Can you take Wellbutrin for weight loss?

Obesity is a major health problem. Having an elevated body mass index puts one at greater risk for other conditions including Type 2 diabetes, heart disease, high blood pressure, and osteoarthritis. A reduction in weight by even 10% can decrease the risk of obesity-related illnesses. For those that struggle to lose weight, it might be welcomed news to hear that there are medications available to help. 

While no drug is a silver bullet, and an emphasis on diet and exercise should always be a cornerstone of overall wellness, Wellbutrin (bupropion) has demonstrated a side effect of weight loss in those taking the medication for its primary purpose-to treat depression. Wellbutrin is an antidepressant and works a little differently than the most commonly prescribed medications for depression known as selective serotonin reuptake inhibitors (SSRIs) in that its primary mechanism is thought to be norepinephrine-dopamine reuptake inhibitor. These are neurotransmitters involved with regulating mood and emotions. 

Wellbutrin is approved by the Food and Drug Administration (FDA) for the management of major depressive disorder (MDD), the prevention of seasonal affective disorder (SAD), and smoking cessation, but is used off-label for several conditions including weight loss, SSRI-induced sexual dysfunction, and attention-deficit hyperactivity disorder (ADHD). 

Does Wellbutrin cause weight loss?

In pre-marketing clinical studies of brand name Wellbutrin SR (sustained-release bupropion) in the treatment of depression, mild weight loss of greater than five pounds occurred in 28% of all patients receiving the medication-at either a dose of 300 mg per day or 400 mg per day. This was more than any weight loss observed in patients taking a placebo as the comparator. This led to the medication being studied in overweight and obese adult women and showed that bupropion was more effective at achieving weight loss at eight weeks compared to placebo. What is even more profound with bupropion is its apparent ability to allow for weight loss that is sustained over time. 

A 2012 study found that overweight or obese adults taking sustained-release bupropion in 300 mg or 400 mg doses lost weight in a dose-dependent manner when combined with a lifestyle intervention program. 

According to a clinical trial published in the Journal of Clinical Medicine, conducted by Group Health researchers, when different antidepressants were examined to understand their relationship on long-term weight change, it was found that bupropion is the only antidepressant associated with long-term weight loss-others had modest effects on weight loss, while others were associated with weight gain. Given no known difference in efficacy on antidepressant effects, bupropion should be considered the best initial choice of antidepressant in depressed overweight, and obese patients when no known contraindications are present. 

How does Wellbutrin cause weight loss?

The exact mechanism for Wellbutrin weight loss is not well defined. Bupropion has dual neurotransmitter properties as a norepinephrine and dopamine reuptake inhibitor—it has no clinically significant effect on serotonin levels. The stimulation of norepinephrine and dopamine suppresses the hypothalamus, the area of the brain involved in appetite regulation. It’s a two-way street, as medications known to decrease the level of the brain chemical dopamine have been linked to obesity. Bupropion may also influence the mesolimbic dopamine circuit of the brain known to deal with the rewards system. In addition, because Wellbutrin improves stress and mood, it may be especially helpful for weight loss in individuals who exhibit stress-eating habits. 

The combination tablet of extended-release bupropion and naltrexone, a known opioid antagonist, also has a beneficial impact on chronic weight management. Naltrexone on its own has no effect on weight management, but in conjunction with its role of opiates in the reward aspects of dense sugar and high-fat meal intake, its antagonism of opioid receptors should reduce the subjective reward experienced in liking certain foods. This combination is available as a single tablet, brand name Contrave. 

Who can take Wellbutrin for weight loss?

Wellbutrin SR and Wellbutrin XL do not have FDA-approved indications for weight loss, but can be used off-label as a weight-loss drug, and may be particularly good choices in patients who also require antidepressant treatment. A dose of 400 mg/day was associated with a higher percentage of total body weight loss when compared to a 300 mg/day dose. 

