From the Guidelines
Switching from Lexapro 10mg to Wellbutrin should be done gradually under medical supervision, not abruptly, to minimize potential withdrawal symptoms and side effects. When considering this switch, it's crucial to understand the different mechanisms of action between Lexapro (escitalopram), an SSRI that affects serotonin levels, and Wellbutrin (bupropion), which primarily affects dopamine and norepinephrine levels 1. A typical approach to switching involves tapering off Lexapro over 2-4 weeks while introducing Wellbutrin, starting with a lower dose such as 100mg once daily for a few days before increasing to the target dose, which can range from 100 to 400mg per day as per the dosage range indicated in studies 1.
Key Considerations for the Switch
- Gradual Tapering: Reduce Lexapro by 50% every 5-7 days until discontinued to minimize withdrawal symptoms like dizziness, headaches, and irritability.
- Introduction of Wellbutrin: Start with a lower dose (e.g., 100mg) and increase as needed and tolerated, up to the target dose, which is often around 300mg daily given as 150mg twice daily.
- Monitoring for Side Effects: Patients should be aware of potential temporary side effects during the switch, including insomnia, anxiety, or headaches, and report these to their healthcare provider.
- Time to Effectiveness: Wellbutrin may take 4-6 weeks to reach full effectiveness, emphasizing the need for patience during the transition period.
Evidence-Based Decision Making
The decision to switch from Lexapro to Wellbutrin is supported by evidence suggesting that both medications are considered preferred agents due to their favorable adverse effect profiles 1. However, the switch should be tailored to the individual patient's response and medical history, considering factors such as renal or hepatic disease, which may require dose adjustments for Wellbutrin 1.
Patient Guidance
Patients should work closely with their healthcare provider to manage the transition, reporting any concerning symptoms promptly. The goal is to achieve a successful switch with minimal disruption to the patient's quality of life, considering the potential benefits of Wellbutrin in treating depression, especially in cases where SSRIs like Lexapro may not be fully effective or are not well-tolerated.
From the FDA Drug Label
- 4 Switching Patients from WELLBUTRIN Tablets (Bupropion Hydrochloride Tablets) or from WELLBUTRIN SR Sustained-Release Tablets (Bupropion Hydrochloride Sustained-Release Tablets (SR))
When switching patients from WELLBUTRIN tablets (bupropion hydrochloride tablets) to bupropion hydrochloride extended-release tablets (XL) or from WELLBUTRIN SR sustained-release tablets (bupropion hydrochloride sustained-release tablets (SR)) to bupropion hydrochloride extended-release tablets (XL), give the same total daily dose when possible.
The FDA drug label does not answer the question about switching from Lexapro 10mg to Wellbutrin.
From the Research
Switching from Lexapro 10mg to Wellbutrin
- The decision to switch from Lexapro (escitalopram) to Wellbutrin (bupropion) may be influenced by various factors, including efficacy, tolerability, and patient-specific characteristics 2, 3, 4.
- A study published in 2009 found that subjects with low Antidepressant Treatment Response (ATR) index values who were switched to bupropion treatment were 1.9 times as likely to respond to bupropion alone as those who remained on escitalopram treatment 2.
- Another study published in 2018 investigated the effectiveness of combined medications for the treatment of major depressive disorder and found that combination treatment with escitalopram and bupropion was superior to either monotherapy in speed of onset 3.
- In terms of sexual functioning, a study published in 2006 found that bupropion had a significantly better sexual tolerability profile compared to escitalopram, with lower incidence of orgasm dysfunction and worsened sexual functioning 4.
- However, a study published in 2015 found that co-medication of bupropion and escitalopram resulted in a significantly higher increase in body mass index (BMI) compared to monotherapy with escitalopram 5.
- It is essential to consider individual patient characteristics, medical history, and treatment goals when deciding to switch from Lexapro to Wellbutrin, and to monitor patients closely for potential side effects and treatment outcomes 6.