- If an Antidepressant Makes You Thin While You Are Taking It
- 3 Myths About Bupropion
- SIDE EFFECTS
- Clinical Trials Experience
- Postmarketing Experience
- SIDE EFFECTS
- Benefits of Wellbutrin – A Quick Reference Guide
- Wellbutrin for Anxiety?
- Treating Bipolar with Wellbutrin
- Wellbutrin and Withdrawals
- Wellbutrin Withdrawal Symptoms
- What is Wellbutrin?
- How Do You Use Wellbutrin to Treat ADHD?
- What Is the Dosage for Wellbutrin?
- What Side Effects Are Associated with Wellbutrin?
- What Precautions Are Associated with Wellbutrin?
- What Interactions Are Associated with Wellbutrin?
- Is Bupropion Your No. 1 Antidepressant Choice?
Today, the increase in psychiatric problems has reached a very significant level. This incidence has become a problem on both an individual and public health level. Poisoning cases require serious handling and generally respond positively to the treatment applied. It has been determined that 6.1% of new-onset seizures are linked to drugs (4). Studies have reported that 9% of status epilepticus cases admitted to the emergency services is caused by drug toxicity, drug use for pleasure, and excessive dose (5, 6).
Bupropion is a new-generation monocyclic antidepressant whose potential effect on reducing nicotine addiction was accidentally found. It significantly prolongs smoking intervals and was licensed with this aim (7). Unlike other antidepressants on the market, bupropion has a monocyclic aminoketone structure. It is well absorbed in the gastrointestinal system and is metabolised in the liver. The half-life of bupropion is 12 hours; it is excreted in urine (1).
New-generation antidepressants used in the treatment of depression are generally well tolerated. However, almost all antidepressants have the potential to lead to seizure (8). Compared with previous years, while the number of seizures related to tricyclic antidepressants, cocaine, and theophylline has declined, the cases of seizures caused by new drugs containing tramadol, venlafaxine, and especially bupropion have increased (9). Our patients were admitted to hospitals just after drug intake but generalised seizures occurred after 12 hours.
Active metabolites of bupropion result from intensive liver metabolism of (R,R)-hydroxybupropion, (S,S)-hydroxybupropion, threo-hydrobupropion and erythro-hydrobupropion. The mechanism of action is thought to depend on weak noradrenalin and dopamine reuptake inhibition (10). Bupropion has sudden, continuous, and prolonged cyclothymic forms. In sudden and continuous cyclothymic forms, peak plasma levels are seen within about 2 and 3 hours, respectively (1). After an overdose of bupropion, clinical effects are primarily on the neurological, cardiovascular and gastrointestinal systems. Neurological effects can include tremor, confusion, agitation, hallucination, coma, and seizures. Cardiovascular effects involve tachycardia and conduction defects. QRS and QT prolongation can be seen. Gastrointestinal effects include trichinosis and vomiting. Mortalities have been reported but are not common (3, 11).
Seizures can emerge both with treatment doses and an overdose of bupropion. They can be caused by all forms of bupropion available on the market. In therapeutic use of the SR form, the risk of seizure is about 0.1% if the dose is no more than 300 mg/day. It has been reported that the incidence of seizures caused by overdose intake makes up a third of the cases with the IR form (12). A study has suggested that there is a close relationship between seizures and dose. Those who take more than 30 tablets are more prone to seizures and almost every patient who takes more than 60 tablets has seizures (13). In electrocardiograms of our cases, no dysrhythmia or conductive defects were detected. For most of our patients who suffered from seizures, benzodiazepine was used as a treatment regime. The main pillar of treatment in case of bupropion overdose is supportive care. If patients come to the hospital just after the drug is taken, active carbon can be given. In our cases, supportive care was started right after admission and the patients were only given benzodiazepine during seizure. We did not measure serum bupropion concentration in our patients. While serum bupropion concentration measurement could be used as an academic means to confirm intake, laboratory tests are rarely completed on the same day and the result does not affect the patient’s treatment and discharge. Our patients suffered from seizures after each had taken 4.5 g and 9 g of the XL form of bupropion. Our case study suggests that there is a relationship between dose and seizures. It has been established that patients who take more than 15 tablets are more vulnerable to seizures. Consistent with this, both of our patients experienced seizures.
In conclusion, Bupropion, a drug launched to treat depression and smoking cessation, can cause seizures in patients who do not previous history of convulsion. Our study emphasises the importance of determining the potential risk of a drug for suicidal poisoning before it is presented to the market. Therefore, clinicians should consider that bupropion may have convulsive effects even at lower doses.
If an Antidepressant Makes You Thin While You Are Taking It
Substantial weight gain is a common side effect of most antidepressant medication, and for many people, the weight is lost once the medication is no longer being taken. However, one antidepressant, bupropion (also known as Wellbutrin) seems to have the opposite effect. Weight is often lost while on the drug, and gained after it is stopped.
Bupropion is a medication prescribed for depression, but also as an aid to smoking cessation. One of its more attractive side effects, for those who appreciate being a few pounds lighter, is weight loss. Indeed, bupropion is now combined with another drug, naltrexone, and sold as the weight-loss drug Contrave.
Bupropion seems like a wonderful drug. Just imagine yourself feeling dumpy and depressed, having eaten your way through the winter doldrums or out of a difficult breakup. You try to diet, but your emotions keep you putting food in your mouth. The food is comforting, but there is a limit to the bags of salty chips or pints of ice cream you can eat without growing out of your clothes. At some point, you seek professional help for your depression and are started on bupropion. Within a short period of time, not only are you in a better emotional state, you have lost weight. You are thinner and happy. Perfection!
