Wellbutrin Explained: Usage, Dosage, And Side Effects

Every day, nearly 25 million Americans take a prescription called Wellbutrin (K Health). There are a number of symptoms or diagnoses that may prompt a physician to write a Wellbutrin script, but as with any unfamiliar drug, patients may want to be well-informed about a medication before adding it to their daily routine. 

Other prescriptions, health history, treatment goals, and insurance are just a few of the things to consider when another medication may be incorporated into your life. Deciding on Wellbutrin will ultimately be up to the patient with guidance from their physician, but you may want to take some notes and gather some research in your own time before visiting with your doctor to make the final call. Here is everything you need to know about Wellbutrin before choosing it for your treatment plan, including which conditions it may be taken for, common side effects, the different versions of this drug, dosage, and more. 

The medical community developed bupropion specifically to create a more tolerable antidepressant, according to a report in The Primary Care Companion to the Journal of Clinical Psychiatry. Despite Wellbutrin's side effects proving to be milder than those of existing drugs, the acceptance of bupropion has been touch and go over the years, says Psychiatric Times. Bupropion led the second generation of antidepressants as the first "modern" one to hit markets in 1985. The medication didn't last long before it was pulled due to a concerning amount of associated seizures, but by the time the dosage was reconfigured and the drug was re-released in 1989, another widely popular antidepressant — fluoxetine, known by its name brand Prozac — had been on the shelves for two years. 

It was discovered that bupropion's earliest formulation was to blame for its correlation with seizures; the NDRI was originally prescribed as a three-times-daily immediate release formula, and patients who accidentally took their doses too close together were most likely to be at risk for seizures. Because of widespread approval of Prozac and the lasting fear of bupropion's concerns with seizures, the generic Wellbutrin could never regain the momentum it once had. In 2018, an entirely different antidepressant — clomipramine — was determined as the biggest seizure risk by a study, Psychiatric Times notes. 

A sustained-release (SR) version of bupropion was approved by the FDA in 1996, followed by an extended-release (XL) in 2003 (via The Primary Care Companion to the Journal of Clinical Psychiatry). 

Wellbutrin is a norepinephrine and dopamine reuptake inhibitor, or NDRI. In fact, it is the only NDRI currently on the market, says WebMD. Another major type of antidepressants are SSRIs, which stands for selective serotonin reuptake inhibitors. Around 70% of patients taking antidepressants are prescribed an SSRI, according to a Frontiers in Psychiatry report. Common SSRIs include Prozac, Celexa, Zoloft, and Lexapro. 

The way NDRIs and SSRIs manage their targeted chemicals in the brain is different. NDRIs prevent norepinephrine and dopamine levels from dropping, while SSRIs actively increase serotonin production, explains Difference Between. NDRIs are primary used to target depressive disorders and smoking cessation, while SSRIs can also target compulsion disorders and phobias. 

Though these two types of medications are the most common antidepressants, they are the only kinds of drugs used to regulate these chemicals in the brain. Per WebMD, other types include: serotonin-norepinephrine reuptake inhibitors (SNRIs), norepinephrine reuptake inhibitors (NRIs), and serotonin-norepinephrine-dopamine reuptake inhibitors (SNDRIs). As the names suggest, each one regulations the reabsorption of different combinations of chemicals. 

For those under the age of 25, taking antidepressants comes with a heightened risk of suicidal ideation, according to the Mayo Clinic, but many mental health experts agree that the benefits of antidepressants may outweigh the risks, and research shows that the use of antidepressants in young people still decreased the rate of suicide despite the increased rate of suicidal thoughts. According to Medline Plus, only "a small number" of children and young adults up to 24 years old who used bupropion in clinical studies experienced suicidal thoughts. Children under 18 are rarely prescribed Wellbutrin, but doctors may grant exceptions in cases where it is the best medication for a particular child. 

What does the process leading up to an antidepressant prescription for a child look like? The patient should first be evaluated by a child psychiatrist or pediatrician, or a family doctor who's familiar with the diagnosis and treatment of child and teen mental health conditions. The physician will want to know the patient's family history of mental illness and/or suicide, review any potential risk factors that may lead to harm of self or others, and perform an assessment that determines evidence of a mood, anxiety, attention, or eating disorder, explains the Mayo Clinic. Finally, the child's parents and doctor will discuss treatment options and goals. 

If you or anyone you know is having suicidal thoughts, please call the National Suicide Prevention Lifeline by dialing 988 or by calling 1-800-273-TALK (8255)​.

