Bupropion is sold under the brand name "Wellbutrin".
Bupropion is an antidepressant unrelated to all other antidepressants. It is FDA approved for use in Major Depression in adults 18 years old and older and to stop smoking.
Bupropion itself may work by increasing the effectiveness of dopamine in the nucleus accumbans, which is the pleasure center of the brain. The primary active metabolite of bupropion mildly blocks reuptake of norepinephrine. Bupropion is the closest we have in the US antidepressant armamentarium to a purely catecholaminergic (norepinephrine and dopamine) medication. For this reason it is often used to augment or boost the effectiveness of other antidepressants.
Bupropion is processed for elimination from the body (“metabolized”) in the liver to several active metabolites of which hydroxybupropion is the most important. The half life of bupropion itself is quite short. The half life of hydroxybupropion is about one day. When stopped abruptly (which we do not recommend) the bupropion is eliminated over two days but hydroxybupropion requires up to five days to be completely eliminated.
Bupropion is generally well tolerated. It can cause nausea, headaches and sleep problems, but it usually does not cause sexual problems and it often causes a bit of a weight loss. It has been associated with seizures, however, in people without epilepsy. The primary risk factors for seizures are a history of seizures or epilepsy, history of a serious head injury, and active bulimia nervosa. The longer acting formulations, of which there are two, bupropion SR and bupropion XL, seem to be less liable to cause seizures. The risk of seizures increases significantly at doses over bupropion 450 mg per day.
Bupropion can reduce the effectiveness of the CYP450 2D6 metabolic pathway in the liver so that it should be combined with medications eliminated via this pathway only with caution.
All antidepressants have a warning from the FDA against new onset suicidal “thoughts and behaviors”. There is no evidence children taking antidepressants are suiciding; quite otherwise, there is very good evidence that children treated for depression suicide less often than children who are depressed who are not treated with antidepressants.
If you miss a dose of bupropion you should not take extra bupropion with the next dose. Bupropion should generally be taken during the day to avoid sleep disruption.
