- Wellbutrin SR
- SIDE EFFECTS
- Clinical Trials Experience
- Adverse Reactions Leading To Discontinuation Of Treatment
- Postmarketing Experience
- SIDE EFFECTS
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- What is Wellbutrin?
- Wellbutrin for Weight Loss
- Wellbutrin and Naltrexone for Weight Loss
- Considerations While Taking Wellbutrin
- In a Nutshell…
- Why and How Wellbutrin May Be an Effective Treatment for ADHD
- Can I Use Wellbutrin for ADHD?
- About Wellbutrin: Off-Label ADHD Treatment
- Are “off-label” medications legal?
- How Wellbutrin Works: Off-Label ADHD Treatment
- Why Use Wellbutrin for ADHD Symptoms?
- Dose and Forms of Wellbutrin for ADHD Treatment
- Common Side Effects of Wellbutrin
- Important Information About Taking Wellbutrin for ADHD
- What is bupropion, or Wellbutrin?
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
In placebo-controlled clinical trials, 4%, 9%, and 11% of the placebo, 300-mg-per-day, and 400-mg per- day groups, respectively, discontinued treatment due to adverse reactions. The specific adverse reactions leading to discontinuation in at least 1% of the 300-mg-per-day or 400-mg-per-day groups and at a rate at least twice the placebo rate are listed in Table 2.
Table 2: Treatment Discontinuations Due to Adverse Reactions in Placebo-Controlled Trials
Commonly Observed Adverse Reactions
Adverse reactions from Table 3 occurring in at least 5% of subjects treated with WELLBUTRIN SR and at a rate at least twice the placebo rate are listed below for the 300- and 400-mg-per-day dose groups.
WELLBUTRIN SR 300 mg per day: Anorexia, dry mouth, rash, sweating, tinnitus, and tremor.
WELLBUTRIN SR 400 mg per day: Abdominal pain, agitation, anxiety, dizziness, dry mouth, insomnia, myalgia, nausea, palpitation, pharyngitis, sweating, tinnitus, and urinary frequency.
Adverse reactions reported in placebo-controlled trials are presented in Table 3. Reported adverse reactions were classified using a COSTART-based Dictionary.
Table 3: Adverse Reactions Reported by at Least 1% of Subjects and at a Greater Frequency than Placebo in Controlled Clinical Trials
Other Adverse Reactions Observed During The Clinical Development Of Bupropion
In addition to the adverse reactions noted above, the following adverse reactions have been reported in clinical trials with the sustained-release formulation of bupropion in depressed subjects and in nondepressed smokers, as well as in clinical trials with the immediate-release formulation of bupropion.
Adverse reaction frequencies represent the proportion of subjects who experienced a treatment-emergent adverse reaction on at least one occasion in placebo-controlled trials for depression (n = 987) or smoking cessation (n = 1,013), or subjects who experienced an adverse reaction requiring discontinuation of treatment in an open-label surveillance trial with WELLBUTRIN SR (n = 3,100). All treatment-emergent adverse reactions are included except those listed in Table 3, those listed in other safety-related sections of the prescribing information, those subsumed under COSTART terms that are either overly general or excessively specific so as to be uninformative, those not reasonably associated with the use of the drug, and those that were not serious and occurred in fewer than 2 subjects.
Adverse reactions are further categorized by body system and listed in order of decreasing frequency according to the following definitions of frequency: 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.
Body (General): Infrequent were chills, facial edema, and photosensitivity. Rare was malaise.
Cardiovascular: Infrequent were postural hypotension, stroke, tachycardia, and vasodilation. Rare were syncope and myocardial infarction.
Digestive: Infrequent were abnormal liver function, bruxism, gastric reflux, gingivitis, increased salivation, jaundice, mouth ulcers, stomatitis, and thirst. Rare was edema of tongue.
Hemic and Lymphatic: Infrequent was ecchymosis.
Metabolic and Nutritional: Infrequent were edema and peripheral edema.
Musculoskeletal: Infrequent were leg cramps.
Nervous System: Infrequent were abnormal coordination, decreased libido, depersonalization, dysphoria, emotional lability, hostility, hyperkinesia, hypertonia, hypesthesia, suicidal ideation, and vertigo. Rare were amnesia, ataxia, derealization, and hypomania.
