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Resources › Psychotropics A-Z › Bupropion | Wellbutrin | Wellbutrin
Atypical Antidepressant

Bupropion | Wellbutrin

Clinical Overview

Bupropion is an atypical antidepressant with a unique mechanism of action, indicated for major depressive disorder, seasonal affective disorder, and smoking cessation. It is particularly valuable for patients who experience sexual side effects or weight gain with other antidepressants, and may provide benefits for ADHD-like symptoms.

Primary Clinical Applications

Bupropion is indicated for major depressive disorder (Wellbutrin formulations) and smoking cessation (Zyban). It is often chosen for patients with depression accompanied by fatigue, hypersomnia, or decreased motivation. The medication may also help with seasonal affective disorder and has off-label use for ADHD.

Mechanism and Clinical Benefits

Bupropion inhibits dopamine and norepinephrine reuptake with minimal effects on serotonin. This unique mechanism provides antidepressant efficacy while typically causing weight loss rather than weight gain, and having minimal sexual side effects. It may also have mild stimulant-like effects that can improve energy and motivation.

Clinical Advantages

Unlike SSRIs and SNRIs, bupropion typically does not cause sexual dysfunction and often improves sexual function. It commonly causes weight loss rather than weight gain, making it suitable for patients concerned about metabolic effects. The medication has activating properties that can benefit patients with fatigue or low energy.

Prescribing Information

Dosing & Administration

Major Depressive Disorder:

  • Immediate Release: 100 mg twice daily initially, may increase to 100 mg three times daily (maximum 450 mg daily)
  • Sustained Release (SR): 150 mg once daily initially, may increase to 150 mg twice daily (maximum 400 mg daily)
  • Extended Release (XL): 150 mg once daily initially, may increase to 300 mg once daily (maximum 450 mg daily)

Smoking Cessation (Zyban):

  • Dose: 150 mg once daily for 3 days, then 150 mg twice daily
  • Duration: 7-12 weeks
  • Start: 1-2 weeks before quit date

Seasonal Affective Disorder (Wellbutrin XL):

  • Dose: 150-300 mg once daily
  • Timing: Start in autumn before symptoms begin

Administration:

  • Take with food to reduce nausea
  • Avoid bedtime dosing due to activating effects
  • Do not crush or chew sustained/extended-release formulations

Indications

  • Treatment of major depressive disorder
  • Prevention of seasonal major depressive episodes (Wellbutrin XL)
  • Aid to smoking cessation treatment (Zyban)

Contraindications

  • Seizure disorder or history of seizures
  • Current or prior diagnosis of bulimia or anorexia nervosa
  • Use with MAOIs (within 14 days)
  • Abrupt discontinuation of alcohol or sedatives
  • Head trauma or CNS tumor

Warnings & Precautions

  • Boxed Warning: Increased risk of suicidal thoughts and behavior in patients under 25 years
  • Seizure risk: Dose-related, increased with predisposing factors
  • Hypertension: Monitor blood pressure, may cause dose-related increases
  • Activation of mania: Monitor in patients with bipolar disorder
  • Angle-closure glaucoma: Pupillary dilation may trigger attack
  • Weight loss: Monitor weight, especially in underweight patients

Drug Interactions

  • MAOIs: Contraindicated – minimum 14-day washout
  • CYP2B6 inhibitors: May increase bupropion levels
  • CYP2D6 substrates: Bupropion inhibits CYP2D6
  • Drugs lowering seizure threshold: Increased seizure risk
  • Dopaminergic drugs: May enhance dopaminergic effects

Adverse Reactions

Common (≥5%):

  • Dry mouth, nausea, insomnia, dizziness, pharyngitis
  • Agitation, anxiety, tremor, weight loss

Advantages:

  • Minimal sexual side effects, often improves sexual function
  • Weight loss rather than weight gain
  • No sedation, may improve energy

Serious:

  • Seizures (0.1-0.4%), hypertensive reactions

Special Populations

  • Seizure risk factors: Contraindicated in many high-risk patients
  • Hepatic Impairment: Reduce dose and frequency
  • Renal Impairment: Consider dose reduction
  • Pregnancy: Category C – use only if benefits outweigh risks
  • Elderly: Start with lower doses, monitor for confusion
Medical Disclaimer: This information is for educational purposes only and is not intended as medical advice. Always consult with qualified healthcare professionals before making any treatment decisions. Individual patient circumstances may vary significantly.