Bupropion

Bupropion is an antidepressant that treats depression without the usual negative side effects of other antidepressant medications.

Bupropion is an antidepressant that also goes by the brand name Wellbutrin. Though it has multiple uses, it is commonly used to treat depression. When compared to other antidepressants, bupropion tends to be better tolerated, having fewer unfavorable side effects.

What Is Bupropion (Wellbutrin)?

Bupropion, also known by the brand name Wellbutrin, is an antidepressant prescribed to treat depression and seasonal affective disorder, as well as help with smoking cessation. Other names for bupropion include: 

• Chantix
• Aplenzin
• Forfivo
• Budeprion
• Zyban

Background and History

Nariman Mehta first made bupropion in 1969. Mehta patented the drug, along with the pharmaceutical company Burroughs Wellcome, now known as GlaxoSmithKline, in 1974. In 1989, bupropion obtained FDA approval for the treatment of major depressive disorder.

The initial form of bupropion was an immediate-release formula, meaning the active drug was released right away after taking it. In 1996, a slow-release formula was approved that allowed the active drug to be released slowly over time, increasing the required time between doses. Finally, an extended-release version of the drug, Wellbutrin XL, was approved in 2003, which increased release time, even more, allowing for it to be taken only once a day.

Bupropion was uniquely developed as an antidepressant to improve on the existing available antidepressants of the time. It was designed to be safer and better tolerated by patients. It has since been approved for multiple uses. In 1997, bupropion was approved for smoking cessation treatment, and in 2006 it was approved to treat seasonal affective disorder.

Now, bupropion is approved in over 50 countries for the treatment of depression and smoking cessation. In 2019, it was the fourth most prescribed antidepressant and ranked 28 among the most prescribed medications in the United States.

Uses for Bupropion

The most common use of bupropion is to treat depression. It can also be used to treat seasonal affective disorder, a condition where people experience depression in autumn and winter when there are fewer hours of daylight. 

Bupropion is sometimes also used to treat attention deficit hyperactivity disorder (ADHD) when it cannot be treated using conventional medications. 

Additionally, bupropion has been reported to help in the treatment of methamphetamine addiction by easing symptoms of withdrawal.

Depression Treatment

The antidepressant bupropion is used to treat depression. It is effective on its own, but can also be used in combination with other antidepressants such as selective serotonin reuptake inhibitors (SSRIs). It is commonly used for patients who do not respond well to other antidepressant medications or added as a second therapy to improve the effectiveness of other antidepressants.

Bupropion may be considered more favorable than other antidepressants due to a decreased chance of undesirable side effects like weight gain and sexual dysfunction. It has been shown to reverse sexual dysfunction induced by other antidepressants and can lead to weight loss.

Bupropion can also be used to treat depressive episodes that occur with bipolar disorder. Bipolar disorder is characterized by mood episodes that are either elevated, where the person is experiencing increased energy and happiness, or depressed. Bupropion is thought to help stabilize mood, avoiding the swing between the two polar ends of the spectrum.

Smoking Cessation

Bupropion has also been used for smoking cessation. The versions of bupropion commonly used for smoking cessation include Zyban and Chantix. Bupropion is approved as an initial treatment for people wishing to quit smoking. It has been shown to diminish the severity of cravings and help relieve withdrawal symptoms.

Roughly 1 in 5 smokers will successfully quit when taking bupropion and continue to be smoke-free for one year following treatment. The dose used for smoking cessation is slightly lower than that used for depression. Patients are prescribed 150 mg bupropion daily for six days, followed by 150 mg twice daily for seven to nine weeks. 

How Does Bupropion Work?

Similar to other antidepressants, bupropion works by inhibiting neurotransmitter reuptake in the brain. When reuptake is prevented, more neurotransmitters are available for the brain to use. The neurotransmitters that are affected by bupropion include dopamine and norepinephrine, which differs from most antidepressants, which inhibit reuptake of serotonin or a combination of serotonin and another neurotransmitter.

Bupropion aids in smoking cessation because it interferes with the pleasurable effects of nicotine, the addictive substance found in cigarettes. Bupropion blocks nicotine from binding to receptors on nerves in the brain and throughout the body, preventing those nerves from signaling in response to nicotine.

The recommended dose of bupropion is 100 mg three times daily, or 150 mg twice daily, for a total of 300 mg per day. A single dose of bupropion should not exceed 150 mg and a daily dose should not exceed 450 mg. More recently, a single dose of up to 450 mg has made it easier for patients to adhere to the dosing schedule. This unique formula — also known as Wellbutrin XL, or extended-release — of the drug allows the active ingredients to be released slowly over time, giving the patient a steady dose for 24 hours.

