Bupropion XL

WELLBUTRIN XL

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What it isBupropion extended-release (WELLBUTRIN XL, 2003) inhibits norepinephrine and dopamine reuptake; depression and seasonal affective disorder.

Why this oneTaken once daily, it is the only antidepressant with a seasonal-affective-disorder indication (2006) while retaining an activating, sexually sparing profile.

What limits itSeizure risk and insomnia limit it; avoid in eating or seizure disorders. Strong CYP2D6 inhibition drives interactions.

FDA-approved for

depression (2003)
seasonal affective disorder (2006)

FDA label

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BOXED WARNING Suicidal thoughts and behaviors in children, adolescents, and young adults

FDA dosing	Population	Start	Target	Max
Major depressive disorder	Adults	150 mg QAM	300 mg QD	300 mg QD
Prevention of seasonal affective disorder	Adults	150 mg QAM	300 mg QD	300 mg QD

Titration MDD: after 4 days may increase to 300 mg QD; SAD: after 7 days may increase to 300 mg QD

Renal Reduce dose and/or frequency (GFR <90 mL/min)

Hepatic Moderate–severe (Child-Pugh 7–15): max 150 mg every other day; mild: reduce dose/frequency

Instructions

Swallow whole; do not crush, divide, or chew
Take once daily in the morning, with or without food
On discontinuation taper 300 mg to 150 mg QD before stopping
For SAD, initiate in autumn and taper/discontinue in early spring

Contraindications

Seizure disorder
Current or prior diagnosis of bulimia or anorexia nervosa
Patients undergoing abrupt discontinuation of alcohol, benzodiazepines, barbiturates, and antiepileptic drugs
Use of MAOIs (intended to treat psychiatric disorders) concomitantly with Wellbutrin XL or within 14 days of discontinuing treatment; starting Wellbutrin XL in a patient treated with reversible MAOIs such as linezolid or intravenous methylene blue is contraindicated