What is the use of Wellbutrin (Bupropion)?

From the Guidelines

Wellbutrin (bupropion) is a suitable antidepressant option for patients with major depressive disorder, given its efficacy and relatively favorable side effect profile, as supported by the American College of Physicians guideline 1.

Key Points to Consider:

• The typical starting dose of Wellbutrin is 150 mg once daily, which can be increased to 150 mg twice daily after several days if tolerated.
• Wellbutrin works by inhibiting the reuptake of dopamine and norepinephrine, rather than serotonin, making it less likely to cause sexual side effects or weight gain compared to other antidepressants, such as fluoxetine or sertraline 1.
• Common side effects of Wellbutrin include insomnia, headache, dry mouth, and nausea, but it is generally well-tolerated.
• However, Wellbutrin should be used cautiously in people with seizure disorders, eating disorders, or those taking other medications that lower seizure threshold, as it can increase seizure risk, as noted in various studies 1.
• The American College of Physicians recommends that clinicians select between either cognitive behavioral therapy or second-generation antidepressants, such as Wellbutrin, to treat patients with major depressive disorder after discussing treatment effects, adverse effect profiles, cost, accessibility, and preferences with the patient 1.
• It is essential to monitor patients for potential adverse effects, including increased risk of seizures, and to adjust the dose or discontinue the medication as needed, as advised in the guideline 1 and supported by evidence from studies 1.
• Additionally, Wellbutrin has been used as a smoking cessation aid, and its efficacy in this context has been established, with a recommended regimen that begins 1-2 weeks before the quit date 1.

From the FDA Drug Label

INDICATIONS AND USAGE Bupropion hydrochloride extended-release tablets (XL) are an aminoketone antidepressant, indicated for: • treatment of major depressive disorder (MDD) ( 1.1) • prevention of seasonal affective disorder (SAD) ( 1.2)

The drug is indicated for treatment of major depressive disorder (MDD) and prevention of seasonal affective disorder (SAD). Wellbutrin is another name for bupropion, which is the drug described in the label 2.

From the Research

Overview of Wellbutrin

• Wellbutrin, also known as bupropion, is a medication used to treat major depressive disorder and seasonal affective disorder 3, 4, 5.
• It is available in several formulations, including immediate release, sustained release, and extended release 4, 5.

Mechanism of Action and Efficacy

• The mechanism of action of bupropion is still uncertain, but it may be related to inhibition of presynaptic dopamine and norepinephrine reuptake transporters 3.
• Bupropion has been shown to be effective in treating major depressive disorder, with comparable efficacy to other antidepressants in clinical trials 3, 4.
• It is also effective in helping people quit tobacco smoking and may have other benefits, such as reducing fatigue and improving concentration 3.

Side Effects and Safety

• Common side effects of bupropion include nervousness, insomnia, and nausea 3.
• Bupropion is relatively safe in overdose, with seizures being the predominant concern 3.
• It may be less likely to provoke mania than antidepressants with prominent serotonergic effects 3.

Comparison to Other Antidepressants

• Bupropion has been compared to selective serotonin reuptake inhibitors (SSRIs) in several studies, with mixed results 4, 6.
• One study found that SSRIs may have a modest advantage over bupropion in treating anxious depression, but the difference was not statistically significant 6.
• Another study found that bupropion and SSRIs had similar efficacy in treating major depressive disorder, but bupropion may have a lower risk of sexual dysfunction 4.

Emotional Blunting

• Emotional blunting is a potential side effect of antidepressants, but a recent study found that bupropion and SSRIs did not significantly decrease emotional responsiveness 7.
• The study suggested that emotional blunting may be better conceptualized as a residual symptom of depression rather than an adverse drug effect 7.