Medical Review by Jennie Stanford, MD, FAAFP, DipABOM
Summary
- Wellbutrin® (bupropion) is a prescription antidepressant that increases levels of norepinephrine and dopamine in the brain, helping to treat depression and seasonal affective disorder.
- It works by preventing the reabsorption of these chemicals, which can improve your mood, alertness, and concentration.
- As you start taking Wellbutrin®, you might experience side effects like dry mouth, insomnia, tremors, tinnitus, and nausea. They often improve as your body adjusts to the medication.
- Be aware that Wellbutrin® may also come with some serious side effects, such as suicidal thoughts, seizures, high blood pressure, and mania. If you notice any severe symptoms, seek immediate medical attention.
- Communicating with your healthcare provider about any side effects you experience is essential for effective management.
Here’s what you need to know as you start taking Wellbutrin®
Wellbutrin® (the branded version of bupropion) is a prescription antidepressant that belongs to a class of drugs called norepinephrine and dopamine reuptake inhibitors (NDRIs). It’s prescribed to treat depression and seasonal affective disorder by boosting norepinephrine and dopamine levels in your brain by preventing their reabsorption.
The increased norepinephrine helps with your alertness, attention and how you deal with stress, while dopamine improves your pleasure, motivation, and concentration. However you may experience side effects that you should understand before taking it.
In this article, we’ll dive deeper into Wellbutrin®’s side effects, and explain why they happen, how they can affect your body, and when to seek help from a healthcare professional.
Common side effects
Side effects can occur with Wellbutrin®, especially when you first start taking the medication. As your body adjusts, you may notice a variety of symptoms ranging from mild to more noticeable.
Within 7 to 10 days, the medication will reach steady levels in your body, but it could take up to 4 weeks before you begin to feel its full effects. The most common side effects of Wellbutrin® are:
Dry mouth
Dry mouth (xerostomia) is one of the most common side effects of antidepressants, including Wellbutrin®. It occurs when your salivary glands produce less saliva, leading to a dry or burning mouth, difficulty swallowing, or changes in taste. Wellbutrin® affects nervous system receptors that are linked to norepinephrine, and since these receptors are also found in your salivary glands, it can reduce saliva production.
In clinical trials, dry mouth was reported by 17% of people taking 300 mg/day and 24% of people taking 400 mg/day, compared to just 7% of those on a placebo.
Insomnia
Insomnia is when you have trouble falling asleep, staying asleep, or getting good quality sleep, which leads to daytime problems like tiredness or difficulty concentrating. Wellbutrin® has one of the highest rates of insomnia among newer antidepressants. Since it increases dopamine, which aids in arousal, and norepinephrine, which promotes wakefulness, these increased levels can affect your sleep-wake cycle and make it harder to fall asleep.
Tremor
Wellbutrin® may cause tremors because it increases norepinephrine levels, which can heighten nervous system activity and lead to muscle overactivity. A recent review showed that out of 710 people taking Wellbutrin®, 488 experienced tremors as a side effect.
Tinnitus
Tinnitus is the sensation of hearing high-pitched ringing or buzzing that only you can hear, with no external source causing it. Wellbutrin® may cause tinnitus because it increases dopamine levels, which also play a key role in the brain’s auditory pathway. Dopamine influences the signals from your ear to your brain, so when its levels rise, it may disrupt this pathway and trigger ringing or buzzing sounds.
Agitation
Wellbutrin can sometimes cause agitation due to its stimulating effects on the nervous system. By increasing norepinephrine levels, it boosts your alertness and energy, which can make you feel restless or agitated.
In clinical trials, agitation was most frequently reported in those taking 400 mg per day, with 9% of participants experiencing it. This was followed by 3% of people taking 300 mg per day, and 2% of participants on a placebo.
A single 400 mg dose showed mild amphetamine-like effects compared to the placebo, indicating an increase in agitation, restlessness and/or excitement. Starting with a smaller dose and gradually increasing it if needed can help manage agitation—but remember, only a qualified healthcare provider can adjust your dosage of Wellbutrin®. Never adjust your dosage by yourself.
