Anorexiant · Antidepressant, Dopamine/Norepinephrine Reuptake Inhibitor
Contrave is for weight management—not for depression or anxiety.
It can change sleep, anxiety, irritability, and mood (especially in the first 1–2 months or when the dose is adjusted). If you have bipolar risk, seizure risk, a history of an eating disorder, uncontrolled blood pressure, or you use opioids, this medicine can be a bad fit. If your mood gets darker or suicidal thoughts show up, treat that as urgent—not “just side effects.”
Reviewed by the HeyPsych Medical Review Board · Reviewed January 20, 2026
Used for
Long-term weight management, alongside a reduced-calorie diet and more physical activity, in adults with obesity, or overweight plus at least one weight-related health problem and 1 more
Starts working
Appetite and craving changes often start during the weekly dose step-up
Know first
Boxed warning: In people under 25, it can raise suicidal thoughts, mostly in the first months or after a dose change. Tell someone right away if that happens.
This combo hits appetite, reward, and energy—so the experience can feel like “less cravings,” “more drive,” or “too wired.” Here’s how people often describe it:
“The constant snack-brain got quieter.”
“I still got hungry, but the urge to keep eating wasn’t running the show.”
“It didn’t kill appetite completely—it just made it easier to stop.”
Choose a condition to see how it's used for it.
Used for
Also prescribed for (off-label)
Common use
Naltrexone/Bupropion ER is used for Long-term weight management, alongside a reduced-calorie diet and more physical activity, in adults with obesity, or overweight plus at least one weight-related health problem. The full guide below has the details.
How many people in 100 notice each one in clinical studies. Many early side effects fade within a few weeks.
About 33 in 100 people in studies
What helps
This is the top complaint. It often hits early while the dose is being stepped up and may fade over time. Taking it as directed (and not with high-fat meals) can help.
Choose what applies to you.
Not recommended during pregnancy. Weight loss offers no clinical benefit in pregnancy and may cause fetal harm; discontinue if pregnancy is detected.
Information on this specific combination in pregnancy is limited.
General information, not advice for your case. Talk it through with your prescriber or pharmacist.
ges): urgent evaluation required
Permanently discontinue if seizure occurs
Psychosis, hallucinations, paranoia, severe agitation, hostility, homicidal ideation—stop medication and seek urgent care
Evaluate promptly
Can be severe; avoid unsafe opioid overlap
Stop if signs/symptoms of hepatitis develop
Boxed warning. In people under 25, it can raise suicidal thoughts, mostly in the first months or after a dose change. Tell someone right away if that happens.Official wording: Contrave is not approved for treating depression or other mental health conditions, but it contains bupropion (an antidepressant ingredient).
Thoughts of suicide? Call or text 988, any time.
Everything we know about Naltrexone/Bupropion ER (Contrave), section by section.
14 chapters · about 16 min to read it all. Open any one.
Contrave is titrated up weekly, so the “effect” usually ramps rather than hitting all at once. The weight loss is gradual, but side effects (especially nausea, insomnia, jitteriness) can show up early.
Simple Explanation
This med is built to ramp up slowly. The slow weekly increase is there for a reason: it reduces side effects and helps lower seizure risk. If you miss doses, don’t “catch up” by doubling—just restart safely with your prescriber’s guidance.Most common: nausea, constipation, headache, dizziness, and sleep problems. Psych-relevant side effects include insomnia, anxiety/jitteriness, irritability, mood changes, and (rarely) severe neuropsychiatric symptoms.
This medication is a combo of an opioid blocker (naltrexone) and an activating antidepressant ingredient (bupropion). Interactions matter—especially anything that affects opioids, seizure risk, or monoamine systems.
With: Opioids (including buprenorphine, methadone, and opioid pain medications)
Risk: Can precipitate acute opioid withdrawal and block opioid analgesia. Attempts to overcome blockade with high opioid doses can cause fatal overdose.
Action: Avoid opioid use. If opioid therapy is required, stop Contrave under prescriber guidance. If opioids are restarted after naltrexone exposure, lower doses may have stronger-than-expected effects—overdose risk is real.
With: MAOIs (and within 14 days of MAOI use)
Risk: Serious interaction risk with bupropion; must not be combined. Contrave also must not be started in someone receiving linezolid or IV methylene blue (which act like MAOIs).
