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The Pros and Cons of Bupropion

Medically Reviewed by
Nzinga Harrison, MD
December 14, 2023

Bupropion is an antidepressant drug approved by the U.S Food and Drug Administration (FDA)  for the treatment of Major Depressive Disorder (MDD), Seasonal Affective Disorder (SAD), and as an aid for smoking cessation. This medication works by improving your mood and your sense of well-being. This is achieved by restoring the chemical balance of dopamine and norepinephrine in the brain. Bupropion is also used off-label for the treatment of a variety of health conditions such as:

  • Attention Deficit Hyperactivity Disorder (ADHD)
  • Anxiety
  • Social anxiety disorder
  • PTSD
  • Obesity
  • Certain forms of nerve pain

Bupropion is available in three main forms:

  • Immediate-release tablet
  • A sustained-release tablet
  • An extended-release tablet for oral administration

How is Bupropion Different From Other Antidepressants?

One of the key differences between bupropion and other antidepressants is that it doesn’t affect the user’s libido, and it doesn’t cause any weight gain as other antidepressants usually do. In fact, it’s often prescribed along with other antidepressants to help counteract the sexual side effects of other medications.

Most antidepressants are selective serotonin reuptake inhibitors (SSRI), which means that they boost the levels of serotonin in the brain. Bupropion, on the other hand, is different. It is a norepinephrine-dopamine reuptake inhibitor (NDRI). An NDRI boosts levels of the neurotransmitters norepinephrine, also known as noradrenaline and dopamine.

As well as being an antidepressant, bupropion is an antagonist to nicotinic receptors. This means that it blocks receptors where nicotine normally binds, making it useful in helping people quit smoking.

The overall effects of bupropion are complex, and its neurological effects and mechanism of action are only partly understood.

Bupropion for Major Depressive Disorder 

Major depressive disorder, also referred to as clinical depression, is a significant mental health condition that can affect many areas of a person’s life. It impacts mood and behavior as well as various physical functions, such as appetite and sleep. According to the National Survey on Drug Use and Health (NSDUH), major depressive disorder is characterized as a period of at least two or more weeks of depressed mood, loss of interest, pleasure in daily activities, and other symptoms, such as sleep problems, low in appetite, energy, concentration, and self-worth.

MDD is one of the most common mental health conditions in the United States. The National Institute of Mental Health (NIMH) suggests that 8.4% of U.S. adults, experienced a major depressive episode in 2020.

Bupropion is an ideal medication for the treatment of depression as it works by inhibiting the reuptake of dopamine, serotonin, and norepinephrine and helps balance out the neurotransmitter imbalance that causes depression.

Bupropion for Seasonal Affective Disorder

The American Psychiatric Association (APA) identifies seasonal affective disorder as a type of major depressive disorder with seasonal patterns. People with SAD experience mood changes and symptoms that are quite similar to depression. The symptoms usually occur during the fall and winter months when there is less sunlight but usually improve with the arrival of spring. Common symptoms of SAD include fatigue and weight gain.

The most difficult months for people with SAD in the U.S. tend to be between January and February. It is estimated that around 5% of the U.S. adult population experience SAD. Additionally, the disorder is more common in women than in men and in younger adults than older adults.

SAD has been linked to a biochemical imbalance in the brain caused by shorter daylight hours and less sunlight during winter. Seasonal changes cause certain people to experience a shift in their internal biological clock or a circadian rhythm that causes them to be out of step with their daily schedule.

According to the American Academy of Family Physicians (AAFP), extended-release bupropion in 300 mg taken once daily effectively prevents recurrent symptoms in high-risk adults with a history of SAD and those at a lower risk.

Bupropion for Smoking Cessation

Studies reveal bupropion to be a great aid for smoking cessation as it helps reduce nicotine withdrawal and cravings to a great extent.

The type of bupropion used for smoking cessation is sold under the brand name of Zyban. It is described as a safe and cost-effective treatment for nicotine addiction. Zyban helps around one in 5 people quit smoking in the U.S each year. The effectiveness of this medication as an aid against nicotine dependence increases when bupropion is used in conjunction with other nicotine replacement products such as the nicotine patch, gum, and lozenges. However, Zyban may only be recommended for people who smoke ten or more cigarettes per day.

Who Should Avoid Taking Bupropion?

You should not take bupropion if you have ever had an allergic reaction to bupropion.

Bupropion can cause seizures, especially in people with certain medical conditions or when it interacts with certain other drugs. So it is important to inform your doctor of any other medications you’re on to avoid adverse reactions.

It is also helpful to inform your doctor of any medical condition you may have as bupropion may not  be suitable for certain medical conditions such as:

  • Liver or kidney disease
  • Bipolar disorder
  • Diabetes
  • High blood pressure
  • Patients with alcohol use disorder or substance use disorder
  • Seizures
  • Eating disorder such as anorexia or bulimia
  • Abruptly stopped using alcohol, seizure medications, or sedatives

Though bupropion is often used in children and adolescents, it is not FDA approved for use by anyone younger than 18 years of age. Bupropion has been associated with a risk of suicidal ideation in children.

The pros and cons of using Bupropion

Bupropion Side Effects

Even though bupropion treats various health conditions, it also comes with its own set of side effects that range from mild to severe. The more common side effects of bupropion may emerge within a few days of use and disappear within a few weeks.

