Tapering off Wellbutrin
Consider your reasons for no longer wanting to take Wellbutrin. Wellbutrin is usually very effective at controlling symptoms of depression. Generally, those taking the drug should continue it to help manage the respective depression or disorder unless directed otherwise by a care provider; however, there are a few good reasons to discontinue or change the therapy, including: If you experience severe or continuous side effects If your depression or disorder is not under control with Wellbutrin. For example, your depression may not be adequately controlled if you have persistent sad, anxious or empty feelings, irritability, loss of interest in pleasurable activities or hobbies, fatigue, difficulty concentrating, sleep disturbances such as insomnia or excessive sleeping, appetite changes, thoughts of suicide, or physical aches and pains. It is important to note that Wellbutrin generally takes up to eight weeks to fully work and may require dosage increases. If you have been on Wellbutrin for a while (six to 12 months) and your doctor feels that you are not at risk for (or do not have) chronic or recurrent depression.
Monitor any side effects. Some mild side effects of the medication can include: nausea, dry mouth, drowsiness, weight loss, insomnia, anxiety, changes in taste, frequent urination, and uncontrollable shaking. Let your doctor know if any of these side effects are severe or do not go away. Serious side effects include seizures, hallucinations, irregular heartbeat, or allergic reactions. Stop taking Wellbutrin and call your doctor right away if you experience any serious side effects. Ideas of suicide may present in younger adults and children. Let your doctor know right away if you have thoughts related to suicide.
Talk to your doctor. Discuss your reasons for wanting to stop taking Wellbutrin with your doctor. Inform your doctor if you feel you don't need medication any longer, have trouble with side effects, or feel that your medication is not working after waiting the initial eight weeks for it to fully work. This helps your doctor make an informed decision and decide if the time is right for you to stop taking Wellbutrin.
Discontinue Wellbutrin slowly. Antidepressants need to be slowly discontinued with a gradual decrease in doses to avoid discontinuation symptoms. This is called tapering. Wellbutrin is usually tapered for approximately two weeks before stopping the medication completely. If you stop right away or go “cold turkey,” your body does not have enough time to adjust and you may experience worse discontinuation symptoms. Note that these symptoms may be different than SSRI discontinuation symptoms or those of other antidepressants. Symptoms can occur within hours to three days after discontinuation and may include: Abdominal issues such as nausea, vomiting, diarrhea, or cramps Sleep issues such as insomnia or nightmares Balance issues such as dizziness or lightheadedness Sensory or movement issues such as numbness, tingling, tremors, or lack of coordination Feelings of irritability, agitation, or anxiety This constellation of symptoms is sometimes called "discontinuation syndrome."
Taper based on your doctor’s schedule. The length of time it takes to completely stop taking Wellbutrin may depend on how long you were on the medication and the dose you were prescribed. Your doctor will determine the best way to taper Wellbutrin. The usual target dose of Wellbutrin according to the manufacturer is 300 mg per day in the form of 150 mg twice daily (with a maximum dose at 400mg per day as 200 mg twice daily). However, your specific prescription may vary. Always follow prescribed dosages. The standard reduction schedule for patients at the target dosage of 300 mg daily is to reduce to 200 mg at the first reduction, followed by subtracting 50 mg on subsequent reductions; however, the amount of time and dosage between reductions will ultimately depend on your first initial reaction to the first reduction, which your doctor will monitor closely to determine the best reduction schedule for you. The process can take anywhere from weeks to months depending on the individual patient. For regular, immediate release tablets, your doctor may recommend cutting the tablet to change the dose; however, it is important to note that Wellbutrin is usually prescribed as a longer-acting tablet. With extended- or sustained-release formulations, you cannot cut the tablets. Tapering these formulations may include prescribing lower dose tablets or taking the same dose at longer intervals such as every other day. Keep track of your tapering schedule by writing down the dates and the dosage changes.
Document any effects you experience. Even if you are tapering off Wellbutrin, it is still possible to experience discontinuation symptoms, such as the ones mentioned in Part 1. Keep track of your symptoms and talk to your doctor if you develop any issues. Discontinuation symptoms have a quick onset, slowly get better over one to two weeks, and include more physical complaints. In order to differentiate between relapse and discontinuation symptoms, look at when the symptoms start, how long they last, and the type of symptoms. While discontinuation symptoms with bupropion are not common, there is a greater risk of side effects with discontinuing if the patient is not starting a new antidepressant with a similar pharmacodynamic profile. Relapse, or the recurrence of your depression, may also occur with discontinuation of your therapy. Keep you doctor informed about how you are feeling and if you have concerns about a relapse. Relapse symptoms gradually develop after two to three weeks and get worse over two to four weeks. Contact your doctor if any symptoms last more than one month.