Respiratory: Rare was bronchospasm.
Special Senses: Infrequent were accommodation abnormality and dry eye.
Urogenital: Infrequent were impotence, polyuria, and prostate disorder.
Changes In Body Weight
In placebo-controlled trials, subjects experienced weight gain or weight loss as shown in Table 4.
Table 4: Incidence of Weight Gain and Weight Los s ( ≥ 5 lbs ) in Placebo-Controlled Trials
|Weight Change||WELLBUTRIN SR 300 mg/day
|WELLBUTRIN SR 400 mg/day
(n = 112)
|Gained > 5 lbs||3%||2%||4%|
|Lost > 5 lbs||14%||19%||6%|
In clinical trials conducted with the immediate-release formulation of bupropion, 35% of subjects receiving tricyclic antidepressants gained weight, compared with 9% of subjects treated with the immediate-release formulation of bupropion. If weight loss is a major presenting sign of a patient’s depressive illness, the anorectic and/or weight-reducing potential of WELLBUTRIN SR should be considered.
The following adverse reactions have been identified during post-approval use of WELLBUTRIN SR 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 .
Complete atrioventricular block, extrasystoles, hypotension, hypertension (in some cases severe), phlebitis, and pulmonary embolism.
Colitis, esophagitis, gastrointestinal hemorrhage, gum hemorrhage, hepatitis, intestinal perforation, pancreatitis, and stomach ulcer.
Hyperglycemia, hypoglycemia, and syndrome of inappropriate antidiuretic hormone.
Hemic and Lymphatic
Anemia, leukocytosis, leukopenia, lymphadenopathy, pancytopenia, and thrombocytopenia. Altered PT and/or INR, infrequently associated with hemorrhagic or thrombotic complications, were observed when bupropion was coadministered with warfarin.
Metabolic and Nutritional
Muscle rigidity/fever/rhabdomyolysis and muscle weakness.
Abnormal electroencephalogram (EEG), aggression, akinesia, aphasia, coma, completed suicide, delirium, delusions, dysarthria, euphoria, extrapyramidal syndrome (dyskinesia, dystonia, hypokinesia, parkinsonism), hallucinations, increased libido, manic reaction, neuralgia, neuropathy, paranoid ideation, restlessness, suicide attempt, and unmasking tardive dyskinesia.
Alopecia, angioedema, exfoliative dermatitis, hirsutism, and Stevens-Johnson syndrome.
Deafness, increased intraocular pressure, and mydriasis.
Abnormal ejaculation, cystitis, dyspareunia, dysuria, gynecomastia, menopause, painful erection, salpingitis, urinary incontinence, urinary retention, and vaginitis.
Read the entire FDA prescribing information for Wellbutrin SR (Bupropion Hydrochloride Sustained-Release)
Publicado em 11 de maio de 2018
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A healthy diet and proper exercise are heralded for their wondrous effects on weight loss. However, there are some people who – no matter how hard they try – can’t shed the extra pounds with the aforementioned methods.
If you are one of these unfortunate few, you need not worry – medications such as Wellbutrin is now being considered a ‘miracle drug’ for weight loss.
What is Wellbutrin?
Wellbutrin, with the generic name bupropion, is an aminoketone medication used to treat major depressive and seasonal affective disorders. In some cases, it has been used to treat anxiety, attention deficit hyperactivity disorder, post-traumatic stress disorder, social phobia, and nerve pain.
Its mechanism of action is widely hazy, although experts contend that it works by affecting the reuptake of the neurotransmitters dopamine and norepinephrine.
Wellbutrin is available in two dosage forms, with the 75 mg tablet colored yellow-gold, and the 100 mg tablet colored red.
The usual recommended initial dose is 200 mg per day, with a dose of 100 mg at two times a day. It can then be increased to as much as 300 mg day at three divided doses of 100 mg tabs, spaced at an interval of at least 6 hours.
A maximum of 450 mg Wellbutrin can be given in a day, which can be taken in four doses of 100 mg tablets. Such can also be taken at 150 mg per dose at three times a day.