But at some point, theoretically, you and your therapist agree that it is time to stop the drug. You do this slowly, because there are some serious side effects if you stop abruptly. But you withdraw correctly and everything seems okay—until you notice you just gained 10 pounds. And then, maybe 20 pounds were suddenly added to your standard weight. Your amazing control over eating has vanished, along with your smaller jean size. How did this happen?
The reason is well-known to those who work on the chemistry of the brain. Bupropion increases the potency of two related brain chemicals: dopamine and norepinephrine, which have a stimulant effect on behavior. As a result, the sluggish, foggy brain, lethargic feelings of depression disappear, and more importantly? The sensation of hunger disappears, so it is very easy to eat less and even skip meals.
The problem is that when the antidepressant is no longer being taken, the withdrawal effects can be, well, depressing. Some people feel their mood becoming bleak again. They experience the fatigue we tend to associate with the aftermath of the flu, and no longer experience the bouncy, upbeat mood they had when they were on the drug. And for those who celebrated their almost magical ability to say no to fattening foods while on the drug, they now sadly find themselves saying yes.
This doesn’t mean that bupropion should not be taken. Every antidepressant drug seems to produce some side effects in most people, and at least patients don’t have to worry about gaining weight while they are taking this medication. But are patients being helped as they approach the end of their treatment with this drug to prevent them from gaining weight, and sometimes a considerable amount? I suspect not.
Consider this: If the patient — you perhaps — were taking bupropion as a weight-loss drug, and not as an antidepressant, you would also need help to improve your food choices, avoid overeating triggers, and stay engaged in an exercise regimen. Obviously this type of support is unlikely to be available from the therapist to whom you are going for your depression. He or she, after all, is not a weight-loss counselor or personal trainer, and you are not going to your therapist to lose weight.
But on the other hand, your therapist does know that you have a good chance of gaining weight when you stop the bupropion. This being established, doesn’t it make sense to offer you the support and advice of a weight-loss facility, or an individual to help you not gain weight during the transition from drug use to drug withdrawal? Indeed, the support should be started while the bupropion is still being taken, so that drug-assisted improvements in food intake and willingness to exercise are maintained when it has been discontinued.
But a note of realistic expectations must be inserted here. Even with the aid of weight-loss professionals, it may not be possible to prevent some weight gain when this stimulant anti-depressant is discontinued. You will feel hungrier and will need willpower to prevent yourself from gobbling everything in sight, at least for a short period. Willpower combined with eating small amounts of carbohydrates should work better than willpower alone. Eating carbohydrates will increase the activity of serotonin, the brain chemical that terminates eating. Serotonin won’t prevent you from wanting to eat, but it will make you feel full and satisfied before you have eaten too much.
Not all side effects from bupropion can be prevented. But certainly, it should be possible to limit its potential to cause weight gain when it is no longer being taken for depression. If that can be achieved, then it really will improve mood and weight. And that is a good track record for any drug.
3 Myths About Bupropion
Bupropion ranks fourth in the more frequently prescribed antidepressants, and has always lagged behind the serotonin agents (SSRIs and SNRIs) in popularity. The reason may have more to do with a few myths about bupropion than the actual evidence.
Why does this matter?
Bupropion lacks many of the side effects that can hinder adherence to SSRIs: sexual side effects, weight gain, apathy, sedation, and withdrawal problems.
A little history
Bupropion was the first modern, or “second generation” antidepressant, to enter the market, but it entered the scene in the worst sort of way. Released in 1985, it soon became associated with an alarming rate of seizures, particularly in patients with bulimia. It was withdrawn from the market soon after, and rereleased in 1989 with a lower maximum dosage: 450 mg per day instead of 600mg per day. By that time, Prozac (fluoxetine) had already come out in 1987 and was rapidly becoming one of the biggest blockbusters in psychiatry. Bupropion had lost ground, and never regained it.
Myth #1: Bupropion is the antidepressant with the highest risk of seizures
No. It’s likely that the instant release version does, because the risk is dose-dependent so when it’s dosed three times a day patients might accidentally take their tablets too close together, raising the blood level and the seizure risk. With the SR, XL, Aplenzin, and Forfivo varieties, the risk of seizures has gone down. In a meta-analysis of 164 articles from 2018, it was clomipramine that came out with the highest seizure risk, and bupropion was not even at the top.1 A separate study from 2018 of over 5,000 elderly patients with new onset seizures found that escitalopram (Lexapro) and citalopram (Celexa) had the highest seizure risk, while the risk for bupropion was about the same as the other antidepressants they looked at.2
Myth #2: Bupropion can cause anxiety
Yes it can, but the rate of anxiety as a side effect to bupropion are about the same as that of other antidepressants, according to several analyses of controlled FDA-registration trials.3 All antidepressants can cause anxiety, and they do in about 1 in 10 depressed patients. Likewise, the risk of “agitation” with bupropion is similar to that with other second-generation antidepressants.
I’ve found that this risk is significantly improved when I dose bupropion low and slow in patients with anxiety. Using the instant release bupropion, I’ll start at 75 mg per day and raise the daily dosage by 75 mg each week until I reach the target dose, and then switch to an extended-release version. I also use this strategy when starting bupropion in a patient with bipolar depression. Although I try to avoid antidepressants in that population bupropion does have a lower risk of causing manic switches.
