Successful Treatment of Seasonal Affective Disorder in a 45-Year-Old Woman Using Wellbutrin XL: A Case Report

No Need to Be SAD

SAD, classified under Major Depressive Disorder with Seasonal Pattern in the DSM-5, affects approximately 1-2% of the population in its full clinical form, with higher prevalence in northern latitudes. Patients typically experience depressive episodes during the fall and winter months, which often remit in the spring or summer. Common symptoms include low mood, hypersomnia, lethargy, carbohydrate cravings, weight gain, and impaired concentration.

The pathophysiology of SAD is not fully understood, but it is thought to involve dysregulation of circadian rhythms, reduced serotonergic transmission, and increased melatonin secretion in response to decreased light exposure. First-line treatments include light therapy and selective serotonin reuptake inhibitors (SSRIs); however, these are not always effective or well-tolerated. Bupropion, an aminoketone antidepressant that inhibits norepinephrine and dopamine reuptake, is FDA-approved for the prevention of seasonal major depressive episodes. This case report presents the successful treatment of a woman who declined light therapy and expressed concern about SSRI-induced fatigue, ultimately achieving remission with bupropion XL.

Case Presentation

Jessica presented in late October with complaints of low mood, excessive sleep, fatigue, and weight gain. She reported that these symptoms had recurred annually during the fall and winter months for the past three years, resolving by late April without intervention. She described a loss of motivation, difficulty concentrating at work, and intense cravings for carbohydrate-rich foods. Her energy levels were significantly reduced, and she reported sleeping up to 11 hours per night, with difficulty getting out of bed in the mornings.

Her past medical history included mild, well-controlled hypertension. She was taking lisinopril 10 mg daily with good adherence. She had no prior psychiatric diagnoses and no history of antidepressant use. Her family history was negative for mood disorders. Jessica was married, working full-time in marketing, and denied alcohol abuse, drug use, or tobacco use. She had no suicidal ideation or psychotic symptoms.

Her Patient Health Questionnaire-9 (PHQ-9) score at initial assessment was 17, consistent with moderate depression. The timing and nature of her symptoms supported a diagnosis of Major Depressive Disorder with Seasonal Pattern (winter type). No other comorbid psychiatric conditions were identified.

Treatment Plan

Jessica expressed a preference for medication over light therapy, citing concerns about practicality and previous difficulties using a lightbox consistently. After a discussion of treatment options, she was started on bupropion hydrochloride extended-release (Wellbutrin XL) 150 mg once daily in the morning, with plans to increase the dose to 300 mg after one week if well tolerated. The rationale for choosing bupropion included its activating profile, potential weight neutrality, and FDA approval for SAD prophylaxis.

Jessica was counseled on potential side effects, including insomnia, dry mouth, and anxiety, and was advised to take the medication early in the day. A follow-up appointment was scheduled for two weeks after initiation.

Clinical Course and Outcome

At the two-week follow-up, Jessica reported a mild improvement in energy and mood. She had titrated to 300 mg as planned and experienced no adverse effects aside from transient dry mouth. By week four, she noted significant improvements in mood and motivation. Her sleep had normalized to 7-8 hours per night, and she had resumed regular exercise. She described feeling “back to myself” for the first time in months.

By week six, her PHQ-9 score had dropped to 5, indicating remission. She reported improved productivity at work, a normalized appetite, and stabilized weight. No adverse effects were reported throughout treatment.

Jessica continued taking Wellbutrin XL 300 mg daily through March. In late April, as daylight increased and her mood remained stable, the dose was gradually tapered and discontinued by mid-May. The following fall, she restarted Wellbutrin XL in early October as a preventive measure. Over two seasonal cycles, she experienced no return of depressive symptoms.

Discussion

This case illustrates the successful use of bupropion XL in treating SAD in a middle-aged woman with atypical depressive features. Unlike SSRIs, which may exacerbate fatigue and contribute to weight gain, bupropion is activating and weight-neutral, making it particularly suitable for patients with hypersomnia and increased appetite. It also lacks significant serotonergic activity, reducing the risk of sexual side effects commonly associated with SSRIs.

The timing of symptom onset, consistency across seasons, and spontaneous remission in spring support the diagnosis of SAD. Bupropion XL’s efficacy in this case aligns with findings from large clinical trials, including the PREVENT-SAD study, which demonstrated that bupropion XL significantly reduced the recurrence of depressive episodes in individuals with SAD.

In clinical practice, individualized treatment remains essential. Light therapy is a practical option, particularly for those with milder symptoms or a preference for non-pharmacologic approaches. However, for patients who prefer medication, or for whom light therapy is impractical or insufficient, bupropion XL offers a valuable alternative.

Jessica’s rapid response, favorable tolerability, and sustained prevention of relapse over two years suggest a strong therapeutic role for bupropion XL in the management of SAD. Notably, she experienced no insomnia despite the drug’s activating profile, possibly due to morning dosing and the sedating nature of her depressive symptoms.

Conclusion

Jessica’s case demonstrates that bupropion XL is an effective and well-tolerated treatment option for patients with seasonal affective disorder (SAD), particularly those with atypical depressive features. It may serve as a practical alternative or complement to light therapy. Early identification of SAD and timely initiation of treatment can significantly improve quality of life and functional outcomes during the winter months.