Bupropion

Jul 26, 2018 | Articles

Bupropion

Is bupropion (Wellbutrin) safe during pregnancy?

This is a great question. Unfortunately, there is not a simple answer. Bupropion (Wellbutrin) is not completely risk free, but neither is untreated maternal illness. Women should decide whether or not to take bupropion during pregnancy after consultation with a perinatal psychiatric specialist. Together, they can evaluate the risks and benefits of taking bupropion after considering the woman’s personal psychiatric history, preferences, and values.

Untreated maternal mental illness

Women with a history of depression who stop taking their antidepressant have a 70% chance their depression recurring during pregnancy (compared to a 25% chance for women who continue taking their antidepressant).[i] Depression during pregnancy has been linked to increased rates of miscarriage and exposure of a developing fetus to stress.[ii] It has also been linked to an increased risk of postpartum depression, which, in turn, can affect a mother’s bonding with her baby, her ability to tolerate breastfeeding, and her attention to her baby’s safety.[iii]

Mental illness during pregnancy is risky, often—but not always—more risky than the use psychiatric medications.

Benefits of bupropion in women with depression
Bupropion is an antidepressant with similar efficacy to most other antidepressants. However, it is in its own class and has a different side effect profile. It may be less effective for anxious depression than SSRIs. On the other hand, rather than causing dysfunction, some women may find it to be beneficial when it comes to sex. While SSRIs are better studied and are considered preferred antidepressants during pregnancy, bupropion is a reasonable choice when women have not fully responded to an SSRI, have been unable to tolerate an SSRI, or have benefited from bupropion in the past.[iv]

Risks of bupropion

Prior to pregnancy

  • Side effects
    Bupropion is generally well tolerated. It can cause insomnia and weight loss. Seizures have been reported but are rare.[v]
  • Fertility
    There is no strong evidence that suggests bupropion impairs fertility.[vi]

During pregnancy

  • Miscarriage
    There is not sufficient evidence to conclude that there is an association between bupropion and miscarriage. One study suggested that there might be, but the study had serious flaws in its design. Rates of miscarriage were similar between women on bupropion and other antidepressants, suggesting that depression, not bupropion, might be responsible for the possible increased risk.[vii]
  • Congenital defects
    While there are studies that suggest that bupropion may be associated with cardiac defects, other studies, including the study likely to be the best study, suggest that there is no association.[viii]
  • Gestational hypertension and preeclampsia
    Bupropion is not associated with gestational hypertension or preeclampsia.[ix]
  • Preterm birth
    Bupropion is not associated with preterm birth.[x]
  • Low birth weight
    Bupropion is not associated with low birth weight.[xi]

At delivery

  • Postpartum hemorrhage
    Bupropion is not associated with postpartum hemorrhage.[xii]

After delivery

  • Future development of the baby
    One study suggested that a mother’s use of bupropion during pregnancy may be associated with her child later developing ADHD. This study has severe methodologic limitations and has not been replicated.[xiii]
  • Breastfeeding
    Women on bupropion may breastfeed. The amount the infant would be expected to consume through breastmilk is quite low and is often undetectable in the infant’s blood.[xiv]

Summary

Bupropion during pregnancy are not entirely risk free, but neither is untreated maternal mental illness. Women should decide whether or not to take bupropion during pregnancy after consultation with a perinatal psychiatric specialist. Together, they can evaluate the risks and benefits of taking bupropion after considering the woman’s personal psychiatric history, preferences, and values.

 

[i]

  1. Cohen LS, Altshuler LL, Harlow BL, Nonacs R, Newport DJ, Viguera AC, Suri R, Burt VK, Hendrick V, Reminick AM, Loughead A, Vitonis AF, Stowe ZN. Relapse of major depression during pregnancy in women who maintain or discontinue antidepressant treatment. JAMA. 2006 Feb 1;295(5):499-507. Erratum in: JAMA. 2006 Jul 12;296(2):170.

[ii]

  1. Bonari L, Pinto N, Ahn E, Einarson A, Steiner M, Koren G. Perinatal risks of untreated depression during pregnancy. Can J Psychiatry. 2004 Nov;49(11):726-35.
  2. Siu AL; US Preventive Services Task Force (USPSTF), Bibbins-Domingo K, Grossman DC, Baumann LC, Davidson KW, Ebell M, García FA, Gillman M, Herzstein J, Kemper AR, Krist AH, Kurth AE, Owens DK, Phillips WR, Phipps MG, Pignone MP. Screening for Depression in Adults: US Preventive Services Task Force Recommendation Statement. JAMA. 2016 Jan 26;315(4):380-7.
  3. Vigod SN, Wilson CA, Howard LM. Depression in pregnancy. BMJ. 2016 Mar 24;352:i1547.
  4. Schaffir J. Consequences of Antepartum Depression. Clin Obstet Gynecol. 2018 Apr 13.

[iii]

  1. Field T. Postpartum depression effects on early interactions, parenting, and safety practices: a review. Infant Behav Dev. 2010 Feb;33(1):1-6.
  2. Banti S, Mauri M, Oppo A, Borri C, Rambelli C, Ramacciotti D, Montagnani MS, Camilleri V, Cortopassi S, Rucci P, Cassano GB. From the third month of pregnancy to 1 year postpartum. Prevalence, incidence, recurrence, and new onset of depression. Results from the perinatal depression-research & screening unit study. Compr Psychiatry. 2011 Jul-Aug;52(4):343-51
  3. Viguera AC, Tondo L, Koukopoulos AE, Reginaldi D, Lepri B, Baldessarini RJ. Episodes of mood disorders in 2,252 pregnancies and postpartum periods. Am J Psychiatry. 2011 Nov;168(11):1179-85.

