Can Wellbutrin Really Help with Anxiety? Here’s What You Need to Know

Bottom Line: Wellbutrin isn’t approved by the FDA for any anxiety disorders, but new research shows it might help in certain cases, just like common anxiety medications like Zoloft or Lexapro, with fewer sexual side effects. Still, using it for anxiety is considered “off-label” and needs careful medical supervision.

Disclaimer: Wellbutrin carries a risk of seizures, especially for people with a history of eating disorders or certain medical conditions. Always discuss your full medical history with your provider before starting this medication. This content is for informational purposes and not a substitute for medical advice. Always talk with your doctor before making treatment decisions.

How Wellbutrin Works and Why It’s Prescribed

What is Wellbutrin and How Does It Affect the Brain?

Wellbutrin (also called bupropion) works completely differently than most anxiety medications. While drugs like Zoloft and Prozac focus on serotonin in your brain, Wellbutrin targets two other brain chemicals: norepinephrine and dopamine [1]. This makes it unique among antidepressants.

Your body actually turns Wellbutrin into other active compounds that do most of the work. The main one is called hydroxybupropion, which your body makes much more of than the original medication [2]. This might explain why Wellbutrin could help with anxiety symptoms.

How It Differs from SSRIs and SNRIs

Unlike medications like Zoloft that boost serotonin right away but take weeks to work, Wellbutrin affects your brain’s chemical messengers differently [3]. The FDA has approved Wellbutrin for depression, seasonal depression, and to help people quit smoking [4]. When doctors prescribe it for anxiety, this is called “off-label” use, meaning it’s not officially approved for that purpose. Off-label prescribing should only be done under the careful direction and supervision of a qualified healthcare provider who can properly assess the risks and benefits for your specific situation.

Is Wellbutrin Effective for Anxiety?

What the Research Says About Wellbutrin and Anxiety

Here’s the surprising news: One recent study (2023) followed over 8,400 people and found that Wellbutrin worked just as well as common anxiety medications over 12 weeks [5]. While it’s not considered a first-line treatment for anxiety disorders, the study challenges longstanding assumptions..

Another big review looked at data from 10 different studies involving nearly 3,000 people with both depression and anxiety. The researchers found no real difference between how well Wellbutrin and other antidepressants worked for anxiety symptoms [6]. They concluded that “contrary to what doctors often think, Wellbutrin seems to work just as well as other antidepressants for anxiety.”

Who Might Benefit from Wellbutrin for Anxiety?

When researchers looked specifically at people with severe anxiety and depression, they found only small differences. People taking traditional anxiety medications like Zoloft had about a 6% better response rate, but you’d need to treat 17 people with Zoloft instead of Wellbutrin to get just one extra person feeling better [7]. That’s not a huge difference.

Studies show Wellbutrin has helped people with anxiety that comes along with depression [8]. Isolated reports suggest it might help people with panic attacks, though more research is needed [9]. Remember, any use of Wellbutrin for anxiety is considered off-label and should only be prescribed and monitored by a qualified healthcare provider who can carefully evaluate whether this treatment approach is appropriate for your individual circumstances.

Pros and Cons of Wellbutrin for Anxiety

Wellbutrin vs. Common Anxiety Medications: Quick Comparison

Feature	Wellbutrin	SSRIs (Zoloft, Prozac)	SNRIs (Effexor, Cymbalta)
FDA-approved for anxiety	No (off-label only)	Yes	Yes
Sexual side effects	Very low	Common	Common
Weight gain	No (may lose weight)	Common	Common
Energy level	May increase	May decrease	Varies
Withdrawal symptoms	Rare	Common	Common
Seizure risk	Yes (rare)	No	No

Why Some People Prefer Wellbutrin Over Other Medications

Bupropion (Wellbutrin) offers several distinct advantages compared to other commonly prescribed antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs). One of its most notable benefits is its minimal impact on sexual functioning. Clinical trials have shown that bupropion’s rate of sexual side effects is comparable to placebo, making it a favorable option for individuals sensitive to SSRI-induced sexual dysfunction [10].

Unlike many antidepressants associated with weight gain, bupropion is weight-neutral and may even contribute to modest weight loss in some individuals. It also has a lower risk of discontinuation symptoms, allowing for a smoother tapering process when compared to SSRIs or SNRIs.

Pharmacologically, bupropion is a norepinephrine-dopamine reuptake inhibitor (NDRI), and its stimulating profile can be especially beneficial for patients whose depression or anxiety is accompanied by low energy, fatigue, or a motivation. Rather than causing sedation, bupropion often enhances alertness and drive, which may contribute to improvements in both mood and functional outcomes [11].

Furthermore, bupropion is frequently used as an augmentation strategy when first-line antidepressants produce only partial response. Its distinct mechanism of action complements serotonergic agents, and its favorable side effect profile makes it a common and effective add-on therapy in clinical practice [12].

When Wellbutrin Might Not Be the Best Fit

The most significant concern with Wellbutrin is its seizure risk. Approximately 1 in 1,000 individuals taking the sustained-release (SR) formulation at 300 mg/day may experience a seizure, and the risk increases to about 4 in 1,000 with the immediate-release (IR) version at higher doses [13]. Due to this, Wellbutrin is contraindicated in individuals with a history of seizures or eating disorders such as anorexia nervosa or bulimia, as these conditions independently raise the risk of seizures.

Additionally, it’s important to note that Wellbutrin is not FDA-approved for the treatment of anxiety disorders [4]. This means that any use for anxiety is considered off-label, a practice that is both legal and common in psychiatry, but one that requires close medical oversight. Off-label prescribing should only be done by a qualified healthcare provider who can assess your medical history, current medications, and individual risk factors to determine whether Wellbutrin is appropriate and safe for you.