The dosage is adjusted to a maximum of 75 mg per day for patients with liver problems. Similar dosage reductions are also recommended for individuals with kidney problems.
Wellbutrin for Weight Loss
How Wellbutrin brings about weight loss remains a puzzle to most experts.
Some believe that since it is chemically same with amphetamines, it brings about the appetite suppression that is associated with the said drugs.
Others, on the other hand, postulate that its role as a norepinephrine and dopamine uptake inhibitor plays a major role in moderating the eating process. Both hormones, after all, have been linked with the intensity of food cravings.
In Depressed Patients
Fact: most antidepressants bring about weight gain.
In fact, a study by Serretti and Mandelli showed that “Psychotropic drugs often induce weight gain, leading to discomfort and discontinuation of treatment and, more importantly, increasing the risk of obesity-related illnesses such as diabetes mellitus, hypertension, and coronary heart disease.”
But with Wellbutrin, the case is the actual opposite. In fact, many studies have proven its effectiveness when it comes to weight loss.
To wit, a 2002 study by Jain et al and described in studies at Thyroid Advisor, has shown that obese patients with depressive symptoms who took Bupropion alongside a 500 kcal/d-deficit diet lost an average of 4.4 kilograms. Not only did the drug improve physical appearance after 6 months of treatment, the accompanying weight loss has also been linked with ‘improved mood’ amongst the study participants.
Bupropion’s effects are not only short-term; they are effective in the long run as well. Proving this was the study by Arteburn et al, which has shown that Bupropion was the sole antidepressant that can lead to long term weight loss. Results showed that those who took Bupropion lost as much as 8.4 pounds in a span of two years.
The limitation to Bupropion’s ability though is that the long-term weight loss is only applicable to nonsmokers. While Wellbutrin is used as an adjunct drug for smoking cessation, disruption of said vice has always been linked with weight gain.
As such, smokers taking Bupropion are expected to exhibit weight gain rather than weight loss. This was explicitly shown in the study as it was noted that smokers who took the drug gained as much as 14.2 pounds.
Due to the promising effects of Bupropion, Arteburn and his colleagues recommend that it be the “first-line drug of choice for all overweight and obese patients unless there are other existing contraindications such as a history of seizure disorder, anorexia nervosa or bulimia, or patients undergoing abrupt discontinuation of ethanol or sedatives including anticonvulsants, barbiturates, or benzodiazepines. All other antidepressant medications should be considered second-line pharmacological treatments for depression among overweight and obese patients.”
In Non-Depressed Patients
Wellbutrin is initially prescribed for overweight or obese depressed patients because of its weight loss capabilities. Outside its primary use, several studies have shown that Wellbutrin is just as effective in non-depressed individuals who wish to lose weight.
A 2001 study by Gadde et al showed that “Bupropion was more effective than placebo in achieving weight loss at 8 weeks in overweight and obese adult women.” Those who completed the program – which included a 1600 kcal/day diet and the use of food diaries – mean weight loss percentage was as much as 6.2% for the Bupropion group compared to 2.9% of the placebo group. In fact, 12 of the 18 participants of the Wellbutrin cluster achieved a whopping 5% weight loss.
Echoing this finding was the study of Anderson et al, where participants were placed in the placebo, Bupropion 300 mg/day, and Bupropion 400 mg/day groups respectively. Those who completed the 24-week therapy – which included exercise, meal replacements, and energy-restricted diets – weight loss was 7.2% and 10.1% for the Bupropion 300 mg and 400 mg groups respectively. Those who finished the 48-week program maintained losses of 7.5% for the Bupropion 300 mg group and 8.6% for the Bupropion 400 mg group.
Similarly, Anderson et al has the same recommendation as that of Arteburn. The authors go on to say that “Because of its effectiveness and safety, bupropion SR warrants consideration as an adjunct to lifestyle changes for enabling obese individuals to lose weight.”
Wellbutrin and Naltrexone for Weight Loss
Because of Wellbutrin’s effects on weight loss, it has been marketed with Naltrexone in obesity treatment. Further studies show that both medications exert short- and long-term weight loss effects, resulting to as much as 5% body weight loss.
