What to Know About Wellbutrin (Bupropion)

Wellbutrin (bupropion hydrochloride) is an antidepressant drug. It’s used to treat major depressive disorder (known as clinical depression or MDD) or seasonal affective disorder, now known as major depressive disorder with a seasonal pattern.

The prescription drug is available in tablet form, including a sustained-release tablet (Wellbutrin SR) and an extended-release tablet (Wellbutrin XL).

Wellbutrin is also sold under other brand names, including:

• Aplenzin
• Forvivo XL

It’s also available as a generic as:

• Bupropion HCL
• Bupropion SR
• Bupropion XL 

Uses

Wellbutrin is distinct from other common antidepressants, which are classified as selective serotonin reuptake inhibitors (SSRIs). SSRIs are typically used to treat depression and other mental health issues. They’re frequently prescribed because they tend to produce fewer side effects than other antidepressants.

SSRIs inhibit serotonin reuptake. Serotonin is a neurotransmitter that plays a role in how you experience emotions and moods. By inhibiting serotonin reuptake, SSRIs help increase active serotonin levels in the brain, improving mood and anxiety.

By contrast, Wellbutrin is thought to act by influencing levels of the neurotransmitters norepinephrine and dopamine. These brain chemicals are also involved in the regulation of mood as well as other functions.

The FDA-approved uses for Wellbutrin include MDD and seasonal MDD. The symptoms of these disorders include the following.

MDD. People with major depression have several of these symptoms for at least two weeks:

• Feeling low or depressed
• Loss of interest in usual activities
• Changes in appetite
• Sleep changes, including poor sleep
• Fatigue, low energy
• Feelings of worthlessness 
• Sluggishness of thoughts
• Agitation
• Concentration problems 
• Suicidal thinking  

Seasonal MDD: A major depressive episode with the symptoms above that also consistently recurs at particular times during the year, usually during the dark winter months.  

Off-Label Uses

Wellbutrin is sometimes used off-label for the following conditions:

• Attention deficit hyperactivity disorder (ADHD)
• Depression in bipolar disorder
• Obesity 

Wellbutrin is less likely than SSRIs to cause a loss of libido and other sexual side effects, so it’s sometimes used as a replacement for other antidepressants. Some studies also suggest that Wellbutrin may help treat hypoactive sexual disorder in women.

Before Taking

Wellbutrin is only available via prescription. You need to see a qualified health professional to get a diagnosis and a prescription. A healthcare provider can evaluate your symptoms and help you decide whether Wellbutrin is right for you.

Precautions and Contraindications

Some people need to be careful when taking Wellbutrin, including people who:

• Have a known hypersensitivity to bupropion or any inactive ingredient in Wellbutrin
• Have a seizure disorder
• Have recently stopped taking drugs like benzodiazepine, anticonvulsants, and barbiturates, or consuming alcohol, all of which can trigger seizures
• Have a prior history of anorexia or bulimia (because it can increase the risk of seizures)
• Are taking monoamine oxidase inhibitors (MAOIs; there is a risk of a drug interaction)

People with a history of the following should be cautious when taking Wellbutrin or avoid it altogether.

• Bipolar disorder: There’s a heightened risk of experiencing manic, hypomanic, or mixed episodes when taking Wellbutrin.
• Uncontrolled high blood pressure: The drug can occasionally increase blood pressure.
• Glaucoma: The drug can worsen this condition in some people.
• History of psychosis
• Liver disease, including cirrhosis

Your healthcare provider can help you weigh the benefits and risks of taking Wellbutrin. If you have any underlying conditions, they should be closely monitored by a qualified healthcare provider while you are taking Wellbutrin. 

Dosage

Wellbutrin is available in three different formulations. Dosing is different for each version:

• Wellbutrin, used for the treatment of MDD, is available as 75-milligram (mg) and 100-mg tablets.
• Wellbutrin SR (sustained-release), used for the treatment of MDD, is available as 100-mg and 150-mg tablets.
• Wellbutrin XL (extended-release), used for the treatment of MDD and seasonal MDD, is available as 150-mg and 300-mg tablets.

Typically, a healthcare provider will start you off on a lower dose and increase as needed until the desired effect is achieved. It can take up to six weeks to feel the full benefit of treatment—this may vary depending on the person. Some symptoms may improve sooner, within a week or two. 

Modifications

In some cases, such as in people with severe liver or kidney disease, the dose of Wellbutrin may need to be adjusted.

If you’re replacing your MAOI drug with Wellbutrin, you need to stop taking the MAOI 14 days before starting Wellbutrin to make sure it’s entirely out of your body.

How to Take and Store

You can take Wellbutrin, Wellbutrin SR, and Wellbutrin XL with­­ or without food. All formulations can be stored safely at room temperature (up to 77 degrees F). If you have any questions about how to take the drug, ask your pharmacist or healthcare provider. 

If you no longer need Wellbutrin, the dose should be gradually tapered to avoid withdrawal symptoms. Never stop taking Wellbutrin or change the dose without first speaking with your healthcare provider.

Side Effects

Side effects can happen with all antidepressants. It’s up to you to decide what side effects you feel you can tolerate. Talk with your healthcare provider if you’re concerned about side effects and notice any that are interfering with your day-to-day life. 

Common

The most common side effects of Wellbutrin are gastrointestinal. Wellbutrin can also affect the central nervous system and motor function. The following side effects happen in about 1% to 10% of users:

• Stomach upset
• Nausea or vomiting
• Constipation
• Dizziness
• Dry mouth
• Changes in taste
• Loss of concentration
• Anxiety
• Tremors
• Weakness

If side effects don’t go away or get worse, talk to your healthcare provider. 

Severe

In rare cases, Wellbutrin can cause dangerously high blood pressure or liver failure. These side effects usually happen in people with uncontrolled high blood pressure or existing liver disease. 

High blood pressure doesn’t always produce symptoms. Your healthcare provider may recommend regularly checking your blood pressure to check for this side effect. Possible symptoms include:

• Blood spots in the eyes
• Face flushing
• Dizziness 
• Nosebleed 
• Severe headache

Symptoms of liver failure may include:

• Yellowing of the skin
• Abdominal pain on the upper-right side 
• Nausea and vomiting 
• Weakness

One of the most serious concerns when taking any drug is a hypersensitive reaction, such as anaphylaxis or Stevens-Johnson syndrome.

Warnings and Interactions

Black box warning: Wellbutrin and other SSRIs have been linked to an increased risk of suicidal thoughts and behaviors in children, teens, and young adults under the age of 24.

Wellbutrin should be used with caution during pregnancy, as animal studies have suggested that it may have adverse effects on the human fetus.

Because Wellbutrin relies on a liver enzyme called cytochrome P2B6 (CYP2B6) for metabolism, it may interact with other drugs that impact CYP2B6 metabolism. This can affect the levels of Wellbutrin and its metabolites in your bloodstream. In addition, Wellbutrin can affect the metabolism of certain other drugs. Drugs that can potentially interact with Wellbutrin include:

• Tegretol (carbamazepine)
• Lotrimin (clotrimazole)
• Cough suppressant (dextromethorphan)
• Sustiva (efavirenz)
• Luvox (fluvoxamine)
• Viracept (nelfinavir)
• Prozac (fluoxetine)
• Paxil (paroxetine)
• Luminal (phenobarbital)
• Dilantin (phenytoin)
• Rifadin (rifampicin)
• Norvir (ritonavir)
• Zoloft (sertraline)