Wellbutrin (bupropion): uses, side effects, and precautions


Wellbutrin (bupropion): uses, side effects, and precautions

Wellbutrin is the trade name for the drug bupropion. It is also sold under the names Aplenzin, Budeprion, Forfivo, and Zyban, among others. It is predominantly used to treat depression.

In the following article, we will discuss its uses, mode of action, the side effects, and any important warnings.

Here are some key points about Wellbutrin. More detail and supporting information is in the main article.

  • Wellbutrin does not act in the same way as other popular antidepressants
  • It was first discovered in 1969 and approved for use as an antidepressant in 1985
  • Some studies show that Wellbutrin might be useful in treating methamphetamine dependence
  • Side effects can include dizziness, rashes, and confusion

What is Wellbutrin?

Wellbutrin is most commonly used as an antidepressant, but it also works well as a smoking cessation aid.

Wellbutrin is classed as an aminoketone; its full chemical name is 3-chloro-N-tert-butyl-β-ketoamphetamine.

Wellbutrin is one of the most frequently prescribed antidepressants in the English-speaking world.

The drug was first synthesized and patented by Burroughs Wellcome (now part of GlaxoSmithKline) in 1969 and was approved for clinical use in the United States in 1985.

The primary uses for Wellbutrin are to treat depression and ward off depression in people affected by seasonal affective disorder (SAD). Wellbutrin is also useful as a smoking cessation aid.

Wellbutrin has a different mode of action to other common antidepressants such as selective serotonin reuptake inhibitors (SSRIs). Because of its alternative mechanism, Wellbutrin is often prescribed as an add-on medication for those with depressive episodes that do not respond sufficiently to SSRIs.

Wellbutrin is chosen in preference to other antidepressants because its use is less likely to cause weight gain or sexual dysfunction. However, it does carry a risk of inducing seizures in people already prone to seizures; this seizure risk forced the drug off the market for a short time, and the recommended dosage was reduced.

How does Wellbutrin work?

Wellbutrin's action is complex and only partly understood. SSRIs work by selectively blocking the reuptake of serotonin.

Wellbutrin, however, is referred to as a norepinephrine-dopamine reuptake inhibitor (NDRI); but this is not the only actions the drug takes; Wellbutrin is also an antagonist at nicotinic receptors. In other words, the drug blocks receptors at which nicotine normally binds, explaining its use in smoking cessation.

The interactions mentioned above seem to be just part of the picture. Other mechanisms are also thought to play a role.

Medicinal uses of Wellbutrin

Wellbutrin has been trialed for use in ADHD, weight loss, and bipolar depression; however, to date, only the following two uses are backed by significant evidence:

Depression

Wellbutrin is at least as effective as other popularly prescribed antidepressant medication. Additionally, it leads to less weight gain, somnolence (sleepiness), and sexual dysfunction than other forms of treatment.

Patients with major depressive disorder (MDD) who do not respond fully to SSRIs are sometimes prescribed Wellbutrin as an additional medication. Not only does the drug help treat depression, but it also appears to work actively against sexual dysfunction caused by the original antidepressants.

Smoking cessation

Wellbutrin works at least as well as nicotine replacement products to help quit smoking.

Wellbutrin has been found to significantly reduce nicotine cravings. A course of treatment normally takes 7-12 weeks, but by day 10, the individual has often stopped smoking.

Wellbutrin doubles the chances of quitting smoking after 3 months. After 1 year, ex-smokers are 1.5 times more likely to still be ex-smokers than a placebo group.

A meta-analysis comparing Wellbutrin with nicotine replacement therapies (nicotine gum and patches, for example) found that Wellbutrin was at least as effective as nicotine replacement therapies, although perhaps slightly less powerful than varenicline (a prescription drug that helps quit smoking tobacco).

Side effects of Wellbutrin

The potential side effects of Wellbutrin are:

Most common side effects

  • Restlessness and shaking
  • Dizziness
  • Anxiety
  • Trembling
  • Arrhythmia (irregular heart beat)
  • Dry mouth
  • Increased perspiration
  • Hyperventilation and shortness of breath
  • Trouble sleeping

Less common side effects

In some individuals, Wellbutrin can cause headaches.

  • Blurred vision
  • Severe headache
  • Changes in taste perception
  • Increased tiredness
  • Increased urination
  • General feeling of being unwell
  • Ringing or buzzing in the ears
  • Rashes, itching, hives

Rare side effects

  • Seizures
  • Difficulty concentrating
  • Confusion
  • Fainting
  • Distrust of people and holding false beliefs
  • Visual and auditory hallucinations
  • Anger and aggressive behavior
  • Increased heart rate
  • Restlessness and a need to keep moving

Precautions for Wellbutrin use

Before embarking on a course of Wellbutrin, it is important to note the associated precautions:

Seizures

Wellbutrin has the potential to lower the seizure threshold. This means that it may make it easier for people already at risk of seizures to have seizures. Thus, anyone who is at an increased risk of seizures should avoid it. This group includes people with the following:

  • Epilepsy
  • Benzodiazepine withdrawal
  • Alcohol withdrawal
  • Anorexia nervosa
  • Bulimia nervosa
  • Active brain tumors

Monoamine oxidase inhibitors

Anyone who is taking monoamine oxidase inhibitors (MAO) should avoid taking Wellbutrin. If taken together, side effects may include confusion, restlessness, stomach discomfort or pain, elevated body temperature, dangerously high blood pressure (inducing headaches, dizziness, and blurred vision), and increased risk of convulsions.

MAOs include:

  • Isocarboxazid (Marplan)
  • Phenelzine (Nardil)
  • Selegiline (Emsam)
  • Tranylcypromine (Parnate)

Wellbutrin should not be taken within 2 weeks of stopping MAOs. Similarly, individuals should not start taking MAOs within 2 weeks of stopping taking Wellbutrin.

Anaphylaxis

A severe allergic reaction known as anaphylaxis can occur when taking Wellbutrin. If any of the following symptoms occur, medical assistance should be sought immediately: a skin rash, itching, trouble breathing, chest pain, or swelling of the face, tongue, or throat.

Skin reactions

Should the following reactions occur, medical advice should be sought: red lesions, severe acne or a skin rash, sores or ulcers on the skin, fever, chills or blistering, peeling, or loosening of the skin.

Other notes

Alcohol should be avoided or at least severely limited.

It is also worth noting that dizziness, tiredness, blurred vision, and a false sense of wellbeing can be generated by Wellbutrin. Because of this, using heavy machinery or driving should be considered with caution.

Other groups of people who may exhibit significant adverse effects after taking Wellbutrin are those with hypertension or kidney disease.

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Section Issues On Medicine: Psychiatry