While a healthy diet and exercise are instrumental for weight loss, Tek, in his paper, recognized that sometimes, they are not enough. He goes on to say that “the problem is that very few obese/overweight people can adequately follow these diets and exercise routines, and even fewer people can sustain them over long periods of time.”
As such, he recommends pharmacological support such as that of Wellbutrin and Naltrexone, “since obesity affects not only how one thinks about food and activity, but also the brain physiology that is connected to energy regulation.”
True enough, both medications are successful when it comes to weight loss because they affect brain processes that lead to overeating. As it was mentioned, Bupropion can affect the reuptake of neurotransmitters that lead to intense food cravings. Naltrexone, on the other hand, has the ability to modify a person’s eating behavior by modifying the brain’s reward systems.
The Wellbutrin-Naltrexone pill has recently been approved for use in the United States and Europe. The available sustained release tablet comes at a dose of 90 mg and 8 mg for Bupropion and Naltrexone, respectively. According to medical experts, the recommended maximum dose for weight loss is at 360 mg Bupropion and 32 mg of Naltrexone.
Considerations While Taking Wellbutrin
Although many studies have proven that Wellbutrin leads to weight loss, the study by Anderson et al noted that “Bupropion SR seems to have a weight-neutral effect for most depressed individuals of normal weight.”
With that being said, experts recommend the use of Wellbutrin ONLY for overweight or obese individuals (in conjunction with exercise and a healthy diet of course,) as it will most likely be ineffective in normal-weight individuals who are looking for an instant way to lose further weight.
Should you decide to take Wellbutrin for weight loss, you need to disclose your complete medical history to your doctor – including ailments such as neurologic, cardiac, renal, and liver diseases, as well as glaucoma, diabetes, and other mental illnesses. Do note that Wellbutrin might cause seizures if taken with certain drugs prescribed to cure certain conditions.
Keep yourself safe by following these pointers once you get started with Wellbutrin therapy:
- Swallow your bupropion tablet entirely. Avoid chewing, crushing, or breaking the pill.
- You can take the drug with or without food.
- Store the drug in room temperature; avoid exposing it to light and moisture.
- Side effects of Wellbutrin treatment include dizziness, joint pain, mild anxiety, nausea, constipation, stuffy nose, dry mouth, and sleeping problems.
- Do not take the last dose beyond 5 pm in order to avoid the insomniac effect associated with bupropion.
- Provide a 6-hour interval in between taking dosages as this will help reduce, if not eliminate the possibility of seizures associated with Wellbutrin use.
- Wellbutrin can cause sedation and impaired concentration, as such avoid driving or performing other hazardous tasks after the intake of the drug.
- Discontinue use if you experience signs of Wellbutrin allergy such as difficulty in breathing, hives, and facial swelling.
- Consult with your doctor immediately once you experience the following adverse effects:
- Mood or behavioral changes
- Rapid heartbeat
- Manic episodes (irritability, talkativeness, heightened energy, racing thoughts, callous behavior, extreme happiness, and difficulty sleeping)
- Vision problems (blurring, tunnel vision, halos, pain, or inflammation of the area)
- It is important to distinguish signs of bupropion overdose, which include loss of consciousness, slow heartbeat, unusual tiredness, fainting, dizziness, and lightheadedness. Contact your doctor immediately once you experience any of the aforementioned symptoms.
- Women who plan are pregnant or nursing should avoid Wellbutrin as the medication can pass through the baby through breastfeeding.
- Should you need to undergo a drug test, tell the examiner that you are taking bupropion as such can lead to a false-positive result.
- Suicidal thoughts are common in young (adolescent and teen) first-time takers of antidepressants such as bupropion. As such, tell your doctor if you feel anxious, or if you experience panic attacks. Your relative or caregiver should be wary to report any signs of behavioral changes such as irritability, impulsiveness, hostility, aggressiveness, restlessness, hostility or hyperactivity, to name a few.
Here are more pointers (DON’TS) that you need to remember while undergoing Wellbutrin therapy:
- Don’t discontinue your Wellbutrin treatment abruptly as this will lead to uncomfortable withdrawal symptoms.