[iv]

  1. Papakostas GI, Stahl SM, Krishen A, Seifert CA, Tucker VL, Goodale EP, Fava M. Efficacy of bupropion and the selective serotonin reuptake inhibitors in the treatment of major depressive disorder with high levels of anxiety (anxious depression): a pooled analysis of 10 studies. J Clin Psychiatry. 2008 Aug;69(8):1287-92.
  2. Safarinejad MR, Hosseini SY, Asgari MA, Dadkhah F, Taghva A. A randomized, double-blind, placebo-controlled study of the efficacy and safety of bupropion for treating hypoactive sexual desire disorder in ovulating women. BJU Int. 2010 Sep;106(6):832-9.
  3. Monden R, Roest AM, van Ravenzwaaij D, Wagenmakers EJ, Morey R, Wardenaar KJ, de Jonge P. The comparative evidence basis for the efficacy of second-generation antidepressants in the treatment of depression in the US: A Bayesian meta-analysis of Food and Drug Administration reviews. J Affect Disord. 2018 Aug 1;235:393-398.

[v]

  1. Settle EC, Stahl SM, Batey SR, Johnston JA, Ascher JA. Safety profile of sustained-release bupropion in depression: results of three clinical trials. Clin Ther. 1999 Mar;21(3):454-63.
  2. Fava M, Rush AJ, Thase ME, Clayton A, Stahl SM, Pradko JF, Johnston JA. 15 years of clinical experience with bupropion HCl: from bupropion to bupropion SR to bupropion XL. Prim Care Companion J Clin Psychiatry. 2005;7(3):106-13.

[vi]

  1. Bupropion. https://reprotox.org/member/agents/17782. Accessed June 25, 2018.

[vii]

  1. Chun-Fai-Chan B, Koren G, Fayez I, Kalra S, Voyer-Lavigne S, Boshier A, Shakir S, Einarson A. Pregnancy outcome of women exposed to bupropion during pregnancy: a prospective comparative study. Am J Obstet Gynecol. 2005 Mar;192(3):932-6.
  2. Bupropion. https://reprotox.org/member/agents/17782. Accessed June 25, 2018.

[viii]

  1. Cole JA, Modell JG, Haight BR, Cosmatos IS, Stoler JM, Walker AM. Bupropion in pregnancy and the prevalence of congenital malformations. Pharmacoepidemiol Drug Saf. 2007 May;16(5):474-84.
  2. Alwan S, Reefhuis J, Botto LD, Rasmussen SA, Correa A, Friedman JM; National Birth Defects Prevention Study. Maternal use of bupropion and risk for congenital heart defects. Am J Obstet Gynecol. 2010 Jul;203(1):52.e1-6.
  3. Louik C, Kerr S, Mitchell AA. First-trimester exposure to bupropion and risk of cardiac malformations. Pharmacoepidemiol Drug Saf. 2014 Oct;23(10):1066-75.
  4. Huybrechts KF, Palmsten K, Avorn J, Cohen LS, Holmes LB, Franklin JM, Mogun H, Levin R, Kowal M, Setoguchi S, Hernández-Díaz S. Antidepressant use in pregnancy and the risk of cardiac defects. N Engl J Med. 2014 Jun 19;370(25):2397-407.

[ix]

  1. Palmsten K, Huybrechts KF, Michels KB, Williams PL, Mogun H, Setoguchi S, Hernández-Díaz S. Antidepressant use and risk for preeclampsia. Epidemiology. 2013 Sep;24(5):682-91
  2. Newport DJ, Hostetter AL, Juul SH, Porterfield SM, Knight BT, Stowe ZN. Prenatal Psychostimulant and Antidepressant Exposure and Risk of Hypertensive Disorders of Pregnancy. J Clin Psychiatry. 2016 Nov;77(11):1538-1545.

[x]

  1. Chun-Fai-Chan B, Koren G, Fayez I, Kalra S, Voyer-Lavigne S, Boshier A, Shakir S, Einarson A: Pregnancy outcome of women exposed to bupropion during pregnancy: a prospective comparative study. American Journal of Obstetrics & Gynecology 2005; 192(3):932-6.

[xi]

  1. Chun-Fai-Chan B, Koren G, Fayez I, Kalra S, Voyer-Lavigne S, Boshier A, Shakir S, Einarson A: Pregnancy outcome of women exposed to bupropion during pregnancy: a prospective comparative study. American Journal of Obstetrics & Gynecology 2005; 192(3):932-6.

[xii]

  1. Palmsten K, Hernández-Díaz S, Huybrechts KF, Williams PL, Michels KB, Achtyes ED, Mogun H, Setoguchi S. Use of antidepressants near delivery and risk of postpartum hemorrhage: cohort study of low income women in the United States. BMJ. 2013 Aug 21;347:f4877.

[xiii]

  1. Figueroa R. Use of antidepressants during pregnancy and risk of attention-deficit/hyperactivity disorder in the offspring. J Dev Behav Pediatr. 2010 Oct;31(8):641-8.

[xiv]

  1. Bupropion. https://toxnet.nlm.nih.gov/cgi-bin/sis/search2/f?./temp/~HBlEoe:1. Accessed June 25, 2018.