What to Know About Wellbutrin (Bupropion)

An antidepressant approved to treat MDD and SAD

A woman examines her bottle of medication.
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Wellbutrin (bupropion) is an antidepressant that treats a number of conditions. It comes as an immediate-release, sustained-release, or extended-release tablet that is taken orally. 

One factor that makes it especially unique among antidepressants is that Wellbutrin doesn't tend to affect your libido and sexual function. In fact, it's often prescribed along with other antidepressants to help counter the sexual side effects found in other types like loss of desire.

That said, Wellbutrin in any form isn't without side effects, some of which are serious, so if your doctor prescribes Wellbutrin for you, it's important to be aware of these. Some are merely bothersome and likely to disappear as your system gets used to the medication, but others may be serious and should prompt you to call your doctor right away to let him or her know that you're having problems.

side effects of wellbutrin
Illustration by JR Bee, Verywell

Uses

Wellbutrin is approved by the U.S. Food and Drug Administration (FDA) to treat major depressive disorder and seasonal affective disorder (SAD).

Off-Label Uses

Wellbutrin is also used off-label to help with symptoms of attention-deficit/hyperactivity disorder (ADHD), bipolar disorder, anxiety, and obesity. Additionally, another brand of bupropion (the active ingredient in Wellbutrin) called Zyban is used to help people quit smoking.

Before Taking

Wellbutrin is often used as a first-line antidepressant in the treatment of major depressive disorder and seasonal affective disorder. Your doctor will evaluate your symptoms and current health status to determine if Wellbutrin is right for you.

Precautions and Contraindications

Your doctor may not prescribe this drug if you have certain health conditions.

  • You should not take Wellbutrin if you have an eating disorder, angle-closure glaucoma, or a seizure disorder.
  • People with bipolar disorder may be at an increased risk of experiencing manic, mixed or hypomanic episodes after taking Wellbutrin. While bupropion is sometimes prescribed off-label to treat depressive episodes, it is not approved for the treatment of bipolar depression. Those with bipolar disorder may also have an increased risk of experiencing suicidal thoughts after taking Wellbutrin.
  • If you have a history of kidney problems, kidney disease, or liver problems, your doctor may recommend a reduced dosage of the drug.
  • Never take Wellbutrin if you have a known allergy to bupropion. You should contact emergency services immediately if you begin to experience allergic symptoms such as rash, swelling, hives, itching, and difficulty breathing.
  • The drug should not be used by women who are breastfeeding or by children.

Wellbutrin is a category C pregnancy drug, meaning that it has been shown to have adverse effects on the fetus in animal studies and that not enough studies have been conducted to determine the effect it may have in humans. For this reason, the drug should only be used during pregnancy if your doctor has determined that the potential benefits outweigh the risks.

Because older adults may have reduced kidney function, they may require smaller doses since the drug remains in the body longer.

Other NDRIs

Among antidepressants, bupropion is in a category all its own—it's the only medication in its class, called norepinephrine-dopamine reuptake inhibitors (NDRIs), that boosts the neurotransmitters norepinephrine and dopamine.

By contrast, selective serotonin reuptake inhibitors (SSRIs) like Prozac (fluoxetine) and Zoloft (sertraline) affect serotonin, while serotonin and norepinephrine reuptake inhibitors (SNRIs) such as Cymbalta (duloxetine) and Effexor (venlafaxine) boost norepinephrine and serotonin.

Dosage

Wellbutrin contains chemicals called aminoketones and comes in three versions, including:

  • Immediate release: The regular formulation, simply named Wellbutrin, is an immediate release medication, which means that it begins to work shortly after you take it. Because it acts quickly, it can be taken up to three or four times a day. This formulation is used to treat major depressive disorder (MDD). A starting dose is usually 100 mg taken twice a day and potentially increased to 100 mg taken three times a day. The maximum dose is 150 mg per single dose.
  • Sustained-release: Wellbutrin SR, the sustained release version, also treats MDD. This formulation is typically started at 150 mg once a day and potentially increased to 150 mg twice a day. It can be increased to a maximum of 200 mg taken twice a day.
  • Extended-release: Taken once a day, Wellbutrin XL is used to treat MDD and to prevent seasonal affective disorder (SAD). It's typically started out as a dose of 150 mg once a day and can be increased to 300 mg or even 450 mg maximum, both taken once a day.

Modifications

In some cases, your doctor may prescribe a modified dosage of the drug due to possible side effects or another health concern.

  • With liver impairments: The dosage is often lowered to a maximum dose of 75mg per day for those with moderate to severe liver impairment.
  • With kidney problems: Your doctor may also lower your dosage or the frequency of use if you have kidney impairments.
  • After or before MAOIs: If you have previously taken an MAOI or are switching to an MAOI, you should allow 14 days between the discontinuation of your previous drug and the initiation of your new treatment.

How to Take and Store

You should always take your medication as directed. Always swallow pills whole and never crush, chew, break, or mix with other substances. The drug can be taken on an empty stomach or with food.

