BuPROPion HCI ER (SR) - Wellbutrin SR

What is Wellbutrin?

Wellbutrin is an antidepressant medicine that is thought to work in the brain and nerves on the chemical messengers norepinephrine and dopamine. Wellbutrin XL  is used to treat major depressive disorder (MDD) and seasonal affective disorder, and Wellbutrin SR is only used to treat major depressive disorder (MDD).

Another brand of bupropion called Zyban is used to help to stop smoking, Wellbutrin is not indicated to help quit smoking.

Wellbutrin (bupropion) is an atypical antidepressant - it works differently from SSRIs like Prozac or SNRIs like Pristiq.

How it works: It primarily affects norepinephrine and dopamine (not serotonin), which gives it a unique profile among antidepressants.

Primary uses:

• Major depressive disorder
• Seasonal affective disorder (SAD)
• Smoking cessation (marketed as Zyban for this)
• Sometimes ADHD off-label

Characteristic effects:

• More activating/energizing than most antidepressants
• Doesn't typically cause weight gain (often weight-neutral or slight loss)
• Less likely to cause sexual side effects than SSRIs/SNRIs
• Can improve focus and motivation

Common side effects:

• Insomnia (if taken too late in the day)
• Anxiety or jitteriness (especially when starting)
• Dry mouth
• Headache
• Increased blood pressure in some people

Critical consideration - seizure risk: Wellbutrin lowers seizure threshold more than other antidepressants. Risk increases with:

• Higher doses
• History of seizures or eating disorders
• Alcohol withdrawal
• Other medications that lower seizure threshold

In the context of schizoaffective bipolar type:

This is where it gets interesting and potentially complicated:

Potential benefits:

• Can help with depressive symptoms without the sedation of some other antidepressants
• Less likely to cause the metabolic/weight side effects that antipsychotics like Invega can cause
• The dopamine activity might help with negative symptoms (motivation, energy) or cognitive dulling from antipsychotics

Potential risks:

• Dopamine activity could theoretically worsen psychosis in some people (though this is debated and doesn't always happen)
• Can potentially trigger manic episodes, like other antidepressants
• The activating effect might increase anxiety or agitation during mixed states

Typical use pattern: When used in schizoaffective bipolar type, Wellbutrin would usually be added after psychosis and mood are stabilized with an antipsychotic (like Invega) and mood stabilizer. It's generally not used as monotherapy for this condition.

Some psychiatrists are more comfortable using Wellbutrin in schizoaffective disorder than traditional SSRIs/SNRIs because its mechanism is different and it might have less risk of triggering mania. But it's always used cautiously with close monitoring.

Formulations:

• Immediate release (2-3x daily)
• SR (sustained release, 2x daily)
• XL (extended release, once daily - most common)

The extended-release versions help maintain steadier levels and reduce side effects.