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Wellbutrin XL (bupropion) is an antidepressant used to treat depression and certain similar conditions, such as seasonal affective disorder (SAD) and Social anxiety disorder.

Why Wellbutrin XL?

The most commonly prescribed antidepressants are selective serotonin reuptake inhibitors (SSRIs), which includes brands such as Prozac, Zoloft, Lexapro and so forth. SSRIs are believed to elevate mood by increasing the amount of serotonin in the brain.

The active ingredient in Wellbutrin XL, bupropion, is a norepinephrine and dopamine reuptake inhibitor (NDRI). It is believed to improve mood by elevating levels of dopamine in the brain, rather than serotonin.

In practice the effects of both SSRIs and NDRIs are very similar; both improve mood and help patients break out of depression. Wellbutrin XL, however, provides some additional benefits:

• Wellbutrin XL does not produce the sexual side effects commonly experienced with SSRIs;
• Patients taking Wellbutrin XL do not experience the weight gain associated with SSRIs;
• Wellbutrin products have shown to be considerably less addictive than SSRIs;
• Wellbutrin is more effective at eliminating depression-related fatigue and anxiety.

In fact, Wellbutrin not only doesn't produce sexual side effects or promote weight gain, it very often does the opposite--so much so that Wellbutrin is often prescribed to counteract these side effects of SSRI therapy.

In most cases Wellbutrin XL is significantly less costly than SSRI medications, too--not a small consideration when treatment spans months or years.

Treatment Overview

Note that there are several Wellbutrin products:

• Wellbutrin immediate release, usually taken 3 times per day;
• Wellbutrin SR (sustained-release), also marketed as Zyban, taken twice per day;
• Wellbutrin XL (extended-release), taken once per day.

These products have differing dosage and administration guidelines. The following pertains to Wellbutrin XL only and should not be applied to other Wellbutrin products.

In otherwise healthy adults, treatment with Wellbutrin XL is typically similar in all patients:

• Treatment should start by taking 150 mg once daily, ideally in the morning.
• After at least 4 days of 150 mg, dosage may be increased to 300 mg once daily; this dose is sufficient for the majority of patients.
• If results are inadequate after 4 weeks of treatment with 300 mg per day, dosage may be increased to 450 mg once daily.
• Never exceed 450 mg in a 24 hour period; doing so greatly increases risk of serious side effects.
• Always swallow Wellbutrin XL tablets whole; do not crush, chew, dissolve or otherwise damage tablets. Doing so will cause too much medication to be released at once.
• Tablets may be taken with or without food according to personal preference.

Many patients notice some improvement just days after the first dose, but it takes at least 4 weeks for full benefits to be felt. Occasionally Wellbutrin will be prescribed along with an SSRI antidepressant if either of the medications alone are not sufficiently effective.

If Wellbutrin XL has been used long-term, dosage is usually tapered down over several days when treatment stops.

Warnings & Side Effects

If taken properly (not exceeding dosage guidelines) side effects are relatively rare, usually mild, and usually stop occurring after several weeks of treatment. The most commonly experienced side effects include:

• Headache
• Stomach upset
• Dry mouth
• Loss of appetite
• Mild euphoria
• Mild weight loss

Patients with certain preexisting conditions are at greater risk of experiencing serious side effects, most notably those who:

• Have a history of seizures
• Have a history of liver, kidney, or heart disease
• Have high blood pressure
• Have taken monoamine oxidase inhibitors (MAOIs) within 14 days
• Are taking other medications, including other antidepressants
• Are excessively using alcohol or recreational drugs

The above conditions do not necessarily rule out Wellbutrin XL use, but risks should be discussed with a doctor before initiating treatment; it is likely that dosage adjustments will need to be made.