Are you struggling with depression, managing your weight, or trying to quit cigarettes? Discover the uses, benefits, and potential side effects of Bupropion (Aplenzin/Wellbutrin) and whether it might be the right choice for you.
Introduction
Bupropion, available under the brand names Aplenzin and Wellbutrin, is an antidepressant medication that has also been found to have weight loss effects. This article explores how bupropion works, who qualifies for its use, its effectiveness compared to other weight loss medications, potential side effects, and other important considerations.
What is Bupropion?
Bupropion is an antidepressant medication used to treat depression and aid in smoking cessation. It is sold under the brand names Aplenzin and Wellbutrin. Although primarily prescribed for mood disorders, it can also be used off-label to assist in weight management, particularly when depression is a comorbidity. The main difference between Aplenzin and Wellbutrin lies in their dosing schedules; both contain the same active ingredient and treat similar conditions.
How Does Bupropion Work?
The exact mechanism by which bupropion promotes weight loss is not entirely clear. However, it is believed to work by influencing neurotransmitters in the brain, specifically dopamine and norepinephrine. These neurotransmitters play a crucial role in regulating appetite, cravings, and energy metabolism.
Bupropion may help reduce appetite and food cravings, leading to decreased calorie intake. It might also increase energy expenditure by boosting the body's metabolic rate, although the precise mechanisms behind this are still under investigation.
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Who Qualifies for Bupropion?
Wellbutrin and Aplenzin are FDA-approved for treating depression. Wellbutrin is also approved for smoking cessation. You may be eligible for Wellbutrin or Aplenzin if you have Major Depressive Disorder (MDD) or Seasonal Affective Disorder (SAD). Wellbutrin is also an option if you are a smoker who wants to quit.
Additionally, Wellbutrin and Aplenzin can be used off-label for weight loss. You may be eligible if you have a BMI of 30 or higher, or a BMI of 27 or higher with at least one weight-related condition such as diabetes, high blood pressure, or high cholesterol.
Can Bupropion Be Used For Weight Loss?
Research indicates that bupropion can be beneficial for weight loss, especially for individuals struggling with obesity. A 2012 study examined the effects of bupropion on obese patients. Participants were given varying doses of bupropion in conjunction with a calorie-restricted diet and regular exercise for 24 weeks. The results demonstrated that those taking bupropion, along with diet and exercise, experienced a weight loss of approximately 7-10% of their initial body weight. It's important to note that bupropion, like any prescription weight loss medication, should be used in conjunction with a healthy diet and regular physical activity to maximize its effectiveness.
In a preliminary study involving 50 overweight and obese women (body mass index: 28.0 to 52.6 kg/m(2)), a randomized, double-blind, placebo-controlled comparison was conducted for 8 weeks. Bupropion or placebo was initiated at 100 mg/d, with a gradual dose increase to a maximum of 200 mg twice daily. All subjects were prescribed a 1600 kcal/d balanced diet, and compliance was monitored with food diaries. Responders continued the same treatment in a double-blind manner for an additional 16 weeks, totaling 24 weeks. Subjects receiving bupropion achieved greater mean weight loss (last-observation-carried-forward analysis) over the first 8 weeks of the study (p = 0.0001): 4.9% +/- 3.4% (n = 25) for bupropion treatment compared with 1.3% +/- 2.4% (n = 25) for placebo treatment. For those who completed the 8 weeks, the comparison was 6.2% +/- 3.1% (n = 18) vs. 1.6% +/- 2.9% (n = 13), respectively(p = 0.0002), with 12 of 18 of the bupropion subjects (67%) losing over 5% of baseline body weight compared with 2 of 13 in the placebo group (15%; p = 0.0094). In the continuation phase, 14 bupropion responders who completed 24 weeks achieved weight loss of 12.9% +/- 5.6% with fat accounting for 73.5% +/- 3.7% of the weight lost and no change in bone mineral density as assessed by DXA. Bupropion was more effective than placebo in achieving weight loss at 8 weeks in overweight and obese adult women in this preliminary study.
Bupropion vs Other Prescription Weight Loss Medications
Bupropion vs Contrave
Contrave is an FDA-approved prescription weight loss medication combining naltrexone and bupropion. In the COR-II trial (2013), participants with obesity were given Contrave for 56 weeks, along with a calorie-restricted diet and regular exercise. The results showed that Contrave led to approximately 6% body weight loss after 56 weeks and reduced cardiometabolic risk factors.
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While bupropion appears to have a more significant weight loss effect in a shorter timeframe compared to Contrave, Contrave's FDA approval for weight loss may make it easier to qualify for if you do not have depression or are not currently smoking. Contrave should be avoided in patients with a history of opioid use disorder or chronic opioid use, making bupropion a better option for these individuals. Additionally, Contrave cannot be prescribed for depression, so bupropion may be preferred for those with depression.
Bupropion vs Qsymia
Qsymia is a weight loss medication that combines phentermine and topiramate. Phentermine suppresses appetite by affecting the central nervous system, while topiramate, an anti-seizure drug, helps with weight loss by reducing appetite and increasing feelings of fullness.
