From the Guidelines
Wellbutrin (bupropion) is generally not considered a first-line treatment for anxiety and may actually worsen anxiety symptoms in some people. Unlike medications such as SSRIs or benzodiazepines that are commonly prescribed for anxiety, Wellbutrin works differently by affecting dopamine and norepinephrine rather than serotonin. Regarding side effects, Wellbutrin commonly causes:
- Insomnia
- Dry mouth
- Headache
- Nausea
- Dizziness
- Constipation It has a unique side effect profile compared to other antidepressants as it's less likely to cause sexual dysfunction or weight gain, which some patients find beneficial 1. However, it carries a small risk of seizures (about 0.4% at doses up to 450mg/day) and can increase blood pressure 1. The medication is typically started at 150mg once daily for several days before increasing to 150mg twice daily, with a maximum recommended dose of 450mg daily. If you're primarily dealing with anxiety, medications like SSRIs (such as sertraline or escitalopram) or SNRIs (like venlafaxine) are typically more effective first choices, as they have established efficacy for anxiety disorders and generally don't worsen anxiety symptoms during initial treatment 1. It's essential to discuss treatment effects, adverse effect profiles, cost, accessibility, and preferences with the patient to determine the best course of treatment 1. In terms of switching or augmenting treatments, evidence suggests that various strategies, including switching to another antidepressant or augmenting with a medication like bupropion, can be effective for patients who do not respond to initial treatment 1. Ultimately, the choice of treatment should be based on a thorough discussion with the patient and consideration of their individual needs and preferences.
From the FDA Drug Label
The most common side effects of bupropion hydrochloride extended-release tablets (XL) include: • trouble sleeping • feeling anxious • stuffy nose • nausea • dry mouth • constipation • dizziness • joint aches Anxiety 3% 5% 6% Insomnia 6% 11% 16% Dizziness 5% 7% 11% Agitation 2% 3% 9% Tremor 1% 6% 3% Nervousness 3% 5% 3% Somnolence 2% 2% 3% Irritability 2% 3% 2%
Bupropion may not be suitable for anxiety as it can cause anxiety in some patients, and it can also cause other side effects such as insomnia, dizziness, agitation, tremor, nervousness, somnolence, and irritability. The decision to use bupropion for anxiety should be made with caution and under the guidance of a healthcare provider, considering the potential benefits and risks. 2
From the Research
Efficacy of Wellbutrin for Anxiety
- Wellbutrin, also known as bupropion, is an antidepressant that has been studied for its efficacy in treating anxiety symptoms in patients with major depressive disorder (MDD) 3, 4.
- A meta-analysis of individual patient data from 10 double-blind, randomized clinical trials found that bupropion and selective serotonin reuptake inhibitors (SSRIs) had comparable efficacy in reducing anxiety symptoms in patients with MDD 4.
- However, another study found that SSRIs had a modest advantage over bupropion in treating anxious depression, with a 6% difference in response rates 3.
Side Effects Profile of Wellbutrin
- The side effects profile of Wellbutrin is generally considered to be favorable, with a lower risk of sexual side effects and weight gain compared to SSRIs 5, 6.
- However, Wellbutrin can cause other side effects such as dry mouth, insomnia, and nausea, and can increase the risk of seizures in some patients 5, 6.
Comparison with Other Treatments
- SSRIs and serotonin-norepinephrine reuptake inhibitors (SNRIs) are commonly used to treat anxiety disorders, and have been shown to be effective in reducing symptoms of anxiety, obsessive-compulsive, and stress-related disorders 5, 6.
- A 3-level network meta-analysis found that all SSRIs and SNRIs were effective for multiple symptom domains, and that there were minimal differences between medications concerning efficacy and acceptability 6.
- Cognitive behavioral therapy (CBT) combined with an SSRI has been shown to be more effective than either treatment alone in reducing symptoms of depression and anxiety in youth 7.