Bupropion

Bupropion is a type of prescription medicine called an antidepressant, which means it helps treat depression and other conditions. Common brand names for bupropion include Wellbutrin, Zyban, Aplenzin, and Forfivo.

It’s thought that people with depression have lower levels of certain brain chemicals, including dopamine and norepinephrine. Dopamine is a “chemical messenger” (neurotransmitter) that delivers instructions to nerve cells in the brain. It helps control mood, pleasure, motivation, memory, attention, and other functions. Norepinephrine is also a chemical messenger. While it’s known for keeping your body alert and ready to respond to stress, it also plays a role in mood, memory, and interest.

Bupropion works by increasing the levels of dopamine and norepinephrine in your brain. It’s considered a norepinephrine-dopamine reuptake inhibitor, or NDRI.

There are three main types of this medicine: 1) bupropion immediate-release tablets;
2) bupropion SR (a sustained-release tablet); and 3) bupropion XL (an extended-release tablet). Bupropion also comes in different chemical formulations, including bupropion hydrochloride (the main ingredient in Wellbutrin, Zyban, and Forfivo) and bupropion hydrobromide (the main ingredient in Aplenzin).

Bupropion has been around for a long time. Despite the constant development of newer medications, it’s still a preferred choice for many people because it’s effective and is generally well-tolerated.

All three forms of bupropion are approved to treat adults diagnosed with a type of depression called major depressive disorder, or MDD. Certain brand names are also approved to treat other conditions. Wellbutrin XL is also approved to treat adults with seasonal affective disorder (SAD), and Zyban is approved as a smoking cessation treatment.

Bupropion is sometimes prescribed in an off-label (non-FDA approved) capacity. Common off-label uses include treatment for:

• Anxiety
• Bipolar depression
• Attention-deficit hyperactivity disorder (ADHD)
• Nerve pain
• Obesity
• Post-traumatic stress disorder (PTSD)
• Sexual dysfunction caused by other types of antidepressants
• Social phobia
• • Treatment of ADHD, anxiety, or depression in children under 18

Bupropion offers a wide range of benefits that vary by person. The benefits you may experience depend on several factors, including your diagnosis and the severity of your symptoms.

Symptoms commonly improved by bupropion include:

• Changes in appetite (loss of appetite or overeating)
• Excessive, persistent, or uncontrollable worry
• Fatigue
• Feeling restless or fidgety
• Feeling sluggish
• Feelings of worthlessness or guilt
• Food cravings
• Impulsivity
• Irritability
• Loss of interest in previously enjoyable activities
• Low sex drive
• Nicotine cravings and withdrawal symptoms
• Persistent low mood or sadness
• Seasonal fluctuations in mood
• Sleep problems (insomnia or excessive sleeping)
• Thoughts of suicide
• Trouble concentrating

Don’t worry if you don’t see some of your symptoms referenced above; this is just a sample list. If your doctor recommends you take bupropion, it’s because they think it may be a good fit for you.

That’s one of the questions we hear most. Unfortunately, there isn’t a straightforward answer. That’s because many factors influence a person’s response to a medication. Because we are all different, some medicines work better for certain people than others. These differences include our genetics, age, gender, underlying health conditions, and other medications we may take.

At Brightside, we understand the subtle differences between common antidepressants and other medications – and why certain treatments may be better suited to some people more than others. You can also take comfort knowing Brightside providers closely monitor your progress to make sure you’re on the ideal medication.

Keep in mind that it may take at least two weeks before you notice any improvements with bupropion. If you’re not sure it’s working, don’t stop taking it; instead, tell your provider. Sometimes we simply need to adjust your dosage before you experience the maximum benefits.

We understand that mental health concerns often can’t wait, so if you need to meet with a provider right away to discuss a new or existing medicine, Brightside offers same-day consultation and telehealth services.

The amount of time you’ll need to take bupropion or any antidepressant depends on your personal treatment plan – which is based on your diagnosis, symptoms, and how well you respond to the medication.

For example, people who use Zyban for smoking cessation typically take it for less than a year. Those who use Wellbutrin XL for SAD may take it every year starting in the fall, then finish treatment in the spring.

If you use bupropion to treat depression, the amount of time you’ll need to take it is hard to predict. However, doctors typically recommend patients take antidepressants for six months to a year after they no longer feel depressed. People taking depression medication for the first time may only need treatment for a year, while those with recurrent, persistent, or treatment-resistant depression may take medication longer.

Most importantly, we recommend that you keep taking your medicine until your doctor says it’s time to stop – even after you start to feel better. Stopping too early can cause symptoms to return.

