Does Wellbutrin Affect Tic Disorders?
Yes, bupropion (Wellbutrin) can exacerbate tics in patients with existing tic disorders and has been reported to induce new-onset tics in susceptible individuals. 1, 2
Evidence of Tic Exacerbation
Multiple case reports and case series demonstrate that bupropion worsens tics in patients with pre-existing tic disorders:
A 1993 retrospective case series of four children with comorbid ADHD and Tourette syndrome showed that bupropion exacerbated tics in all patients, leading the authors to conclude that bupropion is not an appropriate alternative to stimulants in this population. 2
A 2019 case report documented tic exacerbation in an older adult with a known tic disorder that had been in remission but worsened during bupropion treatment. 1
Additional case reports from 2014 describe new-onset motor and vocal tics developing with bupropion XL use. 3
Mechanism and Clinical Context
The dopaminergic activity of bupropion likely underlies its potential to worsen tics, similar to other dopaminergic compounds like methylphenidate. 1 This is particularly relevant because:
Tic disorders (including Tourette syndrome) are treated with dopamine receptor-blocking drugs (neuroleptics), suggesting dopaminergic enhancement can worsen tics. 4
Bupropion acts as a dopamine and norepinephrine reuptake inhibitor, increasing dopaminergic neurotransmission. 5
Clinical Recommendations for ADHD with Comorbid Tic Disorders
When treating ADHD in patients with tic disorders, the evidence suggests a specific hierarchy:
First-line options:
- Atomoxetine is positioned as a first-line option for comorbid ADHD and tic disorders because it has been shown not to worsen tics in clinical trials. 4
- Alpha-2 agonists (clonidine or guanfacine) are also first-line options for comorbid tic/Tourette's disorder. 4
Stimulant considerations:
- Recent controlled studies show that stimulants (particularly methylphenidate) do not worsen tics in the majority of patients with ADHD and comorbid tic disorders. 4, 6
- Methylphenidate may be less likely to exacerbate tics than amphetamine-based medications. 7, 6
- With proper informed consent, a stimulant trial can be undertaken; if tics worsen markedly, switch to an alternative. 4
Bupropion should be avoided:
- Given the documented cases of tic exacerbation and the availability of safer alternatives (atomoxetine, alpha-2 agonists), bupropion is not recommended for patients with known tic disorders. 2
Important Caveats
The evidence base for bupropion-induced tic exacerbation consists primarily of case reports and small case series rather than large controlled trials. 1, 3, 2
However, one isolated case report suggests atomoxetine may also rarely be associated with new-onset tics, though this contradicts larger controlled trial data. 8
Clinicians prescribing bupropion to any patient should screen for personal or family history of tic disorders before initiating treatment. 1