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Wellbutrin Tapering (Bupropion)

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Medically Reviewed Fact Checked

Last Updated on January 2, 2024 by Carol Gillette

Alternative to Meds Editorial Team
Medically Reviewed by Dr Samuel Lee MD

If you’re searching for concrete information on Wellbutrin tapering, weaning, and titration, we can help. Alternative to Meds Center is a well-recognized rehab center providing professional, tailored solutions.

Reactions associated with weaning off Wellbutrin (generic bupropion) can be unbearable to withstand and oftentimes require specialist-level support. You may also be suffering from drug-induced adverse effects, according to the FDA, including the risk of suicide, seizure, hallucinations, renal failure, and more. Wellbutrin is a serious drug, that can require well-planned and supervised weaning protocols for success.3


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Information on Tapering from Wellbutrin

Information here is given for anyone searching for information on Wellbutrin tapering, or for general information on the drug if you are considering stopping Wellbutrin. Please be advised that this drug is also prescribed under quite a number of other names. The generic drug name is bupropion, and the list of brand names includes Zyban, Fortivo XL, Aplenzin, Prolev, and Quomem.1

All of these various drug names, however, refer to the same basic molecular blueprint. Some may have additional drugs added, for example, naltrexone is added to bupropion in a drug called Contrave.10 Other versions may be timed-release, where XL (extended-release) or SR (sustained-release) follows the drug name. Look for this information on the prescription label. Curiously, Zyban is primarily approved for quitting smoking, but Wellbutrin, with exactly the same molecular structure, is not approved for use in quitting smoking. The key point, despite confusion generated by marketing practices, is to understand that Zyban is the same as Wellbutrin, and should not be viewed as “less toxic” or less habit-forming, or without similar side effects. Wellbutrin is a stimulant, classed as an “NDRI” or a norepinephrine and dopamine reuptake inhibitor.3,5

Challenges of Wellbutrin Tapering and Titration

Below, we will discuss some of the main challenges and how to stay healthy during tapering from Wellbutrin (or any other of Wellbutrin’s namesakes).

An important challenge is estimating how quickly or slowly to administer a Wellbutrin tapering program. Alternative to Meds Center structures its Wellbutrin tapering programs with built-in monitoring, involving real-time discussions, and coordinated teamwork between the client and the various staff on your team. This is how we designed our Wellbutrin cessation programs in order to address this exact point in an alert and flexible way. The client is always consulted at each step so that the estimation of how quickly or slowly to proceed is always in consultation and agreement with the client. Below, we will cover some of the more concerning side effects of Wellbutrin, which may be avoided by tapering off the drug safely.6

Wellbutrin Discontinuation Syndrome

When weaning off an NDRI (Wellbutrin is an NDRI type of medication, targeting both norepinephrine and dopamine), a cluster of symptoms can commonly emerge, sometimes referred to as Wellbutrin discontinuation syndrome. These can occur regardless of whether bupropion was prescribed for depression, smoking cessation, or any other reasons. 2,4,13,14

Wellbutrin discontinuation symptoms may include:
  • brain zaps
  • flu-like symptoms, lethargy, headache, achiness, sweating
  • insomnia, vivid nightmares, and dreams
  • hyperarousal, mania, rage, aggression, agitation, anxiety, restlessness
  • jerky muscle motions
  • abdominal symptoms, nausea, vomiting, change in appetite

More information is given below on these and other adverse effects involved. Many clients come to us referred by their prescribers because they felt ill-equipped to navigate their patients through Wellbutrin discontinuation syndrome. Often, more support is needed than can realistically be provided in an outpatient setting, and inpatient care is preferred. Commonly, these adverse effects can occur while weaning off Wellbutrin including brain zaps, emotional upheavals, unusual sensory perceptions, disrupted sleep, and many more. Abruptly stopping is NOT recommended, as it can intensify and even prolong these reactions.

Wellbutrin Tapering Guidelines and Schedule

wellbutrin tapering guidelinesStopping Wellbutrin safely is not necessarily as simple as cutting the dosage over time. While mathematics does play a role, there is much more that can be done to make the process surprisingly comfortable, as well as efficient time-wise. Our goal at Alternative to Meds Center is to make it possible to actually improve the client’s health in the process. A gradual Wellbutrin cessation is important but is one part only of a multi-faceted process. This is best done within an individualized step-by-step process aimed towards regaining natural mental health, without drugs.