Myth #3: Bupropion won’t help anxiety in depressed patients
I have reason to doubt this one. In a meta-analysis of 10 randomized controlled trials of depression with anxiety, outcomes for anxiety were not significantly different between bupoprion and the SSRIs, including several large trials where it was compared head-to-head with an SSRI.4 Now, there is a slight twist in this story. The same authors of that paper reanalyzed the data looking specifically at patients with very high levels of anxiety. In that subgroup, the SSRIs had a slight advantage, but the authors concluded that you’d need to treat 17 patients with a highly anxious depression with an SSRI in order to see one benefit over bupropion.5 That’s a lot of patients who might lose their sex drive for a slight advantage.
The following adverse reactions are discussed in greater detail in other sections of the labeling:
- Suicidal thoughts and behaviors in adolescents and young adults
- Neuropsychiatric symptoms and suicide risk in smoking cessation treatment
- Activation of mania or hypomania
- Psychosis and other neuropsychiatric reactions
- Angle-closure glaucoma
- Hypersensitivity reactions
Clinical Trials Experience
Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared with rates in the clinical trials of another drug and may not reflect the rates observed in clinical practice.
Adverse Reactions Leading To Discontinuation Of Treatment
Adverse reactions were sufficiently troublesome to cause discontinuation of treatment with WELLBUTRIN in approximately 10% of the 2,400 subjects and healthy volunteers who participated in clinical trials during the product’s initial development. The more common events causing discontinuation include neuropsychiatric disturbances (3.0%), primarily agitation and abnormalities in mental status; gastrointestinal disturbances (2.1%), primarily nausea and vomiting; neurological disturbances (1.7%), primarily seizures, headaches, and sleep disturbances; and dermatologic problems (1.4%), primarily rashes. It is important to note, however, that many of these events occurred at doses that exceed the recommended daily dose.
Commonly Observed Adverse Reactions
Adverse reactions commonly encountered in subjects treated with WELLBUTRIN are agitation, dry mouth, insomnia, headache/migraine, nausea/vomiting, constipation, tremor, dizziness, excessive sweating, blurred vision, tachycardia, confusion, rash, hostility, cardiac arrhythmia, and auditory disturbance.
Table 2 summarizes the adverse reactions that occurred in placebo-controlled trials at an incidence of at least 1% of subjects receiving WELLBUTRIN and more frequently in these subjects than in the placebo group.
Table 2. Adverse Reactions Reported by at Least 1% of Subjects and at a Greater Frequency than Placebo in Controlled Clinical Trials
(n = 323)
(n = 185)
|Cutaneous temperature disturbance||1.9||1.6|
|Impaired sleep quality||4.0||1.6|
Other Adverse Reactions Observed During The Clinical Development Of WELLBUTRIN
The conditions and duration of exposure to WELLBUTRIN varied greatly, and a substantial proportion of the experience was gained in open and uncontrolled clinical settings. During this experience, numerous adverse events were reported; however, without appropriate controls, it is impossible to determine with certainty which events were or were not caused by WELLBUTRIN. The following enumeration is organized by organ system and describes events in terms of their relative frequency of reporting in the database.
The following definitions of frequency are used: Frequent adverse reactions are defined as those occurring in at least 1/100 subjects. Infrequent adverse reactions are those occurring in 1/100 to 1/1,000 subjects, while rare events are those occurring in less than 1/1,000 subjects.
Cardiovascular: Frequent was edema; infrequent were chest pain, electrocardiogram (ECG) abnormalities (premature beats and nonspecific ST-T changes), and shortness of breath/dyspnea; rare were flushing, and myocardial infarction.
Dermatologic: Infrequent was alopecia.
Endocrine: Infrequent was gynecomastia; rare was glycosuria.
Gastrointestinal: Infrequent were dysphagia, thirst disturbance, and liver damage/jaundice; rare was intestinal perforation.
Genitourinary: Frequent was nocturia; infrequent were vaginal irritation, testicular swelling, urinary tract infection, painful erection, and retarded ejaculation; rare were enuresis, and urinary incontinence.
Neurological: Frequent were ataxia/incoordination, seizure, myoclonus, dyskinesia, and dystonia; infrequent were mydriasis, vertigo, and dysarthria; rare were electroencephalogram (EEG) abnormality, and impaired attention.
Neuropsychiatric: Frequent were mania/hypomania, increased libido, hallucinations, decrease in sexual function, and depression; infrequent were memory impairment, depersonalization, psychosis, dysphoria, mood instability, paranoia, and formal thought disorder; rare was suicidal ideation.
Oral Complaints: Frequent was stomatitis; infrequent were toothache, bruxism, gum irritation, and oral edema.
Respiratory: Infrequent were bronchitis and shortness of breath/dyspnea; rare was pulmonary embolism.
Special Senses: Infrequent was visual disturbance; rare was diplopia.
Nonspecific: Frequent were flu-like symptoms; infrequent was nonspecific pain; rare was overdose.
Altered Appetite And Weight
A weight loss of greater than 5 lbs occurred in 28% of subjects receiving WELLBUTRIN. This incidence is approximately double that seen in comparable subjects treated with tricyclics or placebo. Furthermore, while 35% of subjects receiving tricyclic antidepressants gained weight, only 9.4% of subjects treated with WELLBUTRIN did. Consequently, if weight loss is a major presenting sign of a patient’s depressive illness, the anorectic and/or weight-reducing potential of WELLBUTRIN should be considered.
The following adverse reactions have been identified during post-approval use of WELLBUTRIN and are not described elsewhere in the label. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure.
Arthralgia, myalgia, and fever with rash and other symptoms suggestive of delayed hypersensitivity. These symptoms may resemble serum sickness .
Hypertension (in some cases severe), orthostatic hypotension, third degree heart block.
