How To Taper Off Bupropion: Approach & Potential Risks

Learn about the potential risks of discontinuing Bupropion and how to reduce the risk of relapse and withdrawal.

How To Taper Off Bupropion

Stopping antidepressants may lead to several different setbacks, both short-term and long-term. Users must aware of these potential negative effects and how to minimize the risk of running into them.

Discontinuing antidepressants like Bupropion (Wellbutrin), which target dopamine and norepinephrine, generally cause fewer issues overall than other commonly prescribed antidepressants that target serotonin, such as Paroxetine and Venlafaxine. 

There is a lack of evidence on how to taper off Bupropion. Research for other antidepressants indicates that lowering the dosage every 4 weeks may be a safe strategy to minimize the risk of withdrawal and rebound symptoms. 

Potential Risks of Stopping Antidepressants

The main risks of discontinuing antidepressants include experiencing withdrawal symptoms and the risk of having depressive symptoms reoccur up to half a year after stopping treatment. 

Be sure to discuss with your prescribing physician or psychiatrist before stopping Bupropion. It is preferable to stop antidepressants when you have completely recovered from the depressive episode and your life is otherwise stable.

If you haven't been exercising regularly, make it a goal to start when you discontinue Bupropion. Exercise reduces the risk of depression and can increase your mood.

Antidepressant Discontinuation Syndrome

Withdrawal symptoms from antidepressants are also known as antidepressant discontinuation syndrome (ADS). It characteristically occur in some individuals when rapidly stopping treatment or drastically reducing the dose. 

While not fully understood, research indicates that the minimum treatment duration for being at risk of developing withdrawal symptoms is 4-8 weeks and that this risk does not change to any relevant extent with longer treatment.

Withdrawal Symptoms

The most common symptoms of ADS include flu-like symptoms, nausea, and dizziness. There may also be hyperarousal i.e. anxiety, agitation, and irritability. Some individuals will also experience sensory disturbances, like electric shock-like sensations or dysesthesia. Others will experience sleep disturbances and nightmares.

Symptoms of ADS are typically mild and last for one to two weeks. They quickly fade away once you resume taking the antidepressant medication. Some antidepressants may be at higher risk of ADS than others, like Paroxetine.

For Bupropion the research is scarce and unclear, but a couple of case reports suggest that discontinuation of the drug may also lead to withdrawal symptoms, primarily including agitation and irritability. 

Rebound and Relapse

The rebound effect can happen when the body becomes more vulnerable after stopping a medication. This can lead to the return of depression or anxiety symptoms to a greater extent than before the antidepressant was started. 

In some cases, the symptoms are more severe than previously. Anxiety, panic disorders, sleep issues, and bipolar symptoms have been observed after stopping certain antidepressants. The risk of relapse is particularly high in the first 6 months following discontinuation.

How To Taper Off Bupropion

There is limited evidence regarding the occurrence of discontinuation syndrome when stopping Bupropion. However, the medication's pharmacological characteristics would suggest that it is not as prevalent or severe as antidepressants that modulate serotonin levels. 

As such, there is a distinct lack of guidelines on how to taper off Bupropion. In general, the best way to reduce the risk of ADS is to taper antidepressants slowly. 

How to Approach Tapering

Generally, it appears safe to decrease the dosage of Bupropion more rapidly than with SSRIs or SNRIs in terms of withdrawal symptoms. 

The American Psychiatric Association recommends that all antidepressants be tapered down to lower the risk of withdrawal symptoms. 

Individual Approach

The speed of tapering is individual and should be decided in collaboration with your doctor. For example, those who have experienced withdrawal symptoms in the past may want to taper more slowly.

Individuals at risk may opt for a slower tapering schedule, such as reducing the dose every 4-6 weeks until reaching total discontinuation. 

This approach also allows individuals to monitor for any signs of withdrawal or recurring depression symptoms and seek medical advice accordingly. 

Consult Your Doctor

Always follow a tapering schedule for antidepressant under the guidance of your prescribing doctor or psychiatrist. 

They can assist you in customizing the Bupropion tapering process to suit your individual needs and may provide relief through recommendations or by prescribing alternative medications to alleviate your symptoms.

If you sense a recurrence of depressive symptoms, contact your doctor promptly for assistance. In case you are unsure, you can take our short quiz to screen for the symptoms of depression.

Cover image by yanalya on Freepik

Author: J. Martin, M.D.
Last update: March 24, 2024

Disclaimer: The information provided is intended for general informational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always consult with a qualified healthcare provider, such as a physician, before starting any new treatment or making changes to your existing treatment plan. Individual responses to treatment may vary, and a healthcare professional can provide personalized guidance based on your specific needs and circumstances. If you are experiencing severe or persistent symptoms of disease or mental illness, seek immediate medical attention.