Bupropion, commonly known by its brand names Wellbutrin and Zyban, has garnered attention in recent years for its effectiveness in treating depression, seasonal affective disorder (SAD), and even to aid in smoking cessation¹. While hailed as a valuable tool in mental health treatment, it’s crucial to acknowledge the potential dangers associated with this medication.
I myself was recently rather surprised by a side effect I didn’t know about a drug that I’d been taking for a few years. The notification spurred me to dig a bit deeper.
A Shocking New Alert
Both because it is my job to do so, but also because I am a human navigating the real world, I continue to find new and concerning side effects that may also worry me enough to weigh my options. This past week, it was a “personalized education printout” that caught my eye and reminded me of an important lesson: we must be vigilant in our own healthcare journey.
My note came from my pharmacy. After a weekend visit to Urgent Care, I was prescribed Prednisone to assist in clearing my lungs from bronchitis (which I had alongside a long-lasting sinus infection). With the help of an antibiotic, prednisone would serve to reduce the swelling, that contributed to my struggling lungs and stuffy nose. Besides ruining my weekend, the medication sparked an alert at my national chain drug store. By adding Prednisone, I was increasing my risk for seizures!
My warning noted I should seek medical help right away if “you experience jerking movements in your arms or legs, stiff muscles, or lack of awareness of yourself or your surroundings,” as they are signs of a potential seizure.
“Your medicines may increase your risk for seizures,” was the alarming phrase that stood out in bold font. I knew my medication had side effects. All medications do. But, this warning reminded me to dig a little deeper, and be sure I knew about all of my risks on Bupropion, on its own, in conjunction with other medications I may be prescribed, and what adverse events I should watch for while taking this antidepressant.
A Personal Experience with Bupropion
I have, personally, battled depression for most of my adult life. As each patient can be different, finding the right balance of approaches for your individual needs is important. Not all medications impact a person in the exact same way. You may experience different side effects. You may find it works better for you than it does for someone else or not at all. Each body has its own unique chemistry, and no “one-size-fits-all” solution exists for this difficult mental illness.
Medication is also not your only option. I have personally found that walking outdoors greatly improves my depression. Even being outside can help my moods. I, personally, have not been able to completely remove medication for my mental health needs. But, adding important life changes has helped immensely.
In addition to exercise, others find relief with integrative or complementary medicine approaches (which can be done instead of or alongside prescription medication), including:
- Yoga
- Mindfulness and Meditation
- Acupuncture
- Aromatherapies
- Socialization
One review of 64 different studies² (including 7,104 people) noted small improvements of depression in patients that tried acupuncture. The review notes that by the end of treatment, those who tried acupuncture saw an improvement of “1.69 points on the Hamilton Depression Rating Scale (HAMD).” For reference, the HAMD scale typically gauges those with a score of 0-7 to be in the acceptable, “normal” range (or in clinical remission), while a score of 20 or more is considered a moderate severity.
Thankfully, after years of trial and error, I have found my own balance of what works for me. But, it wasn’t easy. My first stages included trying the commonly prescribed serotonin reuptake inhibitors (SSRIs). Sadly, the side effects over time began to outweigh the benefits for me. It was then, that my doctor suggested bupropion, which works differently from SSRIs’ usual method. This new medication has helped me over the last two years.
Here’s what I learned.
What is Bupropion?
Bupropion is a medication primarily used as an antidepressant and smoking cessation aid. Unlike many other antidepressants, bupropion does NOT belong to the class of SSRIs, which sets it apart from many medications, in terms of its mechanism of action.
SSRIs, on the other hand, work by preventing your brain cells from recycling a neurotransmitter called serotonin, leaving more of it available to act in your brain. However, bupropion works differently—by preventing the recycling of two other neurotransmitters: dopamine and norepinephrine. It is called an NDRI, or a dual “Norepinephrine and Dopamine Reuptake Inhibitor.”
While the drug didn’t work for everyone in the studies, the review³ pointed out that when it does work, its main benefit was that it often does so while causing fewer side effects than SSRIs such as sexual dysfunction, weight gain, or sedation.
