Bupropion (Wellbutrin, Aplenzin, Zyban) is a drug that is approved by the US Food and Drug Administration (FDA) to treat depression, seasonal affective disorder, and to help people stop smoking 1. Doctors also frequently prescribe bupropion to patients to treat other “off-label” conditions such as attention deficit hyperactivity disorder (ADHD), bipolar disorder, sexual problems, and obesity 2.
Bupropion is classified as an antidepressant, but it works differently than other commonly used antidepressants like selective serotonin reuptake inhibitors (SSRIs, e.g., Zoloft and Prozac) or serotonin and norepinephrine reuptake inhibitors (SNRIs, e.g., Effexor and Cymbalta). Bupropion increases the levels of norepinephrine and dopamine in the brain but has no effects on serotonin 2.
Although bupropion is not typically the first option for treating depression, most studies have shown that it is equally effective as the most popularly prescribed class of antidepressants, the SSRIs 3. Unlike SSRIs, bupropion does not produce side effects like sexual dysfunction or weight gain, and it can be added to SSRI therapy in patients with depression who do not respond to standard therapy 3. Because of these properties, some experts have suggested that this drug can be a safe and effective tool for treating a variety of disorders from social phobia to neuropathic pain 4. However, despite all of the potential therapeutic effects of bupropion, there has been some evidence of this drug being abused 2.
Bupropion (Wellbutrin) Abuse
Bupropion’s versatility in treating depressive disorders and its successful track record as a smoking cessation aid make this drug a valuable tool to help patients live happier, healthier lives. Initial research in humans also suggested bupropion has a low potential for abuse 2. This combination of safety and effectiveness led some to refer to bupropion as a “wonder drug” but the reality has turned out to be somewhat more complicated 5.
Wellbutrin in the News
In recent years, several Canadian news outlets have profiled the problem of bupropion abuse, particularly by injection 5,9.
These stories highlight the ease of obtaining bupropion, especially tablets sold as the antismoking aid Zyban, which are sold without a prescription in Canada 5.
Nearly half of Toronto’s injection drug users are estimated to have tried bupropion, despite the caustic effects 9. “I think the thing that surprises me most about this is that people continue to do it even after they’ve developed the most gruesome lesions that you could imagine,” said Dr. Leah Steele, a Toronto Public Health physician 9.
The effects of bupropion on dopamine and norepinephrine levels in the brain overlap with illicit stimulants such as cocaine2. Animal experiments using bupropion also suggested that it had addictive potential 6. Concerns about possible abuse increased when individuals began posting accounts of bupropion abuse on the website Erowid.org starting in 2001 7, and the first medical report on a case of recreational bupropion use appeared in 2002 8.
Although the effects of non-medical use have not been well studied, bupropion appears capable of producing stimulant-like effects if taken in doses far higher than those prescribed for medical purposes 2,6. The maximum daily dose of bupropion is 450 mg, but reported cases of abuse have involved ingesting from 600 mg 8 to 1200 mg of the drug 2.
Most bupropion abusers take this drug by crushing and snorting (insufflating) the pills. This route of ingestion delivers a high dose of bupropion directly to the bloodstream and defeats the slow-release mechanism built in to some types of bupropion tablets (e.g., Wellbutrin XL, Forfivo XL, Aplenzin) 2,5. Other reported methods of bupropion abuse include taking more pills than prescribed, and even dissolving pills in water and then injecting the solution 2.
Signs and Symptoms
Individuals who’ve abused the drug have described the high from bupropion abuse as similar to that of stimulants such as cocaine or amphetamine 2,5,7. In at least one case, a man complained of hearing multiple voices and told clinic staff the voices started when he began abusing bupropion 6.
Some other common signs and symptoms of stimulant abuse include 10:
- Sense of exhilaration.
- Increased sense of self-esteem.
- Heightened energy and activity.
- Loss of appetite.
- Long periods of wakefulness/insomnia.
In addition to displaying the physical effects of stimulant abuse while high, bupropion abusers may also engage in unusual behaviors connected with obtaining the drug or hiding use from others. These may include requesting Wellbutrin specifically from a physician despite never being prescribed the drug previously or obtaining multiple prescriptions from different doctors (doctor shopping).
Effects of Bupropion Abuse
The abuse of bupropion can lead to dangerous side effects. Many cases of overdose have been documented including intentional abuse, suicide attempts, and accidental poisoning 7. The common effects of overdose include profound 6,7:
- Involuntary muscle contractions.
- Tachycardia, or rapid heart rate.
The higher the dose of bupropion ingested, the more likely seizures are to occur, making this an especially dangerous side effect to abusers 2, and overdose has been known to be fatal in some cases 7,13.
