IS IT SAFE TO TAKE WELLBUTRIN WHILE PREGNANT?
KEY TAKEAWAYS
- Current evidence does not show an increased overall risk of birth defects associated with Wellbutrin (bupropion) use during pregnancy.
- Do not stop Wellbutrin abruptly. If you and your healthcare provider decide to stop or switch medications before pregnancy, the dose should generally be tapered gradually.
- Other options during pregnancy may include SSRIs such as Zoloft (sertraline), therapy, nicotine replacement, or counselling to support smoking cessation.
Wellbutrin (bupropion) is an atypical antidepressant approved by the FDA to treat major depressive disorder and seasonal affective disorder. Unlike many selective serotonin reuptake inhibitors (SSRIs), it primarily affects other brain chemicals, including dopamine and norepinephrine. It is available as sustained-release (Wellbutrin SR) and extended-release (Wellbutrin XL) tablets.
Pregnancy can be an exciting time, but mental health conditions such as anxiety and depression can also occur during pregnancy. If you are already taking Wellbutrin or are considering pregnancy, you may not necessarily need to stop the medication. Some people continue taking Wellbutrin throughout pregnancy under the guidance of their healthcare provider.
Can you take Wellbutrin while pregnant?
There isn’t a simple yes-or-no answer about taking Wellbutrin during pregnancy. The decision to continue an antidepressant should be based on an individualized discussion of the medication’s potential risks and the risks of untreated depression.
Depression during the childbearing years is common. About 1 in 10 women of reproductive age in the U.S. report symptoms of a recent major depressive episode, according to the CDC. Mental health conditions can also develop during the perinatal period.
Wellbutrin is a norepinephrine-dopamine reuptake inhibitor (NDRI) and has not been studied during pregnancy as extensively as SSRIs. However, current research is generally reassuring. According to the FDA label, studies of women who took bupropion during the first trimester did not find an increased overall risk of birth defects. The Bupropion Pregnancy Registry followed 675 women who took bupropion during their first trimester and reported birth defects in approximately 3.6% of pregnancies, similar to the rate reported in the general population.
Whether to continue Wellbutrin when trying to conceive may depend on factors such as:
- How severe your symptoms have been
- How well your symptoms are currently controlled
- Whether you have experienced depression during pregnancy or after giving birth
- Your risk of relapse
- How soon you plan to become pregnant
For someone with moderate to severe depression who has not responded well to other treatments, a healthcare provider may determine that continuing Wellbutrin is appropriate.
If you prefer to switch to an antidepressant with more pregnancy-related research, the change should be carefully planned with your healthcare provider. Antidepressants can take time to work, so switching before conception may allow enough time to establish an effective treatment and keep symptoms controlled.
What are the risks of taking Wellbutrin while pregnant?
Wellbutrin crosses the placenta, but studies indicate that concentrations of bupropion in the fetus are much lower than those in the mother.
Earlier studies raised concerns about a possible association between bupropion use during pregnancy and certain heart defects, although the evidence has been inconsistent:
- One older study reported an association between bupropion use during early pregnancy and a specific heart defect.
- Another older study found a slightly higher rate of ventricular septal defects when bupropion was used alone during the first trimester.
- Larger, more recent studies have not consistently confirmed these findings.
Overall, current research has not shown that bupropion increases the overall risk of major birth defects. Dr. Zink notes that some earlier findings may have been influenced by maternal smoking, since bupropion is also used to support smoking cessation.
Researchers are continuing to study other potential pregnancy outcomes:
- A large study involving more than 145,000 pregnancies exposed to antidepressants, including bupropion, found no increased risk of autism, ADHD, or other neurodevelopmental disorders after accounting for the mother’s underlying illness and other factors.
- Wellbutrin may have a slightly lower risk of neonatal withdrawal than SSRIs, although more research is needed.
- More research is needed regarding outcomes such as preterm birth and low birth weight.