Your medication should be stored at room temperature and protected from light and moisture.

If you happen to miss a dose of bupropion, take it as soon as you remember. Any remaining doses for the day should be taken at least four hours apart. Never take two doses at once to make up for a missed dose. Taking two doses at the same time can increase your risk of experiencing a seizure or an accidental overdose.

Never stop taking your medication suddenly. If you stop suddenly, your symptoms may worsen. If you want to stop taking Wellbutrin, talk to your doctor about tapering off of your medication gradually.

Side Effects

Common

Side effects may go away within a few weeks as your body adjusts. The most common side effects for Wellbutrin, Wellbutrin SR, and Wellbutrin XL include:

Severe

Some side effects of Wellbutrin can be severe or even potentially life-threatening. Get medical help right away if you experience any of these while taking any version of Wellbutrin: 

  • Skin rash; hives; itching; difficulty breathing; a feeling of tightness in your chest; swelling of your mouth, face, or tongue; and/or unusual hoarseness, all signs that you may be having a serious allergic reaction to the drug
  • Changes in vision
  • Changes in sexual desire or function
  • Chest pain
  • Confusion
  • Dark urine
  • Delusions or hallucinations
  • Fainting
  • Rapid or irregular heartbeat
  • Fever, chills, or a sore throat
  • Hearing problems
  • Changes in your menstrual cycle
  • Worsening depression and/or suicidal thoughts
  • Exaggerated feelings of well-being
  • Trouble concentrating
  • Panic attacks
  • Aggressiveness
  • Hostility
  • Impulsiveness
  • Agitation
  • Inability to sit still
  • Pale-colored stools
  • Swollen, blistered, or peeling skin
  • Seizures
  • Severe headache
  • Severe or lingering joint or muscle pain
  • Severe or lingering nausea, vomiting, or stomach pain
  • Severe or lingering nervousness, restlessness, or insomnia
  • Difficulty breathing
  • Unusual swelling
  • Yellow skin or eyes

Warnings and Interactions

Seizures and suicidal thoughts are two of the scariest potential side effects of Wellbutrin. Seizures are rare with this drug, but do be aware that the risk of seizures is about four times greater with Wellbutrin than with other antidepressants. For that reason, it's especially important to let your doctor know if you have or have had a seizure disorder; you take any other medications that contain bupropion, such as Zyban (for quitting smoking); or you have or have had an eating disorder such as anorexia or bulimia, as seizures are more likely to occur with these disorders.

Antidepressant drugs like Wellbutrin may increase the risk of suicidal thoughts and behavior in children, teens, and young adults up to age 24, especially when they first start taking the medication or when there's a change in their dose.

If you have a child taking Wellbutrin or another medication for treating depression, keep a close eye out for signs of self-harm or suicidal thinking.

Interactions

There are a number of potential interactions that can occur when taken at the same time as Wellbutrin. Other medications may influence how bupropion works or increase the risk of side effects. These include:

  • MAOIs
  • Other antidepressants including fluoxetine, sertraline, and venlafaxine
  • Antipsychotics such as risperidone or haloperidol
  • Corticosteroids including prednisone
  • Blood thinners
  • Adderall
  • Thyroid medications such as levothyroxine
  • OTC pain relievers such as ibruprofen
  • Diabetes medications including metformin

Using Wellbutrin with alcohol may also influence the frequency and severity of side effects, including seizures and suicidal thoughts.

Managing Side Effects

Check-in with your doctor about any side effects you're having with Wellbutrin if they're severe, bothersome, get worse, or don't go away. Again, the most common ones are the least serious and are likely to be temporary. Get help right away if you have any side effects that could be serious or life-threatening.

In either case, don't stop taking Wellbutrin until you've checked with your doctor first. Going cold-turkey off of any antidepressant can cause your symptoms to come back or get worse. Stopping abruptly also can lead to discontinuation syndrome, an array of flu-like symptoms such as stomach upset, headache, strange sensations, and muscle aches. If you need to stop taking Wellbutrin, your doctor will guide you in gradually tapering off of it.

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Article Sources

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  • GlaxoSmithKline. Wellbutrin Prescribing Information. Updated August 2017. https://www.gsksource.com/pharma/content/dam/GlaxoSmithKline/US/en/Prescribing_Information/Wellbutrin_Tablets/pdf/WELLBUTRIN-TABLETS-PI-MG.PDF

  • Hirsch MH, Birnbaum RJ. Atypical Antidepressants: Pharmacology, Administration, and Side Effects. UpToDate. Updated September 14, 2016. https://www.uptodate.com/contents/atypical-antidepressants-pharmacology-administration-and-side-effects

  • MedlinePlus. Bupropion. The American Society of Health-System Pharmacists, Inc. National Institutes of Health. U.S. National Library of Medicine. Updated September 5, 2018. https://medlineplus.gov/druginfo/meds/a695033.html