Bupropion
Wellbutrin · Forfivo
Norepinephrine-Dopamine Reuptake InhibitorGeneric availableTDM data
The exact mechanism of the antidepressant action of bupropion is not known but is presumed to be related to noradrenergic and/or dopaminergic mechanisms. Bupropion is a relatively weak inhibitor of the neuronal reuptake of norepinephrine and dopamine and does not inhibit the reuptake of serotonin. Bupropion does not inhibit monoamine oxidase.
Compare Bupropion →FDA-Approved Indications
- Major depressive disorder (adults)
- Seasonal affective disorder — prevention (adults; XL only)
Common Off-Label Uses
- ADHD
- Sexual dysfunction (SSRI-induced)
- Weight loss (adjunct)
- Bipolar depression (adjunct)
What Sets This Drug Apart
- Only antidepressant with no serotonergic activity (NDRI mechanism) — zero risk of serotonin syndrome, sexual dysfunction, or SSRI-type weight gain
- FDA-approved for both MDD and smoking cessation (Zyban) — unique dual psychiatric indication
- Weight-neutral or weight-loss profile; one of very few antidepressants that does not cause weight gain
- Dose-dependent seizure risk: contraindicated in seizure disorders, bulimia nervosa, and anorexia nervosa (lowered seizure threshold); 450 mg/day max
- Strong CYP2D6 inhibitor despite being a CYP2B6 substrate — increases levels of CYP2D6 substrates significantly
- Activating profile: insomnia and agitation are common; avoid in anxiety-predominant presentations unless combined with an anxiolytic
Boxed Warning
SUICIDAL THOUGHTS AND BEHAVIORS SUICIDALITY AND ANTIDEPRESSANT DRUGS
Boxed Warning
SUICIDAL THOUGHTS AND BEHAVIORS