Bupropion

Key facts

• Bupropion (sold as Wellbutrin and Zyban, and as generics) is used for major depressive disorder, to aid smoking cessation, and for seasonal affective disorder.
• You take it once or twice daily depending on the formulation; mood effects build over 2 to 4 weeks, while cravings for cigarettes often ease within the first 1 to 2 weeks.
• Bupropion carries a dose-dependent seizure risk: the higher the dose, the greater the chance of a seizure. It is contraindicated in anyone with a current or past seizure disorder, or with bulimia or anorexia nervosa.
• Unlike most antidepressants, bupropion rarely causes sexual side effects or weight gain, which is why it is sometimes chosen over an SSRI or added to one.

What bupropion treats

Bupropion treats major depressive disorder and seasonal affective disorder. As a separate, lower-dose product it is also used to help people stop smoking by reducing nicotine cravings and withdrawal symptoms.

How bupropion works

Nerve cells release dopamine and norepinephrine, chemical messengers involved in motivation, focus and alertness, and then reabsorb them. Bupropion blocks that reabsorption (reuptake), so more of both stay active between nerve cells. It has little effect on serotonin, which sets it apart from SSRIs and SNRIs and explains its different side-effect profile.

Before you take it

• Do not take bupropion if you have a seizure disorder, are going through alcohol or sedative withdrawal, or have a current or past eating disorder such as bulimia or anorexia; each of these sharply raises seizure risk.
• Never take bupropion within 14 days of a monoamine oxidase inhibitor (MAOI); the combination can trigger a dangerous rise in blood pressure. Bupropion has little serotonergic activity, so classic serotonin syndrome is uncommon, but combining it with other serotonergic antidepressants still needs medical supervision.
• Tell your prescriber about any head injury, brain tumour, or other medicines that lower the seizure threshold (antipsychotics, other antidepressants, tramadol), and never exceed your prescribed dose.
• In people under 25, bupropion can increase suicidal thoughts and behaviour, especially early in treatment.

Side effects

Common effects: dry mouth, insomnia, headache, nausea and tremor.

Stop and seek urgent medical care for any of these:

• A seizure.
• New or worsening suicidal thoughts, especially if you are under 25.
• A significant rise in blood pressure, chest pain or a pounding heartbeat.
• Severe rash, swelling or difficulty breathing.

Safety essentials

• Bupropion's seizure risk rises with dose. Never take more than your prescribed amount or double up on a missed dose, and avoid it entirely if you have a seizure disorder or an eating disorder.
• This class carries a warning for increased suicidal thinking in people under 25, particularly in the first weeks of treatment.
• Never combine bupropion with an MAOI, and taper off under medical guidance rather than stopping abruptly, even though withdrawal effects are milder than with SSRIs.

This page is educational and does not replace advice from a doctor or pharmacist who knows your health history.