Wellbutrin vs. Lexapro: Which one is right for you?

In this article:

• Main differences
• Conditions treated
• Side effects
• Can you combine Wellbutrin and Lexapro
• Coverage and cost
• Expert takeaway
• FAQs

In this article

• Main differences
• Conditions treated
• Side effects
• Can you combine Wellbutrin and Lexapro
• Coverage and cost
• Expert takeaway
• FAQs

Wellbutrin and Lexapro are two prescription medications that are used to treat  major depressive disorder, or MDD. People with MDD often exhibit a loss of interest in activities they normally enjoy, low energy, or pain without any known cause. For some, counseling or physical activity may effectively control symptoms of depression, but for many, medication is also needed in addition to those lifestyle changes. Even though both Wellbutrin and Lexapro treat depression, there are differences in what they treat, how they work, and potential side effects.

Compare Wellbutrin vs. Lexapro at a glance
Difference/similarity	Wellbutrin	Lexapro
Generic name	Bupropion	Escitalopram
Drug class	Aminoketone antidepressant	Selective serotonin reuptake inhibitor (SSRI)
How it works	Increases dopamine and norepinephrine	Increases serotonin
Common forms	Immediate-release (IR), sustained-release (SR), and extended-release (XR) tablet (once daily)	Oral tablet and oral solution (once daily)
FDA-approved uses	MDD, seasonal affective disorder (XL only), smoking cessation	MDD, generalized anxiety disorder
Ages approved for	Adults (use in adolescents is off-label)	Adolescents and adults (exact age varies by indication)

What are the main differences between Wellbutrin and Lexapro?

Several types of medications treat depression. Wellbutrin is an aminoketone antidepressant that works by increasing available dopamine and norepinephrine, while Lexapro is a selective serotonin reuptake inhibitor (SSRI) that increases available serotonin.

Wellbutrin (bupropion) is a prescription medication indicated in the treatment of MDD and seasonal affective disorder. The active ingredient, bupropion, is also approved for use in smoking cessation in its sustained-release formulation. This was previously marketed under the brand name Zyban. Wellbutrin works as a dopamine and norepinephrine reuptake inhibitor at the neuronal level. This leaves higher levels of each neurotransmitter freely available, and dopamine and norepinephrine levels play an important role in mood and affect.

Wellbutrin is available in immediate-release tablets in 75 mg and 100 mg. The sustained-release tablet indicated for every 12-hour dosing is available in 100 mg, 150 mg, and 200 mg. The extended-release tablet indicated for once every 24-hour dosing is available in 150 mg and 300 mg.

Lexapro (escitalopram) is also a prescription medication indicated for the treatment of MDD. It belongs to the family of antidepressants known as SSRIs. Lexapro works by blocking the reuptake of serotonin at the neuronal membrane transport pump, effectively leaving more free serotonin in the neuron synapse. Other commonly used SSRIs include Prozac, Zoloft, Celexa, or Paxil.

Lexapro is available as an oral tablet in strengths of 5 mg, 10 mg, and 20 mg and as an oral solution in a 5 mg/5 ml concentration.

Conditions treated by Wellbutrin vs. Lexapro

Wellbutrin and Lexapro are both indicated in the treatment of major depression. MDD is characterized by prolonged (2 weeks or more) feelings of low mood and decreased energy levels. Oftentimes patients do not find joy in things they enjoyed before.

Lexapro is also indicated in the treatment of generalized anxiety disorder (GAD). GAD is characterized by prolonged and obsessive worrying about a variety of topics.

Bupropion, the active ingredient in Wellbutrin, carries a unique indication for smoking cessation. Although the mechanism is not entirely understood, patients taking bupropion are more likely to be able to achieve smoking cessation.

A systematic review of numerous studies with an overall large sample size supports this statement, though patients may experience more adverse events than with other smoking cessation interventions.

Many patients who use bupropion to help quit smoking notice that they feel less anxious and  jittery, and do not return to nicotine use after stopping nicotine, says Leslie Greenberg MD, Associate Professor in the Department of Family and Community Medicine at University of Nevada Reno School of Medicine.

Wellbutrin and Lexapro are both used off-label in a variety of psychological disorders that are closely related to depression. The following is not intended to be a complete listing of potential uses for Wellbutrin and Lexapro. Only your healthcare professional can diagnose your disorder and decide which treatment option is best for you.  Follow-up is especially important with mental health issues.  If symptom relief is not achieved, the dose or the medicine may need to be changed.

Compare Wellbutrin vs. Lexapro conditions treated
Condition	Wellbutrin	Lexapro
Major depressive disorder	Yes	Yes
Seasonal affective disorder	Yes	No
Smoking cessation	Yes	No
Generalized anxiety disorder	No	Yes
Attention-deficit disorder	Off-label	No
Bipolar depression	Off-label	No
Augmentation of SSRI induced sexual dysfunction	Off-label	No
ADHD	Off-label	No
Neuropathic pain	Off-label	No
Cocaine dependence	Off-label	No
Amphetamine stimulant use disorder	Off-label	No
Irritability in Autism	No	Off-label
Binge eating disorder	No	Off-label
Bulimia nervosa	No	Off-label
Obsessive-compulsive Disorder	No	Off-label
Panic disorder	No	Off-label
Post-traumatic stress disorder	No	Off-label
Premenstrual dysphoric disorder	No	Off-label
Premature ejaculation	No	Off-label
Social anxiety disorder	No	Off-label

Wellbutrin vs. Lexapro side effects

Wellbutrin and Lexapro affect the levels of different neurotransmitters. While their potential to cause certain side effects may be similar, there are some key differences.

The following list is not intended to be a complete list of adverse events. Please consult a pharmacist, healthcare provider, or another medical professional for a complete list of possible side effects.