Side Effects of Bupropion
While known for its unique approach to treating depression, bupropion is also building a reputation for causing fewer side effects than other antidepressants. For my personal situation, the effects of SSRIs were becoming more than I could tolerate. I was gaining weight far too quickly and easily. I was, and continue to suffer from the lasting impacts in my sex life. Switching to Wellbutrin helped with my weight, but some side effects of the SSRIs I used before continue to affect me, even though I’ve stopped the medication.
However, that does not mean it is without its own side effects. Here are some of the side effects of Bupropion.
Common Side Effects
- Headache
- Weight loss
- Dry mouth
- Trouble sleeping (insomnia)
- Nausea
- Dizziness
- Constipation
- Fast heartbeat
- Sore throat
Rare Side Effects
In less than 10 percent of the population, rare side effects included:
- Skin rash
- Sweating
- Ringing in the ears
- Shakiness
- Stomach pain
- Muscle pain
- Thought disturbances
- Anxiety
- Angle closure glaucoma (symptoms of angle closure glaucoma may include eye pain, changes in vision, swelling or redness in or around the eye).
Seizures
One of the most significant risks associated with bupropion is the potential to lower the seizure threshold. Seizures are rare but can occur, particularly at higher doses⁴. Individuals with certain medical conditions, such as eating disorders, brain injuries, or a history of seizures, may be at higher risk of experiencing a seizure while taking bupropion. Additionally, combining bupropion with other medications that lower the seizure threshold, such as certain antidepressants or stimulants, can further increase this risk.
Prednisone is another drug that can raise your risk of seizures. That’s why it sparked the alert at my pharmacy, which had records showing that I was taking bupropion. This drug, designed to help me kick a lung issue, when taken alongside bupropion, put me at a higher risk for this particular side effect.
Psychiatric Symptoms
While bupropion is used to treat depression, a mental health condition, in some cases, it can exacerbate psychiatric symptoms or even precipitate new ones. This may include
- Agitation
- Anxiety
- Panic attacks
- Suicidal thoughts or behaviors (particularly in young adults and adolescents).
Cardiovascular Effects:
Bupropion has been associated with a slightly increased risk of cardiovascular events, including hypertension and tachycardia (rapid heartbeat). Patients with preexisting cardiovascular conditions should exercise caution when considering bupropion therapy, and close monitoring is crucial, especially during the initial stages of treatment.
In one small study⁵, 14% of patients discontinued use of the drug because of cardiovascular risks.
Bupropion for Special Populations
Bupropion is not for everyone. Some populations need to be particularly cautious of its risks.
Pregnancy and Breastfeeding
The safety of bupropion during pregnancy and breastfeeding is a subject of ongoing debate. While some studies suggest a potential risk of adverse outcomes⁶ for babies, particularly when used in the first trimester, others indicate that the benefits may outweigh the risks in certain cases. Pregnant or breastfeeding individuals should discuss the potential risks and benefits of bupropion with their healthcare provider.
A “Mother to Baby” fact sheet showed that, as bupropion does enter the breast milk in small amounts, it may have caused seizures in two cases involving six-month-old babies. The seizures ended when the medication was stopped.
Elderly Patients
Elderly patients may be more susceptible to certain side effects⁷ of bupropion, including confusion, dizziness, and falls. Dosing adjustments may be necessary, and close monitoring is essential to ensure safety and efficacy.
You Control Your Own Health and Wellness
While bupropion can be an effective treatment for depression and even smoking cessation, it’s essential to recognize and understand the potential dangers associated with this medication. Patients and healthcare providers alike should weigh the risks and benefits of any medication carefully, considering individual medical history, comorbidities, and other medications you may end up needing. Close monitoring and open communication are key to minimizing risks and ensuring the safe and effective use of bupropion in clinical practice.
As for me, I have found the benefits of Wellbutrin to outweigh the risks I’ve encountered. For me, it is still a medication worth taking, even if it doesn’t “mix well” with prednisone. Thanks to my pharmacy’s warning note, I took extra precautions by simply monitoring my body closely. I had family near me during my illness, and let them know my risk increased, too, just in case anything unexpected happened. Thankfully, I didn’t experience any seizure symptoms of any kind.
At the end of the day, pharmacy warnings are a great help in reminding us to be diligent and careful about what we put into our bodies. But, it is only ourselves that we can trust to be the “gatekeeper” of our health and wellness.
Be sure you are asking your doctor questions, keeping track of all of your own medications, and staying informed about your medication and treatment options!
