From the Guidelines
Both sertraline and bupropion can cause headaches as a side effect, with headaches being among the most common side effects of these medications, particularly during the first few weeks of treatment. According to the study by 1, a discontinuation syndrome characterized by headaches, among other symptoms, has been reported following missed doses or acute discontinuation of sertraline. Similarly, the study by 1 notes that headaches are among the most commonly reported adverse events associated with second-generation antidepressants, including sertraline and bupropion.
The incidence of headaches may vary between the two medications, with some studies suggesting that sertraline may have a higher rate of diarrhea, but not specifically headaches, compared to bupropion 1. However, both medications can cause headaches, and the severity and frequency of these headaches can vary from person to person.
It is essential to note that the headaches caused by these medications are usually mild to moderate and tend to diminish over time as the body adjusts to the medication, typically within 2-4 weeks. If you experience severe, persistent, or worsening headaches, you should contact your healthcare provider. The headaches occur because these medications affect neurotransmitters in the brain, particularly serotonin for sertraline and dopamine/norepinephrine for bupropion, which can temporarily alter brain chemistry and blood vessel function.
To reduce headache severity, it is recommended to stay hydrated, avoid alcohol, maintain regular sleep patterns, and take the medication with food. Your doctor might also recommend temporarily reducing the dose and then gradually increasing it to help your body adjust more comfortably. Regular monitoring of treatment response and adverse effects is crucial, as recommended by 1, to ensure the safe and effective use of these medications.
From the FDA Drug Label
Adverse Reactions Occurring at an Incidence of >1% in Patients Treated with Bupropion HCl Immediate-Release or Bupropion HCl Sustained-Release in MDD ... Seasonal Affective Disorder ... The adverse reactions leading to discontinuation in at least 1% of patients treated with bupropion and at a rate numerically greater than the placebo rate were insomnia (2% vs. <1%) and headache (1% vs. <1%) 2 Discontinuation of Treatment with Sertraline ... During marketing of sertraline and other SSRIs and SNRIs (Serotonin and Norepinephrine Reuptake Inhibitors), there have been spontaneous reports of adverse events occurring upon discontinuation of these drugs, particularly when abrupt, including the following: ... headache ... 3
Headache is a reported side effect of both bupropion and sertraline, particularly upon discontinuation of sertraline.
- Bupropion may cause headache in approximately 1% of patients.
- Sertraline may cause headache upon discontinuation. It is essential to monitor patients for these symptoms when discontinuing treatment with sertraline and to consider a gradual reduction in the dose rather than abrupt cessation whenever possible 3 2
From the Research
Headache as a Side Effect of Sertraline and Bupropion
- Headache was reported as a side effect in patients treated with sertraline and bupropion in several studies 4, 5.
- In a study comparing the efficacy and safety of bupropion SR and sertraline, headache was the most frequently reported adverse event in all three treatment groups, occurring with similar frequency in each group (30% to 40%) 4.
- Another study found that headache was not significantly more common in patients treated with sertraline compared to those treated with bupropion SR 5.
- There is no evidence to suggest that the combination of bupropion and sertraline increases the risk of headache compared to treatment with either medication alone 6, 7.
Comparison of Side Effects between Sertraline and Bupropion
- Sertraline was associated with more frequent reports of nausea, diarrhea, somnolence, and sweating compared to bupropion SR 4, 5.
- Bupropion SR was associated with more frequent reports of dry mouth compared to sertraline, although the difference was not significant 4.
- Orgasm dysfunction was significantly more common in sertraline-treated patients compared to bupropion SR-treated patients 4, 5.