Bupropion | Medication Guide
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Bupropion is the generic name for this medication. Brand names in the U.S. include Wellbutrin, Aplenzin, Forfivo, and Zyban.
How does bupropion work?
Bupropion is quite fascinating as it is one of the medications in the antidepressant class that really has a unique mechanism. Unlike the vast majority of antidepressants which function to increase the amount of serotonin, this medication doesn’t alter serotonin at all. This medicine functions by increasing the amount of norepinephrine and dopamine in the nerve synapse.
Given this unique mechanism, the initial benefits to improving mood and treating depression can occur more quickly, sometimes in the first 1 or 2 weeks of treatment, rather than the 4-6 weeks for other common antidepressants like sertraline and fluoxetine.
There are several different types commonly used in clinical practice: instant release, sustained release, and extended release. The choice of which option to use depends on many factors. For example, for someone who has decreased absorption due to gastric bypass or needs to take medications by a feeding tube, the instant release is the better choice. For most healthy individuals with a normal digestion, the extended release version is preferred since it only needs to be dosed once daily.
For dosing, I find that most adults respond to 150mg or 300mg of the extended release option. Only rarely, do I need to increase to the max 450mg dose.
What conditions are commonly treated with bupropion?
Major Depressive Disorder
Bipolar Depression (as long as the patient is taking a mood stabilizing secondary medication)
Sexual dysfunction caused by other antidepressants
Smoking Cessation (I have seen this be successful for some, but it’s not as effective as other medications like varenicline)
ADHD (this is a great option for people who need ADHD treatment and are not able to take stimulants)
What are the most common side effects (and non-target benefits)?
seizure risk (less than 1% and even lower with the extended release options, but for heavy alcohol users and untreated epilepsy I will typically not use this medication)
weight loss
headache
enhances sexual drive
insomnia (very important to take it early in the morning so the energizing aspect wears off by evening)
anxiety (rarely, the energizing aspect of this medicine will cause or worsen baseline anxiety)
high blood pressure (recommended to get a baseline blood pressure and then periodic measurements thereafter)
What I find useful about this medication?
This medication is older than prozac, so it has been around a long time which means that it’s well studied and safe. In my mind, this is the ideal antidepressant for most people because (1) it increases energy and concentration during the day, (2) no sexual side effects and in some there’s increased libido, (3) no concern for weight gain. I also find that, anecdotally, it’s much easier for patients to discontinue this medicine because it does not impact serotonin. The serotonin based antidepressants tend to have a more noticeable discontinuation syndrome when trying to get a patient off of them.
What are important consideration for pregnancy and breastfeeding?
Mother to Baby has a great fact sheet on this.
Sources:
Ghaemi, N. (2013). Clinical Psychopharmacology: Principles and Practice. Oxford University Press.
UpToDate. (June 2023). Bupropion (Drug Information). Retrieved from https://www.uptodate.com/contents/bupropion-drug-information?source=mostViewed_widget#F143181