Keep your doctor informed. It is crucial to keep your doctor informed about your progress whether you develop any symptoms or not. In addition, inform your doctor about any relapse symptoms or concerns you may have. Your doctor will monitor you for at least a few months after discontinuation.
Take any new medications according to your doctor’s prescription. If you are discontinuing Wellbutrin because of side effects or if Wellbutrin is not controlling your depression, your doctor may prescribe a different antidepressant. Choice of medication depends on many aspects such as patient preference, prior response, effectiveness, safety and tolerance, cost, side effects, and drug interactions. If you experienced side effects or inadequate control of your depression, your doctor may recommend: Selective serotonin reuptake inhibitors (SSRIs), including Prozac (fluoxetine), Zoloft (sertraline), Paxil (paroxetine), Celexa (citalopram), or Lexapro (escitalopram) Serotonin norepinephrine reuptake inhibitors (SNRIs), such as Effexor (venlafaxine) Tricyclic antidepressants (TCAs), such as Elavil (amitriptyline) Monoamine oxidase inhibitors (MAOIs) can also be used after waiting at least two weeks after discontinuation of Wellbutrin.
Including Lifestyle Changes and Alternative Therapies
Try to exercise regularly. Studies show that regular exercise can help produce endorphins and increase neurotransmitters that may help with symptoms of depression. Try to exercise for approximately 30 minutes each day.
Change your diet. A healthy diet can help improve your overall health. In particular, omega-3 fatty acids have been shown to help as an adjunctive therapy for depression. Omega-3- fatty acids are contained in foods such as kale, spinach, flaxseeds, walnuts, and fatty fish such as salmon. They are also available over the counter, usually as fish oil gelatin capsules. Studies that showed benefits from omega-3 fatty acids in mood disorders included doses between 1–9 grams; however, more evidence supports the lower doses in that range.
Follow a consistent sleep schedule. Sleep is often disturbed by depression. It is important to follow good sleep hygiene to ensure you are getting proper rest. Good sleep hygiene includes: Going to bed and getting up the same time each day Avoiding stimulation before sleeping, such as exercise, watching TV, or doing computer work Avoiding alcohol and caffeine before bed Avoiding eating large meals and drinking large amounts of liquid within a few hours of bedtime Sleeping in a cool, dark and quiet room Associating your bed with sleep as opposed to reading or doing other work
Get some sun. There is not a consensus on how much exposure you need to help symptoms of depression; however, researchers agree some types of depression, such as seasonal affective disorder, may benefit from getting more exposure to sunlight. Research also suggests sunlight can affect your levels of serotonin. Generally, there isn’t a maximum amount of exposure for sunlight. Make sure you wear sunscreen if you are going to be in the sun longer than 15 minutes.
Have a good support system. Throughout the process, stay in touch with your doctor and let them know about your status, feelings, or symptoms. Keep a relative or close friend involved as well. They may be able to provide emotional support or recognize signs of relapse.
Consider psychotherapy. An analysis of different studies found that people who undergo psychotherapy while discontinuing an antidepressant are less likely to have a relapse. Psychotherapy is a way to help people with mental disorders by teaching them ways to deal with unhealthy thoughts and behaviors. It gives people tools and strategies to manage their stress, anxieties, thoughts, and behaviors. There are different types of psychotherapy. Treatment plans depend on the individual, the disorder, severity of disorder, and numerous other factors such as if you are on medications. Cognitive behavioral therapy’s (CBT) goal is help a person think more positively and influence behavior. It focuses on current problems and solutions to those problems. A therapist helps the person identify unhelpful thinking and change inaccurate beliefs, thus aiding a change in behavior. CBT is particularly effective for depression. Other therapies—such as interpersonal therapy, which focuses on improving communication patterns; family-focused therapy, which helps by resolving family conflicts that may be influencing the patient’s illness; or psychodynamic therapy, which focuses on helping people gain self-awareness—are also available options.
Consider meditating. A Johns Hopkins analysis of previous studies suggests that thirty minutes of daily meditation may improve symptoms of depression and anxiety. Practical ways you can practice meditation are repeating a mantra, prayer, taking time to focus on breathing, or reflecting on what you have read. Aspects of medication include: Focus: Focusing on a specific object, image, or breathing can free your mind of worry and stress. Relaxed breathing: Slow, deep, diaphragmatic breathing (breathing that makes your belly rise when you inhale, not your chest) activates your parasympathetic nervous system, which has a calming effect. Quiet setting: This is an important aspect to meditation, especially for beginners, so that you have fewer distractions.
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