Q. I have a long history of depression and have been taking Wellbutrin (bupropion SR) for several years now. Every time I try to come off the medication, the depression comes back. I am planning to get pregnant within the next year and was wondering if it is safe to use Wellbutrin.
A. While there is information to support the reproductive safety of certain antidepressants, including fluoxetine, citalopram and the tricyclic antidepressants, during pregnancy, there are much less data on the reproductive safety of bupropion (Wellbutrin). Information from the manufacturer (GlaxoSmithKline) includes data from 426 pregnancies involving first trimester exposure to bupropion. In this sample, there were 12 outcomes that involved major malformations. This represents a 2.8% risk of congenital malformation, which is consistent with what is observed in women with no known history of medication exposure. While this information regarding the overall risk of malformation associated with fetal exposure to bupropion is reassuring, the most recent report revealed that 8 of the 12 cases reported involve malformations of the heart and great vessels. In addition, among the 16 retrospectively reported cases of malformations in bupropion-exposed infants, seven involved cardiac defects. While these reports may signal a potential risk, the manufacturers point out that the relatively small sample size and the high percentage of cases lost to follow-up (n=302) make it difficult to draw solid conclusions regarding the impact of bupropion on the developing cardiovascular system; further studies regarding the reproductive safety of this medication are warranted.
Clinical Implications: Given the incomplete nature of these findings, women may want to switch to the better characterized SSRIs or a tricyclic antidepressant during plans to conceive. However, there may be certain situations when it is appropriate to use this medication during pregnancy. If a woman has had a poor response to SSRIs in the past but has had a good response to bupropion, it may be clinically thoughtful to consider bupropion treatment during pregnancy . However, this is done, of course, in the context of an informed conversation between the patient and her doctor, acknowledging the lack of extensive information regarding the reproductive safety of this agent. It is important to remember that untreated depression in the mother is not benign and may contribute to maternal psychiatric morbidity both during pregnancy and the postpartum period.
Ruta Nonacs, MD PhD
Information regarding the use of bupropion during pregnancy may be obtained from the manufacturer at 1-800-336-2176.
*This post was originally published as an article in the Spring 2005 newsletter