Dosage, Administration, and What to Expect

Common Doses and Formulations (IR, SR, XL)

If your doctor prescribes Wellbutrin for anxiety, they’ll likely start you on the extended-release (XL) version because it’s easier on your system. Most people start with 150mg once a day, then might increase to 300mg after about a week if needed. The maximum dose is usually 450mg daily [14].

Wellbutrin comes in different forms:

• XL tablets: Take once daily (150mg, 300mg, or 450mg)
• SR tablets: Take twice daily (100mg, 150mg, or 200mg)
• Regular tablets: Take multiple times daily¹⁵

How Long It Usually Takes to Work for Anxiety?

Like other antidepressants, Wellbutrin takes time to work fully, usually 4-6 weeks for the complete effect. Some people may notice their energy and motivation improve within 1-2 weeks, but don’t expect your anxiety to be fully under control until you’ve been taking it for at least a month¹⁶. Since using Wellbutrin for anxiety is off-label, your healthcare provider will need to carefully monitor your progress and adjust treatment as needed throughout this period.

Managing Side Effects and Safety Considerations

Contrary to common belief, Wellbutrin does not appear to worsen anxiety more than other antidepressants⁵. In fact, many individuals tolerate it well. However, like all medications, it carries the risk of side effects. The most commonly reported include:

• Dry mouth (reported in 5–35% of users)
  
• Insomnia or trouble sleeping (11–28%)
  
• Headache (3–34%)
  
• Nausea (7–21%) [17]
  

As with other antidepressants, bupropion carries a boxed warning for an increased risk of suicidal thoughts and behaviors, particularly in individuals under age 25. It’s essential that you and your loved ones monitor for worsening mood, agitation, or thoughts of self-harm, especially during the first few weeks of treatment or following any dose adjustments [18]. Prompt communication with your healthcare provider is critical if these symptoms arise.

Drug Interactions and When to Seek Help

Wellbutrin can alter the metabolism of other medications, potentially increasing blood levels of certain antidepressants, antipsychotics, and cardiovascular drugs [19]. Always provide your doctor with a complete list of medications and supplements you are taking, including over-the-counter products and herbal remedies.

Do not take Wellbutrin with monoamine oxidase inhibitors (MAOIs) or if you are currently using another form of bupropion (such as Zyban for smoking cessation), as this significantly raises seizure risk. Additionally, limit alcohol intake, as alcohol can lower your seizure threshold and increase the likelihood of adverse effects [20]. Seek medical advice immediately if you experience unusual mood changes, neurological symptoms, or signs of drug interactions.

How to Talk to Your Doctor About Wellbutrin

What to Ask Before Starting Wellbutrin

Come prepared with these questions:

• Could Wellbutrin be a good option for my anxiety?
• Do I have any risk factors for seizures?
• How will it interact with my other medications?
• What should I watch out for?
• How often will I need check-ups?

Questions to Prepare Before Your Appointment

Be ready to discuss:

• Your complete medical history (especially seizures, eating disorders, or head injuries)
• All medications and supplements you take
• What anxiety treatments you’ve tried before and how they worked
• Your specific anxiety symptoms and how they affect your daily life
• Your biggest concerns about starting a new medication

FAQs About Wellbutrin for Anxiety

Is Wellbutrin FDA-approved for anxiety? No, Wellbutrin isn’t approved by the FDA for any anxiety disorder⁴. When doctors prescribe it for anxiety, it’s called “off-label” use. This is legal and common practice in medicine, but it means the medication hasn’t been specifically studied and approved for anxiety treatment. Off-label prescribing should only be done under the careful direction of a qualified healthcare provider who can properly evaluate your individual medical situation and monitor your response to treatment.

What if Wellbutrin makes my anxiety worse? Large studies show Wellbutrin doesn’t increase anxiety more than other antidepressants [5]. Some people might feel more “activated” or energetic at first, but this usually gets better with time or a dose adjustment. Since this is off-label use, it’s especially important to stay in close contact with your doctor and report any worsening of anxiety symptoms immediately.

Can I combine Wellbutrin with therapy or other treatments? Yes! Wellbutrin works well when added to other antidepressants [12], and therapy is always an important part of anxiety treatment. Many people do best with a combination of medication and counseling. However, any combination therapy involving off-label use of Wellbutrin for anxiety should only be managed by a qualified healthcare provider who can safely coordinate all aspects of your treatment plan. 

It is also important to ensure your daily lifestyle supports your overall health and well-being. Quality sleep, movement, nutrition, exposure to sunlight and nature, meaningful connections with others and yourself (perhaps explored in therapy), are all important for supporting anxiety from a holistic perspective. 

Conclusion and Next Steps

Is Wellbutrin Right for You?

Wellbutrin offers a unique approach to anxiety treatment that challenges old assumptions. New research shows it works about as well as traditional anxiety medications [6], but with some advantages like fewer sexual side effects and no weight gain [10].

However, since it’s not FDA-approved for anxiety and has some serious risks (like seizures), it’s not right for everyone. It may be considered in specific cases—such as anxiety with co-occurring depression—especially when first-line treatments are not well-tolerated or effective.

How to Get Started with PsychPlus

If you’re wondering whether Wellbutrin could help with your anxiety, talk with a qualified provider today. At PsychPlus, our doctors create personalized treatment plans, whether you’re just starting treatment or looking for something different. Get started here.

References

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