The main ingredient of these brand-name medications, bupropion, is available in combination with naltrexone as Contrave extended-release tablets. Contrave was FDA approved in 2014 as an adjunct to a reduced-calorie diet and increased physical activity for chronic weight management in obese or overweight adults in the presence of at least one weight-related comorbid medical condition. The dose of Contrave is a titrated dose for adults at least 18 years of age, up to a maximum of two tablets (16 mg naltrexone/180 mg bupropion) taken twice daily, and clinical studies have demonstrated an average weight loss of nine pounds at 56 weeks of follow-up. 

Is it safe to take Wellbutrin for weight loss?

Wellbutrin and its active ingredient bupropion are generally safe when taken per the advice of a healthcare provider. Taking Wellbutrin for weight loss may also improve overall mood and reduce feelings of stress. However, there are certain patients in which Wellbutrin should be avoided, including those with a diagnosis of an eating disorder like anorexia, a seizure disorder, people taking monoamine oxidase (MAO)-inhibitors, or those with a known allergic reaction. Labeling for Wellbutrin, like most antidepressants, was updated in 2005 to add a warning that it may cause rare cases of depression and comes with a risk of suicidal thoughts—especially in young adults. 

The addition of naltrexone extended-release in a combination tablet with the main ingredient of Wellbutrin, bupropion, as brand name Contrave adds some populations that should avoid the medication due to safety concerns. In addition to the above warnings, Contrave should not be used in patients with uncontrolled high blood pressure; in patients undergoing abrupt discontinuation of alcohol and certain medications, like antiepileptics; with use of other medications containing bupropion; patients on chronic opioids or opiate agonists (e.g., methadone) or partial agonists (e.g., buprenorphine) or undergoing acute opioid withdrawal. While Wellbutrin for depression during pregnancy should be discussed on an individual basis, Contrave during pregnancy should be avoided since medications for weight loss are not recommended. 

Bupropion is known to cause several drug interactions based on the way it is metabolized by the body, which is one of many possible medication errors that a person can experience. It is critical to provide a complete medical history including a list of current medications, vitamins, and over-the-counter drugs you are taking to your healthcare provider if being initiated on Wellbutrin.

The benefits of weight loss in obese and overweight people are profound. Obesity is an increasingly serious and costly health problem in the United States, with a prevalence of over 40%. Obesity-related conditions, such as heart disease, Type 2 diabetes, and certain types of cancers, are some of the leading causes of preventable and premature death in the United States. Medical costs in obese patients are almost $2000 higher than medical costs for patients with a healthy weight. Weight loss can also benefit mental health with a self-esteem boost and improved sleep. Overall, despite some rare safety concerns, Wellbutrin is well-tolerated and safe. 

Wellbutrin side effects

Common side effects of Wellbutrin are generally benign, and include: 

• Dizziness or headache
• Shakiness
• Feeling nervous and excitable
• Trouble sleeping

More serious side effects, like seizures, hallucinations, skin rash, high blood pressure, a fast heart rate, ocular effects, and suicidal thoughts are possible. If any of these adverse effects arise, immediately contact your provider.

How to maximize Wellbutrin benefits

To get the most out of your prescription with Wellbutrin to shed those extra pounds, it is important to know some critical points. If taken only once a day, Wellbutrin is best taken in the morning as it can be a little stimulating, and combine with caffeine cautiously until you know how the two impact you. If taking a formulation that is prescribed more than once daily, the last dose should be limited to taking in the mid-afternoon, or else some insomnia may be experienced. Otherwise, Wellbutrin can be taken with or without food. You should swallow the medication whole-do not chew, break, or crush the tablets. Avoiding drinking alcohol while taking Wellbutrin, as the main ingredient may result in a decreased tolerance during treatment. 

While the side effect of weight loss has been described as dose-dependent, with more weight loss seen with higher doses, never take more than the prescribed dose and under the advice of a medical professional since higher doses result in a higher risk of unwanted side effects.