Last updated 4/3/2024
Bupropion is an antidepressant, but quite different than the more usually prescribed medications like fluoxetine/Prozac and escitalopram/Lexapro. It doesn’t cause weight gain or sexual problems like the more commonly used antidepressants. And it works just as well.
Why isn’t bupropion used more often?
Answer: three reasons.
1. Once daily dosing (but it didn’t start that way)
First, when it first came out, it had to be taken twice or even three times a day, and the dose had to be carefully increased. Now, there’s an “extended release” version that can be taken once every morning. But when bupropion came out, prescribers had other antidepressants that could be taken once daily. Tough to compete with that.
2. Anxiety and insomnia? Wrong.
Second, many prescribers (primary care providers, psychiatric nurse practitioners, and psychiatrists) have the impression that bupropion can make anxiety worse. That’s not clear. Some studies say that bupropion can treat anxiety just as well as the other antidepressants. But once an impression like this gets going, it’s hard to reverse.
Related: many prescribers think that bupropion can make insomnia worse. True, it is less likely to help than some other antidepressants that promote sleep (like mirtazapine/Remeron — you know, the one that can cause a lot of weight gain). In truth, a once-per-morning dose of extended release bupropion does not cause insomnia. (The prescribers are right: the old versions of bupropion, immediate and sustained release, do worsen insomnia. But there’s very little reason to use those versions anymore).
3. Seizure risk no higher than other antidepressants
Third, the immediate release version of bupropion was associated with a slightly increased risk of having a seizure. That risk was cut in half with the SR version. And with the XL, the rate of seizures in one study was lower than with citalopram or escitalopram (for which it’s rare for “seizures” to even be mentioned).
But that association of bupropion and seizures has stuck around, likely influencing prescribers choice.
Bupropion side effects (mostly beneficial)
- No effect on sexual function. In fact bupropion is used as an “antidote” to sexual problems caused by other antidepressants. Makes you think: if you’re going to add bupropion to counter a side effect of an antidepressant, why didn’t you just start with bupropion in the first place?
- No weight gain. In fact it’s been combined with another medication that blocks appetite somewhat and sold as a weight loss drug (bupropion + naltrexone = “Contrave”). In some people that’s been associated with weight loss.
- Smoking cessation: right, it also helps people stop smoking. (Better than a nicotine patch in several studies (e.g. this one).
Oh, side effects? Just like other antidepressants: nausea, dizziness, headaches were all slightly more common on bupropion than on placebo. Not much (because these are common on placebo too).
Tapering off: easier than other antidepressants
When stopping other antidepressants, withdrawal symptoms are common. How common? That’s a big controversy. See more on my page about Tapering Antidepressants. But at least one person in 100 has severe withdrawal symptoms.
Withdrawal symptoms are much less common when stopping bupropion. How much less? That’s hard to say, since we don’t have a good figure for any antidepressant. But despite controversy about withdrawal rates in general, pretty much everyone agrees that bupropion causes the least trouble.
If/when you are tapering off bupropion, here’s some information that might be useful.