Bupropion Review: Better Than SSRI for Depression?

Bupropion Review: Better Than SSRI for Depression?


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​​Disclaimer: None of the information in this article constitutes medical advice, and is just the opinion of the writer(s). We recommend that patients follow their doctor’s guidance in regard to prescription medication.

Bupropion, sometimes referred to by its full chemical name bupropion hydrochloride or bupropion HCL for short, is a prescription antidepressant that’s one of the most commonly-prescribed in the U.S. Unlike most medications for depression, it's not a selective serotonin reuptake inhibitor (SSRI).

But is bupropion really proven to reduce or eliminate depression in clinical research? Is it as effective as SSRI drugs? Does bupropion cause side effects? And how do real users rate its effects?

In this article we'll answer all of these questions and more as we review clinical studies on bupropion to determine if it's effective and safe for treating depression, explain whether the drug causes weight loss, investigate whether it reduces symptoms of anxiety and share a real, unsponsored user review of bupropion.

Is Bupropion Proven Effective for Depression?

The brand-name version of bupropion is called Wellbutrin, and as we noted in our Wellbutrin reviews article, there have been hundreds of clinical studies investigating the efficacy of bupropion for treating depression.

A meta-study published in 2016 analyzed a number of clinical trials on bupropion as an antidepressant. The study authors found that the drug reduced depression scores in 24 of 27 trials.

Another medical review, published in the Primary Care Companion journal, found similarly positive results. Bupropion was shown to cause a "full" or "partial" response in 65% of depressed patients, which means this percentage of patients experienced some symptom reduction or total elimination of their depression.

A more recent clinical trial evaluated whether bupropion is an effective adjunctive treatment (a drug used at the same time as another drug) for patients with depression who aren’t responding well to SSRIs.

The researchers found that when bupropion was used as an add-on therapy in this manner, it reduced depression scores by more than the group taking SSRI alone. 60% of patients using bupropion and SSRI experienced a significant reduction in their depression symptoms, while only 24% of patients on SSRIs alone did.

Based on the available research, we will conclude that bupropion is effective for treating depression.

Bupropion Side Effects

Bupropion does cause side effects in some patients, as do most prescription antidepressants. A medical review documents that “many side effects occur” in over 10% of patients on the medication. Some of the most common side effects are tachycardia (rapid heart beat), headache, insomnia and constipation.

The more rare, but more concerning side effect in our opinion is the risk of suicidal thoughts and actions. Bupropion’s FDA label contains a “black box” warning indicating this side effect, which is the most severe category of warning issued by the FDA. It indicates a side effect that may be life-threatening.

According to the drug's label, bupropion may increase the risk of suicidal behavior in children, adolescents and young adults. The risk does not appear to affect patients over the age of 24.

This information suggests that young adults or parents caring for their child may want to speak with their doctor or pediatrician about an alternative medication for depression. Not all antidepressants increase the risk of suicidality, and it seems logical to consider alternatives for this at-risk group.

Real, Unsponsored Bupropion User Review

One of the most popular YouTube reviews of bupropion is published by a creator named CoraFromYouTube and has over 100,000 views. 

Cora shares her experience after using bupropion for a month, and explains the pros and cons. The video is unsponsored (it has "Wellbutrin" in the title but remember that's the same drug, just the branded version):

Does Bupropion Cause Weight Loss?

Patients are often curious about whether bupropion causes weight loss, and the drug actually has been studied to that effect even though it's only FDA-approved for depression.

A 2002 clinical trial found that the standard release (SR) form of bupropion did cause weight loss in obese patients. Trial participants using bupropion lost 4.6% of their baseline weight over 12 weeks. This is a significant amount of weight loss, and equates to weight loss of 11.5 pounds for someone who started the trial at 250 pounds.

recent medical review of bupropion for weight loss analyzed data from three clinical trials on the topic, and documented that the medication caused weight loss in all three trials. The researchers noted that although bupropion isn’t approved by the FDA for weight loss, “There might be a role for this drug as a second-line consideration for obesity.”

