexia nervosa as a higher incidence of seizures was observed in such patients treated with bupropion." 1 This contraindication applies to:
- All formulations of bupropion (immediate release, SR, XL) 1
- All indications (depression, smoking cessation, weight management combinations) 1
- Both current AND prior diagnoses - the contraindication does not expire with eating disorder resolution 1
Seizure Risk Mechanism
The heightened seizure risk in patients with eating disorder history stems from multiple factors:
- Electrolyte abnormalities that may persist or recur even after behavioral recovery 1
- Neurobiological changes from prior malnutrition that can lower seizure threshold permanently 1
- Purging behaviors (if they recur) that acutely increase seizure susceptibility 1
Bupropion already carries baseline seizure risk of approximately 0.1% (1 in 1,000) at standard doses, which increases substantially with the additional risk factors present in eating disorder patients. 2, 1
Clinical Guidance from Eating Disorder Literature
Recent pharmacotherapy guidelines for eating disorders reinforce this contraindication. Bupropion should not be considered for treatment of comorbid depression in patients with anorexia nervosa or bulimia nervosa, regardless of recovery status. 3
For patients with eating disorder history who require antidepressant treatment:
- SSRIs (particularly fluoxetine, sertraline) are safer alternatives for comorbid depression 3, 4
- Mirtazapine can be considered, particularly if weight gain would be beneficial 3
- Avoid bupropion entirely - the contraindication is absolute, not relative 1, 3
Naltrexone-Bupropion Combination Products
The naltrexone-bupropion ER combination (used for weight management) carries the same absolute contraindication for eating disorder history. 5, 2 The FDA label specifically lists "any condition that predisposes to seizure such as: anorexia/bulimia nervosa" as a contraindication. 5
Critical Clinical Pitfall
Do not assume that years of eating disorder remission makes bupropion safe. The FDA contraindication language specifically includes "prior diagnosis," indicating this is a lifetime contraindication. 1 The increased seizure incidence observed in clinical trials led to this permanent restriction. 1
Alternative Antidepressant Options
For patients with resolved eating disorders requiring antidepressant therapy: