Bupropion/Wellbutrin

Bupropion is an antidepressant that works by increasing levels of dopamine and norepinephrine, two neurotransmitters involved in mood regulation, energy levels, and motivation. It differs from SSRIs, which primarily target serotonin. Because of its unique mechanism, bupropion is often prescribed to patients who experience fatigue, low energy, or sexual dysfunction with SSRIs.

Bupropion is FDA-approved for major depressive disorder (MDD) and seasonal affective disorder (SAD). It is also commonly prescribed off-label for attention-deficit hyperactivity disorder (ADHD) and as an adjunct therapy for bipolar disorder. Additionally, Zyban (a version of bupropion) is approved for smoking cessation.

• Low energy and fatigue
• Depressed mood
• Lack of motivation
• Difficulty concentrating
• Withdrawal symptoms from nicotine (for smoking cessation)

Bupropion is often a good option for people who struggle with fatigue or sexual side effects from SSRIs. However, it may not be ideal for those with anxiety, as it can be more stimulating than other antidepressants. A healthcare provider can help determine if it’s a suitable option based on your symptoms and medical history.

Treatment duration varies depending on the individual. For major depressive disorder, many patients take it for at least 6-12 months, while those using it for seasonal affective disorder may take it only during the fall and winter months. If prescribed for smoking cessation, it’s typically taken for 7-12 weeks.

Studies have shown bupropion to be as effective as SSRIs in treating major depressive disorder. It is also effective for smoking cessation, with studies showing that it can double the chances of successfully quitting.

Bupropion is designed to help regulate mood and increase motivation, but it does not change personality. If significant personality changes occur, they may be related to other underlying factors and should be discussed with a doctor.

You will still be yourself, but you may feel more balanced, less overwhelmed, and better able to manage stress. If you feel emotionally numb or like a different person, talk to your doctor about adjusting your dosage or exploring other options.

Common side effects include:

• Insomnia
• Dry mouth
• Increased heart rate
• Anxiety or restlessness
• Headaches
• Nausea

Rare but serious side effects can include seizures (risk increases at high doses), increased blood pressure, and mood changes.

Bupropion withdrawal symptoms are generally mild compared to SSRIs and SNRIs. However, stopping suddenly can lead to irritability, mood swings, and dizziness. It’s best to taper off under medical supervision.

Bupropion is classified as a Pregnancy Category C drug, meaning potential risks should be weighed against the benefits. Some studies suggest a small increased risk of congenital heart defects, but the data is not conclusive. It does pass into breast milk, so it should only be used during breastfeeding if the benefits outweigh the risks.

Bupropion is not considered addictive. However, it can have mild stimulant-like effects, so some people may misuse it in high doses, which increases the risk of seizures.

The FDA has approved bupropion for depression, seasonal affective disorder, and smoking cessation. It includes a black box warning about the increased risk of suicidal thoughts in young adults. It also warns about the seizure risk, especially at high doses or when taken with alcohol or other medications that lower the seizure threshold.