Syndrome of inappropriate antidiuretic hormone secretion, hyperglycemia, hypoglycemia.
Hemic And Lymphatic
Ecchymosis, leukocytosis, leukopenia, thrombocytopenia. Altered PT and/or INR, infrequently associated with hemorrhagic or thrombotic complications, were observed when bupropion was coadministered with warfarin.
Muscle rigidity/fever/rhabdomyolysis, muscle weakness.
Aggression, coma, completed suicide, delirium, dream abnormalities, paranoid ideation, paresthesia, parkinsonism, restlessness, suicide attempt, unmasking of tardive dyskinesia.
Skin And Appendages
Stevens-Johnson syndrome, angioedema, exfoliative dermatitis, urticaria.
Tinnitus, increased intraocular pressure.
Read the entire FDA prescribing information for Wellbutrin (Bupropion Hcl)
Benefits of Wellbutrin – A Quick Reference Guide
- Total: 26
What is Wellbutrin and it’s benefits, especially in the treatment of bipolar disorder?
This is NOT your typical antidepressant! Wellbutrin, (generic name bupropion), can be considered a “helping hands” medication if someone with bipolar disorder is taking a mood stabilizer and exhibits mainly anti-manic signs.
Wellbutrin is often preferred over a Selective Serotonin Reuptake Inhibitor (SSRI) such as Zoloft or Prozac, since it does NOT cause sexual dysfunction or weight gain.
These are often the primary reasons people with bipolar disorder cite for not taking their meds, even during a serious depressive episode.
Wellbutrin does NOT cause these side effects. Medical News Today states:
“Wellbutrin is chosen in preference to other antidepressants because its use is less likely to cause weight gain or sexual dysfunction.”
Other benefits of Wellbutrin?
This is more than just a good medication for treating some cases of bipolar depression. Clinical studies have shown that as an antidepressant, Wellbutrin can be as effective as Zoloft, Prozac and Paxil. It is also more effective than Effexor.1
IN ADDITION, Wellbutrin is effective in helping compulsive gamblers that have other bipolar disorder symptoms.
It is also marketed under the name of Zyban and prescribed to help smokers quit.
Wellbutrin is FDA approved for treating major depression but NOT for bipolar disorder.
It may also be effective in treating ADHD.
Wellbutrin for Anxiety?
On the downside, it does not appear to be effective as an anti-anxiety medication. However, if you are experiencing a major depressive episode along with anxiety, then it might be beneficial. Complicating this is another caveat – if given in higher doses, your anxiety could increase.
A report released by the drug’s manufactured noted that a large percentage of patients treated with Wellbutrin experienced heightened feelings of agitation and anxiety, especially in the beginning.
Some licensed psychiatrists are quick to point out that every patient will react to the drug differently, most agree that it should not be prescribed to treat anxiety.
The reason Wellbutrin can exacerbate feelings of anxiety is due to it being a norepinephrine-dopamine reuptake inhibitor (NDRI).
When taken as prescribed it will increase the amount of norepinephrine your body produces. This is one of the “fight or flight” chemicals that are produced in response to any stimuli that results in feelings of anxiety. While this can help balance out dull and inactive moods that are often a result of depression, it is seldom beneficial for someone that has been diagnosed with an anxiety disorder.
Lastly, another benefit of Wellbutrin is that it is on the FDA approved list for treating Major Depressive Disorder as well as Seasonal Affective Disorder (SAD). Please note it is NOT approved as a treatment for bipolar disorder and should not be used in preference to a “bipolar-specific” anti-depressant such as Lamictal.
Get detailed information on Wellbutrin benefits from the National Institutes of Health and the U.S. National Library of Medicine.
Treating Bipolar with Wellbutrin
As with many medications, there are pros and cons to treating bipolar with Wellbutrin.
Perhaps the most obvious benefits of Wellbutrin lie in its different side effect profile. There is something almost too good to be true about an antidepressant that can improve sex drive and assist weight loss!
While increased libido and a smaller waist are certainly benefits that almost anyone can appreciate, it is also important not to lose sight of the fact that this medication comes with possible negative side effects. Like any prescribed drug these can range from mildly annoying to life threatening.
Your psychiatrist will be able to discuss these potential side effects with you in greater detail. Some of the less serious ones can include,
- Stomach cramps, nausea, dry mouth
- Dizziness, headaches, ringing in the ears
- Decrease in sex drive
- Muscle pain, sore throat
- Changes in appetite and weight
- Skin rash, itching
- Increased urination
If you ever experience any of the following while taking Wellbutrin, it is imperative that you contact your primary health care provider immediately. Some of the more serious ones associated with this NDRI can include,
- Convulsions (seizures)
- Rapid heartbeat
- Confusion, trouble breathing, unusual thoughts or hallucinations
- Severe skin reaction
- Fever, joint pain or swollen glands
Even though these are serious side effects associated with Wellbutrin, for most patients with depression the pros outweigh the cons.
Wellbutrin does not cause as much manic switching as other antidepressants, and this is a definite benefit.
It has helped me profoundly during my own periods of bipolar depression. It has been the much needed “helping hand” that has pulled me out of a black hole and made it possible to get out of bed, wash my hair, and go to work. Fortunately, this “boost” in motivation and energy was not accompanied by any mania.
I also highly recommend bipolar counseling online if you’re going through bipolar depression. Sometimes, you just need to talk. But WHO you talk with is just as important.
Wellbutrin can also produce positive results when it is used to treat attention-deficit/ hyperactivity disorder (ADHD) and depression. Though it is usually not the first medication prescribed, if the other common stimulants are ineffective it might be a viable option.