- Do not take Wellbutrin with Zyban, a drug prescribed to stop smoking.
- Don’t take Wellbutrin if you have an eating disorder or if you suffer from seizure episodes.
- Avoid taking bupropion if you have just stopped taking sedatives, seizure medication, or alcohol.
- If you have taken MAO Inhibitors such as linezolid, phenelzine, isocarboxazid, selegiline, rasagiline, and tranylcypromine within the past 14 days, keep away from Wellbutrin as the marriage of these drugs might cause a hypertensive crisis and untoward side effects.
In a Nutshell…
Wellbutrin is effective for weight loss, as long as two important criteria are met. You have to be a) overweight or obese and b) you must be a non-smoker.
While Wellbutrin use for weight loss is promising, ALL studies show that it is more effective if it is complimented with a healthy diet and exercise. With that being said, you can’t pin all your weight loss hopes on Wellbutrin alone – you need to do your part too. As long as you eat healthy and exercise regularly, bupropion can help out with the rest of your weight woes.
Wellbutrin Uses, Dosage & Side Effects. (n.d.). Retrieved March 11, 2018, from https://www.drugs.com/wellbutrin.html
Why and How Wellbutrin May Be an Effective Treatment for ADHD
Can I Use Wellbutrin for ADHD?
Wellbrutin is an antidepressant that is commonly prescribed as an off-label treatment for ADHD. While stimulant medications are the first line of treatment, scientific research has shown that using Wellbutrin may help to improve ADHD symptoms, including impulsivity, hyperactivity, and inattention.
About Wellbutrin: Off-Label ADHD Treatment
Stimulant medications — methylphenidates and amphetamines — are the first-line ADHD treatment prescribed by the vast majority of clinicians. Why? Because they work for 70 to 80 percent of patients with attention deficit disorder (ADHD or ADD).
But what about those who have a less-than-optimal response to stimulant medications? What about the ADHD patients with other co-existing conditions, such as depression, anxiety, or other medical conditions? What about those who hesitate to try a stimulant? An alternative medication option considered and prescribed for a growing number of adults with ADHD is Wellbutrin, the trade name for the anti-depressant drug Bupropion.
Wellbutrin was first approved for use as an anti-depressant by the Federal Drug Administration (FDA) in 1985. Since then, it has been used to treat seasonal affective disorder (SAD) and help minimize nicotine cravings when stopping smoking. Although it is classified as an anti-depressant, Wellbutrin enhances actions that impact dopamine and norepinephrine in the brain, so today it is also commonly prescribed as an “off-label” treatment for ADHD.
Are “off-label” medications legal?
Prescribing “off-label” is legal and common. A medication can be prescribed “off-label” when research has shown that it might help with a condition (like ADHD), even though it is not currently approved by the FDA for that specific condition. In this case, Wellbutrin has been approved to treat depression, and scientific studies 1, 2, 3 have shown that it might help improve concentration, focus, and other symptoms of ADHD for patients aged 18 and older.
How Wellbutrin Works: Off-Label ADHD Treatment
Wellbutrin, like other medications used to treat ADHD, affects neurotransmitter function in the brain. Specifically, it blocks the reuptake (reabsorption) of dopamine and norepinephrine by the presynaptic neuron after those chemicals have been released from the nerve cell. Medications that act in this way are called NDRIs (Norepinephrine Dopamine Reuptake Inhibitors).
Reuptake is a normal way the body controls how long a nerve signal lasts. Blocking the reuptake increases the concentration of dopamine and norepinephrine active in the brain. When more of these neurotransmitters stay active, they are available to send messages to other nerves. In this case, more is better.
Why Use Wellbutrin for ADHD Symptoms?
If stimulants are the most effective treatment for ADHD, why would someone be prescribed Wellbutrin? There are several reasons:
- Not everyone taking stimulant medication experiences a significant reduction of his or her ADHD symptoms. In these cases, adding Wellbutrin, which enhances the action of dopamine and norepinephrine in the brain, might help.
- Patients taking stimulant medications sometimes experience negative side effects. The action of Wellbutrin is different than that of stimulant medications, so some patients may experience fewer negative side effects on Wellbutrin.
