Wellbutrin
Wellbutrin is not an FDA-approved ADHD medication, but rather an antidepressant sometimes used off label to treat ADHD symptoms including hyperactivity and distractibility in people with attention deficit hyperactivity disorder.
Generic Name: Bupropion HCL
What is Wellbutrin?
Wellbutrin (Generic Name: bupropion HCL) is an antidepressant medication primarily used to treat depression, major depressive disorder, and seasonal affective disorder in adults. Its safety has not been established for children or young adults under the age of 18.
Wellbutrin may help to relieve common symptoms of depression including disinterest in typical activities, impaired concentration, change in weight or appetite, and insomnia.
Wellbutrin has been neither studied nor approved to treat attention deficit hyperactivity disorder (ADHD). Physicians sometimes prescribe it “off-label” to treat symptoms. However, the clinical evidence for bupropion for ADHD “far weaker” than for FDA-approved treatments, according to the American Academy of Child & Adolescent Psychiatry1.
There is very little published evidence that bupropion works well for ADHD. Two studies found that the benefits of bupropion for ADHD were barely detectible and in some cases only achieved at dangerously high dosages that could increase risk of seizures2,3. It is a low side effect, low efficacy option used by patients who are unwilling or unable to take stimulant medications.
When prescribed for ADHD treatment, it can be prescribed in conjunction with a stimulant medication like Vyvanse or Adderall XR.
How Do You Use Wellbutrin to Treat ADHD?
Before starting or refilling a Wellbutrin prescription, have a conversation with your doctor, who has a holistic view of your medical history, other diagnoses, and other prescriptions. If you have questions, ask your doctor or pharmacist before you begin taking the medication.
What Is the Dosage for Wellbutrin?
As with all medications, follow your Wellbutrin prescription instructions exactly. Wellbutrin is taken orally, with or without food. It is available in two formulations:
- Immediate-release tablets (Wellbutrin SR): Taken once or twice daily with at least six hours between doses. Available in 75mg and 100mg dosages.
- Extended-release tablets (Wellbutrin XL): Taken once daily with at least 24 hours between doses. Available in 150mg and 300mg dosages. The time-release formulation is designed to maintain a steady level of medication in your body throughout the day.
If you miss a dose, wait to take your next dose at the scheduled time. You should not take two doses of Wellbutrin at the same time.
The risk of seizures is highly dose-dependent, and is no higher than other antidepressants. Taking too much Wellbutrin can increase risk of seizures. It is only when a daily dose goes above 450mg that the incidence of seizures climbs to 5%4. When beginning treatment with Wellbutrin, a patient’s dose should be increased gradually to minimize the risk of seizure.
Do not drink alcohol while taking this drug.
The optimal dosage varies patient by patient and condition treated. If you are over 60 years of age, or have certain health conditions, your doctor may recommend a lower dosage.
Your doctor may incrementally adjust your daily dosage until you experience the best response — that is, until you find the lowest dosage at which you experience the greatest improvement in symptoms without side effects.
When discontinuing treatment, or decreasing dosage, patients should work with a doctor to gradually taper the level of medication. Stopping antidepressant medications suddenly can cause new symptoms.
What Side Effects Are Associated with Wellbutrin?
Most people taking this medication do not experience any of these side effects.
The most common side effects of Wellbutrin are similar to those associated other antidepressant medications, and are as follows: agitation, dry mouth, nervousness, constipation, headache, nausea and vomiting, difficulty sleeping, dizziness, pharyngitis, muscle pain, shakiness, fast heartbeat, and heavy sweating.
Other serious side effects include increased risk of suicide or suicidal thoughts, seizures, and angle-closure glaucoma.
Taking Wellbutrin may impair your ability to drive, operate machinery, or perform other potentially dangerous tasks. This side effect usually wears off with time. If side effects are bothersome, or do not go away, talk to your doctor.
Disclose to your physician all mental health issues including any family history of suicide, bipolar disorder, mania, or depression. The manufacturer, Valeant, recommends evaluating patients for bipolar disorder prior to administration of Wellbutrin to avoid inducing a manic episode. Wellbutrin may create new or exacerbate existing behavior problems, bipolar disorder, or suicidal ideation, especially in the first few months of treatment or after a dosage change. Call your doctor immediately if you experience new or worsening mental health symptoms including reckless behavior, hallucinations, or sudden excessive happiness or irritability.