Your prescribing physician may be able to guide you on how to cut the dosage which may involve actually cutting the pills. In the case of Wellbutrin, the lowest dosage is 75mg yellow round tablets. The tablets can be cut in half when needed providing a 37.5mg option, but it will lose the extended-release attribute, which reduces the half-life elimination of the drug. Be sure to ask your doctor about these matters. Wellbutrin has a half-life of 21 (±9) hours,4 which is about average for antidepressants. The longer the half-life, the slower the medication will leave your body, which, generally speaking, makes the tapering easier. As is common with stimulants, fatigue, and depression are common features of this withdrawal.

Please note: The below information is intended to be shared with your prescriber and health care team and is not intended as medical advice or direction.

Examples of Wellbutrin Tapering Guidelines include:
  • Gradual tapering is recommended — exceptions include a medical emergency such as seizure or serotonin syndrome, etc. requiring immediate transport to a hospital for emergency intervention.2
  • Get the smallest dose possible to work with, which in this case, is 75mg Wellbutrin yellow round tablets
  • You can cut the 75mg pills in half for smaller dosing but if you are using WellbutrinXL, it will lose its time-released attribute. This means that the withdrawal onset may occur faster than 21 hours. A half pill would be 37.5mg.
  • Generally, 10-25% reduction is a good starting point — be alert to reactions that may require less of a reduction and adjust as needed, in discussion with your prescribing physician.
  • Withdrawals generally emerge around the drug’s half-life range. In this case, the elimination half-life is 21 (±9) hours depending on individual variability.3 Onset and duration of symptoms of withdrawal will be different for each person.
  • After a reduction, allow time to settle out at that level, for instance, 2 to 4 weeks, before attempting further adjustments.
  • If the final cuts are problematic, you may need to slow down at the end.

Please note that all the above estimated times can vary according to an individual’s general health, dosage, and other factors. Should a protracted withdrawal develop, be sure to enlist a professional to help you who is familiar with Wellbutrin alternatives and withdrawal management.

Side Effects That Cause People to Consider Wellbutrin Weaning

Frequent Wellbutrin Side Effects: 3,11,12
  • Seizures
  • Suicidal thoughts and behavior
  • Hallucinations
  • Dyskinesia
  • Renal failure
  • Depression
  • Mania
  • Psychosis, delusions, hallucinations
  • Aggression, hostility, irritability
  • Insomnia
  • Anxiety, panic, paranoia
  • Weight loss, loss of appetite, nausea
  • Tachycardia, cardiac arrhythmias
  • Headache
  • Dry mouth
  • Constipation

FDA WARNINGS:  The FDA cautions that Wellbutrin (bupropion) can cause seizures and suicidal thoughts.3

These and other side effects may lead to the decision to wean off Wellbutrin. Safety is of prime concern. This is our specialty.

Alternative to Meds Center has been helping clients wean off Wellbutrin and many other drugs safely and gently for more than a decade and a half. Part of the center’s success comes from sound principles of holistic treatment in a safe and nurturing inpatient setting. During the process, clients receive many therapeutic aids, such as therapeutic massage, mineral baths, detoxifying foot baths, targeted nutrition therapy, nebulized glutathione treatments, art therapy, Reiki, acupuncture, and other ways to support client comfort at every step along the way.

Addressing Root Causes to Assist Wellbutrin Titration

investigate root causesAside from providing strategic Wellbutrin titration support, equally if not more important, is investigating and correcting root causes for a person’s pre-medication symptoms. This is where some vital life-changing health improvements can occur. For example, lab testing can isolate causal factors that can then be addressed. Resolving these factors will tend to resolve the person’s symptomology without needing further reliance on drugs to mask unwanted symptoms.