Have a hard time settling down after hitting the hay? Wellbutrin is known in some cases to agitate or cause troubles with insomnia, according to the Med Shadow Foundation. A report published in The Primary Care Companion for CNS Disorders details that the immediate release form of Wellbutrin is most likely to cause insomnia, and taking the extended release formulation in the morning hours will decrease the risk of sleep troubles due to a lower concentration of the drug in your system during the evening. The researchers recommend not taking Wellbutrin IR after 2 or 3 p.m. to avoid a peak level of bupropion in your system at night. 

Despite the side effect of causing trouble falling asleep (especially for those in the early stages of taking bupropion), Wellbutrin may ultimately improve the quality of rest, says Psychiatric Times. Bupropion is known to reverse the disruptions that depressive disorders cause to sleep — including entering REM cycles too quickly, issues with REM density and latency, and inadequate slow-wave restorative sleep — while SSRIs are known to make those issues worse. Wellbutrin is also less likely to cause restless leg syndrome, a common sleep disorder of SSRI patients. 

Patients with anxiety disorders should be aware of how bupropion can impact their stress and anxiety levels before starting the medication. The connection between Wellbutrin and anxiety is complex; some cases report that Wellbutrin has actually helped to mitigate anxiety disorders in patients, but has agitated or caused anxiety in orders (via Healthline). According to the FDA, a small number of clinical trial participants — around 2% — experienced such severe anxiety that their use of Wellbutrin had to be stopped altogether. Others chose to incorporate anti-anxiety medications or sedatives into their regimen to cope with Wellbutrin's side effect while still taking it. Symptoms closely related to anxiety, such as irritability, agitation, and restlessness, are often reported simultaneously, says Psych Central. 

Worsened or new anxiety is not always the case for those who begin taking Wellbutrin, however. A report in The Primary Care Companion to the Journal of Clinical Psychiatry details that Wellbutrin treats anxiety associated with depression more efficiently than the SSRIs fluoxetine (Prozac) and sertraline (Zoloft). Psychiatric Times notes that cases of anxiety as a side effect happen at no higher of a rate with Wellbutrin than with other antidepressants. The best way to discourage anxiety in Wellbutrin patients, the source says, is to start patients at low doses and gradually increase to the target dose, then switch to Wellbutrin XL. 

Sudden discontinued use of Wellbutrin can cause withdrawal symptoms (via American Addiction Centers). Withdrawal symptoms are most likely in instances of Wellbutrin abuse (via snorting or injecting the drug) but can occur even if the medication has been taken appropriately over an extended period of time. Signs that a patient may be in bupropion withdrawal include: headaches and/or dizziness, irritability, hostility, aggression, flu-like physical symptoms such as fever, aches, and sweats, anxiety, depression, insomnia, nausea or stomach cramps, suicidal thoughts, balance issues, heat sensitivity, or sweating. Signs of withdrawal are likely to start within three to five days after use stops. 

Tapering off Wellbutrin should always be done under medical guidance and supervision. According to the American Addiction Centers, a Harvard Medical School article suggests that longtime bupropion users be tapered off from 300 milligrams to 200, then 150, then 100 milligrams. Harvard Health Publishing recommends taking at least two weeks and up to six weeks between dose changes.

There are multiple reasons that a patient and their physician may find that Wellbutrin isn't the best option for them, ranging from the drug's effectiveness to side effects to accessibility and cost. Unfortunately, bupropion is a bit of a lone wolf in the antidepressant world, as it's the only norepinephrine-dopamine reuptake inhibitor (NDRI) currently sold on the market (per WebMD), so options that act similarly to Wellbutrin in the body are limited. Aplenzin is another NDRI that uses bupropion as an active ingredient; the difference between this drug and Wellbutrin is the type of salt used as the inactive ingredient, according to GoodRx. Aplenzin is typically more expensive than Wellbutrin, according to Medical News Today. 

Other alternatives to Wellbutrin are most atypical antidepressants, per the Mayo Clinic, and these include: vortioxetine, an SSRI under the name brand Trintellix; mirtazapine, brand names Remeron or Remeronsoltab, a tetracyclic antidepressant also used for insomnia due to its sedative properties; nefazodone, a serotonin antagonist and reuptake inhibitor (SARI) usually reserved as an alternative after other antidepressants don't work out due to its risk for liver disease; trazodone, an SARI also used as a sleeping pill; and vilazodone, brand name Viibryd, an SSRI and partial serotonin antagonist.