Understanding Bupropion: Types, Uses, and Evidence

Condition: DepressionTopic: AntidepressantsService: Medication ManagementResources: Depression Treatment
Written By Dr. David Danish

Dr. Danish frequently works with patients using various medications, including Bupropion, to manage a range of mental health conditions. Bupropion, also known as Wellbutrin, is a medication specifically designed to help individuals with depression, seasonal affective disorder (SAD), and smoking cessation. It works differently than many other antidepressants by affecting the levels of dopamine and norepinephrine in the brain. This unique mechanism helps Bupropion avoid some of the typical side effects associated with serotonin-based antidepressants, such as weight gain and sexual dysfunction. By stabilizing these neurotransmitters, Bupropion helps alleviate symptoms of these conditions.

Bupropion’s effectiveness in treating depression, SAD, and aiding smoking cessation has been demonstrated in multiple studies. By targeting the neurochemical imbalances associated with these conditions, this medication provides a valuable tool in the comprehensive treatment plans that Dr. Danish and his team at Philadelphia Integrative Psychiatry develop for their patients. This holistic approach, which combines medication management with therapy, lifestyle adjustments, and other supportive measures, aims to address the multifaceted nature of mental health disorders.

Types of Bupropion Dosing

Bupropion is available in three different formulations: Regular, Sustained-Release (SR), and Extended-Release (XL). Each formulation has specific dosing schedules and uses.

Regular Bupropion:

  • Dosage: Typically started at 100 mg twice a day, which may be increased to 100 mg three times a day.

  • Uses: Primarily prescribed for depression.

  • Administration: Immediate-release tablets should be taken at least 6 hours apart to minimize the risk of seizures.

Sustained-Release (SR) Bupropion:

  • Dosage: Usually starts at 150 mg once a day, increasing to 150 mg twice a day if needed.

  • Uses: Approved for depression and off-label for ADHD and other conditions.

  • Administration: SR tablets should be taken at least 8 hours apart.

Extended-Release (XL) Bupropion:

  • Dosage: Often begins at 150 mg once a day, increasing to 300 mg once a day. 450 mg daily is the maximum dose. 

  • Uses: Approved for depression, SAD, and smoking cessation.

  • Administration: XL tablets are taken once daily and should not be crushed or chewed.

Evidence for On-Label Uses

Depression:

  • Bupropion is widely used for the treatment of major depressive disorder (MDD). Studies have shown it to be effective in improving mood and reducing depressive symptoms by modulating neurotransmitter levels.

Seasonal Affective Disorder (SAD):

  • Bupropion XL is specifically approved for the prevention of SAD. Patients typically start treatment in the autumn and continue through the winter months.

Smoking Cessation:

  • Bupropion (marketed as Zyban) is also approved to help people quit smoking. It helps reduce withdrawal symptoms and the urge to smoke.

Evidence for Off-Label Uses

Attention-Deficit/Hyperactivity Disorder (ADHD):

  • While not FDA-approved for ADHD, Bupropion has been used off-label to help improve focus and reduce hyperactivity and impulsivity in some patients. Studies suggest it can be a useful alternative for those who do not respond well to traditional stimulant medications.

Weight Loss:

  • Bupropion is sometimes used off-label for weight loss, particularly in combination with other medications. It can help reduce appetite and increase energy expenditure, although it is not officially approved for this use. It is also used in combination with naltrexone to create a weight loss medication called Contrave.

Energy, Motivation, and Apathy:

  • Bupropion’s stimulating effects can help improve energy levels, motivation, and reduce feelings of apathy, making it a valuable option for patients experiencing these symptoms as part of their depressive disorders or other conditions.

How Long Does It Take for Bupropion to Work?

Sleep, energy, or appetite may show some improvement within the first 1-2 weeks. Improvement in these physical symptoms can be an important early signal that the medication is working. Depressed mood and lack of interest in activities may need up to 6-8 weeks to fully improve.

After starting Bupropion, symptoms gradually decrease over a period of weeks. In MDD and SAD, sleep and other physical symptoms may improve before there is noticeable improvement in mood or interest in activities. 

Once symptoms are under control, MDD usually requires long-term treatment to help prevent the return of depressive symptoms. If you are using Bupropion for SAD or smoking cessation, the length of your treatment may be shorter, but it really depends on the individual.

Common Side Effects

Bupropion is known as one of the few antidepressants that does not cause sexual dysfunction or weight gain.

Common side effects of Bupropion include headache, weight loss, dry mouth, trouble sleeping (insomnia), nausea, dizziness, constipation, fast heartbeat, and sore throat. These side effects often improve over the first week or two as you continue to take the medication.

Contraindications

Bupropion is avoided in individuals with a history of seizures, as there is some correlation between seizures and higher doses of the medication.

Bupropion is also avoided in patients with active eating disorders, including those who are abusing laxatives, due to the increased seizure risk.

Summary of FDA Black Box Warnings

Because Bupropion is classified as an antidepressant, it carries a black box warning about the potential for suicidal thoughts or actions. Depression and certain other psychiatric disorders are themselves associated with increases in the risk of suicide. Patients with major depressive disorder (MDD), both adult and pediatric, may experience worsening of their depression and/or the emergence of suicidal ideation and behavior (suicidality) or unusual changes in behavior, whether or not they are taking antidepressant medications. This risk may persist until significant remission occurs.

Getting in Touch with Dr. Danish and his Team

At Philadelphia Integrative Psychiatry, we take pride in our ability to practice the most subtle nuances of psychiatry, which is an inherently subjective field full of misdiagnoses and lazy and inaccurate assessment techniques. We want to provide the level of care we would want for our own family members. Our holistic and integrative approach ensures that we consider all aspects of our patients' well-being in developing personalized treatment plans. If you or a loved one are seeking support for PDA or similar conditions, please text or call 610-999-6414 to learn how we can help.

For more on this topic and related subjects, check out these blogs:

A new antidepressant called Auvelity contains bupropion and dextromethorphan; read this blog for more on Auvelity including side effects, dosing, and information on how fast it works for many. 

Sources:

Disclaimer:

Dr. Danish creates these handouts based on research but they are not meant to be 100% comprehensive and patients are invited to discuss the ideas brought up in the document with their provider. For full lists of side effects on medications and supplements, refer to resources such as drugs.com and webmd.com, which are always expanding with more research occurring.

Dr. David Danish
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