Is Wellbutrin (Bupropion) an Antianxiety Medication?
No, Wellbutrin (bupropion) is not an antianxiety medication but rather an antidepressant that works primarily as a norepinephrine and dopamine reuptake inhibitor, and it may actually increase anxiety in some patients. 1, 2
Mechanism and Classification
Bupropion has a unique mechanism of action compared to other antidepressants:
- Functions as a norepinephrine-dopamine reuptake inhibitor (NDRI) 3
- Unlike SSRIs and other antidepressants, it has no significant serotonergic activity 3
- FDA-approved for depression, seasonal affective disorder, and smoking cessation 4
- Also used in combination with naltrexone for weight management 5
Anxiety Effects of Bupropion
Bupropion can actually exacerbate anxiety in some patients:
- Listed as a common adverse effect in FDA labeling (6% at 300mg/day, 9% at higher doses) 2
- Clinical guidelines note that bupropion can cause anxiety/jitteriness as a side effect 1
- Has historically been associated with increased anxiety in clinical practice 6
Recent Evidence on Anxiety
While historically believed to worsen anxiety, recent research suggests a more nuanced picture:
- A 2023 naturalistic study using propensity matching found no significant differences in anxiety outcomes between bupropion and SSRIs over 12 weeks of treatment 6
- Earlier meta-analyses (2008) showed comparable anxiolytic efficacy between bupropion and SSRIs in treating anxiety symptoms associated with major depression 7
- However, another 2008 pooled analysis found a modest advantage for SSRIs over bupropion in treating anxious depression (65.4% vs. 59.4% response rates) 8
Medication Selection for Anxiety
When treating patients with anxiety disorders:
- SSRIs (like fluoxetine and sertraline) are generally first-line for anxiety disorders 5
- Bupropion is typically considered when:
- A patient has depression without significant anxiety
- Weight gain or sexual dysfunction from SSRIs is a concern
- Comorbid ADHD or smoking cessation is desired 4
Clinical Considerations and Cautions
Important considerations when prescribing bupropion:
- Contraindicated in patients with seizure disorders or conditions that lower seizure threshold 1
- Not recommended for patients with uncontrolled hypertension 1
- Requires monitoring for increased blood pressure and heart rate 1
- Common side effects include insomnia, dry mouth, decreased appetite, and headache 2
Bottom Line
For patients with primary anxiety disorders, bupropion would not be a first-choice medication. SSRIs and SNRIs remain the standard pharmacological treatments for anxiety disorders, while bupropion is better suited for depression without significant anxiety, especially when weight neutrality or smoking cessation is desired.