- Addiction & recovery
How Long Does it Take for Bupropion to Work?
David Schwartz, MD
December 6, 2022
Bupropion, sold under brand names such as Wellbutrin, and Aplenzin, is an antidepressant medication approved by the U.S. Food and Drug Administration (FDA) to treat major depressive disorder (MDD), seasonal affective disorder (SAD), and nicotine addiction. It’s also used off-label to treat conditions such as anxiety, attention deficit hyperactivity disorder (ADHD), obesity, post-traumatic stress disorder (PTSD), and neuropathic pain.
Bupropion is considered unique to other antidepressants as it’s a norepinephrine-dopamine reuptake inhibitor (NDRI). NDRI is a new formulation of antidepressants that rarely produce the side effects of its former counterparts, such as weight gain and sexual dysfunction. Hence, bupropion is considered relatively safe when used as prescribed.
Bupropion is available in three main forms, such as:
- Immediate-release tablet
- Sustained-release tablet
- Extended-release tablet
How Does Bupropion Work?
Bupropion works by affecting the way the body produces neurotransmitters responsible for transporting messages between the nerve cells. Bupropion blocks the brain from absorbing neurotransmitters such as dopamine and norepinephrine to increase their levels and make them available longer. This function helps improve mood, attention, and focus and thus, treat symptoms of depression and ADHD.
However, the exact mechanism of bupropion as a smoking cessation aid remains unclear. But it’s believed that the increase in dopamine production mimics the effects of nicotine in the brain and minimizes nicotine withdrawal and cravings. Although bupropion for nicotine addiction does not work the same way as nicotine replacement therapies such as nicotine patches, gum, or inhaler, it is still considered effective, especially when combined with intensive behavioral therapy.
How Long Does it Take for Bupropion to Work?
Bupropion may take several weeks to begin functioning as a treatment for MDD, SAD, and nicotine addiction. Individuals may experience significant improvements to physical symptoms such as sleep patterns, appetite, and energy levels during the first couple of weeks of treatment. However, it may take around four to six weeks to experience any noteworthy improvements in mood and interest in activities. Bupropion for MDD treatment may be required long after the symptoms are under control to prevent the depressive symptoms from re-emerging. In contrast, bupropion for SAD and smoking cessation is only required for a shorter period.
Since bupropion for nicotine addiction treatment takes several weeks to start working, most people are advised to establish a target “quit date” and start bupropion treatment while still smoking to give the medication enough time to take effect. Bupropion for smoking cessation is generally recommended seven to twelve weeks after quitting smoking to minimize withdrawal symptoms.
Side Effects of Bupropion
Bupropion can cause side effects ranging from mildly uncomfortable to severe. According to the National Center for Biotechnology Information (NCBI), side effects occur in more than 10% of those taking bupropion for medical purposes. Most of such side effects dissipate with continued use. However, if any of the symptoms persist or worsen, call a healthcare provider right away.
Some of the common side effects of bupropion are:
- Weight loss
- Skin rash
- Excessive sweating
- Ringing in the ears (tinnitus)
- Stomach pain
- Muscle pain
- Rapid heartbeat
- Sore throat
- Frequent urination
- Dry mouth
Some of the less common side effects of bupropion are:
- Chest pain
- Hot flashes
- Problems with swallowing
- Urinary tract infections
Risks Associated with Bupropion
One of the risks of using bupropion is the possibility of seizures. Although seizures are rare with bupropion, the risk is still four times greater than with other antidepressants. The risk is even higher when the doses exceed 450mg per day. Some of the risk factors for seizures while on bupropion include:
- A history of seizures
- Past injury to the head
- Tumor on the brain
- Severe liver disease
- An eating disorder
- Taking another medication that also lowers the seizure threshold
- Heavy drinking while on the medication
Bupropion comes with a black box warning to alert users of the medication’s ability to cause changes in behaviors, including suicidal thoughts and behaviors. The risk of suicidal thoughts and behaviors is even higher in children, teens, and young adults up to 24 years of age, especially when the medication is taken for the first time or in higher doses. Hence, it’s important to keep an eye out for signs of self-harm or suicidal ideations in children taking bupropion for depression.
People on bupropion for medical purposes are highly unlikely to form an addiction or dependence on it. However, the risk is not non-existent as the medication can cause stimulating effects like cocaine when taken in high doses. In addition, bupropion in high doses can also cause an overdose.
Some of the symptoms of a bupropion overdose include:
- Muscle stiffness
- Fast or uneven heartbeat
- Shallow breathing
Bupropion overdose is a medical emergency. Seek immediate medical attention if you experience any of the following symptoms.
Interactions With Other Medications
Bupropion may interact with certain medications when taken together. Although some interactions do not trigger any considerable reaction, others can influence how either medication works or increase their side effects. For example, bupropion’s interaction with antipsychotic medications of the phenothiazine class can reduce an individual’s seizure threshold. In contrast, bupropion’s interaction with monoamine oxidase inhibitors (MAOIs) such as phenelzine and selegiline can cause severe side effects.
Interactions between medications such as ritonavir can also increase the breakdown of bupropion and eliminate the medication from the body sooner, making them less effective. Lastly, the opposite can occur with bupropion reducing other medications levels in the body. An example of this is bupropion decreasing tamoxifen, a medication used to keep certain cancers in remission. Hence, it’s vital to inform your doctor of any other medications being taken before starting bupropion treatment.
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