Wellbutrin for anxiety: What you should know

What is Wellbutrin? | Off-label use | Wellbutrin for anxiety | Interactions | Side effects | Dosage | Cost

Bupropion hydrochloride (generic Wellbutrin) is a popularly prescribed FDA-approved antidepressant medication. As of 2020, it was the 18th most prescribed medication, with almost six million Americans filling nearly 29 million prescriptions. 

Wellbutrin is categorized in an antidepressant class known as norepinephrine-dopamine reuptake inhibitors (NDRIs). It works by blocking norepinephrine and dopamine (neurotransmitters or chemical messengers) from being reabsorbed, which helps increase norepinephrine and dopamine levels in the brain. This helps improve mood as well as memory and alertness. Because many antidepressants are also used to treat anxiety, many people ask if Wellbutrin can also be used to treat anxiety.

What is Wellbutrin?

Before discussing Wellbutrin for anxiety, let’s talk more about this medication. Wellbutrin contains the active ingredient bupropion and is available in three formulations:

• Immediate-release (Wellbutrin); available as generic bupropion only
• 12-hour sustained-release, which is generally dosed twice a day; available as both brand (Wellbutrin SR) and generic (bupropion SR)
• 24-hour extended-release, which is usually dosed once a day; available as both brand (Wellbutrin XL) and generic (bupropion XL)

All three formulations are FDA-approved to treat major depressive disorder (depression). Additionally, Wellbutrin XL is FDA-approved to treat seasonal affective disorder (SAD). 

The 12-hour sustained-release form of bupropion is sometimes prescribed to help people stop smoking. It’s commonly known by the brand name Zyban, although the brand name is no longer available in the U.S.

Off-label uses for Wellbutrin

Wellbutrin is not FDA-approved for anxiety. If a healthcare provider prescribes Wellbutrin for anxiety, it would be considered off-label prescribing. This is when a healthcare provider prescribes a medication for use that is not approved by the U.S. Food and Drug Administration (FDA). In addition to anxiety, some off-label uses of Wellbutrin include:

• To treat sexual dysfunction caused by antidepressants
• Weight loss
• Attention deficit hyperactivity disorder (ADHD) associated with bipolar disorder
• ADHD in children and adolescents

Wellbutrin for anxiety

Often, people with depression also experience anxiety. In general, antidepressant medication is the first choice of treatment for anxiety. However, usually, an SSRI antidepressant such as Lexapro (escitalopram) or SNRI antidepressant such as Effexor (venlafaxine) is recommended (and FDA-approved for both depression and anxiety). 

Since Wellbutrin is FDA-approved for the treatment of depression, but not anxiety, using Wellbutrin for anxiety would be considered an off-label use. Wellbutrin is not classified as an anti-anxiety medication. 

A 2023 study in the Journal of Clinical Psychopharmacology notes that Wellbutrin has some advantages over other antidepressants—Wellbutrin is less likely to:

• Cause weight gain
• Cause sexual side effects
• Cause sedation
• Induce mania

 Researchers note that some healthcare providers are reluctant to prescribe Wellbutrin because they think it may worsen anxiety. The study examined many clinical trials and found that selective serotonin reuptake inhibitors (SSRIs) and Wellbutrin were similarly effective in reducing symptoms of anxiety.

The positive results led researchers to conclude that Wellbutrin can be an effective treatment option, similar to an SSRI antidepressant, in people with depression and anxiety.

In clinical studies, some people taking Wellbutrin for depressive symptoms reported experiencing anxiety as a side effect. However, these numbers are small, and some people who took a placebo (inactive medicine) also reported experiencing anxiety. (In clinical studies, about 2% of participants stopped taking Wellbutrin due to side effects like anxiety, agitation, or trouble sleeping.)

Because everyone has a different medical history, the best way to determine if Wellbutrin will help you with anxiety is to talk to your healthcare professional. You can also ask about other methods to help you cope with anxiety, such as cognitive behavioral therapy with a mental health professional. 

Wellbutrin interactions

Before taking Wellbutrin, tell your healthcare provider about all the medications you take, including prescription and over-the-counter (OTC) medicines, vitamins, and supplements. 

In terms of food and beverage interactions, there are several to be aware of:

• Alcohol: Alcohol can worsen the side effects of Wellbutrin. Additionally, drinking too much alcohol—or abruptly stopping alcohol use—can increase the risk of seizures.  
• Caffeine: Consuming too much can increase the risk of high blood pressure. Consult your healthcare provider about caffeine consumption.

Wellbutrin can also interact with certain medications, including:

• Medications that help you sleep, such as Ambien (zolpidem), anti-seizure medications, or benzodiazepines such as Xanax (alprazolam): stopping one of these medicines abruptly can increase the risk of seizure
• Monoamine oxidase inhibitors (MAOIs) such as phenelzine or tranylcypromine: The combination can cause dangerously high blood pressure. An MAOI should be separated from Wellbutrin by at least 14 days
• Ritonavir, lopinavir, efavirenz, carbamazepine, phenobarbital, and phenytoin: These medications can decrease bupropion levels in the body
• If you take certain medications, Wellbutrin could increase the levels of the medication in the body. You may need a lower dose of the other medication, including certain antidepressants (such as venlafaxine, nortriptyline, paroxetine, fluoxetine, or sertraline), antipsychotics (haloperidol, risperidone, thioridazine), beta-blockers (such as metoprolol), and Type 1C antiarrhythmics (propafenone and flecainide).