These potential medication risks need to be weighed against the risks of untreated depression. Untreated maternal mental illness may increase the risk of preterm birth, low birth weight, preeclampsia, postpartum depression, and difficulties with mother-infant bonding.
Wellbutrin and breastfeeding
If you plan to breastfeed, you may not necessarily need to stop Wellbutrin. Bupropion passes into breast milk, but the NIH’s LactMed database indicates that it does so in small amounts.
However, rare cases of seizures have been reported in breastfed infants. Talk with your healthcare provider before starting, stopping, or changing Wellbutrin while breastfeeding.
When to stop Wellbutrin before pregnancy: Safety tips
Many people continue taking Wellbutrin throughout pregnancy. If you and your healthcare provider decide that stopping the medication is the best option, Wellbutrin should not be stopped abruptly.
According to MaryEllen Eller, MD, abruptly stopping Wellbutrin may cause withdrawal symptoms such as:
- Headaches
- Increased anxiety
- Irritability
- Vivid dreams
- Fatigue
- Flu-like symptoms
These symptoms typically begin within a few days of the last dose and last about a week for most people. Some people may experience headaches and fatigue for up to a month.
To reduce withdrawal symptoms, healthcare providers generally recommend gradually tapering the medication. The tapering schedule depends on factors such as your current dose, how long you have taken Wellbutrin, and whether you use a short- or long-acting formulation. Tapering may take anywhere from a few weeks to several months, depending on your provider’s guidance.
If you are already pregnant and taking Wellbutrin, Dr. Eller says psychiatrists generally do not recommend automatically switching antidepressants. Any medication change should be carefully considered with your healthcare provider, taking into account both medication exposure and the risks of untreated mental health symptoms.
What can I take instead of Wellbutrin during pregnancy?
For depression, SSRIs are among the best-studied antidepressants during pregnancy. Common options a healthcare provider may consider include:
- Zoloft (sertraline)
- Lexapro (escitalopram)
- Celexa (citalopram)
- Prozac (fluoxetine)
Dr. Eller notes that Zoloft is generally considered a preferred option during pregnancy.
Medication is not the only treatment option. Psychotherapy has strong safety data during pregnancy and can effectively treat depression without systemic exposure that could cause birth defects. Transcranial magnetic stimulation (TMS) is also being studied as an option because it does not act directly on the fetus.
For smoking cessation, bupropion is generally not a first-choice option during pregnancy unless the person also has depression and other approaches have not worked. Behavioral counseling is recommended as a first step, while nicotine replacement may be considered as a safer alternative to continued smoking during pregnancy under healthcare-provider guidance.
Managing depression during pregnancy
Medication is one important part of managing mental health during pregnancy, but a broader plan can provide additional support during pregnancy and after birth, which Dr. Eller describes as a particularly high-risk period for women.
If you’re planning a pregnancy and have a personal or family history of depression, consider:
- Make a plan with a trusted provider: Connecting with a mental health professional early can help you develop a plan for pregnancy and the postpartum period. Psychotherapy, including mentalization-based therapy and cognitive behavioral therapy, can help prevent and treat depression.
- Follow a healthy lifestyle: Regular movement, adequate sleep, and nutritious food can support overall health and mood.
- Take a prenatal vitamin: A prenatal supplement containing folic acid supports your baby’s development and can help fill nutritional gaps. Always discuss new supplements or treatments with your healthcare provider first.
Depression during pregnancy is common and treatable. With appropriate support, therapy, medication, lifestyle changes, or a combination of these approaches can help support mental health during pregnancy and after birth.
Expert takeaway
Taking medication during pregnancy can understandably raise concerns about potential effects on the developing baby. However, Dr. Zink points out that untreated mental health conditions can also affect pregnancy and maternal well-being. In her clinical experience, she has treated many pregnant patients who continued Wellbutrin and maintained good mental health during pregnancy and the postpartum period without observed adverse outcomes in their newborns.
Source: SingleCare