Bupropion is actually one of two active ingredients in a prescription medication that’s approved by the FDA called Contrave.

It appears based on early research that bupropion does cause weight loss in overweight and obese patients. We do not recommend using the drug for that purpose alone, and it may be dangerous as that would be an "off-label" use not authorized by the FDA.

We would consider the potential for weight loss to be a secondary benefit of the medication for overweight and obese patients that are prescribed bupropion for depression.

Does Bupropion Cause Sexual Side Effects?

Many prescription antidepressants cause sexual side effects, particularly in men, so patients are often curious about whether bupropion has this risk.

An extensive meta-study published in the Cureus journal examined the side effect profile of bupropion and has some interesting findings on sexual side effects. Not only was bupropion found to be more favorable than SSRIs in regard to sexual side effects, the drug may actually improve sexual function.

The researchers noted that some medical research found bupropion to increase sexual desire and sexual frequency compared to placebo.

However, in a separate clinical trial, 6% more patients on bupropion than placebo experienced sexual dysfunction.

It appears inconclusive whether or not bupropion causes sexual side effects based on the current state of the research. Many prescription antidepressants conclusively cause sexual side effects, so bupropion appears to be superior in this regard.

Is The Brand-Name Version More Effective?

As we've mentioned previously, the brand name version of bupropion is called Wellbutrin. Patients are often curious about whether one or the other is more effective.

We would recommend that patients speak with their doctor about bupropion rather than Wellbutrin.

An extensive medical review published in 2019 compared the effectiveness of branded and generic versions of drugs, and found them to be equally effective on average. This suggests that bupropion should be equally effective to Wellbutrin, but may be cheaper.

Generic drugs are often significantly cheaper than branded drugs. On CostPlusDrugs, which is Mark Cuban’s generic drug venture, the cost of 30 days worth of bupropion SR is only $5.10, while SingleCare reports the retail price of Wellbutrin is currently $535.98.

Does Bupropion Interact With Alcohol?

Bupropion may negatively interact with alcohol if the alcohol is consumed at high doses. Bupropion’s FDA label mentions that patients who consume high amounts of alcohol should speak with their doctor prior to taking the medication, and that patients consuming high amounts of alcohol that abruptly stop while using bupropion may be at higher risk for severe side effects such as seizure.

The amount of drinks categorized as “high” is not described on the label.

It seems as though bupropion has no interactions with alcohol consumed in moderate amounts, but we would strongly suggest that patients who regularly consume alcohol speak with their doctor about what constitutes a “high” amount in the context of this potential interaction.

It may be logical for patients that regularly drink alcohol to choose an alternative antidepressant medication that does not have any interaction with alcohol to be safe.

Can Bupropion Treat ADHD?

Attention deficit hyperactivity disorder (ADHD) has been theorized to be related to dopamine dysfunction, so patients are often curious about whether bupropion can treat this condition given that it modulates dopamine levels.

An extensive medical review published in 2017 examined whether bupropion was an effective treatment for ADHD. The researchers analyzed a data set from six clinical trials, totalling 438 patients. While the drug was found to reduce symptoms of ADHD, the study authors described the evidence as “low-quality” due to methodological issues in some of the studies.

We would not recommend using bupropion for ADHD, as the drug is not approved by the FDA for this purpose and this would be an “off-label” use. There are existing medications with much more research backing for treating ADHD in adults that patients can speak with their doctor about.

Can Bupropion Treat Anxiety?

Bupropion has been studied in clinical trials for its efficacy in treating anxiety disorders.

A medical review compared data on bupropion to SSRI drugs for treating anxiety. Bupropion was 6% less effective than SSRI drugs for treating anxiety, suggesting that bupropion may be effective for reducing anxiety symptoms but is not as effective as SSRI drugs.

We would not recommend using bupropion for anxiety alone, but since the drug may be able to reduce anxiety levels somewhat, it may be a good option for patients with both anxiety and depression.

Does Bupropion Cause Withdrawal Symptoms?