In most cases a person that has been diagnosed with ADHD will find that stimulants like Adderall, Ritalin, Concerta and others will help reduce their symptoms, but this is not always the case. This can be especially true if the person is also suffering from depression.
If the commonly prescribed treatments for ADHD are not minimizing the symptoms, a re-evaluation might be needed to check for another contributing factor. ADHD can exhibit some of the same signs associated with depression, and Wellbutrin might be the best course of treatment. This is because it can target the symptoms associated with both problems.
Since it has shown to be effective at increasing the amount of norepinephrine and dopamine it can help improve focus and concentration. These are two of the main symptoms associated with ADHD. When the production of these chemicals is increased, some people have noticed a significant improvement in their symptoms.
If you are dealing with ADHD and depression, Wellbutrin might be a good treatment option. However, if you have only been diagnosed with ADHD it will probably not be your best course of action.
Are there benefits of Wellbutrin in relation to the most typical comorbid bipolar conditions? For example, anxiety, substance abuse, impulsivity, and obesity?
There is evidence that it can help with social anxiety and generalized anxiety. However, it does not help against panic attacks and may even make them worse. For someone that does not have panic problems, Wellbutrin may still be a good option, especially in combination with an anticonvulsant mood stabilizer or lithium.)
Substance abuse? One of the best-known benefits of Wellbutrin is how it helps folks quit smoking cigarettes! It may increase sensitivity to alcohol – or it may not – the evidence is inconsistent.
Even though the studies are still ongoing, there are a few things you should know if you are considering drinking alcohol on Wellbutrin.
It is commonly prescribed to treat depression, and alcohol is classified as a sedative. This alone makes overindulging a poor decision if you have been diagnosed with depression. Wellbutrin also reacts chemically with alcohol. This can intensify the side effects from both substances. The most common complaints regarding mixing the medication with alcohol include symptoms associated with a lower tolerance level such as,
- Black outs
While these side effects can be debilitating, there have been reports of more serious health problems occurring when Wellbutrin and alcohol are mixed.
- Impaired motor control
- Impaired judgment
- Suicidal thoughts/feelings
Psychiatrists and physicians state that since Wellbutrin has shown to enhance the effects of alcohol, it only makes sense that problems associated with having a lower tolerance would be commonly reported. Adding to the danger of taking the two substances together is the fact that some of these side effects could easily become life threatening.
People used to consuming large amounts of alcohol will often find that their risk for a seizure increases, along with their chances for an overdose.
With that being said, suddenly stopping alcohol consumption when starting Wellbutrin can also increase your risk for seizures, along with some of the more serious side effects associated with this medication.
If you are used to consuming alcohol on a regular basis, this should be discussed with your psychiatrist before starting a treatment plan that includes Wellbutrin. In most cases you will want to stop drinking before you start taking the medication, but once again this will be up to you and your doctor. Every patient is different, and the best course of action for one person might not be right for you.
Impulsive behavior? Wellbutrin has been shown to be helpful for compulsive gamblers. It should be kept mind though that it is a medicine with stimulant properties and there is not enough data at this time to understand how it may either fuel or control impulsivity.
Obesity? Wellbutrin has been trialed as a weight loss aid and is unusual in being an antidepressant that contributes to weight loss rather than gain. This is extremely important as people with bipolar disorder suffer from higher than normal rates of obesity and are up to 3 times more likely to die from related conditions such as heart disease and diabetes.
Unlike SSRIs that often list weight gain as one of the side effects, clinical trials are showing the opposite to be true with Wellbutrin. Even though, relieving the symptoms associated with depression is preferable, even if it comes with a slight weight gain, if it is more than a few pounds loss of confidence and issues with self-image are common.
This can lead to problems with depression again, rendering the treatment ineffective.
On average a person can expect to gain around 10 pounds when they are on some of the commonly prescribed antidepressants. This might not seem like a lot of added weight, but for some people with fragile egos it can cause their depression symptoms to worsen.
Currently there is only one antidepressant on the market in the United States that is showing to be effective in some people at promoting weight loss. It is important to remember that the clinical trials are still ongoing, but preliminary results are showing that Wellbutrin is linked to the weight loss some people experience.
It is a NDRI and this means that it speeds up your metabolism, and increases your energy level. This helps you get up and start moving, which can be difficult to do when you are suffering from depression. The boost in energy results in more calories being burned, and this is enhanced by the increase in your metabolism.
In some people Wellbutrin also acted as an appetite suppressant, which in turn resulted in the loss of a few pounds.
The only downside associated with weight loss and Wellbutrin are the feelings of anxiety that some people reported experiencing. This is usually only a problem if their serotonin levels are already unbalanced. Since the drug is not designed to even this out, relief from the anxiety typically only occurs after the treatment has stopped.
If you are concerned about any weight gain that might occur from treating your depression, Wellbutrin might be the best treatment option for you. It is important to remember that it should not be taken as a primary weight loss aid. It is an antidepressant and contains powerful medication that should only be used under the strict guidance of a licensed health care professional.
There have been some rare cases of people reporting weight gain on Wellbutrin. This only emphasizes the fact that it does affect everyone differently.
IF THESE STATS CONCERN YOU (THEY SHOULD!) DISCOVER THE BIPOLAR DIET.
Here’s what you’ll get:
- A list of meds most likely to cause weight gain (and varying degrees of weight gain)
- The 12 worst foods people with bipolar disorder should never eat!
- Easy and straight-forward daily food plans you can follow
- And many more winning strategies to manage your weight and take control of your life
Wellbutrin should not be taken by anyone who CANNOT afford to lose more than 5% of their body weight. It MUST NOT be used by anyone with anorexia or bulimia.
