Can Wellbutrin Cause Sweats?
Yes, bupropion (Wellbutrin) can cause sweating, though it is notably less common compared to SSRIs like sertraline. In fact, one of the key advantages of bupropion over SSRIs is its more favorable side effect profile regarding sweating and other common antidepressant adverse effects.
Evidence for Bupropion and Sweating
Direct Evidence from Clinical Trials
- In a placebo-controlled trial, sweating was reported more frequently with bupropion than placebo in hospitalized patients with primary depression receiving 300-600 mg/day 1.
- However, the overall incidence remains lower than what is typically seen with SSRIs 2.
Comparative Advantage Over SSRIs
- Second-generation antidepressants as a class (including SSRIs, SNRIs, and bupropion) commonly cause sweating as an adverse effect, with approximately 63% of patients experiencing at least one adverse effect during treatment 2.
- Bupropion demonstrates a distinct advantage in having fewer typical antidepressant side effects, particularly sexual dysfunction, which is significantly less common than with fluoxetine or sertraline 2.
- The most common side effect of bupropion is dry mouth, not sweating 3, 4.
Clinical Context for Your Patient
Given that your 31-year-old patient with severe depression did not tolerate sertraline:
- If sweating was a problem with sertraline, switching to bupropion may actually improve this symptom 5.
- SSRIs like sertraline are well-documented to cause excessive sweating (hyperhidrosis) as a common side effect 5.
- Bupropion is considered a preferred alternative for patients who cannot tolerate SSRIs due to its different mechanism of action (dopamine-norepinephrine reuptake inhibitor rather than serotonergic) 4.
Important Caveats
- While sweating can occur with bupropion, it is generally mild and less problematic than with SSRIs 1.
- The primary contraindication for bupropion is seizure risk, which increases at doses above 450 mg/day or in patients with predisposing factors 3, 4.
- Monitor for other common bupropion side effects including insomnia, tremor, and dry mouth 2, 4.
Bottom Line
Bupropion can cause sweating, but this is relatively uncommon and significantly less problematic than with SSRIs like sertraline 1, 5. For your patient who did not tolerate sertraline, bupropion represents an excellent alternative with a more favorable side effect profile overall 2, 4.