Can you take Wellbutrin while pregnant?

In this article:

• Wellbutrin and pregnancy
• Potential risks
• Stopping Wellbutrin
• Alternatives
• Managing depression during pregnancy
• Expert takeaway

In this article

• Wellbutrin and pregnancy
• Potential risks
• Stopping Wellbutrin
• Alternatives
• Managing depression during pregnancy
• Expert takeaway

Wellbutrin (bupropion) is an atypical antidepressant the FDA has approved to treat major depressive disorder and seasonal affective disorder. Instead of working mainly on serotonin like many selective serotonin reuptake inhibitors (SSRIs), it mostly affects other brain chemicals, such as dopamine and norepinephrine. The medication is available as sustained-release (Wellbutrin SR) and extended-release (Wellbutrin XL) tablets.

While pregnancy may be happy news for your family, 1 in 5 women experience a mental health issue such as anxiety or depression while expecting, according to Postpartum Support International. Or, you may already be taking Wellbutrin to manage an existing condition. If you’re pregnant or planning to be, you may not necessarily need to stop taking Wellbutrin. Many people continue taking the medication throughout their pregnancy with the guidance of their mental health provider.

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Can you take Wellbutrin while pregnant?

There isn’t a simple yes-or-no answer, says Susan Zink, MD, a board-certified psychiatrist and reproductive psychiatry expert adviser to the New Jersey Psychiatric Association.

“The decision to continue any antidepressant is always an individualized risk-benefit discussion,” Dr. Zink explains. “Nothing is guaranteed to be completely ‘safe,’ but illness isn’t safe either. We weigh the known and unknown risks of the medication against the risks of untreated illness.”

Depression during the childbearing years is common. About 1 in 10 women of reproductive age in the U.S. report symptoms of a recent major depressive episode, according to the Centers for Disease Control and Prevention (CDC). Many are already taking an antidepressant when they become pregnant. It’s also common to experience new mental health issues during the perinatal period.

Wellbutrin is a norepinephrine-dopamine reuptake inhibitor (NDRI), which hasn’t been studied in pregnancy as extensively as SSRIs. However, the current research is mostly reassuring. According to the FDA label, studies following pregnant women who took bupropion in the first trimester did not find an increased overall risk of birth defects. In the Bupropion Pregnancy Registry, which followed 675 pregnant women who took bupropion during their first trimester, birth defects were reported in about 3.6% of pregnancies. This is similar to what’s reported in the general population.

So should you stop taking Wellbutrin if you’re trying to get pregnant? Not necessarily. Dr. Zink says she considers the following factors when deciding:

• How severe your symptoms have been
• How well symptoms are currently managed
• Whether you’ve had depression during pregnancy or after birth before
• Your risk of relapse
• How soon you hope to conceive

“For a patient with moderate to severe depression who hasn’t responded well to other treatments, staying on Wellbutrin is often the lowest-risk choice,” she says.

If you’d rather switch to a medication that’s been studied more in pregnancy, it’s best to do so gradually and with careful planning. “Antidepressants take time to work, so if you prefer to change treatments, we need enough time to make the switch and get symptoms well controlled before conception,” Dr. Zink explains.

What are the risks of taking Wellbutrin while pregnant?

Wellbutrin crosses the placenta. However, studies show that the drug’s concentration in the fetus are much lower than in the mother.

Some earlier studies raised concerns that bupropion might be linked to certain heart defects in babies, though the evidence has been mixed:

• An older study found a link between early pregnancy bupropion use and a specific heart defect. .
• Another older study found a slightly higher rate of ventricular septal defects when bupropion was taken alone in the first trimester.
• Larger and more recent studies haven’t consistently confirmed the same patterns reported in earlier research.

Overall, the research so far has not shown that bupropion increases a baby’s overall risk of major birth defects. Dr. Zink notes that the earlier signals may have had more to do with maternal smoking than with the medication itself, since bupropion is also used to help with smoking cessation.

Researchers are still learning about other possible effects of Wellbutrin in pregnancy:

• A large study that followed more than 145,000 pregnancies exposed to antidepressants, including bupropion, found no increased risk of autism, attention-deficit hyperactivity disorder (ADHD), or other neurodevelopmental disorders once researchers accounted for the mother’s underlying illness and other confounding factors.
• Wellbutrin may carry a slightly lower risk of neonatal withdrawal than SSRIs, according to Dr. Zink, but more research is needed to confirm that.
• Questions remain about other outcomes, such as the risks of preterm delivery and low birth weight.