It may be true that in the past, the only “solution” that was offered was to address symptoms with medication. In the past, perhaps that was all that was possible and would be more humane than letting a person suffer. But with today’s testing and other diagnostic and investigative tools, and a wealth of nutritional research,  Alternative to Meds Center can help our clients to truly move forward into bonafide better health. Some of these benefits might include more energy, a brighter mood, a better quality of sleep, more vitality overall, and therefore not needing the artificial stimulation of medication. These therapies also make Wellbutrin titration more tolerable.

Will a Person’s Original Symptoms Return When Stopping Wellbutrin?

Administering a safe and effective Wellbutrin tapering program must include helping to prevent a person’s symptoms from returning as the medication is being incrementally reduced. For instance, when a person took Wellbutrin to combat depression, if Wellbutrin tapering is too fast it would not be unusual for the person’s depressive symptoms to return which can do so with increased intensity. However, the Alternative to Meds Center Program is designed so that fluctuations in mood or other reactions can be monitored extremely closely and can be mitigated through exact supplementation, therapies, or adjusting the speed of the taper to compensate. The goal is to administer Wellbutrin tapering without these fluctuations, without major or intense Wellbutrin discontinuation symptoms, and without a return of original symptoms as much as possible.

Researchers state that the mechanism of bupropion-based drugs is not understood, but suspect that the drug attenuates (dampens) the stimulating effects of nicotine receptors in the CNS.7 It is not clear how this would affect weight loss or depression, two other common reasons for prescribing Wellbutrin.

But, as the drug label suggests, regardless of why a person started taking Wellbutrin, suicidal thoughts, worsened depression, seizures, mania, or other frequent adverse events can occur and require close and careful monitoring. Each client is a unique person with their own history. The results we achieve for our clients at Alternative to Meds Center would never be possible with a cookie-cutter-style program. Each client has a program aimed toward neurotransmitter rehabilitation, designed specifically for their needs and their health profile.

Wellbutrin Abuse on the City Streets

Wellbutrin has found a significant presence in some city streets where it is known as “poor man’s cocaine” due to its euphoric and stimulating effects which are enhanced when snorted. Wellbutrin is classified as an antidepressant but because of being a cathinone derivative, it also belongs to a class of drugs chemically related to amphetamines or “bath salts,” all of which have stimulating effects.8

Wellbutrin, cocaine, and amphetamines are all DRI drugs (dopamine reuptake inhibitors). Wellbutrin is the only DNRI legally approved to treat depression. To compare effects, cocaine is a DRI, meaning it enhances the stimulating effects by Inhibiting the reuptake of dopamine.

holistic tapering sedona drug rehabOther prescription drugs that are stimulants, act by inhibiting the reuptake of norepinephrine (adrenaline). Those drugs are called SNRIs ( selective norepinephrine reuptake inhibitors ). Unfortunately, many street users have been harmed by overuse or overdose on stimulants including DRIs, SNRIs, and NDRIs. The inherent risk for drug-liking and addiction is very high in stimulant drugs, hence their presence as street drugs in some cities.9

Wellbutrin’s FDA label does not say a single word about how to come off the drug safely. The FDA label suggests that if a person is “depressed” about weight loss, Wellbutrin might be a drug to consider. This is because many people who take it lose their appetite and will lose weight. In fact, a “new” version of this drug called “Contrave” (a combination of bupropion and naltrexone) hit the market in 2014 specifically marketed for weight loss in obese adults.10

Correctly planned Wellbutrin tapering should be carefully monitored due to suicide risk, potential mania, seizure, hallucination, renal failure, and many other well-documented potential problems.3

This is important whether the drug was prescribed for depression, or under a different name for quitting smoking, weight-loss, ADHD, or for any other reason. Whether NDRI drugs were non-prescribed or prescribed, we strongly recommend seeking guidance to mitigate these risks.

Wellbutrin Tapering Protocols at Alternative to Meds Center

There is much more to learn about the programs delivered at Alternative to Meds Center and what they entail in terms of treatments and therapies that are available to our clients. We believe there is no more comprehensive program for Wellbutrin tapering help than what is delivered in our comfortable, luxurious, and nurturing inpatient facility.

