Wellbutrin for Bipolar Disorder: Risks and Benefits

Wellbutrin, also known by its generic name, bupropion, is an antidepressant that may also be used for management of depression in bipolar disorder. It is available in immediate release 75 and 100 mg tablets, sustained release 100 and 150 mg and 200MG Wellbutrin SR tablets, and extended-release 150 mg, 300MG and 450MG Wellbutrin XL formulations.

Wellbutrin for Bipolar Disorder

Bipolar disorder is a challenging condition to live with because it is characterized by the opposite moods of mania and depression, both of which can be quite extreme and neither of which is optimal. 

Antidepressants, including Wellbutrin, are widely used in managing depression in bipolar disorder. There are concerns when it comes to antidepressants and bipolar disease. One of these concerns is called phase switching, which is a shift in mood from depression to mania. This can be a serious problem because mania can result in impulsive or dangerous behavior. Studies show that Wellbutrin has the same risk of inducing phase shifting as that of most other antidepressants when it is used in bipolar disorder. 

Wellbutrin may work to reduce depressive symptoms by inhibiting the reuptake of the neurotransmitters serotonin, dopamine and norepinephrine, and prolonging their action, which prevents depression. 

General Guidelines for Starting Wellbutrin

If you are starting to take Wellbutrin for the first time, your doctor will begin your medication at a low dose first and gradually increase your dose, due to the risk of side effects. 

When you first begin taking Wellbutrin, your initial dosage should be no more than 200 mg/day, taken as two 100 mg doses per day, ideally spaced about 12 hours apart. This may be increased to a target dose of 300 mg/day on the fourth day, taken as 100 mg doses at least six hours apart. A maximum dose of 450 mg per day can be taken as 150 mg, three times per day.

If you experience agitation, restlessness or insomnia, you should take a lower dose for a longer period of time and/or increase the dosage more gradually. These are common side effects that sometimes may occur when you start taking the medication and then resolve as you adjust to it. 

Do not expect to feel improvement of your depression right away. It may take two to three months for you to feel the antidepressant effects of the medication. 

Cautions and Side Effects of Wellbutrin

Here are some things you should watch out for when taking this medication:

Side Effects

• The most common side effects of Wellbutrin include headaches, dry mouth, nausea, and insomnia. If you experience these symptoms, make sure to tell your doctor if they are severe or if they suddenly worsen. 
• A small percentage of people experience anorexia (lack of appetite) while taking bupropion, so patients with a history of anorexia nervosa (deliberate food restriction) or bulimia should not take this medication. You should not take Wellbutrin if you cannot afford to lose more than 5% of your current body weight.  
• Studies show that bupropion is not harmful during pregnancy, but of course, your obstetrician should know all medications you are taking at all times.
• At doses of 400-450 mg/day, your risk of seizures triples, although it's still very, very small: four in every 1,000 people experience seizures from Wellbutrin at a dose this high.
• If you miss a dose, skip it. The risk of seizure is dose-dependent, and doubling up is more likely to cause a seizure.

Drug and Alcohol Interaction

• If you're taking an MAOI antidepressant, you should wait at least two weeks following your last dose of that medication to start Wellbutrin because these medications can interact with each other.
• Never take both Wellbutrin AND Zyban, which is also bupropion. Zyban is used for smoking cessation, but taking both will dangerously increase your dose of the same chemicals.  
• Drinking alcohol if you take bupropion increases the risk of seizures.