Wellbutrin Side Effects, Interactions, Withdrawal, & Treatment
What Is Wellbutrin?
Wellbutrin (bupropion) is an antidepressant medication used for Major Depressive Disorder treatment (known as clinical depression or MDD) and seasonal affective disorder. Seasonal depressive disorder is episodes of depression that occur at the same time each year, usually in the fall and winter, but rarely may occur in the spring or summer months. Understanding the Wellbutrin side effects can help a patient better understand what to expect, as well as ensure the person knows when they should contact their doctor or seek medical assistance.
The prescription drug is available in tablet form, including a sustained-release tablet (Wellbutrin SR) and an extended-release tablet (Wellbutrin XL). Wellbutrin is distinct from other common antidepressants. Its unique mechanism of action among antidepressants is thought to be due to the reuptake of dopamine and norepinephrine.
It appears that bupropion may be an effective antidepressant across a wide spectrum of depressive conditions. It is a safe and effective medication in the treatment of depression in the elderly. In addition to having a favorable side effect profile, bupropion has been shown to have positive results in treating anxiety associated with depression compared with sertraline and fluoxetine.
Why Is This Medication Prescribed?
The U.S. Food and Drugs Administration (FDA) approved uses for Wellbutrin include major depressive disorder (MDD) and seasonal depressive disorder (SAD.) The symptoms of these disorders include the following.
Major Depressive Disorder (MDD). Individuals with major depression have several of these symptoms for at least two weeks:
- Depressed mood – feeling sad, empty, or tearful
- Loss of interest or pleasure in your usual activities
- Feeling worthless, guilty, hopeless, and helpless
- Sleep and eat more or less than usual (for most people it is less)
- Low energy, trouble concentrating, or thoughts of death (suicidal thinking)
- Psychomotor retardation (feeling like you are moving and thinking in slow motion)
- Psychomotor agitation (‘nervous energy’)
- Suicidal thoughts or behaviors
Seasonal depressive disorder (SAD): A major depressive episode with the symptoms same as MDD that also consistently recurs at particular times during the year, usually during the dark winter months.
Off-Label Uses Wellbutrin
Wellbutrin is sometimes used off-label (using an FDA-approved drug for unapproved use to treat a medical condition) for the following conditions:
- Attention deficit hyperactivity disorder (ADHD)
- Depression in bipolar disorder
- Sexual dysfunction due to SSRI antidepressants
Your mental health provider should justify his or her thinking in recommending an “off-label” treatment. They should be clear about the limits of the research around that medication and if there are any other options.
Wellbutrin For Anxiety
Medications can affect individuals in different and more ways than one. As such, Wellbutrin has been linked to anxiety in some cases. But while it can cause anxiety in some individuals, it is an effective treatment for anxiety disorders in others. In clinical trials, some of the test subjects developed anxiety-related side effects shortly after they started taking Wellbutrin. It was also noted that these effects are exacerbated in the period following a dosage increase. These Wellbutrin anxiety-related side effects include:
- Restlessness and agitation
According to the FDA, up to 2% of the people who experienced these side effects discontinued their use of the medication. For some subjects, these side effects were so severe that they required treatment with anti-anxiety medication and sedatives.
Wellbutrin Side Effects
Here are some examples of side effects commonly reported with Wellbutrin SR and Wellbutrin XL treatment:
- Dry mouth
- Insomnia (trouble falling asleep or staying asleep)
These are only a few of the side effects that can occur with Wellbutrin. In the sections below, we review other possible mild and serious side effects the drug may cause.
Examples of mild side effects that have been reported with Wellbutrin SR and Wellbutrin XL include:
- Weight loss
- Decreased libido
- Abdomen (belly) pain
- Dry mouth
- Heart palpitations (fluttering, skipping, or pounding feeling in your heart)
- Loss of appetite
- Muscle pain
- Ringing in your ears
- Sore throat
- Tremor (uncontrollable shaking)
- Urinating more often than usual
- Weight gain
The side effects of Wellbutrin may be temporary or long-lasting. And some may be easily managed. If you have any symptoms that continue or bother you, consider talking with your medical professional or pharmacist. Also, it’s important to continue taking Wellbutrin unless your medical professional recommends that you stop.
Gastrointestinal Side Effects
Gastrointestinal side effects are the most common effect seen with these drugs. It is concentrated in saliva, this is why it severely causes dry mouth which can increase thirst. It can also alter taste sensation owing to its strong metallic aftertaste. Individuals taking Wellbutrin have also reported GIT (gastrointestinal tract) disorders like decreased appetite and constipation.
Central Nervous System(CNS) Side Effects
As Wellbutrin interacts with dopamine receptors, it is very likely to cause central nervous system (CNS) side effects. These negative reactions can be related to the peripheral or central nervous system. These are seldom dangerous but can affect the everyday functionality of individuals taking the drug. These can include conditions like agitation, insomnia, dizziness, shaking, tremors, restlessness, and fainting spells.