These possible medication risks have to be weighed against the risk of untreated depression. “Untreated maternal mental illness raises the risk of preterm birth, low birth weight, preeclampsia, postpartum depression, and poor mother-infant bonding,” Dr. Zink says. The CDC estimates that about 1 in 8 women experience symptoms of postpartum depression after a live birth.

If you plan to breastfeed, you may not need to stop Wellbutrin then, either. Breastfeeding while taking bupropion is generally considered possible with caution. The NIH’s LactMed database states that bupropion passes into breast milk, but only in small amounts. Because there have been rare reports of seizures in breastfed infants, talk with your healthcare provider before making any changes.

When to stop Wellbutrin before pregnancy: Safety tips

Many people continue taking Wellbutrin throughout their pregnancy. If you and your provider determine that stopping the medication is best for your health, there are some important things to know. MaryEllen Eller, MD, a board-certified psychiatrist at Radial Health, says stopping Wellbutrin abruptly can cause withdrawal symptoms, including:

• Headaches
• Increased anxiety
• Irritability
• Vivid dreams
• Fatigue
• Flu-like symptoms

These withdrawal symptoms usually show up a few days after your last dose and last about a week for most people, Dr. Eller explains. However, some people may have headaches and fatigue for up to a month after stopping the medication.

“To minimize side effects, we recommend tapering off [Wellbutrin] slowly to give your brain time to adapt,” Dr. Eller says. How long this takes depends on your current dose, how long you’ve been on the medication, and whether you’re taking the short- or long-acting version. Tapering can take anywhere from a couple weeks to a several months based on your provider’s guidance.

If you’re already pregnant and taking Wellbutrin, Dr. Eller says psychiatrists usually don’t recommend switching antidepressants, because the more medications a growing fetus is exposed to, the higher the potential risk of side effects.

What can I take instead of Wellbutrin during pregnancy?

For depression, SSRIs are the best-studied antidepressants in pregnancy. “Zoloft (sertraline) is generally considered the ‘safest’ in pregnancy,” Dr. Eller says.

Common options your healthcare provider may consider include:

• Zoloft (sertraline)
• Lexapro (escitalopram)
• Celexa (citalopram)
• Prozac (fluoxetine)

Medication isn’t the only way to treat depression. “Psychotherapy has the best safety data in pregnancy; it can effectively treat depression and poses no systemic risk of birth defects to your growing baby,” Dr. Eller explains. Transcranial magnetic stimulation (TMS) is also getting more attention for treating depression during pregnancy because it doesn’t act directly on the baby.

For quitting smoking, bupropion usually isn’t the first choice in pregnancy unless you also have depression and other methods haven’t helped. “If you are currently smoking and planning to become pregnant, behavioral counseling is the best first step,” Dr. Eller says. “During pregnancy, nicotine replacement is a healthier alternative to smoking.”

Managing depression during pregnancy

Medication is one important tool, but having a broader plan can better protect your mental health during pregnancy and after birth, a time Dr. Eller calls “a particularly high-risk period for women.” She recommends being proactive if you’re planning a pregnancy and have a personal or family history of depression.

• Make a plan with a trusted provider: Connecting with a mental health provider early can help you map out a plan for your childbearing years. “Psychotherapy, especially mentalization-based therapy and cognitive behavioral therapy, is a very effective tool for protecting against and treating depression,” Dr. Eller says.
• Follow a healthy lifestyle: Making small habit changes can also help support your mood, which may include regular movement, good sleep, and nourishing food.
• Take a prenatal vitamin: A supplement that contains folic acid helps support your baby’s development. These vitamins can also help fill small nutrient gaps, which may boost your overall health. Always check with your healthcare provider before starting a new supplement or therapy during pregnancy.

Depression during pregnancy is common, and it’s treatable. With the right support system in place, you can set yourself up for a healthier pregnancy and postpartum period using therapy, medication, lifestyle changes, or all three.

Expert takeaway

“Most people intuitively understand that taking medication during pregnancy is a potential exposure for the baby,” Dr. Zink says. “What’s less intuitive is that untreated mental illness is an exposure, too. In my own practice, I’ve treated many pregnant patients on Wellbutrin with no adverse neonatal outcomes, and with good control of their mental health throughout pregnancy and postpartum.”