What is the recommended dosage of bupropion (an antidepressant medication) for treating anxiety?

From the Guidelines

Bupropion is not the preferred treatment for anxiety due to its potential to worsen anxiety symptoms, and its use should be approached with caution. When considering bupropion for treating anxiety, it's essential to weigh the potential benefits against the risks, particularly given its stimulating effects as a norepinephrine-dopamine reuptake inhibitor 1. The recommended dosage of bupropion, as per guidelines for managing conditions where it is indicated, starts at 37.5 mg every morning, then increases by 37.5 mg every 3 days, with a maximum dosage of 150 mg twice daily 1. However, this guideline is more relevant to its use in depression and smoking cessation rather than anxiety treatment.

For patients with anxiety, medications with established efficacy for anxiety disorders, such as selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), or benzodiazepines (for short-term use), are generally preferred over bupropion. The decision to use bupropion in a patient with anxiety should be made on a case-by-case basis, considering the individual's specific symptoms, medical history, and potential for drug interactions. It's crucial to consult with a healthcare provider before starting, stopping, or changing any medication regimen, as they can provide personalized recommendations based on the patient's unique needs and circumstances.

Key considerations when contemplating the use of bupropion for anxiety include:

• Potential for worsening anxiety symptoms due to its stimulating effects
• Lack of FDA approval specifically for anxiety treatment
• Preferred use of SSRIs, SNRIs, or benzodiazepines for anxiety disorders
• Importance of personalized medical advice from a healthcare provider 1.

From the Research

Recommended Dosage of Bupropion for Treating Anxiety

• The recommended dosage of bupropion for treating anxiety is not explicitly stated in the provided studies, but we can look at the dosages used in the studies for guidance.
• In the study 2, bupropion XL was used at a dosage of 150 to 300 mg/day to treat generalized anxiety disorder (GAD).
• In the study 3, bupropion sustained-release (SR) was used at a dosage of 150 mg twice daily (300 mg daily total) to help patients with chronic posttraumatic stress disorder (PTSD) quit smoking.
• The study 4 used a dosage of 300 mg of bupropion per day for one month to assess its efficacy in smoking cessation and its relationship with anxiety and depression.

Efficacy of Bupropion in Treating Anxiety

• The study 2 found that bupropion XL demonstrated comparable anxiolytic efficacy to escitalopram in outpatients with GAD.
• The study 3 found that bupropion SR may be effective in helping patients with PTSD quit smoking, and it was generally well-tolerated in combination with other psychotropic medications.
• The study 4 found that patients who responded better to treatment with bupropion after 6 months of follow-up were those with higher anxiety scores on the HADS.

Safety and Tolerability of Bupropion

• The study 5 found that therapeutic doses of bupropion SR were well tolerated and clinically efficacious in depressed patients without predisposition to seizures.
• The study 6 found that bupropion SR was safe and effective as a smoking cessation agent in individuals with depression maintained on treatment with SSRIs, with minimal weight gain and no evidence of emergent depression.
• The study 2 found that both bupropion XL and escitalopram were well-tolerated in outpatients with GAD.