Palm Sweating: Wellbutrin vs. Gabapentin
Wellbutrin (bupropion) is significantly LESS likely to cause palm sweating than gabapentin. In fact, bupropion is one of the few antidepressants that does NOT commonly cause hyperhidrosis (excessive sweating), while gabapentin is not typically associated with sweating as a side effect either—but the question appears to contain a typo ("gavel tin" likely refers to gabapentin).
Evidence-Based Analysis
Bupropion and Sweating
Bupropion stands out among antidepressants for its notably LOW risk of causing sweating. According to FDA drug labeling, sweating occurred at rates at least twice that of placebo only at the 300 mg/day dose of bupropion sustained-release 1. However, this was not a prominent adverse effect leading to discontinuation.
More importantly, a comprehensive 2017 meta-analysis of 76 trials involving 28,544 subjects found that bupropion did NOT significantly increase the risk of hyperhidrosis compared to placebo (RR = 1.23,95% CI: 0.57-2.67) 2. This distinguishes bupropion from most other antidepressants, particularly SSRIs and SNRIs, which showed risk ratios of approximately 2.93-3.17 for hyperhidrosis.
Clinical Context for Sweating
The most commonly reported adverse effects with bupropion in clinical trials were:
- Dry mouth and insomnia (most common, dose-related) 3
- Tremor, rash, headache, and urticaria (leading to discontinuation in 7-12% of patients) 3
When sweating was reported with bupropion at 300 mg/day, it occurred alongside other effects like anorexia, rash, and tinnitus 1. However, one older 1984 study noted that tremor and sweating were reported more often with bupropion than placebo, though this was in the context of immediate-release formulations at higher doses (300-600 mg/day) 4.
Mechanism of Palm Sweating
Palm sweating is primarily triggered by psychological and physical stress through cholinergic innervation of eccrine sweat glands 5. Adrenergic pathways may play an augmentary role, but recent research using adrenergic antagonists found no modulation of exercise-induced palmar sweating 6. This is relevant because bupropion works as a norepinephrine-dopamine reuptake inhibitor—not through cholinergic or direct adrenergic mechanisms that would typically trigger palmar hyperhidrosis.
Comparison with Other Antidepressants
SSRIs and SNRIs are the primary culprits for antidepressant-induced sweating, with nicotine replacement therapy patches also commonly causing sweating 3. The 2017 meta-analysis confirmed that medications like fluvoxamine (RR = 0.56), bupropion (RR = 1.23), and vortioxetine (RR = 1.35) were the ONLY antidepressants that did not significantly increase hyperhidrosis risk 2.
Clinical Recommendation
If a patient is experiencing palm sweating and is taking Wellbutrin (bupropion), look elsewhere for the cause. Bupropion is among the least likely antidepressants to cause this symptom. Consider:
- Other medications the patient may be taking (particularly SSRIs, SNRIs, or nicotine replacement)
- Underlying medical conditions (hyperthyroidism, anxiety disorders, autonomic dysfunction)
- Psychological stressors that trigger palmar sweating through cholinergic pathways 5
If sweating is problematic and the patient is on an SSRI/SNRI, switching TO bupropion may actually reduce sweating symptoms while maintaining antidepressant efficacy 2, 7.
Important Caveat
The sustained-release 300 mg/day formulation showed sweating at twice the placebo rate in FDA trials 1, so while uncommon, it can occur. If bupropion is truly the cause (after ruling out other etiologies), management options include dose reduction or switching to another agent, though this should be weighed against bupropion's benefits for depression or smoking cessation 3.