Coping with depression can feel like a struggle. Depression is most commonly known for feelings of sadness, but it can also bring on other symptoms that can interfere with your moods, physical well-being, and relationships. That’s why it is critical that people with depression seek support.
While there are many ways to treat depression, some choose to take antidepressants. Wellbutrin SR and Wellbutrin XL are examples of prescription medications that treat symptoms of depression. Almost 25 million Americans use Wellbutrin to improve their mood and energy.
What Is Wellbutrin?
Wellbutrin SR and Wellbutrin XL are two prescription antidepressant medications. Both drugs contain the active ingredient, bupropion hydrochloride (HCl). Although they are similar, they cannot be taken interchangeably.
Wellbutrin SR is the sustained-release version that is taken more frequently while Wellbutrin XL is the extended-release version. The main difference is that the XL version stays in your system longer meaning you don’t have to take it as often.
Is Wellbutrin an SSRI?
Wellbutrin SR and Wellbutrin XL are atypical antidepressants that are not selective serotonin reuptake inhibitors (SSRIs). Wellbutrin medications belong to the drug class called norepinephrine-dopamine reuptake inhibitors (NDRIs). They are also known as aminoketone antidepressants. They act to balance chemicals in the brain to help improve symptoms of depression.
Wellbutrin Generic Name
Wellbutrin SR is the brand name for bupropion HCl sustained-release tablets. It was approved by the U.S Food and Drug Administration (FDA) for the treatment of major depressive disorder (MDD) in 1996.
Wellbutrin XL is the brand name for bupropion HCl extended-release tablets. It was FDA approved in 2003 for both major depressive disorder and seasonal affective disorder (SAD). Wellbutrin XL is absorbed in the body more slowly. Compared to sustained-release bupropion, the XL form releases the drug over a longer period of time.
Both Wellbutrin SR and Wellbutrin XL are available as generic bupropion tablets.
Both Wellbutrin SR and Wellbutrin XL are prescription medications that are FDA approved to treat adults with major depressive disorder. Wellbutrin XL is also used to treat adults with seasonal affective disorder.
Major depressive disorder
Major depressive disorder is a serious mood disorder which most commonly affects young adults between the ages of 18-25. More women than men suffer from this clinical depression and over 7% of American adults having at least one major depressive episode a year.
If you have MDD, you continually feel sadness and a loss of interest in your previously enjoyable daily activities. These symptoms persist to the extent that you may feel as if life isn’t worth living. You find it difficult to function in your daily tasks and may also suffer from physical symptoms such as chronic pain or digestive issues.
According to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), to be diagnosed with major depressive disorder, you will have at least five of the following symptoms Including either a depressed mood or a loss of interest/pleasure:
- Depressed mood
- Noticeable loss of interest or pleasure in your usual activities
- Significant/noticable change in weight and/or appetite
- Slower thoughts and movements, and physical and emotional reactions (psychomotor retardation)
- Fatigue or lack of energy
- Feelings of excessive or inappropriate guilt or worthlessness
- Difficulty thinking and concentrating, or indecisiveness
- Suicidal thoughts, recurrent suicidal ideation, or a suicide plan or attempt
If you have MDD you suffer from these symptoms persistently nearly every day for a minimum of two weeks.
Seasonal affective disorder
Seasonal affective disorder (SAD) is seasonal depression or sometimes called winter depression. It is important to realize that SAD is not simply a case of ‘winter blues’ but a form of major depression with distressing symptoms that can feel overwhelming and interfere with your daily activities. The symptoms usually happen during the fall and winter months and improve with the arrival of spring and more sunlight. In the U.S. most people with SAD find that January and February are the most difficult months.
SAD affects up to 10% of people in the U.S. and approximately 70% of people with depression feel worse during the winter and better in the summer. Women are four times as likely as men to suffer from SAD.
The causes of SAD have been linked to a biochemical imbalance in the brain triggered by less sunlight and shorter daylight hours in the winter. With the change in seasons, your internal biological clock or circadian rhythm is shifted resulting in you being out of step with your normal daily schedule. Indeed, people living far from the equator where there are fewer daylight hours in the winter more commonly suffer from SAD.
According to the DSM-5, to be diagnosed with seasonal affective disorder:
- Depression should be present only at a specific time of the year (such as fall and winter)
- Full remission occurs at a characteristic time of the year (such as spring)
- There have been at least two episodes of clinical depression in the previous two years
- Seasonal depressive episodes should substantially outnumber nonseasonal episodes
If you suffer from SAD, you will have symptoms of MDD and also further symptoms not typical of MDD including:
- Hypersomnia or excessive sleeping
- Increased appetite
- A craving for carbohydrates
How Does Bupropion Work?
Bupropion is a norepinephrine-dopamine reuptake inhibitor which acts to inhibit the reuptake or absorption of chemicals or neurotransmitters in the brain. These neurotransmitters include dopamine, serotonin, and norepinephrine. Depression is thought to occur due to an imbalance in the amounts of neurotransmitters released from neurons on brain cells. Bupropion therefore works to allow more dopamine, serotonin and norepinephrine to be available and improve your mood.
