Wellbutrin (Bupropion) During Pregnancy: Is It Safe?

New Article: Is Wellbutrin (Bupropion) Safe During Pregnancy?

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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 (neurotransmittersⁱXChemical messengers in the brain that send signals throughout the body to carry out its vital functions ) to help people with major depressive disorder (MDD) (1).

So can you take Wellbutrin while pregnant? This post explains the safety aspects of Wellbutrin (Bupropion) During Pregnancy, possible side effects, and the precautions to follow before taking this medicine.

In This Article

Is Wellbutrin Safe During Pregnancy?

It is better to avoid Wellbutrin during pregnancy

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The US Food and Drug Administration (FDA) lists Wellbutrin under pregnancy category C (fetal toxicityⁱXPossible adverse effects of a substance or a factor on the developing fetus during pregnancy 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 dopamineⁱXA chemical that transport messages among nerve cells and also acts as a hormone that induces happiness and motivation and, to a lesser extent, noradrenaline (norepinephrine)ⁱXA chemical messenger that also acts as a hormone and regulates blood pressure, mental abilities, and physiological response during stress in the brain. A liver enzyme, CYP2B6, converts Bupropion to hydroxy bupropion, which is also active and reinforces the action of the drug (3).

Quick fact

Bupropion’s duration of action may last from one to two days, and its therapeutic effects may begin a week after the drug ingestion (3).

Does Taking Wellbutrin In The First Trimester Increase The Risk Of Birth Defects?

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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 malformationsⁱXStructural or functional abnormalities present since birth 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)ⁱXA defect in the heart that limits the flow of blood out of the left ventricle (a main chamber of the heart) .
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)ⁱXA chronic condition of childhood characterized by inattentiveness, hyperactivity, and impulsive behaviors in the offspring (5).
In 2012, a study from the Slone Epidemiology Center at Boston University suggested an increased risk for ventricular septal defect (VSD)ⁱXA heart condition in which there is an opening in the wall of the lower heart chambers (ventricles) 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).

Research finds

Bupropion does not impact the functioning of the placental tissues (13). Also, its concentrations in the umbilical cord were reported to be 30% to 60% lower than maternal plasma concentrations (14).

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)

Wellbutrin may cause rhinitis in pregnant woman

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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):

SeizuresⁱXSudden and abnormal surges of electrical activity in the brain characterized by jerking body movements and loss of consciousness
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

Sudden stoppage of Wellbutrin may produce withdrawal symptoms

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These events may also occur at doses exceeding the recommended daily dose. Therefore it is necessary to exercise caution while taking this medication.

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

Some women may experience restlessness during essential treatment

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Discuss combination therapy with counseling and behavioral therapy with your healthcare provider to minimize the dose of medication.

Expert says

Lauren Osborne, Assistant Director, Johns Hopkins medical center, US, suggests that pregnant women experiencing mood/mental-health disorders see a reproductive psychiatrist to discuss medication needs and dosage to ensure good mental health (11).

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.

Frequently Asked Questions

1. Does bupropion pass through the placenta?

Yes. Studies show that bupropion and its active metabolites can pass through the placenta and reach the fetus (9).

2. How long should I be off antidepressants before getting pregnant?

According to some experts, you should not avoid antidepressants before and during pregnancy as your physical and mental health take a toll. Untreated depression and anxiety may cause fetal health complications too. It is better to consult a doctor and talk about the effects of your medication on your pregnancy. Your doctor may help you find an alternative, safer medication for your baby or reduce the dosage so you enjoy a healthy pregnancy. Stopping antidepressants without consulting a doctor may be harmful (10) (11).

3. What alternatives to Wellbutrin (Bupropion) are available for pregnant women with depression?

A doctor might recommend alternative antidepressant medications based on the mother’s mental-health history, overall health condition, and treatment plan. If the condition is mild, the doctor may suggest alternative therapies such as acupuncture, prenatal yoga, and psychotherapy (11) (15).

4. How should I adjust my dosage of Wellbutrin (Bupropion) during pregnancy?

Your doctor will modify your dosage according to your condition, and you need to follow proper guidance on maintaining your mental health. It is crucial to seek medical advice regarding the appropriate dosage of medications during pregnancy.

5. Can taking Wellbutrin (bupropion) during pregnancy affect the baby’s behavior or development?

Taking Wellbutrin weeks before giving birth can cause withdrawal symptoms in the newborn for some time. Hence, the baby may be observed and monitored for symptoms such as breathing difficulties, uneasiness, and trouble sleeping (16).

Treating depression is necessary during pregnancy because, if untreated, it may contribute to adverse outcomes such as preterm labor, 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 serotoninⁱXA molecule secreted in the brain that transports messages from nerve cells and helps regulate mood, sleep, and appetite . It may be of theoretical importance in pregnancy as altered serotonin systems in fetal brains are often linked to adverse developmental effects (6). However, it is essential to discuss with your doctor the risks and benefits of the drug, including whether you can take Wellbutrin while pregnant for a safe and healthy pregnancy.

Infographic: What More May Happen If You Discontinue Wellbutrin Abruptly?

You should inform your doctor if you are already on Wellbutrin and are planning for pregnancy or have become pregnant. You should never stop the medication on your own as it may produce unfavorable effects. Besides the ones mentioned in the article, the infographic below lists some more withdrawal symptoms that may occur on sudden cessation of Wellbutrin.

additional withdrawal of wellbutrin (infographic)

Key Pointers

Wellbutrin, a brand name of Bupropion, could be prescribed as antidepressant medication during pregnancy.
However, a few studies have demonstrated an increased risk of adverse pregnancy outcomes such as ADHD and congenital heart defects due to the use of Bupropion.
Consequently, the FDA advises using this medicine only if its benefits outweigh the potential risks to the fetus.
If you are advised of Wellbutrin during pregnancy, talk to your healthcare provider about your existing medications and risk of side effects.

Wellbutrin (Bupropion) During Pregnancy_illustration

Image: Dall·E/MomJunction Design Team

Pregnant and feeling down? Learn about the safest antidepressant to take during pregnancy in this informative video!

References

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