Is diarrhea a known side effect of Zoloft (sertraline) or Wellbutrin (bupropion)?

Diarrhea as a Side Effect of Zoloft and Wellbutrin

Yes, diarrhea is a known side effect of Zoloft (sertraline), with sertraline having a higher rate of diarrhea than bupropion (Wellbutrin) and several other antidepressants. 1

Comparison of Gastrointestinal Side Effects

Zoloft (Sertraline)

• Diarrhea is explicitly listed as a common side effect in the FDA drug label for sertraline 2
• According to the American College of Physicians guideline, sertraline has a higher rate of diarrhea than bupropion, citalopram, fluoxetine, fluvoxamine, mirtazapine, nefazodone, paroxetine, or venlafaxine 1
• Clinical trials comparing sertraline with bupropion found diarrhea occurred in significantly more patients taking sertraline (26%) compared to those taking bupropion SR (7%) 3

Wellbutrin (Bupropion)

• Diarrhea is not a prominent side effect of bupropion
• Bupropion is more commonly associated with other side effects such as dry mouth 3
• Constipation is actually more frequently reported with bupropion than diarrhea, with some case reports of severe constipation requiring medical intervention 4

Incidence and Clinical Significance

The American Family Physician guideline notes that about 63% of patients receiving second-generation antidepressants (including SSRIs like sertraline) experience at least one adverse effect during treatment, with diarrhea being among the commonly reported adverse events 1.

In direct comparative studies:

• Diarrhea occurred in 26% of sertraline-treated patients compared to only 7% of bupropion-treated patients 3
• Multiple clinical trials consistently show higher rates of diarrhea with sertraline than with bupropion 5, 6, 3

Management Considerations

For patients experiencing diarrhea:

• The side effect may diminish over time as the body adjusts to the medication
• Dose adjustments may help reduce the severity of diarrhea
• Taking sertraline with food might help reduce gastrointestinal side effects
• If diarrhea is severe or persistent, switching to an alternative antidepressant with a lower risk of diarrhea (such as bupropion) may be considered

Clinical Decision Making

When choosing between these medications for a patient concerned about diarrhea:

1. Consider bupropion as a first choice if diarrhea is a significant concern
2. If sertraline is preferred for other clinical reasons (e.g., better efficacy for a specific patient's condition), counsel the patient about the potential for diarrhea
3. Monitor for gastrointestinal side effects during the initial weeks of treatment
4. Consider prophylactic measures (taking with food, adequate hydration) if sertraline is selected

Important Caveats

• Individual responses to medications vary significantly
• The presence or absence of side effects should be balanced against the medication's efficacy for the specific patient
• While diarrhea is more common with sertraline, it may not occur in all patients
• Bupropion may cause constipation in some patients, which could be problematic for those with a history of constipation 4

In summary, when considering these two medications, sertraline is more likely to cause diarrhea than bupropion, which is an important factor to consider in medication selection, particularly for patients with gastrointestinal sensitivities or conditions.