Compare Wellbutrin vs. Lexapro side effects
	Wellbutrin		Lexapro
Side effect	Applicable?	Frequency	Applicable?	Frequency
Asthenia (generalized weakness)	Yes	2%	No	n/a
Nausea	Yes	13%	Yes	5%
Dry mouth	Yes	17%	Yes	5%
Sweating	Yes	6%	Yes	5%
Vomiting	Yes	4%	No	n/a
Diarrhea	Yes	5%	Yes	8%
Constipation	Yes	10%	Yes	3%
Dyspepsia	No	n/a	Yes	3%
Dizziness	Yes	7%	No	n/a
Somnolence	Yes	2%	Yes	6%
Agitation	Yes	3%	No	n/a
Headache	Yes	26%	No	n/a
Decreased appetite	Yes	5%	Yes	3%
Decreased libido	No	n/a	Yes	2%
Weight loss	Yes	14%	No	n/a
Weight gain	Yes	3%	No	n/a

Source: Wellbutrin (DailyMed) Lexapro (DailyMed)

Lexapro, like other SSRIs, has the potential to cause decreased libido or sex drive. Wellbutrin had no reported incidence of decreased libido. Some researchers estimate that up to 80% of the side effects of SSRIs are related to sexual dysfunction. Compliance is an important factor in treating depression, so patient awareness of this possible side effect is important in managing a patient’s and their partner’s expectations.

Wellbutrin causes headaches in as many as a quarter of the patients who take it, while headaches were not reported with Lexapro. Both Wellbutrin and Lexapro may cause nausea, vomiting, sweating, and diarrhea.

There is evidence to show that Wellbutrin is less likely to cause weight gain than serotonergic antidepressants such as Lexapro, but this varies by patient. Many patients experiencing depression experience weight changes before treatment, and this can include both weight loss and weight gain. For some, depression can lead to a loss of appetite and unhealthy weight loss, and by treating depressive symptoms, their appetite may return to normal levels. Weight management in depression involves many aspects of treatment, and you should discuss weight change concerns with your prescriber.

Wellbutrin is contraindicated in patients with a seizure disorder.  Lexapro can be prescribed in patients with a seizure disorder.

Can you use Wellbutrin and Lexapro together?

Never combine medicines without the guidance of a healthcare provider. Wellbutrin and Lexapro can be prescribed and taken at the same time in patients who need a better antidepressant response, to treat residual symptoms, or to counteract SSRI-associated sexual dysfunction.  There is a possible drug interaction because the liver breaks them down using the same pathway.

Coverage and cost comparison of Wellbutrin vs. Lexapro

Wellbutrin is a prescription medication typically covered by commercial and Medicare drug plans. The out-of-pocket price for one month of Wellbutrin XL 150 mg can be more than $3,200, but with a coupon from SingleCare, you could get the generic for less than $10.

Lexapro is also a prescription medication typically covered by both commercial and Medicare drug plans. Similar to Wellbutrin, the out-of-pocket price for a 30-day supply of Lexapro 10 mg can be as much as $550. SingleCare offers a coupon for generic Lexapro, which lowers the price to $8.

Compare Wellbutrin vs. Lexapro cost and coverage
Cost/coverage factor	Wellbutrin	Lexapro
Typically covered by insurance?	Yes	Yes
Typically covered by Medicare?	Yes	Yes
Standard dosage	30, 150 mg XL tablets	30, 10 mg tablets
Average cost without insurance	$566	$596
SingleCare cost	$6	$8
How to save	Get coupon	Get coupon

Which is better: Wellbutrin or Lexapro?

Researchers have sought to compare Wellbutrin and Lexapro as singular therapies for MDD, and together as dual therapy. One trial evaluated the efficacy of Wellbutrin as a single therapy compared to Lexapro single therapy. This study also sought to compare the prevalence of negative sexual side effects. The results found that Wellbutrin and Lexapro produced similar improvements in depressive symptoms. However, Wellbutrin was significantly less likely to cause sexual dysfunction.

Wellbutrin and Lexapro affect different neurotransmitters and are oftentimes used together. The results of one clinical trial found that the use of both drugs together leads to significantly higher response and symptom remission rates as compared to typical monotherapy with SSRIs. While further studies may be warranted, this study suggests some value in dual therapy with both medications.

RELATED: What you should know before switching antidepressants

Expert takeaway

“If sexual side effects are a concern, consider starting with Wellbutrin to assess whether it adequately improves depression and anxiety symptoms. Add Lexapro only if additional treatment is needed,” advises Dr. Greenberg.

Frequently asked questions

Can I use Wellbutrin or Lexapro while pregnant?

The Food and Drug Administration (FDA) states that both Wellbutrin and Lexapro may be used during pregnancy when the benefits outweigh potential risks. For many patients, the risks of untreated depression are greater than the small or uncertain fetal risks. The American College of Obstetrics and Gynecology (ACOG) generally recommends continuing an effective antidepressant during pregnancy to reduce relapse risk. Treatment decisions should be individualized with your healthcare provider.

Is Wellbutrin or Lexapro better for anxiety?

Lexapro is generally more effective for anxiety and is FDA-approved as a first-line treatment for generalized anxiety disorder. Wellbutrin is not FDA-approved for this purpose and may worsen anxiety.

Does switching from Lexapro to Wellbutrin cause withdrawal symptoms?

There are two common ways to switch from Lexapro to Wellbutrin. One is to gradually lower your Lexapro dose until you stop taking it completely. The other is to taper Lexapro while gradually starting and increasing Wellbutrin. Both approaches are generally well tolerated. Because Wellbutrin is not an SSRI, it can be taken at the same time as Lexapro during the transition.