What to Know About Wellbutrin (Bupropion)

Antidepressant Used for Major Depression and Seasonal Depression

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 (SAD) in adults.

The prescription drug is available in tablet form, including a sustained-release tablet (Wellbutrin SR) and an extended-release tablet (Wellbutrin XL). It’s rarely used in children because of a documented risk of suicidal thoughts and behaviors. This risk is also heightened in teens and young adults.

Wellbutrin is also sold under other brand names, including:

  • Aplenzin
  • Fortivo XL

It’s also available as a generic as:

  • Bupropion HCL
  • Bupropion SR
  • Bupropion XL 

Wellbutrin and Smoking Cessation

Buproprion hydrochloride is also the active ingredient in the drug Zyban. However, Zyban is used for smoking cessation, often at the same or similar dose.

Close-up of person sitting on bed holding pills and glass of water

Grace Cary / Getty Images

Uses

Wellbutrin is classified as a selective serotonin reuptake inhibitor (SSRI). 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. 

The FDA-approved uses for Wellbutrin include major depressive disorder and seasonal affective disorder. The symptoms of these disorders include:

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  

SAD: A depressive episode that usually occurs during and coincides with the dark winter months 

SSRIs, like Wellbutrin, are usually the first-line treatment for MDD. Wellbutrin XL is considered the drug of choice for the prevention of SAD. 

Off-Label Uses

When other options have failed, Wellbutrin is sometimes used off labels for the following conditions:

  • Attention deficit hyperactivity disorder (ADHD): Because of the risks involved, its use in children is still controversial.
  • Anxiety disorders like panic disorder and obsessive-compulsive disorder (OCD)
  • Bipolar disorder
  • Obesity 

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

Before Taking

Wellbutrin is only available via prescription. You need to see a qualified mental health professional to get a diagnosis and a prescription. A doctor 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, alcohol, anticonvulsants, and barbiturates, 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)
  • Are taking Zyban (taking the two together can increase suicide risk)

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. It can also increase a person’s risk of suicidal ideation.
  • History of psychosis
  • Uncontrolled high blood pressure: The drug can increase blood pressure.
  • Liver disease, including cirrhosis: People with impaired liver function need to be closely monitored to prevent further damage.
  • Glaucoma: The drug can worsen this condition in some people.

Your doctor can help you weigh the benefits and risks of taking Wellbutrin. If you have any underlying conditions they need to be closely monitored by a qualified physician while taking Wellbutrin. 

Other SSRI

Other SSRIs that are used to treat MDD include:

The choice of SSRI depends on the drug’s safety and side effect profile and whether that matches up with your needs and concerns. Other considerations include cost, ease of use, and tolerability.

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 SAD, is available as 150-mg and 300-mg tablets.

Typically a doctor 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 effects of the drug and the full benefit of treatment—this varies depending on the severity of your depression. Some symptoms, like sleep issues, low energy, and appetite, may improve within a week or two. 

 Drug Condition Starting Dose Subsequent Dose Maximum Daily Dose
Wellbutrin MDD 100 mg twice daily 100 mg three times daily 450 mg
Wellbutrin SR MDD 150 mg once daily 150 mg twice daily 400 mg
Wellbutrin XL MDD 150 mg once daily 300 mg once daily 300 mg
  SAD 150 mg once daily 300 mg once daily 300 mg

Check With Your Doctor

All these dosages are from the drug manufacturer. Always check your prescription and talk to your doctor to make sure you are taking the right dose for you.

Modifications

In some cases, like in people with severe liver disease, the dose of Wellbutrin may need to be adjusted: 

  • Wellbutrin: Reduce to 75 mg once daily.
  • Wellbutrin SR: Reduce to 100 mg once daily or 150 mg every other day.
  • Wellbutrin XL: Reduce to 150 mg every other day.

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 F). If you have any questions about how to take the drug, ask your pharmacist or doctor. 

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 doctor.

Proper Dosing

To ensure proper treatment, Wellbutrin needs to be taken on a strict schedule. Take the tablets exactly 12 hours apart for twice-daily dosing and exactly eight hours apart for thrice-daily dosing. Once-daily doses need to be taken at the same time every morning.

Side Effects

Side effects can happen with all SSRIs. While some, like sexual dysfunction and weight gain, are less common with Wellbutrin, others are more common. It’s up to you to decide what side effects you feel you can tolerate. Talk with your doctor 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 doctor. 

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 doctor 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 (SJS).

When to Call 911

Symptoms of a severe allergic reaction include:

  • Skin rash or hives
  • Chest pain
  • Swelling
  • Shortness of breath 

Left untreated, anaphylaxis can lead to organ failure and death. Seek emergency help if you experience these symptoms.

Warnings and Interactions

Black box warning: Wellbutrin and other SSRIs are linked to suicidal thoughts and behaviors in children, teens, and young adults under 24. People under 24 should only take Wellbutrin when all other treatment options have failed, and the benefits outweigh the risks.

Wellbutrin is a pregnancy category C drug. Animal studies have shown that it may have adverse effects on the human fetus.

Tell Your Doctor

Always tell your doctor about the medications you’re taking, including prescription, over-the-counter, nutritional, herbal, or recreational drugs. 

Because Wellbutrin relies on a liver enzyme called cytochrome P2B6 (CYP2B6) for metabolism, it may interact with other drugs that depend on CYP2B6 for metabolization. This can lessen the effectiveness of either drug. Known major drug interactions 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)
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Article Sources
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