Wellbutrin and Withdrawals
For some people the relief from their depression symptoms combined with its relatively low risk of side effects makes a treatment plan that includes Wellbutrin something that they and their doctor intend to continue for an extended. Others may find that the side effects are worse than their symptoms or that they just want to experience life without the use of prescription medications.
If you are planning on removing Wellbutrin from your treatment plan there are a few things you should know.
Chances are you will experience some type of withdrawal, and it is important that you are aware of any symptoms you might experience. The type and severity, along with the duration will vary depending on several factors which should be discussed with your prescribing doctor before you stop taking Wellbutrin.
- Time Span
The amount of time you were taking Wellbutrin will determine the length and severity of the withdrawal symptoms. If you have only been on the antidepressant for a few weeks, there might not be any noticeable symptoms. If there are, they typically only last for a few days. However, if you have been on the medication for several months or years you can expect the withdrawal symptoms to be more severe. In this case you might be better off weaning the dosage down, instead of trying to stop “cold turkey”.
- Dosage and Subtype
The dosage will play a key role when you are trying to “come off” of the medication. A person on a higher dosage will find that the withdrawal symptoms are more severe. It will also take more time before the withdrawal effects aren’t felt anymore.
The subtype also affects withdrawal. If you were taking “IR” (immediate release) or “XL” (extended release) Wellbutrin you might discover that the symptoms from withdrawal are more noticeable. “SR” (sustained release) Wellbutrin is designed to be taken twice a day, instead of only once. This can make the withdrawal symptoms less noticeable, and easier to fully “come off” the antidepressant without experiencing any severe side effects since it is easier to gradually reduce your dosage.
- Your Physiology
It cannot be stressed enough that Wellbutrin withdrawal symptoms will affect everyone differently. Your environment, amount of support that you receive, along with your nervous system will all play a role in the severity and duration of the withdrawal symptoms, and this means that it is impossible to compare your case to another.
Wellbutrin Withdrawal Symptoms
Not everyone will experience all the symptoms associated with withdrawal. The severity and duration will also vary. While some people might experience two or three symptoms, others might have to deal with more. Some lucky people also report not experiencing any withdrawal symptoms, though this usually only occurs when they were on the antidepressant for a short period of time. Some of the common ones’ users report experiencing include,
- Body Aches
- Crying Spells
- Depersonalization (no longer feel like yourself)
- Depression (if this symptom returns it is important to speak with your physician)
- Increased appetite
- Lack of coordination
- Decrease in sex drive
- Seizures (this should be immediately reported to your physician)
- Weight Gain
You should also be aware that Wellbutrin can stay in your system for 5 to 10 days, and this will affect how long you experience the symptoms associated with withdrawal.
Even though the amount of time it takes you to fully withdrawal will vary, there are a few things you can do to make it a little less miserable. Exercise, eating a healthy diet and making time to socialize with friends and family can all help to lessen the severity of the symptoms, and even speed up the withdrawal process. In most cases you can expect to start noticing a significant decrease in withdrawal symptoms after a few weeks of stopping the medication.
If you feel like the withdrawal process is taking longer than it should or your feelings of depression return it is important that you make time to discuss any problems or concerns with your prescribing psychiatrist or physician.
“Someone gave me some very good advice one time. Perhaps I have not been so good at following it. This was it: You are the one that is in charge of your own wellness. Go in to your appointment armed with research.”
Note that Wellbutrin is FDA approved for treating major depressive disorder, NOT bipolar depression specifically. However, there is growing belief it is one of the antidepressants LEAST likely to cause a switch into mania.
“Newer “atypical” antidepressants work differently than other available drugs. Currently, none are approved by the FDA to treat bipolar depression. But some evidence suggests they may play a role in treating depression in bipolar disorder. Studies have shown that Wellbutrin is effective when added to lithium therapy. However, findings are still preliminary.” (From WebMD)
- Current Psychiatry. 2012 June; 11(6):E3-E4
- Michigan Medicine. University of Michigan
- Harvard Health Publications. Harvard Medical School
- Total: 29
What is Wellbutrin?
Wellbutrin (Generic Name: bupropion HCL) is an antidepressant medication primarily used to treat depression, major depressive disorder, and seasonal affective disorder in adults. Its safety has not been established for children or young adults under the age of 18.
Wellbutrin may help to relieve common symptoms of depression including disinterest in typical activities, impaired concentration, change in weight or appetite, and insomnia.
Wellbutrin has been neither studied nor approved to treat attention deficit hyperactivity disorder (ADHD). Physicians sometimes prescribe it “off-label” to treat symptoms. However, the clinical evidence for bupropion for ADHD “far weaker” than for FDA-approved treatments, according to the American Academy of Child & Adolescent Psychiatry1.
There is very little published evidence that bupropion works well for ADHD. Two studies found that the benefits of bupropion for ADHD were barely detectible and in some cases only achieved at dangerously high dosages that could increase risk of seizures2,3. It is a low side effect, low efficacy option used by patients who are unwilling or unable to take stimulant medications.
When prescribed for ADHD treatment, it can be prescribed in conjunction with a stimulant medication like Vyvanse or Adderall XR.
How Do You Use Wellbutrin to Treat ADHD?
Before starting or refilling a Wellbutrin prescription, have a conversation with your doctor, who has a holistic view of your medical history, other diagnoses, and other prescriptions. If you have questions, ask your doctor or pharmacist before you begin taking the medication.
What Is the Dosage for Wellbutrin?
