Can bupropion (Wellbutrin) be used to treat anxiety?

From the Guidelines

Wellbutrin (bupropion) is not typically recommended as a first-line treatment for anxiety, as it may worsen anxiety symptoms in some individuals due to its stimulating effects. According to the evidence from studies such as 1, Wellbutrin works differently from most antidepressants by primarily affecting dopamine and norepinephrine rather than serotonin. For anxiety disorders, medications like SSRIs (such as Zoloft, Lexapro, or Prozac) or SNRIs (like Effexor or Cymbalta) are usually prescribed first because they have proven efficacy for anxiety and are generally well-tolerated.

Some key points to consider when evaluating the use of Wellbutrin for anxiety include:

• The potential for Wellbutrin to exacerbate anxiety symptoms in some individuals, as noted in studies such as 1 and 1
• The importance of considering alternative treatment options, such as SSRIs or SNRIs, which have demonstrated efficacy for anxiety and are generally well-tolerated, as discussed in 1 and 1
• The need for careful evaluation and monitoring by a healthcare provider to determine the best course of treatment for individual patients, as emphasized in 1

However, in some specific cases, particularly when anxiety co-occurs with depression and the person cannot tolerate SSRIs or has had poor response to them, a doctor might consider Wellbutrin as part of a treatment plan. If you're experiencing anxiety, it's essential to consult with a healthcare provider who can evaluate your specific symptoms and medical history to recommend appropriate treatment options, which may include medication, therapy, or a combination of approaches.

From the Research

Use of Wellbutrin for Anxiety

• Wellbutrin, also known as bupropion, is an antidepressant that can be used to treat anxiety symptoms in major depressive disorder (MDD) 2.
• Studies have compared the efficacy of bupropion with selective serotonin reuptake inhibitors (SSRIs) in treating anxiety symptoms in MDD, with some showing comparable improvement in anxiety symptoms between the two treatments 2.
• However, other studies suggest that SSRIs may have a modest advantage over bupropion in treating anxious depression, with a 6% difference in response rates 3.
• Bupropion is less likely to cause weight gain and sexual dysfunction, side effects that are common with SSRIs, but it is rarely prescribed when comorbid anxiety disorders or symptoms of central nervous system activation are present 4.
• Combination treatment with benzodiazepines and SSRIs/SNRIs may be effective for comorbid anxiety and depression, but there is limited research on the combination of benzodiazepines and bupropion 5.

Efficacy of Bupropion for Anxiety

• A meta-analysis of individual patient data from 10 double-blind, randomized clinical trials found that bupropion and SSRIs led to a comparable degree of improvement in anxiety symptoms in MDD 2.
• Another study found that SSRIs had a greater reduction in anxiety symptoms compared to bupropion in patients with anxious depression 3.
• However, a review of the literature on combination treatment with benzodiazepines and SSRIs/SNRIs suggests that bupropion may be effective in treating anxiety symptoms in MDD, especially when used in combination with other medications 5.

Prescribing Habits for Bupropion

• Psychiatrists are less likely to prescribe bupropion for depressed patients with high anxiety, despite the lack of evidence that patient factors predict differential medication response 4.
• Bupropion is more often prescribed when the desire to avoid side effects, such as sexual dysfunction and weight gain, is the basis of selection 4.