Some of the most common side effects include:

  • Stomach pain
  • Appetite loss
  • Changes in the way food tastes
  • Constipation
  • Drowsiness
  • Dizziness
  • Dry mouth
  • Flushing
  • Gas
  • Hair Loss
  • Headache
  • Insomnia
  • Profuse sweating
  • Joint aches
  • Nausea
  • Nervousness
  • Tremors
  • Restlessness
  • Vomiting
  • Ringing in the ears
  • Weakness
  • Weight loss
  • Urinating more often
  • Sleeping troubles

Bupropion can also cause severe side effects that can potentially be life-threatening. Some such side effects include:

  • Aggressiveness
  • Agitation
  • Changes in the menstrual cycle
  • Changes in vision
  • Changes in sexual function
  • Dark urine
  • Chest pain
  • Rapid or irregular heart rate
  • Swollen, blistered, or peeling skin
  • Yellow skin or eyes
  • Unusual swelling in parts of the body
  • Severe or lingering muscle or joint pain
  • Severe headache
  • Pale-colored stools
  • Hallucinations
  • Breathing difficulties
  • Hearing problems

Dangers of Bupropion 

Bupropion comes with a black box warning to help alert doctors and patients about the drug’s adverse effects. This is the most serious type of warning from the U.S. Food and Drug Administration (FDA).

Taking this drug may cause you to have changes in behavior such as hostility, agitation, depressed moods, or suicidal thoughts. The potential risk of suicidal thoughts and behavior is higher in children, adolescents, and young adults who consume bupropion. It is vital that you inform your doctor immediately should you experience any of these adverse effects.

In rare instances, bupropion can cause seizures that can be severe and potentially life-threatening. As such, it is not recommended for patients who are prone to seizures or to be consumed with other drugs that lower the seizure threshold. The risk of seizures increases when the doses of bupropion are increased.

Even though bupropion is an effective treatment option for most patients with anxiety disorders, it can also cause anxiety as a side effect in certain patients. Bupropion can also cause severe high blood pressure and periods of mania.

Risks of Mixing Bupropion and Alcohol

Individuals combining alcohol with bupropion to attain a chemical high are at risk of developing an alcohol use disorder and an addiction to bupropion. The physical dependence on alcohol or/and bupropion is a serious problem that can cause adverse, long-term health complications. Some serious side effects of mixing bupropion and alcohol are:

Seizures

Epileptic seizures are one of the rare but serious side effects of bupropion. The risk of seizure is even higher in people who combine alcohol with bupropion or indulge in excessive alcohol consumption while on bupropion. This can trigger seizures that can be particularly distressing. Seizures can also be triggered when a person tries to quit drinking after a prolonged period of combining an alcoholic drink with bupropion. This is because going through alcohol withdrawal syndrome while on bupropion can reduce the threshold for seizures and also cause adverse effects such as: 

  • Severe shaking and tremors
  • Vomiting 
  • Confusion or disorientation 
  • Hallucinations 
  • Paranoia

People are advised to talk to a healthcare provider before quitting alcohol while on bupropion. It’s also recommended that they refrain from any social drinking while on antidepressants such as bupropion. 

Overdose

The liver can only process a limited amount of a substance at one time. So when you drink while taking bupropion, it will be conditioned to only process small quantities of each substance. This slow processing time will result in increased side effects of both the alcoholic drink and bupropion. It can also increase the amount of alcohol that ends up in the bloodstream and heighten the risk of alcohol poisoning or overdose. Overdoses are a medical emergency. So it’s important to seek immediate medical attention when one faces the following symptoms:

  • Confusion 
  • Vomiting 
  • Irregular breathing (a gap of more than 10 seconds in between breaths)
  • Slow breathing (less than eight breaths per minute)
  • Pale skin 
  • Low body temperature 
  • Unconsciousness 

Severe Side Effects

In addition to the risk of overdose and seizures, combining alcohol with bupropion can also increase the risk of severe side effects. The combination can also increase the risk of suicidal thoughts and behaviors associated with bupropion. Mixing bupropion with alcohol can further increase the risk and make it difficult for people to carry out their normal lives. 

Individuals combining alcohol with bupropion to attain a chemical high are at risk of developing an alcohol use disorder and an addiction to bupropion. The physical dependence on alcohol or/and bupropion is a serious problem that can cause adverse, long-term health complications. 

Bupropion Overdose 

Bupropion is a non-habit-forming drug that is considered to have a low risk of addiction and dependence. And it doesn’t produce much of the side effects seen by other antidepressants. However, it can produce a high that is quite similar to that of amphetamines and crack cocaine when the pills are crushed and snorted.

When bupropion is misused, dangerous doses of the drug enter the body and increase the risk of an overdose. Although there is little evidence provided to show fatal bupropion overdose, it can trigger severe symptoms such as:

  • Seizures
  • Hallucinations
  • Loss of consciousness
  • Abnormal heart rhythm

As with any medication, bupropion has both pros and cons to its use. Even though it has tremendous benefits in treating conditions such as depression and its effectiveness in treating nicotine addiction, it also comes with its own set of adverse side effects.  It is important to consult your healthcare provider before you take bupropion to avoid any potential risks associated with its use.

If you are seeking help with your loved one’s addiction, contact us today to speak with an addiction treatment specialist.

If you need help with your substance use disorder, we are here to help you build your confidence and momentum towards the future you want. We provide treatment services for adults with alcohol, opioid, and other substance use disorders. We are currently located in Louisiana, Massachusetts, North Carolina, New Jersey, Ohio, Texas, and Washington.

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Nzinga Harrison, MD

Dr. Harrison serves as the Chief Medical Officer for Eleanor Health with more than 15 years experience practicing medicine. She is a double-board certified physician with specialties in general adult psychiatry and addiction medicine. Dr. Harrison has spent her career as a physician treating individuals from marginalized communities with substance use and other psychiatric disorders. As a physician executive, she has served as Senior Vice President and Chief Medical Officer roles committed to creating and improving systems-based delivery of psychiatric and substance abuse care. She is a vocal advocate for stigma reduction, and is passionate about the necessity for whole-person care as individuals and communities seek to recover from and prevent substance use disorders.

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