How long does it take for bupropion to work? The effects of bupropion will not be felt immediately. It takes several weeks to months for bupropion to start alleviating the symptoms of depression. Once bupropion is working, continued use is recommended to prevent depressive symptoms from returning or withdrawal symptoms from occurring.

Effectiveness of Bupropion

Bupropion is just as effective at treating depression as other common antidepressants, such as SSRIs and serotonin-norepinephrine reuptake inhibitors (SNRIs). The effectiveness is measured by comparing depression symptoms in patients receiving the antidepressant to patients taking a placebo control. Bupropion improves depression symptoms in a similar number of patients and to a similar extent as the other available antidepressants.

Side Effects

Though bupropion is generally tolerated well for both short and long-term use, there are some side effects associated with its use. Common side effects of bupropion use include:

• Trouble sleeping
• Headache
• Nausea or vomiting
• Dizziness
• Constipation
• Increased sweating or fever
• Tremors or shaking
• Dry mouth
• Feeling nervous
• Feeling tired or weak
• Anxiety
• Panic attacks
• Irritability
• Aggression
• Restlessness
• Blurred vision
• Ringing in ears

Though they rarely occur, if you experience major side effects, you should seek medical help immediately. The severe side effects include:

• Seizures
• Delirium
• Hallucinations
• Fast or irregular heartbeat
• Chest pain

Precautions

Bupropion should not be taken if you have also taken a monoamine oxidase inhibitor (MAOI) within the past few weeks. Bupropion is also known to interact with several other drugs, including benzodiazepines and sedatives commonly used to treat anxiety. Because of the many possible bupropion interactions, it is recommended for a person to speak with their doctor about other medications they’re taking before taking bupropion.

Additionally, bupropion and alcohol should not be mixed. Alcohol consumption with bupropion can counteract its effects and increase the risk of seizure.

Bupropion is not an addictive substance, but it can cause withdrawal symptoms if you stop using it. Therefore, a person should contact their doctor before they stop using bupropion.

As with other antidepressants, there is a chance of increased suicidal thoughts with bupropion use. The risk is greater in youth and young adults under the age of 24. If a person is taking bupropion and experiences suicidal thoughts, it is important that they seek help and talk to their doctor immediately. 

If you know someone experiencing suicidal thoughts, you can provide them with mental health first aid until they are able to get professional treatment.

Taking Bupropion While Pregnant

Drug use during pregnancy can have consequences for the mother and baby, so it’s important to check with a health care provider before starting medications during pregnancy. 

Like some other substances, it is not known whether there are safety concerns with bupropion and pregnancy. Therefore an expectant mother should speak with her doctor before taking bupropion while pregnant. 

To learn more about drug use during pregnancy, visit this resource page from The Recovery Village.

What Happens If You Miss a Dose?

If a dose of bupropion is missed, wait until the next time you would normally take the pill to take another. Do not double a dose to make up for the missed one. This action could lead to an overdose of bupropion, as the maximum single dose is 150 mg and each individual dose is usually 100-150 mg.

It is important to maintain a proper dosing schedule, as stopping bupropion use can cause withdrawal symptoms. You should contact your doctor before completely discontinuing use. Symptoms of withdrawal include:

• Vomiting or feeling nauseous
• Headache
• Dizziness
• Numbness in hands or feet
• Recurring vivid dreams

What to Do In Case of Overdose

If it is not taken as recommended, you can overdose on bupropion. If an overdose occurs, it could potentially be life-threatening. To treat bupropion overdose, get help immediately by calling 9-1-1 in the U.S., or call the poison control helpline at 1-800-222-1222.

Symptoms of bupropion overdose include:

• Fever
• Stiff muscles
• Seizure
• Respiratory failure
• Loss of consciousness
• Irregular or fast heartbeat
• Hallucinations

Get More Information on Bupropion

For more information on bupropion, you can: 

• Visit Medline’s bupropion information page
• Talk with your primary care doctor
• Speak to another health care professional
• Call The Recovery Village, if you’re concerned that you need treatment

If you or a loved one are struggling with addiction and depression, The Recovery Village can help. To learn more about our comprehensive treatment plans, contact The Recovery Village to speak with a representative.

Medically Reviewed By – Dr. Trisha Sippel, PhD

Dr. Sippel is a diversely trained scientist with expertise in cancer biology and immunology. Read more

Editor – Camille Renzoni

Cami Renzoni is a creative writer and editor for The Recovery Village. As an advocate for behavioral health, Cami is certified in mental health first aid and encourages people who face substance use disorders to ask for the help they deserve. Read more