In the CONQUER Trial (2011), participants taking different doses of Qsymia lost approximately 8-10 kg (18-22 lbs) over 52 weeks. Around 68% of participants experienced at least a 5% reduction in weight after one year. Qsymia appears more effective at reducing body weight and has FDA approval for obesity management, potentially making insurance approval easier.
Bupropion vs GLP-1 Medications
GLP-1 agonist medications, initially developed for type 2 diabetes, mimic the GLP-1 hormone to regulate blood sugar and slow food movement through the gut. Some GLP-1 agonists like Wegovy® and Saxenda® are FDA-approved for obesity treatment, while others (Mounjaro®, Ozempic®, Rybelsus, Victoza, Trulicity) are used off-label for weight loss.
These medications can lead to a 10-20% reduction in body weight, especially when combined with diet and exercise. For instance, the SURMOUNT-1 Trial showed that people taking Mounjaro® over 72 weeks had an average body weight reduction of 15%.
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While highly effective, GLP-1 medications often cost more than bupropion. Although they may have potential benefits for depression and anxiety, they are not primarily used to treat depression. Bupropion may be a better option for individuals with depression seeking weight loss.
Bupropion Side Effects
When taking bupropion, side effects may vary. Common side effects include:
- Insomnia (45%)
- Vivid Dreams (~13%)
- Decreased libido or sexual drive (~10%)
- Dry Mouth (27%)
- Constipation (26%)
- Nausea and vomiting (22%)
- Headache (34%)
- Sedation (20%)
- Dizziness (22%)
Bupropion Dosage and Administration
Bupropion is available under the brand names Aplenzin and Wellbutrin, with different dosing schedules.
Wellbutrin: Typically started at 100mg twice daily (200mg per day). After three days, the dose may be increased to 300mg per day (three 100mg tablets taken six hours apart). The maximum dosage for Wellbutrin is 450 mg per day.
Aplenzin: Dosing varies depending on the condition being treated (MDD or SAD). For MDD, Aplenzin is usually started at 174mg once per day, increasing to 348mg after four days. For SAD, Aplenzin also starts at 174mg, increasing to 348mg after seven days and continued throughout the winter, then gradually tapered off in the spring.
Wellbutrin XL is an extended-release tablet which releases more slowly than the Wellbutrin SR tablet which is released faster.
Bupropion Contraindications and Warnings
- Severe Allergic Reaction: Signs include swelling of the face, lips, tongue, or throat, breathing or swallowing difficulties, severe rash or itching, fainting, dizziness, and rapid heartbeat.
- History of Seizures: Bupropion can increase the risk of seizures, especially in individuals with a history of seizure disorders.
- Anorexia or Bulimia: People with eating disorders may have a higher risk of seizures when taking Bupropion.
- Suicidal Thoughts and Psychiatric Symptoms: Bupropion may worsen suicidal thoughts or induce psychosis in those at high risk of psychiatric disorders.
- Drug Interactions: Avoid taking bupropion with other bupropion-containing products (Contrave, Wellbutrin, Aplenzin) or Monoamine Oxidase Inhibitors (MAOIs).
- Alcohol Consumption: Drinking alcoholic beverages should be limited or avoided, if possible, with bupropion. This will help prevent seizures.
- High Blood Pressure: Your blood pressure might get too high while you are using this medicine. This may cause headaches, dizziness, or blurred vision.
Bupropion Coverage and Cost
Wellbutrin is generally less expensive than Aplenzin. Wellbutrin can cost around $6-$13 for a month’s supply, with payment assistance programs available. Aplenzin can cost upwards of $2500 for a month's supply, with limited generic options. Depending on your insurance plan, you may be eligible for an Aplenzin CoPay Coupon to help reduce costs.
Where Can I Get Bupropion?
If you would like to learn more about Bupropion or want to see if you might be eligible for medication-assisted weight loss, consult with a healthcare provider.
The Risks of Using Bupropion for Weight Loss
Taking bupropion for weight loss can be risky and may be a sign of an underlying eating disorder. Bupropion doesn’t treat the underlying issues that cause binge eating disorder. It's important to seek therapy for this.
Using bupropion to lose weight could be indicative of disordered eating, especially when other abnormal eating behaviors are present. In fact, using medications like Wellbutrin for weight control significantly increases the risk of being diagnosed with an eating disorder like anorexia nervosa (AN) or bulimia nervosa (BN).
Monitoring Weight on Wellbutrin
Monitoring weight on Wellbutrin takes a well-defined plan that combines a healthy lifestyle, nutrition, and mindfulness.
- Being mindful of your portion sizes and eating regular, consistent meals will help stabilize your metabolism and make maintaining weight easier.
- A healthy diet is vital to maintaining a healthy weight for your body size and type. Focus on eating a balanced diet rich in fruits, vegetables, lean proteins, whole grains, and healthy fats.
- Studies show that working out regularly is great for establishing a healthy weight long-term.
- Mindfulness simply means being aware of what you’re doing in the present. It’s an effective form of meditation that offers positive results, including weight loss.
Conclusion
Bupropion can be a helpful medication for weight loss, especially for individuals also managing depression or seeking to quit smoking. However, it is essential to consider the potential side effects, contraindications, and interactions with other medications. Consulting with a healthcare professional is crucial to determine if bupropion is the right choice for you and to ensure safe and effective use.