Nausea
When you take Wellbutrin®, you might feel nauseous. Increased levels of norepinephrine are thought to affect the gut, triggering a response that leads to feelings of nausea. In clinical trials, nausea was reported by 13% of people taking 300 mg/day and 18% of people taking 400 mg/day, compared to just 8% of those on a placebo.
Other possible side effects at higher doses
Other side effects that may be experienced if you are starting at a higher dose, such as 400mg/day of Wellbutrin®, include:
- Dizziness
- Pharyngitis
- Abdominal pain
- Anxiety
- Weight loss
- Heart palpitations
- Muscle aches and pains
- Skin rash
- Increase in urination
Serious side effects
Suicidal thoughts or attempts
Young people aged 24 and under have a higher risk of suicidal thoughts and behaviors, especially in the first few months of starting an antidepressant, or after a dose change. The exact reason for this is not fully understood.
The clinical trials for Wellbutrin® showed that for those under 18, there were 1.4% more cases of suicidal thoughts and behaviors compared to those on a placebo. For those aged 18-24, the increase was 0.5% when taking an antidepressant.
Seizures
If you’re taking Wellbutrin®, there is a risk of seizures, especially at higher doses or if you’re on other medications that lower your seizure threshold. To keep the risk low, your dose shouldn’t be above 300 mg per day and should be increased slowly if needed.
Wellbutrin® isn’t right for you if you have a seizure disorder or a condition that raises your seizure risk, like certain brain injuries or withdrawal from alcohol or sedatives. At doses up to 300 mg/day, the chance of having a seizure is about 0.1% (1 in 1,000), rising to 0.4% (4 in 1,000) at 450 mg/day.
Hypertension
Wellbutrin® can raise your blood pressure, and in some cases, cause hypertension. In studies on patients with seasonal affective disorder (SAD), 2% of people taking Wellbutrin® had significant blood pressure increases, while none of those on a placebo did.
If you’re using Wellbutrin alongside nicotine replacement therapy (like nicotine patches), there’s a higher chance of developing high blood pressure. 6.1% of people using both Wellbutrin and nicotine patches had high blood pressure, compared to lower rates in those using just one or none. It’s a good idea to monitor your blood pressure if you’re using both treatments.
Mania
Mania lasts at least one week, during which you notice a major shift in your behavior that affects your daily life. You might feel overly excited, talk more and faster than usual, and have racing thoughts. Mood swings, irritability, and impulsive decision making are also common during a manic episode.
Before starting Wellbutrin®, it’s important you check for any personal or family history of bipolar disorder. Many people with bipolar disorder first show depressive symptoms, so an underlying bipolar disorder could increase your risk of mania.
Angle-closure glaucoma
Angle-closure glaucoma is a serious eye problem where pressure builds up quickly inside your eye because the fluid that keeps your eyes nourished can’t drain properly. Antidepressants can cause your pupils to dilate (get larger), which can lead to the iris (the colored part of your eye) blocking the eye’s drainage system.
This blockage causes the fluid to build up, increasing eye pressure, and potentially leading to permanent damage if not treated quickly.
Angle-closure glaucoma often comes on suddenly and can cause severe symptoms, including:
- Intense eye pain
- Blurred or reduced vision
- Rainbow-colored halos around lights
- Nausea and vomiting
When to seek medical help
If you have any new or worsening symptoms while taking Wellbutrin®, let your healthcare provider know right away. This includes common side effects like trouble sleeping, tinnitus, sweating more than usual, rashes, and feeling nauseous. Your healthcare provider can help manage these side effects and adjust your treatment if needed.
For serious side effects, such as suicidal thoughts, seizures, raised blood pressure, symptoms of mania, or sudden vision problems—seek in-person emergency care immediately.
Find your Wellbutrin® support system with Lemonaid Health
While side effects from Wellbutrin® can occur, staying in communication with your healthcare provider is the best way to help you manage them effectively. Side effects often improve over time, but if you experience anything serious, seek help immediately. It’s important to inform your healthcare provider about any side effects you notice.
Our team at Lemonaid Health can help. Set up a virtual visit with a qualified US-based health professional who can help you understand any side effects and find appropriate solutions, including FDA-approved medication in clinically indicated cases.
Wellbutrin® is a registered trademark of GlaxoSmithKline LLC.
