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What is Wellbutrin?

Wellbutrin (bupropion), manufactured by Glaxo Wellcome Inc., is a newer antidepressant medication approved by the FDA for the treatment of depression. Wellbutrin has also been used in an off-label capacity (not specifically approved for, but observed to be effective) to treat attention-deficit/hyperactivity disorder (ADHD) and seasonal affective disorder (SAD). Bupropion, the chemical name for this medication, is additionally sold under the brand name Zyban to help stop the urge to smoke.

How is Wellbutrin different from other antidepressants?

Classified as a dopamine-reuptake blocking compound, Wellbutrin has a chemical structure unrelated to any other antidepressant medication. Unlike some of the other recently developed antidepressants (i.e., Celexa, Paxil, Prozac, and Zoloft) that target the brain chemical serotonin, Wellbutrin acts on the brain chemicals dopamine and norepinephrine. Because of its unique makeup, Wellbutrin also has different side effects, and it may work for individuals who have not had success with other antidepressants.

What are the side effects of Wellbutrin?

Fewer sexual side effects and weight gain are associated with Wellbutrin as well as fewer reports of anticholinergic symptoms (blurred vision, dry mouth, indigestion, and constipation), cardiac problems, and orthostatic hypotension (low blood pressure occurring after standing up).

There has been much talk about Wellbutrin causing seizures. And, in fact, Wellbutrin was temporarily removed from the market after its initial release due to the occurrence of seizures in some patients. However, further investigation showed that seizures were primarily associated with high doses (above the current maximum recommended dose of 450 mg/day), a history of seizures or brain trauma, an eating disorder, excessive alcohol use, or taking other drugs that can also increase the risk for seizures. With new warnings and lower recommended doses, the chance of having seizures has been greatly reduced.

Among the other common side effects of Wellbutrin are restlessness, insomnia, headache or a worsening of preexisting migraine conditions, tremor, dry mouth, agitation, confusion, rapid heartbeat, dizziness, nausea, constipation, menstrual complaints, and rash.

How does Wellbutrin interact with other medications?

Wellbutrin and Zyban should not be taken together as they contain the same active ingredient, which could cause seizures if too much is taken. There are also other medications that make some people more likely to have seizures, so be sure to tell your doctor what drugs you are on before taking Wellbutrin. Withdrawal from alcohol or some street drugs while taking Wellbutrin can additionally increase the chance of having seizures.

It is also recommended that care be taken when combining Wellbutrin with the anticonvulsant medications Dilantin (phenytoin), Tegretol (carbamazepine), or phenobarbital or with the ulcer medication Tagamet (cimetidine). These particular drugs can cause changes in the way the body uses or reacts to Wellbutrin. (Tegretol is frequently used to treat bipolar disorder [manic depression].) People taking any medications containing L-Dopa, primarily people with Parkinson's disease, have reported stronger side effects from taking Wellbutrin. And you should not take Wellbutrin when taking the antidepressant medications called monoamine oxidase inhibitors (MAOIs).

What is the recommended dose of Wellbutrin?

Wellbutrin is available in both standard 75 mg and 100 mg tablets and in 100 mg and 150 mg sustained-release tablets. Because Wellbutrin could cause seizures in some people, your doctor will carefully and gradually increase your dose. The recommended beginning dose for the drug is 100 mg/day twice daily. Your doctor should not increase this starting dose until after at least the first three days of treatment. Once the first few days have passed, the typical dose for Wellbutrin is 300 mg/day-100 mg three times daily, with at least six hours between doses, for the standard tablets and 150 mg twice daily, with no less than eight hours between doses, for the sustained-release tablets. No single dose should exceed 150 mg, and the maximum recommended daily dose for the drug is 450 mg. Sustained-release Wellbutrin, or Wellbutrin SR, should be taken whole-not chewed, crushed, or broken-so that it is correctly absorbed by your body. Elderly individuals taking Wellbutrin are usually prescribed smaller doses of the medication.

Reviewed by Rex Cowdry, M.D., deputy executive director for research and medical director, NAMI, 2/00.