Report to your doctor any heart-related problems or a family history of heart and blood pressure problems. Wellbutrin can increase blood pressure. Physicians should monitor these vital signs closely during treatment.
The above is not a complete list of potential side effects. If you notice any health changes not listed above, discuss them with your doctor or pharmacist.
What Precautions Are Associated with Wellbutrin?
Store Wellbutrin in a secure place out of the reach of children, and at room temperature. Do not share your Wellbutrin prescription with anyone, even another person with depression. Sharing prescription medication is illegal, and can cause harm.
You should not take Wellbutrin if you:
- have or had a seizure disorder or epilepsy
- have or had an eating disorder
- are taking other medications containing bupropion
- drink a lot of alcohol or have recently stopped abusing alcohol
- take a monoamine oxidase inhibitor (MAOI)
- are allergic to bupropion or any of the ingredients in Wellbutrin
You should use caution taking Wellbutrin, and speak with your doctor if you have liver or kidney problems, seizures, bipolar disorder, a history of tumors or heart problems, or diabetes.
If you’re thinking of becoming pregnant, discuss the use of Wellbutrin with your doctor. Animal studies indicate potential risk to the developing fetus. Wellbutrin is passed through breastmilk, so it is recommended that mothers do not nurse while taking it.
Wellbutrin is not approved for use in pediatric patients.
What Interactions Are Associated with Wellbutrin?
Before taking Wellbutrin, discuss all other active prescription medications with your doctor. Wellbutrin can have a dangerous, possibly fatal, interaction with antidepressants including MAOIs.
Wellbutrin inhibits CYP2D6 enzyme, which can change how your body processes certain medications including venlafaxine, nortriptyline and more. It can impact the dosage required for CYP2B6 inducers including ritonavir, carbamazepine, and more. Wellbutrin can interact with certain dopaminergic drugs like levodopa and amantadine.
Wellbutrin can exacerbate the drowsiness created by depressants including alcohol, barbiturates, antihistamines, or other sedatives.
Share a list of all vitamin or herbal supplements, and prescription and non-prescription medications, you take with the pharmacist when you fill your prescription, and let all doctors and physicians know you are taking Wellbutrin before having any surgery or laboratory tests. Wellbutrin can give a false positive for amphetamines.
The above is not a complete list of all possible drug interactions.
More Information on Wellbutrin and Other ADHD Medications:
Why and How Wellbutrin May Be an Effective Treatment for ADHD
Non-Stimulant ADHD Medication Overview
Free Resource: ADHD Medication Tracking Log
Your Toughest ADHD Medication Questions Answered
A Parent’s Guide to ADHD Medications
ADDitude Directory: Find ADHD Specialists or Clinics Near You
Sources:
1Pliszka S et al. “Practice parameter for the assessment and treatment of children and adolescents with attention-deficit/hyperactivity disorder”. J Am Acad Child Adolesc Psychiatry. (2007) 46 (7): 894–921.
2Barrickman LL, et.al., (1995) Bupropion versus methylphenidate in the treatment of ADHD. Journal of the American Academy of Child and Adolescent Psychiatry, 34[5]: 649-57.
3Wilens Te, Spencer TJ, Biederman J (2001) A controlled clinical trial of bupropion for attention deficit hyperactivity disorder in adults. American Journal of Psychiatry; 158(2): 282-8.
4Brown TE, Romero B, Sarocco P, et al. The patient perspective; unmet treatment needs in adults with Attention Deficit/Hyperactivity Disorder. Primary Care Companion: CNS Disorders. 2019; 21 (3)18m02397.
5https://www.gsksource.com/pharma/content/dam/GlaxoSmithKline/US/en/Prescribing_Information/Wellbutrin_Tablets/pdf/WELLBUTRIN-TABLETS-PI-MG.PDF
6https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=cbc8c074-f080-4489-a5ae-207b5fadeba3
7https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=a435da9d-f6e8-4ddc-897d-8cd2bf777b21
8http://www.wellbutrinxl.com/