Injection use is particularly risky. Because many of the ingredients in bupropion pills were not intended to be injected, abusing the drug intravenously can lead to severe side effects such as skin lesions, blood vessel damage, and even death 7.
In addition to the physical risk of abusing bupropion, some abusers have experienced symptoms of withdrawal when they stopped taking the drug, such as irritability and depressed mood 2.
Like any other potentially addictive drug, abusers may begin prioritizing obtaining and using this substance over other important aspects of their life, such as fulfilling work responsibilities or maintaining relationships with family and friends.
Few official statistics exist regarding bupropion abuse because antidepressants are not included in most surveys of drug abuse. However, there has been increasing evidence that abuse of this drug has spread in the last decade.
- Some US correctional facilities have stopped dispensing bupropion to inmates due to high levels of abuse among inmates, among whom the pills are referred to as “Wellies,” “Dubs,” or “Barnies” 14.
- A study in Ontario, Canada found a 10-fold increase in suspicious prescriptions flagged for possible abuse or black market sale between 2000 and 2013 12. These suspicious prescriptions totaled about 48,000 pills in 2013.
- Multiple anecdotal cases have been published in which individuals report cocaine-like effects and euphoria from abusing bupropion 2.
Teen Bupropion Abuse
The first published medical report of bupropion abuse in 2002 described a 13-year old girl who intentionally ingested 4 tablets (600 mg total) in an attempt to get high 8.
There have been other reported cases of teenagers abusing bupropion by crushing and taking tablets stolen from parents6. While the extent of bupropion abuse among adolescents is unknown, it is clear that it does occur.
Many adolescents believe that abusing prescription medications is safer than experimenting with illicit substances. It is important to discuss the dangers of abusing medicines like bupropion with teenagers so that they understand these drugs can be just as deadly as street drugs. This is especially important today because many medications are easily obtainable from online “no-prescription websites” 2 or friends who have a valid prescription.
Resources, Articles, and More Information
For more information, see the following articles:
- Antidepressant Wellbutrin becomes ‘poor man’s cocaine’ on Toronto streets
- Doctors warn of potentially fatal abuse of Wellbutrin antidepressant
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- MedlinePlus. (2016).Bupropion.
- Evans, E. A., & Sullivan, M. A. (2014). Abuse and misuse of antidepressants. Subst Abuse Rehabil, 5, 107-120. doi:10.2147/SAR.S37917
- Patel, K., Allen, S., Haque, M. N., Angelescu, I., Baumeister, D., & Tracy, D. K. (2016). Bupropion: a systematic review and meta-analysis of effectiveness as an antidepressant. Ther Adv Psychopharmacol, 6(2), 99-144. doi:10.1177/2045125316629071
- Berigan, T. R. (2002). The Many Uses of Bupropion and Bupropion Sustained Release (SR) in Adults. Prim Care Companion J Clin Psychiatry, 4(1), 30-32.
- Mulholland, A. (2013). Doctors warn of potentially fatal abuse of Wellbutrin antidepressant.
- Reeves, R. R., & Ladner, M. E. (2013). Additional evidence of the abuse potential of bupropion. J Clin Psychopharmacol, 33(4), 584-585. doi:10.1097/JCP.0b013e318295fe2f
- Li, R. (2014). Bupropion toxicity with unintentional exposure or abuse: More common than you think. BCMJ, 56(9), 445.
- McCormick, J. (2002). Recreational bupropion abuse in a teenager. Br J Clin Pharmacol, 53(2), 214.
- Tryon, J., & Logan, N. (2013).Antidepressant Wellbutrin becomes ‘poor man’s cocaine’ on Toronto streets. Global News website.
- Drug Enforcement Administration. Drug Fact Sheet: Stimulants.
- Phillips, D. (2012). Wellbutrin(R): misuse and abuse by incarcerated individuals. J Addict Nurs, 23(1), 65-69. doi:10.3109/10884602.2011.647838
- Steele, L. S., Macdonald, E. M., Gomes, T., Hollands, S., Paterson, J. M., Mamdani, M. M., . . . Effectiveness Research, N. (2015). Rates of Anomalous Bupropion Prescriptions in Ontario, Canada. Ann Fam Med, 13(4), 343-346. doi:10.1370/afm.1818
- Cass, D. (2013). Interim Chief Coroner’s Alert to Ontario Physicians and Pharmacists.
- Hilliard, W. T., Barloon, L., Farley, P., Penn, J. V., & Koranek, A. (2013). Bupropion diversion and misuse in the correctional facility. J Correct Health Care, 19(3), 211-217. doi:10.1177/1078345813486448