Alternative for Wellbutrin?

[tallikim]

My psychiatrist does not want me to take Wellbutrin postpartum, feeling uncomfortable with a recent category change (from B to C). I was on 300mg XL, but weaned off in my 3rd trimester with an option to start something different during my trial of breastfeeding once baby is here in 8 weeks.

My concern is that Wellbutrin works well for me, and I've tried a number of SSRIs and SNRIs in the past that weren't helpful. After my first child, I was on Zoloft (started about 1-2 months postpartum) and did not like it. At that time, I was exclusively pumping 'round the clock.

Of note, I didn't take any antidepressant medications during my first pregnancy, but had to start back on Wellbutrin by second trimester of this pregnancy. Not sure if that makes a difference.

Bottom line, is there a substitute for Wellbutrin? I am trying to make an informed decision of whether or not to try breastfeeding this time around. I'd like to try, but fear PPD will rear up after baby is born. With a toddler and an infant, I do not want to risk anything.

I appreciate any thoughts and advice on this from admin.

[admin-james]

Hi, thanks for your post.

Dr. Hale and I have discussed this question. Your psychiatrist is right to be concerned when new safety data comes out and categories change. However, the B to C change you mentioned applies to pregnancy only, not breastfeeding. For breastfeeding mothers, we know that Bupropion XL passes minimally into your milk; 0.2% to 2% of your dose goes to the baby. In studies done on infants whose mothers took this medication during breastfeeding, none of the medication was detected in the infants' blood.

We need to mention two special circumstances in case they might apply to you. Babies that have kidney problems or bladder malformations have a harder time clearing some drugs that they may ingest. In these situations, drugs like bupropion may build up in such a baby and cause problems that would not appear in healthy infants. Secondly, if your baby has a seizure disorder, bupropion may make him or her more likely to seize. Again, these are small risks because the baby is exposed to such a small amount of drug in the first place.

Don't forget that your well-being is important too! Having a mom that is healthy and happy does more for a baby's neurobehavioral development than anything else. Make sure that you settle on a drug regimen that really works for you, not just gets you from day to day.

Please call us at the InfantRisk Center if this has not completely answered your question. (806)352-2519

-James Abbey, MD

The following references may be useful to your physician if he or she needs more information:

1. Briggs GG, Samson JH, Ambrose PJ, Schroeder DH. Excretion of bupropion in breast milk. Ann Pharmacother 1993; 27(4):431-433.

2. Baab SW, Peindl KS, Piontek CM, Wisner KL. Serum bupropion levels in 2 breastfeeding mother-infant pairs. J Clin Psychiatry. 2002;63:910-911.

3. Chaudron LH and Schoenecker CJ. Bupropion and breastfeeding: a case of possible infant seizure.(Letter) J.Clin. Psychiatry 2004:64(6):881-882

4. Haas JS, Kaplan CP, Barenboim D, Jacob P, III, Benowitz NL. Bupropion in breast milk: an exposure assessment for potential treatment to prevent post-partum tobacco use. Tob Control 2004 Mar; 13(1):52-6.

5. Davis MF, Miller HS, Nolan PE, Jr. Bupropion levels in breast milk for 4 mother-infant pairs: more answers to lingering questions. J Clin Psychiatry. Feb 2009;70(2):297-298.