Wellbutrin XL aka Bupropion: A Guide for Patients
Introduction:
Wellbutrin XL, known generically as bupropion XL, is an antidepressant medication primarily used to treat Major Depressive Disorder (MDD) and Seasonal Affective Disorder (SAD). It functions by influencing the levels of certain chemicals in the brain, notably norepinephrine and dopamine, which help regulate mood. Wellbutrin is distinctive as an antidepressant for several reasons, such as its absence of sexual side effects, its tendency not to cause weight gain (and in many cases, it contributes to weight loss), its ability to enhance motivation, and its capacity to boost energy levels.
What Percentage of Patients Benefit?
Clinical studies and years of use indicate that Wellbutrin XL effectively manages symptoms of depression in a significant portion of patients. It is particularly noted for its efficacy in improving mood, energy levels, and overall emotional stability.
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.
Dosing Guidelines:
Wellbutrin XL is typically prescribed in extended-release tablets, which should be taken once daily in the morning. The dosing starts at 150 mg daily and often increases to 300 mg daily. The maximum dose is 450 mg daily. It is crucial not to crush, chew, or break the tablets as this can affect the release and absorption of the medication.
Optimal Time for Administration:
For best results, Wellbutrin XL should be taken in the morning to prevent potential interference with sleep, as it can cause insomnia in some patients.
Potential Side Effects:
While Wellbutrin XL is effective in treating depression, it may cause side effects in some individuals. Common side effects include dry mouth, headache, nausea, constipation, and sweating. More serious side effects, such as seizures, manic episodes in patients with bipolar disorder, and suicidal thoughts, especially among younger individuals, have been reported.
Contraindications and Cautions:
Wellbutrin XL is contraindicated in patients with seizure disorders, eating disorders, or those undergoing abrupt discontinuation of alcohol or sedatives. Caution is advised when used concurrently with other medications that can affect the seizure threshold.
It should not be used in patients who are at risk for laxative abuse, primarily because of its potential to lower the seizure threshold. Patients who abuse laxatives may experience electrolyte imbalances, particularly hypokalemia (low potassium levels), which can increase the risk of seizures. Since bupropion itself can lower the seizure threshold even at therapeutic doses, combining it with a condition that already predisposes a patient to seizures (like electrolyte disturbances from laxative abuse) could significantly increase the risk of a seizure event.
FDA Approval and Regulations:
Wellbutrin XL has been approved by the FDA for the treatment of major depressive disorder and seasonal affective disorder. The approval is based on extensive research demonstrating its safety and efficacy for these conditions.
Off-Label Benefits Supported by Research:
Research also supports the use of Wellbutrin XL for other conditions such as ADHD, sexual side effects from other types of antidepressants, weight loss, low energy, low motivation, significant apathy, and for aiding in smoking cessation (under the brand name Zyban). These off-label uses are backed by clinical studies and are often considered when traditional treatments are not effective.
Sources:
MedlinePlus: https://medlineplus.gov/druginfo/meds/a695033.html
NAMI: https://www.nami.org/about-mental-illness/treatments/mental-health-medications/types-of-medication/bupropion-wellbutrin
NCBI: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4162783/