As with all medications, follow your Wellbutrin prescription instructions exactly. Wellbutrin is taken orally, with or without food. It is available in two formulations:
- Immediate-release tablets (Wellbutrin SR): Taken once or twice daily with at least six hours between doses. Available in 75mg and 100mg dosages.
- Extended-release tablets (Wellbutrin XL): Taken once daily with at least 24 hours between doses. Available in 150mg and 300mg dosages. The time-release formulation is designed to maintain a steady level of medication in your body throughout the day.
If you miss a dose, wait to take your next dose at the scheduled time. You should not take two doses of Wellbutrin at the same time.
The risk of seizures is highly dose-dependent, and is no higher than other antidepressants. Taking too much Wellbutrin can increase risk of seizures. It is only when a daily dose goes above 450mg that the incidence of seizures climbs to 5%4. When beginning treatment with Wellbutrin, a patient’s dose should be increased gradually to minimize the risk of seizure.
Do not drink alcohol while taking this drug.
The optimal dosage varies patient by patient and condition treated. If you are over 60 years of age, or have certain health conditions, your doctor may recommend a lower dosage.
Your doctor may incrementally adjust your daily dosage until you experience the best response — that is, until you find the lowest dosage at which you experience the greatest improvement in symptoms without side effects.
When discontinuing treatment, or decreasing dosage, patients should work with a doctor to gradually taper the level of medication. Stopping antidepressant medications suddenly can cause new symptoms.
What Side Effects Are Associated with Wellbutrin?
Most people taking this medication do not experience any of these side effects.
The most common side effects of Wellbutrin are similar to those associated other antidepressant medications, and are as follows: agitation, dry mouth, nervousness, constipation, headache, nausea and vomiting, difficulty sleeping, dizziness, pharyngitis, muscle pain, shakiness, fast heartbeat, and heavy sweating.
Other serious side effects include increased risk of suicide or suicidal thoughts, seizures, and angle-closure glaucoma.
Taking Wellbutrin may impair your ability to drive, operate machinery, or perform other potentially dangerous tasks. This side effect usually wears off with time. If side effects are bothersome, or do not go away, talk to your doctor.
Disclose to your physician all mental health issues including any family history of suicide, bipolar disorder, mania, or depression. The manufacturer, Valeant, recommends evaluating patients for bipolar disorder prior to administration of Wellbutrin to avoid inducing a manic episode. Wellbutrin may create new or exacerbate existing behavior problems, bipolar disorder, or suicidal ideation, especially in the first few months of treatment or after a dosage change. Call your doctor immediately if you experience new or worsening mental health symptoms including reckless behavior, hallucinations, or sudden excessive happiness or irritability.
Report to your doctor any heart-related problems or a family history of heart and blood pressure problems. Wellbutrin can increase blood pressure. Physicians should monitor these vital signs closely during treatment.
The above is not a complete list of potential side effects. If you notice any health changes not listed above, discuss them with your doctor or pharmacist.
What Precautions Are Associated with Wellbutrin?
Store Wellbutrin in a secure place out of the reach of children, and at room temperature. Do not share your Wellbutrin prescription with anyone, even another person with depression. Sharing prescription medication is illegal, and can cause harm.
You should not take Wellbutrin if you:
- have or had a seizure disorder or epilepsy
- have or had an eating disorder
- are taking other medications containing bupropion
- drink a lot of alcohol or have recently stopped abusing alcohol
- take a monoamine oxidase inhibitor (MAOI)
- are allergic to bupropion or any of the ingredients in Wellbutrin
You should use caution taking Wellbutrin, and speak with your doctor if you have liver or kidney problems, seizures, bipolar disorder, a history of tumors or heart problems, or diabetes.
If you’re thinking of becoming pregnant, discuss the use of Wellbutrin with your doctor. Animal studies indicate potential risk to the developing fetus. Wellbutrin is passed through breastmilk, so it is recommended that mothers do not nurse while taking it.
Wellbutrin is not approved for use in pediatric patients.
What Interactions Are Associated with Wellbutrin?
Before taking Wellbutrin, discuss all other active prescription medications with your doctor. Wellbutrin can have a dangerous, possibly fatal, interaction with antidepressants including MAOIs.
Wellbutrin inhibits CYP2D6 enzyme, which can change how your body processes certain medications including venlafaxine, nortriptyline and more. It can impact the dosage required for CYP2B6 inducers including ritonavir, carbamazepine, and more. Wellbutrin can interact with certain dopaminergic drugs like levodopa and amantadine.
Wellbutrin can exacerbate the drowsiness created by depressants including alcohol, barbiturates, antihistamines, or other sedatives.
Share a list of all vitamin or herbal supplements, and prescription and non-prescription medications, you take with the pharmacist when you fill your prescription, and let all doctors and physicians know you are taking Wellbutrin before having any surgery or laboratory tests. Wellbutrin can give a false positive for amphetamines.
The above is not a complete list of all possible drug interactions.
More Information on Wellbutrin and Other ADHD Medications:
Why and How Wellbutrin May Be an Effective Treatment for ADHD
Non-Stimulant ADHD Medication Overview
Free Resource: ADHD Medication Tracking Log
Your Toughest ADHD Medication Questions Answered
How Does ADHD Medication Work?
Is Bupropion Your No. 1 Antidepressant Choice?
1. Zimmerman M, Posternak MA, Attiullah N, et al. Why isn’t bupropion the most frequently prescribed antidepressant? J Clin Psychiatry. 2005;66:603-610.
2. Blumenthal SR, Castro VM, Clements CC, et al. An electronic health records study of long-term weight gain following antidepressant use. JAMA Psychiatry. 2014;71:889-896.