- The majority of ADHD patients also have at least one comorbid condition. Co-existing conditions, such as depression and anxiety, are more than common — they are the norm for patients with ADHD. Adding an antidepressant, such as Wellbutrin, can sometimes help in treating and minimizing these symptoms.
- An underlying medical or psychiatric condition may make the prescription of a stimulant medication less than ideal. For example, a heart condition, sleep disorders, tic disorder, a history of addiction, and some other psychiatric conditions such as mood disorders may preclude a patient from safely taking a stimulant medication.
Dose and Forms of Wellbutrin for ADHD Treatment
Wellbutrin comes in three forms:
- Wellbutrin SR (sustained-release): Lasts 12 hours and is taken twice a day
- Wellbutrin XL (extended release): Lasts 24 hours and is taken once a day
For ADHD, Wellbutrin is usually prescribed in the extended release (XL) form and can be taken with or without food. It is often safely combined with another ADHD medication. The starting dose for adults is typically 150mg, and that can be gradually increased up to 450 mg daily. It’s common for the dosages to be divided into morning and nighttime. The specific dose for an individual differs depending on the effectiveness of the medication.
According to the existing research, Wellbutrin hasn’t been shown to be safe and effective for use in people younger than 18 years old.
Common Side Effects of Wellbutrin
- low appetite
- blurry vision
- agitation, increased anxiety
- difficulty sleeping
- dry mouth
- nausea or vomiting
- muscle twitching, restlessness
Important Information About Taking Wellbutrin for ADHD
- It can take some time to realize the full benefit of Wellbutrin. In contrast to the quick onset of stimulant medication, it may take patients approximately 3 to 7 days to notice any benefits of Wellbutrin. It may also take several weeks for a prescriber and patient to find the most effective therapeutic dose. Once the dose has been adjusted, it can take an additional 4-6 weeks for a patient to experience the full benefit of Wellbutrin. While the dosage is being determined, signs that the medication is working are an improved mood, increased appetite, and better sleep.
- Wellbutrin should not be discontinued without a physician’s assistance. Patients who want to stop taking Wellbutrin should discuss this with their physician. Patients may experience irritability when stopping Wellbutrin abruptly.
- Wellbutrin is not considered safe to take during pregnancy or while breastfeeding.
Patients who are pregnant or planning to become pregnant should discuss medications with their clinician.
- Wellbutrin’s black box warning is important. The FDA puts a warning on certain prescription medications that may have serious or life-threatening risks. Wellbutrin has a black box warning about the possibility of suicidal thoughts or action in children, teens, and young adults. Wellbutrin hasn’t been shown to be safe and effective for use in people younger than 18 years old. There’s no FDA-approved dosage for children. Knowing this risk helps parents, caregivers, and partners watch for any changes in their loved one such as suicidal thoughts, behavior, or attempted suicide.
For all of these reasons, it is important for prescribers and patients to discuss the benefits versus the risks of Wellbutrin, to stay in close contact, and to schedule regular follow-up appointments while taking this medication.
Though Wellbutrin is not a first-line medication treatment for ADHD, it can be helpful in treating ADHD symptoms for some people. Patients interested in adding Wellbutrin as part of an ADHD treatment plan should discuss the options with their prescribing clinician.
Laurie Dupar, PMHNP, RN, PCC, is a member of the ADDitude ADHD Medical Review Panel.
1 Barrickman LL, Perry PJ, and Allen AJ. et al. Bupropion versus methylphenidate in the treatment of attention-deficit hyperactivity disorder. J Am Acad Child Adolesc Psychiatry. 1995 34:649–657.
2 Hudziak JJ, Wilens TE, and Rosenthal NE. et al. The efficacy of extended-release bupropion in adult ADHD . Presented at the 42nd annual meeting of the American College of Neuropsychopharmacology. 7–11December 2003 San Juan, Puerto Rico.
3 Conners CK, Casat CD, and Gualtieri CT. et al. Bupropion hydrochloride in attention deficit disorder with hyperactivity. J Am Acad Child Adolesc Psychiatry. 1996 34:1314–1321.
