What can be done for a patient experiencing extreme anxiety while taking Wellbutrin (bupropion) 300mg and Adderall (amphetamine and dextroamphetamine) 40mg daily?

From the Guidelines

A patient experiencing extreme anxiety while taking Wellbutrin 300mg and Adderall 40mg daily should consult their healthcare provider immediately to discuss potential adjustments to their medication regimen, such as reducing the Adderall dosage or switching to a different stimulant medication, or lowering the Wellbutrin dose or changing to a different antidepressant, as these medications can exacerbate anxiety symptoms 1. The patient's healthcare provider may also recommend adding a short-term anti-anxiety medication like buspirone or a benzodiazepine, such as lorazepam 0.5-1mg as needed, to help manage acute symptoms while medication adjustments take effect. Some key considerations for managing anxiety in this patient include:

• Reducing or adjusting stimulant medication, such as Adderall, which can worsen anxiety symptoms 1
• Adjusting or changing antidepressant medication, such as Wellbutrin, which can also contribute to anxiety 1
• Adding a short-term anti-anxiety medication, such as buspirone or a benzodiazepine, to manage acute symptoms 1
• Implementing lifestyle modifications, including regular exercise, adequate sleep, stress management techniques like deep breathing or meditation, and avoiding caffeine and alcohol, to help reduce anxiety symptoms
• Utilizing individual or group therapy with evidence-based treatment options, such as cognitive-behavioral therapy (CBT), behavioral activation (BA), structured physical activity and exercise, or psychosocial interventions with empirically supported components, as recommended by recent guidelines 1 It is essential for the patient to track their symptoms and any potential triggers to discuss with their provider and not stop or adjust medications without medical supervision, as this could lead to withdrawal symptoms or worsening of their underlying conditions.

From the FDA Drug Label

The following symptoms, anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, akathisia (psychomotor restlessness), hypomania, and mania, have been reported in adult and pediatric patients being treated with antidepressants for major depressive disorder as well as for other indications, both psychiatric and nonpsychiatric Consideration should be given to changing the therapeutic regimen, including possibly discontinuing the medication, in patients whose depression is persistently worse, or who are experiencing emergent suicidality or symptoms that might be precursors to worsening depression or suicidality, especially if these symptoms are severe, abrupt in onset, or were not part of the patient’s presenting symptoms

For a patient experiencing extreme anxiety while taking Wellbutrin (bupropion) 300mg and Adderall (amphetamine and dextroamphetamine) 40mg daily, the following steps can be considered:

• Monitor the patient closely for worsening of anxiety or emergence of other symptoms such as agitation, panic attacks, or suicidal ideation.
• Re-evaluate the therapeutic regimen, considering the potential contribution of bupropion to the patient's anxiety.
• Consider changing the therapeutic regimen, including possibly discontinuing or reducing the dose of bupropion, especially if the patient's anxiety is severe or worsening.
• Alternative treatments for anxiety, such as behavioral therapy or other medications, may be considered in consultation with a healthcare professional 2.

From the Research

Patient Anxiety on Wellbutrin and Adderall

The patient is experiencing extreme anxiety while taking Wellbutrin (bupropion) 300mg and Adderall (amphetamine and dextroamphetamine) 40mg daily. To address this issue, consider the following options:

• Reappraisal and a systematic approach can be helpful, as some anxiety patients remain refractory to standard treatments 3
• Comorbid psychiatric, medical, and neurologic conditions may complicate the treatment of anxiety or require additional specific treatments 3
• Alternative pharmacologic approaches for specific types of anxiety can yield successful outcomes 3

Treatment Options for Anxiety

First-line treatments for anxiety disorders include:

• Cognitive behavioral therapy
• Selective serotonin reuptake inhibitors (SSRIs) such as sertraline
• Serotonin-norepinephrine reuptake inhibitors (SNRIs) such as venlafaxine extended release 4
• Atomoxetine can be used as an adjunctive treatment in adult patients with ADHD and comorbid partially responsive anxiety symptoms 5

Bupropion and Anxiety

There is a clinical belief that bupropion exacerbates anxiety, but a naturalistic study over 12 weeks found that there were no significant interactions between group and time, and groups did not differ and improved comparably over time 6

Additional Treatment Options

Other treatment options for anxiety include:

• Pregabalin, which has been shown to be effective in treating both psychic and somatic symptoms of generalized anxiety disorder 7
• Benzodiazepines, which can be effective in treating anxiety, but may have limitations in terms of efficacy and potential for dependence 7