Please contact us at Alternative to Meds Center so we can provide you with many more details about the various techniques and protocols that are used to help our clients meet their individual health goals. We invite you to contact us and discover how easy it may be for you or your loved one to begin their Wellbutrin tapering treatment: your Wellbutrin tapering program will be designed to be gradual, without harsh side effects, and surprisingly comfortable.

Sources:


1. Gandey, Allison “Bupropion: 1 Drug, 4 Different Brand Names”, CMAJ [2003] [cited 2022 July 6]

2. Gabriel M, Sharma V. Antidepressant discontinuation syndromeCMAJ. 2017;189(21):E747. doi:10.1503/cmaj.160991 [cited 2023 July 29]

3. FDA Wellbutrin label. [approval 1985] [cited 2022 July 6]

4. Berigan TR, Harazan JS “Bupropion-Associated Withdrawal Symptoms: A Case Report.” The Primary Care Companion of the Journal of Psychiatry of 1999 [cited 2022 July 6]

5. Stahl S, Pradko J, Haight B, et al., “A Review of the Neuropharmacology of Bupropion, a Dual Norepinephrine and Dopamine Reuptake Inhibitor.” Primary Care Companion to the Clinical Journal of Psychiatry 2004 [Internet] PMID 15361919 [cited 2022 July 6]

6. Insel, T., “Antidepressants: a complicated picture” (PDF) National Institute of Mental Health [Internet] 2011 Dec [cited 2022 July 6]

7. Wilkes S. The use of bupropion SR in cigarette smoking cessationInt J Chron Obstruct Pulmon Dis. 2008;3(1):45-53. doi:10.2147/copd.s1121 [cited 2022 July 6]

8. “Focus on Bupropion Toxicity and Abuse” published by The British Columbia Drug and Poison Information Center [cited 2022 July 6]

9. Stall N, Godwin J, Juurlink D. Bupropion abuse and overdose. CMAJ. 2014;186(13):1015. doi:10.1503/cmaj.131534 [cited 2022 July 6]

10. Sherman MM, Ungureanu S, Rey JA. Naltrexone/Bupropion ER (Contrave): Newly Approved Treatment Option for Chronic Weight Management in Obese AdultsP T. 2016;41(3):164-172. [cited 2022 July 6]

11. Huecker MR, Smiley A, Saadabadi A. Bupropion. [Updated 2022 May 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470212/ [cited 2022 July 6]

12. Fava M, Rush AJ, Thase ME, Clayton A, Stahl SM, Pradko JF, Johnston JA. 15 years of clinical experience with bupropion HCl: from bupropion to bupropion SR to bupropion XL. Prim Care Companion J Clin Psychiatry. 2005;7(3):106-13. doi: 10.4088/pcc.v07n0305. PMID: 16027765; PMCID: PMC1163271. [cited 2022 July 6]

13. Papp A, Onton JA. Brain Zaps: An Underappreciated Symptom of Antidepressant Discontinuation. Prim Care Companion CNS Disord. 2018 Dec 20;20(6):18m02311. doi: 10.4088/PCC.18m02311. PMID: 30605268. [2023 July 29]

14. Lejoyeux M, Adès J. Antidepressant discontinuation: a review of the literature. J Clin Psychiatry. 1997;58 Suppl 7:11-5; discussion 16. PMID: 9219488. [cited 2023 July 29]


Originally Published Nov 3, 2019 by Diane Ridaeus


This content has been reviewed and approved by a licensed physician.

Dr. Samuel Lee

Dr. Samuel Lee is a board-certified psychiatrist, specializing in a spiritually-based mental health discipline and integrative approaches. He graduated with an MD at Loma Linda University School of Medicine and did a residency in psychiatry at Cedars-Sinai Medical Center and University of Washington School of Medicine in Seattle. He has also been an inpatient adult psychiatrist at Kaweah Delta Mental Health Hospital and the primary attending geriatric psychiatrist at the Auerbach Inpatient Psychiatric Jewish Home Hospital. In addition, he served as the general adult outpatient psychiatrist at Kaiser Permanente.  He is board-certified in psychiatry and neurology and has a B.A. Magna Cum Laude in Religion from Pacific Union College. His specialty is in natural healing techniques that promote the body’s innate ability to heal itself.

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Wellbutrin Tapering (Bupropion)
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