Updated on November 12, 2019
I’ve been suffering from depression and anxiety for the past few years. Although I’ve made tremendous progress mentally due to consulting a therapist, I still feel unmotivated to do things on a daily basis, and in general just feeling down having little energy, so I decided to try medication. The psychiatrist first prescribed Aventyl (Nortriptyline), and after taking it for 3 days, I felt much worse than before… just not seeing the point in doing anything and whatever small motivation that I previously had was gone. So I stopped it and went back to the doctor. This time, he prescribed Wellbutrin (Bupropion).
I was taking 100mg Bupropion SR (generic) for about 2 weeks. I felt somewhat better the first 2 days but then felt really tired and unmotivated again. One day, after taking it for a little less than two weeks, I felt slightly better again. I went back to see the doctor and he upped the dose to 150mg XL instead of SR. Today is my third day on the 150mg XL. I was feeling really great on the first day, I felt like I had alot of energy and could have many things done. Second day, I was energetic and in a positive mood at first, but then it faded maybe around 4 hours later and I went back to feeling tired and unmotivated. Today, I felt really emotional and felt like crying when I was in public, I feel unmotivated and have no energy at all, I just want to be alone with minimal social interaction and am not happy with my life at all.
I will soon complete the third week on this drug and still no positive effects. Does anyone have experience with Wellbutrin? What are your thoughts?
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What is bupropion, or Wellbutrin?
Wellbutrin may not be suitable for people with:
- liver or kidney problems
- bipolar disorder
- high blood pressure
Those who regularly drink large amounts of alcohol may not be able to take it.
These people should not use this drug without first discussing it with their doctor.
Monoamine oxidase inhibitors
Monoamine oxidase inhibitors (MAOIs) are also used to treat depression. Anyone who is taking a MAOI should avoid Wellbutrin.
If taken together, side effects may include confusion, restlessness, stomach discomfort or pain, high body temperature, dangerously high blood pressure, leading to headaches, dizziness, and blurred vision, and an increased risk of convulsions.
- Isocarboxazid (Marplan)
- Phenelzine (Nardil)
- Selegiline (Emsam)
- Tranylcypromine (Parnate)
Wellbutrin should not be taken within 2 weeks of stopping MAOIs. Similarly, individuals should not start taking MAOIs within 2 weeks of stopping Wellbutrin.
When used to help people stop smoking, bupropion is sold as Zyban or Chantix. The Food and Drug Administration (FDA) warns that people who are taking one of these drugs to stop smoking must not take the same drug under another name to treat depression.
This will increase the dose of the same ingredients, and it may raise the risk of seizures.
Other drug interactions
Ritonavir or efavirenz are used to treat HIV infection. These can reduce the effects of Wellbutrin.
People with liver problems should discuss with their doctor whether or not Wellbutrin is suitable, before taking it.
A severe allergic reaction known as anaphylaxis can occur if a person has an allergy to any of the ingredients in Wellbutrin.
If any of the following symptoms occur, medical assistance should be sought immediately: a skin rash, itching, trouble breathing, chest pain, or swelling of the face, tongue, or throat.
Anyone experiencing any of the following reactions should seek medical advice:
- red lesions
- severe acne or a skin rash
- sores or ulcers on the skin
- fever or chills
- blistering or peeling
- loosening of the skin
Alcohol: This should be avoided or at least severely limited when using Wellbutrin, as it has been linked to neuropsychotic side effects in a few cases.
Pregnancy and breastfeeding: Mouse studies have not shown that Wellbutrin is likely to harm a pregnancy or the developing fetus. However, since drugs do not alway affect humans and animals in the same way, this drug should only be used in pregnancy and breast feeding if it cannot be avoided.
Age: It has not been approved for use under the age of 18 years.
Bipolar disorder: A major depressive episode can develop into the first signs of bipolar disorder. A doctor should monitor the patient for signs of this. Wellbutrin is not approved for use in bipolar disorder.
Driving and use of machinery: Dizziness, tiredness, blurred vision, and a false sense of wellbeing can occur when using this drug. Because of this, using heavy machinery or driving should be considered with caution.
Overdose: In rare cases, an overdose has led to seizures. Anyone who may have taken an overdose should go to the hospital.