Before You Take Bupropion
Bupropion should only be taken for its FDA approved uses—MDD or SAD. Any off-label usage should not be considered without consulting your doctor. Bupropion cannot be taken without a prescription from your doctor.
You cannot take bupropion if you have an allergy or hypersensitivity to bupropion.
Other medical conditions
Before you start taking medication to treat your depression, you will need to discuss with your doctor your medical history including any existing medical conditions you may have. Wellbutrin may cause seizures, especially if you have certain medical conditions or use certain drugs. To make sure bupropion is safe for you, let your doctor know if you have any of the following medical conditions:
- Bipolar depression or bipolar mania or other mental illness
- A seizure disorder, head injury, or brain or spinal cord tumor
- An eating disorder such as as anorexia or bulimia
- Angle closure glaucoma
- Kidney or liver disease since this can affect how well you can break down and eliminate bupropion from your body
- Heart disease, high blood pressure, of if you’ve had a heart attack
Pregnancy and Wellbutrin
If you are pregnant, notify your provider right away. There is limited data on the safety of Wellbutrin during pregnancy. It may also not be safe to nurse your baby while on Wellbutrin since the drug can enter your breast milk.
Bupropion can interact with various other medications and affect how well other drugs work. Such drug interactions may also result in some serious side effects which are preventable if you let your doctor know all the medications you are currently taking or have recently taken. These include all over-the-counter (OTC) medications or off-the-counter supplements. Once you are taking bupropion, let your doctor know whether you start or stop taking supplements.
It is important that you have not taken a monoamine oxidase inhibitor (MAOI) in the last 14 days or are about to take an MAOI within the next 14 days when starting bupropion. This is because an MAOI can interact with bupropion and cause your blood pressure to rise dangerously and lead to a serious condition called serotonin syndrome.
St. John’s wort is an herbal supplement used to treat depression and it should not be combined with bupropion or any other depression or anxiety medications. Other medications that may interact with bupropion include:
- Aripiprazole (Abilify)
- Alprazolam (Xanax)
- Amphetamine/dextroamphetamine (Adderall)
- Buspirone (Buspar)
- Citalopram (Celexa)
- Cholecalciferol (Vitamin D3)
- Clonazepam (Klonopin)
- Duloxetine (Cymbalta)
- Escitalopram (Lexapro)
- Fluoxetine (Prozac)
- Lamotrigine (Lamictal)
- Levothyroxine (Synthroid)
- Lisdexamfetamine (Vyvanse)
- Paroxetine (Paxil)
- Quetiapine (Seroquel)
- Sertraline (Zoloft)
- Varenicline (Chantix)
- Venlafaxine (Effexor)
- Zolpidem (Ambien)
Wellbutrin and alcohol
Avoid drinking alcohol with bupropion as this can increase the risk of uncommon side effects such as seizures, hallucinations, delusions, paranoia, mood and behavioral changes, depression, suicidal thoughts, anxiety, and panic attacks.
Make sure that your doctor knows if you drink a lot of alcohol normally because if you stop drinking suddenly this can also increase your risk of seizures while on bupropion.
Bupropion can reduce your mental alertness so avoid driving and carrying out other activities where you need to be alert until you know how bupropion affects you.
The dosage of bupropion depends on which form of the drug you are taking (SR or XL). Your doctor will discuss with you which form and dose is suitable for you. You will start off on a lower dose which will be slowly increased if needed. Do not increase your dose without consulting with your doctor. Increasing your dose too fast can cause seizures in some people.
The following are the recommended dosages of bupropion HCl:
- Bupropion SR (sustained release) is to be taken twice daily; once in the morning and once in mid-afternoon. The dose usually ranges from 100 mg twice daily up to 200 mg twice daily.
- Bupropion XL (extended release) releases the drug over a longer period of time than bupropion SR and so only needs to be taken once a day in the morning. The dose ranges from 150 mg to 450 mg.
- Bupropion XL 150 mg can be taken once daily in the morning. The dose may be increased up to a maximum of 300 mg once daily.
You can take bupropion with or without food but it is recommended to take with food to prevent stomach upset. The tablets need to be swallowed whole without being chewed, crushed, or broken. This is important to do so that your medication is not released too quickly and does not cause serious side effects.
What happens if I miss a dose?
Always take your medication according to your doctor’s instructions and what it says on the information sheet that comes with your tablets.
If you miss a dose of bupropion SR, take it as soon as possible. Then take the remaining doses for the day at evenly spaced times at least four hours apart. Do not try to compensate for your missed dose by taking a double dose.
For the bupropion XL form, do not take an extra tablet to make up for your missed dose. Wait for the next day and take your dose at the regular time.
How long does it take for Wellbutrin or bupropion to work?
Your energy, sleep, or appetite may improve within the first two weeks of taking bupropion which means your medicine is working. However you need to be a little more patient to see improvements in your mood and interest in your daily activities; this can take 4-6 weeks.
