From the Guidelines
Bupropion (Wellbutrin) is known to disrupt sleep architecture and intensify dreams, with insomnia occurring in 10-20% of patients, as evidenced by the most recent study 1. This medication often causes insomnia, typically reducing total sleep time, increasing sleep latency (time to fall asleep), and causing more nighttime awakenings. Patients frequently report more vivid, bizarre, or disturbing dreams, and some experience nightmares. These effects occur because bupropion inhibits the reuptake of norepinephrine and dopamine, neurotransmitters that promote wakefulness and arousal. Unlike many antidepressants that suppress REM sleep, bupropion has less impact on REM, which may contribute to the intense dream experiences.
Key Points to Consider
- Sleep disturbances are usually most pronounced when starting treatment or increasing dosage, as noted in earlier studies 1.
- To minimize these effects, taking the medication in the morning rather than evening is recommended, and the extended-release formulation may cause fewer sleep problems than immediate-release versions.
- If sleep issues persist, they should be discussed with a healthcare provider, as dosage adjustments or addition of sleep aids might be necessary, considering the patient's overall health and potential for interactions with other medications, such as those for obesity or smoking cessation 1.
- Most patients develop tolerance to these sleep effects within a few weeks of consistent use, but monitoring and adjustments as needed are crucial for maintaining quality of life and minimizing morbidity and mortality risks associated with sleep disturbances and other potential side effects of bupropion.
From the FDA Drug Label
Insomnia 6% 11% 16% Abnormal dreams 2% 3%
Bupropion impacts sleep architecture by causing insomnia in a significant percentage of patients, with incidence rates ranging from 6% to 16% and potentially affects dreams as evidenced by reports of abnormal dreams in 2% to 3% of patients 2.
- Key effects on sleep architecture and dreams:
- Insomnia
- Abnormal dreams
From the Research
Bupropion's Impact on Sleep Architecture
- Bupropion has been found to increase REM latency, which is the time it takes to reach the rapid eye movement stage of sleep 3, 4.
- The increase in REM latency has been associated with clinical response to treatment with bupropion, suggesting a possible link between bupropion's effect on REM latency and its antidepressant action 3.
- Bupropion has also been found to increase the number of stable-unstable sleep transitions, which may indicate vulnerability to cardiovascular disease due to its association with low heart rate variability 4.
Bupropion's Impact on Dreams
- There have been reports of bupropion-induced vivid dreaming and nightmares, although these are not as common as other adverse events such as insomnia and dry mouth 5, 6.
- A case study found that bupropion-induced somnambulism (sleepwalking) was associated with eating behavior and amnesia, suggesting an interaction between bupropion and nicotine withdrawal at the level of monoaminergic neurotransmitters 6.
- An analysis of internet user reviews found that bupropion was associated with a lower probability of developing sleep disorders such as nightmares and sleepwalking, and that patients described strange but less negative dreams when taking bupropion 7.
Comparison to Other Antidepressants
- Bupropion has been found to have a lower risk of inducing sleep disorders compared to other antidepressants such as vilazodone and mirtazapine 7.
- The relative frequency of sleep disorders induced by bupropion was found to be lower than that of other antidepressants, with a proportional reporting ratio (PRR) of 0.2 to 0.7 for five sleep disorders 7.