3. Ravindran PP, Zang W, Renukunta S, et al. Effect of comedication of bupropion and other antidepressants on body mass index. Ther Adv Psychopharmacol. 2015;5:158-165.
4. Paige E, Korda R, Kemp-Casey A, et al. A record linkage study of antidepressant medication use and weight change in Australian adults. Aust N Z J Psychiatry. 2015;49:1029-1039.
5. Arterburn D, Sofer T, Boudreau DM, et al. Long-term weight change after initiating second-generation antidepressants. J Clin Med. 2016;5(4). doi:10.3390/jcm5040048.
6. Delgado PL, Brannan SK, Mallinckrodt CH, et al. Sexual functioning assessed in 4 double-blind placebo- and paroxetine-controlled trials of duloxetine for major depressive disorder. J Clin Psychiatry. 2005;66:686-692.
7. Serretti A, Chiesa A. Treatment-emergent sexual dysfunction related to antidepressants: a meta-analysis. J Clin Psychopharmacol. 2009;29:259-266.
8. Warner CH, Bobo W, Warner C, et al. Antidepressant discontinuation syndrome. Am Fam Physician. 2006;74:449-456.
9. Phelps J. Tapering antidepressants: is 3 months slow enough? Med Hypotheses. 2011;77:1006-1008.
10. Fava GA, Gatti A, Belaise C, et al. Withdrawal symptoms after selective serotonin reuptake inhibitor discontinuation: a systematic review. Psychother Psychosom. 2015;84:72-81.
11. Weitz ES, Hollon SD, Twisk J, et al. Baseline depression severity as moderator of depression outcomes between cognitive behavioral therapy vs pharmacotherapy: an individual patient data meta-analysis. JAMA Psychiatry. 2015;72:1102-1109.
12. Papakostas GI, Stahl SM, Krishen A, et al. Efficacy of bupropion and the selective serotonin reuptake inhibitors in the treatment of major depressive disorder with high levels of anxiety (anxious depression): a pooled analysis of 10 studies. J Clin Psychiatry. 2008;69:1287-1292.
13. Maguire MJ, Weston J, Singh J, Marson AG. Antidepressants for people with epilepsy and depression. Cochrane Database Syst Rev. 2014;12:CD010682.
14. Cotterman-Hart S. Depression in epilepsy: why aren’t we treating? Epilepsy Behav. 2010;19:419-421.
15. Hesdorffer DC, Ishihara L, Mynepalli L, et al. Epilepsy, suicidality, and psychiatric disorders: a bidirectional association. Ann Neurol. 2012;72:184-191.
16. Davidson J. Seizures and bupropion: a review. J Clin Psychiatry. 1989;50:256-261.
17. Rissmiller DJ, Campo T. Extended-release bupropion induced grand mal seizures. J Am Osteopath Assoc. 2007;107:441-442.
18. Rosoff DM. Another case of extended-release bupropion-induced seizure. J Am Osteopath Assoc. 2008;108:189-190.
19. Fava M, Rush AJ, Thase ME, et al. 15 years of clinical experience with bupropion HCl: from bupropion to bupropion SR to bupropion XL. Prim Care Companion J Clin Psychiatry. 2005;7:106-113.
20. Patel K, Allen S, Haque MN, et al. Bupropion: a systematic review and meta-analysis of effectiveness as an antidepressant. Ther Adv Psychopharmacol. 2016;6:99-144.
Does Wellbutrin XL Interact with other Medications?
These medications are not usually taken together. Consult your healthcare professional (e.g., doctor or pharmacist) for more in formation.
- BUPROPION; SOLRIAMFETOL/MAO INHIBITORS
- SELECTED ANTIDEPRESSANTS/IOMEPROL
These medications may interact and cause very harmful effects. Consult your healthcare professional (e.g., doctor or pharmacist) for more in formation.
- BUPROPION/ARIPIPRAZOLE LAUROXIL SUBMICRONIZED
- AGENTS THAT AFFECT CATECHOLAMINES/IOBENGUANE I 123
- AGENTS THAT AFFECT CATECHOLAMINES/IOBENGUANE I 131
- STRONG & MODERATE CYP2D6 INHIBITORS/ELIGLUSTAT
- DOPAMINE TRANSPORTER BINDERS/IOFLUPANE I 123
- STRONG CYP2D6 INHIBITORS/TAMOXIFEN
- STRONG 2D6 INHIBITORS/ATOMOXETINE; VORTIOXETINE
These medications may cause some risk when taken together. Consult your healthcare professional (e.g., doctor or pharmacist) for more in formation.
- BUPROPION/SELECTED ANTIDEPRESSANTS
- BUPROPION/HYPOGLYCEMICS; INSULIN
- BUPROPION/TRICYCLIC ANTIDEPRESSANTS
- BUPROPION/SNRIS; SSRIS
- STRONG CYP2D6 INHIBITORS/PITOLISANT
- BUPROPION/AMANTADINE, LEVODOPA
- SELECTED CYP2D6 INHIBITORS/METOPROLOL
- STRONG CYP2D6 INHIBITORS/HYDROCODONE; OXYCODONE
- STRONG 2D6 INHIBITORS/VALBENAZINE
- SELECTED STRONG CYP2D6 INHIBITORS/FLECAINIDE
- SELECTED MODERATE TO STRONG CYP2D6 INHIBITORS/TRAMADOL
- STRONG CYP2D6 INHIBITORS/DEUTETRABENAZINE;TETRABENAZINE
- STRONG CYP2D6 INHIBITORS/CODEINE