Sleepiness and Bupropion: Side Effect Profile
No, sleepiness is not a common side effect of Wellbutrin (bupropion). In fact, bupropion is considered an "activating" antidepressant that is more likely to cause insomnia than sleepiness.
Bupropion's Effect on Sleep and Alertness
Bupropion is characterized in clinical guidelines as an "activating" antidepressant that typically increases energy levels rather than causing sedation. According to the American College of Physicians guidelines:
- Bupropion is described as "activating" with "possible rapid improvement of energy level" 1
- It "should not be used in agitated patients" due to its stimulating properties 1
- To minimize the risk of insomnia, the second daily dose should be taken before 3 p.m. 1
Comparative Side Effect Profile
When compared to other antidepressants, bupropion stands out for its activating properties:
- Trazodone is associated with a "higher incidence of somnolence than bupropion" 1
- Research shows bupropion "induced somnolence to a lower extent than placebo" in clinical trials 2
- Bupropion has been shown to have the highest incidence of insomnia among second-generation antidepressants 2
Mechanism and Sleep Architecture Effects
Bupropion's effects on sleep architecture help explain why it tends to cause insomnia rather than sleepiness:
- It increases REM latency (time to first REM sleep) 3, 4
- It increases REM activity and density during the first REM period 4
- Unlike many sedating antidepressants, it does not suppress REM sleep 4
Common Side Effects of Bupropion
According to the FDA label, the most common side effects of bupropion include:
- Trouble sleeping (insomnia)
- Feeling anxious
- Stuffy nose
- Nausea
- Dry mouth
- Constipation
- Dizziness
- Joint aches 5
The FDA specifically notes: "If you have trouble sleeping, do not take bupropion hydrochloride extended-release tablets (XL) too close to bedtime" 5.
Clinical Implications
For patients experiencing sleepiness while taking bupropion:
- Consider alternative causes of sleepiness (poor sleep quality due to insomnia, other medications, medical conditions)
- Evaluate timing of medication administration (taking too late in the day can disrupt sleep)
- Consider that paradoxical reactions can occur in some individuals
- Monitor for neuropsychiatric symptoms, as bupropion carries warnings about depression and suicidal ideation 6
Special Considerations
- Bupropion carries a seizure risk of approximately 0.1%, which increases with certain risk factors 6
- It is contraindicated in patients with seizure disorders, eating disorders, or during abrupt discontinuation of alcohol or sedatives 6
- The medication should not be taken with MAOIs due to risk of hypertensive reactions 1
If a patient is experiencing sleepiness on bupropion, this would be considered an unusual reaction that warrants further investigation of other potential causes or consideration of an alternative antidepressant.