Can Wellbutrin (bupropion) be used as an adjunct therapy for anxiety in patients already taking Lexapro (escitalopram) 20mg?

Medical Advisory BoardAll articles are reviewed for accuracy by our Medical Advisory Board
Educational purpose only • Exercise caution as content is pending human review
Article Review Status
Submitted
Under Review
Approved

Last updated: October 16, 2025 • View editorial policy

Personalize

Help us tailor your experience

Which best describes you? Your choice helps us use language that's most understandable for you.

Wellbutrin (Bupropion) as an Adjunct for Anxiety with Lexapro 20mg

Bupropion should not be used as an adjunct therapy for anxiety in patients already taking escitalopram 20mg, as it is activating and should not be used in agitated patients, which could potentially worsen anxiety symptoms. 1

Mechanism and Concerns

  • Bupropion is a norepinephrine and dopamine reuptake inhibitor that tends to be activating rather than anxiolytic, with potential for rapid improvement of energy levels 1, 2
  • Bupropion is specifically contraindicated for use in agitated patients according to clinical guidelines 1
  • The activating properties of bupropion may exacerbate anxiety symptoms rather than alleviate them 3

Evidence Against Combination for Anxiety

  • Guidelines specifically note that bupropion "should not be used in agitated patients" which would include many anxiety disorder presentations 1
  • While bupropion is effective for depression, its pharmacological profile (lacking serotonergic activity) makes it less suitable for anxiety disorders compared to SSRIs 4
  • The risk of increased agitation and anxiety when initiating bupropion could worsen the patient's existing anxiety condition 1

Better Alternatives for Anxiety Augmentation

  • For patients with anxiety not responding to escitalopram 20mg, consider:
    • Optimizing the current escitalopram dose and ensuring adequate trial duration (8-12 weeks) 5
    • Adding cognitive-behavioral therapy (CBT), which has demonstrated superior efficacy when combined with SSRIs compared to monotherapy 5
    • Switching to another SSRI (sertraline, paroxetine) or an SNRI (venlafaxina) if escitalopram is ineffective 5
    • Consider buspirone as an adjunct, which is specifically indicated for mild to moderate anxiety (initial dose 5mg twice daily, maximum 20mg three times daily) 1

Special Considerations

  • Escitalopram has a favorable drug interaction profile compared to other SSRIs, making it easier to use at higher doses if needed 5
  • When initiating any adjunctive medication for anxiety, start with low doses and increase gradually to minimize the risk of initial anxiety/agitation 1, 5
  • Monitor closely for adverse effects, particularly during the first few weeks of treatment and following dosage adjustments 5

Research on Bupropion for Anxiety

  • While one small pilot study (n=24) suggested bupropion XL might have comparable anxiolytic effects to escitalopram in generalized anxiety disorder 6, this is contradicted by:
    • Larger body of evidence and clinical guidelines indicating bupropion's activating properties 1, 2
    • Bupropion's pharmacological mechanism lacking serotonergic activity typically associated with anxiolytic effects 4
    • Guidelines specifically cautioning against its use in agitated patients 1

Common Pitfalls to Avoid

  • Assuming all antidepressants have similar effects on anxiety - bupropion's mechanism differs significantly from SSRIs 4
  • Overlooking the potential for drug-induced anxiety/agitation when adding bupropion to an existing SSRI regimen 1
  • Failing to consider the risk of seizures with bupropion, especially at higher doses (should be maintained at ≤450 mg/day in divided doses) 3

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

5
Guideline

Tratamiento del Trastorno de Ansiedad Generalizada Resistente a Monoterapia con Escitalopram

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2025

Related Questions

What is Wellbutrin (bupropion) effective for?
What is the recommended treatment approach using Wellbutrin (bupropion) for a patient with Major Depressive Disorder (MDD), Attention Deficit Hyperactivity Disorder (ADHD), Generalized Anxiety Disorder (GAD), and Premenstrual Dysphoric Disorder (PMDD)?
What is the appropriate dose of Wellbutrin (bupropion) for an adult?
What antidepressants, such as bupropion (Wellbutrin), are associated with weight loss?
Is bupropion (Wellbutrin) a suitable adjunct to escitalopram (Lexapro) 15 milligrams daily for a 43-year-old female patient with generalized anxiety disorder and panic disorder, now experiencing increased sadness and crying, potentially exacerbated by occupational stress?
How to manage an unsuppressed menstrual cycle?
What dose of oral (per oral) potassium supplementation is typically used to increase potassium levels in patients with hypokalemia?
What is the recommended treatment for recurrent vaginal yeast infections?

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

Have a follow-up question?

Our Medical A.I. is used by practicing medical doctors at top research institutions around the world. Ask any follow up question and get world-class guideline-backed answers instantly.

Ask Question