Studies have shown that antidepressants relieve symptoms of depression about 40-60% of the time – and additional treatments (such as therapy and lifestyle improvements) on top of medication often lead to the best outcomes.

To get the best results with medication, it’s important to consistently measure progress during treatment. This is known as Measurement Based Care, and it’s the approach we use at Brightside. It’s common to adjust the dose and/or medication when starting antidepressants until you find just the right fit.

Bupropion’s use as a treatment for depression, anxiety, and other disorders has been studied for decades. Some of the research that supports its effectiveness is summarized below:

Bupropion was initially approved for MDD by the Food and Drug Administration (FDA) in 1985 after its efficacy was established in three placebo-controlled clinical trials.

In the years since, researchers have continued studying its safety and efficacy ¬– particularly for depression. A meta-analysis of 51 studies evaluating the effectiveness of bupropion as an antidepressant showed it works better than a placebo. This analysis also showed that in head-to-head trials comparing bupropion to other common antidepressants, bupropion showed an “equivalent effectiveness.”

The FDA approved Zyban as a smoking cessation treatment in 1997. Its efficacy was demonstrated in three placebo-controlled, double-blind trials in chronic cigarette smokers who did not have depression symptoms.

Wellbutrin XL was approved to treat SAD (in addition to MDD) in 2006 following three clinical trials that tested the drug in adults with a history of MDD that followed an autumn-winter seasonal pattern. In all three trials, the percentage of patients who were depression-free at the end of treatment was significantly higher in the bupropion group than in the placebo group.

There is limited research showing the effectiveness of bupropion as an off-label treatment.

It’s normal to worry that taking an antidepressant will alter your personality. As long as you’re taking the correct dose, bupropion should not change who you are. Instead, it can help you feel like yourself again by increasing your motivation and energy levels and helping you find pleasure in your regular activities.

Just remember that your symptoms won’t improve overnight. Keep taking your medication as prescribed, and talk to us if you have any questions or concerns.

We’re here to help you find a treatment that provides the most benefit with minimal side effects.

Compared to many other antidepressants, bupropion is well-tolerated and has a lower risk of side effects such as sexual dysfunction and weight gain. However, like any medication, bupropion can cause side effects that range from mild to severe. It’s important to review the FDA’s warnings before starting this medicine – especially because research has shown that antidepressant use may increase suicide risk in people under 25.

The most common side effects associated with bupropion often go away after a week or two. They include:

• Constipation
• Dizziness
• Drowsiness
• Dry mouth
• Headache
• Insomnia
• Nausea 
• Shakiness
• Weight loss

Because bupropion increases the risk of seizures, especially compared to other antidepressants, this medication is not recommended for people with seizure disorders. Other serious side effects associated with bupropion include:

• Confusion
• High blood pressure
• Irregular heartbeat
• Menstrual changes
• Skin rash
• Vision changes

You should also know that drinking alcohol while taking bupropion may increase your risk of side effects, including seizures and suicidal thoughts.

Taking bupropion for depression can make you feel better. When this happens, you may think it’s time to stop taking it. But it’s important to remember that bupropion is probably contributing to those good feelings.

You shouldn’t stop taking bupropion without talking to your doctor. That’s because sudden, abrupt withdrawal from an antidepressant can cause your symptoms to come back or get worse. You may also experience a group of flu-like side effects known as antidepressant discontinuation syndrome. These side effects include headaches, muscle aches, and an upset stomach.

If you and your doctor decide you’re ready to stop taking bupropion, you’ll do so by gradually lowering your dosage. This is often referred to as “tapering off.”

It’s important to let your doctor know if you’re pregnant or planning to become pregnant. We’ll work together to find treatment options that work for you but won’t harm your unborn baby.

Bupropion is a pregnancy category C drug. This means studies in animals have shown it can harm the fetus – but there haven’t been enough studies about adverse effects on a human fetus. For this reason, you should only take bupropion during pregnancy if your doctor believes the benefits outweigh the potential risks.

You should also talk to your doctor if you plan to breastfeed, as bupropion passes into breast milk.

Bupropion is a safe medication – and is not considered addictive – when taken as prescribed, under the supervision of a doctor. However, there is a risk of addiction among people who take the drug recreationally. When misused or abused, bupropion can act as a stimulant; people who use it to get high say it’s similar to cocaine.

The risks of bupropion overdose include seizure, abnormal heart rhythm, and death.

If you have concerns about your dependence on this medicine, don’t hesitate to talk to your Brightside team.

You can view the FDA black box warning for bupropion here. If you have questions about whether the black box warning for bupropion applies to you, please talk to your doctor.