Another possible side effect of Wellbutrin SR is that many individuals tend to notice changes in their weight while they are using Wellbutrin. This particular negative effect does not affect everyone in the same way. Wellbutrin weight loss happens in some individuals who use the drug. In some individuals, however, negative reactions may rather cause the person to experience weight gain instead. Weight gain of roughly 5-10 pounds is found in 15% of the patients. This weight change can be easily managed by regular exercise and counseling. It does not increase any comorbidities chances.
Sexual Wellbutrin Side Effects
Certain negative reactions may arise relating to a patient’s sexual health and performance. For instance, in some individuals, Wellbutrin hypersexuality side effects can happen. This may cause the person to experience an increase in their libido. It is, however, possible for an individual to experience a loss of their sex drive while they are using antidepressants, especially during the early stages. Loss of libido is temporary and usually goes away within 2-3 weeks of using antidepressants.
Almost all antidepressants have some seizure risk. Whether using Wellbutrin for depression or ADHD, the seizure disorder is a dose-dependent case that does affect some individuals. However, it is not a common clinical issue with doses less than 400mg. At high doses, it can cause a severe and life-threatening reaction that may result in an overdose on these drugs.
This is why Wellbutrin should be kept under 350-400mg until further information about its side effects on the patient can be gathered. While rare, this is a severe Wellbutrin side-effect, and the individual would usually be advised to stop using the medication if this type of event happens. As Wellbutrin may cause seizures, people who have experienced a seizure in the past should consider an alternative to this medication.
Wellbutrin can cause doubled vision, blurry vision, and image distortion due to its nor-epinephrine and dopaminergic effect. When this medication starts affecting the vision of the patient, then it is also considered a serious complication. In most cases, vision change and visual disturbances are temporary conditions and resolve on their own when the person is taken off medicine but can cause permanent vision distortion if not addressed on time. These vision changes, such as sudden blurry vision, should be reported to the prescribing doctor to ensure appropriate action can be taken.
Cardiovascular Wellbutrin Side Effects
There are certain Wellbutrin side effects that may affect the cardiovascular system as well. For example, there may be an increase in the person’s blood pressure levels. Tachycardia, palpitations, irregular heartbeat, chest pains, and panic attacks are common cardiovascular side effects. When heart palpitations or irregular heartbeats are experienced, however, it is generally advised that the patient discusses this particular adverse event with their doctor.
Discontinuing Wellbutrin requires the advice of a doctor and should never be stopped abruptly. A gradual decrease is necessary to avoid withdrawal symptoms. Over 50 withdrawal symptoms associated with Wellbutrin have been reported. They range in severity from mild annoyances to life-threatening conditions and generally require monitoring by a medical professional.
Physical Withdrawal Symptoms
Physical withdrawal symptoms include difficulties maintaining balance, lack of coordination, increased headaches or migraines, electric shock-like or tingling sensations, and general lethargy and fatigue. These may signal a more severe condition that needs medical intervention.
Psychological Withdrawal Symptoms
Wellbutrin withdrawal may trigger a host of psychological symptoms that are out of character for the user. Aggressive behavior that is not characteristic for the person taking the medication, irritability, hostility, paranoia may occur. Anxiety, troubling thoughts, and worsening depression that cannot be explained by circumstances should be reported to the doctor.
Highly emotional states, overreaction to normal situations, depersonalization, and severe internal restlessness happen for some individuals. Crying spells and nervousness may surface with no apparent reason. Notify your physician immediately if you experience psychological disturbances that are not characteristic of you or have suicidal thoughts.
Wellbutrin And Alcohol
Some people who take Wellbutrin may be able to drink occasionally without any side effects. However, if an individual mixes alcohol with Wellbutrin regularly, or drinks large amounts of alcohol with Wellbutrin, it can be hazardous to their health.
Some of the risks of taking Wellbutrin with alcohol include:
- Poor judgment
- Suicidal thoughts
Alcohol is a depressant substance and should be used with caution, especially for individuals who suffer from depression. Combining alcohol with an antidepressant prescription drug like Wellbutrin not only increases the side effects of both but can heighten the chances of developing a physical dependence or alcohol addiction.
Mixing alcohol and Wellbutrin can have long-term effects on your health, including:
- Decreased effectiveness of Wellbutrin
- Elevated risk of overdose
- Increased risk of abusing alcohol or becoming addicted
- Higher chance of becoming physically dependent on alcohol
Overall, bupropion is a safe, effective medication when it’s used as prescribed. However, like other antidepressants, bupropion can interact with other medications.
Monoamine Oxidase Inhibitors (MAOIs)
Monoamine oxidase inhibitors (MAOIs) are a class of older antidepressants, many of which are still used to treat depression and several other conditions. Some commonly prescribed MAOIs include the following medications:
- Phenelzine (Nardil)
- Tranylcypromine (Parnate)
- Isocarboxazid (Marplan)
- Selegiline (Emsam)
Bupropion can interact with MAOIs, which may lead to an elevated risk of several side effects, including dangerously high blood pressure.
