Cochrane for Clinicians

Putting Evidence into Practice

Extended-Release Bupropion for Preventing Seasonal Affective Disorder in Adults


Am Fam Physician. 2017 Jan 1;95(1):10-11.

Author disclosure: No relevant financial affiliations.

Clinical Question

Is extended-release bupropion (Wellbutrin XL) more effective than placebo for preventing symptoms of seasonal affective disorder (SAD) in adults?

Evidence-Based Answer

When started in the fall, extended-release bupropion, 300 mg once daily, is effective in preventing recurrent symptoms in high-risk adults with a history of SAD (number needed to treat [NNT] = 5), as well as those at lower risk (NNT = 8). Headaches, nausea, and insomnia may limit adherence to treatment.1 (Strength of Recommendation: B, based on inconsistent or limited-quality patient-oriented evidence.)

Practice Pointers

SAD is a recurrent depressive disorder that occurs only during a particular season, typically the winter months.2 SAD is more common at northern latitudes; the prevalence is estimated at 9% in the northern United States,3 and two-thirds of patients experience the symptoms every year.4 Preventive measures are of particular interest for this group of patients.

The authors of this Cochrane review sought studies that compared any second-generation antidepressant with placebo, other medications, or other therapies for the prevention of episodes of SAD.1 They found only three randomized trials, each comparing extended-release bupropion with p

Author disclosure: No relevant financial affiliations.


show all references

1. Gartlehner G, Nussbaumer B, Gaynes BN, et al. Second-generation antidepressants for preventing seasonal affective disorder in adults. Cochrane Database Syst Rev. 2015;(11):CD011268....

2. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington, DC: American Psychiatric Association; 2013.

3. Rosen LN, Targum SD, Terman M, et al. Prevalence of seasonal affective disorder at four latitudes. Psychiatry Res. 1990;31(2):131–144.

4. Rodin I, Thompson C. Seasonal affective disorder. Adv Psychiatr Treat. 1997;3:352–359.

5. Lam RW, Levitt AJ, eds. Canadian Consensus Guidelines for the Treatment of Seasonal Affective Disorder. Vancouver, British Columbia, Canada: Clinical and Academic Publishing; 1999.

These are summaries of reviews from the Cochrane Library.

This series is coordinated by Corey D. Fogleman, MD, Assistant Medical Editor.

A collection of Cochrane for Clinicians published in AFP is available at


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