March 28, 2023

This is a detailed response to a question I received regarding the risk of seizure and Bupropion use. What I found in the literature is not what you might expect.

What’s up everybody dr rossi shrinks and so again thank you to everyone who’s liked and subscribed to the channel if you’re new to the channel please subscribe below and we’re going to be covering lots of things related to mental health specifically i want to cover today this idea of bupropion or wellbutrin and seizure risk so this was a question that

Popped up in one of the one of the previous videos that i made where somebody asked does bupropion cause increased risk of seizure now of course like everything else in life it’s a nuanced point so it’s actually not quite as black and white as we’d like it to be but let’s go through the data and let’s see what the research actually says does bupropion increase

Your risk of seizure so in my experience there’s kind of two different people in this category there’s those who are not concerned enough with the risk of seizure in bupreon and i’ve had some attendings who like to even go beyond 450 milligrams which i would not advise and i’ll explain why in a minute but there’s some people that feel like oh it works better at

Higher doses and you got to go up on the dose in order to get the full effect then you have other people who are way too cautious and feel like oh you know anybody who has a hint of seizure risk i’m not going to prescribe this medication okay so both of those people are wrong right for different reasons and we’re going to go ahead and crack into why that is so

Bupropion is actually a very valuable antidepressant right and one of the big reasons why it’s a valuable antidepressant is because it doesn’t cause sexual dysfunction and sexual dysfunction can be a major cause for people to stop taking these medications and feel like they don’t need to take them anymore because it’s disrupting a major part of their life i mean

Our sexual health is very important and if you can’t perform adequately or you’re having difficulty that’s going to cause you more stress anxiety and depression so sexual dysfunction is one reason another good reason is weight gain a lot of antidepressants have been known to cause weight gain this is one that is actually used as part of a weight loss medication

And i’ve talked about this a little bit with naltrexone and it’s it’s actually it so it actually can help people to lose weight so it can improve sexual function or at least not hinder it it can decrease the risk for weight gain and it can be energizing so a lot of times if i have a patient who’s very very low energy lethargic listless just can’t get out of

Their own way i like to use things like bupropion to help that person so we need to correctly kind of understand the seizure risk of bupropion and what the reality is versus what the perceived notions are you may be shocked to find out that the risk of seizure and bupropion sustained release up to 300 milligrams a day so sustained release be proprion up to 300

Milligrams a day is 0.1 so what does that translate to that translates to approximately one in 1 000 people which is exactly the same risk of seizure as as ssris as selective serotonin reuptake inhibitors so if you’re taking lexapro or you’re taking circulane you’re you’re at the same risk as someone taking 300 milligrams of buprogram 0.1 or one in a thousand

So with that said people taking between 150 milligrams to 300 milligrams a day actually don’t have a higher seizure risk than those taking ssris so it’s the same same risk up to 300 milligrams now it starts to change a little bit when you start to talk about higher doses and we’re going to talk a little bit about that so the risk of new onset seizure in the

General population is actually 0.08 percent so there’s actually like a risk of people in the general population developing a seizure and it’s about 0.08 percent so if you compare the 0.1 to 0.08 it’s actually not that different right so the risk of being on an ssri and having a seizure the risk of being on bupropion up to 300 milligrams per day is actually not

That much different than what it would be for the gen for someone in the general population to develop a seizure so major points here lower doses of bupropion are not that much worse than say the general population’s risk for having a seizure and also it’s equal to that of those taking selective serotonin reuptake inhibitors or other traditional antidepressants

So not really much of a difference there now on the other hand when we start looking at higher doses so the risk of seizure of course becomes greater with bupropion so that’s why i said in one of in my response to this person’s comment that that it’s dependent so it’s those dependent now if you’re taking sustained release 400 milligrams per day the risk actually

Goes up to 0.4 percent so the risk is higher right 0.1 versus 0.4 and that’s four times greater than the doses up to 300 milligrams per day so this is a pretty this is more significant um so we want to be aware of that and in many cases you don’t ever want to go above 450 milligrams which is the fda approved limit so i would not in my own practice and i would

Not recommend to anyone else in their practice to go above 450 milligrams unless they have a lot of clinical experience doing so and are comfortable doing so because above 450 milligrams per day the risk of seizure increases ten fold it’s actually four percent which is really unacceptably high four percent significant risk here in this case so i would not

Necessarily want to go above 450 milligrams again unless i really had a good reason for it and even if you have a good reason for it you’re likely going to be held liable if there’s an adverse outcome with that said the reality is that we should not undervalue the utility of bupropion and we should not underestimate the risk of seizure but when we’re using this

Medication in the proper dose range it does not seem to have as much risk for seizure as some would lead you to believe so i don’t think there’s a reason to pull bupropion out of your medication regimen just because you’re concerned about seizure obviously that changes a little bit if you have a pre-existing seizure condition you’re probably not going to start

Bupropion to begin with but with that said that concludes the video if you guys have questions or comments about bupropion and want to know more about the seizure risk i’m happy to answer those questions please like and subscribe to the channel and we’ll continue making videos tailored to your questions and your thoughts

Transcribed from video
Does Bupropion or Wellbutrin Increase Seizure Risk? By Shrinks In Sneakers