Keep your follow-up appointments with your doctor to make sure you are continuing on the best dosage for you.
Can you stop bupropion cold turkey? Does bupropion cause withdrawal symptoms?
When you and your doctor have determined it is time to stop taking bupropion, the safest way is to taper your dose to reduce the risk of some unpleasant withdrawal symptoms. However, this only needs to take one or two weeks.
When you stop taking bupropion, 99% of the drug is eliminated from your body in under 5 days.
Common Side Effects
Common Wellbutrin or bupropion side effects include but are not limited to:
These side effects will normally resolve over the first one to two weeks as you continue to take the medication.
Does Wellbutrin cause or treat anxiety?
About 2% of people stop taking Wellbutrin shortly after starting it because of anxiety-related side-effects. Such symptoms including anxiety, feeling restless, unable to sleep, and shaking may occur if the dosage is increased too quickly.
Conversely, there is some preliminary research and anecdotal evidence that bupropion may help with anxiety in some people. In fact, there are doctors who prescribe Wellbutrin off-label (not FDA approved) for anxiety disorders.
Does Wellbutrin cause weight loss?
Wellbutrin may have a side-effect of weight loss. This is the opposite to SSRI antidepressants which can cause weight gain. Studies have shown that if you take Wellbutrin and watch your diet, you can lose significant weight. However, the FDA has not approved Wellbutrin for weight loss.
Bupropion is not suitable for everyone who suffers from depression. You may have a pre-existing medical condition or be taking another medication that would preclude you from being suitable to take bupropion. Discuss with your doctor about whether you can try other medications, various therapies such as cognitive-behavioral therapy, psychotherapy, acceptance and commitment therapy (ACT), or other ‘talk therapies’. Many people suffering from depression find such therapies very helpful.
Wellbutrin vs. Lexapro
Wellbutrin and Lexapro are similar in that they are both antidepressants used to treat major depressive disorder. The difference is that Wellbutrin also treats seasonal affective disorder (SAD) while Lexapro is also FDA approved to treat generalized anxiety disorder.
Wellbutrin and Lexapro belong to different drug classes. Wellbutrin is an aminoketone, while Lexapro is an SSRI. This means that Wellbutrin works in the brain to prevent the reuptake or absorption of dopamine and norepinephrine in addition to preventing the reuptake of serotonin.
The two drugs have some side effects in common and both drugs interact with MAOIs.
Wellbutrin vs. Zoloft
Both Wellbutrin and Zoloft have some common characteristics. They are both antidepressants used to treat major depressive disorder. However, Wellbutrin also treats seasonal affective disorder while Zoloft has many other FDA approved uses. These include treating obsessive-compulsive disorder, panic disorder, post-traumatic stress disorder, social anxiety disorder, and premenstrual dysphoric disorder.
Wellbutrin and Zoloft belong to different drug classes. Wellbutrin is an aminoketone, while Zoloft is an SSRI. As we mentioned above, this means that Wellbutrin works in the brain to prevent the reuptake or absorption of dopamine and norepinephrine in addition to preventing the reuptake of serotonin.
The two drugs have some side effects in common and both drugs interact with MAOIs.
When to See a Doctor
Major depression including seasonal affective disorder can be effectively treated. Go to see your doctor so that you can discuss which is the best medication and/or other therapy for you. Once you are being treated, you will feel a noticeable difference in your mood and interest in your daily activities.
If you start to take bupropion, it is very important that you let your family and close friends know you are taking an antidepressant. This is because when you start to take bupropion or other antidepressants, including SSRIs, you are at a greater risk of suicide thoughts or actions. This is especially true in young people aged up to 25 years. It is vital that you immediately seek medical assistance if you start having changes in your mood or suicidal ideation.
Make sure to get the necessary emergency medical assistance if you have signs of a rare allergic reaction to bupropion. Symptoms to watch for include:
- Skin rash or hives
- Difficulty breathing
- Swelling of your face, lips, tongue, or throat
- Severe dizziness
In the rare case you have a serious side effect, stop taking bupropion and call your doctor without delay. Serious side effects include:
- Chest pain
- Rapid, irregular heart
- Rise in blood pressure
- Tinnitus (noise or ringing in the ears)
- Irrational fears
- Muscle or joint pain
- Swelling of the face, throat. tongue, lips, eyes, hands, feet, ankles, or lower legs
- Difficulty breathing or swallowing
If you think you have overdosed on bupropion, call 911 or call Poison Control at 1-800-222-1222. Symptoms of overdose can include:
- Slurred speech
- Non-regular heart beat
How K Health Can Help
Anxiety and depression are among the most under-reported and under-treated diseases in America. Nearly 20% of adults in the US suffer from mental health illness and fewer than half receive treatment. Our mission is to increase access to treatment for those suffering in silence.
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K Health articles are all written and reviewed by MDs, PhDs, NPs, or PharmDs and are for informational purposes only. This information does not constitute and should not be relied on for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.