What should I do if I experience increased depression and heightened anxiety after starting Wellbutrin XL (bupropion) 150mg?

Immediate Action Required: Contact Your Prescriber Today

You should contact your prescriber immediately to discuss discontinuing or adjusting your Wellbutrin XL, as worsening depression, heightened anxiety, and emotional disconnection after starting an antidepressant are serious warning signs that require prompt medical evaluation. 1

Why This Matters

The FDA explicitly warns that patients and their families must be alert to "the emergence of anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, akathisia (psychomotor restlessness), hypomania, mania, other unusual changes in behavior, worsening of depression, and suicidal ideation, especially early during antidepressant treatment." 1 Your symptoms—increased depression, heightened anxiety, and emotional disconnection—fall directly into this category of concerning neuropsychiatric adverse events.

What Your Doctor Needs to Know

When you contact your prescriber, describe:

• Timeline: Symptoms began within one week of starting Wellbutrin XL 150mg 1
• Specific symptoms: Worsening depression, increased anxiety, emotional blunting, and feeling disconnected from people and surroundings 1
• Severity: These changes are significant enough that you're seeking medical advice 1

The FDA medication guide states these symptoms "should be reported to the patient's prescriber or health professional, especially if they are severe, abrupt in onset, or were not part of the patient's presenting symptoms." 1 Your experience of feeling "more depressed" and having "heightened anxiety" after starting the medication qualifies as an abrupt change that wasn't part of your baseline presentation.

Why Bupropion May Not Be Right for You

While bupropion is generally well-tolerated and effective for many patients with depression 2, 3, it has activating properties that can paradoxically worsen anxiety in some individuals. 4 The National Comprehensive Cancer Network acknowledges that bupropion should be monitored for neuropsychiatric adverse effects, particularly early in treatment. 5

A critical caveat: One week is actually too early to expect therapeutic benefit from bupropion. The American College of Physicians recommends assessing for adequate response within 6-8 weeks before considering treatment modification. 4 However, this timeline applies to waiting for positive effects—not tolerating negative effects. The FDA is clear that worsening symptoms require immediate attention regardless of how recently treatment started. 1

What Happens Next

Your prescriber will likely:

1. Discontinue Wellbutrin XL immediately if symptoms are severe or concerning 1
2. Consider alternative antidepressants such as SSRIs (sertraline, escitalopram) which may be better tolerated if you have prominent anxiety 5, 6
3. Monitor you closely for the next 1-2 weeks, as the risk for worsening depression and suicidal thoughts is greatest during the first 1-2 months of antidepressant treatment 4

Important Safety Information

• Do not stop Wellbutrin abruptly without medical guidance, especially if you use alcohol or take other medications 1
• Seek emergency care immediately if you experience suicidal thoughts, severe agitation, or any thoughts of harming yourself 1
• Have someone stay with you if possible until you can speak with your prescriber, as the FDA recommends family members observe for day-to-day changes in behavior during early antidepressant treatment 1

Why Bupropion Causes These Effects

Bupropion works differently from typical antidepressants—it inhibits norepinephrine and dopamine reuptake rather than serotonin. 3 This activating mechanism can increase energy and alertness, but in some patients, particularly those with underlying anxiety, it can manifest as increased agitation, anxiety, and emotional dysregulation. 4 The emotional disconnection you describe may represent a form of dissociation or depersonalization that can occur with neuropsychiatric adverse effects. 1

Common Pitfall to Avoid

Do not wait the full 6-8 weeks to see if symptoms improve. While it's true that antidepressants take time to work, the FDA and clinical guidelines are explicit that worsening symptoms require immediate evaluation and potential medication changes. 1, 4 The distinction is crucial: waiting for therapeutic benefit is appropriate, but tolerating worsening psychiatric symptoms is not.