PsychRounds: The Psychiatry Podcast [NDRI] - Buproprion (Wellbutrin)
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Dec 22, 2023 Dive into the fascinating world of Bupropion, an NDRI with a rich history as both an antidepressant and smoking cessation aid. Discover its unique effects on neurotransmitters and how it stands out with fewer sexual side effects. The discussion highlights its FDA approvals for seasonal affective disorder and smoking addiction, along with promising off-label uses like treating methamphetamine use disorder. Learn about the potential benefits and risks, including its association with seizures, and why it’s underutilized despite its effectiveness.
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Bupropion's Unique Mechanism
- Bupropion is a norepinephrine dopamine reuptake inhibitor (NDRI) and is activating, often dosed in the morning.
- It lacks serotonergic effects and shows anti-inflammatory activity, useful especially for depressed overweight patients with high CRP.
Choosing the Bupropion Formulation
- Prefer bupropion XL formulation for once-daily dosing and lower seizure and GI side effect risks.
- Start at 150 mg and titrate up to 300-450 mg as needed for effectiveness.
Bupropion vs SSRIs Benefits
- Bupropion's antidepressant efficacy is similar to SSRIs but lacks sexual side effects.
- It can cause weight loss, contrasting the mild weight gain often seen with SSRIs.