Wellbutrin is a brand name for the generic antidepressant drug Bupropion. This drug may also be prescribed for smoking cessation (under the brand name Zyban). Wellbutrin modulates the function of certain natural substances in the brain (neurotransmitters) to help people with major depressive disorder (MDD) (1). This post explains whether or not you can use Wellbutrin while pregnant, its safety profile, possible side effects, and the precautions to follow before taking this medicine.
Is Wellbutrin Safe During Pregnancy?
The US Food and Drug Administration (FDA) lists Wellbutrin under pregnancy category C (fetal toxicity was shown in animal reproduction studies, whereas there are no adequate and well-controlled studies in pregnant women). FDA advises, “Wellbutrin should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus” (2).
How Does Wellbutrin Work?
The mechanism of antidepressant action of Bupropion is not clearly known. The drug may increase the availability of neurotransmitters dopamine and, to a lesser extent, noradrenaline in the brain. A liver enzyme, CYP2B6, converts Bupropion to hydroxy bupropion, which is also active and reinforces the action of the drug (3).
Does Taking Wellbutrin In The First Trimester Increase The Risk Of Birth Defects?
There is very little safety data about Wellbutrin and pregnancy. Some scientific studies show no association between Wellbutrin use during early pregnancy and increased risk of congenital malformations or disabilities, while others show potential risks (4).
In 2006, first-trimester exposure to Bupropion was seen to cause congenital cardiac anomalies (congenital defects of the heart). However, a 2007 study did not support the observations. In 2010, mothers exposed to Bupropion during the first trimester were found to be at a higher risk of giving birth to infants with congenital left ventricular outflow tract obstruction (LVOTO). Another study in 2010 showed an association between Bupropion exposure, especially in the second trimester, and an increased risk of attention-deficit hyperactivity disorder (ADHD) in the offspring (5). In 2012, a study from the Slone Epidemiology Center at Boston University suggested an increased risk for ventricular septal defects (VSD) in newborns whose mothers took Bupropion in early pregnancy.
All the studies showed low absolute risk and had certain limitations, making them inconclusive. Current evidence suggests that Bupropion may be a reasonable treatment option for depressed pregnant women who require therapy and those who wish to reduce nicotine consumption (smoking) during pregnancy (6).
Does Taking Wellbutrin Increase The Risk Of Spontaneous Abortion (Miscarriage)?
Adequate human studies are not available to confirm whether or not Wellbutrin increases the risk of miscarriages. A study on 136 women exposed to Bupropion during the first trimester of pregnancy showed a higher risk of spontaneous abortion. However, prenatal depression is itself a risk factor for miscarriage. Hence, you should talk to your doctor regarding the risks and benefits (6) (7).
What Are The Side Effects Of Wellbutrin?
The drug’s action on neurotransmitters may cause side effects in more than 10% of its users. The side effects may include the following (3).
Tachycardia (increased heart rate) Rhinitis (irritation in the nasal passage)
Pharyngitis (inflammation of the pharynx) Headache Sleep problems Agitation Diaphoresis (excessive sweating) Weight loss Dry mouth Constipation Nausea Tremor Blurred vision
More serious adverse reactions, which you should immediately inform your doctor are (1):
Seizures Worsening of suicidal thoughts An allergic reaction such as hives, itching, difficulty breathing, swelling of face, throat, tongue, lips, eyes, hands, feet, ankles, or lower legs
Sudden stoppage of the medication may produce withdrawal symptoms, including (4):
Agitation and abnormalities in mental status Nausea and vomiting Seizure Headache Sleep disturbances Rash
These events may also occur at doses exceeding the recommended daily dose.
What Are The Precautions To Be Taken Before And While Taking Wellbutrin?
Pregnancy causes changes in the body’s hormonal, metabolic, and psychological status, requiring dosage adjustment of drugs. Talk to your physician if you are or plan to be pregnant while already on Wellbutrin. Other precautions that you may take include the following (8).
Make sure you inform your doctor about all medications, dietary supplements, or herbal products that you are taking to minimize drug interactions. Take the Wellbutrin (Bupropion) dose exactly as directed by your doctor. Feel free to discuss any side effects to avoid any adverse outcome. The FDA has warned that antidepressants may cause worsening suicidal ideation. Inform your mental health provider about any family history of suicide or bipolar disorder (2). The drug may increase your risk of having seizures. Inform your healthcare provider if you have had seizures before. Do not abruptly stop taking the medication without consulting your doctor. It may cause withdrawal symptoms. Some patients may experience restlessness, agitation, anxiety, and insomnia during the initial treatment. It is advised that the caretakers and family members be aware of the risks associated with the treatment
Discuss combination therapy with counseling and behavioral therapy with your healthcare provider to minimize the dose of medication.
Cessation of smoking is necessary for the well-being of the mother and baby. There are many support groups available for cessation of smoking, which could be tried as an alternative to medicines like Wellbutrin. Talk to your doctor to know your options.
Treating depression is necessary during pregnancy because, if untreated, it may contribute to adverse outcomes such as premature birth, low birth weight, fetal growth restriction, and postnatal complications (12). Wellbutrin or Bupropion acts differently from other commonly prescribed antidepressant medications as it does not affect the functioning of the neurotransmitter serotonin. It may be of theoretical importance in pregnancy as altered serotonin systems in fetal brains are often linked to adverse developmental effects (6). However, discuss with your doctor the risks and benefits of the drug for a safe and healthy pregnancy.