This is not a full list of drug interactions, and others may occur. Talk to your healthcare provider about potential Wellbutrin interactions and how they may affect you. 

Wellbutrin side effects

Common potential side effects of Wellbutrin include, but are not limited to:

• Trouble sleeping
• Headache
• Agitation
• Appetite loss
• Weight loss or gain
• Dry mouth 
• Sweating 
• Ringing in the ears
• Tremor
• Stomach pain
• Anxiety
• Dizziness
• Muscle pain
• Nausea
• Heart palpitations
• Increased urinary frequency

Severe side effects may occur, which may include, but are not limited to:

• Severe allergic reaction: If you have symptoms of hives, difficulty breathing, or swelling of the face, lips, tongue, or throat, get emergency medical help. 
• Severe, life-threatening skin reactions: Get emergency medical help if you have skin pain, red or purple rash, blistering/peeling skin, fever, burning eyes, or sore throat.
• Suicidal thoughts or behaviors: Patients and their caregivers and families should be alert to changes in mood and behavior, such as anxiety, agitation, panic attacks, insomnia, irritability, aggressiveness, and impulsivity.
• Worsening of depression
• Mania: Symptoms may include intensely high energy levels, severe trouble sleeping, racing thoughts, grand ideas, reckless behavior, talking more and faster, and excessive happiness or irritability
• Seizures: To lower the risk of seizures, take Wellbutrin as prescribed. Do not take higher doses than prescribed. Certain people are at higher risk for seizures, such as people who take tricyclic antidepressants such as Elavil (amitriptyline), people who misuse prescription medications, people who use illicit drugs, and people with certain medical conditions like low blood sugar or severe liver problems.
• Severely high blood pressure
• Heart attack
• Irregular heartbeat
• Liver problems

Who should not take Wellbutrin for anxiety?

Before you take Wellbutrin, tell your healthcare provider about any allergies to medications, your medical and family history, any medical conditions you currently have, and the medications you take. Wellbutrin is not safe for everyone. It should not be used in:

• People who are allergic to bupropion or any ingredient in the medication
• People who have seizure disorders
• People who have (or previously had) bulimia or anorexia
• People who are abruptly stopping the use of alcohol, a benzodiazepine, phenobarbital, or an anti-seizure medication
• People who take an MAOI (Wellbutrin should be separated from an MAOI by at least 14 days)

Additionally, people with certain health conditions may or may not be appropriate candidates for Wellbutrin—for example, people with diabetes, bipolar disorder, or kidney or liver problems. The healthcare provider will weigh potential benefits and risks in these cases. If the decision is made to start treatment with Wellbutrin, the patient will be closely monitored. 

Wellbutrin dosages for anxiety

Because Wellbutrin is not FDA-approved to treat anxiety disorders, there are no guidelines for dosage for anxiety. Your healthcare provider can determine the dosage based on general prescribing guidelines. 

For example, if your healthcare provider starts you on Wellbutrin SR, you may be prescribed a dose of 150 mg once daily for three days, and then you will increase the dose to 150 mg twice daily thereafter.

Or, if your healthcare provider prescribes Wellbutrin XL, you may be prescribed a dose of 150 mg once daily. After about four days, the healthcare provider may recommend increasing the dose to 300 mg once daily—or staying at 150 mg daily. 

Always store Wellbutrin at room temperature, away from direct light, heat, and moisture. Keep out of reach and out of sight of children and pets.

When it is time to stop taking Wellbutrin, your doctor will advise you on a tapering schedule. This will help you come off the medication gradually and safely, minimizing the risk of withdrawal symptoms. 

How much does Wellbutrin cost?

Because all forms of Wellbutrin are available as generic medications, the price can be quite reasonable—especially if you use your insurance or a SingleCare discount. 

See examples below:

• The out-of-pocket price of 30 tablets of bupropion immediate-release 75 mg is about $32, but a free SingleCare card will bring the price down to as low as $4. The immediate-release form is only available as a generic medication, not a brand-name product.
• The out-of-pocket price of brand-name Wellbutrin SR is about $549 for #60, 150 mg tablets. Choosing generic and using a free SingleCare coupon can bring the price down to about $12.
• The out-of-pocket price of Wellbutrin XL is approximately $2,900 for #30, 300 mg tablets. Opting for generic and applying a SingleCare discount will bring the price down to about $13. 

For more information about pricing, contact your insurance company or Medicare prescription plan for up-to-date coverage information. You can always ask a pharmacy staff member at a local participating pharmacy to compare your price with insurance to the price with a SingleCare discount. You can save up to 80% on the cost of your prescription drugs with SingleCare.