Bupropion is metabolized by the enzyme CYP2B6. Medications that increase the activity of the CYP2B6 enzyme, called CYP2B6 inducers, may make bupropion less effective in the body and necessitate a higher dosage. CYP2B6 inducers include the antiretroviral medications ritonavir, lopinavir, and efavirenz, which are commonly used in combination with other medications to treat HIV/AIDS.
Medications that reduce the activity of the CYP2B6 enzyme, called CYP2B6 inhibitors, may increase the concentration of Bupropion and other medications metabolized by CYP2B6 in the body. Medications metabolized by CYP2B6 include several other antidepressants, such as sertraline venlafaxine (Effexor), (Zoloft), paroxetine (Paxil), fluoxetine (Prozac), desipramine (Norpramin or Pertofrane), imipramine (Tofranil), nortriptyline (Pamelor), and others.
Anxiety Disorder And Alcohol Issues
A person who is suffering from an anxiety attack might think that a couple of drinks will help them relax. In fact, drinking alcohol can make an anxious person feel worse. Here’s an illustration of a typical cycle:
- A person drinks alcohol
- They initially feel calm as the alcohol affects the brain
- They feel anxiety as a symptom of alcohol withdrawal as the body processes the alcohol
- They may want to drink again to try to relieve their anxiety
- But this only starts the process from the origin. As the initial calming effect disappears, the person can feel anxiety after quitting drinking alcohol build again as the effects wear off
Remember, the more alcohol consumed, the greater the tolerance will be. Over time there is a need to drink more alcohol to feel the same effects. Over time this may negatively affect the mental health, resulting in a higher level of anxiety and depression after drinking. Anxiety disorder makes an individual start drinking alcohol, which worsens their anxiety, which leads them to drink more and worsens their anxiety further. It’s a never-ending vicious cycle of alcohol and anxiety.
Treatment For Alcohol Misuse & Mental Health Disorder
To determine the most effective ways to treat Wellbutrin side effects, especially if it is mixed with alcohol, it’s crucial to first get an accurate assessment of all the symptoms. When the symptoms have been evaluated by a mental health professional, it may be determined that another form of depression is present and needs a particular type of treatment. Very often, some combination of psychotherapy, medication, and/or lifestyle changes are effective for coping with functional.
Detox is often considered the first stage of treatment. It will help you navigate the complicated process of alcohol withdrawal, but it doesn’t address patterns of thought and behavior that contribute to alcohol use. Various treatment approaches and settings can help provide the ongoing support necessary to maintain long-term sobriety after you complete detox.
Cravings are very common during detox and can be challenging to overcome. This often leads to relapse. Constant medical care provided during inpatient treatment helps prevent relapse. Clinicians can provide necessary medication and medical expertise to lessen cravings and the effects of alcohol withdrawals.
Psychotherapy for Depression
Several different modalities of psychotherapy have been used in the treatment of depression including:
- Cognitive Behavioral Therapy (CBT) – an effective treatment that involves making changes in both the patterns of negative thoughts and the behavioral routines which are affecting the daily life of the depressed person for various forms of depression.
- Person Centered Therapy – a strategy that allows and encourages clients to understand and resolve their concerns in a safe, support environment.
- Solution Focused Therapy – an approach interested in solutions which can be quickly implemented with a simple first step leading to further positive consequences.
Dual Diagnosis Treatment
Alcoholism and mental health disorders often co-occur. In many cases, traumatic experiences can result in a mental health disorder and substance abuse. Dual diagnosis rehabilitation treats both of these issues together. The best approach for the treatment of dual diagnosis is an integrated system. In this strategy, both the substance abuse problem and the mental disorder are treated simultaneously. Regardless of which diagnosis (mental health or substance abuse problem) came first, long-term recovery will depend largely on the treatment for both disorders done by the same team or provider.
Medication-Assisted Treatments (MAT) for alcohol use disorder and mental health disorder are commonly used in conjunction with one another. This includes the use of medications and other medical procedures. During your rehab, the staff from your treatment facility will help you identify what caused your addiction and teach you skills that will help you change your behavior patterns and challenge the negative thoughts that led to your addiction. Sometimes, the pressures and problems in your life lead you to rely on substances to help you forget about them momentarily.
If you or a loved one are struggling with long-term substance abuse and a co-occurring mental health condition such as depression and anxiety, contact one of our helpful treatment specialists today. We Level Up NJ can provide information on dual diagnosis and detox programs that may fit your specific needs.
 FDA – https://www.accessdata.fda.gov/drugsatfda_docs/label/2009/018644s039s040.pdf
 NCBI – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC314381/
 NCBI – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4837968/
 NCBI – https://pubmed.ncbi.nlm.nih.gov/?cmd=link&linkname=pubmed_pubmed&from_uid=29262173