While there are some case reports in the medical literature (example 1, example 2) of bupropion causing withdrawal symptoms, we cannot locate a comprehensive study proving this drug causes withdrawal symptoms for the average patient.

A case report documents one single patient’s response to a drug, and while it can be valuable in spurring further research, it doesn’t necessarily prove that a drug causes withdrawal symptoms, given that bupropion is prescribed millions of times annually and anyone can have an allergic or otherwise unique reaction to a drug (or a supplement or a food product).

Bupropion’s FDA label does not mention withdrawal symptoms other than in regard to concurrent nicotine use. Patients who smoke while using bupropion should speak to their doctor about this risk.

Bupropion doesn’t appear to cause withdrawal symptoms in patients who don’t smoke.

Is Bupropion an SSRI?

Patients are often curious about whether or not bupropion is an SSRI, because this class of drugs is typically prescribed for depression.

Bupropion is a not an SSRI, but rather a member of a drug class called norepinephrine-dopamine reuptake inhibitors (NDRI). When this type of drug is taken, the body’s natural processing and clearance of these important neurotransmitters is delayed, which causes artificially increased levels of them in the brain.

Dopamine directly affects mood, motivation and reward-seeking behavior, and low levels of this neurotransmitter are thought to be associated with higher risk of depression. 

Norepinephrine is critically involved with proper sympathetic nervous system function, which affects the response to various stimuli. Similar to dopamine, low levels of this compound have been associated with increased risk of depression.

By artificially increasing levels of dopamine and norepinephrine, bupropion theoretically normalizes their levels in the brain and normalizes depression symptoms. However, it has not been conclusively proven that patients with depression have naturally low levels of these neurotransmitters.

Bupropion Dosage

Bupropion is prescribed at a wide range of doses, and in a wide variety of different formats. The drug has an immediate release (IR) form, and an extended release (XR) form.

According to StatPearls, which is one of the largest free medical databases in the U.S., the effective daily dose range for bupropion is between 75 milligrams (mg) and 522 mg. The IR pills range between 75 and 100 mg, while the XR pills range between 100 and 450 mg.

Doctors will typically prescribe bupropion at a lower starting dose of around 75 or 100 mg, and may increase the dose slowly over the course of weeks if the patient isn’t experiencing benefit. Lower doses generally confer lower risk of side effects, so if a patient has success on a lower dose it’s a good sign.

Our Mental Wellness Recommendation

We recommend a platform called Brightside to patients on a mental health journey. It's an online therapy and medication platform that connects patients with licensed therapists and doctors from the comfort of their home.

medical review published in the Clinical Psychology & Psychotherapy journal found that online therapy was equally effective to in-person therapy for treating depression, anxiety and PTSD. Therapy may be a good first option for patients who want to avoid the side effects of medication.

Brightside also can connect patients with licensed psychiatrists that can prescribe medication. Some patients choose only therapy, some choose only medication, and some choose both. The brand reports that 86% of members feel significantly better within 12 weeks of treatment.

Patients with and without health insurance can use Brightside. For many patients with health insurance, treatment is entirely covered by insurance.

The cost for medication without health insurance is capped at $95/month and the cost for therapy without health insurance is capped at $299/month.

Interested patients can check out Brightside at this link to the brand's website.

Stay up-to-date on our research reviews

Conclusion

Bupropion is effective for treating major depression, but may cause some serious side effects such as rapid heartbeat and insomnia. Patients under the age of 24 are at increased risk of suicidal thoughts and behaviors when taking this drug, so young patients may benefit from speaking with their doctor about antidepressants which don’t increase suicide risk.

Bupropion does appear to cause weight loss in overweight and obese patients, which can be seen as a potential secondary benefit of the drug for this patient population.

It's yet unclear whether bupropion causes withdrawal symptoms or sexual side effects, but there doesn't appear to be much medical research suggesting either negative effect.

Bupropion should be equally effective to its brand-name counterpart Wellbutrin, but is often significantly cheaper, especially for patients in the U.S. without health insurance.




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