Action: Allow 14 days between stopping an MAOI and starting Contrave, and 14 days between stopping Contrave (bupropion) and starting an MAOI.
With: Other bupropion-containing products
Risk: Excess bupropion exposure increases seizure risk and adverse effects.
Action: Contraindicated. Do not combine with Wellbutrin (any formulation), Aplenzin, Zyban, or any other bupropion product.
With: Alcohol (especially heavy use or withdrawal risk)
Risk: Bupropion lowers seizure threshold. Abrupt alcohol discontinuation is a seizure risk state and is a contraindication scenario.
Action: Avoid if you’re at risk for alcohol withdrawal. Be honest about drinking patterns before starting.
With: Medications/conditions that raise seizure risk (some antipsychotics, antidepressants, theophylline, systemic corticosteroids, hypoglycemic agents)
Risk: Additive seizure risk and activation side effects (jitteriness, insomnia).
Action: Risk-screen carefully. Dose titration must be gradual; avoid stacking multiple seizure-threshold-lowering agents when possible.
With: High-fat meals
Risk: Significantly increases systemic exposure of bupropion and naltrexone, increasing adverse effect risk.
Action: Do not take with high-fat meals.
With: Thioridazine (Canadian labeling)
Risk: Additional contraindication in Canada.
Action: Avoid combination in settings where this applies.
Continue-or-Stop Checkpoint
Contrave is not approved to treat depression. But it contains bupropion—the same active ingredient used in some antidepressants (like Wellbutrin). That means it can feel activating (more energy, less appetite, more drive) and it can also worsen insomnia, anxiety, or irritability in some people.
It’s not approved for anxiety or depression, and it’s not prescribed as a primary psychiatric treatment. Some people notice mood/energy changes because of the bupropion component, but others feel worse (more anxious, more wired, more irritable). If you’re struggling with mood symptoms, treat that directly with your clinician rather than hoping Contrave will “cover it.”
Because it contains bupropion, which is also used in antidepressants. In short-term trials, antidepressants increased suicidal thoughts and behavior in children, adolescents, and young adults. That’s why the key rule is: monitor closely for worsening mood, suicidal thoughts, or unusual behavior changes—especially early in treatment and during dose changes.
Yes. Insomnia and sleep problems are common. Some people also feel jittery, restless, or more anxious—especially during the weekly dose step-up. If sleep falls apart, mood often follows, so this isn’t a minor side effect for mental health—it can be a reason to stop.
Use caution. Anything with antidepressant-like activation can trigger hypomania/mania in bipolar-spectrum patients. If there’s bipolar risk, your clinician should screen carefully first and monitor for red flags: less need for sleep, racing thoughts, impulsive behavior, or unusually elevated/irritable mood.
No—this is one of the biggest safety issues. Naltrexone blocks opioids and can trigger withdrawal if opioids are in your system. It can also make opioid pain meds not work. And trying to override the blockade by taking more opioids is dangerous and can lead to fatal overdose.
It’s a weekly step-up: Week 1 is 1 tablet in the morning. Week 2 is 1 tablet twice daily. Week 3 is 2 tablets in the morning and 1 in the evening. Week 4 and beyond is 2 tablets twice daily (max 4 tablets/day). Don’t take more than 2 tablets at one time.
A common checkpoint is around 3 months: if you haven’t lost about 4-5% of your starting weight, it may not be worth continuing—especially if side effects are significant.
Sudden-stop symptoms are less likely than with antidepressants that raise serotonin, but lowering the dose gradually is still reasonable if you’ve been on it for a while—mainly so you can track what returns (sleep issues, cravings, mood changes) and avoid a rough rebound. If you’re stopping because of serious mental health symptoms, your clinician may recommend stopping faster.
It can. It should not be used if you have uncontrolled high blood pressure. Blood pressure and heart rate should be checked before starting and from time to time after that—especially in the first 3 months.
People with seizure risk, eating disorder history (bulimia/anorexia), uncontrolled hypertension, heavy alcohol use with withdrawal risk, or bipolar-spectrum risk without proper screening/monitoring. And anyone using opioids should avoid it due to the naltrexone component.
This treatment information is for educational purposes only. Treatment decisions should be made in consultation with qualified healthcare professionals based on individual circumstances, symptoms, and medical history. Do not attempt treatment without professional guidance.
Thinking about Naltrexone/Bupropion ER (Contrave)? A prescriber can tell you if it fits.
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